Junctional epithelium and hemidesmosomes: Tape and rivets for solving the “percutaneous device dilemma” in dental and other permanent implants

• Published in: Bioactive materials 2022-12, Vol.18, p.178-198
• Main Authors: Fischer, Nicholas G., Aparicio, Conrado
• Format: Article
• Language: English
• Subjects: Bioinspired surfaces; Hemidesmosome; Junctional epithelium; Percutaneous device; Percutaneous implant; Review
• ISSN: 2452-199X; 2452-199X
• DOI: 10.1016/j.bioactmat.2022.03.019

The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the “device”/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant – as a model percutaneous device – placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists. [Display omitted] •Implanted percutaneous medical and dental devices frequently fail due to infection.•The naturally percutaneous tooth provide inspiration as it can last a patient's entire lifespan.•The tooth's hemidesmosome formation and junctional epithelium maybe useful to mimic.•Biomaterial strategies to promote hemidesmosomes will be useful to prevent infection and failure.•Future collaboration between clinicians, engineers, and matrix biologists are needed.