Titanium particles in peri-implantitis: distribution, pathogenesis and prospects / 国际口腔科学杂志·英文版

Peri-implantitis is one of the most important biological complications in the field of oral implantology. Identifying the causative factors of peri-implant inflammation and osteolysis is crucial for the disease's prevention and treatment. The underlying risk factors and detailed pathogenesis of peri-implantitis remain to be elucidated. Titanium-based implants as the most widely used implant inevitably release titanium particles into the surrounding tissue. Notably, the concentration of titanium particles increases significantly at peri-implantitis sites, suggesting titanium particles as a potential risk factor for the condition. Previous studies have indicated that titanium particles can induce peripheral osteolysis and foster the development of aseptic osteoarthritis in orthopedic joint replacement. However, it remains unconfirmed whether this phenomenon also triggers inflammation and bone resorption in peri-implant tissues. This review summarizes the distribution of titanium particles around the implant, the potential roles in peri-implantitis and the prevalent prevention strategies, which expects to provide new directions for the study of the pathogenesis and treatment of peri-implantitis.

Comparison of three methods for establishing rat peri-implantitis model / 北京大学学报(医学版)

OBJECTIVE@#To compare the efficiency and effect of establishing rat peri-implantitis model by traditional cotton thread ligation and local injection of Porphyromonas gingivalis lipopolysaccharide (LPS) around the implant, as well as the combination of the two methods.@*METHODS@#Left side maxillary first molars of 39 male SD rats were extracted, and titanium implants were implanted after four weeks of healing. After 4 weeks of implant osseointegration, 39 rats were randomly divided into 4 groups. Cotton thread ligation (n=12), local injection of LPS around the implant (n=12), and the two methods combined (n=12) were used to induce peri-implantitis, the rest 3 rats were untreated as control group. All procedures were conducted under 5% isoflurane inhalation anesthesia. The rats were sacrificed 2 weeks and 4 weeks after induction through carbon dioxide asphyxiation method. The maxilla of the rats in the test groups were collected and marginal bone loss was observed by micro-CT. The gingival tissues around the implants were collected for further real time quantitative PCR (RT-qPCR) analysis, specifically the expression of tumor necrosis factor-alpha (TNF-α) as well as interleukin-1β (IL-1β). The probing depth (PD), bleeding on probing (BOP) and gingival index (GI) of each rat in the experimental group were recorded before induction of inflammation and before death.@*RESULTS@#After 4 weeks of implantation, the osseointegration of implants were confirmed. All the three test groups showed red and swollen gums, obvious marginal bone loss around implants. After 2 weeks and 4 weeks of inflammation induction, PD, GI and BOP of the three test groups increased compared with those before induction, but only BOP was statistically significant among the three test groups (P < 0.05). At the end of 2 weeks of inflammation induction, marginal bone loss was observed at each site in the cotton thread ligation group and the combined group. At each site, the bone resorption in the combined group was greater than that in the cotton thread ligation group, but the difference was not statistically significant (P > 0.05), bone resorption was observed at some sites of some implants in LPS local injection group. At the end of 4 weeks of inflammation induction, marginal bone loss was observed at all sites in each group. The marginal bone loss in the cotton thread ligation group and the combined group was greater than that in the LPS local injection group, and the difference was statistically significant (P < 0.05). At the end of 2 weeks and 4 weeks of induction, the expression of TNF-α and IL-1β in the test groups were higher than those in the control group (P < 0.05).@*CONCLUSION@#Compared with local injection of LPS around the implant, cotton thread ligature and the two methods combined can induce peri-implantitis in rats better and faster.

Collagen quantification in peri-implant soft tissues in human peri-implantitis lesions / Cuantificación de colágeno en tejidos blandos periimplantarios en lesiones de periimplantitis en humanos

SUMMARY: Peri-implantitis is an inflammatory lesion of bacterial etiology characterized by inflammation of the mucosa and bone loss. Chronic inflammation is characterized by neovascularization and collagen neoformation. Mast cells have been shown to participate in the inflammatory process by releasing mediators and proteases such as chymase and tryptase, important in the collagen neoformation process. Although a higher percentage of collagen has been described in periodontal disease, the literature is scarce about the percentage of collagen in peri-implantitis. The aim of this study was to quantify the percentage of collagen fibers present in the peri- implant soft tissue of patients with peri-implantitis lesions. A descriptive observational cross-sectional study was performed. Samples of peri-implant soft tissue were collected from eleven patients with peri-implantitis and then processed by Masson's Trichrome Technique. In microscopic analysis, collagen fibers were observed in all samples, with an average percentage of 39.89 %, standard deviation of 17.02 %, with a minimum value of 8.99 % and a maximum value of 75.65 % density. From these results, it can be concluded that in human peri-implantitis lesions with bone loss greater than 50 %, there is an important percentage of collagen fibers, which is interpreted as connective tissue in a permanent process of reparative response, in the presence of inflammatory infiltrate.

RESUMEN: La periimplantitis es una lesión inflamatoria de etiología bacteriana caracterizada por inflamación de la mucosa y pérdida ósea. La inflamación crónica se caracteriza por neovascularización y neoformación de colágeno. Se ha demostrado que los mastocitos participan en el proceso inflamatorio liberando mediadores y proteasas como quimasa y triptasa, importantes en el proceso de neoformación del colágeno. Aunque se ha descrito un mayor porcentaje de colágeno en la enfermedad periodontal, la literatura sobre el porcentaje de colágeno en la periimplantitis es escasa. El objetivo de este estudio fue cuantificar el porcentaje de fibras de colágeno presentes en el tejido blando periimplantario de pacientes con lesiones de periimplantitis. Se realizó un estudio observacional descriptivo transversal. Se recogieron muestras de tejido blando periimplantario de once pacientes con periimplantitis y luego se procesaron mediante la técnica tricrómica de Masson. En el análisis microscópico, se observaron fibras de colágeno en todas las muestras, con un porcentaje promedio de 39,89 %, desviación estándar de 17,02%, con un valor mínimo de 8,99 % y un valor máximo de 75,65% de densidad. De estos resultados se puede concluir que en las lesiones de periimplantitis humana con pérdida ósea superior al 50 %, existe un porcentaje importante de fibras de colágeno, que se interpreta como tejido conectivo en un proceso permanente de respuesta reparadora, en presencia de infiltrado inflamatorio.

Quantification of pro-inflammatory cytokines and osteoclastogenesis markers in successful and failed orthodontic mini-implants

Abstract Objectives: Miniscrew has been frequently used, considering that anchorage control is a critical point in orthodontic treatment, and its failure, the main adverse problem. Using two groups of stable (successful) and unstable (failed) mini-implants, this in vivo study aimed to quantify proinflammatory cytokines IL-1 α, IL-6, IL-17, and TNF-α and osteoclastogenesis marker RANK, RANKL, and OPG in gingival tissue, using the real-time polymerase chain reaction technique. Methodology: Thirteen patients of both sexes (11-49 years old) under orthodontic treatment were selected, obtaining 11 successful and 7 failed mini-implants. The mini-implants were placed and removed by the same surgeon, in both jaws. The mean time of permanence in the mouth was 29.4 months for successful and 7.6 months for failed mini-implants. At removal time, peri-mini-implant gingival tissue samples were collected and processed for quantification of the proinflammatory cytokines and osteoclastogenesis markers. Nonparametric Wilcoxon rank-sum test considering the clusters and Kruskal-Wallis test were used for statistical analysis (α=0.05). Results: No significant difference (p>0.05) was observed between the groups for either quantification of cytokines or osteoclastogenesis markers, except for IL-6 (p<0.05). Conclusions: It may be concluded that the expression of IL-1α, IL-17, TNF-α, RANK, RANKL, and OPG in peri-implant gingival tissue were not determinant for mini-implant stability loss, but the higher IL-6 expression could be associated with mini-implant failure.

Utilização de aparelho sônico na remoção de cálculo em implantes osseointegrados - Caso clínico / Use of ultrasonic device for the removal of calculus in osseointegrated implants - Case report

A completa remoção do cálculo dental, que retêm bactérias na sua superfície, é essencial para o controle da inflamação periodontal incluindo a periimplantite. Contudo, o manejo do cálculo dental é diferente nos dentes naturais e nos implantes. Naqueles, a estruturado tecido duro (cemento e dentina) é muito favorável à remoção completa do cálculo. Não obstante, nos implantes, a estrutura de titânio é desenhada com superfícies metálicas com roscas e uma geometria favorável ao alojamento e adesão do cálculo dificultando suaremoção e agindo como fator etiológico predisponente. Existem vários métodos de remoção do cálculo nos implantes, desde curetas de plástico e titânio, aparelhos de ultrassom até a ação de raios laser. Neste trabalho apresenta-se um caso clínico onde a remoção de cálculo em implantes foi realizada mediante utilização de aparelho sônico.

The complete removal of dental calculus, which retains bacteria in its surface, is essential for controlling periodontal inflammation including perimplantitis. However, the management of dental calculus is different in natural teeth and dental implants. The structure of hardtissue (radicular cementum and dentine) presents in natural teeth is more favorable to the complete removal of dental calculus. Nevertheless in cases of dental implants, the structure of titanium is drawn on metallic surfaces with threads and a geometry that is favorable to the lodging and adhesion of calculus, difficulting calculus removal and actingas a predisponent etiological factor. There are several methods of calculus removal of dental implants, such as plastic curettes, ultrasonic devices and laser. The present study has shown a clinical case of calculus removal in osseointegrated dental implants performed by using a sonic device.