Biological Processes in Gingival Tissue Integration around Dental Implants

Peri-implant gingival tissue integration (GTI) is pivotal in determining the long-term success and functionality of dental implants. To enhance GTI, researchers have increasingly focused during the past decade on unravelling the response of gingival tissues to implant surfaces. This increased focus on soft instead of hard tissue integration has led to the development of various models, including in vitro cell culture systems and in vivo animal models, designed to predict and assess GTI around dental implants. However, inconsistent study outcomes between the different models have created confusion, highlighting the need for a comprehensive review. Therefore, the main objective of this review is to present a comprehensive overview of existing in vitro models, ranging from 2D to 3D, specifically designed to investigate cellular behavior relevant to peri-implant GTI. To facilitate a better comprehension of the utility of these models, the review initiates an elucidation of the histological characteristics of gingival tissues surrounding natural dentition, offering insights into the healing dynamics and histological adaptation processes occurring in gingival tissues adjacent to dental implants. Additionally, through a critical evaluation of the strengths and limitations inherent in each model, our aim is to contribute to a more profound understanding of their applicability and effectiveness in GTI research.