Elastase, alpha2-macroglobulin and alkaline phosphatase in crevicular fluid from implants with and without periimplantitis

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.

Enzymes in Peri-implant Sulcular Fluid: A Window into Periodontal Health - A Comprehensive Review

Enzymes in peri-implant sulcular fluid (PISF) have emerged as essential biomarkers in the field of periodontics, providing critical insights into the health and stability of dental implants. This essay explores the significance of various enzymes in PISF, including matrix metalloproteinases (MMPs), elastase, alkaline phosphatase, acid phosphatase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT), in assessing the local inflammatory environment and diagnosing peri-implant diseases. The analysis of these enzymes facilitates early detection of complications, personalized treatment planning, and long-term monitoring, emphasizing the need for a multidisciplinary approach to patient care. Collaboration among dental professionals and patient education is crucial in ensuring the successful management and maintenance of dental implants. Understanding the role of enzymes in PISF and their implications in periodontal health underscores their significance in contemporary periodontics and emphasizes the need for ongoing research and technological advancements.

Biomarkers from Peri-Implant Crevicular Fluid (PICF) as Predictors of Peri-Implant Bone Loss: A Systematic Review

The aim of the present systematic review is to summarize current knowledge regarding the analysis of biomarkers extracted from peri-implant crevicular fluid (PICF) as predictors of peri-implant bone loss (BL). An electronic search was conducted on three databases, PubMed/MEDLINE, Cochrane Library, and Google Scholar, to find clinical trials published until 1 December 2022 suitable to answer the following focused question: in patients with dental implants, are biomarkers harvested from PICF predictive of peri-implant BL? The initial search yielded a total of 158 entries. After a full-text review and application of the eligibility criteria, the final selection consisted of nine articles. The risk of bias in included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools (JBI). According to the present systematic review, some inflammatory biomarkers harvested from PICF (collagenase-2, collagenase-3, ALP, EA, gelatinase b, NTx, procalcitonin, IL-1β, and several miRNAs) seem to be correlated with peri-implant BL and may assist in the early diagnosis of pathological BL, that characterizes peri-implantitis. MiRNA expression demonstrated a predictive potential of peri-implant BL that could be useful for host-targeted preventive and therapeutic purposes. PICF sampling may represent a promising, noninvasive, and repeatable form of liquid biopsy in implant dentistry.

Etiology, occurrence, and consequences of implant loss

Implant therapy aims at providing the patient with a functional and esthetically pleasing rehabilitation in a long‐term perspective. The loss of an implant constitutes a major complication, which may have an impact on the treatment plan and/or jeopardize the longevity of the restoration. Implant loss may occur during the phase of osseointegration (early) or at a later time when the previously achieved osseointegration is lost (late). The present work evaluates the evidence on the occurrence of both events and discusses etiology, risk factors, and consequences.

Effects of smoking on the bone alkaline phosphatase in peri-implant crevicular fluid and implant stability quotient around implants before loading

We aimed to examine the implant stability quotient (ISQ), alveolar bone level measurements (ABL), and bone alkaline phosphatase (BALP) in peri-implant crevicular fluid (PICF) around implants in smokers and non-smokers before loading in 3 months. 44 dental implants were placed into smoker and non-smoker patients equally. ISQ was measured at baseline and 3 months after surgery. The levels of PICF BALP and alveolar bone were measured. ISQ values significantly increased in smokers and non-smokers in the 3rd month (p < 0.05). ABL measurements were lower at 3 months compared to baseline in both groups (p < 0.05). Although ISQ and ABL values were higher in non-smokers than smokers at 3 months, the difference between the groups did not show any statistical significance. The PICF BALP levels in the 3rd month changed in both groups. But, these differences were insignificant. Although some of the measurements presented differences between the groups during the assessment periods, they were not indicative of the hazardous effects of smoking on bone healing around implants after surgery till functional loading in 3 months. However, smoking is an important factor to be considered for osseo-integration outcomes. Further studies are needed to clarify the influence of smoking on osseo-integration.

Factors affecting the decision to rehabilitate the posterior maxilla following surgical closure of oroantral communications/fistulae - A cohort study

BACKGROUND

Search of the English literature yielded no studies assessing the chosen dental treatment following surgical closure of oroantral communication/oroantral fistula (OAC/OAF). The purpose of the present study was to assess factors affecting the decision to rehabilitate the posterior maxilla following surgical closure of OAC/OAF.

METHODS

Consecutive patients at a single center. A structured form served to collect the data. The differences between groups (cases with versus cases without restoration) were assessed statistically.

RESULTS

A total of 58/121 responding individuals (62.1% men). Average age 51.57 years. Average waiting time prior to restoration 10.34 months. Most (51.7%) healthy. Most had a dental etiology (60.3%). Thirty-nine (67.2%) patients had a restoration of the posterior maxilla. Most of the patients responded that the reason not to do any restoration is the fear of failure (65.5%). Most of the patients completed the restoration procedure in a private clinic (87.2%). Only one patient (2.6%) reported a complication. Approximately half of the patients had implant supported prosthesis (ISP) following sinus augmentation (48.3%) with delayed implant placement. Most of the patients responded that the reason not to have ISP was the fear of failure (72.7%), and the rest responded because of financial issues (27.3%). For tooth supported restoration, most of the patients responded removable (90.9%).

CONCLUSIONS

Surgeons generally wait 6-12 months following surgical treatment of OAC/OAF prior to reconstruction with ISP. The chance for complications is low. Healthy women after dental induced OAC/OAF have the highest chances to seek for ISP in such circumstances.

Evaluation of the Effects of ß-Adrenergic Receptor-Propranolol on Osseointegration of the Titanium Implants

ABSTRACT

This study aimed to investigate the effects of systemic propranol on the osseointegration of titanium implants. After the surgical insertion of titanium implants into the metaphyseal part of the tibial bone, the rats were randomly divided into 2 equal groups: the control (CNT) (n = 10) and propranol group (P) (n = 10); CNT: Rats received no further treatment during the 4 week experimental period after surgery. Rats received 10 mg/kg propranol in every day during the 4 week experimental period in PRP group after the surgical insertion of the implants. After the experimental period, the rats were euthanized, blood serum were collected to biochemical analysis and the implants and surrounding bone tissues were used for the histopathologic analysis. To analysis of the data between tests and controls student T test was used. There were no significant differences in the biochemical parameters (alcaline phosphatase, calcium, phosphor) of the groups (P > 0.05). Bone implant connection (BIC) ratios was detected higher in test animals compared with the controls (P < 0.05). Systemic propranolol may increases titanium implant osseointegration.

A collagen membrane influences bone turnover marker in vivo after bone augmentation with xenogenic bone

Background

The aim was to compare early biochemical and histological osseous healing of chronic mandibular defects regenerated with bovine bone substitute with and without collagen membrane in vivo.

Methods

Eight weeks after formation of a lateral full-thickness perforating bone defect in the mandible of 40 rabbits, bovine bone substitute with (“+”;n = 20) and without (“-”;n = 20) collagen membrane was applied. Blood and bone was collected 24, 72 h, 7, 14 and 21 days after surgery. Total acid phosphatase, bone acid phosphatase, total alkaline phosphatase and bone alkaline phosphatase activities were compared between groups. Formation of new bone was quantified histologically for all time points.

Results

Twenty-four hours after surgery, bone alkaline phosphatase was significantly elevated in “+” group when compared to “-” (p=0.012). After 72 hours, all bone turnover markers except for total acid phosphatase (p=0.078) where significantly elevated in “+” (all p < 0.05). Fourteen days after surgery, the significant highest values for all bone turnover markers were detected in “-” (all p < 0.05). A significant difference in favor of group “-” could also be detected after 3 weeks in terms of both acid phosphatases (p < 0.05). In histology, no significant differences could be detected.

Conclusion

Bone regeneration with bovine bone substitute material and collagen membrane shows a significantly earlier bone remodeling activity but does not seem to influence formation of new bone in histological samples.

Relation between the stability of dental implants and two biological markers during the healing period: a prospective clinical study

OBJECTIVES

The purposes of this study were to examine the correlation between the stability of dental implants and bone formation markers during the healing period and to monitor the stability of dental implants using the resonance frequency analysis (RFA) method. The null hypothesis of the study is no correlation between the stability of dental implant and bone formation markers.

METHODS

The study is a prospective clinical study during the 3-month healing period of implant. At implant placement (PW Plus, Nakhon Pathom, Thailand) and after 1, 2, 3, 4, 6, 8, 10, and 12 weeks, RFA assessments were performed and gingival (GCF)/peri-implant crevicular fluids (PICF) were collected from ten patients. The level of osteocalcin (OC) was measured by using ELISA kits, and the level of alkaline phosphatase (ALP) activity was measured by colorimetric analysis. Repeated measures analysis of variance, the Friedman test, the Mann-Whitney U test, and the Pearson correlation were performed for data analysis.

RESULTS

There was a statistical decrease in the mean implant stability quotient (ISQ) values between 1 and 3 weeks (P < 0.05). The ISQ values recovered to the initial values at 4 weeks. There was no statistical difference in the ALP level at each measurement, while there was a statistical increase in the OC level at 6, 8, 10, and 12 weeks when compared with 1 week (P < 0.05). There was a significant correlation between ALP levels and ISQ values (r = 0.226, P < 0.05). There was a statistically significant correlation between OC levels and ISQ values at 1-12 weeks (r = 0.245, P < 0.05).

CONCLUSIONS

The ISQ values were weakly correlated with both ALP and OC. The three-thread-design implant showed a high stability through healing period.

Effects of Low-Level Laser Therapy in Orthodontic Patients on Immediate Inflammatory Response After Mini-Implants Insertion: A Preliminary Report

BACKGROUND

The primary stability of a mini-implant is crucial to treatment sequence since most orthodontic mini-implant failures occur at an early stage. Irritation or inflammation of peri-implant tissues has been related to decreasing mini-implant success.

PURPOSE

This study evaluates the effect of low-level laser therapy on initial inflammation after orthodontic mini-implants installation.

METHODS

Ten volunteers received two mini-implants (1.3 mm diameter, 7 mm length). One mini-implant was inserted on each side of the maxilla following manufacturer recommendation. On the right side, low-level laser therapy (LLLT) was applied (diode laser 660 nm, 40 mW, 1 min, 2.4 J of total energy). Peri-implant crevicular fluid (PGF) was obtained after 24 h (T1), 48 h (T2), and 72 h (T3) to identify levels of interleukin (IL)-6 and IL-8 around mini-implants and around upper first premolars.

RESULTS

An increase in interleukin levels was observed for both groups, compared to upper first premolar. PGF around nonirradiated mini-implants showed higher levels of IL-8. Levels of IL-6 24 h after mini-implant insertion were higher for laser group.

CONCLUSIONS

LLLT modulates the initial inflammation after the insertion of mini-implant, possibly increasing the mini-implant success prognostic and decreasing patient discomfort.

Pro-inflammatory cytokines at zirconia implants and teeth. A cross-sectional assessment

OBJECTIVES

The aim of this study was to compare the expression of host-derived markers in peri-implant/gingival crevicular fluid (PCF/GCF) and clinical conditions at ceramic implants and contralateral natural teeth. As a secondary objective, we compared zirconia implants with titanium implants.

METHODS

One zirconia implant (ZERAMEX® Implant System) and one contralateral natural tooth were examined in 36 systemically healthy subjects (21 males, 15 females, mean age 58). The levels of Il-1β, Il-1RA, Il-6, Il-8, Il-17, b-FGF, G-CSF, GM-CSF, IFNɣ, MIP-1β, TNF-α, and VEGF were assessed in PCF/GCF using the Bio-Plex 200 Suspension Array System. The plaque index (PI), gingival index (GI), probing depth (PD), and bleeding on probing (BOP) were assessed at six sites around each implant or tooth. Titanium implants were also assessed when present (n = 9).

RESULTS

The zirconia implants were examined after a loading period of at least 1.2 years (average 2.2 years). The mean PI was significantly lower at zirconia implants compared to teeth (p = 0.003), while the mean GI, PD, and BOP were significantly higher (p < 0.001). A correlation was found in the expression of Il-1RA, Il-8, G-CSF, MIP-1β, and TNF-α at zirconia implants and teeth. The levels of IL-1β and TNF-α were significantly higher at zirconia implants than at teeth. No significant differences were found between zirconia and titanium implants. A correlation was found between the levels of IL-1RA, IL-8, GM-CSF, and MIP-1β at zirconia and titanium implants.

CONCLUSIONS

The correlation in the expression of five biomarkers at zirconia implants and teeth, and of four biomarkers at zirconia and titanium implants, is compatible with the existence of a patient-specific inflammatory response pattern. Higher mean GI, PD, and BOP around implants suggests that the peri-implant mucosa may be mechanically more fragile than the gingiva.

CLINICAL RELEVANCE

Similar expression of selected biomarkers at zirconia implants and teeth and at zirconia and titanium implants reflects existence of patient-specific inflammatory response patterns.

Biomarkers associated with periimplant diseases

PURPOSE

Recently, implantology has shifted its focus from implant placement to periimplant disease early detection, prevention, and treatment. The purpose of this article was to review the current understanding of the biomarkers associated with periimplant diseases.

MATERIALS AND METHODS

A search of PubMed was conducted up to August 2013 with keywords "peri-implantitis" and "biomarkers." Selected articles addressed the relationship between biomarkers and periimplant mucositis or peri-implantitis.

RESULTS

Biomarkers have been shown to possess potential in detecting periimplant diseases. For example, interleukin (IL)-1β levels were shown to be a good marker to detect periimplant mucositis lesions before they progress to peri-implantitis. Matrix metalloproteinase (MMP)-8 levels in periimplant sulcus fluid may be useful for monitoring the progression of periimplant disease. Osteoprotegerin (OPG) and receptor activator of NFκB ligand (RANKL) were found to be significantly higher in peri-implantitis sites compared with healthy implant sites.

CONCLUSION

Biomarkers such as IL-1β, MMP-8, OPG, RANKL, and others have shown promising outcomes in differentiating from periimplant disease to health. However, because of varying results, additional evidence is needed to validate the links reported.

Peri-Implant Crevicular Fluid Analysis, Enzymes and Biomarkers: a Systemetic Review

OBJECTIVES

To review the current understanding of the biomarkers and enzymes associated with different forms peri-implant diseases and how their level changes influence the pathogenesis of the inflammatory diseases around dental implants.

MATERIAL AND METHODS

An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE between 1996 to 2016. Human studies analyse peri-implant crevicular fluid (PICF) biomarker and enzyme levels of implants having peri-implant mucositis and peri-implantitis published in English language, were evaluated. A systematic review was performed to assess which biomarkers and enzymes in PICF were used to identify the inflammatory conditions around dental implants.

RESULTS

Fifty-one articles were identified of which 41 were further evaluated and included in the analysis. Due to significant heterogeneity between included studies, a meta-analysis could not be performed. Instead, a systematic descriptive review was performed.

CONCLUSIONS

Biomarkers and enzymes in peri-implant crevicular fluid have shown promising results in differentiating from peri-implant disease condition to health. However, due to inconsistent results and acquiring much evidence from cross-sectional studies, additional evidence supported by randomized-controlled trials is needed to validate the links reported.

Peri-implant disease: what we know and what we need to know

Peri-implant disease is a serious problem that plagues today's dentistry, both in terms of therapy and epidemiology. With the expansion of the practice of implantology and an increasing number of implants placed annually, the frequency of peri-implant disease has greatly expanded. Its clinical manifestations, in the absence of a globally established classification, are peri-implant mucositis and peri-implantitis, the counterparts of gingivitis and periodontitis, respectively.

However, many doubts remain about its features. Official diagnostic criteria, globally recognized by the dental community, have not yet been introduced. The latest studies using metagenomic methods are casting doubt on the assumption of microbial equivalence between periodontal and peri-implant crevices. Research on most of the features of peri-implant disease remains at an early stage; moreover, there is not a commonly accepted treatment for it. In any case, although the evidence so far collected is limited, we need to be aware of the current state of the science regarding this topic to better understand and ultimately prevent this disease.

Experimental mucositis and experimental gingivitis in persons aged 70 or over. Clinical and biological responses

Objectives

To compare in persons aged 70 years or older the clinical and inflammatory changes occurring around implants and natural teeth during and after a phase of undisturbed plaque accumulation.

Material and methods

Twenty partially edentulous participants with titanium implants refrained from oral hygiene practices while being clinically monitored in weekly intervals for 21 days. Teeth and implants were then cleaned, oral hygiene resumed, and the participants were further monitored for 3 weeks. Twelve biomarkers were assessed in gingival and peri‐implant crevicular fluid (GCF, PCF).

Results

During 3 weeks of oral hygiene abstention, the gingival index (GI) continuously increased. On day 21, there were significantly more sites with GI >1 at implants than at teeth. After restarting oral hygiene, the GI decreased markedly in both groups. Throughout the experiment, the plaque index was significantly higher on teeth than on implants.

The different biomarkers reacted variably. IL‐1β increased significantly with plaque accumulation. IL‐1β, GM‐CSF, TNF‐α, and IFN‐γ were significantly higher in GCF compared to PCF at day 21. IL‐8 decreased significantly in GCF up to day 14. MIP‐1β decreased significantly in GCF, but not in PCF. At the 3‐week follow‐up, the levels of all biomarkers assessed in GCF and PCF had returned to baseline values.

Conclusions

In an elderly cohort, plaque accumulation induced an inflammatory reaction around both teeth and implants. Although there was less plaque accumulation on implants, the peri‐implant mucosa showed a stronger clinical response than gingiva.

Alpha-2-Macroglobulin Levels in Gingival Crevicular Fluid Pre- and Post-scaling and Root Planing with Adjunctive Tetracycline Fibers in Chronic Periodontitis: A Randomized Controlled Trial

BACKGROUND

This split-mouth clinical study aimed to investigate levels of alpha-2-macroglobulin (a2M) in gingival crevicular fluid (GCF) of chronic periodontitis patients pre- and post-scaling and root planing (SRP) with or without adjunctive use of tetracycline fibers.

MATERIALS AND METHODS

In 30 patients of chronic periodontitis, samples of GCF were collected from the gingival sulcus before SRP. Recording of clinical parameters was conducted. This was followed by local drug delivery (LDD) of tetracycline fibers in test sites. In control sites, no LDD was done. Second samples of GCF were taken 90 days after treatment. Samples of crevicular fluid were analyzed to determine the levels of a2m.

RESULTS

A gain of clinical attachment (CAL) of 3.30 mm for SRP and LDD and for SRP alone was 1.62 mm (p < 0.001). The pocket probing depth was significantly decreased by 2.43 mm for SRP and LDD and for SRP alone was 1.61 mm (p < 0.001) after 90 days. Alpha-2-macroglobulin was significantly reduced in GCF by SRP and SRP and LDD after 90 days (p < 0.001).

CONCLUSION

Clinical and biochemical variables showed a more favorable outcome when SRP was combined with LDD of tetracycline fibers in management of patients suffering from chronic periodontitis.

Levels of Myeloperoxidase and Alkaline Phosphatase in Periimplant Sulcus Fluid in Health and Disease and After Nonsurgical Therapy

PURPOSE

The study evaluated 2 biomarkers (myeloperoxidase [MPO] and alkaline phosphatase) along with clinical parameters in periimplant sulcus fluid (PISF) in conditions of periimplant health and disease. The effect of nonsurgical therapy was also evaluated on the biochemical and clinical parameters in diseased implants at 3 months after the baseline.

MATERIALS AND METHODS

A total number of 30 implants were studied in 20 subjects and divided into healthy group (group 1) and periimplant disease group (group 2). PISF was collected in both groups along with recording of clinical parameters. The periimplant disease group was then instituted a nonsurgical anti-infective therapy. The clinical and biochemical parameters were evaluated and compared at baseline and at the end of 3 months.

RESULTS

Group 2 showed statistically significant higher PISF MPO values at baseline as compared with groups 1 and 2 (at 3 months) (P < 0.001). Also, difference in the mean value of PISF MPO in group 2 (at 3 months) was greater than that in group 1 and was statistically nonsignificant (P = 1.85).

CONCLUSION

Within confines of the study, it can be concluded that evaluation of biochemical markers in PISF can be a useful diagnostic tool to aid the clinician in decision making regarding the management of the condition.

Clinical, microbiological, and immunological aspects of healthy versus peri-implantitis tissue in full arch reconstruction patients: a prospective cross-sectional study

Background

Due to the world-wide increase in treatments involving implant placement, the incidence of peri-implant disease is increasing. Late implant failure is the result of the inability to maintain osseointegration, whose most important cause is peri-implantitis. The aim of this study was to analyze the clinical, microbiological, and immunological aspects in the peri-implant sulcus fluid (PISF) of patients with healthy dental implants and patients with peri-implantitis.

Methods

PISF samples were obtained from 24 peri-implantitis sites and 54 healthy peri-implant sites in this prospective cross-sectional study. The clinical parameters recorded were: modified gingival index (mGI), modified plaque index (mPI) and probing pocket depth (PPD). The periodontopathogenic bacteria Tannerella forsythia, Treponema denticola and Porphyromonas gingivalis were evaluated, together with the total bacterial load (TBL). PISF samples were analyzed for the quantification of Interleukin (IL)-8, IL-1β, IL-6, IL-10 and Tumor Necrosis Factor (TNF)-α using flow cytometry (FACS).

Results

The mGI and PPD scores in the peri-implantitis group were significantly higher than the healthy group (p < 0.001). A total of 61.5% of the patients with peri-implantitis had both arches rehabilitated, compared with 22.7% of patients with healthy peri-implant tissues; there was no implant with peri-implantitis in cases that received mandibular treatment exclusively (p < 0.05). Concentrations of Porphyromonas gingivalis (p < 0.01), association with bacteria Porphyromonas gingivalis and Treponema denticola (p < 0.05), as well as the TBL (p < 0.05) are significantly higher in the peri-implantitis group. IL-1β (p < 0.01), IL-6 (p < 0.01), IL-10 (p < 0.05) and TNF-α (p < 0.01) are significantly higher at the sites with peri-implantitis compared to healthy peri-implant tissue, while IL-8 did not increase significantly.

Conclusion

The results of the present study involving a limited patient sample suggest that the peri-implant microbiota and which dental arch was rehabilitated involved could contribute to bone loss in peri-implantitis. A significant relationship is observed between the concentration of cytokines (interleukins 1β, 6 and 10 and TNF-α) and the inflammatory response in peri-implantitis tissue.

Single-blind randomized clinical trial to evaluate clinical and radiological outcomes after one year of immediate versus delayed implant placement supporting full-arch prostheses

Purpose: To evaluate and compare peri-implant health, marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses. Material and Methods: The present study was a prospective, randomized, single-blind, clinical preliminary trial. Patients were randomized into two treatment groups. In Group A implants were placed immediately post-extraction and in Group B six months after extraction. The following control time-points were established: one week, six months and twelve months after loading. Measurements were taken of peri-implant crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified gingival index and presence of mucositis. Implant success rates were evaluated for the two groups. The study sample included fifteen patients (nine women and six men) with a mean average age of 63.7 years. One hundred and forty-four implants were placed: 76 placed in healed sites and 68 placed immediately. Results: At the moment of prosthetic loading, keratinized mucosa width and probing depth were higher in immediate implants than delayed implants, with statistically significant differences. However, after six and twelve months, differences between groups had disappeared. Bone loss was 0.54 ± 0.39 mm for immediate implants and 0.66 ± 0.25 mm for delayed implants (p=0.201). No implants failed in either group. Conclusions: The present study with a short follow-up and a small sample yielded no statistically significant differences in implant success and peri-implant marginal bone loss between immediate and delayed implants with fixed full-arch prostheses. Peri-implant health showed no statistically significant differences for any of the studied parameters (crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified gingival index and presence of mucositis) at the twelve-month follow-up.

Key words:Immediate implants, delayed implants, peri-implant health, success rate.

Influence of occlusal loading on peri-implant clinical parameters. A pilot study

Objectives: To investigate the relation between occlusal loading and peri-implant clinical parameters (probing depth, bleeding on probing, gingival retraction, width of keratinized mucosa, and crevicular fluid volume) in patients with implant-supported complete fixed prostheses in both arches. Material and Methods: This clinical study took place at the University of Valencia (Spain) dental clinic. It included patients attending the clinic for regular check-ups during at least 12 months after rehabilitation of both arches with implant-supported complete fixed ceramo-metallic prostheses. One study implant and one control implant were established for each patient using the T-Scan®III computerized system (Tesco, South Boston, USA). The maxillary implant closest to the point of maximum occlusal loading was taken as the study implant and the farthest (with least loading) as the control. Occlusal forces were registered with the T-Scan® III and then occlusal adjustment was performed to distribute occlusal forces correctly. Peri-implant clinical parameters were analyzed in both implants before and two and twelve months after occlusal adjustment. Results: Before occlusal adjustment, study group implants presented a higher mean volume of crevicular fluid (51.3±7.4 UP) than the control group (25.8±5.5 UP), with statistically significant difference. Two months after occlusal adjustment, there were no significant differences between groups (24.6±3.8 UP and 26±4.5 UP respectively) (p=0.977). After twelve months, no significant differences were found between groups (24.4±11.1 UP and 22.5±8.9 UP respectively) (p=0.323). For the other clinical parameters, no significant differences were identified between study and control implants at any of the study times (p>0.05). Conclusions: Study group implants receiving higher occlusal loading presented significantly higher volumes of crevicular fluid than control implants. Crevicular fluid volumes were similar in both groups two and twelve months after occlusal adjustment.

Key words:Occlusal loading, crevicular fluid, peri-implant clinical parameters, T-Scan®.

A study of interleukin 1β levels in peri-miniscrew crevicular fluid (PMCF)

Background

This study provides a vital insight in assessing the clinical and biochemical changes in interleukin (IL)-1β levels in peri-miniscrew crevicular fluid (PMCF) during the course of orthodontic tooth movement.

Methods

The study comprised the analysis of IL-1β in peri-miniscrew crevicular fluid obtained from crevices around the miniscrews inserted in 11 patients (eight females and three males, mean age 17.3 ± 4.64 years) with all first premolar extraction and maximum anchorage requirement using miniscrew-supported anchorage. Miniscrews were loaded at 3 weeks after placement by 200-g nitinol closed coil springs of 9-mm length for en masse retraction. Peri-miniscrew crevicular fluid was collected at miniscrew placement (T1), at 3 weeks (T2/baseline) and on loading at 0 (T3) and 1 day (T4), 21 (T5), 72 (T6), 120 (T7), 180 (T8) and 300 (T9) days. IL-1β levels were estimated by enzyme-linked immunosorbent assay (ELISA). Peri-miniscrew tissue was examined for signs of inflammation, and also, miniscrew mobility was assessed with Periotest and handles of two mouth mirrors.

Results

IL-1β levels in all miniscrews were significantly higher at T1 and peaked again at T4 showing a bimodal peak. However, there was a gradual and statistically significant decrease in IL-1β till T5, while further changes till the end of the study were statistically not significant.

Conclusions

The changing levels of IL-1β levels in PMCF over a duration of 300 days are suggestive of the underlying inflammatory process. IL-1β levels in PMCF show a significant rise during miniscrew insertion and on immediate loading. The trend of gradually reducing IL-1β levels around the miniscrew over the period after loading towards baseline is suggestive of adaptive bone response to stimulus.

Comparison of peri-implant crevicular fluid levels of adrenomedullin and human beta defensins 1 and 2 from mandibular implants with different implant stability quotient levels in nonsmoker patients

BACKGROUND AND OBJECTIVE

To achieve satisfactory osseointegration, primary stability and healthy peri-implant tissue must be available. In this study, our objective was to compare the adrenomedullin, human beta-defensin (hBD)-1 and hBD-2 levels in implants with different implant stability quotient (ISQ) values and with different peri-implant tissue health values in the peri-implant crevicular fluid.

MATERIAL AND METHODS

Thirty patients with 60 endosseous osseointegrated implants were included in this study. Following the completion of the osseointegration process, these implants were divided into two main groups: a group of 15 implants with peri-implantitis (peri-implantitis: 40 ≤ ISQ ≤ 80 peri-implantitis, n = 15) and a group of 45 implants with healthy peri-implant tissue. The healthy peri-implant tissue group was further divided into three subgroups according to their ISQ values (Healthy-60: 60 ≤ ISQ ≤ 70, healthy peri-implant, n = 15; Healthy-80: 71 ≤ ISQ ≤ 80, healthy peri-implant, n = 15; and Healthy-100: 81 ≤ ISQ ≤ 100, healthy peri-implant, n = 15). The levels of adrenomedullin, hBD-1 and hBD-2 in the peri-implant crevicular fluid were assessed using ELISAs.

RESULTS

When the peri-implant clinical measurements were compared within groups, they were found to be highest in the peri-implantitis group and lowest in the Healthy-100 group. The adrenomedullin, hBD-1 and hBD-2 levels in the peri-implant crevicular fluid of the peri-implantitis group were found to be significantly higher than those in the Healthy-60, Healthy-80 and Healthy-100 groups. When only the healthy peri-implant tissue groups were evaluated, the adrenomedullin, hBD-1 and hBD-2 levels in the peri-implant crevicular fluid of the Healthy-60 group were found to be significantly higher than those in the Healthy-80 and Healthy-100 groups. The lowest adrenomedullin, hBD-1 and hBD-2 levels were observed in the Healthy-100 group.

CONCLUSION

In cases of peri-implantitis, higher adrenomedullin, hBD-1 and hBD-2 levels were observed. These results indicate the presence of a tissue response to prevent the creation of a pathological environment in the peri-implant tissue. In groups with healthy peri-implant tissues, the ISQ value decreases as the adrenomedullin, hBD-1 and hBD-2 levels increase. This condition is thought to be caused by increased dental plaque accumulation and bone resorption in addition to increased lateral implant movements and colonization of microorganisms in the microcavities between the implant elements.

Evaluation of beta-2 microglobulin and alpha-2 macroglobulin levels in patients with different periodontal diseases

BACKGROUND

Beta-2 microglobulin (B2M) and alpha-2 macroglobulin (A2M) play key roles in the immune system. The aim of this study was to compare B2M and A2M levels in patients with different periodontal diseases.

METHODS

Eighty patients (20 periodontally healthy, 20 with gingivitis, 20 with chronic periodontitis and 20 with generalized aggressive periodontitis) were enrolled in the study. The analysis of B2M and A2M was performed on gingival crevicular fluid (GCF) using an enzyme-linked immunosorbent assay in GCF.

RESULTS

The total levels of B2M and A2M were statistically lower in the periodontally healthy group than in the other groups (p < 0.05) and significantly higher in the generalized aggressive periodontitis group compared to the other groups (p < 0.05).

CONCLUSIONS

B2M and A2M play key roles in the balance between periodontal health and disease. It is proposed that tissues release B2M and A2M to stop inflammation and inhibit the proliferation of microorganisms and this may be the reason for the high levels of B2M and A2M in the generalized aggressive periodontitis and chronic periodontitis groups. B2M and A2M are assumed to be user-friendly and cost-effective markers for periodontal disease to identify asymptomatic diseases.

Influence of etiologic factors in peri-implantitis: literature review and case report

Peri-implantitis is a pathology that has been described in many clinical studies and case reports. However, it is still not clear how the roles of its etiologic agents work. This article is based on a review of the literature and a case report. It aims to offer data related to the factors that cause this pathology, and to analyze how these factors interact, leading to the contamination of the peri-implant tissue.

Chondroitin sulphate (WF6 epitope) levels in peri-miniscrew implant crevicular fluid during orthodontic loading

The aim of this study was to monitor changes in chondroitin sulphate (CS; WF6 epitope) levels in peri-miniscrew implant crevicular fluid (PMICF) during orthodontic loading. Ten patients (seven males and three females; aged 22.0 +/- 3.4 years), who required orthodontic treatment with extraction of all four premolar teeth, participated in the study. Twenty miniscrew implants (used as orthodontic anchorage) were placed, two in each patient, buccally and bilaterally in the alveolar bone between the roots of the maxillary posterior teeth. Sentalloy closed-coil springs (50 g) were used to load the miniscrew implants and to move the maxillary canines distally. During the unloaded period, PMICF samples were collected on days 1, 3, 5, and 7 after miniscrew implant placement and on days 14, 21, 28, and 35 during the loaded period. Clinical mobility assessments of the miniscrew implants were recorded at each visit. The competitive enzyme-linked immunosorbent assay with monoclonal antibody WF6 was used to detect CS (WF6 epitope) levels in the PMICF samples. The differences between the CS (WF6 epitope) levels during the unloaded and loaded periods were determined by a Mann-Whitney U-test. During the loaded period, two miniscrew implants were considered to have failed. The CS (WF6 epitope) levels during the unloaded period ranged from 0.00 to 758.03 ng/ml and those during the loaded period from 0.00 to 1025.11 ng/ml. Medians of CS (WF6 epitope) levels, around 'immobile' miniscrew implants, between the unloaded and loaded periods were not significantly different (P = 0.07). CS (WF6 epitope) levels in PMICF can be detected and may be used as biomarkers for assessing alveolar bone remodelling around miniscrew implants during orthodontic loading.

Gingival crevicular fluid in the diagnosis of periodontal and systemic diseases

Gingival crevicular fluid (GCF) can be found in the physiologic space (gingival sulcus), as well as in the pathological space (gingival pocket or periodontal pocket) between the gums and teeth. In the first case it is a transudate, in the second an exudate. The constituents of GCF originate from serum, gingival tissues, and from both bacterial and host response cells present in the aforementioned spaces and the surrounding tissues. The collection and analysis of GCF are the noninvasive methods for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers, such as prostaglandin E2, neutrophil elastase and ?-glucuronidase, and on the marker of cellular necrosis - aspartat aminotransferase. Further, the analysis of inflammatory markers in the GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease, and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases). Major factors which influence the results obtained from the analyses of GCF are not only the methods of these analyses, but the method of GCF collection as well. As saliva collection is less technique-sensitive than GCF collection, some constituents of saliva which originate from the GCF can be analyzed as more amenable to chairside utilization.

Reliability of findings around healthy implants in association with oral hygiene measures: a clinical, microbiological, and immunological follow-up in edentulous patients

OBJECTIVES

To assess the performance of clinical, microbiological, and immunological diagnosis of peri-implant health and the influence of professional hygiene measures on them.

MATERIAL AND METHODS

Twenty-one edentulous patients with oral implants supporting a lower overdenture were followed up over 3 months beginning 1 week before their annual recall visit. Hygiene scores, probing depth, bleeding on probing (BOP), implant stability, gingival crevicular fluid (GCF) volume, sulcular interleukin-1beta (IL-1beta) and prostaglandin E2 (PGE2) concentrations, and relative concentrations of five bacterial species (polymerase chain reaction) were investigated. Measurement variation was assessed as a function of (a) intra- and (b) inter-examiner reliability, (c) inter-implant variation in each patient, (d) time, and (e) effect of hygiene measures by accuracy, repeatability, reproducibility, and visualization with the Bland and Altman Plot.

RESULTS

Measurement means and accuracy (in parentheses) were as follows: GCF volume 1.5 microl (1.5), Interleukin-1beta 8 ng/ml (26), PGE2 63 ng/ml (185), bacteria sum score 0.2 (0.7), plaque score 1 (1), BOP score 0 (1), Periotest value -4 (3), resonance frequency analysis ISQ 66 (11), and pocket probing depth 2.3 mm (0.7). No finding exhibited any statistically significant measurement variation as explained by accuracy, repeatability, or reproducibility. Bland and Altman Plots revealed insufficient agreement for replicated BOP assessments. A short post-treatment reduction in plaque and BOP scores was visually apparent. Still, professional oral hygiene measures exerted no sustained influence on the clinical and biochemical appearance of the peri-implant tissues.

CONCLUSION

All findings except BOP showed statistically acceptable repeatability and moderate vulnerability to influences present 'chairside' in clinical practice.

Analysis of gingival crevicular fluid as applied to the diagnosis of oral and systemic diseases

Gingival crevicular fluid (GCF), a serum transudate or inflammatory exudate, can be collected from the gingival crevice surrounding the teeth. As such, the fluid reflects the constituents of serum, the cellular response in the periodontium, and contributions from the gingival crevice. The study of GCF has focused on defining the pathophysiology of periodontal disease, and identification of a potential diagnostic test for active periodontitis. The majority of markers that have been identified as potential candidates for such a test are measures of inflammation (i.e., prostaglandin E2 (PGE2), neutrophil elastase, and the lysosomal enzyme beta-glucuronidase). Further, analysis of inflammatory markers in GCF may assist in defining how certain systemic disorders (e.g., diabetes mellitus) can modify periodontal disease, and how periodontal disease/periodontal inflammation can influence certain systemic disorders (i.e., cardiovascular/cerebrovascular diseases). Methodological concerns related to the collection and analysis of GCF are important factors that need to be considered when studying GCF. Practical concerns argue against the widespread clinical application of GCF as an adjunct to periodontal diagnosis. Rather, analysis of GCF-derived mediators in saliva may serve as a means of rapid screening for periodontal disease.

Gingival crevicular fluid alkaline phosphatase levels in postmenopausal women: effects of phase I periodontal treatment

BACKGROUND

The aim of this study was to determine how estrogen status may possibly influence gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels in estrogen-deficient (ED) and -sufficient (ES) postmenopausal women at baseline (BL) and 1 year after periodontal phase I treatment (AT).

METHODS

Thirty-six postmenopausal women on estrogen supplements (mean serum estradiol levels >30 pg/ml; estrogen sufficient) and 37 postmenopausal women not on estrogen supplements (mean serum estradiol levels <30 pg/ml; ED) were divided into two subgroups as chronic periodontitis and clinically healthy controls after clinical and radiographic examination. The ES group consisted of 19 control (ES/C) and 17 chronic periodontitis (ES/P) patients, and the ED group consisted of 20 control (ED/C) and 17 chronic periodontitis (ED/P) patients. Plaque (PI) and gingival (GI) indices, bleeding on probing (BOP), probing depths (PD), clinical attachment loss (CAL) scores, and GCF samples were recorded at BL and AT. The levels of ALP in the GCF were measured photometrically. The paired samples Student t and Wilcoxon tests were used to compare the ALP levels and clinical parameters between BL and AT. The correlation among the ALP and clinical parameters was analyzed using the Pearson correlation.

RESULTS

The mean of all clinical parameters (PI, GI, BOP, PD, and CAL) was significantly (P <0.05) higher in periodontitis groups (ES/P and ED/P) than controls (ES/C and ED/C). Periodontitis groups (ES/P and ED/P) demonstrated significantly increased GCF volumes and GCF ALP levels (P <0.05) compared to controls (ES/C and ED/C). There were no significant differences in the concentrations of ALP between periodontitis and control groups (P >0.05). The BL GCF ALP total levels of the ED/P group were significantly higher than the ES/P group (P <0.05). The BL and AT serum ALP levels of the ED/P group were not significantly but were numerically higher than the ES/P group. One year after periodontal treatment, the GCF volume, GCF ALP total, and concentrations decreased significantly in both periodontitis groups (P <0.05). However, the GCF ALP levels were still numerically higher in the ED/P group. A positive statistical correlation was found between total ALP levels and PD (r = 0.621; P <0.05).

CONCLUSION

These data suggest that the presence of ALP in GCF is not simply a reflection of the local inflammation state and that a patient's estrogen status may possibly influence local ALP levels in GCF.

Analysis of Aspartate Aminotransferase and Alkaline Phosphatase in Crevicular Fluid From Implants With and Without Peri-implantitis

PURPOSE

The aim of this investigation was to determine the presence of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in crevicular fluid collected from implants with and without clinical and radiographic signs of peri-implantitis.

MATERIALS AND METHODS

There were 17 implants with symptoms of peri-implantitis in 12 subjects, including 4 females and 8 males, compared to 17 implants in 13 subjects, including 5 females and 8 males, with healthy peri-implant tissues. Filter paper strips were used to collect peri-implant crevicular fluid for 30 seconds in the base of the crevice/pocket. SPSS statistical software (SPSS, Inc., Chicago, IL) was used to determine AST and ALP activity.

RESULTS

The results showed that there was a significant difference in the activity of AST and ALP between the 2 study groups (P < 0.0001). AST activity was significantly associated with the amount of bleeding on probing (P = 0.02), but no statistical correlation was found between ALP activity and increased amount of bleeding on probing (P = 0.05).

CONCLUSIONS

Within the limits of this study, our results may suggest that peri-implant crevicular fluid analysis could be further investigated in longitudinal studies as a suitable diagnostic strategy in the evaluation of dental implants.

Peri-implantitis

The risk of developing peri-implantitis seems to be more pronounced in patients with a history of periodontitis. Pretreatment to eliminate periodontal pathogens from the patient's oral cavity before dental implant treatment therefore is important to reduce the risk of peri-implantitis. Smoking has been shown to be a negative risk factor for treatment success. Several protocols have been used in the treatment of peri-implantitis. Mechanical infection control following surgical flap procedures, particularly in conjunction with antimicrobial therapy, is the most successful concept. There is no reliable evidence that suggests which intervention is the most effective for treating peri-implantitis. This article includes background information on the biology of tissue-destructive periodontitis and peri-implantitis to help clinicians interpret the clinical manifestation of the risk for peri-implantitis.

Correlation of peri-implant health and myeloperoxidase levels: a cross-sectional clinical study

OBJECTIVES

At present, there are no diagnostic tools that permit early detection of peri-implantitis. The purpose of this cross-sectional study was to evaluate the correlation of myeloperoxidase (MPO) levels with traditional periodontal clinical parameters around dental implants including peri-implant pocket probing depth (PPD), gingival index (GI) and bleeding on probing (BOP), since MPO has been associated with destruction of periodontal tissues.

MATERIAL AND METHODS

Twenty-four healthy adult volunteers (9 men and 15 women) with 64 Ankylos Biofunctional implants (DentsplyFriadent, Mannheim, Germany) were recruited from Tallinn Dental Clinic. Biochemical and clinical parameters evaluated were the following ones: the level of MPO in the peri-implant sulcus fluid (PISF) (an analog for gingival crevicular fluid in natural teeth), PPD (mm), GI (0,1,2 or 3), and BOP (0 or 1).

RESULTS AND CONCLUSION

In comparison to the clinically healthy implants, total amounts of MPO were significantly higher in PISF collected around implants with inflammatory lesions. In addition, the levels of MPO were correlated with the clinical parameters. The results confirm the similarity of the inflammatory response of tissues surrounding implants and natural teeth, and suggest that MPO could be promising marker of inflammation around dental implants.

Histopathological observations of human periimplantitis lesions

OBJECTIVE

The aim of the present study was to analyze some characteristics of advanced and progressive periimplantitis lesions in man.

MATERIAL AND METHODS

Soft tissue biopsies were obtained from 12 implants in six patients. The implants had been in function between 4 and 21 years and were, with one exception, located in the maxilla. The radiographic examination performed prior to biopsy revealed that all sites exhibited advanced bone loss. Further, clinical signs of severe inflammation, such as suppuration, swelling and/or fistula formation were detected in the majority of sites and seven of the 12 implants were found to be mobile at biopsy. Each biopsy was following fixation embedded in epoxy resin and sections were prepared for histometric and morphometric analysis.

RESULTS AND CONCLUSION

It was demonstrated (i). that all soft tissue units harbored large inflammatory cell infiltrates (ICT) that extended to a position apical of a pocket epithelium and (ii). that about 60% of the lesions were occupied by inflammatory cells, among which plasma cells dominated. Numerous amounts of PMN cells occurred not only in the pocket epithelium and adjacent connective tissue areas, but were also present in peri-vascular compartments in more central areas of the ICT.