Vitallium endodontic implants: A scanning

electron microscope, electron

microprobe, and histologic study
Xanlzrel Seltzer, D.D.S., Daniel I?. Green, D.D.X.,
Ruben de la Guardia, D.D.S., Joseph Maggie, D.D.S., and
Abram Bwnett, D.D.S., Philadelphia, Pa.
DEPARTMENT OF ENDODONTOLOGY, SCHOOL OF DENTISTRY,

TEMPLE UXIVERSITY

E ndodontic implants are being used with increasing frequency for stabilizing
loose, periodontally involved, and fractured teeth.les Numerous in vitro and in
vivo studies have been made of implant materia1s.9-12 In order to obtain suf-
ficient material for study, animals have been utilized. Animal tissue reactions to
various implant materials have been studied extensively. The results have ranged
from complete absence of reactions to severe reactions, depending on the
materials, the type of animal, the length of time in which the material was left
in place, and the investigative modality.13-I9
Several in vitro corrosion studies of metal implant materials have been
reported.20-24 However, there have been fewer reported in vivo studies of cor-
rosion of metal implants in human bones, With respect to endodontic implants
in human beings, a review of the literature has uncovered only a study by
Frank and Abramsz5 of the tissue reactions around two teeth which contained
such implants. In both cases, inflammatory responses were found; the inflam-
mation was attributed to the materials which were used to cement the implants
into the teeth.
To study the effects of endodontic implants on the surrounding periapical
tissues, the present study was designed to combine a number of investigative
modalities, such as scanning electron microscopy and electron microprobe
analysis, with classic histologic examination of the involved tissues and materials.
It was hoped that such a combined investigation might shed more light on the
extent of tissue tolerance to implants. In addition, a possible correlation between
corrosion of metals, if found, and tissue reactions could be established.
828
Volume 35 T7itnllinnL endodontic implants 829
Number 6

MATERIALS AND METHODS

Eight Vitallium endodontic implants were placed in each of six roots of
three mandibular teeth and in two roots of two maxillary teeth of a male
mongrel dog, approximately 4 years of age. The following basic operative pro-
cedure was employed for each tooth: The involved tooth was isolated with a
rubber dam and strict asepsis was then maintained throughout the experimental
procedures. A coronal access preparation was made, and the pulp was extirpated.
The root canal was then instrumented 2 to 3 mm. beyond the tooth apex to the
size of a No. 50 or No. 60 root canal file, Repeated irrigations with physiologic
saline solution were made throughout the instrumentation. An osseous channel
was then reamed by hand to a distance of approximately 7 mm. beyond the
tooth apex. Using gradually larger reamers, the final simultaneous instrumenta-
tion of the root canal and bone resulted in a tapered preparation of the approxi-
mate sixe of a No. 60 or No. 70 reamer. The implant was then tightly fitted to
the apex of the tooth and permitted to extend approximately 1 mm. short of
the prepared osseous channel. The implant was then cemented into the tooth with
Diaket,” a proprietary root canal sealer, and the occlusal access cavity was
filled with zinc-free amalgam.
Implants were placed at various time intervals, so that when the animal was
killed by perfusion with fixative, one sample had been inserted for 146 days,
one for 157 days, and each of two samples had been in place for 207, 269, and
340 days.
Following the death of the animal, radiographs of the mandible and maxilla
were taken (Fig. 1). Blocks of bone containing the roots of the teeth were
then sectioned with a rotary saw (Fig. 2, ~1). The roots which contained the
implants were exposed for examination with the scanning electron microscope
in the following manner: The crown of the tooth was removed and the bone
was scored with a fissure bur, placing a groove between the buccal and, lingual
cortices. The section was then split open with a microtome knife and hammer
(Fig, 2, B). The specimens were washed in normal saline solution, clea,red in
ascending grades of alcohol (70 to 100 per cent), placed in amyl acetate for
5 hours, and dried by means of the critical point method of AndersonZF for
approximately 21/, hours. The specimens were coated with 200 ii of gold to
increase their thermal and electrical conductivity. Although a few specimens
were mounted on aluminum stubs, the majority of the specimens were mounted
on beryllium stubs and placed in the scanning electron microscope (S.E.M.)
for examination.
Following the S.E.M. examinations, the bone specimens were prepared for

*Premier Dental Products, Philadelphia, Pa.

Formula:
Liquid :
2,2’-dihydroxy-5,5’-diehloro-diphenyl-methane 0.5%, Copolymers of vinylacetate, vinyl
chloride, and vinoisobutyl-ether, propionyl-acetophenone; capric acid, triethanolamine
Powder :
Bismuth phosphate 20%
Zinc oxide
a30 Seltzer et al, Oral Surg.
June, 1973

Pig. 1. Radiographs of mandible and maxilla following death of animal.

histologic examination in the usual manner. The majority of the serial sections,
approximately 6 microns thick, were stained with hematoxylin and eosin. Every
fifth section was stained by the Masson trichrome stain.

RESULTS
Examinations of unused Vitallium implants were made at the following
magnifications: x60, x100, x1,000, x3,000 and x10,000 (Fig. 3, A to D). At
x60, the implant appeared to be relatively smooth with cross striations, appar-
ently from tooling (Fig. 3, A). At x60 and x100, small protuberances, dispersed
randomly throughout the sample, could be seen. In addition to the protuberances,
small pits were observed (Fig. 3, B). At x3,000 and ~10,000, the irregularly
rounded protuberances measured approximately 2 microns in diameter (Fig. 3,
D). Striations, evident at xl,000 and x3,000 (Fig. 3, C), were actually depres-
sions alternating between ridges of metal.
The composition of the implant was analyzed with the electron probe micro-
analyzer. An x-ray spectrum, using a 25 kv. accelerating voltage and approxi-
mately 1.5 by 1O-Qamperes beam current for 200 seconds, confirmed the presence
of chromium, cobalt, and nickel (Fig. 4).

340-day specimens
DISTAL ROOT, MANDIBULAR LEFT FIRST MOLAR

In the radiograph, the implant appeared to be centrally located within the

root and extended a distance of approximately 5 mm. beyond the apex of the
Volume 35 Vitallium endodontic implants 831
Number 6

Fig. b. A, Bone block containing implant. B, Block split open revealing implant. Counter-
part is at left.

tooth, but short of the mandibular cortex. When radiographed buccolingually,

however, it was noted that the implant contacted the lingual bone cortex (Fig.
5).
S.E.M. findings. The sections were examined and photographed at mag-
nifications of x37, x47, x75, x215 and x750 (Fig. 6, A to D). At x47, the implant
was seen as it emerged from the cancellous bone (Fig. 6, A). The implant
appeared to be unaltered, when compared to the controls. Immediately below
the apex of the tooth, fibrous encapsulation of the implant was evident. Collagen
fibers of varying sizes were randomly dispersed. The fibers adhered closely to
the surface of the implant in a webbed pattern (Fig. 6, B). A detailed view of
the collagen fibers can be seen in Fig. 6, C and D. Rounded elevations may be
the nuclei of the fibroblasts. Globular accretions of material were found dis-
persed throughout the collagen network. A microprobe of this material indicated
that the elements present were calcium, chromium, cobalt, and zinc (Fig. 7).
Therefore, those accretions contained those elements present in the total im-
plant (Vitallium, zinc oxide, etc.). Possibly, the globules were bonelike mineral
deposits or dentin filings. However, because the implant was directly under the
tissue, the elements of the implant were almost certainly detected by the probe.
Nevertheless, the calcium and phosphorous were suggestive of mineralization.
832 Seltzer et al. Oral Surg.
June, 1973

Fig. S. Appearance of Vitallium implant prior to use. (Magnifications: A, x60; B, xl00 ;

c, x1,000; u, x3,000.)

After decalcification for the purposes of histologic examination of the tissue,

the implant was removed and re-examined with the S.E.M. Examination of the
distal end of the implant at x60 (Fig. 8, A and B) showed that particles were
adherent to the implant. Cavitations, possibly indicative of minor areas of
corrosion, were present along the implant surface. The adherent particles were
examined at x180 and appeared as elevations, randomly dispersed on the surface
of the implant (Fig. 8, C) It was difficult to identify them on a morphologic
basis. A microprobe of the particles revealed, in addition to the elements con-
tained in the Vitallium, the presence of calcium and bismuth (Fig. 9). These
findings would appear to indicate that the adherent particles were root canal
Volume 35 Vitallium endodontic implants 833
Number 6

Fig. 4. X-ray analysis of elements in Vitallium implant. Aluminum, from the holder and
gold, deposited for scanning electron micrographic examination, are not present in Vitailium.

cement (Diaket) , possibly mixed with endogenous mineral deposits. The areas
of depression were examined at magnifications of x180 and x600 (Fig. 10, A
and B). Stereo pairs of photographs were viewed to determine whether the
areas were actually depressions. The stereoscopic view revealed that these were
depressed areas, typical of metal corrosion. There were spherical agglomerations
dispersed in the craters formed by the corrosion of the implant (Fig. 10, C) .
Higher magnifications of the interface between the crater and the implant were
obtained when the specimen was rotated, so that a direct view of the interface
could be seen. At x3,000, the edge of the corrosion could be seen (Fig. 10, D).
At these magnifications the normal striations, ridges, and globular protuber-
ances had disappeared within the cavitations. Instead, the implant appeared
to be dissolved at the interface. In the crater, globular accretions of material
were visible and relatively large-faceted crystals were evident.
Histologic @dings. The apical area surrounding the implant contained
scattered chronic imflammatory cells, predominantly lymphocytes and micro-
phages. The bone counterpart which overlaid the implant revealed the presence
of a thin collagen fiber capsule (Fig. 11, A and B). Small numbers of scattered
chronic inflammatory cells were seen randomly dispersed throughout the can-
cellous tissue.
834 8cltzer et al. Oral Burg.
June, 1973

Fig. 5. Buccolingual radiograph of implant in distal root of mandibular left first molar.

MESIAL ROOT, MANDIBULAR LEFT FIRST MOLAR

S.E.M. findings. The implant in this root was observed at magnifications

ranging from x37 to x1,800 (Fig. 12, A to E). Fig. 12, A shows the implant
protruding from the bone for a slight distance. The specimen was rotated in
order that we might look at the interface between tissue and implant (Fig.
12, B and C). The collagen fibers appeared to adhere closely to the implant.
At x600, the collagen over the implant could be observed (Fig. 12, D). Gener-
ally, the fibers were tightly interwoven in a weblike pattern and were closely
adapted to the implant. Globular accretions of material were randomly dispersed
throughout the collagen network (Fig. 12, E) . A microprobe analysis revealed
that the particles contained calcium. An x-ray photograph for calcium was
made. The calcium particles appeared to be dense in one area and were randomly
dispersed in lesser density over the implant and throughout the sample (Fig. 13,
A and B).
Microprobe analysis. A microprobe analysis was made of the implant and
the bone overlying the implant. The probe indicated the presence of calcium,
chromium, cobalt, zinc, and nickel (Fig. 14). A second probe was made of the
bone adjacent to the implant and revealed the presence of chromium. Thus,
it appeared that the presence of chromium in the bone adjacent to the implant
was possibly due to corrosion. However, it was also possible that the chromium
from the implant was being detected. Several additional K (Yscans for chromium
were made of the bone approximately 1 to 4 cm. from the implant, both laterally
and apically. All of these scans revealed the presence of chromium. To rule out
the possibility t,hat the chromium of the implant was being detected, a probe
was then made of the bone counterpart which did not contain the implant.
This probe also revealed the presence of chromium. The depression in the bone
caused by the implant can be seen in Fig. 15, A. A line scan analysis for chro-
Volume 35 Vitallium endodontic implants 835
Number 6

Fig. 6. Implant of distal root, mandibular left flrst molar. Implant had been inserted
340 days previously. (Magtications: A, x47; B and C, x215; D, x750.)

mium was made in the bone containing the depression. The line scan indicated
the presence of chromium (Fig. 15, B). To eliminate the possibility that the
chromium was present in the aluminum holder and stub, the specimen was
mounted on a beryllium stub and the brass mounting screw was removed. Probes
of the bone continued to reveal the presence of chromium. All subsequent micro-
probes of bone were made on specimens mounted on beryllium stubs which
had been cleaned ultrasonically with acetone and alcohol. The mounting screw,
which was found to contain chromium, was also eliminated from the stub.
Histologic findings. One wall of the root canal was packed with dentin filings.
Many of these filings were incorporated in hard tissue which resembled cemen-
836 Seltzer ef al. Oral Surg.
June, 1973

Fig. 7. X-ray analysis of material dispersed in collagen fibers surrounding implant in

distal root, mandibular left first molar. The gold is not part of the implant and the zinc
is from the cement.

turn or bone (Fig. 16). A thin connective tissue layer, containing macrophages,
lined the dentin filings on one side and the implant on the other (Fig. 17). This
layer was continuous and confluent with a thin, collagen fiber capsule which
surrounded the implant when it extended beyond the apex of the tooth into the
cancellous bone.

269-&y specimens
DISTAL ROOT, MANDIBULAR RIGHT FIRST MOLAR

S.E.M. fin&nys. Examination of the implant in the distal root of the mandib-
ular right first molar was not possible because the bone did not separate from
the implant. However, a probe of the bone specimen indicated that chromium
was present.
The periodontal ligament of the root was exposed when the bone was split
open (Fig. 18, A). The specimen was turned in order to reveal the interface
between cementum and periodontal ligament (Fig. 18, I?). At x1,000, the fibers
of the periodontal ligament were seen attaching to cementum (Fig. 18, C).
Higher magnifications (x3,000 and ~10,000) revealed the densely interwoven
fiber feltwork. Mineral deposits on the fibers were visible (Fig. 18, D and E) .
Histologic findings. The tissue block of the root containing the implant was
poorly processed. However, the bone counterpart revealed a chronic inflamma-
tory infiltrate, predominantly macrophages, in the marrow spa,ces overlying the
area of the implant.
Volume 35 Vital&m endodontic implants 837
Number 6

Pig. 8. Implant of distal root, mandibular left first molar removed after decalcification of
tissue (Magnifications : A and B, x60; C, x180.)

MESlAL ROOT, MANDIBULAR RIGHT FIRST MOLAR

S.E.M. findbags. The implant of the mesial root of the mandibular right
first molar, extending for a considerable distance beyond the root apex, is seen
in Fig. 19. At x37, no gross morphologic changes were visible. The fibers sur-
rounding the implant as it emerged from the apex were arrayed in a dense net-
work. However, the blunt end of the implant, when examined at x3,000 (Fig.
20, A), was found to be corroded.
Fig. 20, B shows a photograph of the bone at a distance from the implant.
 Oral Surg.
June, 1973

Pig. 9. X-ray analysis of particles adherent to implant of distal root, mandibular left first
molar. Aluminum is from the holder. The calcium and bismuth were deposited on the implant.

The bone appeared to be cortical in nature because of the close packing of the
fibers. No gross morphologic changes were visible at x60.
An x-ray scan was made of the bone in the area of the implant. The fol-
lowing elements were detected: calcium, chromium, nickel, and possibly zinc.
Another area of bone in that specimen and areas of the bone counterpart were
probed. Chromium and nickel were detected. These findings appeared to eon-
firm that corrosion of the implant had occurred,
Histologic fhdings. A chronic inflammatory infiltrate of the periodontal
ligament surrounded the root apex (Fig. 21, A). Within the root canal, chron-
ically inflamed connective tissue was entrapped in hard, cementum-like tissue
which lined the wall of the canal. Dentin filings were also covered with this
hard tissue (Fig. 21, B). Chronic inflammatory cells were also detected in
tissue sections of the bone counterpart (Fig. 22).

207-day specimens
DISTAL ROOT, MANDIBULAR LEFT THIRD PREMOLAR

S.E.M. findings. The distal root of the mandibular left third premolar was
examined at magnifications of x37 and x60. Apically, the tissue overlying the
implant appeared similar to cancellous bone. A thick bulge of bone surrounded
the implant closer to the root apex (Fig. 23, A). Lateral1 y, the tissue contained
fibers which appeared quite distinct in some areas; in other areas, no distinct
fiber morphology was evident. There were disruptions in the tissue continuity
(Fig. 23, B).
A line scan analysis for chromium was made of the area of bone overlying
Volume 35 Vitallium endodontic implants 839
Number 6

Fig. 10. Corroded areas on implant of distal root, mandibular left first molar. (Magni-
fications: 8, x180; B and C, x600; D, x3,000.)

the implant in the counterpart. The scan revealed the presence of chromium.
Histologic jhdi?lys. The root was ankylosed to bone around its entirety (Fig.
24, A and B). A thick, fibrous capsule surrounded the implant in bone (Fig.
24, C). Chronic inflammatory cells were evident in the tissue surrounding the
collagen fibers. A circumscribed area containing woven bone surrounded by
fibroblasts was discernible below the mandibular artery. The lesion had a fibrous
dysplasia-like quality (Fig. 24, D) .

MESIAL ROOT, MANDIBULAR LEFT THIRD PREMOLAR

S.E.M. fi?zdi?zgs. The implant was exposed for a considerable distance beyond
the apex when the bone was split. A composite of this implant can be seen in
 Oral Surg.
June, 1973

Fig. 11. Histologic section of bone counterpart overlying the implant of the distal root
of the mandibular left first molar. A, Collagen fiber capsule surrounding implant. B, Higher
magnification of collagen capsule. (Magnifications : A, x315 ; B, x450.)

Fig. 25. The photographs revealed that as the implant emerged from the bone
there was a profuse fibrous encapsulation of the implant. This dense feltwork
appeared closely adapted and covered the greater portion of the implant in a
continuous sheath. An x-ray scan of the collagen fibers overlying the implant
revealed the presence of chromium, possibly arising from the underlying im-
plant.
Histologic findi~zgs. The root was ankylosed (Fig. 26, A). An intense in-
flammatory infiltrate was present around the root apex and implant. The root
apex was resorbed (Fig. 26, B and C) . The distal end of the implant was found
to be resting on the wall of the mandibular artery (Fig. 26, D) .
Volume 35 Vitalliuvz mdodontic implants 841
Number 6

Fig. 22. Implant of mesial root of mandibular left first molar. Specimen was of 340 days’
duration. B, Specimen rotated to observe interface. (Magnifications: A, x37; 23, x60; C, x180;
D,x600; E,x1,800.)
842 Seltzer et ul. Oral Burg.
June, 1973

B’Q. 13. X-ray photograph for calcium of particles over implant of mesial root of
mandibular left first molar. 8, Area probed. B, Calcium scan of A. White particles indicate
distribution of calcium over area of a.

157-day specimen

S.E.M. findings. The palatal root of the maxillary left first molar contained
the implant. A probe of the area of bone 1 to 2 mm. below the root containing
the implant revealed the presence of chromium. Trace amounts of chromium
wart also detected in the bone below the other roots of the same tooth, despite
the fact that those roots contained no implants. \‘\Then probed, the bone counter-
part also contained chromium. These findings enhanced the probability that
corrosion of the implant hacl occurred.
The implant was examined after it was removed from the decalcified tissue
specimen (Fig. 27). At a magnification of x60, t,herc was pitting corrosion of the
portion of the implant which was in bone. IIt higher magnifications (x180, x600,
and x1,800) ~ craters in the metal are evident (Fig. 28, B and B). Large crystals,
probably calcium phosphate, were discernible on the surface of the crater (Fig.
T-3, C!).
The portion of the implant which was in the root of the tooth did not display
similar c*orrosion (Fig. 29, A, IS, and cl). However, when compared to the con-
trols (Fig. 3)) changes in the surface morphology of the metal mere evident.
The globular protuberances and striations were no longer evident.
Histologic fidings. Chronic inflammation was found around the apex of
the root containing the implant. One side of the root was resorbed. Although
new boric> formation was evident on the periphery of the lesion, the marrow
spaces contained chronic inflammatory cells. The new bone consisted of abundant
matrix and large cells. The bone counterpart also contained inflammatory cells
(Fig. 29, D).

146-day specimen

S.E.M. findings. The maxillary right first molar, with the implant protruding
from the root, is seen in Fig. 30, A. A probe was made of the bone adjacent to
Volume 35 Vitallium endodontic implants 843
Number 0

Fig. 14. X-ray analysis of implant and bone of the meaial root of the mandibular left first
molar.

26s. 15. A, Depression in bone caused by implant. B, Higher magnification of area of

A outlined by rectangle where a K Q scan for chromium wu made. Scan was made along
area depicted by white line. (Magnifications: A, x37; B, x60.)

the implant, and chromium was found. In Fig. 30, B, C, and D are seen views
of the surface of the implant at magnifications of x300 to x3,000. Adherent
material can be seen on the surface of the implant. This material had a
cauliflower-like appearance (Fig. 30, E and P). The exact nature of the material
was uncertain. Some of the adherent material was removed by stripping with
 Oral Surg.
June, 1973

Fig. 16. Composite photomicrograph of mesial root of mandibular left first molar. A
thin collagen fiber capsule (&‘F) surrounds the space which contained the implant (IiKP).
Dentin filings are packed on one wall of the root canal, and hard tissue has been elaborated
around these filings. Some inflamed connective tissue is seen in the upper left and lower
right sides. (Magnification, x50.)

celluloid tape. The tape and the material adhering to it were then examined
with the S.E.M. The material appeared to be amorphous, with some resemblance
to collagen. Histologic sections showed that the material stained eosinophilic. A
microprobe analysis of the material revealed the presence of phosphorus,
calcium, chromium, and zinc. Thus, it appeared that the calcium and phosphorus
deposits might be bone. The histologic sections of the strip containing the
amorphous material did not disclose the presence of bone, but possibly collagen
fibers. Therefore, although the deposits were mineral in nature, whether or not
Volume 35 Vitallium endodontic implants 845
Number 6

Fig. 17. Higher magnification of area in rectangle of Fig. 16. The dentin filings (DE”)
have been enclosed by cementum-like hard tissue. Connective tissue (CT), infiltrated with
macrophages, lines the implant space. D, Dentin. (Magnification, x125.)

they were bone is highly conjectural. A considerable amount of pitting ear-

rosion was evident on the side of the implant (Fig. 31, A and B) .
Hktologic findings. A band of chronically inflamed connective tissue was
present in the root canal (Fig. 32, A). Within the granulation tissue, a dense
collection of polymorphonuclear leukocytes was evident (Fig. 32, B) . Chronic
inflammation was also found in the periodontal ligament surrounding the apex
of the tooth.

DISCUSSION
Four major factors have been elucidated as necessary and desirable for
implantation of metals in the human body1°-15: (1) general inertness, including
nontoxicity and nonatigenicity ; (2) corrosion resistance ; (3) ability to endure
large and variable stresses in the body’s highly corrosive environment; and (4)
ease of fabrication.
Vitallium,” a cobalt-base alloy has a major element composition of 62 to 65
per cent cobalt, 27 to 30 per cent chromium, 5 per cent molybdenum, and 2 to
3 per cent nickel. It has been used extensively as an implant material in the

*Registered trademark of Howmet Corporation, Dental Division Vitallium, New York,

N. Y.
 Oral Burg.
June, 1973

Fig. 18. Periodontal ligament of the distal root of the mandibular right first molar. A, The
root of the tooth is seen in the center of the photograph; the periodontal ligament covers
.~ _ roe’.#f, at’ arrow. D,Y. T\--t-.,-.~A.,
reruxionca~ “.,a-
ug
most of the root; the ligament has been peeled from the
ment fibers attaching to cementum. (Magnif ications: A, x300; B, x300; C, x1,OOO; D, X38QO;
E, x10,000.)
Volume 35 Vitallium endodontic implants 847
Number 6

Fig. 19. Composite photograph of implant of the mesial root of the mandibular right first
molar. (Magnification, x37.)
848 Beltrer et a.!. Oral Surg.
June, 1973

Fig. 80. A, Corroded, blunt end of implant of mesial root of mandibular right first molar.
II, Cortical bone apical to implant. (Magnifications: A, x3,000; B, x60.)

human body. Despite early claims by Venable and associateP that Vitallium
was electropassive in body fluids, and consequently inert and nonirritating to
human tissue, the present study shows that the alloy corrodes in bone.
Ferguson 2R has pointed out that purified metals are not static materials;
they have a natural tendency to revert by oxidation to the form found in nature.
Such reversion results in corrosion. Within the body, corrosion is encouraged
through an exchange of electrolytes and salts. Pitting corrosion results when
differential oxygenation is present over the surface of the meta1.2g The present
study has demonstrated with the scanning electron microscope that pitting cor-
rosion of Vitallium definitely occurs. Laing3” and FergusonZ8 have pointed out,
and the present study has also confirmed, that the corrosion products are re-
leased to the surrounding tissues. Metallosis results. Concentrations of chromium
ions were found dispersed throughout the bony tissue, often at some distance
from the implants. Such metallic ions have been found by Herschfus,31 Fitz-
pa.trick,32 and many other investigators to induce an inflammatory response.
The results of the present study are confirmatory. Although Frank and Abram9”
believed that the inflammation was related to the cementing media, the present
study appears to indicate that the corrosion products themselves were the
primary cause of tissue alterations.
Examination of the periapical tissues around the implants and the bone
counterparts generally indicated the presence of many macrophages scattered
throughout the marrow spaces of the bone.
Whether or not the chronic inflammatory response and the presence of
macrophages resulted from the irritation of corrosion products of the implants
or from the Diaket could not be determined by routine histologic examination
alone. Possibly both irritants contributed to the inflammation. However, the
presence of chromium ions in the bone, frequently at considerable distances
from the implants, was determined by microprobe analysis. Such findings, cor-
related with the presence of the macrophages in histologic sections of the same
Volume 35 Vital&urn endodontic implunts 849
Number 6

Fig. 81. A, Composite photomierograph of mesial root of mandibular right first molar.
Periapical intlammation (INF) is visible. Hard tissue, enclosing islands of idamecl connective
tissue, lines the walls of the root canal (RC). D, Dentin. 3, Higher magnification of area of
rectangle shown in A, Cementum-like tissue surrounds chronically inflamed connective tissue.
(Magnifications: A, x50; B, x125.)

bone specimens, appeared to confirm that the corrosion products of Vitallium

were primarily responsible for the inflammation.
Histologic sections of two roots which had contained implants revealed that
those roots were ankylosed to bone. In addition, there were chronic inflammatory
cells around the apices of both of these roots.
Whether or not the ankylosis of the roots was caused by insertion of the
 Oral Burg.
June, 1973

Fig. 3.8. Composite photomicrograph of histologic section of bone which covered the
implant in the distal root of the mandibular right first molar. The space left by the implant
in bone is seen in the center. Chronic inflammatory cells, predominantly macrophages, are
seen on the periphery. (Magnification, x50.)

Pig. $8. Bone overlying implant of distal root of mandibular left third premolar. A, Bulge
of bone surrounds implant (arrow) which is barely visible. B, Area of bone lateral to left
side of implant. (Magnification, x37.)
Volume 35 Vital&&m endodontic implants 851
Number 6

Fig. 84. Histologic sections of distal root, mandibular left third premolar. 8, Ankylosis
(arrow) of side of root. B, Apex of tooth exhibiting ankylosis (arrow). C, Collagen fiber
capsule (CF) surrounding implant deep in bone (B). Chronic inflammatory cells are seen on
side of implant space. D, Bone trabeculae (BT) in area of mandibular nerve. -4, Mandibular
artery. (Magnification, x50.)
 Oral Surg.
June, 1973

Fig. 85. Composite photograph of implant of mesial root, mandibular left third premolar.
(Magnification, x37.)
Volume 35 Vita&urn endodontic implants 853
Number 6

B’ig. 86. Histologic sections of mesial root of mandibular left third premolar. 8, Ankylosis
of root; D, dentin; BI bone. B, Resorption (R) of root apex and inflammatory response (ZNF)
surrounding area of implant. C, Higher magnification of intense inflammatory infiltrate seen
in B. Most cells are polymorphonuclear leukocytes. D, Implant (IMP) resting on wall of
mandibular artery (A). (Magnifications : A and B, x50 ; C, x450 ; D, x50.)
854 AsC’1t2tl‘ ct al. Oral Slug.
June, 1973

Pig. 17. Composite photograph of implant of palatal root of maxillary left first molar.
(Magnification, x60.)
Volume 35 Vitallium endodontic implants 855
Number 6

Fig. RI. Portion of implant in bone, outlined by top rectangle in Fig. 27. (Magnifications:
8,x180; &x600; C, ~1,800.)

implants could not definitely be determined in this study. It is conceivable that

nerve and blood vessel damage, caused by insertion of the implants, could have
had a causal relationship to the anklyosis. Thermal injury to the periodontal
ligament has also been found to result in ankylosis.33 Whether or not preparation
of the root canals and bone for the reception of the implants caused thermal
injury could not be determined.
A major problem with the insertion of metal implants is the lack of fusion
between the implant and the skeletal system. Part of the problem is the develop-
ment of a fibrous capsule around the implant. The present study has also
shown that large-faceted calcium phosphate crystals are deposited in the craters
of the metal formed as a result of corrosion. The thickness of the fibrous capsule
appears to be directly related to the concentration of corrosion products found
in the surrounding tissues.16~26v34-37The appearance of the fibrous capsule was
described in the S.E.M. photographs.
856 Scltrcr ct al. Oral Surg.
June, 1973

Pig. 29. Portion of implant in root canal, outlined by bottom rectangle in Fig. 27. D,
Histologic section of bone overlying implant. Inflammatory cells are present. (Magnifications :
3,480; B,x600; C,x1,800; D,x50.)
Volume 35 ‘Vitallium endodontic implants 857
Number 6

Fig, SO. Adherent material on surface of implant of the maxillary right first molar.
(Magnifications: 8,x60; B,x300; C,xl,OOO; D,x3,000; E,xl,OOO; F,xlO,OOO.)
 Oral Surg.
June, 1W.3

Fig. $1. Pitting corrosion of implant of maxillary right first molar. (Magnifications: A,
x300; B, x1,000.)

Fig. B. Histologic section of palatal root of maxillary right first molar. A, Chronically
inflamed connective tissue (INF) is seen in root canal. R, Higher magnification of inflamed
connective tissue in A. The predominant cell types are polymorphonuclear leukocytes. (Magni-
fications: A, x50; B, x4.50.)
Volume 35 Vitnllium endodontic implants 859
Number 6

In several roots, inflamed connective tissue was found lining the implants,
despite the fact that pulp tissue had been removed by root canal instruments.
Cementum-like hard tissue had been elaborated around dentin filings.
Thus, it would appear as if the connective tissue invaded the space between
the root canal and the implant. Gradual maturation to collagen fibers appeared
to be taking place, although the connective tissue in the root canal was heavily
infiltrated with polymorphonucleur leukocytes and macrophages. The cementum-
like or bone-like tissue was apparently formed after the implant was inserted.
However, the exact origin of the tissue is unknown.

SUMMARY AND CONCLUSIONS

Eight Vitallium endodontic implants were inserted into the teeth of a dog
for periods ranging from 146 to 340 days. The materials and tissues were then
examined with the scanning electron mircroscope, the electron microprobe, and
histologically. It was found that the implants corroded and that the corrosion
products initiated an inflammatory response. Corrosion products were detected
in the surrounding bone. Other unusual findings were ankylosis of several roots,
nerve and blood supply damage, and the invasion of inflamed connective tissue
between the implants and walls of the root canals.
It is concluded that Vitallium is not inert, nor does it resist corrosion when
implanted in the human body.
REFERENCES
1. Souza, M.: El Uso de Estabilizadores Intraoseo en Apicectomias y en Organos
Paradentosicos, Odontol. Uruguaya 7: 13, 1953.
2. Bruno, B. J. A. : Estabilizacion Intra&ea, Odontol. Uruguaya 8: 311,1954.
3. Held, A. J., Spirigi, M., P&ter, E., and Cimasoni, G: Endosseous Implants for the Rein-
forcement of Teeth, C~%L Bum. 16: 227-237, 1962.
4. Orlay, H. G.: Splinting With Ehdodontic Implant Stabilizers, Dent. Pratt. 14: 481-498,
1964.
5. Shaykin, J. B.: Endodontic Implant Technique, J. Am. Dent. Assoc. 68: 704-707, 1964.
6. Frank, A. L. : Improvement of the Crown-Root Ratio by Endodontic Endosseous Implants,
J. Am. Dent. Assoc. 74: 451-462, 1967.
7. Andreasen, J. 0.: Treatment of Intra-alveolar Root Fractures by Cobalt-Chromium
Implants, Br. J. Oral Surg. 6: 141-146, 1968.
8. Morse, D. R. : Endodontic Implants: a Review and New Approach, N. Y. State Dent. J.
35: 5-12, 1969.
9. Laing, P. G., Ferguson, A. B., Jr., and Hodge, E. 5.: Tissue Reaction in Rabbit Muscle
Exposed to Metalic Implants, J. Blamed. Mater. Res. 1: 135149, 1967.
10. von Liidinghausen, M., Meister, P., and Probst, J.: Metallosis After Osteosynthesis,
Pathol. Eur. 5: 307-314, 1970.
11. Colangelo, V. J., Greene, N. D., Kettlekamp, D. B., Alexander, H., and Campbell, C. J.:
Corrosion Rate Measurements in Vivo, J. Biomed. Mater. Res. 1: 405-414, 1967.
12. Sisca, R. F., Thonard, J. C., Lower, D. A., and George, W. A.: Responses of Epithelial-
like Cells in Tissue Culture to Implant Material, J. Dent. Res. 46: 248-252, 1967.
13. Bernier, J. L., and Canby, C. P.: Histologic Studies on the Reaction of Alveolar Bone
to Vitallium Implants, J. Am. Dent. Assoc. 30: 188-197, 1943.
14. SCO p, 1. W., Dictrow, R. L., Lichtenstein, B., and Blechman, H.: Cellular Response to
En I?odontm Endosseous Implants, J. Periodontol. 42: 717-720, 1971.
15. Baboush, C. A.: Endosseous Blade-Vent Implants: A Research Review, J. Oral Surg. 20:
168-175, 1972.
16. Kaketa, T., and Suzuki, K.: Histopathological Findings on Endo-osseous Implants in
Dogs, Bull. Tokyo Dent. Coll. 10: 61-70, 1969.
17. Harris, R., and Lossin, C. : The Use of Cobalt Chromium Alloy and Titanium Endodosseous
Dental Implants, Aust. Dent. J. 16: 94-108, 1971.
18. Armitage, J., Natiella, J., Greene, G., Jr., and Meenaghan, M.: An Evaluation of Early
860 Relfzer. et (Il. Oral Surg.
June, 1973

Bone ChnnPes After the Insertion of Metal Endosseous Imulants I Into the Jaws of
Rhesus Monkeys, ORAL SURF. 32: 558568, 1971.
19. IIarris. R.: Implantation of Chrome Cobalt Alloy Tooth Forms in the R.abbit’s Mandible,
Ah. Dent. J. i4: 396-406, 1969.
20. Bowden. F. I’.. Williamson. J. B. P.. and Laing. P. G.: Clinical and Metalluraical
Observation on’ the Corrosion on Stainless Steel -Screws Used in Orthopedic Surgery,
Nature (Land.) 173: 186, 1954.
21. Hicks, J. H., and Cater. W. II.: Minor Reactions Due to Modern Metal. J. Bone Joint
Surg.‘44B: 122-128, 1962.
22. Franks, R., Binder, W. D., and Bishop, C. R.: The Effect of Molybdenum and Columbium
on the Structures, Physical Properties and Corrosion Resistance of Austenitic Stainless
Steel, Trans. Am. Sot. Metals 29: 35, 1961.
23. Ferguson, A. B., Laing, P. G., and Hodge, E. 8.: The Ionization of Metal Implants in
Living Tissues, J. Bone Joint Surg. 42A: 77-90, 1960.
24. Orlando! 8. : Impianti Metallici in Stomatologia : Materiali (Loro Affaticamento Ed
Elettrohsi) Strumenti e Medodi, Riv. Ital. Stomatol. 22: 422-454, 1967.
“5. Frank, A. L., and Abrams, A. M.: Histologic Evaluation of Endodontic Implants, J. Am.
Dent. Assoc. 78: 520-554, 1969.
26. Anderson, T. F.: A Method for Eliminating Gross Artifacts in Drying Specimens, Cong.
Microscop. Electron in Rev. d’optique, Paris, 1952, pp. 567.576.
27. Venable, C. S., Stuck, W. G., and Beach, A.: The Effects on Bone of the Presence of
Metals, Based Upon Electrolysis : An Experimental Study, Ann. Surg. 105: 917-938, 1937.
28. Ferguson, A. B.: Metal Behavior: The Corrosion Process. In Metals and Engineering in
Bone and Joint Surgery, Baltimore, 1959, Williams & Wilkins Company.
29. Von Fraunhofer, J. A., and Staheli, P. J.: Corrosion of Amalgam Restorations: A New
Explanation, Br. Dent. J. 130: 522524, 1971.
30. Laing, P. G.: Available Metals. In Metals and Engineering in Bone and Joint Surgery,
Baltimore, 1959 Williams & Wilkins Company.
31. Herschfus, L. : Histopathologic Findings on Vitallium Implants in Dogs, J. Prosthet. Dent.
4: 413-419. 1954.
32. Fitzpatrick, B.: A Comparative Study of Some Implant Materials. Parts I and II,
Aust. Dent. J. 13: 360-362, 422-434, 1968.
33. Atrizadeh, F., Kennedy, J., and Zander, H.: Ankylosis of Teeth Following Thermal
Injury, J. Periodont. Res. 6: 159, 1971.
34. Greener, E. H., Sharkar, M., Lautenschlagor, E., and Kaminski, E.: The Biocompatibility
of Dental Implant Alloys, I.A.D.R. Abstr., 1971.
35. Blakey, K. R., and Rubin, R. L.: Comparative Histologic Study of Various Implant
Materials, I.A.D.R. Abstr., 1971.
36. Quaynor-Malm, W., Alicandri, F., Johnson, A., Motzkin, S., and Shulman, A.: Implant
Experiments on a Base Metal Alloy, T. A. D. R. Abstr., 1971.
37. Nichols, F. C. : Semiburied Denture Implants: Review of Literature and Experimental
Study, J. Oral Surg. 12: 217-231, 1954.

Reprint requests to :
Dr. Samuel Seltzer
Department of Endodontology
School of Dentistry
Temple University
Philadelphia, Pa. 19140