## 3 Results
The high magnification micrograph and EDS analysis were performed at three points: one in the thread surface to show the fixture morphology, one on the attached bone in the upper region, and one on the attached bone in the apical region to compare the bone structure and chemical composition at these two regions (Figure 4A). SEM micrograph of the exposed implant surface revealed the pattern of sandblasting and acid etching surface (Figure 5, 0101-T, white asterisk). EDS analysis of this region showed a homogenous Ti surface covered by a Ti oxide layer (% mass Ti: 82.98%, oxygen (O): 10.93%). In addition, minor signs of carbon (C) and fluorine (F), together with traces of gold (Au), sodium (Na), calcium (Ca), phosphorus (P), and silicon (Si), were recorded. Bone tissue attached at the implant upper part (Figure 5, 0102-U, white asterisk) was found to have a more compact structure than bone in the apical region, per both SEM micrograph analysis and EDS composition results (Figure 5, 0103-A) (% mass of Ca in 0101-T was 35.61% vs. 29.26% in 0103-A). The Ca/P ratio of bone in the upper region was higher than that in the apical region (4.1 vs. 2.6). Noticeably, a significant level of zirconium (Zr) (9.19%) was detected in this upper bone region, together with trace signals of Ti, Na, and Si. The bone at the apical region (Figure 5, 0103-A) exhibited a nonhomogeneous structure, with not only organic particles (Figure 5, 0103-A, blue arrowheads) but also significant signs of Na, Si, Ti, and traces of Au, aluminum (Al), and magnesium (Mg). A Ti particle was also detected and is displayed on the distribution map (Figure 5, 0103-A, distribution map, arrow). In case 2, the implant was removed along the infected bone by mass excision, and the final biopsy result confirmed that the patient had fungal maxillary sinusitis. Two points in the apical area of the implant, one on the integrated bone in the middle of the fixture, and one on the fixture surface in the apical region were chosen to examine the BRONJ-affected and fungal-infected bone and implant morphology (Figure 4b). The integrated bone on the implant surface showed a pattern of sclerosing bone with rare signs of bone lacunae (Figure 5, 0204-M). High levels of Ca (40.75%) and O (31.06%) were detected. Au was also recorded to have a significantly high mass percentage (14.17%). Other detected elements were Si and Na, and a low signal of Ti was observed (1.01%). In the apical region of the implant, a massive infiltration of fungal hyphae was seen (Figure 5, 0205-A, black arrowheads). EDS analysis was performed at the implant surface and also revealed a significantly high percentage of Au (15.68%), along with two other major components, which were Ti and O; Si, Ca, Na were detected at low percentages in this region. In case 3, the implant apex was analyzed after retrieval during the implant apex-cutting surgery (Figure 4c). The implant surface was covered in organic membrane tissue, which can be observed on the low magnification (Figure 5, 0306-A, black asterisks). In \(\times\)10,000 magnifications, the blood cells (Figure 5, 0306-A, blue arrowheads) and fibrin were observed (Figure 5, 0306-A, blue asterisks). After broadly scanning, the exposed surface of the fixture thread was chosen to be analyzed by EDS (Figure 4c). Ti, O, and C were major compositions of this region, with a high percentage of Ti (71.06%). Si and Ca were detected at trace amounts on this surface.