Volumetric Analysis of Gingival Crevicular Fluid and Peri-Implant Sulcus Fluid in Healthy and Diseased Sites: A Cross-Sectional Split-Mouth Pilot Study

Oral Fluid Biomarkers for Peri-Implantitis: A Scoping Review

Peri-implantitis, a prevalent complication in dental implant therapy, poses a significant threat to long-term implant success. The identification of reliable biomarkers for the early detection and monitoring of peri-implantitis is crucial for timely intervention and improved treatment outcomes. Salivary and peri-implant sulcular fluid (PISF) biomarkers have become promising diagnostic tools in the field of implant dentistry. This scoping review aims to explore current studies in the literature on salivary and PISF biomarkers for peri-implantitis. A systematic search was conducted on 2 databases (PubMed and Scopus) to identify relevant studies published up to January 2023. A total of 86 articles were included, which underwent data extraction and analysis. Several biomarkers have been investigated in salivary and PISF samples for association with peri-implantitis. Investigations included a wide range of biomarkers, including inflammatory markers, matrix metalloproteinases and bone loss markers. The findings suggested that certain salivary and PISF biomarkers demonstrated potential in distinguishing healthy peri-implant conditions from peri-implantitis. Elevated levels of proinflammatory cytokines, such as interleukin-1β (IL-1β) and interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), and matrix metalloproteinases, have been consistently associated with peri-implantitis. Additionally, alterations in bone loss markers have shown potential as indicators of disease progression and treatment response. In conclusion, this scoping review provides an overview of current knowledge on salivary and PISF biomarkers for peri-implantitis. The identified biomarkers are promising as noninvasive diagnostic tools for early detection, monitoring, and personalised management of peri-implantitis. Future studies should focus on establishing standardised protocols and conducting well-designed clinical trials to validate the diagnostic accuracy and clinical relevance of these biomarkers.

Spectroscopic insights into peri-implant mucositis and peri-implantitis: unveiling peri-implant crevicular fluid profiles using surface enhanced Raman scattering

The precise identification and differentiation of peri-implant diseases, without the need for intrusive procedures, is crucial for the successful clinical treatment and overall durability of dental implants. This work introduces a novel approach that combines surface-enhanced Raman scattering (SERS) spectroscopy with advanced chemometrics to analyse peri-implant crevicular fluid (PICF) samples. The primary purpose is to offer an unbiased evaluation of implant health. A detailed investigation was performed on PICF samples obtained from a cohort of patients exhibiting different levels of peri-implant health, including those with healthy implants, implants impacted by peri-implantitis, and implants with peri-implant mucositis. The obtained SERS spectra were analysed using canonical-powered partial least squares (CPPLS) to identify unique chemical characteristics associated with each inflammatory state. Significantly, our research findings unveil the presence of a common inflammatory SERS spectral pattern in cases of peri-implantitis and peri-implant mucositis. Furthermore, the SERS-based scores obtained from CPPLS were combined with established clinical scores and subjected to a linear discriminant analysis (LDA) classifier. Repeated double cross-validation was used to validate the method's capacity to discriminate different implant conditions. The integrated approach showcased high sensitivity and specificity and an overall balanced accuracy of 92%, demonstrating its potential to serve as a non-invasive diagnostic tool for real-time implant monitoring and early detection of inflammatory conditions.

Comparison of three fluids for calibration of the new Periotron® 8010

BACKGROUND

The aim of the present study was to calibrate the Periotron® model 8010 with volumes of three different fluids (distilled water, serum, and saliva) and to identify which of the three is the most reliable, feasible, and reproducible for routine calibration.

MATERIAL AND METHODS

A total of 450 samples of Periopaper® were divided into three groups (150 each per group): distilled water, serum matrix and saliva. A calibration curve was run with 0.25, 0.50, 0.75, 1.00 and 1.25 µl of each of the fluids, and the results were determined in Periotron units (PU). Statistical analysis was performed with one-way ANOVA followed by Bonferroni's post hoc test and a linear equation.

RESULTS

Distilled water presented the lowest levels of PU at all volumes, while serum showed the highest levels at high volumes. Linear regression equations rendered similar slopes for saliva and distilled water, while serum was statistically different. Saliva presented a reproduction percentage of 99.7%, which indicated better accuracy and precision than serum and distilled water.

CONCLUSIONS

Saliva is more reliable and accurate than water or serum for the purpose of calibration of the Periotron® model 8010, though it shares drawbacks with serum. Distilled water is more easily available and does not require any additional procedure, in addition to producing a similar slope to saliva and a smaller deviation from the media than serum.

Phase Inversion-Based Doxycycline Hyclate-Incorporated Borneol In Situ Gel for Periodontitis Treatment

Borneol has been successfully employed as a gelling agent for in situ forming gel (ISG). While 40% borneol can regulate drug release, there is interest in novel approaches to achieve extended drug release, particularly through the incorporation of hydrophobic substances. Herein, triacetin was selected as a hydrophobic additive solvent for doxycycline hyclate (Dox)-loaded 40% borneol-based ISGs in N-methyl-2-pyrrolidone (NMP) or dimethyl sulfoxide (DMSO), which were subsequently evaluated in terms of their physicochemical properties, gel formation morphology, water sensitivity, drug release, and antimicrobial activities. ISG density and viscosity gradually decreased with the triacetin proportion to a viscosity of <12 cPs and slightly influenced the surface tension (33.14-44.33 mN/m). The low expelled force values (1.59-2.39 N) indicated the convenience of injection. All of the prepared ISGs exhibited favorable wettability and plastic deformation. Higher gel firmness from ISG prepared using NMP as a solvent contributed to the ability of more efficient controlled drug release. High triacetin (25%)-loaded ISG retarded solvent diffusion and gel formation, but diminished gel firmness and water sensitivity. ISG containing 5% triacetin efficiently prolonged Dox release up to 10 days with Fickian diffusion and presented effective antimicrobial activities against periodontitis pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Therefore, the Dox-loaded 40% borneol-based ISG with 5% triacetin is a potential effective local ISG for periodontitis treatment.

Effects of Candidalysin Derived from Candida albicans on the Expression of Pro-Inflammatory Mediators in Human Gingival Fibroblasts

Candida albicans (Ca) is frequently detected in the peri-implant sulcus with peri-implantitis, a major postoperative complication after oral implant therapy. However, the involvement of Ca in the pathogenesis of peri-implantitis remains unclear. In this study, we aimed to clarify Ca prevalence in the peri-implant sulcus and investigated the effects of candidalysin (Clys), a toxin produced by Ca, on human gingival fibroblasts (HGFs). Peri-implant crevicular fluid (PICF) was cultured using CHROMagar and Ca colonization rate and colony numbers were calculated. The levels of interleukin (IL)-1β and soluble IL-6 receptor (sIL-6R) in PICF were quantified by enzyme-linked immunosorbent assay (ELISA). Pro-inflammatory mediator production and intracellular signaling pathway (MAPK) activation in HGFs were measured by ELISA and Western blotting, respectively. The Ca colonization rate and the average number of colonies in the peri-implantitis group tended to be higher than those in the healthy group. IL-1β and sIL-6R levels in the PICF were significantly higher in the peri-implantitis group than in the healthy group. Clys significantly induced IL-6 and pro-matrix metalloproteinase (MMP)-1 productions in HGFs, and co-stimulation with Clys and sIL-6R increased IL-6, pro-MMP-1, and IL-8 production levels in HGFs compared with Clys stimulation alone. These findings suggest that Clys from Ca plays a role in the pathogenesis of peri-implantitis by inducing pro-inflammatory mediators.

Physicochemical and Bioactivity Characteristics of Doxycycline Hyclate-Loaded Solvent Removal-Induced Ibuprofen-Based In Situ Forming Gel

Modulation with the suppression of infection and inflammation is essential to the successful treatment of periodontitis. An aqueous insoluble hydrophobic anti-inflammatory compound, i.e., ibuprofen (IBU), was investigated in this study as the matrix-forming agent of a doxycycline hyclate (DH)-loaded solvent removal-induced in situ forming gel (ISG) using dimethyl sulfoxide (DMSO) and N-methyl pyrrolidone (NMP) as the solvents. Their physicochemical properties, including pH, density, viscosity, surface tension, contact angle, water tolerance, injectability, mechanical properties, gel formation, and drug release, were determined. Their antimicrobial activities were tested using agar cup diffusion, and their anti-inflammatory activity was assessed using thermal inhibition of protein denaturation of egg albumin. Increasing the IBU content decreased the density, pH, surface tension, and contact angle but increased the viscosity, force and work of injection, and gel formation of IBU-based ISG solution. Although their water tolerance values decreased with the increase in IBU content, the addition of DH and the use of NMP led to high water tolerance. The characterization of the dried gel remnants of ISGs presented no change in IBU crystallinity and thermal properties and confirmed no chemical interaction among the components of ISGs. The obtained transformed IBU matrix prolonged the release of DH and IBU from ISGs over 7 days from its tortuously packed IBU matrix with small pores, and conformed well with Fickian diffusion mechanism. The developed DH-loaded solvent removal-induced IBU-based ISGs exhibited efficient antimicrobial activities against Staphylococcus aureus, methicillin-resistant S. aureus, Escherichia coli, Candida albicans, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans. IBU in formulation promoted the antimicrobial activity of ISGs, whereas DH and NMP promoted the anti-inflammatory activity of ISGs. Consequently, the DH-loaded solvent removal-induced IBU-based ISGs proposed in this study show great potential as an effective bioactive drug delivery system for periodontitis treatment by localized periodontal pocket injection.

Lime Peel Oil–Incorporated Rosin-Based Antimicrobial In Situ Forming Gel

Localized intra-periodontal pocket drug delivery using an injectable in situ forming gel is an effective periodontitis treatment. The aqueous insoluble property of rosin is suitable for preparing a solvent exchange-induced in situ forming gel. This study aims to investigate the role of incorporating lime peel oil (LO) on the physicochemical properties of injectable in situ forming gels based on rosin loaded with 5% w/w doxycycline hyclate (DH) in dimethyl sulfoxide (DMSO) and N-methyl pyrrolidone (NMP). Their gel formation, viscosity, injectability, mechanical properties, wettability, drug release, and antimicrobial activities were evaluated. The presence of LO slowed gel formation due to the loose precipitate formation of gel with a high LO content. The viscosity and injectability were slightly increased with higher LO content for the DH-loaded rosin-based in situ forming gel. The addition of 10% LO lowered gel hardness with higher adhesion. LO incorporation promoted a higher drug release pattern than the no oil-added formulation over 10 days and the gel formation rate related to burst drug release. The drug release kinetics followed the non-Fickian diffusion mechanism for oil-added formulations. LO exhibited high antimicrobial activity against Porphyromonas gingivalis and Staphylococcus aureus. The DH-loaded rosin in situ forming gel with an addition of LO (0, 2.5, 5, and 10% w/w) inhibited all tested microorganisms. Adding 10% LO to rosin-based in situ forming gel improved the antimicrobial activities, especially for the P. gingivalis and S. aureus. As a result, the study demonstrates the possibility of using an LO amount of less than 10% loading into a rosin-based in situ forming gel for efficient periodontitis treatment.

Bruxism Influence on Volume and Interleukin-1β Concentration of Gingival Crevicular Fluid: A Preliminary Study

Bruxism is occlusal behaviour that often leads to stomatognathic system overload. Inflammatory markers in the periodontium are detectable in the gingival crevicular fluid (GCF). GCF production fluctuates due to various factors. Our study aimed to assess the effect of tooth clenching or grinding on GCF volume and proinflammatory IL-1β concentration in GCF. This pilot study was carried out on 20 participants aged 21 to 28 with good general health (per 10 people studied and control groups). GCF volume was measured with Periotron 8010 after absorbing for 30 s with PerioPaper strips. Twelve samples were collected from each patient—the buccal and lingual surfaces of teeth 16, 11, 24, 36, 31, and 44 were included. Laboratory examination of IL-1β concentration was performed. In patients with pathological tooth wear, a tendency to increase GCF secretion and IL-1β concentration in GCF was found. GCF volumes were higher in posterior teeth, while IL-1β levels were higher in anterior teeth. Crevices at the molars seem to have a potential predictive value in diagnosing periodontal microinflammation in patients with probable bruxism. Due to occlusal overload, these bruxists are more prone to microinflammatory processes in the periodontium. Further studies in a broader group are required to confirm this correlation.

Meloxicam-loaded solvent exchange-induced in situ forming beta-cyclodextrin gel and microparticle for periodontal pocket delivery

The in situ forming system has attracted attention for periodontitis treatment owing to its sustainable drug release localisation at a periodontal pocket. Given its low aqueous solubility, beta-cyclodextrin (β-CD) may serve as a matrix former of solvent exchange-induced in situ forming gel (ISG) and microparticle (ISM). Meloxicam (Mex)-loaded-β-CD ISG and ISM were prepared using β-CD in dimethyl sulphoxide (ISG) as the internal phase and camellia oil comprising 5% glyceryl monostearate as the external phase (ISM). Mex-loaded β-CD systems comprising 40% β-CD were easily injected via a 24-gauge needle. During solvent exchange with phosphate buffer saline (pH 6.8), the highly concentrated β-CD ISG promoted the phase inversion of β-CD aggregates into matrix-like. Upon exposure to aqueous phase, the ISM system comprising 40% β-CD transformed into microparticles and extended the drug release to 7 days with minimised initial burst release following Fickian diffusion. Moreover, the potential degradability was evident from the high weight loss. High maximum deformation force with high viscous character initiated the slow diffusion rate of the solvent from the ISM system. Therefore, 40% β-CD ISM is a potential local Mex-controlled release system of anti-inflammatory drug for periodontitis treatment.

Peri-Implantitis Diagnosis and Prognosis Using Biomarkers in Peri-Implant Crevicular Fluid: A Narrative Review

Dental implant diseases, peri-implantitis (PI) and peri-implant mucositis (PIM), have shown wide prevalence in recent studies. Despite the prevalence, diagnosing peri-implant disease (PID) remains challenging as common diagnostic methods of periodontal probing and radiographs may be inaccurate. These methods only document pre-existing destruction rather than current disease activity. Furthermore, there is no current model to predict the progression of PID. Though a predictive model is lacking, biomarkers may offer some potential. Biomarkers are commonly used in medicine to objectively determine disease state, or responses to a therapeutic intervention. Gingival crevicular fluid (GCF) biomarkers have moderate diagnostic validity in periodontitis. Biomarkers in peri-implant crevicular fluid (PICF) also show promising results in regard to their diagnostic and prognostic value. The aim of this review is to summarize the current knowledge of PICF biomarkers in the diagnosis of PID and evaluate their validity to predict disease progression. This review found that PICF studies utilize different methods of sampling and interpretation with varying validity (sensitivity and specificity). A number of promising diagnostic techniques were identified. Commercially available chair-side tests for MMP-8 to diagnose periodontal disease and PID activity are now available. Future directions include proteomics and metabolomics for accurate, site-specific diagnosis and prediction of PID progression. Although more research is needed, this review concludes that the assessment of proinflammatory cytokines (IL-1β, TNFα, MMP-8) in the PICF may be of value to diagnose PI and PIM but current research remains insufficient to indicate whether biomarkers predict peri-implant disease progression.

The determination of pH of peri-implant crevicular fluid around one-piece and two-piece dental implants: A pilot study

There are two main groups of screw-type dental implant designs: one-piece and two-piece implants. Although success rates of both of these types of implants are high, none of them avoid complications, of which the most common are peri-implant mucositis and peri-implantitis. Current clinical diagnostic parameters are relatively noninvasive and cost-efficient; however, they are often not sensitive enough and fail to determine the activity of inflammation. The purpose of this study is to determine pH of peri-implant crevicular fluid (PICF) around one-piece and two-piece implants and pH of gingival crevicular fluid (GCF) around healthy teeth and to find out if our suggested method could function accurately for determination of pH of PICF and GCF. Thermo Fisher Scientific™ Orion™ 9863BN glass microelectrode was used to determine pH of PICF around 29 one-piece (ROOTT, TRATE AG) and 29 two-piece implants (multiple manufacturers) and pH of GCF around 29 healthy teeth. pH of PICF around two-piece implants was more acidic (P < 0.001). Average pH around one-piece implants was 6.46 and around two-piece implants was 6.15. Mean pH of GCF was 6.64. pH of PICF in women around two-piece implants was more alkaline (P < 0.05); no difference was found in control and one-piece implant groups. There was no statistically significant correlation found between age and pH of PICF and GFC. Design of dental implants has an impact on pH of PICF. Glass microelectrode is an appropriate tool for accurate determination of pH in PICF.