Correlation between peri-implant sulcular fluid rate and expression of collagenase2 (MMP8)

Oral Fluid Biomarkers for Peri-Implantitis: A Scoping Review

Peri-implantitis, a prevalent complication in dental implant therapy, poses a significant threat to long-term implant success. The identification of reliable biomarkers for the early detection and monitoring of peri-implantitis is crucial for timely intervention and improved treatment outcomes. Salivary and peri-implant sulcular fluid (PISF) biomarkers have become promising diagnostic tools in the field of implant dentistry. This scoping review aims to explore current studies in the literature on salivary and PISF biomarkers for peri-implantitis. A systematic search was conducted on 2 databases (PubMed and Scopus) to identify relevant studies published up to January 2023. A total of 86 articles were included, which underwent data extraction and analysis. Several biomarkers have been investigated in salivary and PISF samples for association with peri-implantitis. Investigations included a wide range of biomarkers, including inflammatory markers, matrix metalloproteinases and bone loss markers. The findings suggested that certain salivary and PISF biomarkers demonstrated potential in distinguishing healthy peri-implant conditions from peri-implantitis. Elevated levels of proinflammatory cytokines, such as interleukin-1β (IL-1β) and interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and matrix metalloproteinases, have been consistently associated with peri-implantitis. Additionally, alterations in bone loss markers have shown potential as indicators of disease progression and treatment response. In conclusion, this scoping review provides an overview of current knowledge on salivary and PISF biomarkers for peri-implantitis. The identified biomarkers are promising as noninvasive diagnostic tools for early detection, monitoring, and personalised management of peri-implantitis. Future studies should focus on establishing standardised protocols and conducting well-designed clinical trials to validate the diagnostic accuracy and clinical relevance of these biomarkers.

The burden of diabetes on the soft tissue seal surrounding the dental implants

Soft tissue seal around implant prostheses is considered the primary barrier against adverse external stimuli and is a critical factor in maintaining dental implants' stability. Soft tissue seal is formed mainly by the adhesion of epithelial tissue and fibrous connective tissue to the transmembrane portion of the implant. Type 2 diabetes mellitus (T2DM) is one of the risk factors for peri-implant inflammation, and peri-implant disease may be triggered by dysfunction of the soft tissue barrier around dental implants. This is increasingly considered a promising target for disease treatment and management. However, many studies have demonstrated that pathogenic bacterial infestation, gingival immune inflammation, overactive matrix metalloproteinases (MMPs), impaired wound healing processes and excessive oxidative stress may trigger poor peri-implant soft tissue sealing, which may be more severe in the T2DM state. This article reviews the structure of peri-implant soft tissue seal, peri-implant disease and treatment, and moderating mechanisms of impaired soft tissue seal around implants due to T2DM to inform the development of treatment strategies for dental implants in patients with dental defects.

Expression of Interleukin-17, Tumor Necrosis Factor-Alpha, and Matrix Metalloproteinase-8 in Patients with Chronic Peri-Implant Mucositis

Background

The present study aimed to evaluate whether non-surgical treatment interferes with clinical parameters and local patterns of osteo-immunoinflammatory mediators (IL-17 and TNF-α) and matrix metalloproteinase-8 (MMP-8) that are found in peri-implant crevicular fluid (PICF) and biofilms during the progression of peri-implant mucositis.

Material/Methods

We selected 30 patients with peri-implant caused mucositis before (MP) and after treatment (TP) and 30 healthy people (HP) for the analysis of IL-17, TNF-α cytokine, and MMP-8 production in PICF and for analysis of colonization dynamics of periodontopathogenic bacteria in supra- and subgingival plaque samples. The levels of IL-17 and MMP-8 concentrations in samples were assayed by enzymatic immunosorbent assay (ELISA) and TNF-α levels were determined by enzyme amplified sensitivity immunoassay (EASIA) method in PICF. The micro-IDent test was used to detect 11 species of periodontopathogenic bacteria in subgingival biofilm.

Results

We found significantly (P<0.001) higher levels of IL-17, TNF-α, and MMP-8 in the PICF of the MP and TP groups in comparison to the HP group. A significant association was found in MP associated with Parvimonas micra, as TNF-α in PICF was significantly higher (P=0.034) than in patients without Parvimonas micra. TNF-α levels in the samples of PICF showed a moderate correlation with clinical parameters, including plaque index (PI) (P=0.007) and MMP-8 levels (P=0.001), in the MP group.

Conclusions

Assessment of levels of inflammatory cytokines in PICF can aid in the identification of peri-implant mucositis, which can assist in early diagnosis, prevention, and treatment.

Biomarker levels in peri-implant crevicular fluid of healthy implants, untreated and non-surgically treated implants with peri-implantitis

AIM

To compare biomarker levels in peri-implant crevicular fluid (PICF) of healthy implants with levels in PICF of implants with peri-implantitis (before and after non-surgical treatment).

MATERIALS AND METHODS

Samples were taken from 20 healthy implants (n = 17 patients) and from 20 implants with peri-implantitis (n = 19 patients) before and 3 months after non-surgical treatment using the Airflow Master Piezon^® (EMS). A Luminex™ assay was used to evaluate pro-inflammatory and anti-inflammatory cytokines IL-1β, TNF-α, IL-6 and G-CSF, collagen degradation enzyme MMP-8, chemokines MCP-1 & MIP-1α/CCL3, bone markers OPG and sRANKL and interferon-γ. Clinical and radiographical characteristics were assessed. A Mann-Whitney U and Wilcoxon signed-rank test analysed between- and within-group differences.

RESULTS

IL-1β and MMP-8 levels were found significantly elevated in implants with peri-implantitis (p = .007; p = <.001, respectively). No difference in levels of TNF-α, IL-6, MCP-1 and MIP-1α/CCL3, OPG and G-CSF between healthy and diseased implants was found. Levels of sRANKL and INF-γ were under the level of detection. None of the biomarker levels improved after non-surgical therapy, and levels of IL-1β and MMP-8 remained high.

CONCLUSION

Implants diagnosed with peri-implantitis have higher levels of IL-1β and MMP-8 in PICF compared to healthy implants. Non-surgical therapy did not influence the inflammatory immune response.

Levels of Gene Expression of Immunological Biomarkers in Peri-Implant and Periodontal Tissues

This study compared the gene expression of the immunoinflammatory markers interleukin (IL)-6, IL-1ß, and tumor necrosis factor alpha (TNF-α), the matrix metalloproteinases (MMP)-1, -2, -8, and -9, and the tissue inhibitors of matrix metalloproteases (TIMP)-1 and -2 in the gingival tissue of individuals with periodontal and peri-implant disease. The study population included individuals with four periodontal statuses: periodontal health (PH group, n = 20); periodontitis (P group, n = 20); peri-implant health (PIH group, n = 20), and peri-implantitis (PI group, n = 20). Gingival biopsies were collected from one tooth per patient according to the inclusion criteria of each group. The mRNA levels of IL-6, IL-1ß, TNF-α, MMP-1, MMP-2, MMP-8, MMP-9, TIMP-1, and TIMP-2 were evaluated by qPCR. The levels of IL-1ß were significantly higher in the PI group when compared to the other groups (p < 0.05), while the levels of IL-6 were significantly higher in the groups with periodontal and peri-implant disease when compared with the healthy groups (p < 0.05); however, the levels of IL-6 did not differ between the PI and P groups (p > 0.05). For all other studied biomarkers, no significant differences were observed between groups (p > 0.05). IL-6 and IL-1ß presented higher levels of mRNA in diseased periodontal and peri-implant tissues. However, the expression of metalloproteinases and their inhibitors did not differ between the different periodontal statuses.

Diagnostic Accuracy of Oral Fluids Biomarker Profile to Determine the Current and Future Status of Periodontal and Peri-Implant Diseases

Severe periodontitis is ranked as the sixth most prevalent disease affecting humankind, with an estimated 740 million people affected worldwide. The diagnosis of periodontal diseases mainly relies upon assessment of conventional clinical parameters. However, these parameters reflect past, rather than current, clinical status or future disease progression and, likely, outcome of periodontal treatment. Specific and sensitive biomarkers for periodontal diseases have been examined widely to address these issues and some biomarkers have been translated as point-of-care (PoC) tests. The aim of this review was to provide an update on PoC tests for use in the diagnosis and management of periodontal diseases. Among the PoC tests developed so far, active matrix metalloproteinase-8 has shown promising results in terms of diagnostic and prognostic values. However, further studies are required to increase the sensitivity and specificity via combining more than one biomarker and merging these test kits with periodontal risk assessment tools. Furthermore, the validity of these test kits needs to be investigated by applying the results in further independent studies and the impact on these test kits’, together with the results of risk factors for periodontal diseases, such as diabetes and smoking, also needs to be examined.

Matrix Metalloproteinase 9 is Regulated by LOX-1 and erk1/2 Pathway in Dental Peri-Implantitis

BACKGROUND AND OBJECTIVE

Dental peri-implantitis, which can be caused by several different microbial factors, is characterized by inflammatory lesions of the surrounding hard and soft tissues of an oral implant. Matrix Metalloproteinase 9 (MMP9) is thought to be involved in the pathogenesis of peri-implantitis. However, the regulatory mechanism of MMP9 in peri-implantitis has not been fully elucidated. In this study, we tried to evaluate the regulatory mechanism of MMP9 in peri-implantitis.

METHODS

We collected Peri-Implant Crevicular Fluid (PICF) from ten healthy implants and ten periimplantitis patients and compared their expression level of MMP9. We also cultured macrophages from the peripheral blood of healthy volunteers infected by Porphyromonas gingivalis to reveal the regulatory mechanism of MMP9 in peri-implantitis. Western blot, immunofluorescence staining and quantitative Polymerase Chain Reaction (RT-PCR) were used to better characterize the mechanism of MMP9.

RESULTS

The expression of MMP9 was up-regulated in peri-implantitis patient PICF and P. gingivalis infected human macrophages. LOX-1, not dectin-1, was found to mediate MMP9 expression in human macrophages with P. gingivalis infection. Expression of Erk1/2 was responsible for infection-induced MMP9 expression. Finally, use of a broad-spectrum metalloproteinase inhibitor impaired LOX-1 expression in infected macrophages.

CONCLUSION

Our results demonstrate that MMP9 is involved in dental peri-implantitis and is regulated by LOX-1 and Erk1/2. This LOX-1/MMP9 signaling pathway may represent a potential drug target for peri-implantitis.

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy - A Randomized Clinical Trial

Running head

Peri-implant maintenance with CHX

Abstract

Background: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.

LOX-1 is involved in TLR2 induced RANKL regulation in peri-implantitis

PURPOSE

To explore whether receptor activator of nuclear factor kappa-B ligand (RANKL) is involved in the nosogenesis of peri-implantitis and to reveal the regulatory mechanism in Porphyromonas gingivalis induced RANKL production.

METHODS

Therefore, we collected peri-implant crevicular fluid (PICF) and gingival tissues from healthy implants and peri-implantitis patients. The expression of RANKL in samples was tested by ELISA, Western blot and immunofluorescence staining. The production of RANKL in THP-1 macrophages stimulated with P. gingivalis was detected by qRT-PCR and Western blot. Then macrophages were pre-treated with neutralizing antibodies of Toll-like receptor 2 (TLR2) or lectin-type oxidized LDL receptor 1 (LOX-1) and inhibitors of TLR2, LOX-1 or Erk1/2 before P. gingivalis stimulation to evaluate the roles of TLR2, LOX-1 and Erk1/2 in RANKL production by qRT-PCR and Western blot.

RESULTS

The protein level of RANKL was higher in PICF of peri-implantitis patients than healthy implants. We observed increased RANKL expression in P. gingivalis infected macrophages compared to controls. RANKL induced by P. gingivalis stimulation was mediated by TLR2 and Erk1/2 signaling pathway in THP-1 macrophages. LOX-1 is involved in TLR2 induced RANKL expression.

CONCLUSION

RANKL was involved in peri-implantitis, and regulated by TLR2, LOX-1 and Erk1/2 signaling against P. gingivalis infection. As the novel inflammation pathway triggers, TLR2 and LOX-1 which mediate RANKL production seems to be potential drug targets of peri-implantitis.

Detection of peri-implant inflammation by the use of a matrix metalloproteinase-8 chair-side test

BACKGROUND

Active matrix metalloproteinase-8 (MMP-8) enzymes are associated with inflammation and the degradation of implant-supporting tissues. A high concentration of these enzymes in the peri-implant sulcular fluid (PISF) has been associated with a pathological condition. The aim of the present study was to evaluate the ability of a chair-side MMP-8 test to individuate pathological peri-implant site. The working hypothesis is that positive response to MMP-8 test corresponds to pathological values of periodontal indexes. A secondary working hypothesis is that PISF sampling method influences the test accuracy.

METHODS

Fifty implants from 50 patients were evaluated during scheduled follow-up appointments in a clinical setting using the MMP-8 chair-side test and periodontal indices (probing depth, bleeding on probing, plaque index and peri-implant inflammation index). Two methods of PISF sampling were tested.

RESULTS

The MMP-8 test demonstrated significant diagnostic capacity and good sensitivity and accuracy regarding indices of bleeding on probing, plaque index, and peri-implant inflammation index but fair agreement.

CONCLUSIONS

Further studies should be performed to better define the interpretation of the MMP-8 chair-test results and their correlation to peri-implant indexes.

Periodontal disease, peri-implant disease and levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TGF-β and TNF-α: follow-up over 5 years

OBJECTIVE

The aim of this study was to evaluate the levels of salivary biomarkers IL-1β, IL-10, RANK, OPG, MMP-2, TG-β and TNF-α in individuals with diagnosis of peri-implant mucositis in the absence or presence of periodontal and peri-implant maintenance therapy (TMPP) over 5 years.

MATERIAL AND METHODS

Eighty individuals diagnosed with peri-implant mucositis were divided into two groups: one group that underwent periodontal and peri-implant regularly maintenance therapy, called GTP (n=39), and a second group that received no regular maintenance GNTP (n=41). Each participant underwent a complete periodontal and peri-implant clinical examination. Collection of saliva samples and radiographic examination to evaluate peri-implant bone levels were conducted at two times: initial examination (T1) and after 5 years (T2). The salivary samples were evaluated through ELISA for the following markers: IL-1β, IL-10, RANK, OPG, MMP-2, TGF and TNF-α.

RESULTS

A higher incidence of peri-implantitis was observed in the GNTP group (43.9%) than in the GTP group (18%) (p=0.000). All individuals (n=12) who presented peri-implant mucositis and had resolution at T2 were in the GTP group. After 5 years, there was an increase in the incidence of periodontitis in the GNTP group compared to the GTP group (p=0.001). The results of the study revealed an increase in the salivary concentration of TNF-α in the GNTP group compared to the GTP group. The other salivary biomarkers that were evaluated did not show statistically significant differences between the two groups.

CONCLUSIONS

The salivary concentration of TNF-α was increased in individuals with worse periodontal and peri-implant clinical condition and in those with a higher incidence of peri-implantitis, especially in the GNTP group. Longitudinal studies in larger populations are needed to confirm these findings and elucidate the role of this biomarker in peri-implant disease.

Matrix Metalloproteinase-8 as an Inflammatory and Prevention Biomarker in Periodontal and Peri-Implant Diseases

Levels of and especially the degree of activation of matrix metalloproteinase (MMP-8) in oral fluids (i.e., saliva, mouth rinse, gingival crevicular fluid (GCF) and peri-implantitis sulcular fluid (PISF)) increase to pathologically elevated levels in the periodontal and peri-implant diseases. This study aimed at collecting and collating data from previously published studies and determining whether active MMP-8 (aMMP-8) could serve as a biomarker for the diagnosis and prevention of periodontal and peri-implant diseases. The literature search identified a total of 284 articles. Out of 284 articles, 61 articles were found to be relevant. Data obtained from the selected studies were combined, and it indicated that aMMP-8 in oral fluids exerts the strong potential to serve as a useful adjunctive diagnostic and preventive biotechnological tool in periodontal and peri-implant diseases. aMMP-8 can be used alone or in combination with other proinflammatory and/or microbiological biomarkers.

Differential expressions of biomarkers in gingival crevicular fluid of Han and Uygur populations with peri-implantitis

This study aims to investigate and compare the biomarkers in the gingival crevicular fluid between the Han and Uygur subjects with healthy implants and peri-implantitis.Totally 80 subjects were divided into the H-case (Han patients with peri-implantitis), U-case (Uygur patients with peri-implantitis), H-control (Han subjects with healthy implants), and U-control (Uygur subjects with healthy implants) groups. Cytokine levels in the gingival crevicular fluid were detected, and the dominant bacteria species were analyzed.The matrix metalloproteinase (MMP)-13 level in the gingival crevicular fluid in the U-control group was significantly higher than the H-control group, whereas the C-reactive protein level in the H-control group was significantly higher than in the U-control group. No significant difference was observed in the dominant subgingival bacteria species between the H- and U-control groups. The levels of interleukin (IL)-1β and MMP-8 were significantly higher in the H-case group than the U-case group, whereas the IL-17A level in the U-case group was significantly higher. The shared dominant subgingival bacteria species of the case groups mainly included Prevotella, clostridium, Porphyromonas, treponema, Streptococcus, neisseria, and hemophilus. Moreover, Acinetobacter, Micrococcus, and Moraxella were found to be the specific dominant subgingival bacteria species for the U-case group. In addition, compared with the H-case group, the IL-1β levels were negatively correlated with Acinetobacter, Micrococcus, and Moraxella in the U-case group.Han and Uygur populations with healthy implants and peri-implantitis have differentially expressed cytokines in the gingival crevicular fluid. Moreover, dominant subgingival bacteria species differ between the Han and Uygur populations with peri-implantitis.

Evaluation of Metalloproteinase-8 Levels in Crevicular Fluid of Patients with Healthy Implants or Periodontitis

Evaluation of periodontal and peri-implant tissue condition is mainly based on clinical examination and imaging diagnostics. Some data imply that Metalloproteinase-8 (MMP-8) level examination in peri-implant sulcular fluid (PISF) might be useful for evaluating the condition of peri-implant tissues and monitoring a development of peri-implant inflammation, including both mucositis and peri-implantitis. Hence, in this study, we decided to evaluate the level of MMP-8 in PISF obtained from patients without clinical symptoms of mucositis or peri-implantitis and compare it with MMP-8 level in gingival crevicular fluid (GCF) obtained from patients with healthy periodontium and those with varying severity of periodontitis. A total of 189 subjects were included in the study, and GCF/PISF samples were analysed for MMP-8 level by ELISA test. We documented that MMP-8 level in PISF obtained from patients without symptoms of mucositis or peri-implantitis was significantly higher not only than in GCF of periodontally healthy patients but also, which seems to be very interesting, than in GCF of patients with varying degrees of periodontal inflammation, consistent with earlier studies. Our observation might imply that monitoring of MMP-8 level in PISF could help to diagnose mucositis/peri-implantitis in an early stage, prior to clinical manifestations, which may allow for quick start of appropriate therapy.