Title Differential Attachment Mechanisms Of Oral Mucosa Onto Titanium Implants May Increase Susceptibility to Peri-Implantitis
Clinical Question In dental implant patients (P), do the different attachment mechanisms of oral mucosa onto titanium implants (I) versus teeth (C) alter the risk of peri-implant inflammation (O)?
Clinical Bottom Line The attachment mechanisms of oral mucosa onto titanium implants are structurally different when histologically compared to natural teeth as it is evident in a comparative study with a human model and a comparative study with an animal model. The outcome that it increased the inflammation is only a conjecture by the authors of these articles and not directly proven in vivo.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25261052Carcuac/2014 40 patients with generalized severe chronic periodontitis and 40 patients with severe peri-implantitisComparative Study
Key resultsWhen evaluating cellular characteristics of human periodontitis versus peri-implantitis lesions, the surface area of the infiltrated connective tissue in peri-implantitis lesions was more than twice the size of the periodontitis lesions (3.48 ± 2.54 mm2 vs. 1.49 ± 1.05 mm2).
26804139Takamori /201725 ratsComparative Study/Animal Model
Key resultsIn this animal model, the collagen fibers depicted irregular orientation along the surface of the implant. The author proposed that the few collagen fibers around the implant might permit greater penetrability to antigens in comparison to natural tooth fiber orientation. As a result, this will increase the inflammatory process in peri-implant tissue.
Evidence Search ("peri-implantitis"[MeSH Terms] OR "peri-implantitis"[All Fields] OR ("peri"[All Fields] AND "implantitis"[All Fields]) OR "peri implantitis"[All Fields]) AND ("attachment "[MeSH Terms] OR " attachment "[All Fields])
Comments on
The Evidence
Validity: Carcuac/2014 compared two groups of patients. One group had severe chronic periodontitis while the other group also had severe periodontitis along with the presence of one or more dental implants. Diseased tooth/implant sites were identified in both groups and a biopsy was done followed by a histological analysis. Takamori/2017 divided 25 rats into five groups and then extracted the maxillary right first molar and an implant was placed, while the maxillary left first molar was left untreated. The immunized group comprised rats that had received intraperitoneal lipopolysaccharide, while the nonimmunized group received only saline. Histopathological examination was done with staining, and formation of immune complexes was evaluated. Perspective: The mechanism by which peri-implant mucosa attaches to titanium implants has been compared and contrasted to the way periodontium attaches to natural teeth. Although there are several documented similarities between the two mechanisms, there are a number of structural dissimilarities that may in turn lead to critical differences in the way peri-implant mucosa can maintain a proper attachment and barrier integrity around titanium implants. These differences need to be further investigated on a cellular level to rule out any effect it may have on increasing the chance of peri-implantitis.
Applicability Clinicians should be more aware of the attachment configuration difference between an implant and its surrounding tissue. As it is theorized to be due to lack of organization and similarity to a natural tooth, peri-implant tissue is more susceptible to inflammation. Researchers should investigate more into the difference and tissue composition differences between a peri-implant and a periodontal lesion.
Specialty (Oral Surgery) (Periodontics)
Keywords peri-implantitis, attachment, periodontal, implant
ID# 3450
Date of submission 11/25/2020
E-mail althunayan@uthscsa.edu
Author Mashael Al Thunayan
Co-author(s) Hali Hall
Co-author(s) e-mail hallh1@livemail.uthscsa.edu
Faculty mentor Georgios Kotsakis, DDS, MS
Faculty mentor e-mail kotsakis@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available