Dental implants with the periodontium: a new approach for the restoration of missing teeth.

Tooth loss is a common occurrence in mankind and damages human health. Osseointegrated dental implants have been successfully used as a popular prosthetic restoration for the missing teeth for many years. However, osseointegration, representing a direct connection between the implant and bone tissue without the periodontium, causes some inevitable problems, such as masticatory force concentration and immobility of the dental implant. Thus, an ideal dental implant should have its own peri-implant periodontium, as do the natural teeth. A number of attempts have been made to reconstruct the periodontium around the implants. Unfortunately, it has been established that a predictable periodontal reconstruction, especially the acellular cementum reconstruction on the surface of the implant, is a very difficult task. In this paper, we propose the hypothesis that the cementum may be a special phenotype of the bone tissue, on the basis of its strong similarity in development, structure, and function. In a certain condition, the bone tissue may change to cementum for special functional needs. In accordance with this hypothesis, we consider a novel approach to reconstruct the peri-implant tissues. Unlike previous studies, this approach imitates the tooth re-plantation process. The key point is to convert the implant-surrounding bone tissues to cementum as a result of adaptive changes to the implant-support demands. This hypothesis, if proven to be valid, will not only represent a breakthrough in cementum research, but also will open a new door to the restoration of missing teeth.