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

Abstract

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.

An Unexplored Pharmacologic/Diagnostic Strategy for Peri-Implantitis: A Protocol Proposal

“…However, such studies are likely to advance our profession's management of peri-implant disease (beyond local and bleeding on probing (BOP) to discriminate peri-implantitis from healthy dental implant (26 peri-implant and 26 healthy dental implant patients). aMMP-8 PoC test and selected potential biomarkers were assessed as described previously [31]. This figure has been constructed by authors ITR and TS based on the same study group as described in Lähteenmäki et al and further extends their results [31].…”

“…Given the importance of MMP-8, and more specifically aMMP-8 in the pathogenesis of periodontal diseases, more recently, chair-side tests (government-approved in Europe) have been developed that can measure aMMP-8 levels in PISF, GCF and mouthrinse, and have been validated in studies conducted in the USA, Africa, and Europe [26][27][28][29][30][31]. Its advantage, beyond traditional diagnostic procedures (e.g., bleeding on probing, pocket depth), is enhanced diagnostic sensitivity and specificity, including the ability to predictively detect peri-implantitis and periodontitis before clinical and radiographic measurements indicate pathologic changes [26][27][28][29][30][31]. Further studies are required to investigate the utility of this test in different patient populations, such as smokers and non-smokers, given that GCF and serum MMP-8 levels are known to vary between smokers and non-smokers [24,32].…”

“…Similarly, aMMP-8 reference ranges can be proposed for grading peri-implantitis patients and their risk of disease progression. Based on a recent study by Lähteenmäki et al [31], a cut-off of 20 ng/mL for aMMP-8 levels measured in PISF by ImplantSafe®chair-side/point-of-care aMMP-8 test identified all 26 peri-implantitis patients and 26 healthy dental implant controls correctly. Furthermore, the aMMP-8 chair-side test was more accurate than other potential biomarkers such as neutrophil elastase, myeloperoxidase, pro and active forms of MMP-9 and bleeding on probing [31].…”

“…Based on a recent study by Lähteenmäki et al [31], a cut-off of 20 ng/mL for aMMP-8 levels measured in PISF by ImplantSafe®chair-side/point-of-care aMMP-8 test identified all 26 peri-implantitis patients and 26 healthy dental implant controls correctly. Furthermore, the aMMP-8 chair-side test was more accurate than other potential biomarkers such as neutrophil elastase, myeloperoxidase, pro and active forms of MMP-9 and bleeding on probing [31]. With the same study group, we have investigated this further and found that the aMMP-8 chair-side test was also more accurate than calprotectin and gelatinases (25-50 kDa, 95-150 kDa, over 150 kDa and total gelatinolytic activity) (see Figure 1).…”

“…With the same study group, we have investigated this further and found that the aMMP-8 chair-side test was also more accurate than calprotectin and gelatinases (25-50 kDa, 95-150 kDa, over 150 kDa and total gelatinolytic activity) (see Figure 1). Thus, based on the current evidence, grading the risk of periodontal and peri-implant disease progression by utilizing aMMP-8 can be summarized: low aMMP-8 levels are associated with periodontal and peri-implant health and low risk of disease progression, while elevated levels indicate elevated risk of periodontitis and peri-implantitis and their progression (Table 1) [26][27][28][29][30][31]33]. It should be noted that the ImplantSafe®and PerioSafe®lateral flow immunotests utilize the same antibody for aMMP-8 measurements [25,29,33], because different antibodies with differing sensitivities and specificities to target MMP-8 isotypes can give significantly different aMMP-8 results.…”