The Impact of Peri-Implantitis on Systemic Diseases and Conditions: A Review of the Literature

Novel biopolymer spray formulation for drug delivery in precision dentistry

Addressing the growing challenges of periodontal and peri-implant diseases, this study first reports a promising advancement in precision dentistry: an intricately formulated biopolymer spray designed for precise, localized drug delivery during tailored dental procedures. Poly (lactic-co-glycolic acid) (PLGA), recognized for its controlled release, biodegradability, and FDA-approved biocompatibility, forms the core of this formulation. Utilizing the double emulsion method, PLGA microparticles (PLGA-MPs) were loaded with dental antibiotics: sodium amoxicillin (AMX-Na), trihydrate amoxicillin (AMX-Tri), and metronidazole (Met). This antibiotic combination was thoughtfully selected to meet the distinctive requirements of the most impacting dental treatments. The newly developed biopolymer spray underwent thorough in-vitro analysis, revealing an optimized release curve for antibiotics over time, guaranteeing sustained therapeutic efficacy, and dose-dependent efficacy, accommodating personalized treatment approaches. The positive outcomes position the novel biopolymer spray formulation the leaders in advancing localized drug delivery during dental procedures. Moreover, the precise application and the tunable formulation meets the concept of precision medicine: in detail, this formulation represents a significant stride in dental therapeutics, significantly contributing to the predictability of dental implantology.

Microbiological profile of peri-implantitis: Analyses of peri-implant microbiome

PURPOSE

To characterize the microbiome composition in peri-implant pocket of peri-implantitis and peri-implant sulcus controls using 16S rRNA gene sequencing.

MATERIALS AND METHODS

In this controlled clinical cross-sectional study, 23 subjects with control implants (n = 14) and diseased implants (peri-implantitis, n = 21) were included. The peri-implant pocket/sulcus was sampled and used to extract DNA and amplify the 16S rRNA gene using universal primers targeting the V3-V4 regions. The resulting 16S PCR amplicons were sequenced on Illumina MiSeq, and the sequences were processed using DADA2 and the Human Oral Microbiome Database (HOMD) as references. Alpha and Beta diversity, as well as core microbiome and differential abundance analyses, were performed using the MicrobiomeAnalyst workflow.

RESULTS

There were no significant differences in microbial diversity between control implants and implants with peri-implantitis (Shannon p = 0.82). Overall bacterial community structure assessed through beta diversity analysis was also not significantly different between the two groups (p = 0.18). However, high levels of Gram-negative bacteria were detected in peri-implant pockets compared to the control sulcus. Abundant species in peri-implantitis were Capnocytophaga leadbetteri, Treponema maltophilum, Peptostreptococcus, Neisseria, P. gingivalis, and Porphyromonas endodontali, Lactococcus lactis and Filifactor alocis (p < 0.05). Gram-positive bacteria such as Streptococcus salivaris, Prevotella melaninogenica, L. wadei, and Actinomyces spp. serve were more abundant in peri-implant control sulcus.

CONCLUSIONS

Peri-implant sulcus in control implants harbors predominantly Gram-positive bacteria, whereas pockets of implants with peri-implantitis harbor predominantly Gram-negative bacteria.

How Can Imbalance in Oral Microbiota and Immune Response Lead to Dental Implant Problems?

Dental implantology is one of the most dynamically developing fields of dentistry, which, despite developing clinical knowledge and new technologies, is still associated with many complications that may lead to the loss of the implant or the development of the disease, including peri-implantitis. One of the reasons for this condition may be the fact that dental implants cannot yield a proper osseointegration process due to the development of oral microbiota dysbiosis and the accompanying inflammation caused by immunological imbalance. This study aims to present current knowledge as to the impact of oral microflora dysbiosis and deregulation of the immune system on the course of failures observed in dental implantology. Evidence points to a strong correlation between these biological disturbances and implant complications, often stemming from improper osseointegration, pathogenic biofilms on implants, as well as an exacerbated inflammatory response. Technological enhancements in implant design may mitigate pathogen colonization and inflammation, underscoring implant success rates.

Prosthetic Design Factors Influencing Peri-Implant Disease: A Comprehensive Review

Peri-implant disease, encompassing peri-implant mucositis and peri-implantitis, presents a growing challenge in implant dentistry. This comprehensive review explores the intricate interplay between prosthetic design factors and the development of peri-implant disease. By analyzing the impact of prosthetic components on microbial colonization, mechanical stress, and soft tissue health, the review highlights their crucial role in disease prevention and management. Additionally, it emphasizes the significance of maintenance protocols, prosthetic adjustments, and patient education in ensuring favorable long-term outcomes. The review underscores the potential for future advancements in prosthetic design, including innovative materials and digital technologies, and stresses the importance of interdisciplinary collaboration in optimizing patient care. Overall, the review underscores the critical role of prosthetic design in addressing the complexities of peri-implant disease, offering insights for clinicians and researchers to enhance the success and longevity of implant-supported restorations.

Unpredictable Electrochemical Processes in Ti Dental Implants: The Role of Ti Ions and Inflammatory Products

Peri-implantitis is a substantially prevailing condition. A potential risk factor for peri-implantitis is Ti implant corrosion. During inflammation, substantial quantities of reactive oxygen species (ROS) secretion and local acidification occur. Little is known about the interaction between the inflammatory and corrosion products on Ti surface corrosion. Therefore, the objective of the current study was to evaluate the synergistic effect of hydrogen peroxide (H2O2), lactic acid, and Ti ions on Ti corrosion. Twenty-seven commercially pure Ti samples were polished (Ra ≈ 45 nm) and divided into 9 groups as a function of electrolyte: (1) artificial saliva (AS) as control (C), (2) AS + Ti ions 20 ppm (Ti), (3) AS + lactic acid (pH = 5.5) (L), (4) AS + lactic acid + Ti ions 20 ppm (TiL), (5) AS + H2O2 0.5 mM (HP0.5), (6) AS + H2O2 1.0 mM (HP1.0), (7) AS + H2O2 0.5 mM + Ti ions 20 ppm (HP0.5Ti), (8) AS + H2O2 0.5 mM + lactic acid (HP0.5L), and (9) AS + H2O2 0.5 mM + Ti ions 20 ppm + lactic acid (HP0.5TiL). Electrochemical tests were performed following ASMT guidelines. Based on Tafel's method, current density (icorr) and corresponding potential (Ecorr) were acquired from potentiodynamic curves. Using electrochemical intensity spectroscopy (EIS), Nyquist and Bode plots were derived. Using a modified Randles circuit, charge transfer resistance (Rct) and capacitance (Cdl) were estimated. Based on open-circuit potential data, groups C and Ti had the lowest potentials (around -0.3 and -0.4 V vs SCE, respectively), indicating a lower passivation tendency compared to the other groups. From potentiodynamic curves, groups HP0.5 and HP1.0 increased icorr the most. From EIS data, groups HP0.5 and HP1.0 demonstrated the lowest impedance and phase angle on the Bode plot, indicating the highest corrosion kinetics. Based on EIS modeling, the combination of Ti ions, lactic acid, and H2O2 (group HP0.5TiL) significantly decreased Rct (p < 0.05). In conclusion, the concurrent presence of Ti ions, lactic acid, and H2O2 in the vicinity of the Ti surface increased the corrosion kinetics. High corrosion may produce more Ti products in the peri-implant tissues, which may increase the potential risk of peri-implantitis.

Association between peri-implantitis and systemic inflammation: a systematic review

Background

Peri-implantitis is an infectious/inflammatory disease with similar clinical and radiographic features to periodontitis. Overwhelming evidence confirmed that periodontitis causes elevations in systemic inflammatory mediators; this is unclear for peri-implantitis. Hence, this study aimed to appraise all available evidence linking peri-implantitis with systemic inflammation.

Methods

A systematic review was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, Dentistry & Oral Sciences Source, Scopus, LILACS, and China Online), ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and gray literature were searched up to February 9, 2023. Human studies of randomized controlled trials, non-randomized intervention studies, cohort studies, case-control, and cross-sectional studies were eligible for inclusion. Quantitative analyses were performed using random effects models.

Results

A total of 27 full-text articles were retrieved, and 11 clinical studies were included in the final analyses. All evidence gathered demonstrated a consistent association between peri-implantitis and systemic inflammation. Patients with peri-implantitis exhibited higher levels of serum C-reactive protein (CRP) (standard mean difference (SMD): 4.68, 98.7% CI: 2.12 to 7.25), interleukin-6 (IL-6) (weighted mean difference (WMD): 6.27 pg/mL, 0% CI: 5.01 to 7.54), and white blood cell counts (WMD: 1.16 * 103/μL, 0% CI: 0.61 to 1.70) when compared to participants without peri-implantitis.

Conclusion

Peri-implantitis is associated with higher systemic inflammation as assessed by serum CRP, IL-6, and white blood cell counts. Further research is needed to clarify the nature of this association.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=246837, identifier CRD42021246837.

Anti-Peri-implantitis Bacteria's Ability of Robusta Green Coffee Bean (Coffea Canephora) Ethanol Extract: An In Silico and In Vitro Study

OBJECTIVE

 This study was aimed to investigate RGCBE extract as antioxidant and anti-peri-implantitis bacteria through in vitro study and its potential as antioxidant, antibacterial, anti-inflammatory, antibone resorption, and proosteogenic through in silico study.

MATERIALS

AND METHODS:  Absorption, distribution, metabolism, excretion and toxicity prediction, molecular docking simulation, and visualization of chlorogenic acid (CGA) and coumaric acid (CA) as anti-inflammatory, antioxidant, and antibacterial were investigated in silico. Inhibition zone by diffusion method, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC) of RGCBE extract against Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn), and Prevotella intermedia (Pi) were done.

STATISTICAL ANALYSIS

the analysis of variance (ANOVA) difference test, and the post-hoc Tukey's Honest Significant Different (HSD) with a different significance value of p<0.05 RESULTS:  GCA and CA compounds are good drug molecules and it has low toxicity. Chlorogenic acid have higher binding activity than coumaric acid to tumor necrosis factor (TNF)-α, nuclear factor (NF)-κB, receptor activation NF-κB (RANK) and its ligand (RANKL), interleukin (IL)-6, IL-10, runt related transcription factor (RUNX2), receptor activator nuclear Kappa beta Ligand-osteoprotegrin osteocalcin (RANKL-OPG), osteocalcin, nuclear factor associated T-cell 1 (NFATc1), tartate resistant acid phosphatase (TRAP), peptidoglycan, flagellin, dectin, Hsp70, and Hsp10 protein. RGCB ethanol extract has high antioxidant ability and it has MIC, MBC, and inhibit the growth of Aa, Pg, Fn, and Pi at 50% concentration with significantly different (p=0.0001 and<0.05).

CONCLUSION

 RGCB ethanol extract has high antioxidant ability and 50% RGCB ethanol extract may act as strong anti-peri-implantitis bacteria in vitro. In addition, CGA in RGCB potential as antioxidant, antibacterial, anti-inflammatory, antibone resorption, and proosteogenic in silico.

In Vitro Studies of Graphene for Management of Dental Caries and Periodontal Disease: A Concise Review

Graphene is a single-layer two-dimensional carbon-based nanomaterial. It presents as a thin and strong material that has attracted many researchers’ attention. This study provides a concise review of the potential application of graphene materials in caries and periodontal disease management. Pristine or functionalized graphene and its derivatives exhibit favorable physicochemical, mechanical, and morphological properties applicable to biomedical applications. They can be activated and functionalized with metal and metal nanoparticles, polymers, and other small molecules to exhibit multi-differentiation activities, antimicrobial activities, and biocompatibility. They were investigated in preventive dentistry and regenerative dentistry. Graphene materials such as graphene oxide inhibit cariogenic microbes such as Streptococcus mutans. They also inhibit periodontal pathogens that are responsible for periodontitis and root canal infection. Graphene-fluorine promotes enamel and dentin mineralization. These materials were also broadly studied in regenerative dental research, such as dental hard and soft tissue regeneration, as well as periodontal tissue and bone regeneration. Graphene oxide-based materials, such as graphene oxide-fibroin, were reported as promising in tissue engineering for their biocompatibility, bioactivity, and ability to enhance cell proliferation properties in periodontal ligament stem cells. Laboratory research showed that graphene can be used exclusively or by incorporating it into existing dental materials. The success of laboratory studies can translate the application of graphene into clinical use.

The Potential Contribution of Dental Foci and Oral Mucositis to Febrile Neutropenia in Patients Treated With Myelosuppressive Chemotherapy for Solid Tumors and Lymphoma

Introduction

Febrile neutropenia (FN) is a potential life-threatening complication of myelosuppressive chemotherapy, particularly when induced by infection. There is evidence that FN can originate from the oral cavity, but its contribution to FN is largely understudied in patients treated for solid tumors. The aim of this study was to assess the prevalence of FN in these patients and to evaluate its relation with dental foci and oral mucositis.

Material and Methods

A prospective longitudinal observational study was conducted. Patients diagnosed with solid tumors and lymphoma scheduled to be treated with myelosuppressive chemotherapy with an intermediate risk of developing FN were included. A pre-chemotherapy dental examination was performed and patients were followed during and after chemotherapy regimen. During subsequent hospital visits for chemotherapy administration, the oral cavity was inspected and oral mucositis (OM) was scored using the CTC-AE version 3.0. When patients presented with fever, a comprehensive full body examination including laboratory/microbiological/imaging investigation was performed.

Results

Eighty-eight patients were included. Pre-chemotherapy, 39 patients (44.3%) were diagnosed with a dental focus. During chemotherapy, 46 patients developed OM (53.4%), of which 15 patients had a maximum score of grade II (ulcerative mucositis). Ten patients developed FN during the follow-up period. Patients with FN more often suffered from ulcerative OM compared to patients without FN; both FN and mucositis risk was associated with the myelotoxicity of chemotherapy. However, no relation could be established between the presence of dental foci prior to chemotherapy and the development of FN (p > 0.05).

Conclusion

A significant relation was identified between ulcerative OM and FN, but no robust conclusions could be drawn with respect to a relationship between the presence of dental foci and FN.

Bacterial-Specific Induction of Inflammatory Cytokines Significantly Decreases upon Dual Species Infections of Implant Materials with Periodontal Pathogens in a Mouse Model

Cytokine profiles are often perturbed after infections of medical implants. With a non-invasive in vivo imaging system, we report in a mouse model that interferon expression after infection of subcutaneous implants with Streptococcus oralis, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola (alone or as a combination) was species-specific, persisted longer in the presence of implants, and notably decreased upon dual species infections. This type I interferon expression disappeared within two weeks; however, histology of implant–tissue interface indicated high recruitment of immune cells even after three weeks. This was suggestive that biomaterial-associated infections could have prolonged effects, including the systemic stimulation of inflammatory cytokines. The present study investigated the systemic impact of this chronic peri-implant inflammation on the systemic expression of inflammatory cytokines (23) using a multiplex assay. Initially, the cytokine measurement in murine fibroblasts exposed to periodontal pathogens remained limited to the expression of five cytokines, namely, IL-6, G-CSF, CXCL-1/KC, MCP-1 (MCAF), and IL-12 (p40). The systemic determination of cytokines in mice increased to 19 cytokines (IL-1α, IL-2, IL-3, IL-5, IL-6, IL-9, IL-12 (p40), IL-12 (p70), IL-13, IL-17A, CCL-11/Eotaxin, G-CSF, IFN-γ, CXCL1/KC, MCP-1 (MCAF), MIP-1α/CCL3, MIP-1β/CCL4, CCL5/RANTES, and TNF-α). Systemic induction of cytokines was species-specific in the mouse model. The cytokine induction from infected implants differed significantly from sole tissue infections and sterile implants. Notably, systemic cytokine induction decreased after infections with dual species compared to single species infections. These findings describe the systemic effect of chronic peri-implant inflammation on the systemic induction of inflammatory cytokines, and this effect was strongly correlated to the type and composition of initial infection. Systemic modulations in cytokine expression upon dual species infections exhibit an exciting pattern that might explain the complications associated with biomaterial-related infection in patients. Moreover, these findings validate the requirement of multispecies infections for pre-clinical studies involving animal models.

Reversal of Osseointegration as a Novel Perspective for the Removal of Failed Dental Implants: A Review of Five Patented Methods

Osseointegration is the basis of successful dental implantology and the foundation of cementless arthroplasty and the osseointegrated percutaneous prosthetic system. Osseointegration has been considered irreversible thus far. However, controlled heating or cooling of dental implants could selectively damage the bone at the bone–implant interface, causing the reversal of osseointegration or “osseodisintegration”. This review compares five methods for implant removal, published as patent documents between 2010 and 2018, which have not yet been discussed in the scientific literature. We describe these methods and evaluate their potential for reversing osseointegration. The five methods have several technical and methodological similarities: all methods include a handpiece, a connecting device for coronal access, and a controlling device, as well as the application of mechanical and/or thermal energy. The proposed method of quantifying the temperature with a sensor as the sole means for regulating the process seems inadequate. A database used in one of the methods, however, allows a more precise correlation between a selected implant and the energy needed for its removal, thus avoiding unnecessary trauma to the patient. A flapless, microinvasive, and bone-conserving approach for removing failed dental implants, facilitating successful reimplantation, would benefit dental implantology. These methods could be adapted to cementless medical implants and osseointegrated percutaneous prosthetics. However, for some of the methods discussed herein, further research may be necessary.

In vitro assessment of the effect of probiotic lactobacillus reuteri on peri-implantitis microflora

BACKGROUND

Probiotics affect both the development and stability of microbiota by altering the colonization of pathogens and thus helps in stimulating the immune system of the individual. The aim of the present study is to assess the effect of probiotics on peri-implantitis microflora, by determining the minimum inhibitory concentration (MIC) of Lactobacillus reuteri, that can be effectively administered as an antimicrobial agent on specific peri-implantitis pathogens. Hence, this study will be helpful in finding the MIC of L. Reuteri that can be effectively administered as an antimicrobial agent on specific peri-implantitis pathogens.

METHODS

This experimental research was conducted on patients visiting the periodontology department in M. A. Rangoonwala college of dental sciences and research centre. Sub-gingival plaque samples were collected from peri-implantitis patients to identify various peri-implantitis microorganisms. The identified microorganisms were compared to each other and Chi-Square test was used to calculate statistical significance. The isolated microorganisms were subjected to the effect of probiotic Lactobacillus reuteri in-vitro. Minimum inhibitory concentration (MIC) was assessed using serial dilution method.

RESULTS

The research results showed the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Streptococcus salivaris and Staphylococcus aureus in the subgingival samples from peri-implantitis patients. Statistically, significantly higher proportion of samples had Porphyromonas gingivalis. When subjected to the effect of L. reuteri, all the microorganisms were affected by L.reuteri except Aggregatibacter actinomycetemcomitans.

CONCLUSION

This study provides the various MIC value for each isolated pathogen against L.reuteri. The authors recommend to avoid using standard guidelines for probiotic dose in the treatment of peri-implant infections as the antimicrobial profile is different for each periodontal pathogen.