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Mustakim KR, Eo MY, Seo MH, Yang HC, Kim MK, Myoung H, Kim SM. Ultrastructural and immunohistochemical evaluation of hyperplastic soft tissues surrounding dental implants in fibular jaws. Sci Rep 2024; 14:10717. [PMID: 38730018 PMCID: PMC11087521 DOI: 10.1038/s41598-024-60474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
In reconstructive surgery, complications post-fibula free flap (FFF) reconstruction, notably peri-implant hyperplasia, are significant yet understudied. This study analyzed peri-implant hyperplastic tissue surrounding FFF, alongside peri-implantitis and foreign body granulation (FBG) tissues from patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Using light microscopy, pseudoepitheliomatous hyperplasia, anucleate and pyknotic prickle cells, and excessive collagen deposition were observed in FFF hyperplastic tissue. Ultrastructural analyses revealed abnormal structures, including hemidesmosome dilation, bacterial invasion, and endoplasmic reticulum (ER) swelling. In immunohistochemical analysis, unfolded protein-response markers ATF6, PERK, XBP1, inflammatory marker NFκB, necroptosis marker MLKL, apoptosis marker GADD153, autophagy marker LC3, epithelial-mesenchymal transition, and angiogenesis markers were expressed variably in hyperplastic tissue surrounding FFF implants, peri-implantitis, and FBG tissues. NFκB expression was higher in peri-implantitis and FBG tissues compared to hyperplastic tissue surrounding FFF implants. PERK expression exceeded XBP1 significantly in FFF hyperplastic tissue, while expression levels of PERK, XBP1, and ATF6 were not significantly different in peri-implantitis and FBG tissues. These findings provide valuable insights into the interconnected roles of ER stress, necroptosis, apoptosis, and angiogenesis in the pathogenesis of oral pathologies, offering a foundation for innovative strategies in dental implant rehabilitation management and prevention.
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Affiliation(s)
- Kezia Rachellea Mustakim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Mi Hyun Seo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyeong-Cheol Yang
- Department of Dental Biomaterials Science, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Keun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Oral and Maxillofacial Microvascular Reconstruction LAB, Brong Ahafo Regional Hospital, P.O.Box 27, Sunyani, Ghana.
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Galarraga‐Vinueza ME, Tavelli L. Soft tissue features of peri‐implant diseases and related treatment. Clin Implant Dent Relat Res 2022. [PMID: 36444772 DOI: 10.1111/cid.13156] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic. PURPOSE The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites. MATERIALS AND METHODS This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies. RESULTS Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail. CONCLUSIONS Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.
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Affiliation(s)
- Maria Elisa Galarraga‐Vinueza
- Department of Prosthodontics Tufts University School of Dental Medicine Boston Massachusetts USA
- School of Dentistry Universidad de las Américas (UDLA) Quito Ecuador
| | - Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology Harvard School of Dental Medicine Boston Massachusetts USA
- Center for Clinical Research and Evidence Synthesis in Oral TissuE RegeneratION (CRITERION) Boston Massachusetts USA
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor Michigan USA
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Shafizadeh M, Amid R, Mahmoum M, Kadkhodazadeh M. Histopathological characterization of peri-implant diseases: A systematic review and meta-analysis. Arch Oral Biol 2021; 132:105288. [PMID: 34688133 DOI: 10.1016/j.archoralbio.2021.105288] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To conduct a systematic review of the inflammatory elements in peri-implantitis (PI) and peri-implant mucositis (PM) in comparison with healthy peri-implant tissues (HI) and periodontal disease. DESIGN The PubMed, Embase, Web of Science, and Scopus databases were searched up to December 2020. English articles that evaluated human soft tissue biopsies of PI or PM were included. Values reported for the surface area of the infiltrated connective tissue (ICT) were pooled using the random-effect model meta-analysis to estimate the mean (95% CI). RESULTS A total of 33 articles were included. Of 30 studies on PI, the majority evidenced significantly increased vascularization and inflammatory cell counts dominated by plasma cells in PI compared with HI. Studies that compared PI with chronic periodontitis primarily reported more severe inflammatory infiltrates in PI. This was confirmed by the meta-analysis results since the surface area of the ICT was significantly larger in PI (p < 0.001). Only seven studies analyzed the PM lesions and reported increased inflammatory infiltrates and vascularization in PM compared with HI. Based on the meta-analysis results, the surface area of the ICT was 3.00 [1.50, 4.51] mm 2 in PI and 0.23 [0.02, 0.44] mm 2 in PM lesions. Based on the available evidence, presence of foreign body particles considerably increased the inflammatory infiltrate; however, smoking did not have a significant effect. CONCLUSIONS There was controversy regarding the prevalence of various inflammatory cell types in peri-implant diseases; however, a considerably high ICT surface area in PI indicates the aggressive nature of the disease.
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Affiliation(s)
- Marziyeh Shafizadeh
- Periodontics Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran; Dental Research Centre, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Reza Amid
- Periodontics Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Masoumeh Mahmoum
- Periodontics Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Mahdi Kadkhodazadeh
- Periodontics Department, School of Dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran; Dental Research Centre, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran.
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Galárraga-Vinueza ME, Tangl S, Bianchini M, Magini R, Obreja K, Gruber R, Schwarz F. Histological characteristics of advanced peri-implantitis bone defects in humans. Int J Implant Dent 2020; 6:12. [PMID: 32211972 PMCID: PMC7093613 DOI: 10.1186/s40729-020-00208-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Inflammatory osteolysis is the clinical hallmark of peri-implantitis. The morphology of the remaining peri-implant bone and the level of osseointegration, however, remain unknown. Our aim was to characterize advanced peri-implantitis bone defects in humans. METHODS Four patients (3 female and 1 male) were diagnosed with peri-implantitis. A total of 5 implants with machined surfaces and a mean loading time of 12 ± 6 years were removed due to advanced bone loss. The defect extension, the peri-implant bone density (bone area per tissue area in percentage), bone-to-implant contact (%), and the number of filled and empty osteocyte lacunae were calculated based on undecalcified histological specimens. RESULTS The defect extension was on average 4.2 mm (95% CI 0.8-3.4). Remaining peri-implant bone showed a high density of 85.5% (95% CI 79.1-91.3) and covered in total 74% (95% CI 70.5-77.5) of the implant surface. Filled and empty osteocyte lacunae density was on average 191 and 165/mm2 (95% CI 132-251; 103-225), respectively. Histology further revealed signs of ongoing bone formation and resorption. CONCLUSION There are signs that suggest that once the original cortical bone is lost due to peri-implantitis, the remaining apical trabecular bone is reinforced and transformed into cortical bone that might take over the functional load.
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Affiliation(s)
- Maria Elisa Galárraga-Vinueza
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Stefan Tangl
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Marco Bianchini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ricardo Magini
- Post-Graduate Program in Implant Dentistry (PPGO), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
| | - Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Sensengasse 2a, Vienna, Austria.
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Carolinum, Goethe University, Frankfurt, Germany
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Analysis of CD15, CD57 and HIF-1α in biopsies of patients with peri-implantitis. Pathol Res Pract 2017; 213:1097-1101. [PMID: 28778496 DOI: 10.1016/j.prp.2017.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/24/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022]
Abstract
Peri-implantitis is an infectious disease characterized by inflammation of the tissues surrounding the implant, bleeding on probing with or without suppuration, and bone loss. Peri-implant lesions contain a leukocyte infiltrate of plasma cells, lymphocytes, macrophages and neutrophils. A survey of the literature did not show any studies reporting an association between hypoxia and peri-implantitis. The aim of the present cross-sectional study was to evaluate histological changes and immunostaining for CD15, CD57 and HIF-1α in the peri-implant mucosa of patients with and without peri-implantitis. Mucosal biopsies were obtained from 18 patients with peri-implantitis and 10 control subjects without peri-implantitis at a private health care center between 2010 and 2012. The sections were fixed in 10% buffered formalin, processed and embedded in paraffin for histopathological and immunohistochemical study. Acanthosis, spongiosis and exocytosis were observed in both groups, with no significant difference between them. The peri-implantitis group showed increased immunostaining for CD15, a neutrophil marker, and HIF-1α, a tissue hypoxia marker, but no significant difference in immunostaining for CD57, a Natural Killer cell marker. The increase in neutrophil (CD15) and hypoxia (HIF-1α) markers in patients with peri-implantitis suggests an active participation of neutrophils and hypoxia in the pathogenesis of this disease. Since the present study was the first to evaluate the expression of CD15, CD57 and HIF-1α in peri-implant tissues, further studies should be performed to better understand the role of these molecules in peri-implantitis.
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Wilson TG, Valderrama P, Burbano M, Blansett J, Levine R, Kessler H, Rodrigues DC. Foreign bodies associated with peri-implantitis human biopsies. J Periodontol 2016; 86:9-15. [PMID: 25224174 DOI: 10.1902/jop.2014.140363] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis. METHODS Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer. RESULTS At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells. CONCLUSIONS At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.
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Pais ES, Slavescu D. Degenerative and regenerative morphological aspects in peri-implantitis. Ultrastruct Pathol 2016; 40:171-5. [PMID: 26986184 DOI: 10.3109/01913123.2016.1154632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this study was to describe the tissues surrounding two early failed dental implants morphologically and ultrastructurally. In the first case, the implant's surface was analyzed by scanning electron microscopy (SEM) using an environmental scanning electron microscope and the surrounding tissues were analyzed by light microscopy (LM) and transmission electron microscopy. In the second case we used only LM. By SEM analysis, very thin connective tissue was seen at the implant's apex; in the middle part, highly vascularized connective tissue and poorly mineralized areas were found, and there were fewer mineralized areas at the implant's base. Histologically and ultrastructurally, we identified a heterogeneous cellular population including fibroblast-like cells and osteoblasts with abundant amorphous extracellular matrix, as well as a number of inflammatory cells, predominantly neutrophils. In a small area around the implant, microorganisms classified as Actinomyces were identified. In this case, degenerative aspects were predominantly caused by infection. In the second case, our observations focused on recruitment of mesenchymal stem cells, their proliferation and differentiation into epithelial cells with keratinocyte phenotype, and formation of de novo capillaries from mesenchymal progenitors of endothelial cells. These regenerative events were accompanied by multiple areas of mineralization, culminating in bone formation around the implant. Correlative microscopic observations are necessary to conduct in future studies, in various clinical conditions and post-operative stages, to better define the cellular events involved in healing and osseointegration; our observations clearly depict significant regenerative aspects despite the degenerative ones.
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Affiliation(s)
- Emil S Pais
- a Cedars-Sinai Medical Center , Los Angeles , CA , USA
| | - Dragos Slavescu
- b Plastic Surgery and Reconstructive Microsurgery Clinic, Clinical Emergency Hospital Bucharest , Bucharest , Romania
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de Araújo MF, Filho AFL, da Silva GP, de Melo MLR, Napimoga MH, Rodrigues DBR, Alves PM, de Lima Pereira SA. Evaluation of peri-implant mucosa: clinical, histopathological and immunological aspects. Arch Oral Biol 2014; 59:470-8. [PMID: 24631629 DOI: 10.1016/j.archoralbio.2014.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/13/2013] [Accepted: 01/28/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim was to compare the inflammatory response in peri-implant mucosa between patients with peri-implantitis (PP-group) and patients with healthy peri-implant tissues (HP-group). MATERIALS AND METHODS Two fragments of peri-implant mucosa of 18 patients were collected and serial sections were performed for histological and immunohistochemical analysis. RESULTS When compared with HP-group, PP-group showed higher immunostained cell density for TGF-β, IL-17 and CD31, beyond greater density of red cells, leukocytes, mast cells chymase (MCC) and mast cell tryptase (MCT). HP-group patients showed higher IL-13 expression and increased amount of collagen fibres when compared with PP-group. In PP-group there was significant positive correlation between MCT density and density of blood vessels immunostained, and between MCC density and density of blood vessels immunostained. There was significant negative correlation between the IL-17 density and collagen percentage. CONCLUSIONS This study demonstrated that in patients with peri-implantitis there was higher of TGF-β and IL-17, indicating that these cytokines are directly involved in the inflammatory process. Thus, understanding the influence of cytokines in the peri-implantitis installation, new therapies could be developed in order to inhibit the synthesis of IL-17 and induce synthesis of IL-13 in peri-implant tissue, contributing to increase the longevity of the implant.
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Affiliation(s)
| | | | | | | | - Marcelo Henrique Napimoga
- Laboratory of Immunology and Molecular Biology, São Leopoldo Mandic Institute and Research Center, Brazil
| | - Denise Bertulucci Rocha Rodrigues
- Laboratory of Biopathology and Molecular Biology, University of Uberaba (UNIUBE), Brazil; Cefores, Federal University of Triangulo Mineiro (UFTM), Brazil
| | | | - Sanivia Aparecida de Lima Pereira
- Laboratory of Biopathology and Molecular Biology, University of Uberaba (UNIUBE), Brazil; Cefores, Federal University of Triangulo Mineiro (UFTM), Brazil.
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Mouraret S, Hunter DJ, Bardet C, Popelut A, Brunski JB, Chaussain C, Bouchard P, Helms JA. Improving oral implant osseointegration in a murine model via Wnt signal amplification. J Clin Periodontol 2013; 41:172-80. [PMID: 24164629 DOI: 10.1111/jcpe.12187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2013] [Indexed: 11/28/2022]
Abstract
AIM To determine the key biological events occurring during implant failure and then we use this knowledge to develop new biology-based strategies that improve osseointegration. MATERIALS AND METHODS Wild-type and Axin2(LacZ/LacZ) adult male mice underwent oral implant placement, with and without primary stability. Peri-implant tissues were evaluated using histology, alkaline phosphatase (ALP) activity, tartrate resistant acid phosphatase (TRAP) activity and TUNEL staining. In addition, mineralization sites, collagenous matrix organization and the expression of bone markers in the peri-implant tissues were assessed. RESULTS Maxillary implants lacking primary stability show histological evidence of persistent fibrous encapsulation and mobility, which recapitulates the clinical problems of implant failure. Despite histological and molecular evidence of fibrous encapsulation, osteoblasts in the gap interface exhibit robust ALP activity. This mineralization activity is counteracted by osteoclast activity that resorbs any new bony matrix and consequently, the fibrous encapsulation remains. Using a genetic mouse model, we show that implants lacking primary stability undergo osseointegration, provided that Wnt signalling is amplified. CONCLUSIONS In a mouse model of oral implant failure caused by a lack of primary stability, we find evidence of active mineralization. This mineralization, however, is outpaced by robust bone resorption, which culminates in persistent fibrous encapsulation of the implant. Fibrous encapsulation can be prevented and osseointegration assured if Wnt signalling is elevated at the time of implant placement.
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Affiliation(s)
- Sylvain Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA; Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis, Diderot University, U.F.R. of Odontology, Paris, France
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