Correlation of peri-implant health and myeloperoxidase levels: a cross-sectional clinical study

OBJECTIVES: At present, there are no diagnostic tools that permit early detection of peri-implantitis. The purpose of this cross-sectional study was to evaluate the correlation of myeloperoxidase (MPO) levels with traditional periodontal clinical parameters around dental implants including peri-implant pocket probing depth (PPD), gingival index (GI) and bleeding on probing (BOP), since MPO has been associated with destruction of periodontal tissues. MATERIAL AND METHODS: Twenty-four healthy adult volunteers (9 men and 15 women) with 64 Ankylos Biofunctional implants (DentsplyFriadent, Mannheim, Germany) were recruited from Tallinn Dental Clinic. Biochemical and clinical parameters evaluated were the following ones: the level of MPO in the peri-implant sulcus fluid (PISF) (an analog for gingival crevicular fluid in natural teeth), PPD (mm), GI (0,1,2 or 3), and BOP (0 or 1). RESULTS AND CONCLUSION: In comparison to the clinically healthy implants, total amounts of MPO were significantly higher in PISF collected around implants with inflammatory lesions. In addition, the levels of MPO were correlated with the clinical parameters. The results confirm the similarity of the inflammatory response of tissues surrounding implants and natural teeth, and suggest that MPO could be promising marker of inflammation around dental implants.     

Effect of different localizations of microgap on clinical parameters and inflammatory cytokines in peri-implant crevicular fluid: a prospective comparative study

The purpose of this study was to evaluate the effect of microgap on clinical and biochemical parameters around dental implants for 1 year. All patients received four implants: group A—Standard Straumann^? implants, group B—1 mm subcrestal placement of the polished surface of group A implants, group C—esthetic plus Straumann? implants, group D—subcrestal placement of the polished surface of group C implants. Clinical measurements and peri-implant crevicular fluid (PICF) were collected immediately before loading and at 3rd, 6th, and 12th months after loading, and interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α) have been assessed in the crevicular fluid. No significant differences were found in plaque index, gingival index, and probing between the groups throughout the study. However, the PICF volumes of group D were significantly higher than that in the other groups, and group A were significantly lower than the other groups (P < 0.05). With respect to bleeding on probing values, the percentage of BOP (+) sides in group A implants were fewer than group C and D implants (P < 0.05). With regard to IL-1β, the levels of IL-1β in group A were lower than that in the other groups during the study (P < 0.05). In point of TNF-α total amounts, the levels of TNF-α in group A implants were lower than those in group B and D implants (P < 0.05). Moving microgap coronally from alveolar crest could be recommended for the health of periodontal tissues. Most coronal location of microgap can be suggested in order to maintain the peri-implant health status, particularly in implant sites without esthetic priority.     

The Association Between Thalassemia Major and Periodontal Health

Background : The aim of this cross‐sectional study is to compare the local and systemic levels of soluble receptor activator of nuclear factor‐κB ligand (sRANKL), osteoprotegerin (OPG), a proliferation‐inducing ligand (APRIL), B‐cell activating factor (BAFF), interleukin (IL)‐6, and IL‐8 in biofluids of patients with thalassemia major (TM) with or without gingivitis. Methods: Seventy‐seven patients are included in this study (TM, n = 29; systemically healthy, n = 48). Gingival crevicular fluid (GCF), saliva, and serum levels of IL‐6, IL‐8, sRANKL, OPG, BAFF, and APRIL were determined by enzyme‐linked immunosorbent assay. Data were analyzed by appropriate non‐parametric or parametric statistical tests. Results: Median GCF, serum, and saliva levels for BAFF (P <0.001) and IL‐6 and IL‐8 (P <0.005) were higher in TM gingivitis than in systemically healthy gingivitis (P <0.001). GCF, serum, and saliva levels for APRIL, sRANKL, IL‐6, and IL‐8 were higher in TM than in systemically and periodontally healthy comparison groups (P <0.05). Positive correlations were found between bleeding on probing (BOP), plaque index (PI) scores, and GCF APRIL, serum sRANKL, serum OPG, and sRANKL concentrations in TM groups (P <0.05). Several significant positive correlations were found between BOP, PI scores, and biofluid parameters also in systemically healthy groups. Conclusion: TM may have a role in the underlying systemic hematologic condition and potentially affect gingival inflammation via dysregulation of lymphocytes and increased activation of osteoclasts.     

Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial

Background

Peri-implant diseases have been recognized as being among the ever-increasing complications related to dental implants. The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) to mechanical debridement (MD) in patients with these conditions in terms of clinical parameters and cytokine levels of peri-implant crevicular fluid (PICF).

Methods

In the present double-blind clinical trial, 46 patients with peri-implant mucositis (PM) were randomly divided into control and test groups. Two different therapeutic protocols, consisting of non-surgical MD alone (control group) and MD with the application of EMD (test group), were considered for the two groups. Clinical parameters [bleeding on probing (BOP) and probing depth (PD)] and sampling from PICF were carried out before treatment and 3 months postoperatively. The levels of IL-6 and IL-17 cytokines in PICF were evaluated by enzyme-linked immunosorbent (ELISA).

Results

Three-month post-interventional assay revealed significant improvements in BOP and PD in the test group in comparison to the control group (P < 0.0001). Relative to control, IL-6 and IL-17 levels were reduced significantly (p < 0.05) in the test group compared to the control group.

Conclusion

Application of EMD can be considered an adjunct to MD in the non-surgical treatment of PM. However, complete recovery was not observed using either treatment approach showing that management of implant-associated disease is still a significant clinical problem.

     

Biomarkers and Bacteria Around Implants and Natural Teeth in the Same Individuals

Background: This cross‐sectional study assesses cytokine levels in peri‐implant crevicular fluid (PICF)/gingival crevicular fluid (GCF) and a selection of subgingival/submucosal plaque bacteria from clinically healthy or diseased sites in the same individuals. Methods: Samples from 97 implants/teeth (58 implants [19 healthy, 20 mucositis, 19 peri‐implantitis] and 39 natural teeth [19 healthy, 12 gingivitis, eight periodontitis] in 15 systemically healthy patients were investigated by immunoassay and real‐time polymerase chain reaction. Samples were obtained first, with probing depth, clinical attachment level, bleeding on probing, plaque index scores, and keratinized tissue width then recorded. Data were analyzed by Wilcoxon, Mann–Whitney U, and permutation tests on dependent, independent, and mixed dependent and independent samples and Spearman correlation. Results: Interleukin (IL)‐1β levels were significantly higher in PICF samples of healthy implants than in GCF samples of healthy teeth (P = 0.003), and soluble receptor activator of nuclear factor‐κB ligand (sRANKL) concentrations were significantly higher in the gingivitis than the mucositis group (P = 0.004). Biomarker levels were similar in peri‐implantitis and periodontitis groups (P >0.05). Actinomyces naeslundi and Streptococcus oralis levels were significantly higher in the healthy implant group than in healthy teeth (P <0.05). Prevotella intermedia and Treponema denticola (Td) levels were lower in the mucositis group than the gingivitis group (P <0.05). Prevotella oralis and S. oralis levels were significantly higher in the periodontitis group (P <0.05), and Td levels were significantly higher in the peri‐implantitis group (P <0.05). Conclusion: There were many similarities but, crucially, some differences in biomarker levels (IL‐1β and sRANKL) and bacterial species between peri‐implant and periodontal sites in the same individuals, suggesting similar pathogenic mechanisms.     

Interleukin-1beta,tumor necrosis factor-alpha levels and neutrophil elastase activity in peri-implant crevicular fluid

The aim of this study was to determine interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha) levels and neutrophil elastase (NE) activity in peri-implant crevicular fluid (PICF) of smoker and nonsmoker patients, and to investigate their relationships with clinical parameters. A total of 42 endosseous root-form dental implants of 14 patients were clinically examined by modified Plaque index (PI), modified Gingival index (GI) and probing depth (PD). Smoking habits of the patients were recorded. PICF of implants were collected by Periopaper strips and IL-1beta, TNF-alpha levels were determined by enzyme-linked immunosorbent assay (ELISA). NE was analyzed with a neutrophil specific chromogenic substrate, N-methoxysuccinyl-Ala-Ala-Pro-Val-p-nitroanilide. The cytokine and enzyme levels in PICF were expressed as total amount/activity and as concentrations. NE activity in PICF significantly correlated with GI and PD, and IL-1beta levels with GI and PICF volume (P < 0.05). The correlations were stronger when the PICF levels were expressed as total IL-1beta amount and as total NE activity. The implants with inflamed gingiva (GI > 1) had higher levels of IL-1beta and NE activity than implants with noninflamed or slightly inflamed gingiva (GI 3 mm) was greater than the implants with shallow pockets (PD 相似文献   

Comparison of Osteoimmunological and Microbiological Parameters of Extra Short and Longer Implants Loaded in the Posterior Mandible: A Split Mouth Randomized Clinical Study

ObjectivesThis study aimed to evaluate the levels of TNF-α, PGE₂, RANKL, RANK, OPG, the markers of periimplant bone loss in peri-implant crevicular fluid obtained around standard and extra short implants. Moreover, the levels of putative oral pathogens were investigated in the submucosal biofilm samples.Material and MethodsThe implants were divided into two groups according to their lengths: standard (≥8 mm) and extra short (4 mm). A total of 60 implants were researched in 30 patients. The probing depth (PD), clinical attachment level (CAL), presence of bleeding on probing (BOP), 3-year survival rate (CSR), and bone loss (BL) were measured.ResultsNo statistically significant difference was found in the values of PD, CAL, BOP, CSR, and BL between the groups (P> 0.05). Total amounts of PGE₂, TNF-α, RANKL, RANK, OPG, and RANKL/OPG were not statistically significantly different between the groups (P> 0.05). The abundance of F. nucleatum, T. forsythia, P. intermedia, P. gingivalis, S. oralis and T. denticola was compared between the groups and the results were not statistically significant (P> 0.05).ConclusionThe results of this study suggested that PGE₂, TNF-α, RANKL, RANK, OPG, and RANKL/OPG in PICF, as well as microbiological parameters in submucosal biofilms, were similar between standard (≥8 mm) and extra short (4 mm) implants. Therefore, the implant length does not seem to influence the bone loss, levels of osteoimmunological and microbiological markers in the peri-implant tissues and survival rates.     

Longitudinal Comparison of Cytokines in Peri‐Implant Fluid and Gingival Crevicular Fluid in Healthy Mouths

Background: Peri‐implant and gingival tissues provide important sealing and protective functions around implants and teeth, but comparisons of the immunologic responses of these tissues after implant placement have not been conducted. Cytokine levels were measured in peri‐implant crevicular fluid (PICF) and gingival crevicular fluid (GCF) as surrogate measures of immune function at subcrestally placed dental implants and healthy periodontal sites during a 1‐year monitoring period. Methods: A total of 27 dental implants were placed subcrestally in 21 periodontally healthy patients (mean age: 49.0 ± 13.4 years). Repeated clinical and cytokine measurements were obtained over 12 months. GCF and PICF samples were collected and analyzed by cytokine microarray. Data were examined by non‐parametric analysis of variance. Results: Plaque and bleeding indices were similar among all patients (P >0.05) at baseline. During 1 year of monitoring, the mean volumes of PICF and GCF were similar (P >0.05). The levels of interleukin (IL)‐4, ‐6, ‐10, and ‐12p70, tumor necrosis factor‐α, and interferon‐γ in GCF and PICF were not significantly different and did not vary over time (P >0.05). The levels of IL‐1α were higher in GCF than PICF at 1, 2, 6, and 12 months, as were the levels of IL‐8 at 1, 2, 4, 6, and 12 months (P <0.001). Transforming growth factor‐β1 in PICF and GCF exhibited time‐dependent increases, and vascular endothelial growth factor was reduced at 1 year without differences between PICF and GCF (P >0.05). Conclusion: Within the limitations of this study design, it can be concluded that after subcrestal implant placement, the immune response of peri‐implant and periodontal tissues, as assessed by cytokine levels in PICF and GCF, is similar.     

Osmotic pressure of periimplant sulcular and gingival crevicular fluids: a split-mouth, randomized study of its measurement and clinical significance

Objectives: This study comparatively investigated periimplant sulcular fluid (PISF) and gingival crevicular fluid (GCF) by means of the osmotic pressure (OP) levels of PISF (PISFOP) and GCF (GCFOP). It was a preliminary research that aimed to quantify PISFOP and GCFOP as well as to evaluate their clinical significances around implants and teeth. Material and methods: Partially edentulous implant patients treated by the same clinicians and using the same implant system were randomized in a split‐mouth trial design. Fifty‐four implants and teeth from these patients were selected in the same mouth and jaw as matched pairs of samples, i.e. as symmetrical or corresponding implant and tooth. PISFOP/GCFOP measurement was performed by an osmometer following PISF/GCF sampling procedures. Clinical significance was evaluated by the correlations between PISFOP/GCFOP and some clinical examination parameters of periimplant/periodontal soft tissues. These parameters included Silness–Löe plaque index (PI), Löe–Silness gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and probing attachment level (PAL). Results: PISFOP was higher than GCFOP, and GI, BOP, PPD and PAL were higher in the implant group than in the tooth group (P<0.05). PISFOP positively correlated with the clinical parameters of implants (P<0.01 for PI, GI and BOP; P<0.05 for PPD and PAL), and GCFOP positively correlated with the clinical parameters of teeth (P<0.01 for PPD; P<0.05 for PI, GI, BOP and PAL). Conclusions: The results reveal that PISFOP and GCFOP may be measured by osmometer, and their levels may be related with the clinical conditions of periimplant/periodontal soft tissues. To cite this article:
Sakallιo?lu U, Lütfio?lu M, Sakallιo?lu EE, Sert S, Ceylan G. Osmotic pressure of periimplant sulcular and gingival crevicular fluids: a split‐mouth, randomized study of its measurement and clinical significance.
Clin. Oral Impl. Res. 22 , 2011; 706–710
doi: 10.1111/j.1600‐0501.2010.02044.x     

The dimensions of keratinized mucosa around implants affect clinical and immunological parameters

Objectives: To investigate the association between keratinized mucosa (KM) width and mucosal thickness (MTh) with clinical and immunological parameters around dental implants. Methods: Sixty‐three functioning dental implants (3I osseotite) were examined. Clinical examinations included plaque index (PI), probing depth (PD), bleeding on probing (BOP), KM width, MTh and buccal mucosal recession (MR). Peri‐implant crevicular fluid (PICF) samples were collected for PgE2 assay. Results: KM width ranged from 0 to 7 mm (mean 2.5±2), MTh ranged from 0.38 to 2.46 mm (mean 1.11±0.4) and the mean MR was 0.62 mm, ranging from 0 to 3 mm. A negative correlation was found between MTh and MR (r=?0.32, P=0.01); Likewise, KM width showed a negative correlation with MR, periodontal attachment level (PAL) and PgE2 levels (r=?0.41, P<0.001; r=?0.26, P=0.04; r=?0.26, P=0.04, respectively). In contrast, a positive correlation was found between KM width and PD (r=0.27, P=0.03). When data were dichotomized by KM width, a wider mucosal band (>1 mm) was associated with less MR compared with narrow (≤1 mm) band (0.27 and 0.9 mm, respectively, P=0.001). A wider KM band was also associated with a greater PD (3.13 mm) compared with a narrow band (2.66 mm, P=0.04). Similarly, a thick mucosa (≥1 mm) was associated with lesser recession compared with a thin (<1 mm) mucosa (0.45 and 0.9 mm, respectively, P=0.04). Conclusion: The KM around dental implants affects both the clinical and the immunological parameters at these sites. These findings are of special importance in the esthetic zone, where thin and narrow KM may lead to a greater MR.     

3I和奥齿泰种植体系统周围组织稳定性差异的临床对比研究

目的：探讨3I种植体和奥齿泰种植体修复后对种植体周围软硬组织的影响，为临床种植系统的选择提供临床依据。方法随机选取单牙缺失需种植修复的患者42例，分别行3I种植体（23枚）和奥齿泰种植体（26枚）种植修复，于修复后3、6、9和12个月测量种植体周围骨吸收、龈沟出血指数（sulcus bleeding index， SBI）、菌斑指数（plaque index，PLI）、探诊深度（probing depth，PD）、种植体周围龈沟液（peri?implant crevicular fluid ，PICF）的天冬氨酸转氨酶（aspartate aminotransferase ，AST）水平，并选取对侧健康牙作为对照。结果种植体修复后1年，种植体颈部骨组织呈现不断吸收趋势，且奥齿泰种植体骨吸收量大于3I种植体（P <0.05）。在修复后6、9和12个月，3I种植体SBI、PLI均低于奥齿泰种植体（P<0.05），3I种植体AST水平与天然牙差异无统计学意义，而奥齿泰种植体AST水平高于天然牙（P<0.05）。修复后9、12个月，3I种植体PD明显低于奥齿泰种植体（P<0.05）。结论3I种植体对种植体周围骨组织及周围牙龈组织的影响较奥齿泰小，但两者在研究期内均表现出良好的临床效果。     

Impact of a chronic smoking habit on the osteo-immunoinflammatory mediators in the peri-implant fluid of clinically healthy dental implants

ObjectiveThe aim of this study was to evaluate the influence of chronic cigarette smoking on the profile of osteo-immunoinflammatory markers in the peri-implant crevicular fluid (PICF) from clinically healthy implantsDesignsTwenty-five smokers and 23 non-smoker subjects with a unitary screwed implant-supported crown in the molar or pre-molar region were enrolled in this study. The implants should have been in functioning for at least 12 months, and the peri-implant tissue should be clinically healthy [probing depth (PD) < 4 mm with no bleeding on probing (BoP) and no evidence of radiographic bone loss beyond bone remodeling]. The levels of interferon (INF)-γ, interleukin (IL)-4, IL-17, IL-1β, IL-10, IL-6, IL-8, tumor necrosis factor (TNF)-α, matrix metalloproteinase (MMP)-2, MMP-9, osteoprotegerin (OPG), soluble receptor activator of nuclear factor-κβ ligand (RANKL), osteocalcin (OC), osteopontin (OPN), transforming growth factor (TGF)-β, and cross-linked telopeptide of type I collagen (ICTP) in the PICF were quantified by a multiplexed bead immunoassay.ResultsThe smokers presented reduced levels of IL-4, IL-8, and TNF-α compared with the non-smoker individuals (p < 0.05). In addition, although lower OPG levels were detected in the PICF of the smokers, the RANKL/OPG ratio did not show a significant difference (p > 0.05). Moreover, higher ICTP concentrations and a higher TH1/TH2 ratio were observed in the PICF of the smoker patients (p < 0.05). No differences between the groups were observed for the other markers evaluated (p > 0.05).ConclusionsSmoking habit modulate peri-implant cytokine profile, leading to reductions in IL-4, -8 TNF-α, and OPG levels and an increased ICTP and TH1/TH2 ratio in peri-implant crevicular fluid.     

Elastase,alpha2-macroglobulin and alkaline phosphatase in crevicular fluid from implants with and without periimplantitis

The aim of this investigation was to determine the presence of selected enzymes and enzyme inhibitors in crevicular fluid collected from implants with and without clinical, radiographic and microbiological signs of periimplantitis. Eleven implants with symptoms of periimplantitis in eight patients (four men and four women) were compared to eleven implants in seven subjects (one man and six women) without periimplantitis. Periimplant crevicular fluid (PICF) was collected at the mesial and distal sites of each implant. Alkaline phosphatase activity (ALP) was measured by using p-nitrophenyl-phosphate as substrate, elastase activity (EA) by the use of a low molecular weight fluorogenic substrate, and the inhibitor alpha2-macroglobulin (alpha2M) by ELISA. ALP, EA and alpha2M were detected in the majority of samples in both groups. In comparison to the clinically healthy implants, total amounts of each of these substances were significantly higher in PICF collected around implants with periimplantitis. The mean total amounts of EA, alpha2M and ALP in the healthy group were: EA: 1.8 ng, alpha2M: 3.1 ng, ALP: 24.1 U, and in the periimplantitis group EA: 23.1 ng, alpha2M: 25.2 ng and ALP: 142.3 U. In addition, all three mediators were correlated with the clinical parameters. The results confirm the similarity of the inflammatory response of tissues surrounding implants and natural teeth, and suggest that ALP and EA could be promising markers of bone loss around dental implants.     

Associations of alveolar bone loss and interleukin-1β levels in one- and two-stage surgical procedures: a randomized prospective trial

Objective: Dental implants have been widely and successfully used in recent years as an alternative treatment for removable and fixed dental prostheses. The aim of this randomized prospective study was to determine the alveolar bone loss rate (ABLR) and IL-1β levels in one- and two-stage surgical procedures.

Materials and methods: This study included 40 patients with a single missing tooth in the posterior mandible; dental implants were inserted using a one-stage surgical procedure (Group I) or a two-stage surgical procedure (Group II). All clinical periodontal parameters were recorded; peri-implant crevicular fluid (PICF) samples were collected before loading (T0) and during the third (T1) and sixth (T2) months after loading. ABLR values were evaluated at T0 and T2 by using dental tomography. PICF was analysed after T2 samples were collected. The study was registered through clinicaltrials.gov; identifier NCT03045458.

Results: This study found that, the probing pocket depth was found to be significantly higher in Group I than Group II at both T1 and T2 (p?p?>?.05). There was a significant difference between Group I ABLR values at T0 and T2 (p?p?>?.05).

Conclusions: Within the limitations of the short observational period and small sample size of this study, two-stage implant placement shows comparable clinical outcomes to implants placed using a one-stage placement protocol.     

Effect of smoking on concentrations of receptor activator of nuclear factor κ B ligand and osteoprotegerin in human gingival crevicular fluid

Aim: To compare the levels of the soluble receptor activator of nuclear factor κ B ligand (sRANKL), osteoprotegerin (OPG) and their relative ratio in gingival crevicular fluid (GCF) among periodontitis patients with varying smoking histories.
Material and Methods: GCF samples were collected from 149 periodontitis patients who were never smokers ( n =58), former smokers ( n =39) and current smokers ( n =52). sRANKL and OPG concentrations in GCF were measured by enzyme-linked immunosorbent assays.
Results: sRANKL, OPG and their relative ratio were not statistically significant among the never smokers, former smokers and current smokers. However, OPG was significantly reduced and subsequently the sRANKL:OPG ratio was significantly increased in the high pack-years group as compared with never smokers. The positive correlation between pack-years and the sRANKL:OPG ratio remained statistically significant after adjusting for age and current smoking status.
Conclusion: Increased lifetime exposure to cigarette smoking above a minimum threshold suppresses OPG production and leads to increased sRANKL:OPG. This may partially explain increased bone loss in smoking-related periodontitis.     

Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation

Background: Studies suggest that a single prophylactic dose of amoxicillin reduces early implant complications, but it is unclear whether other antibiotics are also effective. This study compared the local antimicrobial and anti‐inflammatory effects resulting from a single dose of azithromycin or amoxicillin before surgical placement of one‐stage dental implants. Methods: Healthy adult patients requiring one‐stage dental implant placement were allocated randomly to receive either 2 g amoxicillin (n = 7) or 500 mg azithromycin (n = 6) before surgery. Peri‐implant crevicular fluid (PICF) samples from the new implant and gingival crevicular fluid (GCF) from adjacent teeth were sampled on postoperative days 6, 13, and 20. Inflammatory mediators in the samples were analyzed by immunoassay, and antibiotic levels were measured by bioassay. Results: On day 6, azithromycin concentrations in GCF and PICF were 3.39 ± 0.73 and 2.77 ± 0.90 μg/mL, respectively, whereas amoxicillin was below the limit of detection. During early healing, patents in the azithromycin group exhibited a significantly greater decrease in GCF volume (P = 0.03, analysis of variance). At specific times during healing, the azithromycin group exhibited significantly lower levels of interleukin (IL)‐6 and IL‐8 in GCF than the amoxicillin group and exhibited significantly lower levels of granulocyte colony stimulating factor, IL‐8, macrophage inflammatory protein‐1β, and interferon‐gamma‐inducible protein‐10 in PICF. Conclusions: Azithromycin was available at the surgical site for a longer period of time than amoxicillin, and patients taking azithromycin exhibited lower levels of specific proinflammatory cytokines and chemokines in GCF and PICF. Thus, preoperative azithromycin may enhance resolution of postoperative inflammation to a greater extent than amoxicillin.     

Soluble RANKL in crevicular fluid of dental implants: a pilot study

Background Receptor activator of NF‐κB ligand (RANKL), a member of the tumor necrosis factor superfamily, is a key mediator of osteoclast formation, activation, and survival. Thus, it is reasonable to hypothesize that there might be a functional relationship between RANKL expression and peri‐implantitis. Purpose This pilot study was performed to determine the reference levels for soluble RANKL (sRANKL) in peri‐implant crevicular fluid and to correlate them with the clinical parameters associated with inflammatory reactions and bone destruction. Materials and Methods The clinical parameters probing depth (PD), modified bleeding index (MBI), and modified plaque index (MPI) served as indicators for bone resorption and inflammation. Exclusion criteria for calculations were the detection limit of the immunoassay and the minimum acceptable crevicular volume for measurement. From the 84 collected samples of 16 patients, 30–84 years of age, with a total of 19 implants, 29 met these criteria. The absolute amount of sRANKL within crevicular fluid adsorbed to filter strips was a median of 0.18 femtomol (fmol; range, 0.08–0.53) and 0.26 nM (range, 0.09–1.21) when normalized by volume. PD was 4 mm in median and varied within a range between 2 and 12 mm. Results Absolute amounts of sRANKL showed no correlation with the adsorbed volume and the clinical parameters PD, MBI, and MPI. When sRANKL was normalized by volume, no correlation with the clinical parameters PD, MBI, and MPI was observed either. The patients’ age was not associated with total sRANKL and the concentration of RANKL within crevicular fluid. Absolute levels of sRANKL and sRANKL concentration did not show any differences based on the sampling sites buccal and lingual, or on the patients’ gender. A significant difference in sRANKL concentration was detectable when samples from maxillary implants (0.31 nM median; range, 0.12–1.21) were compared with samples from mandibular implants (0.21 nM median; range, 0.09–0.6) (p=.03). Absolute levels of sRANKL were not different between the maxilla and the mandible. Conclusion Given the limited sample size, our data provide a basis for future prospective longitudinal studies on the possible relevance of sRANKL as a prognostic marker in peri‐implantitis, and for an understanding of the pathophysiologic process of the disease as a prerequisite for the design of treatment strategies.     

前列腺素E2在种植体周围龈沟液中的含量测定及其临床意义

目的：探讨前列腺素E2（Prstaglandin E2,PGE2）在种植体周龈沟液中的含量水平与种植牙牙周组织临床指数-菌斑指数（plaque index,PI）,牙龈指数（gingival index,GI）和牙周探诊深度（probing pocket depths,PPD）之间的关系.方法：检查实验组36颗和对照组36颗种植体牙周情况,实验组为有明显炎症的种植体,牙周探诊深度均超过3mm.同时试纸收集种植体周围龈沟液,ELISA法检测其龈沟液中的PGE2含量,所得数据用t检验和Pearson相关分析进行统计学处理.结果：PGE2表达和患种植体周围炎的种植体牙周指数呈显著相关（P＜0.05）,且实验组和对照组的PGE2表达统计学差异明显（P＜0.05）.结论：龈沟液中PGE2含量可为种植体周围炎病变的诊断提供客观参考.     

A review on peri-implant crevicular fluid assays potential in monitoring and predicting peri-implant tissue responses

The early and reliable detection of any adverse peri-implant tissue reaction is a prerequisite for treatment planning in patients treated with endosseous dental implants. However, traditional periodontal markers allow only the documentation of the severity of the preexisting destruction. Thus, simple and reliable clinical tests for monitoring peri-implant tissue condition are needed. As the peri-implant crevicular fluid (PICF) is an osmotically mediated inflammatory exudate, changes in flow rate and profile occur according to the condition of the peri-implant tissues. Consequently, peri-implant crevicular fluid analysis may help in detecting early metabolic and biochemical lesions not readily discernible, as well as in monitoring the osseointegration process and the bone response to occlusal loading, thereby improving the long-term success of implants. The purpose of this paper was to review current information on PICF flow rate and profile changes under various clinical conditions and investigate whether specific PICF assays could be useful in the assessment, monitoring and prediction of peri-implant tissue responses.     

Detection of implant crevicular fluid prostaglandin E2 levels for the assessment of peri-implant health: a pilot study

Inflammatory changes in the peri-implant tissues may lead to peri-implantitis and bone loss. Prostaglandin E2 has been shown to have proinflammatory effects on peri-implant tissues, including mediation of bone resorption. The aim of this study was to assess prostaglandin E2 levels in implant crevicular fluid and the possibility of using this method in diagnosing peri-implant mucositis. Twenty-four dental implants with 3 mm or greater probing depths comprised the test group and another 24 implants with probing depths less than 3 mm served as the control group. Plaque index (PI), gingival index (GI), and probing pocket depths (PPD) were recorded. Implant crevicular fluid was obtained by collection onto periopapers. Then, prostaglandin E2 levels were evaluated using a commercially available enzyme immuno-assay kit. PI, GI, PPD, and implant crevicular fluid (ICF) levels of prostaglandin E2 were found to be statistically significantly higher in the test group (P < 0.05). In the test group, gingival index and probing depths were found to be statistically significantly related with ICF prostaglandin E2 levels (P < 0.05). In the control group, there was no statistically significant positive correlation between clinical parameters and ICF prostaglandin E2 levels (P > 0.05). It may be speculated that biochemical tests, such as the detection of prostaglandin E2 levels in the crevicular fluid are useful diagnostic methods for the maintenance of functional dental implants.