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Isler SC, Romandini M, Akca G, Bakirarar B, Unsal B, Romanos G, Sculean A. Soft-Tissue Phenotype as a Risk Indicator of Peri-Implantitis and Peri-Implant Soft-Tissue Dehiscence-A Cross-Sectional Study. J Clin Periodontol 2024. [PMID: 39189550 DOI: 10.1111/jcpe.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/23/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
AIM To investigate the association, as well as to characterize the associated panel of pro- and anti-inflammatory markers, between the different components of the peri-implant phenotype and the presence of peri-implantitis/peri-implant soft-tissue dehiscence (PISTD). MATERIALS AND METHODS A total of 324 implants in 112 patients were included. The following components of the peri-implant phenotype were clinically measured through the use of a manual periodontal probe or a digital calliper: keratinized mucosa width (PIKM-W), mucosal thickness (MT), attached mucosa (AM) and vestibulum depth (VD). The presence of peri-implantitis and PISTD was assessed through clinical and radiographic examination. Mixed-models logistic regression analyses were performed to analyse the association between peri-implant phenotype and the presence of peri-implantitis or PISTD, adjusting for relevant confounders. Multiplex immunoassays were employed to evaluate the peri-implant crevicular fluid levels of a panel of pro- and anti-inflammatory markers. RESULTS Peri-implant health, peri-implant mucositis and peri-implantitis were diagnosed in 36.6%, 21.4% and 42% of the patients (classified according to their worst implant) and 35.2%, 34.3%, and 30.5% of the implants, respectively. In the multi-level multiple regression model, the absence of PIKM-W (odds ratio [OR] = 9.24; 95% CI: 2.73-31.28), the absence of attached mucosa (OR = 19.58; 95% CI: 6.12-62.56) and a reduced (<4 mm) vestibulum depth (OR = 2.61; 95% CI: 1.05-6.48) were associated with peri-implantitis. Similarly, the absence of PIKM-W (OR = 6.32; 95% CI: 1.67-23.83), a thin (<2 mm) mucosa (OR = 157.75; 95% CI: 14.06-1769.9) and a reduced vestibulum depth (OR = 3.32; 95% CI: 1.02-10.84) were associated with the presence of PISTD. Implants with PIKM-W = 0 mm showed statistically significantly higher levels of interferon-γ in both regular (≥2 maintenance/year) and irregular (<2 maintenance/year) compliers (p = 0.046 and p = 0.012). In irregular compliers, the absence of PIKM-W was also associated with statistically significantly higher levels of interleukin (IL)-1β and IL-21 (p = 0.016, p = 0.046). These associations were independent of the effect of relevant confounders (e.g., plaque, compliance with maintenance, etc.). CONCLUSIONS Within their limits, the present findings indicate that (a) peri-implant soft-tissue phenotype appears to be associated with the presence of peri-implantitis and PISTD, and (b) in the absence of PIKM-W, the inflammatory response seems to be dysregulated and the soft-tissue remodelling up-regulated.
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Affiliation(s)
- Sila Cagri Isler
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Mario Romandini
- Department of Periodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Gulcin Akca
- Department of Medical Microbiology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Batuhan Bakirarar
- Department of Biostatistics, Process Management Coordinator, ADO Group, Antalya, Turkey
| | - Berrin Unsal
- Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Georgios Romanos
- Department of Periodontics and Endodontics, Stony Brook University, Stony Brook, New York, USA
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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2
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Spinell T, Kröger A, Freitag L, Würfl G, Lauseker M, Hickel R, Kebschull M. Dental implant material related changes in molecular signatures in peri-implantitis - A systematic review of omics in-vivo studies. Dent Mater 2023; 39:1150-1158. [PMID: 37839998 DOI: 10.1016/j.dental.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Titanium particles have been shown in in-vitro studies to lead to the activation of specific pathways, this work aims to systematically review in- vivo studies examining peri-implant and periodontal tissues at the transcriptome, proteome, epigenome and genome level to reveal implant material-related processes favoring peri-implantitis development investigated in animal and human trials. METHODS Inquiring three literature databases (Medline, Embase, Cochrane) a systematic search based on a priori defined PICOs was conducted: '-omics' studies comparing molecular signatures in healthy and infected peri-implant sites and/or healthy and periodontitis-affected teeth in animals/humans. After risk of bias assessments, lists of differentially expressed genes and results of functional enrichment analyses were compiled whenever possible. RESULTS Out of 2187 screened articles 9 publications were deemed eligible. Both healthy and inflamed peri-implant tissues showed distinct gene expression patterns compared to healthy/diseased periodontal tissues in animal (n = 4) or human studies (n = 5), with immune response, bone metabolism and oxidative stress being affected the most. Due to the lack of available re-analyzable data and inconsistency in methodology of the eligible studies, integrative analyses on differential gene expression were not applicable CONCLUSION: The differences of transcriptomic signatures in between peri-implant lesions compared to periodontal tissue might be related to titanium particles arising from dental implants and are in line with the in-vitro data recently published by our group. Nevertheless, limitations emerge from small sample sizes of included studies and insufficient publication of re-analyzable data.
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Affiliation(s)
- Thomas Spinell
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany.
| | - Annika Kröger
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Lena Freitag
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | | | - Michael Lauseker
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University, Goethestr. 70, D-80336 Munich, Germany
| | - Moritz Kebschull
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University Collegeof Dental Medicine, New York, NY, United States
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Asami Y, Sasaki H, Harada A, Hanazawa K, Kobayashi T, Mori G, Yajima Y. Rat peri-implant soft tissue specifically expressed CXCL2 on titanium implant during wound healing. J Biomed Mater Res A 2021; 110:899-908. [PMID: 34850541 DOI: 10.1002/jbm.a.37337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 12/22/2022]
Abstract
Many of genes specifically expressed in peri-implant soft tissue (PIST) selected by microarray analysis are involved in the inflammatory response. This study investigated the gene expression and localization of PIST-specific inflammatory markers in PIST during wound healing. Pure titanium implants were implanted into the rat upper mandibular socket to create PIST. Samples were harvested from PIST as an experimental group, and tooth extracted area of oral mucosa tissue (OMT) and healthy periodontal tissue (PT) as control groups. The gene expressions of four standard inflammatory markers and nine PIST-specific inflammatory markers including chemokine (C-X-C motif) ligand 2 (CXCL2) during wound healing were examined. Immunoreactions of CXCL2 and immune cells in PIST and control tissues were compared. During wound healing, gene expression of PIST-specific inflammatory markers was higher in PIST than in OMT (p < .05), but there were no significant differences in the expression of standard inflammatory markers. The molecule CXCL2 was expressed locally at the implant-connective tissue interface, and localization of immune cells closely matched the CXCL2 expression pattern. In PIST, seven of PIST-specific inflammatory markers were expressed specifically and strongly during wound healing and their expression was maintained until the end of healing. Furthermore, CXCL2 expression was due to the creation of the implant-connective tissue interface, and it established a unique defense mechanism in PIST that was not apparent in OMT or PT.
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Affiliation(s)
- Yosuke Asami
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan.,Oral Health Science Center, Tokyo Dental College, Chiyoda-ku, Japan
| | - Hodaka Sasaki
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan.,Oral Health Science Center, Tokyo Dental College, Chiyoda-ku, Japan
| | - Atsuro Harada
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan.,Oral Health Science Center, Tokyo Dental College, Chiyoda-ku, Japan
| | - Kiyotoshi Hanazawa
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan.,Oral Health Science Center, Tokyo Dental College, Chiyoda-ku, Japan
| | - Takafumi Kobayashi
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan
| | - Gentaro Mori
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan
| | - Yasutomo Yajima
- Department of Oral and Maxillofacial Implantology, Tokyo Dental College, Chiyoda-ku, Japan
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He Q, Mu Z, Shrestha A, Wang C, Wang S, Tang H, Li Y, Song J, Ji P, Huang Y, Chen T. Development of a rat model for type 2 diabetes mellitus peri-implantitis: A preliminary study. Oral Dis 2021; 28:1936-1946. [PMID: 33715257 DOI: 10.1111/odi.13845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 02/12/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop an in vivo model to simulate the complex internal environment of diabetic peri-implantitis (T2DM-PI) model for a better understanding of peri-implantitis in type 2 diabetic patients. MATERIALS AND METHODS Maxillary first molars were extracted in Sprague-Dawley (SD) rats, and customized cone-shaped titanium implants were installed in the extraction sites. Thereafter, implants were uncovered and customized abutments were screwed into implants. A high-fat diet and a low-dose injection of streptozotocin were utilized to induce T2DM. Finally, LPS was locally injected in implant sulcus to induce peri-implantitis. RESULTS In the present study, T2DM-PI model has been successfully established. Imaging analysis revealed that abundant inflammatory cells infiltrated in the soft tissue in T2DM-PI group with concomitant excessive secretion of inflammatory cytokines. Moreover, higher expression of MMP and increased number of osteoclasts led to collagen disintegration and bone resorption in T2DM-PI group. CONCLUSIONS These results describe a novel rat model which stimulate T2DM-PI in vivo, characterized by overwhelming inflammatory response and bone resorption. This model has a potential to be used for investigation of initiation, progression and interventional therapy of T2DM-PI.
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Affiliation(s)
- Qingqing He
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Zhixiang Mu
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.,Department of Periodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Annie Shrestha
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Chao Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Si Wang
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Han Tang
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yihan Li
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Ping Ji
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yuanding Huang
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Tao Chen
- Stomatological Hospital of Chongqing Medical University, Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Kobayashi T, Sasaki H, Asami Y, Mori G, Yoshinari M, Yajima Y. The characteristic regulation of gene expression
Lbp
and
Sod3
in peri‐implant connective tissue of rats. J Biomed Mater Res A 2020; 108:592-600. [DOI: 10.1002/jbm.a.36839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Takafumi Kobayashi
- Department of Oral and Maxillofacial Implantology Tokyo Dental College Tokyo Japan
- Oral Health Science Center, Tokyo Dental College Tokyo Japan
| | - Hodaka Sasaki
- Department of Oral and Maxillofacial Implantology Tokyo Dental College Tokyo Japan
- Oral Health Science Center, Tokyo Dental College Tokyo Japan
| | - Yosuke Asami
- Department of Oral and Maxillofacial Implantology Tokyo Dental College Tokyo Japan
- Oral Health Science Center, Tokyo Dental College Tokyo Japan
| | - Gentaro Mori
- Department of Oral and Maxillofacial Implantology Tokyo Dental College Tokyo Japan
| | - Masao Yoshinari
- Oral Health Science Center, Tokyo Dental College Tokyo Japan
| | - Yasutomo Yajima
- Department of Oral and Maxillofacial Implantology Tokyo Dental College Tokyo Japan
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Svensson S, Trobos M, Omar O, Thomsen P. Site-specific gene expression analysis of implant-near cells in a soft tissue infection model - Application of laser microdissection to study biomaterial-associated infection. J Biomed Mater Res A 2017; 105:2210-2217. [PMID: 28395127 DOI: 10.1002/jbm.a.36088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/22/2017] [Accepted: 04/05/2017] [Indexed: 01/10/2023]
Abstract
Analysis of the implant-tissue interface is important for an understanding of the cellular response to biomaterials with different surface characteristics. However, inaccessibility to the site has restricted the detailed evaluation of the tissue surrounding the implant. Laser microdissection enables the isolation of specific cells and tissues for subsequent DNA, RNA, or protein analysis. The present experimental study employed laser microdissection to analyze tissue-specific differences in gene expression in cells around infected or control titanium implants 72 h after subcutaneous implantation in a rat model. Three different tissue zones located 0-800 μm away from the implant-tissue interface were analyzed. Implant sites challenged with a dose of 106 CFU Staphylococcus epidermidis demonstrated higher gene expression of selected markers for inflammation (TNF-α, IL-6), cell recruitment (MCP-1, IL-8, IL-8 R), infection (TLR2), and tissue remodeling (MMP-9) compared with control implants. Furthermore, the gene expression analysis of the three extracted tissue zones revealed marked spatial differences, depending on the distance to the implant. Control implants continuously induced higher cell gene expression in the implant-tissue interface compared with cells 200-800 μm away from the implant, whereas the sites inoculated with S. epidermidis resulted in high gene expression further away from the implant as well. In conclusion, this study demonstrates that laser microdissection is an interesting tool, revealing both gene- and site-specific gene expression patterns in the implant-tissue interface. The technique provides an opportunity for detailed molecular dissection of the biological events related to the implant but occurring at different distances from the implant. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2210-2217, 2017.
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Affiliation(s)
- Sara Svensson
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden
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