Microbiota and crevicular fluid collagenase activity in the osseointegrated dental implant sulcus: A comparison of sites in edentulous and partially edentulous patients

Abstract

The soft tissues adjacent to osseointegrated dental implants (OII) were investigated using clinical, biochemical and microbiological methods. Tooth and implant crevices were compared in 15 partially edentulous patients, examining 28 peri-implant and 19 periodontal sites, and in 6 edentulous patients, examining 13 implant sites. Sites were classified by standard periodontal indices; the crevicular fluid flow determined; crevicular fluid was collected for collagenase assays; and the subgingival bacterial flora was examined and cultured. Differences in clinical parameters were noted in that implants had significantly less keratinized gingiva and deeper probing depths. Crevicular fluid was present in the OII sulcus but the crevicular fluid flow did not differ from that observed from tooth sites either in the partially edentulous or edentulous patients. Tissue collagenase activity and collagenase inhibitor were detected in the implant crevicular fluid and, as in periodontal sites, a strong inverse relationship was found between the levels of active collagenase and collagenase inhibitor. Microbiology included darkfield microscopy, anaerobic culturing for total colony forming unit counts and identification of black pigmented Bacteroides (BPB). Few differences were observed between implants and teeth in partially edentulous patients, indicating that crevices around teeth may act as reservoirs of bacteria which can colonize implant sites. A higher percentage of BPBs and wet spreaders (Capnocytophaga) was noted at partially edentulous implant sites when compared with edentulous implant sites, perhaps reflecting the lower numbers of periodontal pathogens present in edentulous mouths. Overall, the characteristics of implant sulci appear to be similar to periodontal sulci with respect to crevicular fluid flow and microflora.

Analysis of the presence of pathogens which predict the risk of disease at peri-implant sites through polymerase chain reaction (PCR)

“…With this purpose, Gromatzky, Sendyk 15 (2002) established a modern protocol seeking to preserve osseointegration. The absence of relationship amongst the presence of pathogens, clinical signs of severe inflammation and history of periodontitis, observed in this research, contradicts reports of several authors 2,8,13,14,16,20,22,27 and the following considerations try to explain that discrepancy:…”

“…PCR is also reproducible and relatively easy to execute as well as particularly valuable in the detection of non-cultivable organisms or those that are difficult to be distinguished in the cultivation 4,28 . The peri-implant sites of patients with periodontitis can present high concentrations of pathogens in the periodontal pockets 2,10,19,30 . Therefore, periodontal lesions considered irreversible can determine the indication of extraction of unhealthy teeth to avoid infection of future peri-implant sites 8 .…”

“…We should consider that pathogens are usually found at a proportion lower than 1.0% (supplemental microbiota) in healthy sites 9 where they are controlled by the host's defense 2,9 . Likewise, the observation of pathogens at peri-implant sites does not necessarily mean failure of the implant 18 .…”

Dental Implant Tissue Interface - An Appraisal

“…However it has been noted that quality of tissue at the perimucosal region has little effect on the clinical indices. Lack of keratinized gingiva around implants did not result in higher gingival and bleeding indices or increased pocket depths (19). Parallel running supracrestal connective tissue fibres splice with circumferentially oriented fibres resulting in the formation of a mechanical cuff which provides an effective structural and functional seal.…”

Debridement Effect on Periodontal Pathogen <i>Porphyromonas gingivalis</i> Cultured on Titanium by Application of Atmospheric-Pressure Plasma

“…Studies have shown similarities in the microflora from implant or tooth sites [12] [13] [14] [15]. High levels of periodontopathic bacteria including Porphyromonas gingivalis are said to be one of the major etiologic factors in human periodontitis [16] [17].…”