Histologic Evaluation of Soft Tissues around Dental Implant Abutments: A Narrative Review

Influence of Prosthetic Emergence Profile on Peri-Implant Marginal Bone Stability: A Comprehensive Review

The prosthetic emergence profile is a factor potentially affecting marginal bone level around dental implants. The aim of this review is to provide a comprehensive analysis of the influence of the prosthetic emergence profile on peri-implant marginal bone-level stability. The marginal bone level is an important parameter in implant dentistry, reflecting the stability of dental implants, and it is a critical indicator of long-term implant success. Minimizing marginal bone loss around dental implants is a key factor for maintaining implant function, supporting peri-implant soft tissues, and achieving predictable aesthetic outcomes. The scientific literature presents various examples of evidence on the influence of emergence angle and prosthetic designs on marginal bone loss. Several studies suggest that emergence angles exceeding 30° and convex prosthetic designs may increase the risk of peri-implantitis and bone resorption, while others find no significant correlation. Moreover, several studies demonstrated the positive influence of taper joint connections on marginal bone stability. Although the current literature remains diverse, it is essential to prioritize cleanability and minimize plaque accumulation for a successful implant-prosthetic restoration. Proper maintenance and a continuous follow-up to monitor marginal bone loss are beneficial for obtaining stable and optimal long-term results.

Peri-Implant Soft Tissue in Contact with Zirconium/Titanium Abutments from Histological and Biological Perspectives: A Concise Review

Dental implants are crucial in contemporary oral rehabilitation, necessitating optimal integration with the surrounding soft tissues for durable success. The attachment between the implant surface and peri-implant mucosa should establish a secure seal to prevent bacterial infiltration and subsequent tissue inflammation. This concise review examines the histological and biological perspectives of peri-implant soft tissue reactions to zirconium and titanium abutments, shedding light on their respective advantages and limitations. While titanium has been the gold standard, zirconia has gained attention due to its biocompatibility and aesthetic appeal. Histological studies show comparable soft tissue attachment and inflammatory responses between the two materials. Further research is needed to explore surface treatments and optimize outcomes in dental implant rehabilitation.

Surface modification strategies to reinforce the soft tissue seal at transmucosal region of dental implants

Soft tissue seal around the transmucosal region of dental implants is crucial for shielding oral bacterial invasion and guaranteeing the long-term functioning of implants. Compared with the robust periodontal tissue barrier around a natural tooth, the peri-implant mucosa presents a lower bonding efficiency to the transmucosal region of dental implants, due to physiological structural differences. As such, the weaker soft tissue seal around the transmucosal region can be easily broken by oral pathogens, which may stimulate serious inflammatory responses and lead to the development of peri-implant mucositis. Without timely treatment, the curable peri-implant mucositis would evolve into irreversible peri-implantitis, finally causing the failure of implantation. Herein, this review has summarized current surface modification strategies for the transmucosal region of dental implants with improved soft tissue bonding capacities (e.g., improving surface wettability, fabricating micro/nano topographies, altering the surface chemical composition and constructing bioactive coatings). Furthermore, the surfaces with advanced soft tissue bonding abilities can be incorporated with antibacterial properties to prevent infections, and/or with immunomodulatory designs to facilitate the establishment of soft tissue seal. Finally, we proposed future research orientations for developing multifunctional surfaces, thus establishing a firm soft tissue seal at the transmucosal region and achieving the long-term predictability of dental implants.

Comparison of Plaque Accumulation Between Titanium and PEEK Healing Abutments

Titanium (Ti) is considered the gold standard material for provisional implant restorations. Polyetheretherketone (PEEK), a polymeric thermoplastic material, has been progressively used in prosthetic, restorative, and implant dentistry. Recently, PEEK has been used in implant dentistry as a provisional implant restoration. Plaque accumulation and biofilm formation become the major concerns when infection and inflammation occur in the peri-implant tissue. Few reports were studied regarding the biofilm formation on the PEEK surface. This study aimed to compare plaque accumulation between the PEEK and Ti healing abutments. In an in vitro setting, the Ti healing abutment and PEEK healing abutment were subjected to biofilm formation; the result was collected after 24 h, 48 h, 72 h, and 7 days. Biofilms were studied following staining with crystal violet. The data were analyzed by Two-Way ANOVA. It was found that between Ti healing abutment and PEEK healing abutment materials, the biofilm formation on the PEEK surface is slightly higher than Ti, but no statistical difference (p > 0.05) was found. The results suggested that plaque accumulation between the Ti healing abutment and the PEEK healing abutment was not different. We concluded that the plaque accumulation on the surface PEEK healing abutment was similar to the conventional Ti healing abutment materials. Hence, both the PEEK and Ti healing abutments can be used as a healing abutment biomaterial according to the requirements of the prostheses in implant dentistry.

Case Report of a Dental Implant with Conometric Abutment-Prosthetic Cap Connection: Advanced High-Resolution Imaging and Peri-Implant Connective Tissue Performance

Background: In recent years, the use of conometric systems to connect dental implant abutments and prosthetic caps has been advocated because they seem to eliminate the side effects reported when using screw- and cement-connected prosthetic restorations. Objectives: The present case study is focused on conometric connection characterization and its performance in terms of the microarchitecture of peri-implant soft tissues by using a cross-linked approach based on optical microscopy and three-dimensional imaging. Methods: Two dental implants were characterized using micro-CT and another identical one was implanted into a patient; the latter was retrieved 45 days later due to changes in prosthetic needs. Afterward, the peri-implant soft tissues were investigated using synchrotron-based phase contrast imaging, histology, and polarized light microscopy. Results: Micro-CT analysis showed perfect adhesion between the abutment and prosthetic cap; histology and polarized light microscopy showed that connective tissue was richly present around the abutment retrieved from the patient. Moreover, the quantitative evaluation of connective tissues using synchrotron imaging, supported by artificial intelligence, revealed that this tissue was rich in mature collagen, with longitudinal and transverse collagen bundles intertwined. The number and connectivity of transverse bundles were consistently greater than those of the longitudinal bundles. Conclusion: It was found that the peri-implant soft tissue was already mature and well organized after only 45 days of implantation, supporting the hypothesis that conometric connections contribute to the significant stabilization of peri-implant soft tissues.

Influence of screw channel angulation on reverse torque value and fracture resistance in monolithic zirconia restorations after thermomechanical cycling: an in-vitro study

BACKGROUND

While the concept of angled screw channels has gained popularity, there remains a scarcity of research concerning the torque loss and fracture strength of monolithic zirconia restorations with various screw channel angulations when exposed to thermomechanical cycling. This in-vitro study aimed to evaluate the reverse torque value and fracture resistance of one-piece screw-retained hybrid monolithic zirconia restorations with angulated screw channels after thermomechanical cycling.

METHODS

One-piece monolithic zirconia restorations, with angulated screw channels set at 0°, 15°, and 25° (n = 6 per angulation) were fabricated and bonded to titanium inserts using a dual-cure adhesive resin cement. These assemblies were then screwed to implant fixtures embedded in acrylic resin using an omnigrip screwdriver, and reverse torque values were recorded before and after thermomechanical cycles. Additionally, fracture modes were assessed subsequent to the application of compressive load. One-way ANOVA and Bonferroni post hoc test were used to compare the groups (α = 0.05).

RESULTS

The study groups were significantly different regarding the fracture resistance (P = 0.0015), but only insignificantly different in the mean percentage torque loss (P = 0.4400). Specifically, the fracture resistance of the 15° group was insignificantly higher compared to the 0° group (P = 0.9037), but significantly higher compared to the 25° group (P = 0.0051). Furthermore, the fracture resistance of the 0° group was significantly higher than that of the 25° group (P = 0.0114).

CONCLUSIONS

One-piece hybrid monolithic zirconia restorations with angulated screw channels can be considered an acceptable choice for angulated implants in esthetic areas, providing satisfactory fracture strength and torque loss.

Influences of standardized clinical probing on peri-implant soft tissue seal in a situation of peri-implant mucositis: A histomorphometric study in dogs

BACKGROUND

Clinical probing is commonly recommended to evaluate peri-implant conditions. In a situation of peri-implant mucositis or peri-implantitis, the peri-implant seal healing from the disruption of soft tissue caused by probing has not yet been studied. This study aimed to investigate soft tissue healing after standardized clinical probing around osseointegrated implants with peri-implant mucositis in a dog model.

METHODS

Three transmucosal implants in each hemi-mandible of six dogs randomly assigned to the peri-implant healthy group or peri-implant mucositis group were probed randomly in the mesial or distal site as probing groups (PH or PM), the cross-sectional opposite sites as unprobed control groups. Histomorphometric measurements of implant shoulder (IS)-most coronal level of alveolar bone contact to the implant surface (BCI), apical termination of the junctional epithelium (aJE)-BCI, mucosal margin (MM)-BCI, and MM-aJE were performed at 1 day, 1 week, and 2 weeks after probing. Apoptosis, proliferation, proinflammatory cytokines, and matrix metalloproteinases (MMPs) of peri-implant soft tissue were estimated by immunofluorescent analysis.

RESULTS

In the PM group, apical migration of junctional epithelium was revealed by significantly decreased aJE-BCI from 1 day to 2 weeks in comparison to unprobed sites (p < 0.05), while no significant differences were found in the PH group. Immunofluorescent analysis showed higher levels of interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), MMP-1, and MMP-8, together with exaggerated apoptosis and proliferation of peri-implant soft tissue in the PM group.

CONCLUSION

Within the limitations, standardized clinical probing might lead to apical migration of the junctional epithelium in a situation of peri-implant mucositis.

Behaviour of the Peri-Implant Soft Tissue with Different Rehabilitation Materials on Implants

(1) Background: Mucointegration seems to gain interest when talking about success in the maintenance of dental implants. As we well know, collagen fibres cannot be inserted due to the lack of root structure on the implant surface, so the structural integration of peri-implant tissues that provide a firm seal around implants seems to be of interest when it comes to ensuring the survival of dental implants. To achieve a good epithelial barrier, the physicochemical characteristics of the surfaces of the restorative materials are of vital importance; therefore, the objective of this study is to analyse the histological behaviour of the peri-implant soft tissues in three different restorative materials. (2) Methods: Histological analysis of biopsied peri-implant keratinised mucosa, inflammatory epithelium and connective tissue in contact with a reinforced composite (BRILLIANT Crios), a cross-linked polymethylmethacrylate (TELIO CAD), and a hybrid ceramic (Vita Enamic), restored on a customised Atlantis-type abutment (Dentsply Sirona) between 60 and 180 days after restoration. (3) Results: A greater number of cells per mm2 of keratinised epithelium is observed in the reinforced composite, which could indicate greater surface roughness with greater inflammatory response. In this way, the greater number of lymphocytes and the lateral cellular composition of the inflammatory cells confirm the greater inflammatory activity towards that material. The best material to rehabilitate was hybrid ceramic, as it shows a better cellular response. (4) Conclusions: Knowing the limitations of the proposed study, despite the fact that greater inflammation is observed in the reinforced composite relative to the other materials studied, no statistically significant differences were found.

Nanoparticles of Cerium-Doped Zeolitic Imidazolate Framework-8 Promote Soft Tissue Integration by Reprogramming the Metabolic Pathways of Macrophages

Soft tissue integration around the abutment of implants is the basis of long-term retention of implants. Macrophages are an important component involved in the repair of soft tissue due to their crucial role in improving the biological structure of connective tissues by regulating the fiber synthesis, adhesion, and contraction of gingival fibroblasts. Recent studies have illustrated that cerium-doped zeolitic imidazolate framework-8 (Ce@ZIF-8) nanoparticles (NPs) can attenuate periodontitis via both antibacterial and anti-inflammatory effects. However, the effect of Ce@ZIF-8 NPs on soft tissue integration around the abutment is unknown. Herein, we first prepared Ce@ZIF-8 NPs by a one-pot synthesis. Then, we probed the regulatory effect of Ce@ZIF-8 NPs on macrophage polarization, and further experiments were performed to study the changes of fiber synthesis as well as adhesion and contraction of fibroblasts in the M2 macrophage environment stimulated by Ce@ZIF-8 NPs. Strikingly, Ce@ZIF-8 NPs can be internalized by M1 macrophages through macropinocytosis and caveolae-mediated endocytosis in addition to phagocytosis. By catalyzing hydrogen peroxide to produce oxygen, the mitochondrial function was remedied, while hypoxia inducible factor-1α was restrained. Then, macrophages were shifted from the M1 to M2 phenotype via this metabolic reprogramming pathway, provoking soft tissue integration. These results provide innovative insights into facilitating soft tissue integration around implants.

Association between Peri-Implant Soft Tissue Health and Different Prosthetic Emergence Angles in Esthetic Areas: Digital Evaluation after 3 Years’ Function

Background: The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. Methods: Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. Results: A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI_95% −0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI_95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. Conclusions: Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.