Principles and mechanisms of peri-implant soft tissue healing

The long-term clinical and esthetic success of implant-supported restorations is determined by osseointegration and optimal remodeling of peri-implant soft tissues. Complications of soft-tissue management are often caused by fibrotic regeneration of oral mucosa after multiple surgical procedures. Knowledge of the proliferative processes in wound healing is necessary to attain adequate soft-tissue conditions. Successful reconstruction of peri-implant soft tissues is feasible even in fibrotic conditions when appropriate surgical techniques are selected. The pleiotropic proliferative cytokine TGF-beta is involved in the regulation of all phases of wound healing and tissue remodeling. The isoform TGF-beta1 is a cytokine associated with the development of fibrotic tissue. Overexpression of TGF-beta1 causes scarring and fibrosis, and results in limited clinical success of intraoral soft-tissue management. Experimental therapeutic approaches with neutralizing antibodies to block TGF-beta1 resulted in less scarring and a reduction of fibrosis. Further molecular biologic research of cell-matrix-cytokine interactions in wound healing will provide highly specific antifibrotic therapeutic approaches in the future.