Hypertension is a major public health concern, considered the most prevalent among cardiovascular diseases, main cause of mortality and/or disability.
Over last years, the ultrasonic assessment of carotid intima-media thickness (c-IMT) has been used as a reliable, non-invasive diagnostic tool to evaluate presence of atherosclerosis and as a predictor of future CV events.
Based on the latest joint workshop of the European Federation of Periodontology and the World Heart Federation, there is a significant association between periodontal disease and cardiovascular diseases. The association between periodontitis and systemic conditions, such as diabetes, dyslipidaemia, hypertension and CVDs is well known, on the contrary, only a few authors have investigated the possible relationship between peri-implant diseases and systemic diseases.
The aims of this cross-sectional study are to report data on the possible association between IMT values and plaque presence and periodontitis and peri-implant diseases in hypertensive patients.
We designed a cross-sectional study, to conduct at the "Dpt of Translational and Precision Medicine" and "Dpt of Oral and Maxillo-Facial Sciences", "Sapienza" University of Rome, consecutively enrolling hypertensive patients, with at least one osseointegrated implant functioning for >5 years.
Each patient receives detailed descriptions of the study protocol, signing the inform consent form and give written approval to be included in the study population, according to the latest version of the World Medical Declaration of Helsinki (2013).
We consider: anamnestic evaluation, anthropometric and biochemical measurements, 24-hours ABPM, Carotid Doppler scan, screening for Metabolic Syndrome (MetS), Periodontal examination for definition of periodontitis [by computed Periodontal Screening and Recording (PSR), digital periapical x-rays, calibrated software].
Based on the latest joint workshop of the European Federation of Periodontology (EFP) and the World Heart Federation (WHF), there is a significant association between periodontal disease and cardiovascular diseases (CVDs). Periodontitis is a chronic non-communicable inflammatory disease originated by an overwhelming bacterial insult and the subsequent host immune response, with a spontaneous progression, affecting almost 40% of adults in the US. Periodontitis and Peri-implantitis share similarities in aetiology and pathological mechanisms, however their relationship is still unclear. According to the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, peri-implantitis is a plaque-related inflammatory condition characterized by progressive bone loss. Peri-implant diseases are incredibly diffused: around 25% of dental implants are affected by peri-implantitis and 42% by mucositis. The association between periodontitis and systemic conditions, such as diabetes, dyslipidaemia, hypertension and CVDs is well known, on the contrary, only a few authors have investigated the possible relationship between peri-implant diseases and other chronic systemic conditions. In a pivotal study, our Research Group has previously highlighted for the first time, in a cross-sectional study the greater prevalence of peri-implant diseases in patients affected by Metabolic Syndrome. This cross-sectional study would be the first to report data on the possible association between intima-media thickness (IMT) values and plaque presence in patients with peri-implant diseases. Furthermore, major strengths of study would be the coordinated working, availability of complete clinical and laboratory data together with full periodontal charts and x-rays of patients enrolled.
Understanding the possible role of peri-implant diseases as a cardiovascular risk factor is of primary importance and could lead to full treatment of these patients. Demonstrating that patients with peri-implant diseases show higher IMT values and plaque presence, together with greater systemic inflammatory parameters, could help us to obtain a better knowledge on the role of peri-implant inflammation as a stimulus for atherosclerosis and endothelial dysfunction.
The correlation between systemic inflammatory parameters and gingival inflammation around dental implants might influence prevention of cardiovascular events. If these entities are correlated, treating peri-implantitis and reducing gingival inflammation could lead to a reduction of cardiovascular and metabolic risk factors, an effect previously demonstrated for periodontal therapy. Closing this gap of knowledge could potentially impact a large part of the population of Europe and the US, where the prevalence of Metabolic syndrome is around 40% and almost 2.800.000 dental implants are placed per year.
References
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