Role of proinflammatory mutations in peri-implantitis: systematic review and meta-analysis

Risk factors for Peri-implantitis: An umbrella review of meta-analyses of observational studies and assessment of biases

OBJECTIVES

To perform a comprehensive quantitative and qualitative analysis of the findings from previously published meta-analyses and to assess existing biases.

DATA/SOURCES

A search was conducted for meta-analyses of observational studies investigating the association between any risk factor and peri‑implantitis in PubMed, Scopus, Cochrane Database of Systematic Reviews, and Epistemonikos, from inception until October 2023 (PROSPERO: CRD42024512408).

STUDY SELECTION

From a total of 5002 publications, 51 full-text articles were evaluated for eligibility, and 12 articles that described 41 unique meta-analyses evaluating the association between risk factors and periimplantitis were selected. Among 41 associations, 24 associations were significant. None of the associations were graded as convincing evidence. Two associations, presence of periodontitis (OR = 3.84 [95 % CI 2.58,5.72]) and cigarette smoking (RR=2.07 [95 % CI 1.41,3.04]) were graded as highly suggestive. Eight associations, diabetes mellitus, hyperglycaemia, lack of prophylaxis, history of chronic periodontal disease, ongoing or history of periodontal disease, implants located in the anterior region of the jaw (maxillary and mandibular), osteoprotegerin (OPG) gene polymorphisms, and lack of keratinized mucosal width were graded as suggestive evidence.

CONCLUSIONS

Periodontitis and cigarette smoking are highly suggestive risk factors for peri‑implantitis. The remaining risk factors which are suggestive require more high-quality studies to be performed to upgrade the level of evidence.

CLINICAL SIGNIFICANCE

The highly suggestive and suggestive risk factors for peri‑implantitis summarized in this umbrella review should be rigorously assessed, monitored and managed by clinicians to reduce the risk peri‑implantitis, as well as to form part of the preoperative consent process.

A Mapping Review of the Pathogenesis of Peri-Implantitis: The Biofilm-Mediated Inflammation and Bone Dysregulation (BIND) Hypothesis

This mapping review highlights the need for a new paradigm in the understanding of peri-implantitis pathogenesis. The biofilm-mediated inflammation and bone dysregulation (BIND) hypothesis is proposed, focusing on the relationship between biofilm, inflammation, and bone biology. The close interactions between immune and bone cells are discussed, with multiple stable states likely existing between clinically observable definitions of peri-implant health and peri-implantitis. The framework presented aims to explain the transition from health to disease as a staged and incremental process, where multiple factors contribute to distinct steps towards a tipping point where disease is manifested clinically. These steps might be reached in different ways in different patients and may constitute highly individualised paths. Notably, factors affecting the underlying biology are identified in the pathogenesis of peri-implantitis, highlighting that disruptions to the host-microbe homeostasis at the implant-mucosa interface may not be the sole factor. An improved understanding of disease pathogenesis will allow for intervention on multiple levels and a personalised treatment approach. Further research areas are identified, such as the use of novel biomarkers to detect changes in macrophage polarisation and activation status, and bone turnover.

Clinical and radiographic peri-implant outcomes with riboflavin loaded Poly-L-glycolic acid nanoparticles incorporated in aloe-vera gel treating peri-implantitis in chronic hyperglycemic patients

AIM

The objective of the current study was to compare the effectiveness of antimicrobial photodynamic therapy (PDT) versus Poly-L-glycolic acid nanoparticles loaded riboflavin incorporated in aloe vera gel (PGA/RF/AV) on periimplant parameters and bacterial counts in chronic hyperglycemic patients having periimplantitis.

METHODS

One hundred and two diabetic patients undergoing mechanical debridement (MD) were equally divided into three groups: Group 1: PGA/RF/AV+ MD, Group 2: PDT + MD, and Group 3: MD alone. Periimplant parameters [Bleeding on probing (BoP), probing depth (PD), plaque index (PI), marginal bone level (MBL)] were recorded in all three groups. Periimplant plaque samples were studied to record the levels of Tannerella forsythia (Tf) and Porphyromonas gingivalis (Pg). The recordings were taken at baseline, 3 months and 6 months post treatment.

RESULTS

All three groups showed a reduction in severity of periimplantitis measured in terms of PD, PI, MBL and BoP. A statistically significant reduction in PD, PI and MBL was found in patients in Group 2 whereas participants of Group 1 were found to have a significant decrease in BoP. A statistically significant decline in the numbers of both the bacterial species was seen in Group 2 at the three-month follow-up whereas at the six-month follow-up, a statistically significant reduction was observed in treatment Group 2 in the levels of Tf species only.

CONCLUSION

Riboflavin-loaded nanocarrier incorporated in aloe vera gel showed greater clinical efficacy than PDT alone in the treatment of periimplantitis in chronic hyperglycemic individuals.

Genetic Association of the C-C Motif Chemokine Ligand 2 (CCL2) rs1024611 Polymorphism With Periodontitis

Introduction To a large extent, a person's susceptibility to developing periodontitis is determined by their genetic makeup. Research has shown that chemokines generated during an immune response can harm the periodontal ligaments, gingiva, and alveolar bone. Various chemokine genes located on different chromosomes contribute to periodontitis, and one such gene is C-C motif chemokine ligand 2 (CCL2), associated with the rs1024611 polymorphism, which is part of a cytokine gene cluster on the q-arm of chromosome 17. Objective Our specific objective was to investigate whether CCL2 polymorphisms could influence the relative risk of developing periodontitis. Building on these findings, we aimed to compare the frequency of a specific single nucleotide polymorphism (SNP) in the CCL2 gene between individuals with and without periodontitis. Materials and methods Fifty participants were enrolled in the study after obtaining informed consent and ethical clearance. Clinical assessments, including probing pocket depth, clinical attachment loss, and bleeding on probing, were utilized to classify individuals into two groups: a control group (Group A, n=25) and a periodontitis group (Group B, n=25). DNA extraction from collected samples involved drawing 2 ml of venous blood from the antecubital fossa and transferring it into a sterile tube with a pinch of ethylene diamine tetraacetic acid (EDTA) to prevent clotting. DNA extraction was performed and polymorphisms of CCL2 were assessed through polymerase chain reaction (PCR) and restriction enzyme digestion. Results The periodontitis group consisted of 25 patients, with an average age of 39.0±0.22 years, who met the American Academy of Periodontology's 2018 criteria for at least stage II periodontitis. The control group comprised 25 individuals with an average age of 41.3±0.49 years. Regarding the CCL2 gene polymorphism (rs1024611), there was no substantial variation in genotype frequencies between the patients and controls (p = 0.695). An agarose gel electrophoretogram, along with a standard DNA ladder, demonstrated partial amplification of the CCL2 gene spanning the polymorphism site (rs1024611). Genotypes observed were as follows: homozygous AA - 333 bp; heterozygous AG - 333 + 250 + 73 bp; homozygous GG - 250 + 73 bp. Conclusion In conclusion, there is no significant association between the CCL2 gene polymorphism rs1024611 and susceptibility to periodontitis.

Current Molecular, Cellular and Genetic Aspects of Peri-Implantitis Disease: A Narrative Review

(1) Background: Peri-implantitis is a multi-factorial disease with an inflammatory background that occurs in both soft and hard tissues surrounding implants. In recent years, the understanding of the cellular, molecular and genetic background of peri-implantitis has broadened. This study aims to summarize the currently available articles on the subject and highlight the most recent advances over the last 20 years. (2) Methods: For this study, the Embase and PubMed libraries were searched using the keywords: ("peri-implantitis" AND "cytokine" OR "genetics" OR "cellular") and ("peri-implantitis" AND "cytokine" OR "genetics" OR "cellular" AND "risk factors"). The search revealed a total of 3013 articles (992 from PubMed, 2021 from Embase). Following screening of the titles and abstracts and full-text reads, 55 articles were included. (3) Results: In peri-implantitis IL-6, IL-1β, TNF-α, MMP-8 and their genetic variations appear to be the most important cytokines in relation to not only pathogenesis, but also their potential diagnostic capabilities. Epithelial and inflammatory cells, along with those of the bone lineage, are prime cellular elements found in peri-implantitis. (4) Conclusions: A wide array of cells stand behind peri-implantitis, as well as cytokines and their genetic variations that take part in the process. However, the growing interest in this topic has led to the introduction of specific new diagnostic tools to enable a better understanding of patients' responses to treatment and, in turn, to even enable prediction of the risk of developing peri-implant disease.

Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review

STATEMENT OF PROBLEM

The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking.

PURPOSE

Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments.

MATERIAL AND METHODS

An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English.

RESULTS

A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved.

CONCLUSIONS

The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.

Effect of Er,Cr:YSGG laser with a side-firing tip on decontamination of titanium disc surface: an in vitro and in vivo study

PURPOSE

To evaluate the effectiveness of an erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser with side-firing tip in decontamination of titanium (Ti) disc.

METHODS

In the first test series, 29 Ti-discs were contaminated with Staphylococcus aureus and treated as follows: positive control (no treatment); Perioflow; Laser A (0.75 W, 100 Hz), Laser B (1.5 W, 30 Hz); Laser C (no radiation, 60% water); and Laser D (no radiation, 50% water). For bacterial quantification, colony forming units (CFU, vital cells only) and quantitative PCR (qPCR, vital and devital cells) were performed. In a second test series, 92 Ti-discs were used, contaminated with in vivo-grown biofilm and treated as follows: positive control (no treatment); Perioflow; Laser E (1.5 W, 30 Hz), and Laser F (no radiation, 50% water). Considering the different and unknown culture conditions, quantification of bacteria was performed by broad-spectrum bacterial qPCR only. Based on the assumption that all cells of an organism contain an equivalent complement of genetic information, genome equivalent (GE) determination ensured the detection of the different intact and semi-intact genomes, regardless of type of bacterial species and vitality, circumvent the inherent bias of cultures.

RESULTS

The GE values were significantly reduced by all interventions in both test series, compared to the positive control group (p < 0.001). In the first test series with S. aureus as model organism, Perioflow yielded a lower GE than the Laser groups A-D (all p < 0.025). The number of CFUs was significantly reduced in the intervention groups compared to the positive control (p < 0.001), except for Laser A (p = 0.157) and Laser D (p = 0.393). In the second test series, none of the pairwise comparisons of the intervention conditions showed a significant difference (Perioflow vs. Laser E: p = 0.732; Perioflow vs. Laser F: p = 0.590; Laser E vs. Laser F: p = 0.379).

CONCLUSION

The Er,Cr:YSGG laser with side-firing tip and Perioflow were equally capable of effectively decontaminating a Ti-disc surface. It is assumed that the bacterial reduction was largely due to the mechanical effect of the air and water stream.

Topography-mediated immunomodulation in osseointegration; Ally or Enemy

Osteoimmunology is at full display during endosseous implant osseointegration. Bone formation, maintenance and resorption at the implant surface is a result of bidirectional and dynamic reciprocal communication between the bone and immune cells that extends beyond the well-defined osteoblast-osteoclast signaling. Implant surface topography informs adherent progenitor and immune cell function and their cross-talk to modulate the process of bone accrual. Integrating titanium surface engineering with the principles of immunology is utilized to harness the power of immune system to improve osseointegration in healthy and diseased microenvironments. This review summarizes current information regarding immune cell-titanium implant surface interactions and places these events in the context of surface-mediated immunomodulation and bone regeneration. A mechanistic approach is directed in demonstrating the central role of osteoimmunology in the process of osseointegration and exploring how regulation of immune cell function at the implant-bone interface may be used in future control of clinical therapies. The process of peri-implant bone loss is also informed by immunomodulation at the implant surface. How surface topography is exploited to prevent osteoclastogenesis is considered herein with respect to peri-implant inflammation, osteoclastic precursor-surface interactions, and the upstream/downstream effects of surface topography on immune and progenitor cell function.

Mental health and periodontal and peri-implant diseases

Mental health disorders, particularly depression and anxiety, affect a significant number of the global population. Several pathophysiological pathways for these disorders have been identified, including the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and the immune system. In addition, life events, environmental factors, and lifestyle affect the onset, progression, and recurrence of mental health disorders. These may all overlap with periodontal and/or peri-implant disease. Mental health disorders are associated with more severe periodontal disease and, in some cases, poorer healing outcomes to nonsurgical periodontal therapy. They can result in behavior modification, such as poor oral hygiene practices, tobacco smoking, and alcohol abuse, which are also risk factors for periodontal disease and, therefore, may have a contributory effect. Stress has immunomodulatory effects regulating immune cell numbers and function, as well as proinflammatory cytokine production. Stress markers such as cortisol and catecholamines may modulate periodontal bacterial growth and the expression of virulence factors. Stress and some mental health disorders are accompanied by a low-grade chronic inflammation that may be involved in their relationship with periodontal disease and vice versa. Although the gut microbiome interacting with the central nervous system (gut-brain axis) is thought to play a significant role in mental illness, less is understood about the role of the oral microbiome. The evidence for mental health disorders on implant outcomes is lacking, but may mainly be through behaviourial changes. Through lack of compliance withoral hygiene and maintenance visits, peri-implant health can be affected. Increased smoking and risk of periodontal disease may also affect implant outcomes. Selective serotonin reuptake inhibitors have been linked with higher implant failure. They have an anabolic effect on bone, reducing turnover, which could account for the increased loss.

Polymorphisms in Genes Involved in Inflammation and Periodontitis: A Narrative Review

Current evidence pinpoints that the variability in periodontitis traits in humans may be attributable to genetic factors. Different allelic variants can result in alterations in tissue structure, antibody responses and inflammatory mediators. Consequently, genetic variations may act as protective or risk factors for periodontal diseases. A number of features of the inflammatory and immune response that seem to play a role in the development of periodontitis have a clearly established genetic basis. Identifying genes that contribute to the pathogenesis of periodontitis may be utilized for risk assessment in both aggressive and chronic periodontitis. The aim of this narrative review is to summarize the role of polymorphisms in genes involved in inflammation and periodontitis, including cellular receptors, tissue compatibility antigens, antibodies and cytokines.