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      An Unexplored Pharmacologic/Diagnostic Strategy for Peri-Implantitis: A Protocol Proposal


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          Dental implants are widely utilized for the replacement of missing teeth and are increasingly being placed in patients with systemic diseases, as well as in those who are medically healthy. Furthermore, it is recognized that peri-implant mucositis and peri-implantitis are highly prevalent, affecting large numbers of patients with implants, and it is pertinent to consider whether there may be any systemic impact of these conditions, given that there are known links between periodontitis and a number of chronic inflammatory diseases. In this article, we propose that the potential systemic complications of peri-implant diseases should be investigated in future clinical research, together with studies to identify whether systemically-administered host modulation therapies (HMTs) may be of benefit in the treatment of peri-implant diseases. These “HMTs” may prove a useful adjunct to routinely employed debridement and disinfection protocols, as well as potentially being of benefit in reducing risks of systemic complications. We also consider the use of chair-side diagnostic tests for active matrix metalloproteinase-8 (aMMP-8) in the detection of peri-implant disease given the ability of such tests to detect active tissue breakdown associated with peri-implantitis and periodontitis before conventional clinical and radiographic measurements indicate pathologic changes. These novel diagnostic and therapeutic strategies are relevant to consider as they may improve the management of peri-implant disease (beyond local debridement procedures), especially in those patients in whom systemic inflammation might be of concern.

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          Most cited references 39

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          Staging and grading of periodontitis: Framework and proposal of a new classification and case definition.

          Authors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state-of-the-art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance.
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            Analysis of matrix metalloproteinases, especially MMP-8, in gingival creviclular fluid, mouthrinse and saliva for monitoring periodontal diseases.

            Matrix metalloproteinase-8 is a promising candidate biomarker for oral fluid (gingival crevicular fluid, peri-implant sulcular fluid and saliva) and mouthrinse chair-side/point-of-care diagnostics to predict, diagnose and determine the progressive phases of episodic periodontitis and peri-implantitis, as well as to monitor the treatments and medications. Matrix metalloproteinase-8 can be used alone or together with interleukin-1beta and Porphyromonas gingivalis to calculate cumulative risk score at the subject level as a successful diagnostic tool, especially in large-scale public health surveys, in which a thorough periodontal examination is not feasible.
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              To develop preventive strategies addressing peri-implant diseases, a thorough understanding of the epidemiology is required.

                Author and article information

                Diagnostics (Basel)
                Diagnostics (Basel)
                05 December 2020
                December 2020
                : 10
                : 12
                [1 ]Department of Oral Biology and Pathology, School of Dental Medicine, Health Sciences Center, Stony Brook University, Stony Brook, NY 11794, USA; Lorne.Golub@ 123456stonybrookmedicine.edu
                [2 ]Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki and Helsinki University Hospital, PO Box 63 (Haartmaninkatu 8), FI-00014 Helsinki, Finland; timo.sorsa@ 123456helsinki.fi
                [3 ]Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
                [4 ]National University Centre for Oral Health, Faculty of Dentistry, National University of Singapore, Singapore 119077, Singapore; philip.preshaw@ 123456nus.edu.sg
                [5 ]School of Dental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
                Author notes
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).



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