Epithelial attachment refers to the mechanism of attachment of the junctional epithelium to a tooth or dental implant, i.e., hemidesmosomes. The cells of the epithelium at this attachment point are non-keratinized and form a collar around the tooth around the cemento-enamel junction. The cells themselves are formed from reduced enamel epithelium. Issues regarding epithelial attachment may arise in the case of injury or disease to the tooth or surrounding tissues. Depending on the severity of the injury or disease, epithelial attachment will begin to develop again within three days with more substantial healing noticeable after seven days. Epithelial attachment is also important in implant dentistry as the implant is placed where the site of epithelial attachment takes place. Hemidesmosomal epithelium creates a barrier that aids in tissue healing around the implant. With proper oral care, it can also assist with the long-term success of the implant by preventing bacteria from destroying the surrounding tissues.
Epithelialization refers to the healing process that takes place by the growth of epithelium over connective tissue. When an oral surgery takes place such as bone grafting or implant placement, the epithelium that covers the gums is cut in order to provide access to the underlying tissues. Once the surgical procedure is complete, healing of the tissues and epithelium is required to prevent infection and to increase the chances of the procedure’s success. As the underlying tissues begin to heal and new growth of the cells takes place to seal the incision, the epithelium also begins to repair itself and new growth and cell division occurs. When healing is complete, a new layer of epithelium has formed over the procedure site. The length of time required for epithelialization to take place may partially depend on factors such as the patient’s oral hygiene, the presence of any pre-existing health conditions or infections, and the type of procedure performed.
The epithelium is a type of tissue that lines the intraoral mucosal surfaces, extends into the sulcus, and adheres to a dental implant or tooth. Epithelium is classified both by its shape and by its layer pattern. Three different epithelial cell shapes exist: squamous, cuboidal, and columnar. Three different types of epithelial layers also exist: simple, stratified, and pseudostratified. By combining both the cell shape and the type of layer pattern, the epithelium of different parts of the body may be identified. The epithelium lining the mucosal surfaces of the mouth is stratified squamous epithelium. The epithelium in the mouth can further be classified as either keratinized or nonkeratinized. Examples of oral structures which consist of nonkeratinized squamous epithelia include the inner portion of the lips, the floor of the mouth, and the soft palate. Keratinized squamous epithelia may be observed in the hard palate, gingiva, and certain parts of dorsal tongue surface.
An eposteal implant is a device that receives its primary bone support by means of resting upon the bone itself. Though most practitioners prefer endosteal implants, in which the implant is placed in the bone, the eposteal implant may still be used in cases of extreme bone resorption or high risk of bone resorption. Since substantial bone is required in order to place an endosteal implant, some patients may require a bone grafting procedure prior to receiving the implant. However, some patients are at higher risk for bone resorption due to other underlying factors and are not good candidates for grafting and endosteal implants. Though the eposteal implant method is mostly considered outdated, it does still have applications for patients in this resorption risk category. To secure an eposteal implant, it is attached to the jawbone rather than being drilled and placed inside the bone to act as a root replacement.