Assessment of interleukin-1β, interleukin-6, and tumor necrosis factor-Α levels in the peri-implant sulcular fluid among waterpipe (narghile) smokers and never-smokers with peri-implantitis

The impact of electronic cigarettes on peri-implant health: A systematic review and meta-analysis

OBJECTIVES

Recent literature suggests that the use of electronic cigarette (e-cigarette) is a substantial contributing factor to the unsuccessful outcomes of dental implant procedures. Our aim was to systematically review the effect of e-cigarette use on clinical (PI, PD, BOP), radiographic (bone loss), and immunologic (IL-1β) peri‑implant parameters.

DATA

Main search terms used in combination: electronic cigarette, peri‑implantitis, vaping.

SOURCES

An electronic search was undertaken for MEDLINE, EMBASE, COCHRANE, and SCOPUS databases between 2017 and 2023.

STUDY SELECTION

The study protocol was developed according to PRISMA guidelines, and the focus question was formulated according to the PICO strategy. No restriction was accepted regarding language or year to avoid selection bias; the initial database search yielded 49 publications. Following the selection process, only seven studies met the inclusion criteria. Seven studies were statistically analyzed via MedCalc program. A pooled effect was deemed statistically significant if the p-value was less than 0.05.

CONCLUSION

Electronic cigarettes cause an increase in probing depth, bone loss, and the level of IL-1β, one of the bone destruction mediators in the tissues around the implant, and a decrease in bleeding on probing.

CLINICAL SIGNIFICANCE

E-cigarette is a potential risk factor for the healing process and the results of implant treatment, similar to cigarettes. Performing clinical research to evaluate the e-cigarette effect on peri‑implantitis in an age and gender-match population is needed.

Efficacy of Adjunctive Fotoenticine Photodynamic Therapy and Sapindus mukorossi Therapy on Clinical, Radiographic, and Cytokine Profile of Diabetics with Peri-Implantitis

Objective: To evaluate effectiveness of Fotoenticine (FTC)-mediated photodynamic therapy (PDT) and Sapindus mukorossi (SM) as adjunct to mechanical debridement (MD) on peri-implant clinical parameters and levels of proinflammatory cytokines among diabetics. Background: FTC has exhibited robust photodynamic impact against Streptococcus mutans (i.e., an established caries-associated bacterium); however, its efficacy against periodontal pathogens is not known. Methods: One hundred six diabetics with peri-implantitis were randomly categorized into three groups: Group I consisted of 37 participants who were treated with only MD; group II comprised 35 participants who were treated with FTC-mediated PDT, in addition to MD; and group III consisted of 34 participants who were treated with SM, in addition to MD. Peri-implant clinical parameters [plaque index (PI), bleeding on probing (BOP), and probing depth (PD)] and radiographic outcomes [crestal bone loss (CBL)] (PI, BOP, and PD), together with peri-implant sulcular fluid (PISF) interleukin (IL)-1β and IL-6 levels were measured at baseline and 6-month follow-up. Results: In group I (n = 37; 24 males +13 females), group II (n = 35; 20 males +15 females), and group III (n = 34; 17 males +17 females), the mean age of participants was 54.3 ± 4.6, 52.0 ± 5.5, and 50.8 ± 4.5 years, respectively. Significant improvement was observed in the scores of peri-implant PI (p = 0.01), BOP (p = 0.01), and PD (p = 0.02) at the 6-month follow-up among all study groups. Significant improvement in peri-implant CBL among group I subjects at 6-month follow-up compared to baseline (p < 0.05) was observed. PISF levels of IL-1β and IL-6 improved at 6 months. Conclusions: As an adjunct to conventional MD, FTC-mediated PDT and SM might be used as potential therapeutic modalities among diabetics with peri-implantitis.

Folic acid supplementation improved nicotine withdrawal-induced of memory loss via affecting oxidative status, inflammatory response, cholinergic activity, BDNF and amyloid-B in adolescent male rat

BACKGROUND

The present study aimed to assess whether folic acid (FA) have potential to prevent memory impairment caused by nicotine (Nico) withdrawal in adolescent male rats.

METHODS AND MATERIALS

The experiments were divided into 7 groups: 1) vehicle, 2) Nico (Nico 2 mg/kg injection from 21 to 42 days of ages), 3-5) Nico FA5/10/15 mg/kg (received Nico from 21 to 42 days of ages and received FA at three doses 5, 10 and 15 mg/kg 43-63 days of ages), and 6) received normal saline from 21 to 42 days of age after that received FA 15 mg/kg by oral gavage from 43 to 63 days of age. At 64-69 days of ages, behavioral tests related to memory including Morris Water Maze (MWM) and Object Recognition Test (ORT) were performed and related biochemical analysis including the hippocampal levels of oxidative stress markers, inflammatory indices, brain-derived neurotrophic factor (BDNF), nitrite, amyloid-B and acetylcholinesterase [1] were measured.

RESULTS

Results showed that nicotine exposure in adolescence followed by withdrawal dramatically impaired learning and memory performance along with affecting a variety of biochemical markers in the hippocampal tissues. In addition, it was observed that administration of FA significantly ameliorated Nico withdrawal-induced adverse effects through restoration of the mentioned biochemical disturbances.

CONCLUSION

The present study and other relevant researches demonstrated that FA as a well-known, inexpensive, and safe supplement has strong potential to either prevent or ameliorate the detrimental effect of Nico withdrawal. However, further investigation is required to be more elucidated the precise mechanisms underlying memory impairment-induced by Nico withdrawal.

Effects of Nitric Oxide Supplementation on the Levels of Interleukin-6 in Saliva after Dental Implant Placement - A Prospective Study

Introduction

The purpose of the study was to evaluate and compare the levels of salivary Interleukin-6 (IL-6) before and after the placement of dental implants in patients who are supplemented with nitric oxide (NO).

Materials and Methods

The study comprised 34 patients, divided into control and study groups (17 in each group). The control group was given a placebo and in the study group, nitric oxide supplement was prescribed, whereas the control group received a placebo. Saliva samples were taken before placement of dental implants, first and third day after the implant placement. The levels of salivary IL-6 were assessed using an enzyme-linked immunosorbent assay test.

Results

Statistical analysis showed a significant P value (<0.05) with respect to IL-6 levels on first and third days after placement of dental implants. Salivary IL-6 levels in the study group declined significantly. On day three, the IL-6 values for the control and study groups were 0.0639 and 0.0443, respectively. Within the groups, it was observed that there was a significant decrease in IL-6 values from day one to day three.

Discussion

The levels of salivary IL-6 reduced from day one to day three more significantly and consistently in patients prescribed with NO supplements post-dental implant placement, suggesting better resolution of inflammation.

The influence of smoking on the incidence of peri-implantitis: A systematic review and meta-analysis

OBJECTIVE

The aim of this study was to systematically analyze the influence of smoking on the incidence of peri-implantitis.

MATERIALS AND METHODS

The search was performed in the National Library of Medicine (MEDLINE-PubMed), SCOPUS, EMBASE, and ISI Web of Science databases (finished on November 30, 2022). Systematic review and meta-analysis were conducted according to PRISMA statement. Prospective cohort studies that evaluate the incidence of peri-implantitis in smokers and non-smokers were included. Two authors independently searched for eligible studies, screened titles, and abstracts, did the full-text analysis, extracted data, and performed the risk-of-bias assessment. The results were summarized through random-effects meta-analyses. The GRADE method was used to determine the certainty of evidence.

RESULTS

A total of 7 studies with 702 patients and 1959 implants were included for analysis. The meta-analysis revealed a significant difference between smokers and non-smokers for the risk of peri-implantitis in the implant-based (p < .0001) and patient-based analysis (p = .003). A strong association between smoking and the risk for peri-implantitis was verified at the implant level (RR: 2.04, 95% CI: 1.46-1.85) and the patient level (RR: 2.79, 95% CI: 1.42-5.50).

CONCLUSIONS

Moderate certainty evidence suggests that smoking is associated with peri-implantitis compared to non-smoking at the patient and implant levels.

Inflammatory profile of apical periodontitis exacerbated by cigarette smoke inhalation: Histological and immunohistochemical analysis in rats

AIM

The aim of this study was to evaluate the effects of cigarette smoke inhalation (CSI) on inflammation, pro-inflammatory mediators and haematological parameters in rats with induced apical periodontitis (AP).

METHODOLOGY

Thirty-two 3-month-old male Wistar rats were divided into four experimental groups (n = 8): C-Control; S-rats with CSI; AP-rats with AP; and SAP-rats with CSI + AP. Animals in groups S and SAP inhaled cigarette smoke by remaining inside a smoking chamber for 8 min, three times daily, for 50 days. After 20 days of smoke inhalation, animals in AP and SAP groups had the pulps of the lower right first molar exposed to oral environment for 30 days to induce AP. In these subsequent 30 days, animals in group S and SAP continued with CSI. On Day 50, animals were euthanized and mandibles were histologically processed to assess inflammatory infiltrate, immunohistochemical interleukins (IL-1β, IL-6 and TNF-α), and blood samples collected for laboratory analysis. The Mann-Whitney test was performed for non-parametric data and the pairwise analyses of Student's t-test for parametric data, with a significance level of p < .050.

RESULTS

Inflammatory infiltrate was moderate in AP group and more severe in the SAP (p = .010). The interleukins IL-6, IL-1β and TNF-α were higher in SAP group (p < .001) when compared to the AP group. A greater number of red blood cells (p = .010), haemoglobin (p = .007) and neutrophils (p = .014) were observed in the SAP group in comparison with the AP group.

CONCLUSION

Cigarette smoke inhalation induced a more severe inflammatory infiltrate, with increased levels of pro-inflammatory cytokines and changes in haematological parameters in rats with induced AP. Thus, CSI aggravated AP, exacerbating the inflammatory response.

Efficacy of indocyanine green and methylene blue mediated-photodynamic therapy on peri-implant outcomes among diabetics with peri-implant mucositis

BACKGROUND

This study aimed to assess the efficacy of indocyanine green (ICG)-mediated versus methylene blue (MB)-mediated photodynamic therapy (PDT) as an adjunct to conventional mechanical debridement (MD) on the peri‑implant clinical, radiographic, microbiological, and immunological outcomes among diabetics with peri‑implant mucositis (pi-M).

METHODS

For this 3-month follow-up study, diabetics having pi-M were randomly divided into 3 groups: group-I (n = 20) subjects received only MD; group-II (n = 20) participants received ICG-mediated adjunct PDT; and group-III (n = 20) subjects received MB-mediated adjunct PDT. Peri-implant clinical (i.e., plaque index [PI], bleeding on probing [BOP], probing depth [PD]), radiographic (crestal bone loss [CBL]), microbiological (Fusobacterium nucleatum [F. nucleatum], Tannerella forsythia [T. forsythia], Prevotella intermedia [P. intermedia], Porphyromonas gingivalis [P. gingivalis], Aggregatibacter actinomycetemcomitans [A. actinomycetemcomitans]), and immunological (interleukin [IL]-6, IL-1β, tumor necrosis factor-alpha [TNF-α]) outcomes were assessed at baseline and 3-month follow-up.

RESULTS

Mean changes between baseline and 3-month follow-up in peri‑implant clinico-radiographic parameters were significantly different between control (PI: 12.42±21.80%; BOP: 12.10±19.30%; PD: 0.45±0.41 mm; CBL: 1.10±1.02 mm) and test groups (ICG-mediated PDT [PI: 26.55±25.80%; BOP: 28.77±29.24%; PD: 0.84±0.62 mm; CBL: 1.98±1.85 mm] and MB-mediated PDT [PI: 27.24±26.15%; BOP: 27.71±28.16%; PD: 0.85±0.63 mm; CBL: 1.95±1.80 mm]), however comparable differences were observed in peri‑implant PI, BOP, PD, and CBL between group-II and group-III participants (p>0.05). The proportions of T. forsythia were significantly reduced in group-II (4.78 × 10⁴ colony-forming unit per milliliter [CFU/mL]) and group-III (4.76 × 10⁴ CFU/mL) as compared to group-I (-4.40 × 10³ CFU/mL) at 3-month follow-up (p = 0.02). No statistically significant differences were observed between the study groups regarding the proportions of the other assessed target bacterial species. For IL-6 (group-I: 210±108; group-II: 298±165; group-III: 277±121 pg/mL; p = 0.03), IL-1β (group-I: 101±95; group-II: 84±98; group-III: 86±74 pg/mL; p = 0.02), and TNF-α (group-I: 336±121; group-II: 385±210; group-III: 366±198 pg/mL; p = 0.03) peri‑implant sulcular fluid [PISF] levels, all three study groups demonstrated statistically significant reduction at 3-month follow-up.

CONCLUSIONS

ICG-mediated and MB-mediated adjunctive PDT showed statistically significant improvements in peri‑implant clinical, radiographic, microbiological, and immunological parameters as compared to conventional MD alone at 3-month follow-up among diabetics with pi-M. However, comparable outcomes were demonstrated by ICG-mediated and MB-mediated adjunctive PDT regarding the assessed peri‑implant parameters.

Comparison of the postoperative anti-inflammatory efficacy of chlorhexidine, saline rinses and herbal mouthwashes after mechanical debridement in patients with peri-implant mucositis: A randomized controlled trial

AIM

The null hypothesis is that there is no difference in the post-operative anti-inflammatory efficacy of chlorhexidine (CHX), 2% saline rinses (SR) and a herbal mouthwash (MW) after non-surgical mechanical debridement (MD) for treatment of peri-implant mucositis (PiM). The aim was to compare the post-operative anti-inflammatory efficacy of CHX, 2% SR and a herbal oral rinse after non-surgical MD of PiM.

MATERIALS AND METHODS

The present randomized controlled trial had a single-blinded parallel arm design. Patients diagnosed with PiM were enrolled. Demographic information was recorded. All patients underwent MD and were randomly divided into 4 groups: CHX-group: 0.12% non-alcoholic CHX; Sodium chloride (NaCl) group: 2% NaCl rinses; Herbal MW group: Herbal-based MW and H₂ O group: distilled water with peppermint flavour. After MD, all the participants were advised to rinse twice daily (every 12 hrs) for 2 weeks with their respective MWs. In all groups, peri-implant modified plaque index (mPI), modified gingival index (mGI) and probing depth (PD) were measured at baseline and at 12 weeks of follow-up. Sample size was estimated using data from a pilot investigation; and group-comparisons were performed. Statistical significance was confirmed when P-values were below 0.01.

RESULTS

Sixty individuals (15 patients/group) were included. At baseline, mPI, mGI and PD were comparable in all groups. At baseline, there was no significant difference in peri-implant mPI, mGI and PD in all groups. At 12-weeks' follow-up, there was a statistically significant reduction in peri-implant mPI (p < 0.01), mGI (p < 0.01) and PD (p < 0.01) in CHX, NaCl and herbal MW groups compared with H₂ O group. There was no significant relation between implant location, duration for which, implants were functional, gender and peri-implant clinical parameters in all groups.

CONCLUSION

After non-surgical MD, post-operative use of CHX and herbal and NaCl MWs is useful for the management of PiM in the short-term.

Cytotoxic and Genotoxic Effects of Waterpipe on Oral Health Status: Systematic review and meta-analysis

This systematic review and meta-analysis aimed to assess the cytotoxic and genotoxic impacts of waterpipe smoking on oral health. The databases MEDLINE, Cochrane Library and Dimensions were searched to find studies evaluating whether waterpipe smokers exhibited any cytotoxic or genotoxic effects on their oral cells compared to non-smokers, with regard to mouth neoplasms. Particularly, changes in DNA methylation and p53 expression were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted for the systematic review. Review Manager was utilised for statistical analysis with a significance level at P <0.05. To assess the grades of the included articles, a risk of bias analysis was summarised. A forest plot, including some of the included articles included, was created regarding the different grades. A total of 20 studies were included in this review. The results showed that waterpipe smoking has cytotoxic and genotoxic effects on oral cells, with a risk difference of 0.16. Although the published articles are few in number, all confirm the devastating effects of waterpipe smoking related to the carcinogenicity. Waterpipe smoking is harmful to oral health. It causes a series of detrimental cellular and genetic modifications such as acanthosis, epithelial dysplasia and hyperparakeratosis. In addition, waterpipe smoke contains several carcinogenic compounds. As it releases many harmful organic compounds, waterpipe smoking increases the incidence of oral cancer.

Levels of peri-implant sulcular fluid levels of soluble urokinase plasminogen activator receptor and TNF-α among cigarette smokers and non-smokers with peri-implantitis

BACKGROUND

Soluble urokinase plasminogen activator receptor (suPAR) and tumor necrosis factor-alpha (TNF-α) are inflammatory biomarkers. No studies have yet assessed the suPAR levels in relation with TNF-α in the peri-implant sulcular fluid (PISF) among cigarette smokers and non-smokers with peri-implantitis.

OBJECTIVE

The aim was to evaluate PISF levels of suPAR, and TNF-α among cigarette smokers and non-smokers with and without peri-implantitis.

METHODS

Sixty male patients with peri-implantitis were included. There were 20 cigarette smokers and 20 and non-smokers with peri-implantitis (Groups 1 and 2), and 20 non-smokers without peri-implantitis (Group 3). Demographic data and information related to cigarette smoking was recorded. Peri-implant clinicoradiographic parameters (plaque index [PI], gingival index [GI], probing depth [PD] and crestal bone loss [CBL]) were assessed. The PISF samples were collected and levels of suPAR and TNF-α were measured. Sample-size estimation was performed and all parameters were statistically assessed. Level of significance was set at P< 0.05.

RESULTS

Sixty individuals were included in Groups 1, 2 and 3 (20 in each). Peri-implant PI (P< 0.01), PD (P< 0.01) and mesial (P< 0.01) and distal (P< 0.01) CBL were significantly higher in Group 1 than in Groups 2 and 3. The PISF volume (P< 0.01) and suPAR (P< 0.01) and TNF-α levels (P< 0.01) were significantly higher in Groups 1 and 2 than in Group 3. There was no difference in PISF volume and suPAR and TNF-α levels between patients in Groups 1 and 2. In Group 2, there was a statistically significant correlation between peri-implant PD and PISF suPAR and TNF-α levels (P< 0.01). The suPAR and TNF-α levels are expressed in high concentrations in the PISF of smokers and non-smokers with peri-implantitis compared with non-smokers without peri-implantitis.

CONCLUSION

In non-smokers, PISF suPAR and TNF-α levels are correlated with peri-implant PD.

Soft tissue features of peri‐implant diseases and related treatment

BACKGROUND

The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic.

PURPOSE

The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites.

MATERIALS AND METHODS

This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies.

RESULTS

Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail.

CONCLUSIONS

Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.

Disinfection of implant abutment connection using antimicrobial photodynamic therapy and 0.2% chlorhexidine gel applications immediately before prosthesis delivery: Clinical and radiographic status at 1-year of follow-up

OBJECTIVE

The aim of this 1-year follow-up randomized control trial was to compare the clinicoradiographic status of implants that were disinfected with antimicrobial photodynamic therapy (aPDT) and 0.2% chlorhexidine gel immediately before prosthesis delivery.

METHODS

Forty-five partially edentulous patients with implants placed in the region of missing mandibular first molars and a history of periodontal diseases were included. Immediately before prosthesis delivery, patients were divided into three groups. In groups 1 and 2, implant abutment disinfection (IAD) was performed using aPDT and 0.2% chlorhexidine immediately before prosthesis delivery. In Group-3, IAD was performed using a steaming protocol. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth (PD) and crestal bone loss (CBL) were assessed at 1 year of follow-up. Power analysis was done and group comparisons were done. Logistic regression analysis was done to corelate clinical parameters with demographic variables. P<0.01 was considered statistically significant.

RESULTS

In total, 15, 15, and 15 implants were present among patients in groups 1, 2 and 3, respectively. There was no statistically significant difference in peri-implant mPI, mBoP, PD and CBL in all groups (Table 2). None of the patients had periodontal disease and there was no statistically significant correlation between peri-implant clinicoradiographic parameters with age, toothbrushing and flossing habits, and duration of implants in function. Eighty percent, 86.7% and 100% individuals in groups 1, 2 and 3, respectively reported that they were brushing teeth twice daily. Flossing of interproximal spaces once daily was reported by 66.7%, 73.3% and 66.7% individuals in groups 1, 2 and 3, respectively.

CONCLUSION

As long as oral hygiene is stringently maintained after implant prosthesis delivery, IAD can be performed using aPDT, 0.2% CHX gel or steam-disinfection.

Effect of photobiomodulation after non-surgical mechanical debridement on cortisol levels in the peri-implant sulcular fluid among patients with peri-implant mucositis

OBJECTIVE

The aim of this was to compare the efficacy of photobiomodulation after non-surgical mechanical debridement (MD) on cortisol levels (CL) in peri-implant sulcular fluid (PISF) among patients with peri-implant mucositis.

METHODS

Patients with peri-implant mucositis were encompassed. All patients underwent non-surgical MD with (test group) and without (control group) a single application of photobiomodulation. Demographic data were collected and PISF was collected. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth and crestal bone loss were measured, and CL in PISF were recorded. All clinical parameters and PISF CL were re-assessed at 4 months of follow-up. p < .05 showed statistical significance.

RESULTS

Seventeen (14 males and 3 females) and 17 (15 males and 2 females) patients with peri-implant mucositis were recruited in test and control groups. The mean age of patients in the test and control groups was 46.1 ± 6.5 and 50.2 ± 2.7 years respectively. At baseline, mPI, mGI, PD and PISF volume and CL in control and test groups were similar. At follow-up, there was a significant reduction in mPI (p < .001), mGI (p < .001), PD (p < .001) and PISF volume (p < .001) and CL (p < .001) in both groups compared with baseline. There was no difference in mPI, mGI, PD and PISF volume and CL in test and control groups at follow-up.

CONCLUSION

In short term, non-surgical MD with photobiomodulation does not offer additional benefits in terms of reducing soft-tissue inflammatory parameters and PISF CL in patients with peri-implant mucositis.

The effect of conventional versus electronic cigarette use on treatment outcomes of peri-implant disease

Aim

To compare changes in clinical periodontal parameters (gingival consistency, colour, BOP, PI, PD) and changes of salivary inflammatory biomarkers (IL-1 β, IL-6, MMP-8, TNF- α and TIMP-1 between conventional, electronic cigarette smokers and non-smokers after peri-implant treatment.

Methods

Study participants were grouped into three groups (i) Conventional cigarette smokers (ii) Electronic cigarette smokers and (iii) non-smokers respectively. A total of 60 adult patients aged (40–56 years) with 60 implants with active per-impantitis was included.Clinical and Biological parameters were evaluated before surgical treatment at baseline, one, six and twelve month post treatment. Pearson’s chi-square test was used to compare the distribution of the categorical while Two-way repeated analysis of variance was used to compare the mean values of quantitative outcome variables among all study groups across the 4 time points.

Results

A total of 60 subjects (60 implants) were selected and classified into three groups as per their smoking method 20 participants in each group with one single targeted implant diagnosis with active peri-implantitis. The gingival colour, the change was statistically significant at one year of post treatment.The gingival consistency distribution across the three groups is not statistically significant at baseline, but it is statistically significant at one-month (p = 0.001), six months (p = 0.029) and at the completion of one-year (p = 0.018) post treatment. The plaque index of 100% of non-smokers had changed to ‘0’ and 35% change in cigarettes and 30% change in electronic smokers which is statistically significant (p = 0.016).The prevalence of BOP was observed in the three groups as 72%, 76.5% and 88.9% at baseline. The mean values of PD have shown statistically significant change across the three groups over the four-time intervals of observation (p = 0.024). The comparison of mean values of IL-1 β, IL-6 and TIMP-1 has shown statistically significant change across the three groups over the four intervals of observation (p < 0.0001).

Conclusions

Electronic cigarette smoking was found to be most prevalent risk indicator for peri-implantitis. Compromised response of peri-implantitis treatment both clinically and biologically was found more among electronic cigarette smokers when compared to conventional cigarette smokers and non-smokers.

Trial registration: This case-control study was conducted at King Saud University’s Dental College, Riyadh, Saudi Arabia, in accordance with “Helsinki Declaration of Human Studies” and approved by the Institutional Review Board (Reference no: 87563).

Effect of tongue piercing on periodontal and peri-implant health: A cross-sectional case-control study in adults

OBJECTIVES

The authors hypothesize that periodontal and peri-implant inflammatory parameters are poorer in adult patients with tongue piercing compared with controls. The aim was to assess the influence of tongue piercing on periodontal and peri-implant health status in adults.

METHODS

Test and control groups comprised of individuals with and without tongue piercing, respectively. A questionnaire was used to collect information about gender, age, duration of tongue piercing and implants in function, jaw location of the implant, reasoning for wearing the tongue ornament, and oral hygiene and ornament cleaning habits. Full-mouth and peri-implant plaque index (PI), gingival index (GI), clinical attachment loss (CAL), probing depth (PD) and marginal/crestal bone loss (MBL and CBL, respectively) on mesial and distal surfaces of teeth/implants were recorded. The material (plastic or metal) from which, the bar and ball-ends of the ornament were fabricated was also recorded. A p < 0.01 was considered statistically significant.

RESULTS

Forty-eight and 49 individuals were included in the test and control groups, respectively. There was no difference in PI, GI, PD, CAL and MBL (mesial and distal) among individuals in the test and control groups. In the test group, peri-implant PI (p < 0.01), GI (p < 0.01), PD (p < 0.01) and mesial (p < 0.01) and distal (p < 0.01) CBL were significantly higher in the anterior mandible compared with implants in other jaw locations. In the control group, there was no difference in peri-implant PI, GI, PD and CBL around implants placed in both jaws.

CONCLUSION

Wearing tongue piercings could increase the risks of periodontal and peri-implant diseases particularly in the mandibular anterior segment.

Analysis of IL-1β, CXCL8, and TNF-α levels in the crevicular fluid of patients with periodontitis or healthy implants

BACKGROUND

Our study aimed to assess the level of IL-1β, CXCL8, and TNF-α in peri-implant sulcular fluid (PISF) collected from patients with no clinical symptoms of mucositis or peri-implantitis and compare them with cytokine concentration in gingival crevicular fluid (GCF) acquired from patients with healthy periodontium and those with varying severity of periodontitis.

METHODS

A total of 189 subjects were included in the study, and GCF/PISF samples were checked for IL-1β, CXCL8, and TNF-α levels using an ELISA test.

RESULTS

The IL-1β level in PISF in patients with implants was significantly lower than in GCF in patients with mild, moderate, or severe periodontitis. The CXCL8 level in PISF was considerably lower than in patients with moderate periodontitis. The TNF-α level in PISF in patients with implants was markedly higher compared to subjects with healthy periodontium or patients with mild periodontitis.

CONCLUSION

Analysis of cytokine levels may help describe the pathogenesis and early diagnosis of peri-implantitis and prevision in high-risk patients.

Cortisol levels in the peri-implant sulcular fluid among patients with and without peri-implantitis

BACKGROUND AND OBJECTIVE

Cortisol levels remain uninvestigated in peri-implant sulcular fluid (PISF) of patients with and without peri-implantitis. The present investigation investigated levels of cortisol in PISF among controls (individuals without peri-implantitis) and patients with peri-implantitis.

METHODS

The patient population comprised of participants with and without peri-implantitis (groups 1 and 2, respectively). Demographic information and data related to implant characteristics was recorded. Peri-implant radiographic (crestal bone loss [CBL]) and clinical (modified plaque and bleeding on probing indices [PI and BOP], and probing depth [PD]) and parameters were assessed. In all patients, levels of cortisol were measured in the PISF, which was collected using standard methods. Data normality and group comparisons were assessed, and multiple logistic regression was performed. Probability values less than 0.01 were nominated as being significant.

RESULTS

Eighty-eight individuals (44 and 44 in groups 1 and 2, correspondingly) were included. In group 1, 24 and 20 participants were males and females, and there were 22 and 22 males and females in group 2. Mean ages were analogous in both groups. Peri-implant BOP (p < .001); CBL (p < .001); PI (p < .001); and PD (p < .001) were higher among patients in group 1 compared with group 2. The volume of PISF (p < .001) collected and its concentrations of cortisol (p < .001) were significantly higher among patients in group 1 compared with group 2. Regression analysis showed that CBL and PD directly correlated with increased PISF levels of cortisol among participants with peri-implantitis.

CONCLUSION

Within the limits of the present study, it remains debatable whether or not PISF cortisol levels vary among patients with and without peri-implantitis. Further studies are needed to evaluate the role of PISF levels of cortisol in the diagnosis of peri-implantitis.

Interventions to prevent periodontal disease in tobacco-, alcohol-, and drug-dependent individuals

Substance abuse affects more than one sixth of the world's population. More importantly, the nature of the abuse and the type of addictive substances available to individuals is increasing exponentially. All substances with abusive potential impact both the human immuno-inflammatory system and oral microbial communities, and therefore play a critical role in the etiopathogenesis of periodontal diseases. Evidence strongly supports the efficacy of professionally delivered cessation counseling. Dentists, dental therapists, and hygienists are ideally placed to deliver this therapy, and to spearhead efforts to provide behavioral and pharmacologic support for cessation. The purpose of this review is to examine the biologic mechanisms underlying their role in disease causation, to understand the pharmacologic and behavioral basis for their habituation, and to investigate the efficacy of population-based and personalized interventions in prevention of periodontal disease.

Clinical peri-implant health and biological bone marker levels in tobacco users treated with photodynamic therapy

BACKGROUND

What impact does tobacco smoking have on photodynamic therapy (PDT) outcome is still unknown. The aim of the present clinical trial was to evaluate the clinical, radiographic, and biological bone markers after provision of PDT in cigarette, e-cigarette, and never-smokers with peri-implantitis (PI) at 6 months post treatment.

MATERIALS AND METHODS

Twenty-five healthy patients with PI were divided into three groups: Group I: cigarette smokers; Group II: e-cigarettes users; Group III: never-smokers. Full-mouth mechanical debridement with adjunctive methylene blue-mediated PDT was performed. Clinical recordings included peri-implant plaque index (Pi), bleeding on probing (BOP) and probing depth (PD). Peri-implant sulcular fluid was collected for the assessment of biological bone biomarkers including receptor activator of nuclear factor-ligand (RANK-L) and osteoprotegrin (OPG). All assessments were performed at baseline, 3 months and 6 months. P-value of <0.05 was considered significant.

RESULTS

BOP in Group II and III significantly reduced at 3 months (p < 0.05). Group I showed significant reduction only at 6 months (p < 0.05). Mean PD showed no statistically significant difference between the groups at any time-point. Inter-group comparison showed Group III demonstrating statistically significantly reduced mean RANK-L levels at both 3 and 6 months (p < 0.05). A slight increase in the OPG levels were observed at 3 months and followed by a slight decrease at 6 months for all the study groups when compared with baseline values, however, these values did not show statistical significance (p > 0.05).

CONCLUSION

Adjunctive PDT helped in reducing the clinical peri-implant inflammation. However, no significant change was observed for biological bone biomarkers among tobacco smokers.

Effect of scaling and root planing on the expression of anti-inflammatory cytokines (IL-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid of electronic cigarette users and non-smokers with moderate chronic periodontitis

Purpose

The aim of this cross-sectional study was to investigate the effect of scaling and root planing (SRP) on the expression of anti-inflammatory cytokines (interleukin [IL]-4, IL-9, IL-10, and IL-13) in the gingival crevicular fluid (GCF) of electronic cigarette users and non-smokers with moderate chronic periodontitis (CP).

Methods

Electronic cigarette users and non-smokers with CP were included in the study. Full-mouth plaque and gingival indices, probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. The GCF was collected, and its volume and levels of IL-4, IL-9, IL-10, and IL-13 were assessed. These parameters were evaluated at baseline and 3 months after SRP. The sample size was estimated, and comparisons between groups were performed. P<0.05 was considered to indicate statistical significance.

Results

Thirty-six electronic cigarette users (47.7±5.8 years old) and 35 non-smokers (46.5±3.4 years old) with CP were included. At baseline, there were no differences in plaque index (PI), PD, CAL, MBL, and GCF IL-4, IL-9, IL-10, and IL-13 between electronic cigarette users and non-smokers. At the 3-month follow-up, there were no significant differences in PI, gingival index (GI), PD, CAL, and MBL in electronic cigarette users compared to baseline, while there were significant reductions in PI, GI, and PD among non-smokers. At the 3-month follow-up, GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly elevated in both groups (P<0.05) compared to baseline. The increases in GCF IL-4, IL-9, IL-10, and IL-13 levels were significantly higher in non-smokers (P<0.05) than in electronic cigarette users at the 3-month follow-up.

Conclusions

Levels of GCF IL-4, IL-9, IL-10, and IL-13 increased after SRP in electronic cigarette users and non-smokers with CP; however, the anti-inflammatory effect of SRP was more profound in non-smokers than in electronic cigarette users.

Clinicoradiographic markers of peri-implantitis in cigarette-smokers and never-smokers with type 2 diabetes mellitus at 7-years follow-up

BACKGROUND

It is hypothesized that in the long-term, (a) peri-implant inflammatory variables (plaque index [PI], bleeding on probing [BOP], probing depth (PD) and crestal bone loss [CBL]) are worse in cigarette-smokers (CS) and patients with type-2 diabetes mellitus (T2DM) than never-smokers (NS) without T2DM. The aim of the present 7-year follow-up clinical observational study was to assess the survival of dental implant in CS and NS with T2DM.

METHODS

Study participants were divided into four groups based on glycemic status and self-reported cigarette-smoking habit: a) CS with T2DM; b) CS without T2DM; c) NS with T2DM; and d) NS without T2DM. Demographic information was collected using a questionnaire and hemoglobin A1c (HbA1c) levels were measured. Peri-implant PI, BOP, PD, and CBL were measured. Sample-size was estimated was statistical analysis was done using analysis of variance. P <0.01 was considered significant.

RESULTS

In total, 101 male patients were included. There was no significant contrast in age among the groups. Every partaker in the study groups had one dental implant placed in posterior maxilla or mandible. The mean HbA1c levels were significantly higher among CS (P <0.01) and NS (P <0.01) with T2DM than individuals without T2DM. Peri-implant PI (P <0.01), PD (P <0.01), and CBL (P <0.01) were significantly higher among CS and NS with T2DM and CS without T2DM than NS without T2DM. Peri-implant BOP was significantly higher among CS and NS with T2DM than CS and NS without T2DM (P <0.01).

CONCLUSIONS

Peri-implant inflammatory variables were worse among CS and NS with T2DM than NS without T2DM. A state of chronic hyperglycemia seems to be a stronger mediator of inflammation than cigarette smoking in patients with T2DM.

Evaluation of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-1β levels among subjects vaping e-cigarettes and nonsmokers

AIM

The present study aimed to evaluate peri-implant immunological parameters along with clinical and radiographic parameters amongst subjects vaping e-cigarettes and nonsmokers (NS). Two immunological parameters that were included were measurement of tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-1β.

MATERIALS AND METHODS

A statistically significant number of subjects were included in the study and further divided into two groups: Group-1: Vaping e-cigs (n = 47) Group-2: Nonsmokers (n = 45) A structured questionnaire was used at baseline for data collection related to demographic and peri-implant data of each individual. Baseline parameters included plaque index, bleeding on probing, probing pocket depth, and peri-implant bone loss (PI, BOP, PD, and PIBL, respectively) for those vaping e-cigs and nonsmokers with the aid of standardized digital radiographs. ELISA kit was used to assess immunologic parameters using sulcular fluid collected from peri-implant region (PISF).

RESULTS

Bleeding on probing (BOP) was found significantly high in nonsmokers compared to the vaping group. But probing depth greater than 4 mm and PIBL scores were significantly higher in the vaping group than nonsmokers. Mean concentrations of immunologic parameters were significantly higher in vaping group than in nonsmokers. TNF-α levels and IL-1β levels were found to have a positive correlation with bone loss around implants (PIBL). Besides, TNF-α also had a positive correlation with bleeding on probing in vaping group compared to nonsmokers.

CONCLUSIONS

Owing to the effect of nicotine on the peri-implant tissue, levels of inflammatory mediators as detected by ELISA tests were found to be higher showing a greater amount of localized inflammatory tissue destruction and a compromised peri-implant area in vaping subjects. PISF concentrations were also found relatively higher than nonsmokers.

Wnt5a is involved in LOX-1 and TLR4 induced host inflammatory response in peri-implantitis

BACKGROUND AND OBJECTIVE

Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Wnt5a is the activating ligand of the non-canonical Wnt signaling pathways and plays important roles in leukocyte infiltration and cytokine/ chemokine production in inflammatory disorders. Previous studies showed that Wnt5a was significantly up-regulated in gingival tissues of chronic and aggressive periodontitis. However, the roles and the regulatory mechanisms of Wnt5a in peri-implantitis are not well known.

METHODS

The expression of Wnt5a in gingival tissues collected from 8 healthy implant patients and 8 peri-implantitis patients was analyzed by Western blotting and immunofluorescence. Porphyromonas gingivalis infected macrophages isolated from the peripheral blood of healthy volunteers were used as an in vitro cellular model of peri-implantitis. Using neutralizing antibodies, inhibitors and siRNA, the production and roles of Wnt5a in peri-implantitis were assessed by immunofluorescence, quantitative polymerase chain reaction (RT-PCR) and Western blotting. Unpaired two-tailed Student's t test was used to compare qRT-PCR and Western blotting results. P ≤ .05 was considered statistically significant.

RESULTS

Wnt5a was highly expressed in the gingival tissues of peri-implantitis patients. Compared to controls, Wnt5a increased in P gingivalis infected macrophages. Wnt5a production in response to P gingivalis infection was dependent on LOX-1 and TLR4. Compared to controls, Wnt5a knockdown impaired IL-1β, MCP-1, and MMP2 production induced by P gingivalis infection.

CONCLUSION

Our results indicate that Wnt5a is involved in LOX-1 and TLR4 induced inflammatory signature via inflammatory cytokines production in response to P gingivalis infection. These findings demonstrate that Wnt5a maybe an important component of the host immune response in peri-implantitis.

Host response and peri-implantitis

Considering the absence of predictable and effective therapeutic interventions for the treatment of peri-implantitis, scientific evidence concerning the host response profile around dental implants could be important for providing in the future a wider preventive and/or therapeutic window for this peri-implant lesion, indicating biomarkers that provide quantifiable measure of response to peri-implant therapy. Moreover, a better knowledge of pattern of host osteo-immunoinflammatory modulation in the presence of peri-implantitis could either benefit the early diagnostic of the disease or to cooperate to prognostic information related to the status of the peri-implant breakdown. Finally, new evidences concerning the host profile of modulators of inflammation and of osseous tissue metabolism around dental implants could explain the individual susceptibility for developing peri-implant lesions, identifying individuals or sites with increased risk for peri-implantitis. The focus of this chapter was, based on a systematically searched and critically reviewed literature, summarizing the existing knowledge in the scientific research concerning the host osteo-immunoinflammatory response to the microbiological challenge related to periimplantitis.

Effect of waterpipe smoking on peri-implant health: A systematic review and meta-analysis

The aim of the present review was to evaluate the effect of waterpipe smoking (WS) on clinical peri-implant inflammatory parameters compared to non-smokers (NS) with dental implants. Literature searches were performed using bibliographic databases up to May 2018. Primary outcomes included peri-implant bone loss (PIBL), while secondary outcomes were probing depth (PD), plaque index, and bleeding on probing. Relative risk (RR) and 95% confidence intervals (CI) for each PIBL and PD were estimated by a random-effect model. Four retrospective case-control studies were included in the qualitative and quantitative syntheses. All of the included studies showed statistically-significantly worse peri-implant outcomes in WS compared to NS. Considering the effects of WS on peri-implant parameters, significant heterogeneity for PIBL (Q-value = 34.21, P < 0.0001, I²  = 94.16%) and PD (Q-value = 51.97, P < 0.0001, I²  = 96.15%) was observed between both groups. The overall RR for PIBL (RR = 3.32, 95% CI = 1.01-3.97, P = 0.001) and PD (RR = 3.40, 95% CI = 1.91-7.17, P = 0.001) were significant between WS and NS groups. WS has detrimental effect on peri-implant health. Clinicians should instruct and advise patients about poor prognosis and peri-implant diseases caused by WS.

Clinical and radiographic peri-implant health status around narrow diameter implant-supported single and splinted crowns

BACKGROUND

Studies assessing and comparing clinical and radiographic peri-implant status around narrow diameter implant-supported single crowns (NDISCs) and splinted crowns (NDISPs) are scarce.

OBJECTIVE

The aim of this retrospective study was to estimate and compare complication rates, patient satisfaction, peri-implant status and peri-implant bone loss (PBL) of NDISCs and NDISPs.

MATERIALS AND METHODS

Patients receiving narrow diameter implants (NDIs) in the posterior mandible were assessed. Technical complication and patient satisfaction were recorded. Clinical peri-implant plaque index (PI), bleeding on probing (BoP), probing depth (PD) and PBL were assessed. Technical complications and patient satisfaction were recorded. Log-rank test was computed to evaluate the influence of prostheses type and NDIs location on technical complications. P-value less than 0.05 was regarded as significant.

RESULTS

Seventy-eight patients (43 male and 35 females) agreed to follow up. The mean follow-up duration of the patients was 3.6 years. A total of 102 (43 NDISCs and 59 NDISPs) NDIs with moderately rough surfaces were included. No significant differences in PI, BoP, or PD were observed between NDISCs and NDISPs. The average PBL score was 1.17 (range: 0.03-4.15) at implant level and 1.14 (range: 0.03-4.14) at patient level. Seven implants and three patients showed peri-implantitis. The rates of technical complication of single crowns were significantly higher than those of splinted crowns (P = 0.036). PBL was significantly higher in molar sites than those in premolar sites (P = 0.041). A total of 67 patients (85.9%) were satisfied with the esthetics of the crowns, while a total of 59 patients (75.6%) were satisfied with the function of the crowns.

CONCLUSION

NDISCs and NDISPs offer high patient satisfaction and tolerable complication rates. Peri-implant conditions and peri-implant bone levels were comparable around NDISCs and NDISPs. However, bone loss of implants was higher in molar sites than those implants in premolar sites.

Clinical peri-implant parameters and inflammatory cytokine profile among smokers of cigarette, e-cigarette, and waterpipe

BACKGROUND

To date, there has been no study identified that assessed peri-implant parameters and local levels of proinflammatory cytokines between waterpipe smokers (WS) and electronic cigarette users (VS). To evaluate the true effect of the risk indicator (WS and VS), a positive control (cigarette smokers [CS]) was added in the study design.

PURPOSE

To compare clinical and radiographic peri-implant parameters and proinflammatory cytokine profile in the peri-implant sulcular fluid (PISF) among CS, WS, VS, and nonsmokers (NS).

MATERIALS AND METHODS

Forty CS, WS, VS, and NS were included. Details regarding demographics, duration of implants, and habits were recorded. Clinical examination for periodontal and peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD ≥ 4 mm) were assessed. Radiographic bone loss (RBL) was assessed using digital periapical radiographs and viewed on a calibrated computer screen using an image analyzer. Levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, and IL-1β in PISF were evaluated using enzyme-linked immunosorbent assay.

RESULTS

Mean peri-implant PI (P < .05), PD ≥ 4 mm (P < .05), and total RBL (P < .01) was significantly higher among CS, WS, and VS compared with NS. Statistical differences in BOP were observed in NS (P < .01) compared to CS, WS, and VS. CS and WS showed significantly higher PD ≥ 4 mm and RBL compared with VS (P < .05). Levels of TNF-α, IL-6, and IL-1β were significantly higher in CS, WS, and VS compared to NS. There were no statistical differences in the mean levels of all proinflammatory cytokines among individuals in CS and WS.

CONCLUSION

Tobacco smoking is associated with poor peri-implant health. The effect of waterpipe smoking was of largely the same extent as that of cigarette smoking. Higher levels of inflammatory cytokines in tobacco smokers may propose increased peri-implant inflammatory process which could play a principal role in the progression of peri-implant tissue damage.

Proinflammatory cytokine levels and peri-implant parameters among cigarette smokers, individuals vaping electronic cigarettes, and non-smokers

BACKGROUND

Tobacco smoking compromises the prognosis of dental implant treatment and is associated with increased risk of peri-implant bone loss and increased implant failure rate. There is a dearth of studies that have compared clinical, radiographic, and immunological peri-implant parameters among cigarette smokers (CS), individuals vaping e-cigarettes (e-cigs), and non-smokers (NS). This study aimed to compare clinical and radiographic peri-implant parameters and levels of matrix metalloproteinase (MMP)-9 and interleukin (IL)-1β levels among CS, individuals' vaping e-cigs, and NS.

METHODS

Thirty-two CS (group 1), 31 individuals vaping e-cigs (group 2), and 32 NS (group 3) were included. Demographic- and implant-related data were collected using a structured baseline questionnaire. Peri-implant plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded and marginal bone loss (MBL) were assessed using standardized digital radiographs. Enzyme-linked immunosorbent assay was used to assess levels of MMP-9 and IL-1β in peri-implant sulcular fluid. Pearson correlation coefficient was used to analyze for correlations of MMP-9 and IL-1β levels with peri-implant parameters.

RESULTS

BOP showed significantly higher values in group 3 as compared with groups 1 and 2 (P < 0.01). PI (P < 0.01), PD ≥ 4 mm (P < 0.01), and mean concentrations of MMP-9 (P < 0.001) and IL-1β (P < 0.01) were significantly higher in groups 1 and 2 than group 3. MBL was significantly higher in group 1 as compared with group 2 and group 3 (P < 0.01). Significant positive correlations were found between MMP-9 (P = 0.0198) and IL-1β (P = 0.0047) levels and MBL in group 1; and a significant positive correlation between IL-1β and MBL in group 2 (P = 0.0031).

CONCLUSIONS

Peri-implant health was compromised among CS than vaping individuals and NS. Increased levels of proinflammatory cytokines in CS and vaping individuals may suggest greater peri-implant inflammatory response.

Comparison of clinical and radiographic peri-implant parameters among obese and non-obese patients: A 5-year study

BACKGROUND

It is postulated that peri-implant parameters are worse in obese individuals as compared to nonobese.

OBJECTIVE

The aim of the present 5-year longitudinal study was to analyze and compare the changes in clinical and radiographic peri-implant parameters among obese and non-obese patients.

MATERIALS AND METHODS

Twenty patients with body mass index ≥ 27.5 kg/m² and 18 non-obese controls were included. All patients were indicated for single tooth maxillary or mandibular molar replacement with the adjacent teeth intact. Peri-implant clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD]) and radiographic (marginal bone loss [MBL]) parameters were measured at 12, 24, and 60 months of follow-up.

RESULTS

All peri-implant parameters showed statistically significant difference between obese and non-obese individuals. Obese group recorded significant higher BOP, PD, and MBL at different observation times. Probing depth and MBL increased significantly with advance of time in both groups. After 60 months of follow-up period, greater PI and BOP was observed in obese patients (P < 0.01). At 60 months follow-up period, obese patients showed significant increased PD (3.69 mm) as compared to non-obese individuals (2.46 mm). Marginal bone loss in non-obese individuals varied from 0.30 mm after 12 months, reaching 0.55 mm after 60 months of follow-up period, while in obese patients MBL values went from 0.36 mm after 12 months to 0.91 mm at 60 months follow-up (P < 0.01).

CONCLUSIONS

Patients with obesity are at risk of increased localized peri-implant soft and hard tissue inflammation. It is recommended that clinicians should educate obese patients about risk of increased peri-implant tissue inflammation and susceptibility to bone loss and stipulate stringent oral hygiene care for ideal peri-implant health.