Ultrastructural study of the attachment of human gingiva to titanium in vivo.

A study was conducted to determine if the behavior of epithelium in vitro is similar to its attachment behavior in vivo by the use of small sections of titanium-coated implants that could be inserted in human gingiva. The size of the implants allowed their insertion in a limited region and enabled the fixation and embedding procedures that are necessary for electron microscopy to be effective. Examination of the thin sections obtained from this material demonstrated that the epithelial cells attached to titanium in a manner similar to that observed in vitro and similar to the way that epithelium attaches to the tooth in vivo (Fig. 2). That is, there was a formation of hemidesmosomes and basal lamina. Because the ability of the oral epithelium to form such an attachment with an implant may be a crucial factor in the determination of clinical success or failure, this study provides further evidence that one reason for the apparent clinical success of titanium dental implants may lie in the firm attachment of epithelial cells to this material.