The existence of a microgap in two-piece metal implant system has been well documented in the literature. This microgap is in microns size and several in-vitro studies tested the microleakage through the microgap and its effect on hard and soft tissues. It was proven that this gap acts as a reservoir for bacteria which induced peri-implant tissue inflammatory reactions.
Microgap is defined as the microscopic space that exists between the implant body and abutment. This gap is generally measured in microns meters and is located at the junction between the metal implant and implant abutment. The microgap may act as a reservoir for bacteria, which can lead to release of bacterial byproducts and induction of an inflammatory reaction at both soft and hard tissue level. The main mechanism proposed for microgap-related crestal bone loss is the role of this space as a trap for bacteria and thus, as a putative etiological factor for inflammatory reaction in the peri- implant soft tissues. The establishment of inflammatory cell infiltrates at the implant- abutment junction, even around implant with meticulous plaque control and clinically healthy soft tissue, has recently been shown histologically by Ericson et al. In another study, the implant-abutment interface at the alveolar bone crest was associated with persistent peri-implant inflammation. This second study was conducted to compare the distribution and amount of inflammatory cells adjacent to implant with a supra-crestal, crestal or sub-crestal implant-abutment interface. Polymorphonuclear leukocytes or neutrophils accumulated at the greatest levels near or immediately coronal to the interface. However, peri-implant neutrophils increased progressively as the implant-abutment interface depth increased. Thus, the inflammatory cell accumulation below the original bone crest was significantly correlated with bone loss. In a clinical study, Quirynen et al, suggested that the microorganisms detected from the inside of the implant three months after abutment connection may be the result of leakage at the implant-abutment interface or contamination during abutment connection.
The picture above shows how the CeraRoot implant maintains good gingival health.
The titanium implant, however, due to its two-piece design, does not provide good conditions
for the gum to be 100% healthy.
The picture below shows a little screw that is placed on the day of the surgery inside the titanium implant to avoid liquids and food particles to build up inside the threaded connection of the titanium implants. This shows that blood can accumulate inside the implant and bacteria may colonize this area days or weeks after the surgery. This is not possible to happen when the dental implant used is made of one-piece such as CeraRoot, with no gaps and connections where bacteria and blood can accumulate. The picture was taken with a microscope and posted on Instragram by Dr. Liwaa Torbey.