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Shayya G, Benedetti C, Chagot L, Stachowicz ML, Chassande O, Catros S. Revolutionizing Dental Implant Research: A Systematic Review on Three-Dimensional In Vitro Models. Tissue Eng Part C Methods 2024. [PMID: 38587434 DOI: 10.1089/ten.tec.2023.0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Dental implants have been clinically used for almost five decades with high success rates. In vitro research models used in implant dentistry are limited to two-dimensional experiments, which are reproducible and well adapted to evaluate a single parameter but do not reproduce the complexity of clinical settings. On the contrary, the in vivo research models using animals offer similar histological and anatomical features to humans, and tissue healing can be close to a clinical situation, but those models are usually accompanied with ethical concerns, and their outcomes could not be extrapolated to humans because of interspecies variabilities. This makes the development of novel in vitro models that recapitulate physiological events occurring during dental implant placement of particular interest for current research in dentistry. Also, such models could be challenged by setting a pathological environment (peri-implantitis) to better understand the disease and eventually serve as a platform to evaluate novel treatment modalities. The aim of this systematic literature review was to cover all the in vitro three-dimensional (3D) complex models available for research in implant dentistry. To accomplish this, a comprehensive search of the literature present on Scopus and PubMed databases was done using specific keywords, as well as inclusion/exclusion criteria. Out of 1334 articles found, we have finally included 27 articles in this review with publication dates between 2001 and 2022. In those articles, the 3D models were designed to study tissue-implant interface behavior in bone or gingival tissue. The articles focused on simulating implant integration, evaluating the effect of different conditions on implant integration, or developing an infection model for the implant integration process. The methods used involved implant material and cells organized in a specific 3D structure. The 3D models developed were able to simulate the process of dental implant osseo- and soft tissue integration and lead to results comparable with conventional in vitro and in vivo models. A relatively limited number of articles were obtained, which indicates that this is an emerging field, highly dependent on progresses made in biotechnologies and tissue engineering, and that further investigation is needed to enhance these 3D in vitro models.
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Affiliation(s)
- Ghannaa Shayya
- Inserm BioTis, Laboratory for the Bioengineering of Tissues, University of Bordeaux, Bordeaux, France
| | - Clémentine Benedetti
- Inserm BioTis, Laboratory for the Bioengineering of Tissues, University of Bordeaux, Bordeaux, France
| | - Lise Chagot
- Inserm BioTis, Laboratory for the Bioengineering of Tissues, University of Bordeaux, Bordeaux, France
| | - Marie-Laure Stachowicz
- Inserm BioTis, Laboratory for the Bioengineering of Tissues, University of Bordeaux, Bordeaux, France
| | - Olivier Chassande
- Inserm BioTis, Laboratory for the Bioengineering of Tissues, University of Bordeaux, Bordeaux, France
| | - Sylvain Catros
- Inserm BioTis, Laboratory for the Bioengineering of Tissues, University of Bordeaux, Bordeaux, France
- Department of Oral Surgery, University Hospital of Bordeaux, Bordeaux, France
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Tang K, Luo ML, Zhou W, Niu LN, Chen JH, Wang F. The integration of peri-implant soft tissues around zirconia abutments: Challenges and strategies. Bioact Mater 2023; 27:348-361. [PMID: 37180640 PMCID: PMC10172871 DOI: 10.1016/j.bioactmat.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/23/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Stable soft tissue integration around the implant abutment attenuates pathogen penetration, protects underlying bone tissue, prevents peri-implantitis and is essential in maintaining long-term implant stability. The desire for "metal free" and "aesthetic restoration" has favored zirconia over titanium abutments, especially for implant restorations in the anterior region and for patients with thin gingival biotype. Soft tissue attachment to the zirconia abutment surface remains a challenge. A comprehensive review of advances in zirconia surface treatment (micro-design) and structural design (macro-design) affecting soft tissue attachment is presented and strategies and research directions are discussed. Soft tissue models for abutment research are described. Guidelines for development of zirconia abutment surfaces that promote soft tissue integration and evidence-based references to inform clinical choice of abutment structure and postoperative maintenance are presented.
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Affiliation(s)
- Kai Tang
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Meng-Lin Luo
- Institute of Stomatology & Oral Maxilla Facial Key Laboratory, The First Medical Center, Chinese PLA General Hospital & Department of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Zhou
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Li-Na Niu
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
| | - Ji-Hua Chen
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- Corresponding author.
| | - Fu Wang
- National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology &Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, China
- Corresponding author.
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Barker E, AlQobaly L, Shaikh Z, Franklin K, Moharamzadeh K. Implant Soft-Tissue Attachment Using 3D Oral Mucosal Models-A Pilot Study. Dent J (Basel) 2020; 8:E72. [PMID: 32645887 PMCID: PMC7558259 DOI: 10.3390/dj8030072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/23/2020] [Accepted: 07/03/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The aim of this study was to investigate soft-tissue attachment to different metal, ceramic, and polymer implant surfaces using an inflamed, three-dimensional (3D), tissue-engineered, human oral mucosal model, as well as multiple-endpoint qualitative and quantitative biological approaches. METHODS Normal human oral fibroblasts, OKF6/TERT-2 keratinocytes and THP-1 monocytes were cultured, and full-thickness, 3D oral mucosal models were engineered inside tissue culture inserts. Sand-blasted and acid-etched (SLA) and machined (M) titanium-zirconium alloy (TiZr; commercially known as Roxolid; Institut Straumann AG, Switzerland), ceramic (ZrO2), and polyether ether ketone (PEEK) rods (Ø 4 mm × 8 mm) were inserted into the center of tissue-engineered oral mucosa following a Ø 4mm punch biopsy. Inflammation was simulated with addition of the lipopolysaccharide (LPS) of Escherichia coli (E. coli) and tumor necrosis factor (TNF)-alpha to the culture medium. Implant soft-tissue attachment was assessed using histology, an implant pull-test with PrestoBlue assay, and scanning electron microscopy (SEM). RESULTS Inflamed, full-thickness, 3D human oral mucosal models with inserted implants were successfully engineered and histologically characterized. The implant pull-test with PrestoBlue assay showed higher viability of the tissue that remained attached to the TiZr-SLA surface compared to the other test groups. This difference was statistically significant (p < 0.05). SEM analysis showed evidence of epithelial cell attachment on different implant surfaces. CONCLUSIONS The inflamed, 3D, oral mucosal model has the potential to be used as a suitable in vitro test system for visualization and quantification of implant soft-tissue attachment. The results of our study indicate greater soft tissue attachment to TiZr-SLA compared to TiZr-M, ceramic, and PEEK surfaces.
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Affiliation(s)
| | | | | | | | - Keyvan Moharamzadeh
- School of Clinical Dentistry, University of Sheffield, Western Bank, Sheffield S10 2TN, UK; (E.B.); (L.A.); (Z.S.); (K.F.)
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Roffel S, Wu G, Nedeljkovic I, Meyer M, Razafiarison T, Gibbs S. Evaluation of a novel oral mucosa in vitro implantation model for analysis of molecular interactions with dental abutment surfaces. Clin Implant Dent Relat Res 2019; 21 Suppl 1:25-33. [PMID: 30859688 PMCID: PMC6594065 DOI: 10.1111/cid.12750] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 12/25/2022]
Abstract
Background Abutment surfaces are being designed to promote gingival soft tissue attachment and integration. This forms a seal around prosthetics and consequently ensures long‐term implant survival. New scalable and reproducible models are necessary to evaluate and quantify the performance of these surfaces. Purpose To evaluate a novel implantation model by histomorphometric and immunohistochemical characterization of the interactions between human oral gingival tissue and titanium abutments with either novel anodized or conventional machined surface. Materials and Methods Abutments were inserted into an organotypic reconstructed human gingiva (RHG) model consisting of differentiated gingival epithelium cells on a fibroblast populated lamina propria hydrogel following a tissue punch. Epithelial attachment, down‐growth along the abutment surface, and phenotype were assessed via histomorphology, scanning electron microscopy, and immunohistochemistry 10 days after implantation. Results The down‐growing epithelium transitioned from a gingival margin to a sulcular and junctional epithelium. The sulcus depth and junctional epithelial length were similar to previously reported pre‐clinical and clinical lengths. A collagen IV/laminin 5 basement membrane formed between the epithelium and the underlying connective tissue. The RHG expanded in thickness approximately 2‐fold at the abutment surface. The model allowed the evaluation of protein expression of adhering soft tissue cells for both tested abutments. Conclusions The RHG model is the first in vitro 3D model to enable the assessment of not only human epithelial tissue attachment to dental abutments but also the expression of protein markers involved in soft tissue attachment and integration. The two abutments showed no noticeable difference in epithelial attachment.
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Affiliation(s)
- Sanne Roffel
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ivana Nedeljkovic
- Department of Dental Material Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Susan Gibbs
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Molecular Cell Biology and Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Touré G, Gouet E. Use of a 3-Dimensional Custom-Made Porous Titanium Prosthesis for Mandibular Body Reconstruction With Prosthetic Dental Rehabilitation and Lipofilling. J Oral Maxillofac Surg 2019; 77:1305-1313. [PMID: 30689966 DOI: 10.1016/j.joms.2018.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/19/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
Reconstruction of mandibular substance loss by a free flap is a widely used technique. This technique suffers from several disadvantages, including the presence of a second intervention site and a substantial frequency of complications. We have undertaken a custom-made 3-dimensional reconstruction (using computer-aided design and manufacturing) with prosthetic dental rehabilitation and esthetic improvement by lipomodeling of the face. A 50-year-old woman presented with a massive recurrence of an ameloblastoma of the right hemimandible. A cervical approach was used to resect the mandible well away from the tumor site. In light of her refusal to undergo reconstruction by a fibula free flap, reconstruction was performed using a custom-made porous titanium device with dental prosthetic rehabilitation, followed by lipomodeling of the face. The reconstruction was achieved without the occurrence of any complications. The implant-supported prosthetic dental implantation and the lipofilling resulted in functionally and esthetically satisfactory outcomes. Three-dimensional mandibular reconstruction with a custom-made porous titanium device and lipofilling yielded satisfactory results. Fitting of the dental prosthesis was undertaken at an early stage as it did not require osseointegration, although there was a need to overcome difficulties linked with the seal and the stability of the dental prosthesis and titanium support. The duration of patient follow-up was 18 months.
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Affiliation(s)
- Gaoussou Touré
- Professor and Department Head, Service de Chirurgie Maxillo-Faciale, Intercity Hospital Center Villeneuve Saint Georges, Villeneuve-Saint-Georges, France.
| | - Emmanuel Gouet
- Consultant, Service de Chirurgie Maxillo-Faciale, Intercity Hospital Center Villeneuve Saint Georges, Villeneuve-Saint-Georges, France
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Almela T, Al-Sahaf S, Bolt R, Brook IM, Moharamzadeh K. Characterization of Multilayered Tissue-Engineered Human Alveolar Bone and Gingival Mucosa. Tissue Eng Part C Methods 2018; 24:99-107. [PMID: 29092692 DOI: 10.1089/ten.tec.2017.0370] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Advances in tissue engineering have permitted assembly of multilayered composite tissue constructs for potential applications in the treatment of combined hard and soft tissue defects and as an alternative in vitro test model to animal experimental systems. The aim of this study was to develop and characterize a novel three-dimensional combined human alveolar bone and gingival mucosal model based on primary cells isolated from the oral tissues. Bone component of the model was engineered by seeding primary human alveolar osteoblasts into a hydroxyapatite/tricalcium phosphate scaffold and culturing in a spinner bioreactor. The engineered bone was then laminated, using an adhesive tissue sealant, with tissue-engineered gingival mucosa consisting of air/liquid interface-cultured normal human gingival keratinocytes on oral fibroblast-populated collagen gel scaffold. Histological characterization revealed a structure consisting of established epithelial, connective tissue and bone layers closely comparable to normal oral tissue architecture. The mucosal component demonstrated a mature epithelium undergoing terminal differentiation similar to that characteristic of native buccal mucosa, as confirmed using cytokeratin 13 and cytokeratin 14 immunohistochemistry. Ultrastructural analysis confirmed the presence of desmosomes and hemidesmosomes in the epithelial layer, a continuous basement membrane, and newly synthesized collagen in the connective tissue layer. Quantitative polymerase chain reaction (qPCR) assessment of osteogenesis-related gene expression showed a higher expression of genes encoded collagen I (COL1) and osteonectin (ON) compared with osteocalcin (OC), osteopontin (OP), and alkaline phosphatase (ALP). Enzyme-linked immunosorbent assay quantification of COL1, ON, and OC confirmed a pattern of secretion, which paralleled the model's gene expression profile. We demonstrate in this study that, replicating the anatomical setting between oral mucosa and the underlying alveolar bone is feasible and the developed model showed characteristics similar to those of normal tissue counterparts. This trilayered model therefore offers great scope as an advanced and anatomically representative tissue-engineered alternative to animal models.
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Affiliation(s)
- Thafar Almela
- 1 Academic Unit of Oral & Maxillofacial Medicine and Surgery, School of Clinical Dentistry, University of Sheffield , Sheffield, United Kingdom
| | - Sarmad Al-Sahaf
- 1 Academic Unit of Oral & Maxillofacial Medicine and Surgery, School of Clinical Dentistry, University of Sheffield , Sheffield, United Kingdom
| | - Robert Bolt
- 1 Academic Unit of Oral & Maxillofacial Medicine and Surgery, School of Clinical Dentistry, University of Sheffield , Sheffield, United Kingdom
| | - Ian M Brook
- 1 Academic Unit of Oral & Maxillofacial Medicine and Surgery, School of Clinical Dentistry, University of Sheffield , Sheffield, United Kingdom
| | - Keyvan Moharamzadeh
- 1 Academic Unit of Oral & Maxillofacial Medicine and Surgery, School of Clinical Dentistry, University of Sheffield , Sheffield, United Kingdom .,2 Academic Unit of Restorative Dentistry, School of Clinical Dentistry, University of Sheffield , Sheffield, United Kingdom
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Xing R, Salou L, Taxt-Lamolle S, Reseland JE, Lyngstadaas SP, Haugen HJ. Surface hydride on titanium by cathodic polarization promotes human gingival fibroblast growth. J Biomed Mater Res A 2013; 102:1389-98. [PMID: 23733604 DOI: 10.1002/jbm.a.34819] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/07/2022]
Abstract
Connective tissue seal to dental abutment is crucial for peri-implant health. Several efforts have been made previously to optimize abutment surfaces, but no consensus has been reached regarding the optimal surface architecture and/or composition for soft tissue seal. Here, we report on experiments using cathodic polarization in organic acids to optimize titanium (Ti) surfaces for use as abutments. The three main factors affecting surface topography and chemistry were electrolyte composition, current density, and polarization time. Under identical conditions, oxalic acid created rougher surfaces than tartaric acid and acetic acid, and acetic acid produced more surface hydride. Surface hydride amount was suggested to first increase and then decrease with current density from 1 mA/cm(2) to 15 mA/cm(2) . The complexity of the surface topography and hydride production both increased with polarization time. Proliferation rate of human gingival fibroblasts (HGFs) was positively correlated with surface hydride content, suggesting the positive effect of surface hydride on connective tissue growth around dental abutment. Changes in surface topography and hydrophilicity did not significantly influence HGF growth.
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Affiliation(s)
- Rui Xing
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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Chai WL, Brook IM, Palmquist A, van Noort R, Moharamzadeh K. The biological seal of the implant-soft tissue interface evaluated in a tissue-engineered oral mucosal model. J R Soc Interface 2012; 9:3528-38. [PMID: 22915635 DOI: 10.1098/rsif.2012.0507] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
For dental implants, it is vital that an initial soft tissue seal is achieved as this helps to stabilize and preserve the peri-implant tissues during the restorative stages following placement. The study of the implant-soft tissue interface is usually undertaken in animal models. We have developed an in vitro three-dimensional tissue-engineered oral mucosal model (3D OMM), which lends itself to the study of the implant-soft tissue interface as it has been shown that cells from the three-dimensional OMM attach onto titanium (Ti) surfaces forming a biological seal (BS). This study compares the quality of the BS achieved using the three-dimensional OMM for four types of Ti surfaces: polished, machined, sandblasted and anodized (TiUnite). The BS was evaluated quantitatively by permeability and cell attachment tests. Tritiated water (HTO) was used as the tracing agent for the permeability test. At the end of the permeability test, the Ti discs were removed from the three-dimensional OMM and an Alamar Blue assay was used for the measurement of residual cells attached to the Ti discs. The penetration of the HTO through the BS for the four types of Ti surfaces was not significantly different, and there was no significant difference in the viability of residual cells that attached to the Ti surfaces. The BS of the tissue-engineered oral mucosa around the four types of Ti surface topographies was not significantly different.
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Affiliation(s)
- Wen L Chai
- Department of General Dental Practice and Oral and Maxillofacial Imaging, Faculty of Dentistry, University of Malaya, Kuala Lumpur 50603, Malaysia.
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