Molecular tools for preventing and improving diagnosis of peri-implant diseases

The role of oxidative stress biomarkers in the development of peri-implant disease: A systematic review and meta-analysis

OBJECTIVES

To analyze the role of oxidative stress (OS) biomarkers in peri‑implant diseases using a systematic review and meta-analysis approach. DATE: The review incorporated cross-sectional studies, randomized controlled trials, and case-control trials to evaluate the differences in OS biomarkers of peri‑implant disease.

SOURCES

A comprehensive literature search was conducted in electronic databases such as PubMed, Scopus, Embase, Web of Science, and CNKI, and no restrictions were applied during the search process.

STUDY SELECTION

A total of 452 studies were identified, of which 18 were eligible for inclusion. Risk of bias and sensitivity analysis were assessed using Egger's test and funnel plots.

RESULTS

We found that the levels of glutathione peroxidase (GSH-Px) in the peri‑implant sulcus fluid (PISF) of patients with peri‑implant diseases were significantly reduced (SMD = -1.40; 95 % CI = 1.70, -1.11; p < 0.001), while the levels of total myeloperoxidase (MPO) and malondialdehyde (MDA) were significantly increased (SMD = 0.46; 95 % CI = 0.12, 0.80; p = 0.008; SMD = 0.28; 95 % CI = 0.01, 0.56; p = 0.043). However, there were no significant differences of MPO concentration (SMD = 0.38; 95 % CI = -0.39, 1.15; p = 0.331) and superoxide dismutase (SOD)(SMD = -0.43; 95 % CI = -1.94, 1.07; p = 0.572) in PISF between peri‑implant disease group and control group. Similarly, salivary MPO did not show significant differences (SMD = 1.62; 95 % CI = -1.01, 4.24; p = 0.227).

CONCLUSIONS

Our results supported that the level of local OS biomarkers was closely related to peri‑implant diseases. GSH-Px, total MPO and MDA may be PISF biomarkers with good capability to monitor the development of peri‑implant disease.

CLINICAL SIGNIFICANCE

This study found significant differences in the levels of local OS biomarkers (GSH-Px, total MPO, and MDA) between patients with peri‑implant diseases and healthy subjects, which may be ideal candidate biomarkers for predicting and diagnosing peri‑implant diseases.

Diagnostic potential of endothelin-1 in peri-implant diseases: a cross-sectional study

PURPOSE

This study aimed to evaluate the potential of Endothelin-1 (ET-1), a peptide derived from vascular endothelial cells, as a biomarker for diagnosing peri-implant diseases.

METHODS

A cohort of 29 patients with a total of 76 implants was included in this study and subsequently divided into three groups based on peri-implant clinical parameters and radiographic examination: healthy (peri-implant health) (n = 29), mucositis (n = 22), and peri-implantitis (n = 25) groups. The levels of ET-1 (ρg/site) and interleukin (IL)-1β (ρg/site) in peri-implant sulcus fluid (PISF) samples were determined using enzyme immunoassay. Statistical analyses were conducted using Kruskal-Wallis and Steel-Dwass tests. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performance of the biomarkers.

RESULTS

ET-1 levels were significantly elevated in the peri-implantitis group compared to those in the healthy group, and were highest in the peri-implant mucositis group. Additionally, IL-1β levels were significantly higher in the peri-implantitis group than those in the healthy group. ROC curve analysis indicated that ET-1 exhibited superior area under the curve values, sensitivity, and specificity compared to those of IL-1β.

CONCLUSIONS

Our findings suggest that the presence of ET-1 in PISF plays a role in peri-implant diseases. Its significantly increased expression in peri-implant mucositis indicates its potential for enabling earlier and more accurate assessments of peri-implant inflammation when combined with conventional examination methods.

Clinical Efficacy of Different Concentrations of Povidone Iodine in the Management of Peri-Implant Mucositis

Mechanical plaque control is the first line of management of peri-implant diseases. Povidone iodine is one of the broad spectrum and potent antiseptics available at various concentrations. The aim of the study was to assess and compare the efficacy of various concentrations of povidone iodine in the management of peri-implant mucositis. In the present double blinded, parallel designed, randomized clinical trial, a total of 60 patients with peri-implant mucositis (20 participants in each group [Group 1 (povidone iodine 0.1%), Group 2 (povidone iodine 2%) and Group 3 (povidone iodine 010%)] were enrolled. Scaling and root planing was done and then the peri-implant sulcus was irrigated with respective irrigant and repeated once in a week for 4 weeks. Loe and Silness Gingival Index (GI) and Mombelli Modified sulcular bleeding index (BI) were recorded at baseline and after a month and compared. Statistical analysis was done using One-way ANOVA and Tukey's HSD post hoc test. A statistically significant difference (P = 0.000) observed between the three concentrations when compared after 1 month. Also, a statistically significant difference between Group 1 and Group 3 and Group 2 and Group 3 was observed in terms of post GI (P = 0.000) and post BI (P = 0.000) but statistically no significant difference was observed between Group 1 and Group 2 in terms of post GI (P = 0.171) and post BI (P = 0.338). The 2% and 10% povidone iodine showed significant improvement in gingival index and bleeding index and hence it could be an effective adjunct to scaling and root planing in the management of peri-implant mucositis.

Peri-implant diseases diagnosis, prognosis and dental implant monitoring: a narrative review of novel strategies and clinical impact

BACKGROUND

The diagnosis of peri-implantar and periodontal relies mainly on a set of clinical measures and the evaluation of radiographic images. However, these clinical settings alone are not sufficient to determine, much less predict, periimplant bone loss or future implant failure. Early diagnosis of periimplant diseases and its rate of progress may be possible through biomarkers assessment. Once identified, biomarkers of peri-implant and periodontal tissue destruction may alert the clinicians before clinical signs show up. Therefore, it is important to consider developing chair-side diagnostic tests with specificity for a particular biomarker, indicating the current activity of the disease.

METHODS

A search strategy was created at Pubmed and Web of Science to answer the question: "How the molecular point-of-care tests currently available can help in the early detection of peri-implant diseases and throws light on improvements in point of care diagnostics devices?"

RESULTS

The PerioSafe® PRO DRS (dentognostics GmbH, Jena) and ImplantSafe® DR (dentognostics GmbH, Jena ORALyzer® test kits, already used clinically, can be a helpful adjunct tool in enhancing the diagnosis and prognosis of periodontal/peri-implantar diseases. With the advances of sensor technology, the biosensors can perform daily monitoring of dental implants or periodontal diseases, making contributions to personal healthcare and improve the current status quo of health management and human health.

CONCLUSIONS

Based on the findings, more emphasis is given to the role of biomarkers in diagnosing and monitoring periodontal and peri-implant diseases. By combining these strategies with traditional protocols, professionals could increase the accuracy of early detection of peri-implant and periodontal diseases, predicting disease progression, and monitoring of treatment outcomes.

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.

Use of bioinformatic strategies as a predictive tool in implant-supported oral rehabilitation: A scoping review

STATEMENT OF PROBLEM

The use of bioinformatic strategies is growing in dental implant protocols. The current expansion of Omics sciences and artificial intelligence (AI) algorithms in implant dentistry applications have not been documented and analyzed as a predictive tool for the success of dental implants.

PURPOSE

The purpose of this scoping review was to analyze how artificial intelligence algorithms and Omics technologies are being applied in the field of oral implantology as a predictive tool for dental implant success.

MATERIAL AND METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist was followed. A search strategy was created at PubMed and Web of Science to answer the question "How is bioinformatics being applied in the area of oral implantology as a predictive tool for implant success?"

RESULTS

Thirteen articles were included in this review. Only 3 applied bioinformatic models combining AI algorithms and Omics technologies. These studies highlighted 2 key points for the creation of precision medicine: deep population phenotyping and the integration of Omics sciences in clinical protocols. Most of the studies identified applied AI only in the identification and classification of implant systems, quantification of peri-implant bone loss, and 3-dimensional bone analysis, planning implant placement.

CONCLUSIONS

The conventional criteria currently used as a technique for the diagnosis and monitoring of dental implants are insufficient and have low accuracy. Models that apply AI algorithms combined with precision methodologies-biomarkers-are extremely useful in the creation of precision medicine, allowing medical dentists to forecast the success of the implant. Tools that integrate the different types of data, including imaging, molecular, risk factor, and implant characteristics, are needed to make a more accurate and personalized prediction of implant success.

Underdiagnosis in Background of Emerging Public Health Challenges Related to Peri-Implant Diseases: An Interventional Split-Mouth Study

Peri-implant diseases are an emerging public health problem, and it's considered that limitations of standard diagnostics play the role herein. The study objective was the estimation of pathological bone resorption at clinical and biological level in patients with peri-implant mucositis (PIM) and peri-implantitis (PI) before and 6 months after standard treatment and to compare them with healthy controls (HC). The split-mouth interventional study included 60 patients affected with PIM or PI. Patients that also presented at least one more HC were enrolled in the study and underwent standard non-surgical and surgical treatment, respectively. Standard clinical parameters and soluble levels of RANKL were measured in peri-implant crevicular fluid baseline and 6 months following treatment. Clinical parameters and RANKL significantly decreased following treatment in PIM and PI. However, bleeding on probing and probing depth remained significantly increased when compared to HC. RANKL answered requests for biomarker of peri-implant diseases, its baseline levels were significantly increased in PIM and PI, they decreased following treatment and reached HC in peri-implantitis, while in PIM RANKL remained significantly increased. Presence of pathological bone resorption in patients lacked its clinical signs, and respective persistence following treatment suggest the need for biomarker-supported diagnosis for timely diagnosis of peri-implantitis and appropriate orientation of respective management strategies.

Active MMP-8 point-of-care (PoC)/chairside enzyme-test as an adjunctive tool for early and real-time diagnosis of peri-implantitis

Objective

The aim of this study was to investigate the utility of the active matrix metalloproteinase (aMMP‐8)‐point‐of‐care (PoC) test as a quantitative real‐time chair‐side diagnostic tool for peri‐implant diagnosis, as well as assess the potentially developing and ongoing risk relative to the traditional clinical methods.

Background

Current peri‐implant and periodontal disease diagnoses rely on clinical and radiological examinations. This case‐control study investigated the applicability of aMMP‐8‐PoC immunotest for quantitative real‐time diagnosis and monitoring of dental implants in health and disease.

Methods

Sixty‐eight patients visiting a specialist clinic for maintenance following dental implant placement underwent assessment of their peri‐implant health. aMMP‐8‐PoC peri‐implant sulcular fluid (PISF) lateral‐flow immunotests were performed using ImplantSafe® technology quantitated by ORALyzer®. In addition, the PISF samples were analyzed for total MMP‐8, calprotectin, and interleukin (IL)‐6 by enzyme‐linked immunosorbent assays (ELISA), aMMP‐8 by western immunoblot, and MMP‐2 and MMP‐9 by gelatin zymography.

Results

The aMMP‐8‐PoC test promptly recorded and reflected peri‐implant disease, differentiating it clearly from health. X‐ray findings (bone loss > 2 mm), peri‐implant pocket depth ≥ 3 mm, and bleeding on probing were significantly more prevalent among implants positive for the aMMP‐8‐PoC test. aMMP‐8/ORALyzer analysis was more precise in recording disease than total MMP‐8, calprotectin, IL‐6, MMP‐2, and MMP‐9.

Conclusions

The aMMP‐8‐PoC test can be conveniently implemented to alert for and detect active collagenolysis affecting peri‐implant tissues, both in the early and advanced stages of the disease. Active and fragmented MMP‐8 exhibits a strong and significant association with peri‐implantitis as compared to total MMP‐8 and other biomarkers and can be utilized as the POC/chairside biomarker of choice in the new classification of peri‐implantitis.

Bacterial translocation and microgap formation at a novel conical indexed implant abutment system for single crowns

OBJECTIVES

A conometric concept was recently introduced in which conical implant abutments hold the matching crown copings by friction alone, eliminating the need for cement or screws. The aim of this in vitro study was to assess the presence of microgap formation and bacterial leakage at the Acuris conometric restorative interface of three different implant abutment systems.

MATERIAL AND METHODS

A total of 75 Acuris samples of three implant-abutment systems (Ankylos, Astra Tech EV, Xive) were subjected to microbiological (n = 60) and scanning electron microscopic (SEM) investigation (n = 15). Bacterial migration into and out of the conical coupling system were analyzed in an anaerobic workstation for 48, 96, 144, and 192 h. Bacterial DNA quantification using qrt-PCR was performed at each time point. The precision of the conometric coupling and internal fit of cemented CAD/CAM crowns on corresponding Acuris TiN copings were determined by means of SEM.

RESULTS

qrt-PCR results failed to demonstrate microbial leakage from or into the Acuris system. SEM analysis revealed minute punctate microgaps at the apical aspect of the conometric junction (2.04 to 2.64 µm), while mean cement gaps of 12 to 145 µm were observed at the crown-coping interface.

CONCLUSIONS

The prosthetic morse taper connection of all systems examined does not allow bacterial passage. Marginal integrity and internal luting gap between the ceramic crown and the coping remained within the clinically acceptable limits.

CLINICAL RELEVANCE

Conometrically seated single crowns provide sufficient sealing efficiency, relocating potential misfits from the crown-abutment interface to the crown-coping interface.

Scientometric Analysis of Dental Implant Research over the Past 10 Years and Future Research Trends

BACKGROUND

We conducted a bibliometrics analysis to explore the recent trends in dental implant research which could help researchers have a clear grasp of the relevant research hotspots and prospects. Material and Methods. Altogether, 15,770 articles on dental implants, from January 1, 2010, to October 31, 2019, were selected from the Web of Science Core Collection. We used BICOMB software to extract the high-frequency MeSH terms and construct binary and coword matrices. gCLUTO software was used for biclustering and visual analysis, Ucinet 6 software for social network analysis, SCIMAT software for strategic diagram building, Citespace 5.5 software to form timeline visualization, and VOSviewer software, eventually, for bibliometrics cocitation network.

RESULTS

Altogether, 72 high-frequency keywords were extracted from the selected articles and 4 clusters and 7 subcategories were identified through biclustering analysis in the dental implant research field. The use of the strategic diagram also enabled us to find the research hotspot and development trends.

CONCLUSIONS

The survival rate of dental implants and subsequent restoration have always been the core focus of research. Sinus floor elevation and guided bone regeneration are worthy of constant exploration owing to their reliability. With continuous improvement in technology, immediate loading could become a future research hot spot.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

aMMP-8 Point-of-Care/Chairside Oral Fluid Technology as a Rapid, Non-Invasive Tool for Periodontitis and Peri-Implantitis Screening in a Medical Care Setting

This communication article addresses currently available rapid non-invasive methods to screen and detect periodontitis and dental peri-implantitis. In this regard, oral fluid biomarkers have been researched extensively but self-reported oral health (SROH)-questionnaires have also been developed. Both alternatives may offer a quick and easy way to screen and detect diseased patients. Active matrix metalloproteinase (aMMP-8) is one of the most validated biomarkers for screening and detecting periodontal breakdown related to periodontitis and peri-implantitis and monitoring their treatment effects revealing successful, less- and non-successful treatment results. Currently available aMMP-8 lateral-flow technologies allow this kind of analysis, as demonstrated here, to be conducted quantitatively online and real-time as point-of-care/chairside testing in dental and even medical care settings. In this study, an aMMP-8 peri-implant sulcular fluid point-of-care-test diagnosed peri-implantitis and healthy implants far more accurately than bleeding-on-probing or the other biomarkers, such as polymorphonuclear (PMN)/neutrophil elastase, myeloperoxidase and MMP-9. Although, SROH-questionnaires allow screening in similar settings but they lack the information about the current disease activity of periodontitis and peri-implantitis, which is of essential value in periodontal diagnostics and treatment monitoring. Thus, both methods can be considered as adjunct methods for periodontitis and peri-implant diagnostics, but the value of oral fluid biomarkers analysis does not seem to be substitutable.

Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective

Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.

Concepts for prevention of complications in implant therapy

The use of dental implants is nowadays a well-accepted and highly predictable treatment modality for restoring the dentition and reestablishing the masticatory function of edentulous and partially edentulous patients. Despite the high predictability and excellent long-term survival rates reported for implant therapy, complications may still occur and can jeopardize both short- and long-term success. The present paper provides an overview on the most important aspects related to the etiology, prevention, and management of complications associated with implant therapy. Data from the literature indicate that a number of factors, such as surgical trauma, implant diameter, type of implant-abutment connection, abutment disconnection and reconnection, presence of microgap, and implant malpositioning, can substantially influence the biologic processes of bone remodeling and biofilm formation, thus increasing the rate of short- and long-term hard- and soft-tissue complications. Other factors, such as excess cement at cement-retained prosthetic restorations, abutment mobility, and infections (e.g. peri-implant mucositis and peri-implantitis) caused by bacterial biofilm, are further causes for complications and failures. More recent evidence also indicates that besides the need for sufficient bone volume surrounding the implant, the presence of an adequate width and thickness of attached mucosa may improve biofilm control and limit crestal bone resorption. Furthermore, emerging evidence points also to the pivotal role of human factors as one of the most important causes of complications in implant dentistry. It can be concluded that clinicians need to consider all biologic and biomechanical factors affecting implant placement and survival, as well as undergo adequate training to improve their surgical skills to control and prevent implant complications. Careful patient selection and control of environmental and systemic factors, such as smoking, diabetes etc., coupled with an accurate surgical and prosthetic planning, enable a better prevention and control of infections.