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 [Hamdy AA, Ebrahem MA, 2011, J Oral Implantol., 37(3), 325-34.; Smeets R et al., 2014, Head & Face Medicine, 10(34), 2-13], which finally can lead to implant loss. Peri-implantitis is caused by a complex interaction of risk factors such as smoking, genetic factors and certain bacteria of the oral flora. The probability of peri-implantitis occurring is approximately 10 % [Mombelli A, Lang NP, 2000, Periodontol. 1998, 17, 63-76], 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 [Armitage GC et al., 2000, J Periodontol., 71(2), 164-71]) 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 [Jacobi-Gresser et al., 2013, Int. J. Oral Maxillofac. Surg., 42(4), 537-43; Jacobi-Gresser, 2017,  Quintessenz 2017 , 68(12):1-8]. 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 [von Baehr V, Schütt S, 2011, ZMK Sonderausgabe Implantologie, 27, 21-26].