Microstructural Observation with MicroCT and Histological Analysis of Human Alveolar Bone Biopsy from a Planned Implant Site: A Case Report

Abstract

The subject was a 53-year-old male. An alveolar bone sample was obtained from the site of the lower left first molar, before dental implant placement. Although the details of the trabecular structure were not visible with conventional computed tomography, micro-computed tomography (microCT) three-dimensional images of the alveolar bone biopsy sample showed several plate-like trabeculae extending from the lingual cortical bone. Histological observations of the bone sample revealed trabeculae, cuboidal osteoblasts, osteoclasts and hematopoietic cells existing in the bone tissue at the implantation site. Bone metabolic markers and calcaneal bone density were all within normal ranges, indicating no acceleration of the patient's bone metabolism. Using microCT, and histological and histomorphometrical techniques, a great deal of valuable information about the bone tissue was obtained from a biopsy sample extracted from the patient's planned implant site.

Keywords: Bone biopsy; bone micro-structure; dental implant; histomorphometry; human alveolar bone; microCT..

Fig. (1)

Preoperative intraoral findings. a: Upper dentition (occlusal view). b: Lower dentition (occlusal view). c: Front teeth (front view). d: Left-side view of molar occlusal status. Planned implant site indicated with an asterisk (*).

Fig. (2)

Alveolar bone findings. a: Appearance of the alveolar bone sample. b: 3D-microCT image of the longitudinal section, through the center of the sample. c: Hematoxylin-eosin staining of the same section as in (b).

Fig. (3)

Preoperative radiographic findings. a: Periapical radiographof the planned implant site. Arrowheads indicate the borders of an irregularly-shaped radiolucency. b: Panoramic radiograph, with an irregularly-shaped radiolucency (arrowheads) also visible.

Fig. (4)

Conventional CT images. a: Horizontal section at the height of the patient’s dental crowns. (MD: mesio-distal line; BL: bucco-lingual line, through the planned implant site). b: Mesio-distal section at the MD line in (a) above. Dotted line indicates planned implantation site. Solid line indicates planned bone biopsy site. c: Bucco-lingual section at the BL line in (a) above. Dotted line indicates planned implantation site. Solid line indicates planned bone biopsy site.

Fig. (5)

3D-microCT images of the alveolar biopsy sample. Left to right: microCT images, with the sample being successively rotated approx. 60 degrees clockwise each time. CB: cortical bone; TB: plate-like trabeculae.

Fig. (6)

Histological findings.(a) to (d) Hematoxylin-eosin staining of paraffin sections. (e) and (f) TRAP staining of paraffin sections. a: Adipose tissue, visible over a wide range in the marrow space. b: Hematopoietic cells, occasionally visible in certain areas of the marrow. c: Several flattened osteoblasts (fOb), visible at the bone surface. d: Cuboidal osteoblasts (cOb), occasionally visible at the bone surface. e: TRAP-positive bone surface, indicated by the red staining at the bone surface. f: A few TRAP-positive osteoclasts, on the resorption lacuna.

Fig. (7)

Radiographic findings, two years post-operatively. a: Periapical radiograph of planned implant site. b: Panoramic radiograph. Although a radiolucent area is still visible around the center of the implant, bone is also visible directly adjacent to the implant.

Fig. (8)

Intraoral findings, two years post-operatively. a: Occlusal view. Ceramic crown (asterisk) set onto the implant. b: Lateral view at occlusion. Asterisk indicates same ceramic crown. No abnormal findings are clinically visible in the implant area.