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Ligaplants: A Revolutionary Concept in Implant Dentistry

Article in Annals of Maxillofacial Surgery · June 2020

DOI: 10.4103/ams.ams_58_19

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 Systematic Review

Ligaplants: A Revolutionary Concept in Implant Dentistry

Mehvish Saleem, Mayur Kaushik, Apeksha Ghai, Nitin Tomar, Soundarya Singh
Department of Periodontology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India

Abstract
Replacement of the missing tooth with an implant has gained popularity among patients. The advent of periodontal tissue engineering has
brought about a revolution not only in the field of periodontology but also in the field of implant dentistry at large. Currently, the development
of a periodontal ligament (PDL) attachment around dental implants has now become an important new therapeutic tool to replace lost teeth.
PDL houses various vital cells that are important in the dynamic relationship between the tooth and the bone. Thus, ligaplants are now an
available option to improve the biological performance and to prolong the life of the prosthesis.

Keywords: Dental implants, periodontal ligament, tissue engineering

Introduction Ethical Application

The boom in implant dentistry is attributed to a combination Ligaplants are a new treatment modality, which are being
of various reasons: prolonged life span of aging individuals, clinically tried in vivo and in vitro. Moreover, in animal studies,
failures associated with removable and fixed prostheses, they have shown good results, although in vivo results are yet
advantages, and predictable outcomes associated with the to be correlated. Several successful experiments have been
use of implants.[1] Before placement of the implant, local conducted to devise “implant supported by the periodontium”
bone defects and general poor bone quality necessitate bone that can maintain form function and potential proprioceptive
reconstruction. Besides this, localized bone loss around the responses similar to a natural tooth. Based on these strong
implant fixture represents the clinical challenge, especially evidences, the possibility of the future clinical use of such
implant can be strongly stated which would revolutionize the
in the case of gingival recession, which requires further
implant dentistry and favored by the patients as well.
surgical interventions.[2] With loss of natural teeth, periodontal
ligament (PDL) cells are lost as well. Therefore, these cells
cannot participate in wound healing around endosseous Properties of Ligaplants
implants, which are inserted for replacement of lost teeth. Thus, 1. It acts like a shock absorber, giving the tooth some
at present, optimal healing around implants is considered to movement in the socket
be intimate bone‑to‑implant contact, called osseointegration.[3] 2. It also provides proprioception
3. The PDL also has an important interaction with the
Currently, osseointegrated implants are generally agreed to be adjacent bone, playing the role of the periosteum, at the
the most acceptable implants because of their high long‑term bone side facing the root
clinical survival rate. These problems could be resolved, if
implant with PDL could be developed, which could be achieved Address for correspondence: Dr. Mehvish Saleem,
by LIGAPLANTS, a combination of the PDL cells with Department of Periodontology, Subharti Dental College and Hospital,
Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India.
implant biomaterial.[4] Because osseointegrated implants are
E‑mail: [email protected]
“ankylosed” and do not have the same mobility as natural teeth
with a PDL, efforts have been made for years to compensate Submitted: 08‑03‑2019 Revised: 31-07-2019
Accepted: 28-02-2020 Published: 08-06-2020
for this obvious difference by “shock‑absorbing systems” built
into the implant or its suprastructure.[5]
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DOI: How to cite this article: Saleem M, Kaushik M, Ghai A, Tomar N, Singh S.
10.4103/ams.ams_58_19 Ligaplants: A revolutionary concept in implant dentistry. Ann Maxillofac
Surg 2020;10:195-7.

© 2020 Annals of Maxillofacial Surgery | Published by Wolters Kluwer ‑ Medknow 195

 Saleem, et al.: Ligaplants: A revolutionary concept in implant dentistry

4. It contains vital cells such as osteoclasts, osteoblasts, and differentiation is seen as this deliberate trauma triggers a
fibroblasts, cementoblasts, cementoclasts, and most healing process within the PDL.
importantly, the undifferentiated mesenchymal stem cells
The transplantation of the tooth can be performed with millions
5. These cells are all important in the dynamic relationship
of cells attached to its root by new Sharpey’s fibers after
between the tooth and the bone.[6] 14 days, when the cell culture reaches its peak of activity.
Buser et al.[9] showed that titanium dental implants when placed
Advantages in contact with retained root tips, the PDL of these roots served
1. It alleviates problems such as gingival recession and bone as a source for cells which could populate the implant surface
defects of the missing tooth during healing. Now, tissue engineering has opened a new vista
2. Mimics natural insertion of natural tooth roots in the in periodontal regeneration and more so in the treatment of
alveolar process dental implants. From various scaffolds to matrices, all have
3. Ligaplants become firmly integrated without interlocking proved their ability to regenerate the entire periodontium. In
and without direct bone contact, despite the initial fitting another study, Gault et al.[4] used ligaplants (combination of
being loose to spare PDL cell cushion.[7] PDL cells with implant biomaterial) for tooth replacement.
The study involved animal experiments on mice and canine
Disadvantages models as well as human clinical investigation. In the canine
model, PDL formation was observed and a new layer of
1. The culturing of ligaplants should be done with caution.
tissue resembling repair cementum was formed on the
i.e., the temperature, the cells that are used for culturing,
ligaplant surface. In humans, after surgery, a desmodontal
the duration of the culturing, and others. If some problem
gap, corresponding to PDL space of normal width, was
evokes during the culturing, the ligaplants may fail as other
evident around one ligaplant, and the structure of the lamina
nonperiodontal cells may develop
dura resembled that around a natural tooth. In one ligaplant,
2. Besides, the cost of this implant is high due to limited
radiographs indicated that it had moved inside apparently intact
facilities
bone, indicating the presence of newly formed PDL.
3. The factors affecting the host to accept the implant or the
growth of PDL in the socket is unpredictable, which may In the field of periodontal regeneration, debates still exist
result in failure of implant[6] on the type of cells possessing the capability of forming
4. The prolonged cell culturing may favor the appearance of new cementum on previously exposed root surfaces. Some
non‑PDL cell types.[4] authors reported[7,9] that cells residing in the alveolar bone
are responsible for cementum production, whereas some
investigators[5,6] reported that only PDL cells can produce
Discussion cementum, revealing the significance of PDL around dental
Clinical importance of ligaplants implants.[10]
For reconstruction and regeneration, the important elements
required are as follows: Kiong and Arjunkumar[11] stated that ligaplants as tooth
• Matrix or a scaffold replacement have decisive advantages as compared with
• Signaling molecules osseointegration devices, due to their periodontal tissue
• Cells. regeneration. The ligaplants surgery is moderately simple,
because the implant is not tightly fitted to its site. Besides
Tissues prepared in laboratory are cultivated with In vitro that, the patient may not have to undergo bone grafting,
technique. The cells are cultured on the biodegradable scaffolds inconvenience, and discomfort with the ligaplants placement.
or matrix with the help of signaling molecules, following
which they are transplanted into the body. Whereas, when all Success of the Ligaplants??
the cultivated vital elements are placed in a tissue defect and
undergoes a natural healing process in the body giving rise to The development of a regenerative PDL depends on
regeneration, it is called as in vivo technique. site‑specific signaling, which in turn is mediated by an anatomic
code, written in expression patterns of homeogene‑coded
It induces intrinsic healing activity at the site of tissue defect transcription factors. Hence, the homeoproteins influence
using the three elements. This can be done by both in vitro the synthesis of cell surface and signaling components, and
and in vivo.[8] signals from the cell surface feedback to modulate homeogene
expression, whereby cell identities are established according
Procedure to the anatomic site and tissue type.[5]
Transplantation of tooth with double PDL stimulation is
one of the best examples of its healing capacity. The donor Risk Factors of Ligaplants
tooth is extracted and immediately replanted in its original The development of PDL for the generation of PDL depends
alveolus, 14 days before transplantation. Cell proliferation majorly on site signaling, which is largely mediated by

196 Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020

 Saleem, et al.: Ligaplants: A revolutionary concept in implant dentistry

anatomic code and homeogene‑coded transcription factors. References

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Annals of Maxillofacial Surgery ¦ Volume 10 ¦ Issue 1 ¦ January-June 2020 197

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