Microscopic, immunocytochemical, and ultrastructural properties of peri-implant mucosa in humans

Implant surface physicochemistry affects keratinocyte hemidesmosome formation

Previous studies have shown hydrophilic/hydrophobic implant surfaces stimulate/hinder osseointegration. An analogous concept was applied here using common biological functional groups on a model surface to promote oral keratinocytes (OKs) proliferation and hemidesmosomes (HD) to extend implant lifespans through increased soft tissue attachment. However, it is unclear what physicochemistry stimulates HDs. Thus, common biological functional groups (NH2 , OH, and CH3 ) were functionalized on glass using silanization. Non-functionalized plasma-cleaned glass and H silanization were controls. Surface modifications were confirmed with X-ray photoelectron spectroscopy and water contact angle. The amount of bovine serum albumin (BSA) and fibrinogen, and BSA thickness, were assessed to understand how adsorbed protein properties were influenced by physicochemistry and may influence HDs. OKs proliferation was measured, and HDs were quantified with immunofluorescence for collagen XVII and integrin β4. Plasma-cleaned surfaces were the most hydrophilic group overall, while CH3 was the most hydrophobic and OH was the most hydrophilic among functionalized groups. Modification with the OH chemical group showed the highest OKs proliferation and HD expression. The OKs response on OH surfaces appeared to not correlate to the amount or thickness of adsorbed model proteins. These results reveal relevant surface physicochemical features to favor HDs and improve implant soft tissue attachment.

Response of the somatosensory cortex following thermal stimuli to dental implants

In the current study, we investigated the cortical response of the somatosensory cortex following thermal stimuli to dental implants. Five implants were inserted at the site of the left upper canine with immediate implant placement protocols in five cats. Intrinsic signal optical imaging was applied to measure the cortical responses evoked by thermal sensing via dental implants. The cortical response evoked by 60 g of tactile stimulus to implants was also examined. The response strength and activated location were compared between implants and natural teeth. Thermal stimuli via the implant could evoke reliable cortical responses in the tooth-related region. However, the response amplitude evoked by the cold stimuli applied to the implants was significantly lower than that evoked by the cold stimuli applied to the natural teeth, indicating that the implants were less sensitive to thermal change than the natural tooth. The response evoked by tactile stimuli to implants was significantly stronger than that evoked by cold stimuli. Thermal and tactile stimuli activated the same location of the tooth-related somatosensory cortex in both the implants and natural teeth. Therefore, the thermal change in implants could be detected at the cortical response level. Multimodal sensory integration of thermal and tactile functions existed for implants.

The role of gingival mechanoreceptors in the tactile function of dental implants

Dental implants seem to restore some degree of tactile function. The aim of this study was to investigate the role of gingival mechanoreceptors in dental-implant osseoperception at the cortical-response level. The gingiva of the upper-left canine implant was stripped off under local anesthesia in five cats. We used intrinsic-signal optical imaging (ISOI) to measure the population-response characteristics of the feline oral-related cortex when separately applying punctate mechanical stimuli to the left canine implant and right intact natural canine. These response characteristics were compared under local anesthesia after removal of the gingiva. Under local anesthesia, the signal strength of the implant was significantly weaker than that of the tooth under weak but not under strong stimulus. After the gingiva was stripped off, the signal strength of the implant was significantly weaker than that of the tooth at all strengths of stimulus. Based on the evoked cortical responses, the gingiva was involved in the maximal tactile function of the implant.

Tactile sensation of natural teeth and dental implants in the somatosensory cortex

PURPOSE

This study aimed to investigate the cortical response characteristics evoked by natural teeth and implants.

METHODS

Five cats were subjected to intrinsic signal optical imaging to measure the cortical responses evoked by natural teeth and implants. The difference in tactile sensation between the implant and natural tooth was compared in detail at the cortical response level.

RESULTS

Some similarities were observed between the implants and natural teeth. The stimulating-response curves of the implants and natural teeth were generally S-curves, and both implants and natural teeth preferred labial-lingual direction stimulation. The implants and natural teeth differed in terms of their tactile sensitivity: implants were weaker than natural teeth in terms of both static and dynamic sensitivity. However, after saturation, there was no significant difference in tactile strength between implants and natural teeth.

CONCLUSIONS

Both natural teeth and implants are able to distinguish the tactile strength and stimulation direction. Although implants are less sensitive than the natural tooth, the maximal tactile function and directional preference of implants are similar to those of natural teeth.

The biological width around implant

PURPOSE

The concept of biological width has been proposed and widely used in oral implantation. This review aimed to summarize the biological width around implant in detail.

STUDY SELECTION

An electronic search of the literature prior to March 2019 was performed to identify all articles related to biological width in periimplant soft tissue. The search was conducted in the MEDLINE (National Library of Medicine) database accessed through PubMed with no date restriction. The following main keywords were used: "implant", "biological width", "soft tissue", "junctional epithelium", "peri-implant epithelium", "connective tissue", "gingiva", "mucosa" (connecting multiple keywords with AND, OR).

RESULTS

The identified researches focused on several aspects related to biological width in oral implantation, namely the concept, formation, remodeling, dimension, structure and function.

CONCLUSIONS

Based on of the reviewed literature, the concept, formation, remodeling, structure, dimension, and functional significances of periimplant biological width are explored in this narrative review. The formation of biological width around implant is a complex process after several weeks of healing. The biological width around implant is a 3-4mm distance from the top of the peri-implant mucosa to the first bone-to-implant contact or the stabilized top of the adjacent bone, consisting of sulcular epithelium, junctional epithelium and fibrous connective tissue between the epithelium and the first bone-to-implant contact or the stabilized top of the adjacent bone. The biological width forms a biological barrier against the bacteria, influences the remodeling of soft and hard tissue around implant and has implications for clinical aspects of dental implantation.

Effect of Titanium Particles on the Voltage-Gated Potassium Channel Currents in Trigeminal Root Ganglion Neurons

PURPOSE

Titanium (Ti) is the key material used in dental implants because of its excellent biocompatibility. But wear and corrosion Ti particles had been widely reported to induce inflammation and promote bone absorption. However, little information is known about the damage of Ti particles on neurons.

MATERIALS AND METHODS

Trigeminal root ganglion (TRG) neurons were exposed to Ti particles (<5 μm). The electrophysiological properties of 2 main subtypes of voltage-gated potassium channels (VGPCs) (KA and KV) were examined by whole-cell patch-clamp techniques.

RESULT

With the presence of 0.25 mg/mL Ti particles, amplitudes of IK, A and IK, V were both obviously inhibited. For IK, A, the activation V1/2 shifted to the depolarizing direction with an increased k value, whereas the inactivation V1/2 showed obvious hyperdepolarizing shifts. For IK, V, 0.5 mg/mL Ti particles produced a depolarizing shift of activation V1/2 with a slower activation rate. No significant changes of its inactivation kinetics were found.

CONCLUSION

Titanium (Ti) particles might alter the electrophysiological properties of VGPCs on TRG neurons, which are likely to further influence the excitability of neurons.

Bioactive-glass in periodontal surgery and implant dentistry

Bioactive-glass (B-G) is a material known for its favorable biological response when in contact with surrounding fibro-osseous tissues, due not only to an osteoconductive property, but also to an osteostimulatory capacity, and superior biocompatibility for use in human body. The objectives of this paper are to review recent studies on B-G in periodontal and implant therapy, describing its basic properties and mechanism of activity as well as discoursing about state of art and future perspective of utilization. From a demonstrated clinical benefit as bone graft for the elimination of osseous defects due to periodontal disease (intrabony/furcation defects) and surgeries (alveolar ridge preservation, maxillary sinus augmentation), to a potential use for manufacturing bioactive dental implants, possibly allowing wider case selection criteria together with improved integration rates even in the more challenging osteoporotic and medically compromised patients, this biomaterial represents an important field of study with high academic, clinical and industrial importance.

Osseoperception in Dental Implants: A Systematic Review

PURPOSE

Replacement of lost teeth has significant functional and psychosocial effects. The capability of osseointegrated dental implants to transmit a certain amount of sensibility is still unclear. The phenomenon of developing a certain amount of tactile sensibility through osseointegrated dental implants is called osseoperception. The aim of this article is to evaluate the available literature to find osseoperception associated with dental implants.

MATERIALS AND METHODS

To identify suitable literature, an electronic search was performed using Medline and PubMed database. Articles published in English and articles whose abstract is available in English were included. The articles included in the review were based on osseoperception, tactile sensation, and neurophysiological mechanoreceptors in relation to dental implants. Articles on peri-implantitis and infection-related sensitivity were not included. Review articles without the original data were excluded, although references to potentially pertinent articles were noted for further follow-up. The phenomenon of osseoperception remains a matter of debate, so the search strategy mainly focused on articles on osseoperception and tactile sensibility of dental implants. This review presents the histological, neurophysiological, and psychophysical evidence of osseoperception and also the role of mechanoreceptors in osseoperception.

RESULTS

The literature on osseoperception in dental implants is very scarce. The initial literature search resulted in 90 articles, of which 81 articles that fulfilled the inclusion criteria were included in this systematic review.

CONCLUSION

Patients restored with implant-supported prostheses reported improved tactile and motor function when compared with patients wearing complete dentures.

A systematic review on the innervation of peri-implant tissues with special emphasis on the influence of implant placement and loading protocols

OBJECTIVES

To systematically review the available literature on the influence of dental implant placement and loading protocols on peri-implant innervation.

MATERIAL AND METHODS

The database MEDLINE, Cochrane, EMBASE, Web of Science, LILACS, OpenGrey and hand searching were used to identify the studies published up to July 2013, with a populations, exposures and outcomes (PEO) search strategy using MeSH keywords, focusing on the question: Is there, and if so, what is the effect of time between tooth extraction and implant placement or implant loading on neural fibre content in the peri-implant hard and soft tissues?

RESULTS

Of 683 titles retrieved based on the standardized search strategy, only 10 articles fulfilled the inclusion criteria, five evaluating the innervation of peri-implant epithelium, five elucidating the sensory function in peri-implant bone. Three included studies were considered having a methodology of medium quality and the rest were at low quality. All those papers reported a sensory innervation around osseointegrated implants, either in the bone-implant interface or peri-implant epithelium, which expressed a particular innervation pattern. Compared to unloaded implants or extraction sites without implantation, a significant higher density of nerve fibres around loaded dental implants was confirmed.

CONCLUSIONS

To date, the published literature describes peri-implant innervation with a distinct pattern in hard and soft tissues. Implant loading seems to increase the density of nerve fibres in peri-implant tissues, with insufficient evidence to distinguish between the innervation patterns following immediate and delayed implant placement and loading protocols. Variability in study design and loading protocols across the literature and a high risk of bias in the studies included may contribute to this inconsistency, revealing the need for more uniformity in reporting, randomized controlled trials, longer observation periods and standardization of protocols.

Comparative assessment of the interfacial soft and hard tissues investing implants and natural teeth in the macaque mandible

OBJECTIVES

The aim of this study was to conduct a comparative qualitative and quantitative assessment of the interfacial soft and hard tissues investing implants and natural teeth.

MATERIALS AND METHODS

The test sample consisted of six adult healthy male Macaca fascicularis with three-unit splinted crowns, each crown supported by an Ankylos screw-shaped titanium implant. These implants were placed in the mandibular premolar-second molar region, one side by an immediate-loading (IL) and the other by delayed-loading (DL) protocol. The animals were sacrificed after 3 months of functional loading. Another two monkeys with natural dentition served as controls. Nondecalcified sections were prepared for assessment of optical intensities (OI) under a confocal laser scanning microscope.

RESULTS

In both the test (IL and DL) and control, the soft tissue complexes demonstrated a highly fluorescent keratinized layer and diminished cytoplasmic and enhanced membranous fluorescence in the remaining epithelium. Peri-implant mucosa was further characterized by an intense fluorescence at the junctional epithelium-implant interface and in the stromal mononuclear infiltrate. Connective tissue contact and periodontal ligament were weakly fluorescent. In hard tissues, a high fluorescence was observed in peri-implant woven bone and along the implant-bone interface. Mean OI was significantly higher in peri-implant woven bone than around teeth (P < 0.05). In the remaining soft and hard tissue complexes, no significant differences in mean OI between the test and control were observed (P > 0.05).

CONCLUSIONS

Present findings suggest that peri-implant woven bone is highly mineralized, while the peri-implant and gingival mucosa share structural similarities.

CLINICAL RELEVANCE

Optical intensities of interfacial tissues investing implants and teeth are related to their biological properties.

Morphological and functional characteristics of human gingival junctional epithelium

BACKGROUND

This study aims to observe the morphological characteristics and identify the function characteristics of junctional epithelium (JE) tissues and cultured JE cells.

METHODS

Paraffin sections of human molar or premolar on the gingival buccolingual side were prepared from 6 subjects. HE staining and image analysis were performed to measure and compare the morphological difference among JE, oral gingival epithelium (OGE) and sulcular epithelium (SE). Immunohistochemistry was applied to detect the expression pattern of cytokeratin 5/6, 7, 8/18, 10/13, 16, 17, 19, and 20 in JE, OGE and SE. On the other hand, primary human JE and OGE cells were cultured in vitro. Cell identify was confirmed by histology and immunohistochemistry. In a co-culture model, TEM was used to observe the attachment formation between JE cells and tooth surface.

RESULTS

Human JE was a unique tissue which was different from SE and OGE in morphology. Similarly, morphology of JE cells was also particular compared with OGE cells cultured in vitro. In addition, JE cells had a longer incubation period than OGE cells. Different expression of several CKs illustrated JE was in a characteristic of low differentiation and high regeneration. After being co-cultured for 14 d, multiple cell layers, basement membrane-like and hemidesmosome-like structures were appeared at the junction of JE cell membrane and tooth surface.

CONCLUSIONS

JE is a specially stratified epithelium with low differentiation and high regeneration ability in gingival tissue both in vivo and in vitro. In co-culture model, human JE cells can form basement membrane-like and hemidesmosome-like structures in about 2 weeks.

Perceptual changes in the peri-implant soft tissues assessed by directional cutaneous kinaesthesia and graphaesthesia: a prospective study

BACKGROUND

The innervation of skin and oral mucosa plays a major physiological role in exteroception. This innervation is also clinically relevant as sensory changes occur after neurosurgical procedures.

PURPOSE

The goal of this study was to compare the perception of mechanical stimuli applied to the buccal mucosa in the vicinity of osseointegrated oral implants with that in the controlateral dentate side. The role of the previously reported increased innervation in the peri-implant soft tissues in the oral sensorimotor function was thus examined.

MATERIALS AND METHODS

Seventeen subjects with 20 implants were tested. Directional cutaneous kinaesthesia (DCK) and graphesthesia (G) were performed on the buccal side of the alveolar mucosa before and at planned intervals after implant placement. The observation was pursued until 6 months after the prosthetic rehabilitation. In each subject, the contralateral mucosa served as a control to the implant sites. Average percentages of correct responses in a four-choice task for DCK and a three-choice task for G were calculated.

RESULTS

Despite an intersubject variation in both the DCK and G, high intraindividual correlations were found (p < .005). The implant sites showed a significant difference toward the control sites at the four interval test for both tests. For DCK and G, the average of correct responses decreased after abutment connection (i.e., after the implant uncovering surgery) to increase afterwards to reach a level close to, but still lower than, the control sites 3 to 6 months after the prosthetic rehabilitation.

CONCLUSION

The DCK and G are simple but reliable sensory tests that can be easily applied in the oral region. This prospective study indicates that tooth loss reduces tactile function compared with implant-supported prostheses. The peri-implant soft tissues could be partially involved in the osseoperception function.

Immunohistochemical analysis of soft tissues in implants with healthy and peri-implantitis condition, and aggressive periodontitis

Today, implant-supported prostheses are widely accepted as a reliable treatment modality, but failures in longitudinal studies have been shown. In some cases, peri-implantitis with a progressive periodontal bone loss takes place, and mechanical or load factors and biological or plaque-induced lesions have been claimed as main etiologic factors. We compared five cases of peri-implantitis, with five cases of healthy peri-implant tissues and five cases of aggressive periodontitis in order to give new findings on the osseointegration loss process. Biopsy specimens from the peri-implant tissues including oral (O), sulcular, and junctional epithelium and the underlying and supracrestal connective tissue, were taken in all cases for histological and immunohistochemical analysis. T lymphocytes were the most prominent cell in the peri-implantitis (PG) and aggressive periodontitis (AG) groups, but not in the peri-implant healthy group (HG). CD1a-positive cells (Langerhans and immature dendritic cells) were observed more frequently in the O than in the sulcular-junctional (S-J) epithelium: they were located in the basal and parabasal layers, without any differences between the three groups. Vascular proliferation analysed by immunoreactivity for CD34, Factor VIII, and vascular endothelial growth factor was more prominent in the PG comparing with HG and AG in the S-J area. Apoptosis, analysed by bcl2 and p53 immunoreactivity, was similar in the three groups. In conclusion, we suggest that the osseointegration loss process is due to an inflammatory process similar to that observed in aggressive periodontitis according to the number of T lymphocytes, but not to the vascular proliferation.