revista de investigación prostodóntica 65 ( 2021) 11-18

Revista de Investigación de Prostodoncia

Diario Oficial de Japón Sociedad Prostodóntica

Artículo de revisión
El ancho biológico alrededor del implante
Zheng Zhenga, Xiaogang Aoa, Peng Xiea, Fan Jiangb, Wenchuan Chenc*

a Licenciado en Prostodoncia, Laboratorio Estatal de Enfermedades Orales y Centro Nacional de Investigación Clínica de Enfermedades Orales,
Hospital de Estomatología de China Occidental, Chengdu, China y Departamento de Prostodoncia Oral, Hospital de Estomatología de China Occidental,
Universidad de Sichuan, Chengdu, Sichuan, China
b Departamento de Estomatología, el Hospital Afiliado de North Sichuan Medical College, Nanchong, Sichuan, China
c Laboratorio Estatal de Enfermedades Orales y Centro Nacional de Investigación Clínica de Enfermedades Orales, Hospital de Estomatología de China
Occidental, Chengdu, China y Departamento de Prostodoncia Oral, Hospital de Estomatología de China Occidental, Universidad de Sichuan, Chengdu, Sichuan,
China

Abstracto
Propósito: El concepto de ancho biológico ha sido propuesto y ampliamente utilizado en la implantación oral. Esta revisión tenía como objetivo resumir el
ancho biológico alrededor del implante en detalle.
Selección del estudio: Se realizó una búsqueda electrónica de la literatura antes de marzo de 2019 para identificar todos los artículos relacionados con el
ancho biológico en el tejido blando periimplantario. La búsqueda se realizó en la base de datos MEDLINE (Biblioteca Nacional de Medicina) a la que se
accedió a través de PubMed sin restricción de fecha. Se utilizaron las siguientes palabras clave: "implante", "ancho biológico", "tejido blando", "epitelio
de unión", "epitelio periimplantario", "tejido conectivo", "gingiva", "mucosa" (conectando múltiples palabras clave con AND, OR).
Resultados: Las investigaciones identificadas se centraron en varios aspectos relacionados con el ancho biológico en la implantación oral, a saber, el
concepto, la formación, la remodelación, la dimensión, la estructura y la función.
Conclusiones: Partiendo de la literatura revisada, se exploran el concepto, la formación, la remodelación, la estructura, la dimensión y las significaciones funcionales del ancho
biológico periimplantario en esta revisión narrativa. La formación de la anchura biológica alrededor del implante es un proceso complejo después de varias semanas de curación.
El ancho biológico alrededor del implante es una distancia de 3-4 mm desde la parte superior de la mucosa peri-implante hasta el primer contacto hueso-implante o la parte
superior estabilizada del hueso adyacente, que consiste en epitelio sulcular, epitelio de unión y tejido conectivo fibroso entre el epitelio y el primer contacto hueso-implante o la
parte superior estabilizada del hueso adyacente. La anchura biológica forma una barrera biológica contra las bacterias, influye en la remodelación de suave y duro
tejido alrededor del implante y tiene implicaciones para los aspectos clínicos de la implantación dental.
Palabras clave: Implantes dentales, Prótesis parcial fija, Conexión diente-implante, Fallo, Complicaciones

Fecha de recepción:2 julio 2019, Fecha de aceptación: 4 marzo 2020, J-STAGE Fecha de publicación: 9 septiembre 2020

1. Introducción fibras dentoperiosteales, circulares se insertan en el cemento radicular y el

El concepto de anchura biológica en el diente natural se propuso en
1961 [1]. La anchura biológica de 2 mm de ancho alrededor del diente
natural se compone de epitelio de unión de 0,97 mm de ancho y tejido
conectivo fibroso de 1,07 mm de ancho [2], que es una distancia entre el
surco gingival y la cresta alveolar. El epitelio de unión es epitelio
escamoso estratificado no queratinizado y el tejido conectivo consiste en
fibras transseptales que fluyen perpendicularmente y de fibras
dentogingivales, principalmente de fibra colágena. Las fibras de colágeno
se componen de fibras y
* Autor para correspondencia en: State Key Laboratory of Oral Diseases & National
Clinical Research Center for Oral Diseases, Department of Oral Prosthodontics, West
China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan
Road, Chengdu, 610041, Sichuan, China.
Dirección de correo electrónico: hxkqcwc@scu.edu.cn (W. Chen ).
https://doi.org/10.2186/jpr.JPOR_2019_356 1883-1958/© 2020
Japan Prosthodontic Society. Todos los derechos reservados.
hueso alveolar.
La porción gingival de la interfaz del tejido dento-gingival une la
superficie del diente a través de la zona de la membrana basal y
hemidesmosomas [3, 4]. La importancia vital de la anchura biológica
alrededor del diente natural es protestar de la estimulación externa.
Algunos estudiosos detectaron que había un fenómeno análogo en la
implantación oral. Por lo tanto, Berglundh et al. propusieron que la
anchura biológica existía alrededor del implante en 1991 [5]. Similar al
diente natural, el ancho biológico alrededor del implante difiere en muchos
aspectos, como concepto, formación, remodelación, dimensión, estructura
y función. El ancho biológico en la implantación oral parece ser un
concepto en dimensión, a saber, una distancia de 3-4 mm de ancho desde
la parte superior de la mucosa peri-implantada hasta el primer contacto
hueso-implante. Sin embargo, las investigaciones siempre discuten la
estructura específica del ancho biológico, incluyendo el epitelio sulcular,
el epitelio de unión y el tejido conectivo fibroso entre el epitelio y el
primer contacto hueso-implante (fig. 1). La zona de la membrana basal
juega un papel importante en la arquitectura molecular. Además, la función
de la anchura biológica
12 1Z. Zheng et al./ revista de investigación prostodóntica 65 ( 2021 ) 11-18
alrededor del implante es de gran importancia. Como barrera biológica, el
ancho biológico juega un papel importante en la remodelación de los
tejidos blandos y duros periimplantarios, y en los aspectos clínicos de la
implantación dental. El objetivo principal de esta revisión es proporcionar
una visión general sistemática sobre el concepto, la formación, la
remodelación, la estructura, la dimensión y las significaciones funcionales
del ancho biológico alrededor del implante.
momento. En última instancia, hay una barrera epitelial maduro se produjo
y las fibras de colágeno de la mucosa organizada [6, 7]. La curación
epitelial después de la cirugía del colgajo requiere aproximadamente 14
días después de la cirugía. La formación y maduración de la anchura
biológica como barrera biológica alrededor de los implantes
transmucosales se completa después de un período de 6-8 semanas [8]. El
epitelio de la unión peri-implante es un mayor

2. Selección de estudios

2.1. Estrategia de búsqueda

Se realizó una búsqueda electrónica de la literatura antes de marzo de

2019 para identificar todos los artículos relacionados con el ancho
biológico en el tejido blando periimplantario. La búsqueda se realizó en la
base de datos MEDLINE (Biblioteca Nacional de Medicina) a la que se
accedió a través de PubMed sin restricción de fecha. Se utilizaron las
siguientes palabras clave: "implante", "ancho biológico", "tejido blando",
"epitelio de unión", "epitelio periimplantario", "tejido conectivo",
"gingiva", "mucosa" (conectando múltiples palabras clave con AND, OR).
Se realizó una búsqueda manual adicional para verificar las bibliografías
de todos los artículos de texto completo y explorar los sitios web de las
revistas pertinentes.

2.2. Criterios de inclusión

Esta revisión buscó artículos relacionados con la estructura, dimensión

y función del ancho biológico alrededor del implante. Se incluyeron
estudios en animales, estudios vitro y estudios clínicos que informaron la
anchura biológica alrededor del implante, aunque estos estudios tienen
limitaciones de objetos y métodos experimentales, y el número de
muestras. También se incluyeron estudios sobre la relación entre los tejidos
blandos y óseos periimplantarios.

2.3. Criterios de exclusión

No se incluyeron en esta revisión estudios centrados únicamente en el tejido

óseo periimplantario sin reacción de anchura biológica. También se excluyeron
las investigaciones sobre la implantación cigomática en lugar de la mandíbula.
No se mencionaron los informes de casos. Los artículos en cualquier idioma
que no fuera el inglés se dejaron fuera.

3. Resultados

Se identificaron un total de 438 estudios en la literatura, de los cuales

128 fueron seleccionados para el cribado de texto completo. Se excluyeron
32 estudios y finalmente se seleccionaron 96 artículos (fig. 2). Las
investigaciones identificadas se centraron en varios aspectos relacionados
con la anchura biológica en la implantación oral, a saber, la formación,
remodelación, dimensión, estructura y función.

3.1. La formación y remodelación de la anchura biológica alrededor del

implante

La formación de anchura biológica en el tejido blando periimplantario

es un procedimiento secuencial y regular que se relaciona con la
interacción y efectos comunes de múltiples factores. El tejido
periimplantario sigue un patrón similar de cicatrización de heridas. Un
gran número de neutrófilos se infiltran y degradan el coagulo que ocupa en
el compartimento entre la mucosa y el implante durante la fase inicial de
curación. Las células endoteliales, los fibroblastos y las células epiteliales
se activan para formar nuevos capilares, dar lugar a la re-epitelización y
promover la curación del tejido periimplantario. Luego, la proliferación
epitelial comienza a sanar y de un epitelio de barrera en 1-2 semanas de
curación, mientras que el tejido conectivo es rico en fibroblastos en este
Fig. 1.Representación esquemática del ancho biológico alrededor del
implante. GM: margen gingival; cJe: punto coronal del epitelio de unión;
aJe: punto apical del epitelio de unión; B: la parte superior de la cresta o
sea; BIC: el primer contacto hueso-implante. El epitelio sulcular: distancia
del margen gingival a cJe; El epitelio de unión: cJe a aJe; Contacto de
tejido conectivo: aJe a BIC; Anchura biológica: GM a BIC.

la longitud final del epitelio de unión larga y el tejido conectivo blando

periimplantario establecido es similar a la del tejido cicatricial [9].

3.2. Estructura y dimensión de la anchura biológica alrededor del

implante

El tejido blando periimplantario parece ser análogo en morfología y

estructura al diente natural, compuesto por epitelio y tejido conectivo fibroso
entre el epitelio y el primer contacto óseo-implante [10]. Sin embargo, el tejido
peri-implante es menos vascularizado, y solo recibe sangre contribuyente de las
ramas terminales del periostio. Las células no queratinocitas, incluidas las
células de Langerhans, melanocitos y células de Merkel, están presentes en el
tejido periimplantario [11]. Atsuta et al. compararon la histología del sellado de
tejidos blandos alrededor de implantes dentales y dientes, demostrando que el
frágil sello entre la superficie del implante y el tejido periimplantario influyó
negativamente en la respuesta de la inflamación [12].
El epitelio de unión, la porción gingival de los tejidos periimplantarios
blandos, une la superficie del implante, que está esencialmente hecha de
células aplanadas caracterizadas como epitelio escamoso no diferenciado,
no queratinizado y estratificado. El epitelio de unión se compone
esencialmente de dos capas de epitelio incluyendo la lámina basal externa
y la lámina basal interna.
La lámina basal externa es una capa basal que se separa del tejido
conectivo subyacente por una zona de membrana basal. La zona de la
membrana basal se divide en la lámina lúcida, la lamina densa y la lamina
reticularis o la sublamina densa, cuyo espesor oscila entre 50 y 100 nm y
contiene proteínas de matriz extracelular interconectadas altamente
organizadas [13-15]. El epitelio de unión está conectado directamente a la
superficie del implante formando una barrera biológica eficiente contra la
invasión bacteriana a través de un complejo de adherencia llamado aparato
de unión epitelial que incluye la lámina basal interna (LB) y
hemidesmosoma [15, 16]. La lámina basal interna consiste en lucida y
densa en estructura, que incorpora principalmente laminina 332 y colágeno
tipo VIII en composición [17, 18]. El epitelio periimplantario (PIE) que
origina
 Z. Zheng et al./ revista de investigación prostodóntica 65 ( 2021 ) 11-18 13

Fig. 2.Diagrama utilizado para la revisión para identificar estudios.

extracelular de la integrina α6 se combina con BP180, CD151 y laminina-

322 [30-40].
del epitelio sulcular oral se divide en región superior, media e inferior. Hay
mucho más aparatos de unión epitelial en la región inferior y la densidad
periférica de la lámina basal lúcida frente a los hemidesmosomas se
incrementa [16, 19].
Las lamininas son la proteína extracelular más abundante en la lámina
basal y son las estructuras de unión a integrinas más importantes dentro de
la lámina basal. Las lamininas son una familia de glicoproteínas de gran
peso molecular compuestas de cadenas heterotriméricas (α, β, γ) unidas por
enlaces disulfuro en un patrón que se asemeja a un tenedor de tres puntas
[20-22]. Las células epiteliales alrededor del implante secretan laminina- 1
contribuye a la adhesión celular al implante [16]. Laminina-332 (laminina-
5) es una molécula importante estrechamente relacionada con la adhesión y
migración de células epiteliales , y contribuye a la unión de la PIE a la
superficie del implante, que consiste en tres cadenas de polipéptidos
ligados a disulfuro (α3, β3, γ2) que se ensamblan dentro del retículo
endoplásmico en un heterotrimer en forma de cruz [23 -25]. Las
distribuciones de queratinas y desmoplaquinas en la encía humana y en la
mucosa periimplantaria son similares, mientras que la expresión de
desmoplaquina I y II es débil en la mucosa periimplantaria y en el epitelio
articular que co-expresa queratinas 13 y 19 [26, 27].
Las células gingivales regulan la adhesión focal y la expresión del
hemidesmosoma en momentos anteriores para crear un sello libre de
infecciones alrededor del implante dental [28]. Hemidesmosomas (HDs)
son altamente especializados integrina mediada estructuras de unión
epitelial que hacen que las células se adhieren firmemente a la superficie
del implante y establecer vínculos entre el citoesqueleto de queratina de las
células epiteliales y la lámina lúcida a continuación,que se componen de
cinco componentes principales, a saber, integrina α6β4, plectina, CD151,
BP230 y BP180 (colágeno tipo XVII) [29]. La integrina α6β4 es un
heterodímero no covalente y el componente transmembrana de los HDs
que actúa como un receptor de laminina-332 [30-34]. La integrina β4
media las interacciones intracelulares entre los miembros de la familia
plaquina plectina y BP230, así como con la proteína transmembrana
BP180 para asociarse con el citoesqueleto de queratina IF. El dominio
 El tejido conectivo situado bajo el epitelio conjuntivo contiene colágeno
de los tipos I y III, mientras que el tejido conectivo supracrestal está
compuesto principalmente de colágeno de tipo I [41]. La distribución de
los componentes colágenos en el implante es similar a la encía humana
sana, algunos de los cuales eran ricos en células inflamatorias y pobres en
componentes colagenosos. Las fibras de colágeno de la unión del tejido
conectivo son paralelas al eje largo del implante, actuando como un tejido
cicatricial, con una adhesión más pequeña [42]. Los tipos I, III, IV y VII de
colágeno y fibronectina muestran una distribución similar entre el implante
y el diente natural. El colágeno de tipo V se localiza en mayores cantidades
en la lámina propia de los tejidos gingivales periimplantarios, que es
responsable de la mayor estabilidad de la colagenasa [43]. Hay una zona de
tejido conectivo de 200 micras de ancho interpolada entre el borde apical
del epitelio de unión y el tejido óseo, que se divide en la unidad central y
lateral. La zona central de 40 micras de ancho ubicada inmediatamente al
lado de la superficie del implante está en ausencia de vasos sanguíneos y
abundancia de fibroblastos alargados interpuestos entre fibras delgadas de
colágeno, mientras que la zona latera de 160 micras de ancho tiene menos
fibroblastos, pero más fibras de colágeno y vasos sanguíneos [44-46].
Hubo ligeras diferencias en la dimensión del ancho biológico alrededor del
implante en diferentes estudios, mientras que la distancia de 3-4 mm de ancho
fue universalmente aceptada y acorde con los resultados de las investigaciones
de correlación (tabla 1). La dimensión de la anchura biológica en el implante
cónico con conexión interna fue de 3,13-3,34 mm, que consistió en 1,64-1,93
mm para el tejido epitelial y 1,21-1,32 mm para el tejido conectivo [47]. La
dimensión de anchura biológica osciló entre 2,55 0,16 mm en los implantes de
una sola pieza, mientras que fue de 3,26 0,15 mm en los implantes de dos
piezas [48]. La dimensión del ancho biológico varió de 2,84 mm a 3,80 mm con
tejido epitelial de 1,33-2,31 mm de ancho y tejido conectivo de 1,28-1,70 mm
de ancho en diferentes áreas de tratamiento de arenado (grano grande) y superficie
grabada con ácido HCl/H2SO4(SLA) [49]. El epitelio de unión y el tejido conectivo
fueron más largos en los implantes alrededor del diente natural de este espacio
es en general de unos 2 mm, este valor puede variar dependiendo del individuo.
La dimensión de la anchura biológica varió de 1,77 mm a 2,72 mm, es decir,
14 Z. Zheng et al./ revista de investigación prostodóntica 65 ( 2021 ) 11-18

Tabla 1.La dimensión de la anchura biológica alrededor del diente natural y el

implante.

Tipos Autor/referencia Material(s) Epitelial Conectivo Biologic

tejido tejido
(mm) (mm)
La natural Gargiulo AW et al. Humanos 0.97 1.07
diente [1]
Vacek JS et al. [2] Humanos 1.14 1.09
La Bengazi F et al. [91] Beagle dogs 2.3 1.1
implants
Baffone G et al. [96] Labrador dogs 2.1 1.2
Negri B et al. [117] Beagle dogs 2.09 1.35
de Sanctis M et al. Beagle dogs 2.59 1.49
[46]
Abrahamsson I et al. Beagle dogs 2.02 1.34
[139]
Welander M et al. Labrador dogs 2.13 1.34
[140]
0.71-1.35 mm for attached epithelium and 1.06-1.99 mm for connective
tissue [51]. Vacek et al. [2] observed the width between 0.75 mm and 4.3
mm. It means that in some patients a height of 6-7 mm of gingival papilla
can be normal and stable due to that the dimension of the biological width
is of 3-4 mm. By analogy the biological width around implant more than 4
mm is steady with the formation of long junctional epithelium. However, it
is noteworthy that the dimension of biological width around implants with
tapped-in connections such as Bicon® Dental Implants (Bicon, Boston,
MA, USA) is likely to be much more than 4 mm in traditional definition on
account of the subcrestal placement. Bicon implants feature in sloping
shoulder that has the ability to distribute the stress apically, and provides
support for peri-implant soft tissues. The biological width also stands for
the balance between peri-implant tissues and bacteria. The bone tissue is
normal and stable above implant shoulder, and provides a channel to
abutments around Bicon implants related to their unique bacterially-sealed,
and locking taper implant to abutment connection [52-62]. Whereas, it is
noticed that if the distance between the top of the peri-implant mucosa and
stabilized top of the adjacent bone is defined as biological width, the
dimension in Bicon implant system accords with the range of 3-4 mm,
which is a static presentation after oral implantation (Fig. 3). In addition, a
series of long-term follow-up studies showed that there was less crestal
bone loss even bone formation in the dynamic process of placement of
implants with tapped-in connections [63-67]. From the above, the authors
consider it necessary to make a modification of the definition of biological
width around implant that is a distance from the top of the peri-implant
mucosa to the stabilized top of the adjacent bone. The stabilized top of the
adjacent bone faces the implant surface or extends to the coronal of
implant-abutment interface. The revised definition can account for the
differences in different implant systems, which might be helpful to deeply
understand the effect of biological width.
3.3. The functional significances of biological width around implant
3.3.1. Effects of biological barrier against the bacterial invasion
Implants through oral mucosa destroy the integrity of epithelium tissue
and represent a higher pro-inflammatory state [68]. Transmission of the
complete bacterial microflora from teeth to implants could be excluded
based on the different bacterial flora of teeth and implants [69].
Biofilm adhesion is mainly formed in supragingival areas with
significantly increasing by higher surface roughness of implant [70]. The
peri -implant microflora in health consists mainly of Gram-positive cocci
and non-motile bacilli, and a limited number of Gram-negative anaerobic
species [71-73]. The soft tissue surrounding the transmucosal part of dental
implants is remodeled to separate the peri -implant bone tissue from the
oral cavity and form the biological width as a defensive mechanism against
the bacteria, namely soft tissue seal. This seal prevents the development of
ancho
(mm)
2.04
2.23
3.4
3.3
3.44
4.08
3.36
3.47
Fig. 3. Schematic representation of biological width in Bicon implant system.
GM: gingival margin; BHP: the stable top of the adjacent bone; BIC: the first
bone-to-implant contact. Biological width: distance from GM to BIC, which is
greater than 4mm; The revised biological width: GM to BHP, which is 3-4mm.
inflammatory peri-implant diseases, ensures healthy conditions and stable
osseointegration [74-76]. The peri-implant tissue acts as a scar tissue with
smaller adhesion and less vascularized. The width of biological width is
usually greater around the implant than the tooth to enhance the soft tissue
seal as biological barrier [77].
3.3.2 . Effects of biological width on the remodeling of peri-implant soft
and hard tissues
The remodeling of biologic width in soft tissue thickness affects the
initial bone reconstitution [78]. The margin level of soft tissue mainly
depends on the thickness of the peri-implant soft tissue, namely biological
width rather than the bone width [79]. A thin biotype is more susceptible
to biologic width with less peri-implant mucosal dimensions than a thick
biotype resulting in marginal tissue recession and initial crestal bone loss
to form effective biologic width [80-90]. The presence of keratinized
mucosa has a positive effect on peri-implant tissue health to maintain soft
tissue marginal position and accelerate the formation of soft tissue seal
[91-93]. The mucosa around implant undergoes a reduction in thickness
from the time of implant placement till the placement of final restorations,
whereas the placement of the final restorations leads to a rebound of the
tissue thickness [94]. The dimension of soft tissues around implant is
similar in different widths of the buccal bony wall and alveolar bony
ridges on the basis of appropriate abutments [95, 96].
3.3.3.1. Effects of biological width on the placement of dental implants
A minimum of 1.8 mm of external cortical bone is retained to avoid a
vestibular bone loss on account of the formation of stabilized biological width
[97]. The reestablishment of biologic width confirms the vertical position of
the implant seemed highly successful to avoid implant surface exposure [78].
The position of the top of the implant does not compromise the reestablishment
of peri-implant tissue and biological width. However, less resorption of crest
and recession of soft tissues when implants were placed 2 mm subcrestally,
while the remodeling of the biological width around implants placed at crestal
level was in a more coronal position, which had deleterious outcomes on
esthetics [47, 98-100]. Some researches supported that the epithelium length
and peri-implant soft tissue length in subcrestal implant placement with tapered
internal were significantly larger than that in equicrestal placement, whereas
subcrestal implant placement did not increase the inflammation around soft
tissues and resulted in bone contact with the implant neck [101-103]. The
research found that dimension of biological width had no difference in leaving
different buccal bone widths, whereas there was a higher horizontal bone
resorption in a
 Z. Zheng et al. / journal of prosthodontic research 65 ( 2021 ) 11–18 15

buccal bone width of 1 mm and nonsubmerged implant installation was Table 2. Main studies assessing the influence of surface characteristics of
recommended to limit this situation [104]. A minimum of 3 mm of bone is implant on the biological width. PAR4-AP: protease activated receptor 4-
activating peptide; GL13K: a cationic antimicrobial peptide; A10: a novel
retained between adjacent implants and 1.5 mm between implant and tooth synthetic peptide; HGE: human gingival epithelial cells; HaCaT: the epithelial
at the implant-abutment level in lateral dimension [105]. In addition, cell line; OB: osteoblasts; HGF: human gingival fibroblasts; NHDF: the
average 3.4 mm of soft tissue height is expected to form over the crest of fibroblastic cell line; L929: mouse fibroblasts.
bone in vertical, that is, the distance between the gingival margin and the Author/reference Material(s) Type of Main conclusions
placement of implant [106]. This is relevant to form the biological width, evidence
Sugawara S et al. PAR4-AP In vitro: HGE PAR4-AP accelerated the
to counteract the lateral component of the biological width and to avoid a [121, 122] aggregation of platelets
complete resorption of the bone crest. to release epithelial
chemoattractants and
3.3.3.2. Effects of biological width on dental implants types growth factors.
Implants with platform switching displace the interface of implant- Koidou VP et al. Multilayer coating In vitro: Multilayer coating
[123, 124] with LAMA3 HaCaT promoted epithelium
abutment toward medial permit to expose more surface of the platform of cells adhension and
the implant where fibers of the connective tissue can be inserted to form the formation of
the biological width and to reduce the area of infllammatory infiltrate in hemidesmosomes.
bony crest [107- 109]. Bone-level implants restored with platform Abdulkareem EH et Metal oxide In vitro: OB Nanoparticles provided
al. [125] nanoparticles and HGF osteoconductive
switching have less recession of soft tissues [110]. Soft tissues around and antimicrobial
tapered abutment recapitulated the physiologic dimensions of natural tooth functionalities to form
and enhanced peri-implant soft tissue stability [111, 112]. The peri-implant biological width and
improved the success rate
soft tissues and the marginal level of bone-to-implant contact were similar of dental implantation.
between self-tapping standard implants and Osseotite ® implants of the 3i Holmberg KV et al. GL13K In vitro: OB GL13K accelerated the
Implant System with microtextured acid- etched surface [113]. The [126-128] and HGF formation of biological
dimensions of biological width were significant statistical differences width and promoted
cytocompatibility and
between implants with micro- ring and open-thread neck designs, which antibacterial activity
was smaller in the micro -ring implants [114]. There was no statistically simultaneously.
significant difference in the dimension of biological width in the peri- Kihara H et al. [129] A10 In vitro: HGE A1enhanced epithelial
implant soft tissues between platform-switching implants with and without attachment and the
establishment of biological
a machined neck [115, 116]. The establishment of the biological width width via inducing the
showed similar outcomes in implants with or without microthread in neck. adhesion and migration of
The microthread design might result in maintaining the marginal bone loss epithelial cells with low
inflammatory cytokine
against loading [117]. Implants with conical connections could effectively release.
preserve peri-implant tissues and maintain the biological width around
implant [79, 118]. The research yielded that two- piece implants augment Mussano F et al. Anodization In vitro: Anodized surfaces could
the thickening of the connective tissue attachment, resulting in the increase [130] HaCaT and gain the adhesion of the
NHDF epithelial cells and the
of the biological width to form soft tissue seal compared to one-piece fibroblastic cells within the
implants [48]. However, there was no significantly different profilometric peri-implant soft tissues.
and linear change of soft tissues between two-piece implants and one-piece
implants in long-term observation [119, 120]. The main reviewed studies Yang M et al. [131] Dopamine-modified In vitro: HGF The dopamine-modified
titanium titanium implant had
on the surface characteristics of implant related to the biological width are superior soft tissue
reported in Table 2 [121-132]. integration and antibacterial
activity.
3.3.3.3. Effects of biological width on abutments types Teng F et al. [132] Anodic oxidation In vitro: L929 The modification of
The formation of biological width involves in the type of abutments and polydopamine anodic oxidation and
deposition polydopamine deposition
[133]. The anatomic healing abutments could protect soft tissues and on the implant neck yielded
accelerate the remodeling of soft tissues [134]. The surface of chitosan-coated the attachment between an
zirconia and alumina in abutments could promote the formation of biological implant and peri-implant
connective tissue.
width and maintain the health of the surrounding soft tissue barrier [135].
Porous direct metal laser sintering healing abutments affected cell adhesion and
the remodeling of biological width [136]. It seemed that laser-microgrooved
implant healing abutments might involve selective differentiation of epithelium to tissue level, which could accelerate the remodeling of biological width
and induction of the junctional epithelium to form peri-implant soft tissues and around implant [143, 144].
set up biological width [137]. Due to the better mechanical properties and
bioactivity of titanium-zirconium (TiZr) abutment compared with titanium, 4. Conclusion
TiZr had the capacity to improve soft tissue integration and enhance implant
success [138]. Peri-implant soft tissue histomorphology composition was The biological significances of biological width are mainly reflected in
similar in implant abutments made of zirconia and titanium, which was its concept, formation, structure, dimension, and function. The formation
different to that made of AuPt-alloy resulting in soft tissue margin receded and of biological width in peri-implant soft tissue is a sequential and regular
bone resorption occurred [139-141]. However, implants with a titanium procedure. The biological width around implant is a distance from the top
abutment showed a smaller microgap and better sealing than implants with a of the peri -implant mucosa to the first bone -to-implant contact or the
zirconia abutment [142]. Recently, On1 TM restorative system (Nobel Biocare stabilized top of the adjacent bone, consisting of epithelium (including
AB, Gothenburg, Sweden) is supported to preserving both soft tissue sulcular epithelium and junctional epithelium) and fibrous connective
attachment and restorative flexibility, and move the prosthetic platform from tissue between the epithelium and the first bone-to-implant contact or the
bone level stabilized top of the adjacent bone. The most established width of
16 Z. Zheng et al. / journal of prosthodontic research 65 ( 2021 ) 11–18
biological width around implant is 3-4mm. The biological width forms as a
defensive mechanism against the bacteria, influences the remodeling of soft and
hard tissue around implant and clinical aspects in dental implantation.
Acknowledgments
This literature review was approved by Department of Prosthodontics,
West China College of Stomatology, Sichuan University, China. This work
was supported by the Case model curricula of professional degree
postgraduate of Sichuan University (2016KCJS080) and prosthodontics in
State Level Clinical Disciplinary.
Conflict of interest
The authors declare no potential conflicts of interest with respect to
the authorship and/or publication of this article.
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