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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 444-447  

Assessment of levels of C-reactive proteins and interleukin 6 in patients with peri-implantitis: A Case–Control study


1 Departments of Periodontology and Oral Implantology, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
2 Department of Prosthodontics, Crown and Bridges and Oral Implantology, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab, India
3 Prosthodontist, Private Practitioner, Amritsar, Punjab, India

Date of Submission20-Sep-2020
Date of Decision21-Sep-2020
Date of Acceptance23-Sep-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Ruhani Khichy
Department of Prosthodontics and Crown and Bridge, Baba Jaswant Singh Dental College, Hospital and Research Institute, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_540_20

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   Abstract 


Aim: The present study was undertaken for assessing the C-reactive proteins (CRP) levels and IL-6 levels in patients with peri-implantitis. Materials and Methods: A total of 20 patients with confirmed clinical and radiographic diagnosis of peri-implantitis were included in the present study. Another set of 20 subjects who reported for routine health check-up were included as healthy controls. All the subjects were recalled in the morning and fasting (minimum of 12 h) venous blood samples were obtained. Plain vials were used for collecting the venous blood which was sent to the laboratory for biochemical analysis. In the laboratory, levels of CRP were assessed by means of latex enhanced nephelometric method, and interleukin 6 (IL-6) was assessed by means of Elisa kit. Results: Mean levels of CRPs in patients of the peri-implantitis group and the control group was found to be 0.795 mg/dL and 0.294 mg/dL respectively. Mean IL-6 levels among the patients of the peri-implantitis group and the control group was found to be 12.178 pg/ml and 6.458 pg/ml respectively. While analyzing statistically, significant results were obtained. Conclusion: Enhanced periodontal inflammation in peri-implantitis patients is accompanied by a considerable increase in the concentration of CRPs and IL-6.

Keywords: C-reactive proteins, interleukin, peri-implantitis


How to cite this article:
Khichy A, Khichy R, Singh R, Bali Y, Kaur S, Gill TK. Assessment of levels of C-reactive proteins and interleukin 6 in patients with peri-implantitis: A Case–Control study. J Pharm Bioall Sci 2021;13, Suppl S1:444-7

How to cite this URL:
Khichy A, Khichy R, Singh R, Bali Y, Kaur S, Gill TK. Assessment of levels of C-reactive proteins and interleukin 6 in patients with peri-implantitis: A Case–Control study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jun 19];13, Suppl S1:444-7. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/444/317519




   Introduction Top


Periodontal disease basically is an inflammatory process in itself arousing tissue response in the supporting structures of dentition. Gingivitis is an outcome of microbial plaque accumulation around the tooth surface causing inflammation in the gingival tissues.[1],[2] The branch of dental implantology has shown enormous advancements in past years with the target of providing reasonable osseointegration which would provide efficacious outcome. During the time of initiation of any complication has been disregarded as a few sporadic events. However, with an increase in the cases of peri-implantitis of late, a plethora of steps are being undertaken with the aim of avoiding and preventing any such biological management.[3],[4]

A greater concentration of these mediators of inflammation such as C-reactive protein (CRP), fibrinogen, and cytokines are observed in patients suffering from periodontal diseases. Raised levels of interleukin (IL-6) have been demonstrated by various studies which tend to decrease with suitable periodontal treatment. IL-6 stands out to be the chief pro-coagulant cytokine. Moreover, it also leads to the induction of CRP expression which further stimulates the responses of the pro-coagulants and mediators of inflammation.[5],[6],[7] Hence, we aimed to analyze the CRP levels and IL-6 levels in patients with peri-implantitis.


   Materials and Methods Top


Twenty patients with confirmed clinical and radiographic features of peri-implantitis were enrolled. Another set of 20 subjects who reported for routine health check-up were included as healthy controls. Complete data in relation to clinical and demographic details of all the patients were obtained. A set of full-mouth periapical radiographs was taken in all the subjects. Criteria described previously in the literature (Hashim et al.) were used for confirming peri-implantitis.[8] All the subjects were recalled in the morning and fasting (minimum of 12 h) venous blood samples were obtained. Plain vials were used for collecting the venous blood which was sent to the laboratory for biochemical analysis. In the laboratory, serum CRP levels were evaluated by latex-enhanced nephelometric method, and IL-6 was assessed by means of Elisa kit. SPSS software version 20.0 (IBM, Armonk, New York) was used for analysis.


   Results Top


Twenty patients with peri implantitis and 20 healthy controls were done. Sixty percent of the patients of the peri implantitis group and 55% of the patients of the control group belonged to the age group of more than 40 years as shown in [Table 1]. Mean age of the patients of the peri-implantitis group and the control group was found to be 41.3 years and 39.6 years, respectively. Seventy five percent of the patients of the peri-implantitis group and 65% of the subjects of the control group were males.
Table 1: Demographic data

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Mean CRPs levels among the patients of the peri implantitis group and the control group was found to be 0.795 mg/dL and 0.294 mg/dL respectively as shown in [Table 2]. While analyzing statistically, it was seen that mean CRP levels among the patients of the peri-implantitis group was significantly higher in comparison to the healthy controls. Mean IL 6 levels among the patients of the peri implantitis group and the control group was found to be 12.178 pg/ml and 6.458 pg/ml, respectively as shown in [Table 3]. IL-6 levels were significantly higher in peri-implantitis group.
Table 2: Comparison of C-reactive protein levels (mg/dL)

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Table 3: Comparison of interleukin 6 levels (pg/ml)

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   Discussion Top


Peri-implantitis is basically an inflammatory condition associated with a compounded bacterial attack. However, there are a few conditions where an altered immune response may be responsible for marginal bone loss, and the role of microbial attack may be secondary. This in turn may lead to failure of implant osseointegration due to change in the tissue dynamics from a stable to a more active immune system.[9]

A failed case of a dental implant is more or less attributed to weakening of osseointegration. The criteria for a dental implant to be considered failed cases includes lack of osseointegration, a bone loss around the surface of implant which is more than 1 mm at the culmination of 1 year and 0.2 mm in the following year. Peri-implantitis may lead to failure of implant prosthesis by initiating peri-implant bone loss.[10],[11],[12] Hence; we evaluated the CRP levels and IL-6 levels in patients with peri-implantitis.

In the present study, analysis of a total of 20 patients with peri-implantitis and 20 healthy controls was done. Mean CRPs levels among the patients of the peri-implantitis group and the control group was found to be 0.795 mg/dL and 0.294 mg/dL respectively. While analyzing statistically, it was seen that mean CRP levels among the patients of the peri-implantitis group was significantly higher in comparison to the healthy controls. Vohra et al. did a comparison on the peri-implant parameters of inflammatory mediators in obese people and then correlated them with CRP. A total of 84 patients were included in this study. It was observed that patients who presented with severe obesity had significantly elevated levels of mediators of inflammation as was evident in the diagnostic findings.[13] A positive correlation can be seen in the prevalence of peri-implant disease owing to increasing trends of implant treatments. Peri-implant mucositis can be summed up to be an inflammatory soft-tissue lesion around the implant surface with concomitant marginal bone loss.[14]

In the present study, mean IL-6 levels among the patients of the peri-implantitis group and the control group was found to be 12.178 pg/ml and 6.458 pg/ml respectively. While analyzing statistically, it was seen that mean IL- 6 levels among the patients of the peri-implantitis group was significantly higher in comparison to the healthy controls. CRP is basically an acute-phase reactant which induces the expression of cellular adhesion molecules which results in adhesion of white blood cells to the vascular endothelium. CRP is now drawing a greater interest in researches owing to the risk it poses for cardiovascular events when its concentration is >2.1 mg/l. The hepatic expression of CRP is known to be stimulated by IL-6. CRP directly contributes to atherogenesis due to its effects on the vascular wall. CRP also increases the expression of s CD40 ligand and MCP-1, which further accentuates the expression of cellular adhesion molecules.[15],[16],[17]

A lot of researches in the past have tried to analyze the correlation between the chemical mediators of inflammation and clinical parameters of periodontal disease in gingival crevicular fluid (GCF) samples. Moreover, it was evident that these select biomarkers not only show a definite correlation with the inflammatory process but they also tend to predict periodontal destruction in the times to come.[16],[17],[18] Nowzari and Slots analyzed the values of 6 inflammatory chemical mediators in peri-implant sulcus fluid (PISF) and compared these with the samples of GCF in 24 participants. Furthermore, they also analyzed the composition of microbes in the samples of plaque obtained from teeth and implant surface. They found a similar microbial composition in both the cases. They found a distinctive presentation of inflammatory cytokines in PISF to innate immune response, which was in a greater concentration than in GCF. Statistically significant variation in the cytokine concentration between PISF and GCF samples was seen only with tumor necrosis factor-α.[19]


   Conclusion Top


Enhanced periodontal inflammation in peri-implantitis patients is accompanied by a considerable increase in the concentration of CRPs and IL-6. Further studies are therefore recommended with larger sample size for exploring this field of periodontal and implant surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Korsch M, Obst U, Walther W. Cement-associated peri-implantitis: A retrospective clinical observational study of fixed implant-supported restorations using a methacrylate cement. Clin Oral Implants Res 2014;25:797-802.  Back to cited text no. 1
    
2.
Fransson C, Wennström J, Tomasi C, Berglundh T. Extent of peri-implantitis-associated bone loss. J Clin Periodontol 2009;36:357-63.  Back to cited text no. 2
    
3.
Renvert S, Lessem J, Dahlén G, Lindahl C, Svensson M. Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridment of incipient peri-implant infections: A randomizedclinical trial. J Clin Periodontol 2006;33:362-9.  Back to cited text no. 3
    
4.
Sanz M, Chapple IL. Working Group 4 of the VIII European Workshop on Periodontology Clinical research on peri-implant diseases: Consensus report of Working Group 4. J Clin Periodontol 2012;39 Suppl 12:202-6.  Back to cited text no. 4
    
5.
Berglundh T, Armitage G, Araújo MG, Avila-Ortiz G, Blanco J, Camargo PM, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018;89 Suppl 1:S313-8.  Back to cited text no. 5
    
6.
Fransson C, Tomasi C, Pikner SS, Gröndahl K, Wennström JL, Leyland AH, et al. Severity and pattern of peri-implantitis-associated bone loss. J Clin Periodontol 2010;37:442-8.  Back to cited text no. 6
    
7.
Chen S, Darby I. Dental implants: Maintenance, care and treatment of peri-implant infection. Aust Dent J 2003;48:212-20.  Back to cited text no. 7
    
8.
Hashim D, Cionca N, Combescure C, Mombelli A. The diagnosis of peri-implantitis: A systematic review on the predictive value of bleeding on probing. Clin Oral Implants Res 2018;29 Suppl 16:276-93.  Back to cited text no. 8
    
9.
Nowzari H, Slots J. Microbiologic and clinical study of polytetrafluoroethylene membranes for guided bone regeneration around implants. Int J Oral Maxillofac Implants 1995;10:67-73.  Back to cited text no. 9
    
10.
Al-Nsour MM, Chan HL, Wang HL. Effect of the platform-switching technique on preservation of peri-implant marginal bone: A systematic review. Int J Oral Maxillofac Implants 2012;27:138-45.  Back to cited text no. 10
    
11.
Monje A, Caballe-Serrano J, Nart J, Penarrocha D, Wang HL, Rakić M. Diagnostic accuracy of clinical parameters to monitor peri-implant conditions: A matched case-control study. J Periodontol 2018;89:407-17.  Back to cited text no. 11
    
12.
Ramanauskaite A, Becker K, Schwarz F. Clinical characteristics of peri-implant mucositis and peri-implantitis. Clin Oral Implants Res 2018;29:551-6.  Back to cited text no. 12
    
13.
Vohra F, Alkhudhairy F, Al-Kheraif AA, Akram Z, Javed F. Peri-implant parameters and C-reactive protein levels among patients with different obesity levels. Clin Implant Dent Relat Res 2018;20:130-6.  Back to cited text no. 13
    
14.
Derks J, Tomasi C. Peri-implant health and disease. A systematic review of current epidemiology. J Clin Periodontol 2015;42 Suppl 16:158-71.  Back to cited text no. 14
    
15.
Freitas CO, Gomes-Filho IS, Naves RC, Cruz SS, Santos CA, Barbosa MD. Effect of non-surgical periodontal therapy on the levels of C-reactive protein: A pilot study. Revista Odonto Ciência 2011;26:16-21.  Back to cited text no. 15
    
16.
Haba D, Teslaru S, Ungureanu D, Hodorog D, Alecu C, Benghiac AG, et al. Evaluation of serum and gingival crevicular fluid C-reactive protein and IL-6 levels in patients with periodontitis and transient ischemic attacks. Rom J Morphol Embryol 2011;52:1243-7.  Back to cited text no. 16
    
17.
Pirim Gorgun E, Toker H, Korkmaz EM, Poyraz O. IL-6 and IL-10 gene polymorphisms in patients with aggressive periodontitis: Effects on GCF, serum and clinic parameters. Braz Oral Res 2017;31:e12.  Back to cited text no. 17
    
18.
Mallapragada S, Kasana J, Agrawal P. Effect of nonsurgical periodontal therapy on serum highly sensitive capsule reactive protein and homocysteine levels in chronic periodontitis: A pilot study. Contemp Clin Dent 2017;8:279-85.  Back to cited text no. 18
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19.
Nowzari H, Phamduong S, Botero JE, Villacres MC, Rich SK. The profile of inflammatory cytokines in gingival crevicular fluid around healthy osseointegrated implants. Clin Implant Dent Relat Res 2012;14:546-52.  Back to cited text no. 19
    



 
 
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