Is the personalized approach the key to improve clinical diagnosis of peri‐implant conditions? The role of bone markers

Abstract

BackgroundStudy objectives were 1) to estimate diagnostic capacity of clinical parameters, receptor activator of nuclear factor kappa‐B (RANKL) and osteoprotegerin (OPG) to diagnose healthy peri‐implant condition (HI), peri‐implant mucositis (PIM) and peri‐implantitis (PIMP) by assessing respective diagnostic accuracy, sensitivity, specificity and diagnostic ranges 2) to develop personalized diagnostic model (PDM) for implant monitoring.MethodsSplit‐mouth study included 126 patients and 252 implants (HI = 126, PIM = 57, and PIMP = 69). RANKL and OPG concentrations were estimated in peri‐implant crevicular fluid using enzyme‐linked immunosorbent assay method and assessed with clinical parameters using routine statistics, while the diagnostic capacity of individual parameters and overall clinical diagnosis were estimated using classifying algorithms. PDM was developed using decision trees.ResultsBleeding on probing (BOP), plaque index, and probing depth (PD) were confirmed reliable discriminants between peri‐implant health and disease, while increase in PD (PD > 4 mm) and suppuration were good discriminants amongst PIM/PIMP. Bone turnover markers (BTMs) demonstrated presence of bone resorption in PIM; between comparable diagnostic ranges PIM/PIMP, PIMP was clinically distinguished from PIM in about 60% of patients while 40% remained diagnosed as false negatives. PDM demonstrated highest diagnostic capacity (accuracy: 96.27%, sensitivity: 95.00%, specificity: 100%) and defined HI: BOP ≤0.25%; PIM: BOP >0.25%, PD ≤4.5 mm; PIMP: BOP >0.25%, PD >4.5 mm and RANKL ≤19.9 pg/site; PIM: BOP >0.25%, PD >4.5 mm, and RANKL >19.9 pg/site.ConclusionsBTMs demonstrated capacity to substantially improve clinical diagnosis of peri‐implant conditions. Considering lack of difference in BTMs between PIM/PIMP and cluster of PIM with exceeding BTMs, a more refined definition of peri‐implant conditions according to biological characteristics is required for further BTMs validation and appropriate PIMP management.

Clinical retrospective study of dental implant removal: do patients who require implant removal desire implant prosthesis again?

“…Peri-implantitis has been described as a pathological condition that occurs in functionally loaded tissues that surround dental implants and is characterized by mucosal inflammation and progressive marginal bone loss ( 15 ). The clinical features of peri-implantitis are enlarged periodontal pockets and bleeding from probing ( 16 ). It has been reported that blade-type implants are encapsulated with fibrous tissue, which has been proposed as a determinant of implantation failure due to the micromotion induced in the implant by the prosthesis ( 17 ).…”

Microbial and host‐derived biomarker changes during ligature‐induced and spontaneous peri‐implantitis in the Beagle dog

“…Hence, in spite of the conflicting data that have evidenced the morphological and immunophenotypical differences between peri‐implantitis and periodontitis, the former has shown to be more severe in inflammatory infiltrate 7 . In this sense, peri‐implantitis has demonstrated an increase in bone turnover markers, pro‐inflammatory cytokines, such as tumor necrosis factor or interleukin‐1, and proteinases, considered as valid and accurate molecules to monitor peri‐implant disorders 8‐10 …”

“…7 In this sense, peri-implantitis has demonstrated an increase in bone turnover markers, pro-inflammatory cytokines, such as tumor necrosis factor or interleukin-1, and proteinases, considered as valid and accurate molecules to monitor peri-implant disorders. [8][9][10] Therefore, the purpose of the present preclinical in vivo study was to assess the colonization and shifts in microbiota and host-derived biomarkers in the course of ligature-induced and spontaneous progression of peri-implantitis in dogs.…”

New Advances On Biomaterials for Regenerative and Reparative Treatment Following Periodontal and Peri-implant Diseases

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Recent data show that the correct management of periodontitis and peri-implantitis represents a potential challenge in the health system [1,2]. Periodontal disease and peri-implantitis are multifactorial diseases with infectious aetiology which, following an important immune response of the host [3,4], culminating in the progressive loss of supporting tissues, alveolar bone and finally determine the loss of the tooth or of the implant [5] and that affect patients' quality of life [6 -8]. However, in addition to these conditions, the morphostructural alteration of the stomatognathic system's hard and soft tissues can be determined by teeth extraction, trauma, prosthetic restorations [9] oral tumors, and pathological conditions such as severe dental or skeletal malocclusions [10,11].

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“…Recently, efforts have been made in recent years to predictably stimulate true bone regeneration of periodontal tissues by introducing bioactive models or constructing patientspecific bone substitutes or growth factors [5,35].…”