Peri-implant soft tissue integration in humans – influence of materials: A study protocol for a randomised controlled trial and a pilot study results

Abstract

Background Recently, there has been a growing interest in mucointegration as the formation of an early and long-standing soft tissue barrier seems essential for both the initial healing and long-term implant survival. Aim To develop an experimental method to characterize the mucointegration of different transgingival materials (titanium (Ti), polyetheretherketone (PEEK), polymethylmethacrylate (PMMA), zirconia (Zi), polymer infiltrated ceramic network (PICN), cobalt-chrome (Co–Cr), and lithium disilicate (LD)) in a human model. Methods The study is designed as a multi-part randomized controlled clinical trial. Ninety bone level Straumann implants will randomly receive an experimental, custom-made abutment to allow for the removal of the abutment together with the surrounding soft tissues using a punch biopsy device at 8 weeks of healing (10 per material). The specimens will be further processed for non‐decalcified histology, followed by histomorphometric analysis. The same protocol will be used for additional 90 implants-abutments, but during harvesting, soft tissues will be separated from the abutment and processed for immunohistochemistry in order to study tissue inflammation and vascularization, while the abutments will undergo SEM analysis. Additionally, in vitro analyses, including SEM and profilometry, will be performed in order to characterize surface topography of all experimental materials. Conclusion The limited number of pilot samples presented herein indicate that the use of custom-made abutments in humans is a reproducible method to study peri-implant soft tissue integration. This further intensifies the rationale to compare different abutment materials, used as transgingival components in daily practice, under the same conditions.

Soft tissue response to different abutment materials: A controlled and randomized human study using an experimental model

“…The amount of human histological studies that directly assess and compare the soft tissue interactions with experimental abutment materials is sparse, whereas scientific research in that field is urgently needed to improve the understanding of soft tissue integration of implant abutments for long‐term implant success. Just recently, the group of Bacevic et al published a first pilot study that compared multiple experimental abutment materials regarding soft tissue integration and additional outcomes at the histological level (Borie et al, 2020). In their pilot study, a tissue punch was used for paramarginal mucosal excision around experimental abutments.…”

“…Even though several controlled trials report histological data on the soft tissue interactions of the most commonly used materials like titanium vs. zirconia (Arvidson et al, 1996; van Brakel et al, 2012; Degidi et al, 2006; Sampatanukul et al, 2018; Schwarz et al, 2013), the amount of studies comparing novel abutment materials is not satisfactory. To date, for example, there is only one pilot study in humans, in which a study protocol for the controlled and randomized histological comparison of multiple abutment materials is introduced—including non‐standard materials like PEEK (Borie et al, 2020).…”

Nonthermal Plasma Brush Treatment on Titanium and Zirconia To Improve Periabutment Epithelium Formation

“…The normal and health epithelium was remodeled with little signs of inflammation facing the Ti and ZrO 2 abutment surfaces. 36,37 The dimension and composition of PIE tissue were similar in implant abutments made of Ti and ZrO 2 . 8 The active epithelial attachment to the materials was observed with high expression of laminin-332 in both Ti and ZrO 2 .…”

PEEK for Oral Applications: Recent Advances in Mechanical and Adhesive Properties

“…However, PEEK abutments may be suitable for temporary restorations in patients without parafunction, especially in anterior tooth defects [ 31 ]. Apart from this, a custom PEEK healing abutment required fewer restorative steps to create the desired gingival emergency contour during the surgical phase than using a standard healing cap [ 7 , 60 ]. The PEEK custom healing abutment can be adjusted to fit the implant site by adding or reducing the contour intraorally [ 61 ].…”