Comparison of peri‐implant and periodontal marginal soft tissues in health and disease

Abstract

The integrity of the peri-implant soft-tissue seal is crucial for maintaining peri-implant tissue health. Whilst the transmucosal component of the restored implant shares some common features with teeth, namely the presence of a junctional epithelium and a connective tissue component, there are some important differences. A key difference is the nature of the relationship of the connective tissue with the implant surface, whereby there is 'adaptation' of collagen fibers in a parallel orientation in relation to the implant, but insertion of fiber attachment perpendicularly into cementum in the case of teeth. This, combined with reduced cellularity and vascularity in the peri-implant connective tissue, may make implants more susceptible to disease initiation and progression. Furthermore, the presence of a subgingival connection between the implant and the abutment/restoration poses some specific challenges, and maintaining the integrity of this connection is important in preserving peri-implant tissue health. Implant design features, such as the nature of the connection between the implant and the abutment, as well as the surface characteristics of the abutment and implants, may influence the maintenance of the integrity of soft tissue around implants. Iatrogenic factors, such as incorrect seating of the abutment and/or the restoration, and the presence of residual subgingival cement, will lead to loss of soft-tissue integrity and hence predispose to peri-implant disease.

Influence of supracrestal tissue attachment thickness on radiographic bone level around dental implants: A systematic review and meta‐analysis

“…This could be due to the internally relocated implant‐abutment junction, which limits peri‐implant bone loss by moving bacteria and inflammatory cells away from the adjacent crestal bone . It is important to emphasize that the characteristics of the implant design, the nature of the connection between the implant and the abutment, as well as the characteristics of the abutment and the implant surface, can influence the maintenance of soft tissue integrity around the implants …”

“…7 It is important to emphasize that the characteristics of the implant design, the nature of the connection between the implant and the abutment, as well as the characteristics of the abutment and the implant surface, can influence the maintenance of soft tissue integrity around the implants. 8 The term "biological width" was introduced by Gargulio et al in 1961. 9 Several authors have verified that biological width also exists around implants.…”

Surrounding Tissue Response to Surface-Treated Zirconia Implants

“…For example, Buser et al [56] reported that collagen fibers in soft tissue were oriented parallel to the implant although a direct soft-tissue contact has been observed to smoothly polished sandblasted titanium surfaces. It is thought that the difference in the orientation of collagen fibers is one of the causes of peri-implantitis [57].…”

Formation and regeneration of a Wnt‐responsive junctional epithelium

“…Clearly, a new peri-implant epithelium (PIE) forms around a dental implant, but we hypothesize that it is not functionally equivalent to the native JE. Published data (and also reviewed in Atsuta et al, 2005;Ivanovski & Lee, 2018) claim that the PIE shares structural, ultrastructural, and functional characteristics with the JE, but obvious differences such as the morphology (Heyman et al, 2018) and mitotic activity (Fujiseki et al, 2003) are demonstrated to exist between PIE and JE. Another difference is the pattern and onset of Laminin 5 expression following implant placement, which was both delayed and inconsistent within the PIE (Atsuta et al, 2005).…”