Underdiagnosis in Background of Emerging Public Health Challenges Related to Peri-Implant Diseases: An Interventional Split-Mouth Study

Abstract

Peri-implant diseases are an emerging public health problem, and it's considered that limitations of standard diagnostics play the role herein. The study objective was the estimation of pathological bone resorption at clinical and biological level in patients with peri-implant mucositis (PIM) and peri-implantitis (PI) before and 6 months after standard treatment and to compare them with healthy controls (HC). The split-mouth interventional study included 60 patients affected with PIM or PI. Patients that also presented at least one more HC were enrolled in the study and underwent standard non-surgical and surgical treatment, respectively. Standard clinical parameters and soluble levels of RANKL were measured in peri-implant crevicular fluid baseline and 6 months following treatment. Clinical parameters and RANKL significantly decreased following treatment in PIM and PI. However, bleeding on probing and probing depth remained significantly increased when compared to HC. RANKL answered requests for biomarker of peri-implant diseases, its baseline levels were significantly increased in PIM and PI, they decreased following treatment and reached HC in peri-implantitis, while in PIM RANKL remained significantly increased. Presence of pathological bone resorption in patients lacked its clinical signs, and respective persistence following treatment suggest the need for biomarker-supported diagnosis for timely diagnosis of peri-implantitis and appropriate orientation of respective management strategies.

Keywords: biomarker; bone loss; early diagnosis; peri-implant diseases; peri-implant mucositis; peri-implantitis; precision medicine; public health; treatment.

Figure 1

Graphical scheme of the study design.

Figure 2

Diagnostic capacity of RANKL for diagnosis of peri-implant diseases. RANKL concentrations were significantly increased in peri-implant mucositis and peri-implantitis when compared to healthy controls, while there was no significant difference between two peri-implant diseases. Based on estimated diagnostic performance, RANKL answered request for diagnostic marker of peri-implant diseases. PI-mucositis-peri-implant mucositis; *-p < 0.05; diagnostics performance values are expressed as mean % and standard deviation.

Figure 3

RANKL levels in response to standard treatment of peri-implant mucositis and peri-implantitis. RANKL concentration decreased following treatment in both groups, but respective concentration remained significantly increased in PIM. The boxplots of biomarker estimates are plotted at median values (lines), with respective confidence interval and standard deviations, while the mean values are expressed with markers (x) as well. *-significantly higher compared to post-treatment, p < 0.05; #-significantly higher compared to healthy control, p < 0.05.