Molecular tools for preventing and improving diagnosis of peri‐implant diseases

Abstract

Web: www.carin ci.org | INTRODUC TI ONPeri-implant mucositis and peri-implantitis are inflammatory diseases around dental implants that involve infectious agents and destructive immune responses. Current diagnosis in implantology is based on clinical and radiological observations (Figures 1,2). Molecular tests may augment the clinical and radiological examinations. 1,2 A molecular test can potentially provide an early diagnosis, tailor therapy, check treatment, customize clinical recalls and improve patient compliance.The initial evaluation of a prospective implant patient includes radiographic analysis to assess the status of hard tissues.Microbiological tests may also be warranted to evaluate the type and load of microbial pathogens. Microbial samples can be collected by paper points and then shipped to a laboratory, which can issue a laboratory report in a few days ( Figure 3). Treatment planning including oral hygiene instruction and more complex treatment approaches is then implemented (Figure 4). If surgery is scheduled, a second microbiological test might help determine the efficacy of the pre-surgical oral hygiene measures. Posttreatment, testing might be helpful to determine the efficacy of patient home care in order to refine a customized recall program.To become a valuable tool in daily practice, molecular tests must be easy and rapid to perform, and should provide in a reasonably short time laboratory results that would be readily understood (possibly also by the patient) and relatively inexpensive. Generally, two types of test exist: a screening test, such as a pregnancy test (that is performed by the patient and includes one biomarker) and a laboratory test (that is performed by dental professionals using a standardized sampling protocol to investigate several biomarkers). The laboratory test usually follows the screening test. In medicine and specifically in gynecology, the screening test is usually performed at home and may possibly be evaluated by a specialist, who may request additional tests with specific biomarkers. Dental professionals may perform molecular/microbiological tests in a similar matter to ameliorate the diagnosis and treatment of peri-implant mucositis and peri-implantitis.Molecular tests are best used for treatment planning and for designing a preventive program rather than for rescue operations. 1,2 | INFEC TI ON FAC TOR SIt is commonly accepted that bacteria are major initiators of periimplant mucositis and peri-implantitis as well as of periodontal diseases. It is also well known that periodontitis patients have a higher risk of peri-implant mucositis and peri-implantitis than edentulous subjects. 3,4 Although substantial differences exist in terms of anatomy and physiology between the implant mucosa/bone interface and the periodontium, the bacterial profiles 5,6 and the host immune responses may be quite similar in peri-implantitis and periodontitis. 7The early aim of researchers was to detect bacterial quality and quantity differences between peri-implant mucositis and peri...

Biomarker levels in peri‐implant crevicular fluid of healthy implants, untreated and non‐surgically treated implants with peri‐implantitis

“…Objective methods to differentiate between peri‐implant health and disease, and to evaluate the effect of therapeutic intervention are lacking since traditional clinical diagnostic methods, such as pocket probing, bleeding on probing and radiographic assessment, exert a weak sensitivity/specificity (Heitz‐Mayfield, 2008; Hashim et al, 2018, Alassy et al 2019). It is thought that immunological host‐derived molecules, such as cytokines, chemokines, proteolytic and tissue breakdown enzymes, could serve as adjunctive parameters to ameliorate the diagnosis, prediction and management of peri‐implant disease (Ramseier et al, 2009; Sexton et al, 2011; Syndergaard et al, 2014; Kinney et al, 2014; Carinci et al, 2019).…”

“…exert a weak sensitivity/specificity (Heitz-Mayfield, 2008;Hashim et al, 2018, Alassy et al 2019. It is thought that immunological hostderived molecules, such as cytokines, chemokines, proteolytic and tissue breakdown enzymes, could serve as adjunctive parameters to ameliorate the diagnosis, prediction and management of peri-implant disease (Ramseier et al, 2009;Sexton et al, 2011;Syndergaard et al, 2014;Kinney et al, 2014;Carinci et al, 2019).…”

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

“…Salivary/oral fluid biomarkers such as active matrix metalloproteinase-8 (aMMP-8) are becoming increasingly useful in the rapid diagnosis of periodontitis and dental peri-implantitis as documented in several studies [1][2][3]. Proteolytic enzymes capable of degrading connective tissue, as well as their activators and inhibitors, have been a natural target to identify promising candidates causing loss of attachment in both periodontitis and peri-implantitis.…”

“…Recently, Sorsa et al [6] especially implicated the oral mouthrinse aMMP-8 as the needed biomarker for the latest periodontitis classification system [4]. Such oral fluid biomarkers are now commercially available as quantitative point-of-care (PoC) kits for periodontitis and dental peri-implantitis [1][2][3]. Examples regarding aMMP-8 are the quantitative reader equipped oral fluid (mouthrinse, gingival crevicular fluid (GCF), and peri-implant sulcular fluid (PISF)) aMMP-8 lateral-flow chairside/PoC tests (PerioSafe and ImplantSafe with ORALyzer kits) [7], which have been successfully demonstrated in numerous studies globally [6][7][8][9][10][11][12].…”

Concepts for prevention of complications in implant therapy

“…Diagnostic tests to identify and diagnose early peri‐implant diseases have been introduced in the literature. Such tests have been presented by Carinci et al in the present volume of Periodontology 2000 .…”