Student Theses, Dissertations and Capstones

Document Type

Thesis - NSU Access Only

Degree Name

Master of Science (M.S.) in Dentistry

Copyright Statement

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Department

College of Dental Medicine

First Advisor

Saynur Vardar

Date of original Performance / Presentation

January 2021

Publication Date / Copyright Date

1-1-2021

Abstract

Introduction: There are currently an estimated 3 million Americans with dental implants, and 500,000 more are getting implants every year. Unfortunately, the growing number of dental implants placed also means growing numbers of peri-implant diseases. Recent estimations show as many as 80% of all dental implant patients have peri-implant mucositis and as many as 56% have peri-implantitis. Despite the high prevalence of implant disease, there is currently no “gold-standard” treatment for peri-implantitis. Probiotic therapy represents a potential adjunctive treatment for peri-implantitis: while probiotics have long been a topic of interest in medicine for their therapeutic effects on certain gastrointestinal diseases, they are now being examined for their effect on the oral cavity. However, probiotics and their effect on dental implants remains an emerging topic of research; there are few studies to date that have investigated probiotics and peri-implant mucositis, and fewer still that have investigated probiotics and peri-implantitis. The goals of this study were to examine the clinical and inflammatory effects of oral probiotics when used as an adjunct to non-surgical debridement in treating peri-implantitis lesions by evaluating clinical changes as well as levels of pro-inflammatory cytokines (including the DAMP, HSP90) in the peri-implant crevicular fluid over a 6 month period. This study aims to shed some light on not only how oral probiotic therapy may be modulating the host immune response, but how it may also provide a mechanism for an additional, non-plaque induced pathway in the pathogenesis of peri-implantitis. Methods: A double-blind, randomized, controlled trial was conducted in patients with a minimum of one peri-implantitis lesion. Patients were given either a placebo (control group n=2) or orally administered probiotic tablets (test group n=7) as an adjunct to non-surgical treatment of peri-implantitis lesions for 90 days. The probiotics contained strains of S. salivarius K12, S. salivarius M18, L. reuteri and L. paracasei while the control group were given placebos fabricated to have the same taste and appearance as the test probiotics. Clinical measurements (probing depth, modified sulcular bleeding index, modified plaque index, clinical attachment level, and gingival index) were taken and either gingival crevicular fluid (GCF) or peri-implant crevicular fluid (PICF) was sampled from peri-implant, periodontitis, and healthy sites at baseline (day 0) and at day 30, 60, and 90. Following the cessation of probiotic therapy, the same measurements were taken at day 120, 150, and 180 (6-months). The GCF/PICF was then analyzed using a multiplex Luminex assay to evaluate levels of HSP60, IL-1β, IL-10, IL-17A, IL-6, MMP-9, RANKL, and TNF-α. Due to the limitations of the study, meaningful statistical analysis was unable to be done between probiotic and placebo groups. However, non-parametric analysis using the Kruskal-Wallis and Steel Dwass tests were done to compare healthy, periodontitis, and peri-implantitis sites within the probiotic group, and Friedman and Bonferroni tests were done to compare baseline, 90 days, and 180 days within the probiotic group. Results: In this small sample size pilot study, orally administered probiotics applied as an adjunct to non-surgical peri-implantitis therapy did not reach statistical significance on clinical parameters or measured inflammatory markers in GICF/PICF at all time points. However, clear trends were noted in which pro-inflammatory markers HSP60, IL-17A, IL-6, MMP-9, RANKL, and TNF-α were decreased throughout the study in peri-implantitis lesions in comparison to healthy or periodontitis lesions at 6-months. Interestingly, a more pronounced decrease was noted in the 6-months following cessation of probiotic usage as compared to the initial 3 months of active probiotic usage. On the other hand, pro-inflammatory marker IL-1β seemed to increase and anti-inflammatory IL-10 seemed to decrease in the 6-months in peri-implantitis lesions. Conclusions: Despite the limitations of this study, the findings suggest that adjunctive use of oral probiotics appeared to have limited effect on clinical parameters. However, a general trend toward decreased pro-inflammatory markers was noted during active probiotic treatment.

Disciplines

Dentistry

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