Biological determinants in implant design

This paper considers whether fibro-osseous integration is a feasible outcome for dental implants and whether the mucosal-implant junction is a crucial factor for implant success. It is argued that the periodontal ligament is a connective tissue with specific origin determined early in development. Further, it is argued that fibroblasts of the ligament exhibit unique functional characteristics associated with tooth support and that these characteristics cannot, as yet, be duplicated in other fibroblasts. These specific attributes argue against the feasibility of fibro-osseous integration unless cells of the periodontal ligament are available to develop a fibrous attachment. With respect to the dentogingival junction, it is argued that this structure does not provide a functional seal around the normally functioning tooth and therefore a minor degree of inflammation in the connective tissue adjacent to an implant is acceptable. It is also argued that inflammation associated with fibro-osseous integrated implants is not the result of a deficiency in the epithelial attachment but rather is due to the inability of the connective tissue to withstand the forces applied to it.