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VOLUME 2 , ISSUE 2 ( May-August, 2011 ) > List of Articles


The Peri-Implant Zone: A Review of Literature

Lanka Mahesh, Sangeeta Dhir

Citation Information : Mahesh L, Dhir S. The Peri-Implant Zone: A Review of Literature. Int J Oral Implantol Clin Res 2011; 2 (2):61-66.

DOI: 10.5005/jp-journals-10012-1037

License: CC BY-ND 4.0

Published Online: 01-04-2015

Copyright Statement:  Copyright © 2011; The Author(s).


Aim: The peri-implant zone comprises of a stable crestal bone and overlying peri-implant mucosa. Soft tissue esthetics are not attributed to a single parameter. The aim of this article is to highlight the underlying biology of the soft and the hard tissue complex, the associated vital parameters, implant component characteristics which act as the foundation of a successfully osseointegrated implant. Materials and methods: An electronic Medline was conducted with the search words used as: peri-implant, interdental papilla, peri-implant esthetics. Hand search across the journals referring to implantology, periodontology and prosthodontics was also done. Conclusion: This article presents a comprehensive review of the various factors responsible in determining a successful soft tissue esthetic outcome in implantology.

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  1. Branemark PI, Adell R, Briene U. Intraosseous anchorage of dental prosthesis experimental studies. Scand J Plas Recont Surg 1969;3(2):81-100.
  2. Adell R, Lekholm U. A 15-year study of osseointegrated implants in the treatment of edentulous jaws. Int J Oral Surg 1981;10: 387-416.
  3. Naert I, et al. Biologic outcomes of the single implant restorations as tooth replacements: A long-term follow-up study. Clin Implant Dent Relat Res 2000;2:209-18.
  4. Naert I, et al. Biologic outcomes of the implant supported restorations in the treatment of the partial edentulism (Part 2): A longitudinal radiographic evalution. Clin Oral Implant Res 2002;13:390-95.
  5. Gotfredson K, Holm B. Implant supported mandibular overdentures retained with ball or bar attachments: A randomized prospective 5-year study. Int J Prosth 2000;13:125-30.
  6. Albrektsson T, Zarb G, Worthington P. The long-term efficacy of the currently used dental implants: A review and proposed criteria for success. Intl J Oral Maxillo Implants 1986;1:11-25.
  7. Lekholm U, Gunne J. Survival of the branemark implants in partially edentulous jaws: A 10-year prospective multicenter study. Int J Oral Maxillofac Implants 1999;14:639-45.
  8. Hanson HA, Albreketsson T. Structural aspects of the interface between tissue and titanium implants. The Journal of Prosthetic Dentistry 1983;50:108-13.
  9. Gould TR, Westbury L. Ultrastructural study of the attachment of the human gingiva to titanium in vivo. The Journal of Prosthetic Dentistry 1984;52:418-20.
  10. Glauser R, Schupbach P. Peri-implant soft tissue barrier at experimental one-piece mini-implant with different surface topography in humans: A light microscopic overview and histometric analysis. Clin Implant Reltd Res 2005;7:S44-51.
  11. Listgarten MA, Lai CH. Ultrastructure of the intact interface between an endosseous epoxy resin dental implant and host tissues. Journal de Biologie Buccale 1975;3:13-28.
  12. Swope EM, James RA. A longitudinal study on hemidesmosome formation at the dental implant tissue overflow. The Journal of Oral Implantology 1981;9:412-22.
  13. Chavrier CA, Couble ML. Ultrastructural and immunohistochemical study of the interstitial collagenous components of the healthy human keratinized mucosa surrounding implants. Intnl Journal of Oral and Maxillofac Implants 1999;14:108-12.
  14. Berglundh T, Lindhe J. Soft tissue barrier at implants and teeth. Clin Oral Impl Res 1991;2:81-90.
  15. Berglundh T, Lindhe J. The topography of the vascular system in the periodontal and peri-implant tissues. J Clin Perio 1994;21:189-93.
  16. Berglundh T, Lindhe J. Dimensions of the peri-implant mucosa. Biologic width revisited. J Clin Perioodntol 1996;23:971-73.
  17. Cochran DL, Hermann JS, Schenk RK. Biologic width around titanium implants: A histometric analysis of the implantogingival junction around loaded and unloaded implants. Journal of Periodontology 1997;68:186-98.
  18. Siar HC, Swaminathan D. Peri-implant soft tissue integration of immediately loaded implants—a histomorphometric study. J Periodontology 2003;74:571-80.
  19. Watzak G, Zechner W. Soft tissue around three different implant types after 1.5 years of loading without oral hygiene: A preliminary study. Clin Oral Implant Res 2006;17:229-36.
  20. Abrahamson I, Berglundh T. The peri-implant hard and soft tissue at different implant system: A comparative study in dogs. Clin Oral Implants Res 1996;7:212-19.
  21. Hermann JS, Buser D. Biologic width around one and two piece titanium implants: A histometric evaluation of unloaded nonsubmerged and submerged implants. Clin Oral Implant Res 2001;12:559-71.
  22. Weber HP, Buser D. Comparison of healed tissues adjacent to submerged and nonsubmerged unloaded titanium implants: A histometric study in dogs. Clin Oral Implants Res 1996;7: 11-19.
  23. Maynard JG, Wilson RD. Physiologic dimension of periodontium to the restorative dentist. J Periodontol 1979;50:170-74.
  24. Kan JY, Rungcharrassaeng K, Kois JC. Dimensions of periimplant mucosa—an evaluation of maxillary anterior single implants in humans. J Periodontol 2003;74:557-62.
  25. Spray JR, Black CG. The influence of bone thickness on facial marginal bone response: Stage 1 placement through stage 2 uncovering. Ann Periodontol 2000;5:119-28.
  26. Tarnow DP, Cho SC. The effect of interimplant distance on the height of interimplant distance on the height of interimplant bone crest. J Periodontol 2000;71:546-49.
  27. Tarnow DP, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal papilla. J Periodontol 1992;63:995-96.
  28. Cardaropoli G, Lekholm U. Tissue alterations at implant supported single tooth replacement : A 1 year prospective clinical study. Clin Oral Implant Res 2006;17:165-71.
  29. Abrahamson I, Cardaropoli G. Peri-implant hard and soft tissue integration to dental implants made of titanium and gold. Clin Oral Implant Res 2007;18:269-74.
  30. Rimondini L, Cerroni L, Carrassi A, Torricelli P. Bacterial colonization of zirconia ceramic surfaces: An in vitro and in vivo study. Int J Oral Maxillofac Implants. 2002;17:793-98.
  31. Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A. Bacterial adhesion on commercially pure titanium and zirconium oxide disks: An in vivo human study. J Periodontol 2004;75: 292-96.
  32. Kohal RJ, Weng D. Loaded custom made zirconia and titanium implants show similar osseointegration: An animal experiment. J Periodontol 2004;75:1262-68.
  33. Degidi, et al. Inflammatory infiltrate, microvessel density, nitric oxide synthase expression, vascular endothelial growth factor expression and proliferative activity in peri-implant soft tissue around titanium and zirconia healing caps. J Periodontol 2006;77:73-80.
  34. Vigolo P, Givani A. A 4-year prospective study to assess periimplant hard and soft tissue adjacent to titanium and gold alloy abutments in cemented single implant crowns. J Prosthodont 2006;15:250-56.
  35. Oh TJ, Yoon J, Wang HL. The causes of early implant bone loss: Myth or science? J Periodontol 2002;73:322-33.
  36. Jung YC, Han CH. A 1 year radiographic evaluation of marginal bone around dental implants. Int J Oral Maxillofac Implants 1996;11:811-18.
  37. Pecora G, Ronaldo C. Clinical evaluation of laser microtexturing for soft tissue and bone attachment to dental implants. Implant Dentistry 2009;18:57-66.
  38. Linkevicius T, Apse P, Grybauskas S, Puisys A. Effect of soft tissue thickness on crestal bone changes around implants: A 1- year prospective controlled randomized clinical study. Baltic Dental and Maxillofacial Journal 2007;4:S1:28.
  39. Tal H, Artzi Z. Spontaneous early exposure of submerged endosseous implants resulting in cresatl bone loss: A clinical evaluation between stage 1 and stage 2 surgery. Intl J of Oral Maxillofac Implants 2001;16:514-21.
  40. Van A, Collaert B, Quirynen M. Correlation between early perforation of cover screws and marginal bone loss: A retrospective study. J Clin Perioodntol 2008;35:76-79.
  41. Abrahamsson I, Berglundh T. The mucosal barrier following the abutment dis/reconnection: An experimental study in dogs. J Clin Perioodntol 1997;24:568-72.
  42. Albreketsson T, Isidor F. Consensus report of session 4. In Lang NP, Karring T (Eds). Proceedings of 1st European Workshop of Periodontology London Quintessence Publishing 1994; 365-69.
  43. Becker W, Becker BE, Newman MG. Clinical and microbiologic findings that may contribute to dental implant failure. Int J Oral Maxillofac Implants 1990;5:31-38.
  44. Lindquist LW, Rockler B, Carlsson GE. Bone resorption around fixtures in edentulous patients treated with mandibular fixed tissue integrated prosthesis. J Prosthet Dent 1988;59:59-63.
  45. Levignac J. Losteolyse periimplantaire, periimplantose, periimplantite. Rev Fr Odontostomatol 1965;12:1251-60.
  46. Rams TE, Link CC. Microbiology of the failing dental implants in humans: Electron microscopic observations. J Oral Implantol 1983;11:93-100.
  47. Mombelli A, Van Oosten MAC, Lang NP. The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol 1987;2:145-51.
  48. Mombelli A. Prevention and therapy of peri-implantitis infections. In: Lang NP, Karring T, Lindhe J (Eds). Proceedings of 3rd European Workshop on Periodontology: Implant Dentistry. Berlin: Quintessence Publishing Co 1999:281-303.
  49. Lindhe J, Meyle J. Peri-implant diseases: Consensus report of the sixth European Workshop on Periodontolgy. J Clin Periodontol 2008;35(S-8):282-85.
  50. Tarnow D, Elian N, Fletcher P, et al. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2003;74:1785-88.
  51. Ericsson J, Persson LG. Different types of implant-associated reactions in periodontal soft tissues. J Clin Periodont 1995; 22:255-61.
  52. Steinebrunner L, Wolfart S. In vitro evaluation of bacterial leakage along the implant of different implant abutment interface of different implant systems. Int J Oral Maxillofac Implants 2005;20:875-81.
  53. Engelke W, Decco OA. In vitro evaluation of horizontal implant micromovement in bone specimen with contact endoscopy. Implant Dent 2004;13:88-94.
  54. Hermann J, Buser D, Schenk RK, Schoolfield JD. Influence of the size of the microgap on crestal bone changes around titanium implants: A histometric evaluation of unloaded non-submerged implants in canine mandible. J Periodontol 2001;72:1372-83.
  55. Hermann JS, Buser D, Schenk RK, et al. Crestal bone changes around titanium implants: A histometric evaluation of unloaded non-submerged and submerged implants in the canine mandible. J Peridontol 2000;71:1412-24.
  56. Wohrle PS. Nobel perfect esthetic scalloped implant: Rationale for a new design. Clin Implant Dent Relat Res 2003;5:64-73.
  57. Nentwig GH. Ankylos implant system: Concept and clinical application. J Oral Implantol 2004;30:171-77.
  58. Gardener D. Maintaining crestal bone around dental implants: Literature review and clinical technique. Dentistry Today 2006.
  59. Tonetti MS, Sanz M. Consensus report of session B. In: Lang N, Karring T, Lindhe J. Proceedings of the 3rd European Workshop on Periodontology and Implant Dentistry. Berlin: Quintessence 1999:185-88.
  60. Huang MT, Ho CT, Wang ZY, Ferraro T, Lou YR, Stauber K, Ma W, Georgiadis C, Laskin JD, Conney AH. Inhibition of skin tumorigenesis by rosemary and its constituents carnosol and ursolic acid. Cancer Res. 1994 Feb;54(3):701-708.
  61. Bernardes WA, Lucarini R, Tozatti MG, Souza MG, Silva ML, Filho AA, Martins CH, Crotti AE, Pauletti PM, Groppo M, et al. Antimicrobial activity of tosmarinus officinalis against oral pathogens: relevance of carnosic acid and carnosol. Chem Biodivers 2010 Jul;7(7):1835-1840.
  62. Parolia A, Thomas MS, Kundabala M, Mohan M. Propolis and its potential uses in oral health. Int J Med Sci 2010 Jul;2(7): 210-215.
  63. Oncag O, Cogulu D, Uzel A, Sorkun K. Efficacy of propolis as an intracanal medicament against Enerococcus faecalis. Gen Dent 2006 Sep-Oct:54(5):319-322.
  64. Martin MP, Pileggi R. A quantitative analysis of propolis: a promising new storage media following avulsion. Dent Traumatol 2004 Apr:20(2):85-89.
  65. Carbajal D, Casaco A, Arruzazabala L, Gonzalez R, Tolon Z. Pharmacological study of Cymbopogon citratus leaves. J Ethnopharmacol 1989 Feb;25(1):103-107.
  66. Sanches NR, Cortez DAG, Schiavini MS, Nakamura CV, Filho BPD. An evaluation of antibacterial activities of Psidium guajava. Braz Arch Biol Technol 2005 May;48(3):4229-4230.
  67. Sanda KA, Grema HA, Geidam YA, Bukar-Kolo YM. Pharmacological aspects of Psidium guajava: an update. Int J Pharmacol 2011 May;7:316-324.
  68. Menezes SM, Cordeiro LN, Viana GS. Punica grantum (pomegranate) extract is active against dental plaque. J Herb Pharmacother 2006;6(2):79-92.
  69. Vasconcelos LC, Sampaio FC, Sampaio MC, Pereira Mdo S, Higino JS, Peixoto MH. Minimum inhibitory concentration of adherence of punica granatum linn (pomegranate) gel against S. mutans, S. mitis and C albicans. Braz Dent J 2006;17(3): 223-227.
  70. Prasad D, Kunnaiah R. Punica granatum: a review on its potential role in treating periodontal disease. J Indian Soc Periodontol 2014 Jul;18(4):428-432.
  71. Sauvaire Y, Petit P, Baissac Y, Ribes G. Chemistry and pharmacology of fenugreek. In: Herbs, botanicals and teas. Mazza G, Oomah BD, editors. Lancaster, Pennsylvania: Technomic Pub. Co; 2000. p. 107-129.
  72. Acharya SN, Basu SK, Thomas JE. Methods for the improvement of plant medicinal properties with particular reference to fenugreek (Trigonella foenum-graecum L.). In: Acharya SN, Thomas JE, editors. Advances in medicinal plant research. Kerala, India: Research Signpost; 2007b p. 491-412.
  73. Al-Habori M, Raman A. Pharmacological properties in fenugreek. - In: Petropoulos GA, editor. The genus trigonella. 1st ed. London and New York: Taylor and Francis 2002. p. 163-182.
  74. Saini P, Al-Shibani N, Sun J, Zhang W, Song F, Gregson KS, Windsor LJ. Effects of calendula officinalis on human gingival fibroblasts. Homeopathy 2012 Apr;101(2):92-98.
  75. Khairnar MS, Pawar B, Marawar PPA. Evaluation of calendula officinalis as an anti-plaque and anti-gingivitis agent. J Indian Soc Periodontol 2013 Nov-Dec;17(6):741-747.
  76. Chakraborthy GS. Antimicrobial activity of leaf extract of calendula officinalis Linn. J Herb Med Toxicol 2008 Jun;2(2):65–66.
  77. Zilda CG, Claudia MR, Sandra RF. Antifungal activity of the essential oil from calendula officinalis L growing in Brazil. Braz J Microbiol 2008;39(1):61-63.
  78. Bussadori SK, Castro LC, Galvão AC. Papain gel: a new chemo-mechanical caries removal agent. J Clin Pediatr Dent 2005 Winter;30(2):115-119.
  79. Bertassoni LE, Marshall GW. Papain-gel degrades intact nonmineralized type I collagen fibrils. Scanning 2009 Nov- Dec;31(6):253-258.
  80. Moon SE, Kim HY, Cha JD. Synergistic effect between clove oil and its major compounds and antibiotics against oral bacteria. Arch Oral Biol 2011 Sep;56(9):907-916.
  81. Pinto E, Vale-Silva L, Cavaleiro C, Salgueiro L. Antifungal activity of the clove essential oil from Syzygium aromaticumon, candida, aspergillus and dermatophyte species. J Med Microbiol 2009 Nov;58(Pt 11):1454-1462.
  82. Olajide OA, Makinde JM, Awe SO. Evaluation of the pharmacological properties of nutmeg oil in rats and mice. Pharma Biol 2000;38(5):385-390.
  83. Thanoon SZ, Al-Refai AS, Kamal A. Antibacterial effect and healing potential of nutmeg oil for chemically induced oral ulcerations in rabbits. Zanco J Med Sci 2013;17(2): 393-399.
  84. Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertil Steril 2001;75:305-09.
  85. Sammour A, Bijan MM, Tan SL, Tulandi T. Prospective randomised trial comparing the effects of letrazole (LE) and clomiphene citrate (CC) on follicular development, endometrial thickness and pregnancy rate in patients undergoing superovulation prior to intrauterine insemination (IUI). Fertil Steril 2001;76(Suppl 1):S110.
  86. Mitwally MF, Casper RF. Single-dose administration of an aromatase inhibitor for ovarian stimulation. Fertil Steril 2005;83:229-31.
  87. Fisher SA, Reid RL, Van Vugt DA, Casper RF. A randomized double-blind comparison of the effects of clomiphene citrate and the aromatase inhibitor letrozole on ovulatory function in normal women. Fertil Steril 2002;78:280-85.
  88. Fatemi HM, Kalibianakis E, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Clomiphene citrate vs letrozole for ovarian stimulation: A pilot study. Reprod Biomed Online 2003;7:543-46.
  89. Hu Y, Cortvrindt R, Smitz J. Effects of aromatase inhibition on in vitro follicle and oocyte development analyzed by early preantral mouse follicle culture. Mol Reprod Dev 2002;61: 549-59.
  90. Shetty G, Krishnamurthy H, Krishnamurthy HN, Bhatnagar S, Moudgal NR. Effect of estrogen deprivation on the reproductive physiology of male and female primates. J Steroid Biochem Mol Biol 1997;61:157-66.
  91. Mitwally MF, Casper RF. Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 2003;18:1588-97.
  92. Mitwally MF, Casper RF. Aromatase inhibition improves ovarian response to follicle-stimulating hormone in poor responders. Fertil Steril 2002;77:776-80.
  93. Goswami SK, Das T, Chattopadhyay R, Sawhney V, Kumar J, Chaudhury K, Chakravarty BN, Kabir SN. A randomized single blind controlled trial of letrozole as a low-cost IVF protocol in women with poor ovarian response: A preliminary report. Hum Reprod 2004;19:2031-35.
  94. Newkirk KM, Chandler HL, Parent AE, et al. Ultraviolet radiation-induced corneal degeneration in 129 mice. Toxicol Pathol 2007;35:819-26.
  95. Pettenati MJ, Sweatt AJ, Lantz P, et al. The human cornea has a high incidence of acquired chromosome abnormalities. Hum Genet 1997;101:26-29.
  96. Snibson GR. Collagen cross-linking: A new treatment paradigm in corneal disease—a review. Clin Experiment Ophthalmol 2010;38:141-53.
  97. Spoerl E, Raiskup-Wolf F, Kuhlisch E, Pillunat LE. Cigarette smoking is negatively associated with keratoconus. J Refract Surg 2008;24:S737-40.
  98. Rabinowitz YS, Nesburn AB, McDonnell PJ. Videokeratography of the fellow eye in unilateral keratoconus. Ophthalmology 1993;100:181-86.
  99. Goodrich DW, Lee WH. The molecular genetics of retinoblastoma. Cancer Surv 1990;9:529-54.
  100. Moodaley LC, Woodward EG, Liu CS, Buckley RJ. Life expectancy in keratoconus. Br J Ophthalmol 1992;76:590-91.
  101. Honein MA, Dawson AL, Petersen EE, Jones AM, Lee EH, Yazdy MM, Ahmad N, Macdonald J, Evert N, Bingham A, et al. Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy. JAMA 2017 Jan 3;317(1):59-68.
  102. Chervenak FA, Jeanty P, Cantraine F, Chitkara U, Venus I, Berkowitz RL, Hobbins JC. The diagnosis of fetal microcephaly. Am J Obstet Gynecol 1984 Jul 1;149(5):512-517.
  103. Papageorghiou AT, Thilaganathan B, Bilardo CM, Ngu A, Malinger G, Herrera M, Salomon LJ, Riley LE, Copel JA. ISUOG Interim Guidance on ultrasound for Zika virus infection in pregnancy: information for healthcare professionals. Ultrasound Obstet Gynecol 2016 Apr;47(4):530-532.
  104. Chibueze EC, Parsons AJ, Lopes KD, Yo T, Swa T, Nagata C, Horita N, Morisaki N, Balogun OO, Dagvadorj A, et al. Diagnostic accuracy of ultrasound scanning for prenatal microcephaly in the context of Zika virus infection: a systematic review and meta-analysis. Sci Rep 2017 May 23;7(1):2310.
  105. Cordeiro MT. Zika virus: laboratory diagnosis. In: Zika in focus. Springer International Publishing; 2017. pp. 59-62.
  106. Mlakar J, Korva M, Tul N, Popović M, Poljšak-Prijatelj M, Mraz J, Kolenc M, Resman Rus K, Vesnaver Vipotnik T, Fabjan Vodušek V, et al. Zika virus associated with microcephaly. N Engl J Med 2016 Mar 10;374(10):951-958.
  107. Zare Mehrjardi M, Keshavarz E, Poretti A, Hazin AN. Neuroimaging findings of Zika virus infection: a review article. Jpn J Radiol 2016 Dec;34(12):765-770.
  108. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016 Jan;47(1):6-7.
  109. Araujo AQ, Silva MT, Araujo AP. Zika virus-associated neurological disorders: a review. Brain 2016;139(8):2122-2130.
  110. Brasil P, Pereira JP Jr, Moreira ME, Ribeiro Nogueira RM, Damasceno L, Wakimoto M, Rabello RS, Valderramos SG, Halai UA, Salles TS, et al. Zika virus infection in pregnant women in Rio de Janeiro. N Engl J Med 2016 Dec 15;375(24):2321-2334.
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