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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 383-386  

Assessment of titanium level in submucosal plaque around healthy implants and implants with peri-implantitis: A clinical study


1 Reader and HOD of Public Health Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Prosthodontics and Crown and Bridge, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
3 Dental Surgeon, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India
4 Department of Preventive and Restorative Dentistry, College of Dental Medicine, Sharjah, United Arab Emirates
5 Department of Dentistry, Patna Medical College and Hospital, Patna, Bihar, India
6 Department of Periodontology, Dr. HSRSM Dental College and Hospital, Hingoli, Maharashtra, India

Date of Submission08-Dec-2020
Date of Decision08-Dec-2020
Date of Acceptance09-Dec-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Juzer Rasul
Department of Public Health Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_815_20

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   Abstract 


Background: The present study focused on assessing the level of titanium in submucosal plaque in the peri-implant area with peri-implantitis in comparison to healthy implants. Methodology: Sixty patients with titanium dental implants were recruited. The degree of titanium in submucosal plaque around peri-implantitis and healthy implants was estimated using inductively coupled plasma mass spectrometry. Results: The mean ± standard deviation probing depth in Group I was 3.12 ± 1.1 and in Group II was 7.2 ± 2.5; gingival index was 0.64 ± 0.3 and 1.64 ± 0.8 in Group I and Group II, respectively. The plaque index was 0.82 ± 0.2 in Group I and 1.5 ± 0.6 in Group II. The mean plaque mass in Group I was 24.1 ± 3.8 ng/ul and 49.3 ± 6.4 ng/ul in Group II. The mean titanium level in Group I was 0.08 ± 0.02 μg and in Group II was 0.91 ± 0.04 μg. A highly significant difference between both groups was found (P < 0.05). Conclusion: There was a significantly higher titanium level in submucosal plaque around dental implants with signs of peri-implantitis as compared to healthy dental implants.

Keywords: Dental implants, peri-implantitis, submucosal plaque


How to cite this article:
Rasul J, Thakur MK, Maheshwari B, Aga N, Kumar H, Mahajani M. Assessment of titanium level in submucosal plaque around healthy implants and implants with peri-implantitis: A clinical study. J Pharm Bioall Sci 2021;13, Suppl S1:383-6

How to cite this URL:
Rasul J, Thakur MK, Maheshwari B, Aga N, Kumar H, Mahajani M. Assessment of titanium level in submucosal plaque around healthy implants and implants with peri-implantitis: A clinical study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jun 20];13, Suppl S1:383-6. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/383/317704




   Introduction Top


Dental implants have revolutionarized the field of dentistry.[1] Earlier before the advent of dental implants, dentists rely on removable partial denture (RPD), fixed partial denture (FPD), or complete denture for the replacement of missing few or multiple teeth.[2] With the invention of dental implants, the limitation offer by FPD or RPD in the form of sensitivity caused by tooth preparation or cervical abrasion or mobility of adjacent teeth has been minimized.[3] Titanium dental implants have the ability to unite with the bone through structural and functional connections. Titanium dental implants offer excellent osseointegration, i.e., its ability to unite with the bone. One of the requirements of an ideal dental implant is its capability to resist corrosion.[4] Titanium leads to the development of titanium dioxide (TiO2) which is highly resistant to corrosion. It is one of the best biocompatible metals. Although it has superior properties of resistance to corrosion, a complete prevention cannot be ensured in the oral cavity.[5]

There is an alteration in the titanium implant due to the dissolution of titanium from the TiO2 layer. Factors such as increase in the level of caries causing bacteria such as Streptococcus mutans leads to the formation of lactic acid in the oral cavity, peri-implant tissues inflammation, etc.[6] It has been observed that there is a significantly higher concentration of S. mutans around implants with peri-implantitis in comparison to healthy teeth.[7] Considering this, the present study focused on assessing the level of titanium in submucosal plaque around implants with peri-implantitis as compared to healthy implants.


   Methodology Top


The present case–control study was commenced after obtaining ethical clearance from the ethical clearance and review committee of the institute. The sixty enrolled subjects from the periodontics department were made aware of the study and their utilities and after convincing them, written consent for their participation in the study was obtained.

The following inclusion criteria such as the presence of atleast one healthy plus one implant with signs of peri-implantitis and presence of prosthetic part for atleast since 3 years was considered. Subjects with systemic illness, on long-standing steroids and antibiotics for the last 3 months were excluded. A thorough oral examination with assessment of gingival index, plaque index, and bleeding on probing and/or suppuration at six sites was done. Subjects with the occurrence of probing depths ≥5 mm, bleeding on probing and/or suppuration, and bone loss ≥2 mm were considered to have peri-implantitis. Collection of baseline and follow-up radiographs was done for assessment of bone loss. Healthy implants showed no signs of suppuration and clinical and radiographic bone loss. Two groups were formed based on the presence of healthy (Group I) and peri-implantitis implants (Group II).

Each implant site was curetted with mini-five 1–2 Gracey curettes for the collection of submucosal plaques. Samples thus obtained were stored in 500 μl sterile water in screw-cap tubes and frozen at the temperature of −-0°C. A 350 μl aliquot of the sample collected was used for quantification of titanium by inductively coupled plasma mass spectrometry (ICP-MS). DNA isolation and DNA quantification were performed with 150 μl aliquot to validate the amount of plaque in each sample. Data thus found from the above said methods were clubbed together and entered in MS Excel sheet and assessed statistically using Fisher's exact test and Mann–Whitney U test. A significance level was set below 0.05.


   Results Top


[Table 1] shows that there were 16 males and 14 females in Group I and 12 males and 18 females in Group II. The mean age was 45.6 years in Group I and 42.3 years in Group II. The mean duration of dental implants in the oral cavity was 5.6 years in Group I and 5.2 years in Group II. The difference was found to be nonsignificant (P > 0.05).
Table 1: Distribution of implants

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[Table 2] and [Graph 1] show that mean ± standard deviation (SD) probing depth in Group I was 3.12 ± 1.1 and in Group II was 7.2 ± 2.5; gingival index was 0.64 ± 0.3 and 1.64 ± 0.8 in Group I and Group II, respectively. The plaque index was 0.82 ± 0.2 in Group I and 1.5 ± 0.6 in Group II. A significant difference among parameters was found (P < 0.05).
Table 2: Assessment of parameters

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[Table 3] and [Graph 2] show that the mean plaque mass in Group I was 24.1 ± 3.8 ng/ul and 49.3 ± 6.4 ng/ul in Group II. A highly significant difference between both groups was found (P < 0.05).
Table 3: Assessment of plaque mass in both groups

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[Table 4] and [Graph 3] show that the mean titanium level in Group I was 0.08 ± 0.02 μg and in Group II was 0.91 ± 0.04 μg. A highly significant difference between both groups was found (P < 0.05).
Table 4: Assessment of titanium level in both groups

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   Discussion Top


Dental implants are one of the highly opted and recommended dental treatments for partially or completely edentulous patients.[8] It is the treatment of choice among patients as well as dentists. The increased use is because of high success rate as compared to FPD and RPD. Titanium dental implants have maximum strength, chemical stability, wear resistance, and excellent fatigue.[9] Due to the formation of 3–5 nm thick oxide layer on titanium implants, it has higher corrosion resistance. 47Ti and 49Ti in the prevalence of 7.3% and 5.5%, respectively, may be used for quantification with ICP-MS without having problems with chromium, calcium, and vanadium isotopes.[10] It is evident that porphyromonas gingivalis has high tendency for attachment to corroded titanium implants. It is further ascertained that the electrical conductivity of titanium in the occurrence of oral bacteria provides a closed circuit that may enhance the biocorrosive process.[11] The present study assessed the level of titanium in submucosal plaque around implants with peri-implantitis as compared to healthy implants.

In this study, we enrolled 60 patients with the presence of healthy as well as dental implants with the clinically and radiographically presence of signs of peri-implantitis. Both sites were mentioned as Group I (healthy implants) and Group II (dental implants with peri-implantitis). We found that the mean age in Group I and in Group II was 45.6 years and 42.3 years, respectively. The mean duration of dental implants in the oral cavity was 5.6 years in Group I and 5.2 years in Group II. Group I comprised of 16 males and 14 females; Group II had 12 males and 18 females. Safioti et al.[12] conducted a study on 30 patients in which submucosal plaque from 20 implants with peri-implantitis and 20 healthy implants was collected and subjected to coupled plasma mass spectrometry (ICP-MS) to determine levels of titanium. Implants with peri-implantitis revealed mean titanium levels of 0.85 ± 2.47 and those with healthy implants showed 0.07 ± 0.19 which was significantly higher (P < 0.05).

We observed that mean ± SD probing depth in Group I was 3.12 ± 1.1 and in Group II was 7.2 ± 2.5; gingival index was 0.64 ± 0.3 and 1.64 ± 0.8 in Group I and Group II, respectively. The plaque index was 0.82 ± 0.2 in Group I and 1.5 ± 0.6 in Group II. Pettersson et al.[13] conducted an in vivo animal study on digs and evaluated the quantity of titanium discharged around the bone during placement of implants with different surface structures using ICP atomic emission spectroscopy. Implant surface was observed with scanning electron microscopy (SEM), before and after the insertion into the bone. Ti was grounded to the surrounding bone on the placement of a dental implant and the surface roughness of the implant augmented the quantity of Ti observed. Diameter and total implant area were of less significance for the Ti discharged to the bone. No remarkable damage to the implant surfaces could be observed in SEM after insertion.

We found that the mean plaque mass in Group I was 24.1 ± 3.8 ng/ul and 49.3 ± 6.4 ng/ul in Group II. The mean titanium level in Group I was 0.08 ± 0.02 μg and in Group II was 0.91 ± 0.04 μg. Olmedo et al.[14] found a higher concentration of titanium in the peri-implantitis patients in comparison to healthy implants as determined by exfoliative cytology. Senna et al.[15] observed detectable fractures and chipping of the porous structure at the TiUnite surface with the help of scanning electron microscope (SEM) on both inspected surfaces, but in a much increased content on the TiU surfaces.

The shortcoming of the study was small sample size. A short follow-up was done.


   Conclusion Top


The authors found that there was a significantly higher titanium level in submucosal plaque around dental implants with signs of peri-implantitis as compared to healthy dental implants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Liu X, Chu P, Ding C. Surface modification of titanium, titanium alloys, and related materials for biomedical applications. Mater Sci Eng R Rep 2004;47:49-121.  Back to cited text no. 1
    
2.
Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416.  Back to cited text no. 2
    
3.
Brånemark PI, Hansson BO, Adell R, Breine U, Lindström J, Hallén O, et al. Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 1977;16:1-32.  Back to cited text no. 3
    
4.
Kasemo B. Biocompatibility of titanium implants: Surface science aspects. J Prosthet Dent 1983;49:832-7.  Back to cited text no. 4
    
5.
Niinomi M. Recent research and development in titanium alloys for biomedical applications and healthcare goods. Sci Technol Adv Mat 2003;4:445-54.  Back to cited text no. 5
    
6.
Mouhyi J, Dohan Ehrenfest DM, Albrektsson T. The peri-implantitis: Implant surfaces, microstructure, and physicochemical aspects. Clin Implant Dent Relat Res 2012;14:170-83.  Back to cited text no. 6
    
7.
Souza JC, Ponthiaux P, Henriques M, Oliveira R, Teughels W, Celis JP, et al. Corrosion behaviour of titanium in the presence of Streptococcus mutans. J Dent 2013;41:528-34.  Back to cited text no. 7
    
8.
Persson GR, Samuelsson E, Lindahl C, Renvert S. Mechanical non-surgical treatment of peri-implantitis: A single-blinded randomized longitudinal clinical study. II. Microbiological results. J Clin Periodontol 2010;37:563-73.  Back to cited text no. 8
    
9.
Cheng Y, Hu J, Zhang C, Wang Z, Hao Y, Gao B. Corrosion behavior of novel Ti-24Nb-4Zr-7.9Sn alloy for dental implant applications in vitro. J Biomed Mater Res B Appl Biomater 2013;101:287-94.  Back to cited text no. 9
    
10.
Barão VA, Yoon CJ, Mathew MT, Yuan JC, Wu CD, Sukotjo C. Attachment of Porphyromonas gingivalis to corroded commercially pure titanium and titanium-aluminum-vanadium alloy. J Periodontol 2014;85:1275-82.  Back to cited text no. 10
    
11.
Pozhitkov AE, Daubert D, Brochwicz Donimirski A, Goodgion D, Vagin MY, Leroux BG, et al. Interruption of electrical conductivity of titanium dental implants suggests a path towards elimination of corrosion. PLoS One 2015;10:e0140393.  Back to cited text no. 11
    
12.
Safioti LM, Kotsakis GA, Pozhitkov AE, Chung WO, Daubert DM. Increased levels of dissolved titanium are associated with peri-implantitis – A cross-sectional study. J Periodontol 2017;88:436-42.  Back to cited text no. 12
    
13.
Pettersson M, Pettersson J, Molin Thorén M, Johansson A. Release of titanium after insertion of dental implants with different surface characteristics – An ex vivo animal study. Acta Biomater Odontol Scand 2017;3:63-73.  Back to cited text no. 13
    
14.
Olmedo DG, Nalli G, Verdú S, Paparella ML, Cabrini RL. Exfoliative cytology and titanium dental implants: A pilot study. J Periodontol 2013;84:78-83.  Back to cited text no. 14
    
15.
Senna P, Antoninha Del Bel Cury A, Kates S, Meirelles L. Surface damage on dental implants with release of loose particles after insertion into bone. Clin Implant Dent Relat Res 2015;17:681-92.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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