1
|
Aellos F, Grauer JA, Harder KG, Dworan JS, Fabbri G, Cuevas PL, Yuan X, Liu B, Brunski JB, Helms JA. Dynamic analyses of a soft tissue-implant interface: Biological responses to immediate versus delayed dental implants. J Clin Periodontol 2024; 51:806-817. [PMID: 38708491 DOI: 10.1111/jcpe.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/16/2024] [Accepted: 03/10/2024] [Indexed: 05/07/2024]
Abstract
AIM To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around 'immediate' and 'delayed' implants. MATERIALS AND METHODS Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri-implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control. RESULTS No differences were observed in the rate of soft-tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft-tissue integration indicated an initially disorganized peri-implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri-implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri-implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction. CONCLUSIONS Within the timeframe examined, quantitative analyses showed that connective tissue maturation never reached that observed around teeth. Hemidesmosomal attachment protein expression levels were also significantly reduced compared to those in an intact JE, although quantitative analyses indicated that macrophage density in the peri-implant environment was reduced over time, suggesting an improvement in PIE barrier functions. Perhaps most unexpectedly, maturation of the peri-implant soft tissues was a significantly slower process than osseointegration.
Collapse
Affiliation(s)
- Fabiana Aellos
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph A Grauer
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
- Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kasidy G Harder
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julia S Dworan
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
- Department of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Giacomo Fabbri
- Private Practice, Ban Mancini Fabbri Dental Clinic, Cattolica, Italy
| | - Pedro L Cuevas
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Xue Yuan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Bo Liu
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - John B Brunski
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Jill A Helms
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Lim HC, Strauss FJ, Shin SI, Jung RE, Jung UW, Thoma DS. Augmentation of keratinized tissue using autogenous soft-tissue grafts and collagen-based soft-tissue substitutes at teeth and dental implants: Histological findings in a pilot pre-clinical study. J Clin Periodontol 2024; 51:665-677. [PMID: 38268024 DOI: 10.1111/jcpe.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
AIM To histomorphometrically assess three treatment modalities for gaining keratinized tissue (KT) at teeth and at dental implants. MATERIALS AND METHODS In five dogs, the distal roots of the mandibular second, third and fourth premolars were extracted. Dental implants were placed at the distal root areas 2 months later. After another 2 months, KT augmentation was performed at both distal (implants) and at mesial root (teeth) areas in the presence (wKT groups) or absence (w/oKT groups) of a KT band at the mucosal/gingival level. Three treatment modalities were applied randomly: apically positioned flap only (APF), free gingival grafts (FGGs) and xenogeneic collagen matrices (XCMs). A combination of the above produced six groups. Two months later, tissue sections were harvested and analysed histomorphometrically. RESULTS The median KT height and length were greatest at implants with FGG in both wKT (3.7 and 5.1 mm, respectively) and w/oKT groups (3.7 and 4.6 mm), and at teeth with FGG in wKT groups (3.7 and 6.1 mm) and with APF in the w/oKT groups (3.9 and 4.4 mm). The XCM and APF produced more favourable results at teeth than at implants. CONCLUSIONS FGG was advantageous in gaining KT, especially at implants.
Collapse
Affiliation(s)
- Hyun-Chang Lim
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Department of Periodontology, Kyung Hee University, College of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Franz J Strauss
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
- Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile
| | - Seung-Il Shin
- Department of Periodontology, Kyung Hee University, College of Dentistry, Periodontal-Implant Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Ui-Won Jung
- Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Republic of Korea
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Asparuhova MB, Song X, Riedwyl D, van Geest G, Bosshardt DD, Sculean A. Differential molecular profiles and associated functionalities characterize connective tissue grafts obtained at different locations and depths in the human palate. Int J Oral Sci 2023; 15:57. [PMID: 38072943 PMCID: PMC10711016 DOI: 10.1038/s41368-023-00260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/18/2023] Open
Abstract
The present study aimed to assess the molecular profiles of subepithelial connective tissue grafts (CTGs) obtained at different locations and depths in the human palate. Sixty-four CTGs belonging to anterior deep (AD), anterior superficial (AS), posterior deep (PD), and posterior superficial (PS) groups were subjected to RNA-Sequencing and their transcriptomes were analyzed computationally. Functional correlations characterizing the CTG groups were validated by cell biological experiments using primary human palatal fibroblasts (HPFs) extracted from the CTGs. A clearly more pronounced location-dependent than depth-dependent difference between the grafts, with a minimal number of genes (4) showing no dependence on the location, was revealed. Epithelial, endothelial, and monocytic cell migration was strongly (P < 0.001) potentiated by AD- and PS-HPFs. Moreover, significantly increased expression of genes encoding C-C and C-X-C motif chemokine ligands as well as significantly (P < 0.01) activated p38 signaling suggested immunomodulatory phenotype for AD- and PS-HPFs. Increased growth factor gene expression and significantly activated (P < 0.001) Erk and Akt signaling in HPFs originating from A-CTGs implied their involvement in cell survival, proliferation, and motility. Prominent collagen-rich expression profile contributing to high mechanical stability, increased osteogenesis-related gene expression, and strongly activated (P < 0.001) Smad1/5/8 signaling characterized HPFs originating from P-CTGs. The present data indicate that in humans, differences between palatal CTGs harvested from different locations and depths appear to be location- rather than depth-dependent. Our findings provide the basis for future personalization of the therapeutic strategy by selecting an optimal graft type depending on the clinical indications.
Collapse
Affiliation(s)
- Maria B Asparuhova
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland.
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | - Xiaoqing Song
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dominic Riedwyl
- Laboratory of Oral Cell Biology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Geert van Geest
- Interfaculty Bioinformatics Unit, University of Bern, Bern, Switzerland
| | - Dieter D Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Lim HC, Kim CH, Yoon H, Lee S, Chung JH, Shin SY. Keratinized tissue augmentation using collagen-based soft tissue substitute with/without epidermal growth factor on buccally positioned implants: a pilot preclinical study. Clin Oral Investig 2023; 27:7899-7908. [PMID: 37989966 DOI: 10.1007/s00784-023-05382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To investigate the effect of epithelial growth factor (EGF) with collagen matrix (CM) on the gain of KT for buccally positioned implants in dogs. MATERIALS AND METHODS In five dogs, four implants were placed buccally with the whole part of KT excision on the buccal side (two implants per each hemi-mandible). After one month, KT augmentation was performed: 1) free gingival grafts (FGG), 2) collagen matrix (CM) only, 3) CM soaked with 1 μg/g of EGF, and 4) CM soaked with 10 μg/g of EGF (n = 5 in each group). The experimental animals were sacrificed three months post-KT augmentation. Clinical, histologic, and histomorphometric analyses were performed. RESULTS The clinical KT zone was the highest in group FGG (5.16 ± 1.63 mm). Histologically, all groups presented buccal bony dehiscence. Regarding newly formed KT, no specific difference was found among the groups, but robust rete pegs formation in some specimens in group FGG. Histomorphometric KT height (4.66 ± 1.81 mm) and length (5.56 ± 2.25 mm) were the highest in group FGG, whereas similar increases were noted in the rest. The buccal soft tissue thickness at the coronal part of the implant did not exceed 2 mm in all groups. CONCLUSION All groups presented increased KT zone, but FGG treatment was more favored. The addition of EGF to CM appeared not to enhance KT formation. CLINICAL RELEVANCE FGG treatment was more favorable to re-establish the KT zone than other treatment modalities.
Collapse
Affiliation(s)
- Hyun-Chang Lim
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea.
| | - Chang-Hoon Kim
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Heejun Yoon
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Sunmin Lee
- Department of Dentistry, Graduate School, Kyung Hee University, Seoul, Korea
| | - Jong-Hyuk Chung
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung-Yun Shin
- Department of Periodontology, Periodontal Implant Clinical Research Institute, Kyung Hee University College of Dentistry, Kyung Hee University Medical Center, Seoul, Korea
| |
Collapse
|
5
|
Gamal N, Shemais N, Al-Nawawy M, Ghallab NA. Post-extraction volumetric analysis of alveolar ridge contour using subepithelial connective tissue graft in esthetic zone: a randomized controlled clinical trial. Clin Oral Investig 2023; 27:6503-6512. [PMID: 37726486 PMCID: PMC10630239 DOI: 10.1007/s00784-023-05255-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES The aim of this randomized clinical trial was to assess the alveolar ridge contour after soft tissue augmentation using subepithelial connective tissue graft (SCTG) buccal to fresh extraction sockets in patients with thin buccal bone, versus minimally-traumatic extraction followed by spontaneous healing solely. MATERIALS AND METHODS Forty non-restorable maxillary teeth in the esthetic zone were randomly assigned into two groups: minimally-traumatic extraction with SCTG (test) and minimally-traumatic extraction followed by spontaneous healing (control). The outcomes assessed included linear volumetric change of buccal soft tissue contour, vertical tissue loss, gingival thickness (GT), and interdental papilla (IDP) height after 6 months. RESULTS The SCTG group showed a significant improvement (P < 0.001) in all outcomes after 6 months. The SCTG group showed a statistically significant (P < 0.001) gain in the buccal soft tissue volumetric change compared to the control group. The SCTG group showed a statistically significant increase in GT (P < 0.001) and IDP height (P < 0.05) after 6 months compared to the control group. CONCLUSIONS The use of SCTG buccal to extraction sockets in the anterior maxilla might be considered as a predictable approach for preserving the alveolar ridge contour. CLINICAL RELEVANCE SCTG buccal to extraction sockets might counteract post-extraction hard and soft tissue alterations in the esthetic zone.
Collapse
Affiliation(s)
- Nourhan Gamal
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt.
| | - Nesma Shemais
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Marwa Al-Nawawy
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt
| | - Noha A Ghallab
- Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Giza, Egypt
| |
Collapse
|