Abstract
Dental implants are widely utilized for the replacement of missing teeth and are increasingly being placed in patients with systemic diseases, as well as in those who are medically healthy. Furthermore, it is recognized that peri-implant mucositis and peri-implantitis are highly prevalent, affecting large numbers of patients with implants, and it is pertinent to consider whether there may be any systemic impact of these conditions, given that there are known links between periodontitis and a number of chronic inflammatory diseases. In this article, we propose that the potential systemic complications of peri-implant diseases should be investigated in future clinical research, together with studies to identify whether systemically-administered host modulation therapies (HMTs) may be of benefit in the treatment of peri-implant diseases. These “HMTs” may prove a useful adjunct to routinely employed debridement and disinfection protocols, as well as potentially being of benefit in reducing risks of systemic complications. We also consider the use of chair-side diagnostic tests for active matrix metalloproteinase-8 (aMMP-8) in the detection of peri-implant disease given the ability of such tests to detect active tissue breakdown associated with peri-implantitis and periodontitis before conventional clinical and radiographic measurements indicate pathologic changes. These novel diagnostic and therapeutic strategies are relevant to consider as they may improve the management of peri-implant disease (beyond local debridement procedures), especially in those patients in whom systemic inflammation might be of concern.
Highlights
We propose that the potential systemic complications of peri-implant diseases should be considered by the profession and investigated in appropriately designed clinical trials
We suggest that in future studies of peri-implantitis, patients should be analyzed for well-established biomarkers of systemic inflammation (for example, high sensitivity C-reactive protein, cytokines such as interleukin (IL)-6, and collagenolytic enzymes such as MMP-8, MMP-9) in their blood samples, before and after local debridement procedures, and in combination with host modulation therapies (HMTs)
Given the importance of MMP-8, and active MMP-8 (aMMP-8) in the pathogenesis of periodontal diseases, more recently, chair-side tests have been developed that can measure aMMP-8 levels in peri-implant sulcular fluid (PISF), gingival crevicular fluid (GCF) and mouthrinse, and have been validated in studies conducted in the USA, Africa, and Europe [26,27,28,29,30,31]
Summary
We propose that the potential systemic complications of peri-implant diseases should be considered by the profession and investigated in appropriately designed clinical trials. While the issue of local (oral) inflammation in dental implantology has been extensively addressed in a number of studies (see Javed and Romanos [1] for a review), we consider that an additional question should be posed; that is, what is the risk, if any, that peri-implant disease may induce and/or contribute to systemic inflammation?
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