Peri-implant Sulcular Fluid Research Articles

Active MMP-8 point-of-care (PoC)/chairside enzyme-test as an adjunctive tool for early and real-time diagnosis of peri-implantitis.

ObjectiveThe aim of this study was to investigate the utility of the active matrix metalloproteinase (aMMP‐8)‐point‐of‐care (PoC) test as a quantitative real‐time chair‐side diagnostic tool for peri‐implant diagnosis, as well as assess the potentially developing and ongoing risk relative to the traditional clinical methods.BackgroundCurrent peri‐implant and periodontal disease diagnoses rely on clinical and radiological examinations. This case‐control study investigated the applicability of aMMP‐8‐PoC immunotest for quantitative real‐time diagnosis and monitoring of dental implants in health and disease.MethodsSixty‐eight patients visiting a specialist clinic for maintenance following dental implant placement underwent assessment of their peri‐implant health. aMMP‐8‐PoC peri‐implant sulcular fluid (PISF) lateral‐flow immunotests were performed using ImplantSafe® technology quantitated by ORALyzer®. In addition, the PISF samples were analyzed for total MMP‐8, calprotectin, and interleukin (IL)‐6 by enzyme‐linked immunosorbent assays (ELISA), aMMP‐8 by western immunoblot, and MMP‐2 and MMP‐9 by gelatin zymography.ResultsThe aMMP‐8‐PoC test promptly recorded and reflected peri‐implant disease, differentiating it clearly from health. X‐ray findings (bone loss > 2 mm), peri‐implant pocket depth ≥ 3 mm, and bleeding on probing were significantly more prevalent among implants positive for the aMMP‐8‐PoC test. aMMP‐8/ORALyzer analysis was more precise in recording disease than total MMP‐8, calprotectin, IL‐6, MMP‐2, and MMP‐9.ConclusionsThe aMMP‐8‐PoC test can be conveniently implemented to alert for and detect active collagenolysis affecting peri‐implant tissues, both in the early and advanced stages of the disease. Active and fragmented MMP‐8 exhibits a strong and significant association with peri‐implantitis as compared to total MMP‐8 and other biomarkers and can be utilized as the POC/chairside biomarker of choice in the new classification of peri‐implantitis.

Effect of photobiomodulation after non-surgical mechanical debridement on cortisol levels in the peri-implant sulcular fluid among patients with peri-implant mucositis.

The aim of this was to compare the efficacy of photobiomodulation after non-surgical mechanical debridement (MD) on cortisol levels (CL) in peri-implant sulcular fluid (PISF) among patients with peri-implant mucositis. Patients with peri-implant mucositis were encompassed. All patients underwent non-surgical MD with (test group) and without (control group) a single application of photobiomodulation. Demographic data were collected and PISF was collected. Peri-implant modified plaque index (mPI), modified gingival index (mGI), probing depth and crestal bone loss were measured, and CL in PISF were recorded. All clinical parameters and PISF CL were re-assessed at 4months of follow-up. p<.05showed statistical significance. Seventeen (14 males and 3 females) and 17 (15 males and 2 females) patients with peri-implant mucositis were recruited in test and control groups. The mean age of patients in the test and control groups was 46.1±6.5 and 50.2±2.7years respectively. At baseline, mPI, mGI, PD and PISF volume and CL in control and test groups were similar. At follow-up, there was a significant reduction in mPI (p<.001), mGI (p<.001), PD (p<.001) and PISF volume (p<.001) and CL (p<.001) in both groups compared with baseline. There was no difference in mPI, mGI, PD and PISF volume and CL in test and control groups at follow-up. In short term, non-surgical MD with photobiomodulation does not offer additional benefits in terms of reducing soft-tissue inflammatory parameters and PISF CL in patients with peri-implant mucositis.

Correlation between Peri-Implant Marginal Bone Loss Progression and Peri-Implant Sulcular Fluid Levels of Metalloproteinase-8.

Objectives: The aim of this retrospective study was to analyze peri-implant marginal bone loss levels/rates and peri-implant sulcular fluid levels/rates of metalloproteinase-8 in three timeframes (6 months post-surgery—restoration delivery (T0)—and 6 (T6) and 24 (T24)-months post-loading) and to evaluate if there is a correlation between peri-implant sulcular fluid levels of metalloproteinase-8 and peri-implant marginal bone loss progression. Materials and Methods: Two cohorts of patients undergoing implant surgery between January 2017 and January 2019 were selected in this retrospective study. A total of 39 patients received 39 implants with a laser-microtextured collar surface, and 41 subjects received 41 implants with a machined/smooth surface. For each patient, periapical radiographs and a software package were used to measure marginal bone loss rates. Implant fluid samples were analyzed by an enzyme-linked immunosorbent assay (ELISA) test. The modified plaque index, probing depth, and bleeding on probing were also recorded. Results: High marginal bone rates at T24 were strongly associated with elevated rates between T0 and T6. The levels of metalloproteinase-8 were significantly more elevated around implants with marginal bone loss, in relation to implants without marginal bone loss. Marginal bone loss (MBL) rates at 24 months were associated with initial bone loss rates and initial levels of metalloproteinase-8. Conclusions: Peri-implant marginal bone loss progression is statistically correlated to peri-implant sulcular fluid levels of metalloproteinase-8. Moreover, the initial high levels of marginal bone loss and metalloproteinase-8 can be considered as indicators of the subsequent progression of peri-implant MBL: implants with increased marginal bone loss rates and metalloproteinase-8 levels at 6 months after loading are likely to achieve additional marginal bone loss values.

Peri-implant parameters and bone metabolic markers among water-pipe users treated with photodynamic therapy

AimThe study aimed to evaluate the efficacy of Mechanical debridement (MD) with and without adjunct antimicrobial photodynamic therapy (aPDT) in the treatment of peri‑implantitis among waterpipe smokers (WPS) and non-smokers with peri‑implantitis Material and methodsParticipants were stratified into two groups. Group 1: Subjects who smoked water pipes for the last 2 years with peri‑implant disease were treated with aPDT adjunct to MD and group 2: Participants who did not use water pipes in the last 2 years but have periimplantitis (controls) were treated with MD only. Participants were scrutinized with peri‑implantitis (PI) in one dental implant at least based on the inclusion and exclusion criteria. Using structured questionnaire information was gathered from participants. All participants underwent mechanical debridement (MD). Participants of WPS underwent antimicrobial photodynamic therapy (aPDT). Peri implant inflammatory parameters (PI, BI, PD, and CBL) were assessed in all participant at baseline, 3 months and 6 months follow-up. Periimplant sulcular fluid was collected for assessment of bone metabolic biomarkers RANK-L and OPG. For immunological and clinical peri‑implant parameters analysis of variance (ANOVA) and Kruskal-Wallis test were used. For multiple comparisons, Bonferroni post hoc test was deployed. ResultsClinical periodontal parameters at baseline were significantly different in the control group PI (49.8 ± 10.5), BI(46.8 ± 7.7), and PD (5.0 ± 1.8) compared to WPS PI (56.1 ± 12.0), BI (40.9 ± 8.3), and PD (5.6 ± 1.5) (p < 0.05). At 3 months follow-up after PDT, PI (19.1 ± 7.7) and PD (3.9 ± 1.4) were significantly lower in the control group compared to WPS group PI (23.5 ± 8.4) and PD (4.5 ± 1.2) (p < 0.05). Whereas, BI of control (16.3 ± 6.8) and WPS group (17.1 ± 5.3) at 3 months follow-up was comparable (p > 0.05). At six months follow up following PDT, PI (15.7 ± 5.5) and PD (3.4 ± 1.2) was significantly lower in the control group compared to participants with water piped users PI (18.6 ± 7.4) and PD (3.9 ± 1.3) (p < 0.05). No significant difference was noted in BI in both groups (p > 0.05). Participants treated with PDT adjunct to MD demonstrated significantly reduced mean RANK-L levels at both 3 and 6 months (p<0.05). ConclusionaPDT adjunctive to MD improved periodontal parameters i.e., plaque index, pocket depth, and crestal bone loss along with metabolic marker RANK-L in water pipe smokers compared to non piped smokers.

Effect of tetracycline on IL-1β and IL-6 levels of the peri-implant sulcular fluid.

Background Inflammation in the implant-abutment interface is one of the main factors that can reduce implant stability. Therefore, this study investigated the effect of chlorhexidine, tetracycline, saliva, and a dry environment on the interleukin IL-1β and interleukin IL-6 levels of the gingival groove fluid at the implant-abutment interface.Methods Twenty-four (10 men and 14 women) patients referred to the Faculty of Dentistry for implant treatment, who met the inclusion criteria, were examined. Four different materials were used in each implant, including 2% chlorhexidine, 3% tetracycline, saliva, and a dry medium. Each test material was placed inside the implant screw during the anchorage session, and the healing screw was closed. Patients were then sampled in three implantation sessions and one month after prosthesis delivery. Interstitial fluid groove was used for sampling after cleaning the mouth (half an hour after three minutes of thorough brushing). The data were analyzed with SPSS 20 using ANOVA and relevant post hoc tests.Results There was a significant difference in the mean IL-6 and IL-1β levels between the four materials (P<0.05). IL-6β levels were similar in tetracycline and chlorhexidine but significantly higher than in saliva and the dry environment (P<0.05). IL-6 and IL-1β levels in the saliva were significantly higher than in the dry environment (P<0.05).Conclusion The use of tetracycline at the junction of implant and abutment reduces the inflammatory cytokines IL-6 and IL-1β.

Peri-implant Sulcular Fluid Galectin-1, Soluble Urokinase Plasminogen Activator Receptor and IL-1β Levels under Peri-implant Inflammatory Conditions.

Soluble urokinase plasminogen activator receptor (suPAR) and interleukin 1-beta (IL-1β) are inflammatory biomarkers, whereas galectin-1 is an anti-inflammatory cytokine. The relationship between suPAR, galactin-1 and IL-1β levels in peri-implant sulcular fluid (PISF) in relation to dental implants remains unaddressed. The aim was to assess suPAR, galectin-1, and IL-1β levels in PISF under peri-implant inflammatory conditions. Demographic data and information related to jaw location and duration of implants in function as well as systemic health was retrieved from patients' dental records. Peri-implant plaque and gingival indices (PI and GI, respectively), probing depth (PD) and crestal bone loss (CBL) were recorded. The PISF was collected and levels of suPAR, galectin-1 and IL-1β were determined using standard techniques. Sample-size estimation and statistical analyses were done. Correlation of suPAR and galectin-1 with IL-1β were assessed via logistic regression. p-values < 0.05 were considered statistically significant. Seventy-two patients (45 males and 27 females) with peri-implant diseases were included. Thirty-six patients (22 males and 14 females) had peri-implant mucositis; 36 (23 males and 13 females) had healthy peri-implant tissues. The PISF volume was statistically significantly higher among patients with (0.52 ± 0.05 µl) than without peri-implant diseases (0.06 ± 0.01 µl) (p < 0.001). The PISF levels of suPAR (p < 0.01), galectin-1 (p < 0.01) and IL-1β (p < 0.01) were statistically significantly higher among patients with than without peri-implant diseases. In patients with peri-implant mucositis, PISF suPAR (p < 0.001) and galectin-1 (p < 0.001) levels correlated with PISF IL-1β levels. In patients with peri-implant mucositis, increasing peri-implant PD and IL-1β levels directly correlated with increased PISF suPAR (p < 0.001) and galectin-1 (p < 0.05) levels. Increased PISF levels of suPAR, galectin and IL-1β suggest that these proteins possibly contribute towards the pathogenesis of peri-implant inflammation, and are potential biomarkers of peri-implant diseases.

Evaluation of Peri-implant Crevicular Fluid Matrix Metalloproteinase-8 levels of flapped vs. flapless dental implants: A prospective study

Objectives: The objective of this study was to compare the placement of flapped vs. flapless dental implants utilizing clinical and immunological parameters. Subjects and methods: A total of 10 patients were received 20 dental implants. One quadrant in each patient was randomly assigned to control group while other to test group with the help of coin flip. Control group with 10 flapped implants and test group with 10 flapless implants. Follow-up examinations were carried out after 1 week, 1, and 3 months. All treatments were performed under local anesthesia. Peri-implant sulcular fluid samples were collected as well as clinical parameters recorded at the follow up periods. Results: Peri-implant sulcus depth was significantly greater in flapped implants at both 4 and 12 postsurgical weeks (P < 0.005). Matrix metalloproteinase-8 values were higher to a statistically significant level in the control group at 1 (P = 0.003) and 4 weeks (P = 0.007) after placement. Conclusions: Matrix metalloproteinase 8 levels of peri implant crevicular fluid as well as pocket depth were decreased in flapless implants than conventional flap implant surgery.

Expression of Metalloproteinase-8 in Gingival Crevicular Fluid, Peri-Implant Sulcular Fluid and Saliva in Healthy and Diseased Periodontal and Peri-Implant Tissue

Expression of Metalloproteinase-8 in Gingival Crevicular Fluid, Peri-Implant Sulcular Fluid and Saliva in Healthy and Diseased Periodontal and Peri-Implant Tissue

Analysis of IL-1\u03b2, CXCL8, and TNF-\u03b1 levels in the crevicular fluid of patients with periodontitis or healthy implants

BackgroundOur study aimed to assess the level of IL-1β, CXCL8, and TNF-α in peri-implant sulcular fluid (PISF) collected from patients with no clinical symptoms of mucositis or peri-implantitis and compare them with cytokine concentration in gingival crevicular fluid (GCF) acquired from patients with healthy periodontium and those with varying severity of periodontitis.MethodsA total of 189 subjects were included in the study, and GCF/PISF samples were checked for IL-1β, CXCL8, and TNF-α levels using an ELISA test.ResultsThe IL-1β level in PISF in patients with implants was significantly lower than in GCF in patients with mild, moderate, or severe periodontitis. The CXCL8 level in PISF was considerably lower than in patients with moderate periodontitis. The TNF-α level in PISF in patients with implants was markedly higher compared to subjects with healthy periodontium or patients with mild periodontitis.ConclusionAnalysis of cytokine levels may help describe the pathogenesis and early diagnosis of peri-implantitis and prevision in high-risk patients.

Cortisol levels in the peri-implant sulcular fluid among patients with and without peri-implantitis.

Cortisol levels remain uninvestigated in peri-implant sulcular fluid (PISF) of patients with and without peri-implantitis. The present investigation investigated levels of cortisol in PISF among controls (individuals without peri-implantitis) and patients with peri-implantitis. The patient population comprised of participants with and without peri-implantitis (groups 1 and 2, respectively). Demographic information and data related to implant characteristics was recorded. Peri-implant radiographic (crestal bone loss [CBL]) and clinical (modified plaque and bleeding on probing indices [PI and BOP], and probing depth [PD]) and parameters were assessed. In all patients, levels of cortisol were measured in the PISF, which was collected using standard methods. Data normality and group comparisons were assessed, and multiple logistic regression was performed. Probability values less than 0.01 were nominated as being significant. Eighty-eight individuals (44 and 44 in groups 1 and 2, correspondingly) were included. In group 1, 24 and 20 participants were males and females, and there were 22 and 22 males and females in group 2. Mean ages were analogous in both groups. Peri-implant BOP (p<.001); CBL (p<.001); PI (p<.001); and PD (p<.001) were higher among patients in group 1 compared with group 2. The volume of PISF (p<.001) collected and its concentrations of cortisol (p<.001) were significantly higher among patients in group 1 compared with group 2. Regression analysis showed that CBL and PD directly correlated with increased PISF levels of cortisol among participants with peri-implantitis. Within the limits of the present study, it remains debatable whether or not PISF cortisol levels vary among patients with and without peri-implantitis. Further studies are needed to evaluate the role of PISF levels of cortisol in the diagnosis of peri-implantitis.

Evaluation of modified cold-atmospheric pressure plasma (MCAP) for the treatment of peri-implantitis in beagles.

To assess the effect of adjunctive use of modified cold-atmospheric pressure plasma (MCAP) to surgically mechanical debridement (MD) on peri-implantitis (PI) in beagles. Bilateral mandibles of beagles with PI, which induced by cotton ligature twined with steel in sub-marginal around the implant, were randomly divided into two groups: MD in conjunction with 2% CHX irrigation (control group) and MD with adjunctive intervention of MCAP (plasma group). Sulcus bleeding index (SBI), probing depth (PD) and bone height (BH) were examined before and after intervention using computed tomography and histological staining. Additionally, interleukin (IL)-1β, IL-6 and IL-17 levels in peri-implant sulcular fluid (PISF) were measured by ELISA. A significant improvement in SBI, PD and BH was found in the plasma group (p<.05) when compared with the control group after three months of intervention. In addition, IL-1β and IL-17, but not IL-6 levels decreased (p<.05) in the plasma group compared with the control group after intervention. The adjunctive use of MCAP to MD for PI can enhance bone formation around the implant and inhibit the inflammatory response. The application of MCAP could be considered a favourable adjunct to MD for PI.

The occurrence of peri-implant mucositis associated with the shift of submucosal microbiome in patients with a history of periodontitis during the first two years.

To investigate the dynamic changes of peri-implant microbiome in patients with a history of periodontitis and to construct a microbial prediction model. The prospective study was performed at one month (T1), one year (T2) and two years (T3) after restoration. Clinical examinations [probing depth (PD), bleeding on probing (BOP), suppuration (SUP)], radiographic examinations and sample collection were conducted at three timepoints. Peri-implant sulcular fluid (PISF) was collected and analysed by 16S rRNA gene sequencing. Generalized linear mixed model (GLMM) was used to identify differences. Totally, 168 subjects were assessed for eligibility. Twenty-two patients were recruited in the longitudinal study. Eventually, 67 PISF samples from 24 implants of 12 patients were collected and analysed. Peri-implant microbiome showed increasing diversity and complexity over time. Disease-associated genera Porphyromonas, Tannerella, Treponema and Prevotella dramatically increased from T1 to T3. The prediction model for clinical suppuration at T1 showed a high accuracy of 90%. The dysbiosis of peri-implant microbiome increased with time during the two-year observation in patients with a history of periodontitis. Genera of Porphyromonas, Tannerella, Treponema and Prevotella were biomarkers of peri-implant mucositis. Microbiota at the early stage could predict subsequent microbial dysbiosis and clinical suppuration.

AMMP-8 Point-of-Care/Chairside Oral Fluid Technology as a Rapid, Non-Invasive Tool for Periodontitis and Peri-Implantitis Screening in a Medical Care Setting.

This communication article addresses currently available rapid non-invasive methods to screen and detect periodontitis and dental peri-implantitis. In this regard, oral fluid biomarkers have been researched extensively but self-reported oral health (SROH)-questionnaires have also been developed. Both alternatives may offer a quick and easy way to screen and detect diseased patients. Active matrix metalloproteinase (aMMP-8) is one of the most validated biomarkers for screening and detecting periodontal breakdown related to periodontitis and peri-implantitis and monitoring their treatment effects revealing successful, less- and non-successful treatment results. Currently available aMMP-8 lateral-flow technologies allow this kind of analysis, as demonstrated here, to be conducted quantitatively online and real-time as point-of-care/chairside testing in dental and even medical care settings. In this study, an aMMP-8 peri-implant sulcular fluid point-of-care-test diagnosed peri-implantitis and healthy implants far more accurately than bleeding-on-probing or the other biomarkers, such as polymorphonuclear (PMN)/neutrophil elastase, myeloperoxidase and MMP-9. Although, SROH-questionnaires allow screening in similar settings but they lack the information about the current disease activity of periodontitis and peri-implantitis, which is of essential value in periodontal diagnostics and treatment monitoring. Thus, both methods can be considered as adjunct methods for periodontitis and peri-implant diagnostics, but the value of oral fluid biomarkers analysis does not seem to be substitutable.

Assessment of advanced glycation end products in the peri-implant sulcular fluid among moderate cigarette-smokers and nonsmokers with peri-implantitis.

It is hypothesized that the levels of advanced glycation end products (AGEs) are higher in the peri-implant sulcular fluid (PISF) of cigarette-smokers than nonsmokers with peri-implantitis. The purpose was to compare the levels of AGEs in the PISF among moderate cigarette-smokers and nonsmokers with peri-implantitis. Cigarette-smokers and nonsmokers with peri-implantitis and nonsmokers without peri-implantitis were included. A questionnaire was used to gather information related to smoking habit, duration of implants in function and demographic traits. In all groups, peri-implant plaque index (PI), gingival index (GI), crestal bone loss (CBL) and probing depth (PD). The PISF was collected and levels of AGEs were measured. Group comparisons were performed and P < .01 was nominated as pointer of statistical significance. Fourteen smokers with peri-implantitis (12 males and 2 females), 15 nonsmokers with peri-implantitis (14 males and 1 female) and 15 nonsmokers without peri-implantitis (13 males and 2 females) were included. Smokers with peri-implantitis had a smoking history of 22.7 ± 0.3 pack years. The mesial and distal CBL, PI, and PD were significantly higher in smokers with peri-implantitis than nonsmokers with (P < .01) and without peri-implantitis (P < .01). The GI was significantly higher in smokers (P < .01) and nonsmokers with peri-implantitis (P < .01) compared with nonsmokers without peri-implantitis. The levels of AGEs were significantly higher among smokers with peri-implantitis (552.8 ± 87.2 pg/mL) (P < .01) compared with nonsmokers with (141.6 ± 64.9 pg/mL) and without (88.1 ± 27.3 pg/mL) peri-implantitis. The levels of AGEs were significantly higher among nonsmokers with (141.6 ± 64.9 pg/mL) (P < .01) than without (88.1 ± 27.3 pg/mL) peri-implantitis. The levels of AGEs expressed in the PISF are higher among moderate cigarette-smokers than nonsmokers with peri-implantitis.

Bacterial Identification and Monitoring Around Two-Piece Dental Implants by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS).

Context Early microbiological diagnosis and treatment of periodontal pathogens is important for successful retention of dental implants. Aims This study aimed to identify and monitor oral bacterial colonization after successful two-piece dental implants. Settings and Design In this study, 50 two-piece dental implant subjects were included and assessed clinically, radiographically, and microbiologically. Methods and Material All the parameters were recorded at various stages after prosthesis placement. In each stage, nonadherent (peri-implant sulcular fluid) and adherent (curetted inner threads) samples were collected. Semiquantitative anaerobic culture of the samples were done in Anoxomat system. Bacterial colonies were first identified by routine microbiological methods and then by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) method. Statistical Analysis All the results were analyzed by appropriate statistical methods (Chi-square, one factor analysis of variance, etc.). Results All the bacterial isolates were identified in the MALDI-TOF MS system with no failure. After implant placement for the nonadherent samples, the frequency (%) of Fusobacterium nucleatum, Prevotella melaninogenica, and Propionibacterium acnes decreased whereas frequency (%) of Escherichia coli, Staphylococcus epidermidis, and Streptococcus mitis increased. For adherent samples, the frequency (%) of E. coli, Enterococcus faecalis, Porphyromonas gingivalis, P. melaninogenica , and Veillonella parvula decreased, whereas frequency (%) of S. mitis and Streptococcus mutans increased. The postimplant mean nonadherent and adherent bacterial load increased with time but not significantly over the periods ( p = 0.302 and 0.123, respectively). Conclusion Combination of basic (semiquantitative culture method) and advanced microbiological method (MALDI-TOF MS) can be useful for accurate detection and monitoring of potential pathogens around two-piece dental implants.

A Study to Evaluate the Efficacy of an 810-nm Diode Laser in the Maintenance of Dental Implants: A Peri-Implant Sulcular Fluid Analysis.

Biological implant failures are primarily related to biofilm, which can lead to peri-mucositis and, further on, peri-implantitis. The 810-nm diode laser has an affinity for pigmented chromophores, so its use in the peri-implant sulcus has a significant bactericidal effect on the black-pigmented anaerobes such as Porphyromonas gingivalis. Therefore, it can be used to eliminate or reduce the bacterial count in the peri-implant sulcular fluid (PISF), thus increasing the life of the implants and reducing the chances of failure. The purpose of this study was to evaluate the efficacy of the 810-nm diode laser for the maintenance of dental implants and its use as a regular in-office tool for limiting the microbiological count in the PISF. Twenty patients undergoing implant treatment at the Department of Periodontology and Oral Implantology were randomly selected for the study. PISF samples were collected before and after the sulcus was lased with an 810-nm diode laser and sent for quantitative microbiological analysis using universal bacterial count, and the quantity of P gingivalis was evaluated using real-time polymerase chain reaction (PCR). The analysis revealed that after diode application, the median percentage drop in the microbial count was 76.67% and the median percentage drop in P gingivalis count was 99.28%. The use of an 810-nm diode laser resulted in the following outcomes: (1) drastic reduction in the total bacterial count around the implant and (2) significant reduction in the P gingivalis count, as evaluated by real-time PCR.

The Effect of Two Implant-Abutment Connections on Maximum Bite Force, Prosthetic Maintenance and Peri-Implant Sulcular Fluid in Mandibular Implant Supported Telescopic Overdenture: A Split-mouth study

Purpose: The aim of this study was to evaluate and compare two different implant-abutment connections (conical and trilobe connection) in mandibular implant supported telescopic overdenture. The parameters of evaluation were the maximum bite force, prosthetic maintenance and peri-implant sulcular fluid. Materials and method: Twelve completely edentulous patients received new complete dentures. After 3 months of adaption to the new denture, 24 implants (12 implants with conical implant-abutment connection (group A) and 12 implants with trilobe implant-abutment connection (group B). The Insertion of each type of implant was randomly assigned between the two contralateral sides intraorally for each patient using a statistical software. Each patient was treated according to split mouth design. The implants were inserted in the canine region of the mandible using two-stage surgical technique and conventional loading protocol. After 3 months, implants were exposed and a telescopic overdenture was constructed. The maximum bite force, prosthetic maintenance and peri-implant sulcular fluid for each group of implants were evaluated at loading time, after 6 and 12 months.Results: There was no statistically significant difference in maximum bite force between group A and B the at loading time, but there was a statistically significant difference at 6 and 12 months follow up visits. The prosthetic maintenance events in group A were 1 event compared to 5 events in group B. There was no statistically significant difference between group A and B in the peri-implant sulcular fluid at loading time, 6 and 12 months follow up visits. Conclusion: Within the limitations of this study, it can be concluded that the conical implant- abutment connection is associated with increased maximum bite force compared to the trilobe Implant-abutment connection. Conical implant-abutment connection can provide a stable implant system with fewer prosthetic complications and maintenance services compared to trilobe implant -abutment connection.

Comparison of cotinine levels in the peri-implant sulcular fluid among cigarette and waterpipe smokers, electronic-cigarette users, and nonsmokers.

Assessment of cotinine levels in the peri-implant sulcular fluid (PISF) may serve as a valuable biomarker of peri-implant diseases in nicotine-product users. The aim of the present study was to compare cotinine levels in the PISF among cigarette smokers, waterpipe users, electronic-cigarette users, and nonsmokers. Cigarette smokers, waterpipe smokers, electronic-cigarette users, and nonsmokers were included. A questionnaire was used to collect information about age, gender, duration of smoking and vaping, family history of smoking, duration of smoking/vaping, and daily frequency of smoking/vaping. Implant-related data including implant dimensions and duration of implants in function were also recorded. In all groups, peri-implant probing depth (PD), bleeding on probing (BoP), and plaque index (PI) were assessed. Using standard techniques, PISF was collected and levels of cotinine in the PISF were measured. Sample-size estimation was performed, and statistical comparisons were done using one-way analysis of variance and Bonferroni post hoc adjustment tests. P values below .05 were categorized as statistically significant. One hundred two male individuals (35 cigarette smokers, 33 waterpipe smokers, 34 electronic-cigarette users, and 35 nonsmokers) were included. Scores of peri-implant PI (P < .05) and PD (P < .05) were significantly higher among cigarette smokers, waterpipe smokers, and electronic-cigarette users compared with nonsmokers. Peri-implant BoP was more often manifested in nonsmokers compared with cigarette smokers (P < .05), waterpipe smokers (P < .05), and electronic-cigarette users (P < .05). The volume of collected PISF was significantly higher among cigarette (P < .05) and waterpipe smokers (P < .05) and electronic-cigarette users (P < .05) than nonsmokers. Cotinine levels were significantly higher in the PISF of cigarette (P < .05) and waterpipe smokers (P < .05) and electronic-cigarette users (P < .05) than nonsmokers. Habitual use of nicotinic products enhances the expression of cotinine in the PISF. Cotinine levels in the PISF of cigarette and waterpipe smokers and electronic-cigarette users are comparable.

Detection of peri-implant inflammation by the use of a matrix metalloproteinase-8 chair-side test.

Active matrix metalloproteinase-8 (MMP-8) enzymes are associated with inflammation and the degradation of implant-supporting tissues. A high concentration of these enzymes in the peri-implant sulcular fluid (PISF) has been associated with a pathological condition. The aim of the present study was to evaluate the ability of a chair-side MMP-8 test to individuate pathological peri-implant site. The working hypothesis is that positive response to MMP-8 test corresponds to pathological values of periodontal indexes. A secondary working hypothesis is that PISF sampling method influences the test accuracy. Fifty implants from 50 patients were evaluated during scheduled follow-up appointments in a clinical setting using the MMP-8 chair-side test and periodontal indices (probing depth, bleeding on probing, plaque index and peri-implant inflammation index). Two methods of PISF sampling were tested. The MMP-8 test demonstrated significant diagnostic capacity and good sensitivity and accuracy regarding indices of bleeding on probing, plaque index, and peri-implant inflammation index but fair agreement. Further studies should be performed to better define the interpretation of the MMP-8 chair-test results and their correlation to peri-implant indexes.

A Comparison of microbial flora in peri-implant sulcular fluid of ball versus locator retained mandibular implant overdentures. A randomized crossover study

Purpose: To evaluate the microbial flora in peri-implant sulcular fluid of edentulous patients rehabilitated with ball and socket and locator retained mandibular 2-implant overdentures.Materials and Methods: 14 edentulous patients were recruited to receive two mandibular implant overdentures and new conventional maxillary complete dentures. Mandibular implant overdentures (MIODs) were retained either by locator or ball attachment systems in random order. After 6 months of function, the attachment systems in the existing dentures were replaced with the other type of attachment. The prevalence of streptococci and staphylococci species (spp.) was analyzedusing blood-agar media at 3, 6 and 9 weeks after pick-up of attachments. The data was then collected, tabulated and statistically analyzed using SPSS. Results: No significant difference was found in bacterial count of either Streptococcus or Staphylococcus spp. between two attachment systems (Ball and socket, Locator) at any of the evaluated time intervals with P-value > 0.05Conclusions: Within the limitations of this study, it can be concluded that there is no difference in microbial flora between the two attachment systems. It can also be suggested that the locator attachments are valid treatment alternative for ball abutments to retain mandibular 2-implant overdentures from a biological point of view.