Wound healing around dental implants

Abstract

Dental implants have become a part of routine dentistry. Bone healing around modern implants follows established sequence of events and results in predictable osseointegration. Bone formation can be seen as early as four days after implant placement. In a healing bone wound, fibroblast‐like osteogenic progenitor cells differentiate into osteoblasts and start to deposit woven bone that gradually grows towards the implant surface. During 1–3 months of healing, this woven bone is replaced by lamellar bone with increasing bone to implant contact that allows functional loading of the implant. As a clinical application, RFA has suggested that implant stability is initially decreased up to three weeks due to bone remodeling and followed by an increase to the baseline at 4–5 weeks and then reaching plateau in 8 weeks. Regardless of this remodeling, studies have shown that implants can be successfully loaded immediately after placement although with somewhat reduced survival rates. Development of new implant surfaces has played a critical role in expanding these clinical loading protocols.Soft tissue healing around implants has become a focus of attention because it plays a central role in esthetic outcomes. Healing of the peri‐implant soft tissue occurs similarly to that against of a tooth after surgical procedure. Fibrin clot serves as a provisional matrix allowing epithelial and fibroblast migration towards the implant surface. Epithelial and connective tissue contact to the implant or abutment surface is established within 1–2 weeks and further maturation follows up to at least 12 weeks. In the established interphase, the peri‐implant epithelium is similar but longer than the junctional epithelium against the tooth. Orientation of collagen fiber bundles also differs from natural tooth. Instead of attaching to the neck of the implant, collagen fibers run parallel and circumferentially around the implant. Future studies are needed to develop better implant designs and surfaces that improve the soft tissue healing for more predictable esthetical outcomes.