Evaluation of Implant Abutment–Soft Tissue Attachment Using 3D Tissue-Engineered Oral Mucosa: A Systematic Review

Abstract

Objective: Three-dimensional (3D) tissue–engineered oral mucosa models offer a physiologically relevant platform to study interactions between implant abutment materials and peri-implant soft tissues. While osseointegration is well-characterized, soft tissue sealing, essential for preventing infection and maintaining implant stability, remains thoroughly underexplored. Despite many in vitro studies using these models, a comprehensive evaluation in this field is lacking. This study systematically reviews current evidence to guide future research and improve clinical outcomes. Methods: PubMed, Scopus, and Embase were searched (31 March 2026) following preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines, identifying 1551 records. After removing 623 duplicates, 227 records were screened (204 excluded); 23 full texts were assessed (nine excluded), yielding 14 studies using human 3D oral mucosa models (3D-OMMs) to assess implant abutment interfaces. Results: All 14 studies used epithelial-fibroblast cocultures replicating native mucosal architecture. Histological analyses confirmed stratified squamous epithelium formation, with some studies showing epithelial surface maturation via immunohistochemistry. Epithelial interface–associated biological response to different implant surfaces has been assessed using electron microscopy. Surface modifications like anodization, UV treatment, and increased hydrophilicity improved cell adhesion and interface organization. However, permeability and postpull-out metabolic activity assays suggested that barrier function and residual tissue viability were generally similar across materials, although specific surface treatments improved some outcomes. Molecular studies highlighted that peri-implant mucosa interactions with oral biofilms are crucial for maintaining or disrupting tissue homeostasis by modulating immune responses. Conclusions: 3D-OMMs reliably recapitulate peri-implant tissue responses. Overall, the available in vitro evidence suggests that surface modification and host–microbe interactions may influence mucosal homeostasis and barrier integrity, although findings remain heterogeneous and should be interpreted cautiously.