Intraosseous Transcutaneous Amputation Prostheses vs Dental Implants: A comparison between keratinocyte and gingival epithelial cell adhesion in vitro.

INTRODUCTION In the 1960’s Brånemark successfully pioneered the use of transcutaneous implants in the dental field, however subsequent attempts to translate these findings into a solution for amputees have been beset with complications. Infection is the primary failure modality because the skin breach provides a route for pathogens to enter the body. Intraosseous transcutaneous amputation prostheses (ITAP) are being developed to overcome this problem by creating a seal at the skinimplant interface to prevent bacterial invasion and provide secure artificial limb attachments for amputees. For ITAP to be successful a tight seal between cells in the epidermis and the implant is essential. Oral gingival epithelial cell adhesion creates an infection free seal around dental implants; however this has yet to be demonstrated outside the oral environment. All epithelial cells attach via hemidesmosomes (HD) and focal adhesions (FA) and their expression is an indicator of the efficiency of cell adhesion. The aim of this study was to compare epidermal keratinocyte and oral gingival epithelial cell adhesion to titanium alloy in vitro to determine whether these two cell types differ in their speed and strength of adhesion to titanium alloy. It was hypothesised that oral gingival epithelial cells attach to titanium alloy earlier than epidermal keratinocytes; with earlier and greater expression of hemidesmosomes and focal adhesions.