The Metabolic syndrome (MetS) is defined as a spectrum of conditions associated with an increased risk of developing cardiovascular disease and type II diabetes.
Prevalence of periodontal disease in patients affected by MetS is considered almost double: peri-implantitis and periodontitis share similarities in pathogenic mechanisms and clinical features, however, its relationship with MetS was never investigated.
Peri-implantitis has been defined as a chronic inflammatory lesion, characterized by peri-implant bone loss, bleeding at probing and suppuration. Is considered sensitive to factors inducing tissue inflammation and systemic oxidative stress and up-regulation of inflammatory cytokines were hypothesized as a possible cause of reduced insulin sensitivity, a key aspect in MetS development.
The purpose of this cross-sectional survey is to evaluate possible relationship between MetS and peri-implant diseases.
The specific aims of this project will be to:
¿ Evaluate clinical and radiographic parameters of dental implants
¿ evaluate microbiological samples from peri-implant sulcus (PIS)
¿ evaluate antibiotic resistance among peri-implant bacteria
¿ investigate the molecular content of peri-implant crevicular fluid (PICF)
The authors will develop and implement a cross-sectional study: consecutive patients affected by metabolic syndrome will be screened to evaluate presence of dental implants with at least 5 years of functional loading.
A bidirectional relationship between peri-implant diseases and metabolic syndrome may be speculated, similar to the one already been reported in literature for periodontal disease.
The project will last 18 months: between M1-M12 recruitment will be carried out and patients will be screened, the first milestone will be reached at conclusion of the enrollment phase (120 patients).
Between M12-M18 microbiological and immunological analysis will be performed and results evaluated.
The European population is getting older, with an increasing concern about oral health, a condition that has made dental implants the most requested treatment among dentists. Schimmel et al. in 2017 concluded that placement of dental implants in elderly patients has become routine practice and clinicians should carefully take into account coexisting systemic risk factors.
Patients report usually, in their medical history, several comorbidities, with the most common being cardiovascular disease (CVD) and hypertension, diabetes mellitus and hyperglycaemia, osteoporosis and consequent assumption of anti-resorptive medications, dyslipidaemia and temporomandibular disorders.
In this scenario, peri-implantitis represent an emerging disease in dentistry: current treatment strategies had proven to be insufficient and with a low success rate, research in the field is expensive and industries have focused their financial resources in prevention.
In 2016 Khoshkam et al., in a systematic review, concluded that "There is limited evidence in the literature reporting long-term results of the regenerative approach for treating peri-implantitis. [...] regenerative treatment of peri-implantitis resulted in a mean radiographic defect fill of 2.41 mm"
The use of antibiotics is widespread among dentists for peri-implantitis patients: it is conducted without a proper scientific evidence, mostly according to an empirical case by case basis.
This practice could lead to an increase of antibiotic resistance among patients, with effects particularly severe in the elderly population.
Only Rams et al. in 2014 conducted a study on the antibiotic resitance of the human peri-implantitis microbioma, however their work showed major limitations with regards to peri-implantitis diagnosis and sample collection.
Patients were referred to their university from different private practice centers among US and no clinical or radiographic calibrated evaluations were performed, furthermore no information on patients¿ medical status was available, including past antibiotics use or history of periodontitis.
In our study setting, all patients will be screened and evaluated by the same calibrated and expert operators, with the appliance of a uniform case definition of peri-implant diseases.
Furthermore, our study will be the first to conduct this kind of clinical and microbiological analysis in metabolic syndrome patients, aiming to better understand how this condition can influence peri-implant health.
Systemic oxidative stress together with up-regulation of inflammatory cytokines and presence of Gram-negative anaerobes such as Porphyromonas gingivalis, Prevotella intermedia and Aggregatibacter actinomycetemcomitans could be an exacerbating factor for peri-implant diseases.
Understanding bacterial and inflammatory activity may help us to target appropriate antibiotics for every patient, contributing to increment the low success rate of currently adopted peri-implantitis treatment strategies.
Furthermore, understanding the existing relationship between peri-implant diseases and metabolic syndrome could lead to a more conscious approach while treating these patients.