Clinical effects of stannous fluoride dentifrice on peri-implant mucositis, plaque microbiome, and oxidative stress

Abstract

Purpose: This single-center, single-treatment, 4-week study evaluated the efficacy of a stannous fluoride (SnF₂) dentifrice in reducing peri-implant mucositis while assessing changes in biomarkers and the oral microbiome profile.

Methods: 24 healthy participants 18 years of age or older with osseointegrated implants were included, with 19 participants having mucositis and five without mucositis. The non-mucositis participants served as a reference group for microbiome and biomarker assessments (baseline comparison). All participants used the same 0.454% SnF₂ dentifrice (Crest Pro-Health Sensitive and Enamel Shield) and a soft manual toothbrush twice daily throughout the study. Participants received Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI) assessments at Baseline - Day 1 and at Week 4 - Day 1. Subgingival plaque and peri-implant crevicular fluid (PICF) were collected on Baseline - Day 2 and Week 4 - Day 2 for oxidative stress markers, bacterial endotoxins, proinflammatory cytokines and 16S analysis.

Results: After 4 weeks, participants with mucositis experienced a significant reduction from baseline in MGI and GBI scores (63.4% and 79.3%, respectively) and in the number of bleeding sites (72.5% based on GBI analysis). Microbiome analysis of subgingival plaque showed that mucositis was associated with a higher relative abundance of disease-associated genera (Fusobacterium, Porphyromonas, Treponema, and Prevotella) and a lower relative abundance of commensal genera (Rothia and Actinomyces). Alpha diversity was higher in the mucositis group compared to the non-mucositis group at baseline. By Week 4, the profile of participants with mucositis had shifted to align more closely with that of non-mucositis participants. Participants with mucositis showed significant reduction in biomarkers related to bacterial insult, plaque virulence, oxidative stress, and inflammation. Simulated pathway and process analysis revealed that multiple categories of genes were associated with a state of mucositis, and 4 weeks of use of the experimental dentifrice downregulated several virulence-associated genes.

Clinical significance: In participants with mucositis, use of a SnF₂ dentifrice for 4 weeks reduced clinical signs and key biomarkers of peri-implant inflammation and shifted the oral microbiome toward a healthier profile, highlighting the utility of SnF₂ dentifrice in the control of peri-implant mucositis.