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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 15-16

Wound healing around dental implants – A review of literature


1 Postgraduate Student, ACPM Dental College, Dhule, Maharashtra, India
2 Professor and HOD, Department of Prosthodontics, ACPM Dental College, Dhule, Maharashtra, India
3 Professor, Department of Prosthodontics, ACPM Dental College, Dhule, Maharashtra, India
4 Reader, Department of Prosthodontics, ACPM Dental College, Dhule, Maharashtra, India

Date of Submission14-Oct-2020
Date of Acceptance17-Nov-2020
Date of Web Publication29-Jan-2021

Correspondence Address:
Dr. Bhagyashri Bachate
ACPM Dental College, Dhule, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmo.ijmo_6_20

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  Abstract 


The early stage of dental peri-implant wound healing is very important and involves the body's initial response to a foreign material: protein adsorption, platelet activation, coagulation, and inflammation. This results in the formation of a stable fibrin clot that is a depot for growth factors and allows for osteoconduction. Dental implants are believed to be critical in developing biologic design criteria for implant surfaces. This review article shows that treatment outcomes in dental implantology will be critically dependent on proper wound healing.

Keywords: Dental implant, endosseous implants, prosthodontics, wound healing


How to cite this article:
Bachate B, Mahesh A G, Suresh M N, Dodamani G, Sunil R, Hemant G, Khan Rafat A H. Wound healing around dental implants – A review of literature. Int J Med Oral Res 2020;5:15-6

How to cite this URL:
Bachate B, Mahesh A G, Suresh M N, Dodamani G, Sunil R, Hemant G, Khan Rafat A H. Wound healing around dental implants – A review of literature. Int J Med Oral Res [serial online] 2020 [cited 2021 Mar 7];5:15-6. Available from: http://www.ijmorweb.com/text.asp?2020/5/2/15/308278




  Introduction Top


Dental implant fixtures have become an integral part of treatment for partially or fully edentulous patients since Branemark introduced the two-stage treatment protocol.[1] Long-term bone healing/adaptation after a dental implant treatment starts with diffusion of mesenchymal stem cells to the wounded region and their subsequent differentiation. The healing phase is followed by the bone-remodeling phase.


  Peri-Implant Bone Healing Top


Peri-implant bone healing, which results in contact osteogenesis (bone growth on the implant surface), can be phenomenologically subdivided into three distinct phases that can be addressed experimentally. The first, osteoconduction, relies on the migration of differentiating osteogenic cells to the implant surface, through a temporary connective tissue scaffold.[1],[2],[3] Anchorage of this scaffold to the implant surface is a function of implant surface design. The second, de novo bone formation, results in a mineralized interfacial matrix, equivalent to that seen in cement lines in natural bone tissue, being laid down on the implant surface. Implant surface topography will determine if the interfacial bone formed is bonded to the implant. A third tissue response, that of bone remodeling, will also, at discrete sites, create a bone–implant interface comprising de novo bone formation. In general, mechanical loading is in favor of the formation of high-density bone during remodeling, but it is in favor of development of soft tissue during bone healing. The bone healing and remodeling theories, both of which are rooted in empirical observation, lead to this outcome. This work demonstrates the interplay between healing, remodeling, and loading levels and shows that the point in time where bone quality is measured has a major role in the evaluation of the peri-implant osseointegration.[4],[5] This observation perhaps sheds light onto the seemingly contradictory results obtained in clinical and experimental studies involving animals.


  Stability of a Dental Implant Depends on Effective Wound Healing Top


Osseointegration is regarded as a fundamental criterion for long-term success of endosseous dental implants.[1],[2] It is based on the establishment of a primary mechanical stability and subsequent biological fixation.[3] Numerous factors may influence the rate of osseointegration and among them, the original bone architecture/density and the surface topography are likely to play a major role.[4],[5] Bone healing around dental implants is considered a pathway similar to that occurring after injury, based on the following successive phases: inflammation and necrosis, blood clotting organization and replacement, chemotaxis of pluripotential mesenchymal cells into the peri-implant site and adhesion on implant surface, neoangiogenesis, as well as differentiation of these cells into osteoclasts and osteoblasts which collaborate within temporary anatomic structures, named basic multicellular units, by coupling bone resorption and new formation, thus leading to regeneration and remodeling.[6] It is well known that surface topography plays a role from the very beginning of these events; in particular, smooth surfaces integrate through appositional bone growth, whereas microrough surfaces may show bone growth directly to the implant surface, according to a “contact osteogenesis” pattern.[6],[7] Although much data have been published to date and despite the frequent clinical use of osseointegrated titanium implants, failures still occur, in many cases at early stages after insertion and apparently not related to surgical technique.[7] This decreased clinical predictability indicates that the bone healing around a titanium implant is a complex biological process not yet fully understood and underlines the necessity to clarify the initial responses of the surrounding tissue to implant surface. The primary stability of the implant depends also on the insertion torque (IT) and the extent of initial bone to implant contact (BIC). High IT is expected to result in less implant micromotion. It is important to realize that for a given mastication force on an implant, there will be varying ranges of implant micromotion from patient to patient depending on the quality of the surrounding bone and the initial BIC.[5],[6],[7] This work showed that for the largest micromotion value during healing (zmax = 20 μm), octahedral shear strain values of 3.75% and higher cause soft-tissue formation along the vertical sides of the healing gap, whereas in the coronal region of the gap and under the implant, the combination of high shear strain (3.75% and higher) and high fluid velocity (3 μm/s and higher) is the reason for soft-tissue development. The fastest fluid velocity is observed under the implant with values exceeding 9 μm/s. Simulation of the entire treatment duration by using the existing bone healing and remodeling models in a sequential manner explains the apparent inconsistencies reported in clinical studies and helps demonstrate how interrelated and complex this treatment modality can be.[8],[9] In particular, it is seen that reaching a bone mass distribution that appears favorable at the end of a 3- or 4-week-long healing period may not be an indicator of the long-term bone maintenance. The entire healing and remodeling process should be considered to this end. On the other hand, as expected, this work confirms that a healing period that results in low quality/quantity is not indicative of the long-term failure of the treatment. Success and survival of an implant do, however, not depend solely on osseointegration. A soft tissue, which surrounds the transmucosal part of a dental implant, separates the peri-implant bone from the oral cavity. This soft-tissue collar is called “peri-implant mucosa.” Thus, the soft-tissue seal around implants ensures healthy conditions and stable osseointegration and therefore also the long-term survival of an implant. The wound-healing phase may occur following the closure of a mucoperiosteal flap around the neck portion of an implant placed in a so-called one-stage procedure or after a second surgical intervention for abutment connections to an already-installed dental implant (two-stage procedure).[10] Because wound healing occurs in the presence of a biomaterial (i.e., a foreign body) at a critical region, interference of wound-healing events with this biomaterial and adaptation of the soft tissue to this biomaterial have to be taken into consideration. The aim of this part was to review the anatomy and histology of the soft-tissue seal around transmucosal biomaterials used to replace missing teeth and to summarize its morphogenesis during wound healing.


  Summary and Conclusion Top


There are still many aspects of peri-implant healing that need to be elucidated, but we can now state that the healing patterns in cortical and trabecular bone are different and reflect the evolved form and function of this exquisite tissue. Nevertheless, it can be concluded that treatment outcomes employing endosseous implants are critically dependent on implant surface designs that optimize the biological responses of early endosseous peri-implant healing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest



 
  References Top

1.
Brånemark PI, Adell R, Breine U, Hansson BO, Lindström J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 1969;3:81-100.  Back to cited text no. 1
    
2.
Brunski JB. In vivo bone response to biomechanical loading at the bone/dental-implant interface. Adv Dent Res 1999;13:99-119.  Back to cited text no. 2
    
3.
Brunski JB. Biomechanical factors affecting the bone-dental implant interface. Clin Mater 1992;10:153-201.  Back to cited text no. 3
    
4.
Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. Eur J Oral Sci 1998;106:527-51.  Back to cited text no. 4
    
5.
Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. Eur J Oral Sci 1998;106:721-64.  Back to cited text no. 5
    
6.
Chrcanovic BR, Albrektsson T, Wennerberg A. Reasons for failures of oral implants. J Oral Rehabil 2014;41:443-76.  Back to cited text no. 6
    
7.
Raghavendra S, Wood MC, Taylor TD. Early wound healing around endosseous implants: A review of the literature. Int J Oral Maxillofac Implants 2005;20:425-31.  Back to cited text no. 7
    
8.
Atsumi M, Park SH, Wang HL. Methods used to assess implant stability: Current status. Int J Oral Maxillofac Implants 2007;22:743-54.  Back to cited text no. 8
    
9.
Lekholm U, Zarb GA. Patient selection and preparation. In: Brånemark PI, Zarb GA, Albrektsson T, editors. Tissue Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago, IL: Quintessence Publishing; 1985: p. 199-209.  Back to cited text no. 9
    
10.
Morgan MJ, James DF, Pilliar RM. Fractures of the fixture component of an osseointegrated implant. Int J Oral Maxillofac Implants 1993;8:409-14.  Back to cited text no. 10
    




 

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