The Custom Endosteal Implant: histology and case report of a retrieved maxillary custom osseous-integrated implant nine years in service.

The Custom Endosteal Implant (CEI) is a custom-cast osseo-integrated implant that has evolved to replace the "old" fibro-integrated subperiosteal variant. This newly developed implant achieves osseous integration by utilizing a hydroxyapatite (HA) coating, and a specialized grafting technique that produces much improved success rates relative to its fibro-integrated subperiosteal predecessor. This case reported here represents a maxillary CEI implant that was placed and in functional service for 9 years before being retrieved and processed for histologic examination subsequent to the patient's demise. In addition, due to infection that occurred shortly after placement, an early provisional procedure with fluoridated HA was also performed. Histologic analysis of the postmortem specimen revealed a fully integrated new bone formation intimately surrounding the previously dehisced implant strut. The latter had previously been decontaminated and grafted with a thin layer of fluorapatite (FA) material. Results including histologic analysis confirmed complete osseo-integration of the implant following successful FA graft revision.