A diet high in fat and fructose adversely affects osseointegration of titanium implants in rats.

Shalinie King,Carina Baptiston Tanaka,Dean Ross,Iven Klineberg,Jamie J Kruzic,Tara C Brennan‐Speranza,Itamar Levinger

doi:10.1002/cre2.255

Abstract

ObjectivesDiet‐induced metabolic dysfunction such as type 2 diabetes mellitus increases the risk of implant failure in both dental and orthopaedic settings. We hypothesised that a diet high in fat and fructose would adversely affect peri‐implant bone structure and function including osseointegration.Materials and methodsThirty female Sprague‐Dawley rats were divided into three groups (n = 10), control group (normal chow) and two intervention groups on a high‐fat (60%), high‐fructose (20%; HFHF) diet. Titanium implants were placed in the proximal tibial metaphysis in all groups either before commencing the diet (dHFHF group) or 6 weeks after commencing the diet (HFHF group) and observed for an 8‐week healing period. Fasting blood glucose levels (fBGLs) were measured weekly. Structural and functional features of the peri‐implant bone, including bone‐to‐implant contact (BIC), were analysed post euthanasia using microcomputed tomography, pull‐out tests, and dynamic histomorphometry.ResultsThe fBGLs were unchanged across all groups. Peri‐implant trabecular bone volume was reduced in the HFHF group compared with controls (p = .02). Percentage BIC was reduced in both HFHF group (25.42 ± 3.61) and dHFHF group (28.56 ± 4.07) compared with the control group (43.26 ± 3.58, p < .05) and reflected the lower pull‐out loads required in those groups. Osteoblast activity was reduced in both intervention groups compared with the control group (p < .05).ConclusionThe HFHF diet compromised osseointegration regardless of whether the implant was placed before or after the onset of the diet and, despite the absence of elevated fBGLs, confirming that changes in bone cell function affected both the initiation and maintenance of osseointegration independent of blood glucose levels.

Highlights

Titanium implants are an established treatment option for both dental and orthopaedic rehabilitation, in an ageing population where demand is rapidly increasing (Srinivasan, Meyer, Mombelli, & Muller, 2017)
Recent evidence suggests that osseointegration is a result of an immunologically driven foreign body reaction mounted by the body in response to the implant surface and that long-term maintenance of this interface depends on equilibrium of this local inflammatory response, which attenuates over time
The matrix production (MAR) and BFR/BS were both significantly reduced in the dHFHF group (p = .02 and p = .01, respectively) compared with the control group

Summary

Introduction

Titanium implants are an established treatment option for both dental and orthopaedic rehabilitation, in an ageing population where demand is rapidly increasing (Srinivasan, Meyer, Mombelli, & Muller, 2017). 10-year survival rates of 94.6% for dental implants (Moraschini, Poubel, Ferreira, & Barboza Edos, 2015), 95.6% for total hip replacements and 96.1% for total knee replacements have been reported (Bayliss et al, 2017), failures do occur. Metabolic dysfunction such as type 2 diabetes mellitus (T2DM) has been shown to be associated with reduced dental implant survival rates (Naujokat, Kunzendorf, & Wiltfang, 2016) and an increased risk for revision of total hip replacements (Pedersen, Mehnert, Johnsen, & Sorensen, 2010). There is growing evidence that patientrelated risk factors may impact on the maintenance of this interface (Maradit Kremers, Lewallen, van Wijnen, & Lewallen, 2016)

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