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Simple Summary  In recent years, zirconia dental implant systems, also known as “ceramic implants”, became an alternative to the commonly used titanium implants. The clinical success of dental implants depends on several factors, particularly on the soft tissue formation around the implant abutment, but the implant surfaces, which at most support this process, are still to be found. In the present study, we cultured human gingival cells on surfaces that were made from either titanium or zirconia. These surfaces were differently treated and, subsequently, had different roughness: some surfaces were machined and smooth, whereas other surfaces were sand-blasted and rough. The cells ability to attach and grow was slightly decreased by rougher surfaces, whereas no effect of implant material was observed. Furthermore, the expression of some proteins mediating cell attachment to the surface was strongly affected by the roughness and only marginally by the implant material. We concluded that the behavior of gingival cells is primarily influenced by surface roughness, whereas no apparent advantage of either material could be observed. This suggests the importance of surface makeup in relation to how soft tissue healing around the implant is promoted and might provide new approaches for future research.    Abstract  Due to the rising demand for zirconia (Zr) based implant systems, it is important to understand the impact of Zr and titanium (Ti) implants and particularly their topography on soft tissue healing. As human gingival fibroblasts (hGFs) are the predominant cells in peri-implant soft tissue, we focused on examining the effect of implant material and surface roughness on hGFs’ initial attachment, growth and the expression of proteins involved in the focal adhesion. hGFs isolated from eight healthy donors were cultured on the following surfaces: smooth titanium machined surface (TiM), smooth zirconia machined surface (ZrM), moderately rough titanium surface (SLA), or moderately rough zirconia surface (ZLA) for up to 14 days. The initial attachment of hGFs was evaluated by scanning electron microscopy. Cell proliferation/viability was assessed by cell counting kit 8. Focal adhesion and cytoskeleton were visualized by a focal adhesion staining kit. The gene expression of focal adhesion kinase (FAK), α-smooth muscle actin (α-SMA), and integrin subunits ITG-β1, ITG-β4, ITG-α4, ITG-α5, ITG-α6, was evaluated by qPCR. Cell proliferation/viability was slightly decreased by moderately rough surfaces, whereas no effect of surface material was observed. Cell morphology was strikingly different between differently treated surfaces: on machined surfaces, cells had elongated morphology and were attached along the grooves, whereas on moderately rough surfaces, cells were randomly attached. Surface roughness had a more pronounced effect on the gene expression compared to the surface material. The expression of FAK, α-SMA, ITG-β4, ITG-α5, and ITG-α6 was enhanced by moderately rough surfaces compared to smooth surfaces. Within the limitations of this in vitro study, it can be concluded that the behavior of primary hGFs is primarily affected by surface structure, whereas no apparent advantage of Zr over Ti could be observed.

Impact of Implant Surface Material and Microscale Roughness on the Initial Attachment and Proliferation of Primary Human Gingival Fibroblasts