attomol^® Titanium Peri-Implantitis Realtime TM 2

According to the German Association of Oral Implantologie (DGI), approximately one million dental implants are inserted annually. An increasing number of these are titanium implants. Diseases of the soft and hard tissue around the implant occur more and more frequently in addition to the advantages of the implant for the patient. These include peri-implant mucositis and peri-implantitis. In contrast to mucositis, the latter is an inflammatory reaction of the tissue surrounding the implant. It is accompanied by irreversible bone loss, enlargement of tooth pockets and increased suppuration [1][2], which finally can lead to implant loss. Periimplantitis is caused by a complex interaction of risk factors such as smoking, genetic factors and certain bacteria of the oral flora. The probability of periimplantitis occurring is approximately 13-56 % [3][8], including all risk factors.
A certain form of peri-implantitis is induced by titanium, the material of most of the implants used. The development of titanium-induced peri-implantitis is mainly influenced by genetic factors and hyperactivity of macrophages induced by titanium particles. The genetic factors include polymorphisms in the interleukin 1 (IL-1) genes IL-1A, IL-1B and IL-1RN, which are located on chromosome 2. The polymorphisms -889 (C>T) of IL-1A and +3954 (C>T) (formerly +3953 [4]) of IL-1B trigger an increased production of the proteins IL-1a and IL-1b. In addition, the polymorphism +2018 (T>C) in the IL-1RN gene causes a reduced release of the IL-1 receptor antagonist, reducing its anti-inflammatory effect [5][6]. In the European population the probability of such polymorphisms and the resulting increased risk of dental diseases is approx. 15 %. The detection of the mentioned genetic factors in combination with the titanium stimulation test allows the risk evaluation for titanium induced peri-implantitis before implant placement [7]. In order to estimate the course of the disease and the treatment intervals, it is useful to determine the genetic risk factors. Prophylactic examinations can also be initiated in family members with periodontitis/ periimplantitis [8]. Since trait carriers do not necessarily have to develop the disease, the determination of the genetic polymorphisms cannot be used alone for diagnostics [9].

Prevalence
The prevalence of mutations is around 25 % for IL-1A -889C>T (Caucasians, 26 % globally) and 20 % each for IL-1B +3954C>T and IL-RN +2018T>C (Caucasians, 14 % each globally) [6][10]. The genetic disposition for peri-implantitis is only around 15 %, with the combination of mutations being the main deciding factor [7].

[1] Hamdy A. A. et al.: The effect of interleukin-1 allele 2 genotype (IL-1a (-889) and IL-1b (+3954)) on the individual‘s susceptibility to peri-implantitis: case-control study. J Oral Implantol., 2011, 37(3), 325-34.
[2] Smeets R. et al.: Definition, etiology, prevention and treatment of peri-implantitis - a review. Head & Face Medicine 2014, 10(34), 2-13.
[3] Daubert D et al.: Titanium as a Modifier of the Peri-implant Microbiome Structure. Clin Implant Dent Relat Res., 2018, 20(6): 945-953.
[4] Armitage G.C. et al.: Low prevalence of a periodontitis-associated interleukin-1 composite genotype in individuals of Chinese heritage. J Periodontol., 2000, 71(2), 164-71.
[5] Jacobi-Gresser E. et al.: Genetic and immunological markers predict titanium implant failure: a retro-spective study. Int. J. Oral Maxillofac. Surg., 2013, 42(4), 537-43.
[6] Jacobi-Gresser E.: Titanüberempfindlichkeit oder Titanunverträglichkeit? Wissenschaftliche Fakten und klinische Konsequenzen. Quintessenz 2017, 68(12):1-8.
[7] von Baehr V. et al.: Immunologische Grundlagen der Titan-induzierten Periimplantitis. ZMK Sonderausgabe Implantologie, 2011, 27, 21-26.
[8] Dombrowa S: Wie viel Parodontitis steckt in der Periimplantitis? ZMK, 2019, 6(35), 400-405.
[9] Jin et al.: Association between common polymorphisms in IL-1 and TNFα and risk of peri-implant disease: A meta-analysis. PLoS One, 2021, 16(10):e0258138.
[10] Jacobi-Gresser: Pathogenese der Periimplantitis. Dentale Implantologie, 2018, Jg. 22 Ausgabe 5, 298-305.