Evaluation of the Effect of Periimplant Soft Tissue Phenotype on Marginal Bone Loss

Evaluation of the Effect of Periimplant Soft Tissue Phenotype on Marginal Bone Loss Using Biochemical Approach

The goal of this clinical trial to test the effect of periimplant soft tissue phenotype in the participants with implant placed and at least 1 year after implant loading. The main questions it aims to answer are:

1. Is keratinized mucosal thickness (KMT) important in early marginal bone loss and peri implant health?
2. Is keratinized gingival width (KGW) important in early marginal bone loss and and peri implant health? The researchers plan to include 80 implants in the study. These 80 implants will be divided into 2 groups in 2 different ways according to their KMT and KGW on their buccal surfaces: KMT ≥2 mm are included in the adequate KMT, and those with KMT<2 mm are in the insufficient KMT group. Those with KGW≥2 mm are adequate KGW, those with KGW<2 mm are adequate KGW. The researchers will assess marginal bone loss around the implant using radiographs and collect peri-implant crevicular fluid (PICF) using paper strips. Another researchers will measure the Receptor Activator Of Nuclear Factor-Kappa B Ligand (RANKL), Osteoprotegerin (OPG), Tumor Necrosis Factor Alpha (TNF-α), MicroRNA-223 (MiRNA-223), MicroRNA-27a (MiRNA-27a) levels in the collected PICF. They will compare radiographic bone loss and biomarker levels in groups.

Study Overview

• Status: Completed
• Conditions: Dental Implant; Alveolar Bone Loss; Periimplantitis
• Intervention / Treatment: Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; Diagnostic test: Osteoprotegerin (OPG) analysis; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; Diagnostic test: MicroRNA-223 analysis; Diagnostic test: Microrna-27a analysis

Detailed Description

Early marginal bone loss around the implant can be caused by various reasons. Keratinized mucosal thickness (KMT) and keratinized gingival width (KGW) are components of periimplant soft tissue. Recently, KGW and KMT in the peri-implant region have been investigated as possible factors influencing this phenomenon.

The hypothesis of this study: Periimplant soft tissue phenotype is associated with marginal bone loss and peri implant health through Receptor Activator Of Nuclear Factor-Kappa B Ligand (RANKL), Osteoprotegerin (OPG), Tumor Necrosis Factor Alpha (TNF-α), MicroRNA-223 (MiRNA-223) and Microrna-27a 80 implants, at least 1 year after their loading, in patients who continued their routine controls will be included in the study. The participants in this study were selected from patients who underwent implant placement by the same periodontologist (E.Ö.) in the Department of Periodontology of Necmettin Erbakan University in 2020 and still have 6-month radiographic and clinical follow-up. Selected patients, those who signed the written informed consent form were included in the study. In the study, the first radiographs of all patients, the clinical and radiographic conditions obtained at the 6-month routine control examination will be evaluated. During the same routine controls, a sample of peri-implant groove fluid was taken with paper strips.

Diagnoses of the implants included in the study will be made using the criteria of the 2017 World Workshop on Periodontal and Peri-implant Diseases and Conditions. 2 mm marginal bone loss (MBL) which may occur during the bone remodeling process after implant placement and loading, is accepted as the threshold. The absence of signs of inflammation (redness, swelling, bleeding on probing) in the peri-implant soft tissue, probing depth (PD) ≤5 mm with mild force (approximately 0.25 N), and no further bone loss following initial healing are defined as "periimplant health". "Peri-implant mucositis" is defined as clinically observable signs of inflammation (swelling, redness and soft consistency of tissue), bleeding on probing (BOP) (lines or drops) and/or signs of suppuration in the absence of bone loss greater than 2 mm, the threshold for initial bone remodulation defined. The definition of "peri-implantitis" is clinically observable signs of inflammation, probing bleeding and/or suppuration, increased probing depth, progressive bone loss after implant restoration, or MBL ≥3 mm with profuse bleeding in the absence of initial radiographs and PD was ≥6 mm. Implants with periimplantitis will be excluded. Implants will be divided into 2 groups according to their peri-implant health: Peri-implant health and peri-implant mucositis.

In addition to routine clinical and radiographic examination of the implants, KMT and KGW measurements will be made. they will be divided into 2 groups in 2 ways. According to KMT on their buccal surfaces: KMT ≥2 mm are included in the adequate KMT, and those with KMT <2 mm are in the inadequate KMT group (60). According to KGW on their buccal surfaces: KGW≥2 mm are adequate KGW, those with KGW<2 mm are inadequate KGW.

Radiographic evaluation will be made using intraoral periapical radiographs obtained using the parallel technique with the plastic film holder. Calibration of digital images will be performed using the length of the implant as a well-defined fixed reference point. The bone level measurement will be made by measuring between the bone-implant first contact point and the reference point in the coronal part of the implant body selected for different implant systems in both the mesial and distal directions of the implants. In order to evaluate the marginal bone loss (MBL), the measurements obtained will be compared with the measurements on the radiographs taken after the delivery of the prosthesis.

Peri-implant crevicular fluid (PIGF) will be collected from the participants for the biochemical evaluation to be made. PIGF specimens will be collected from the mesiobuccal of each implant, prior to any periodontal probing, and after removal of the supra mucosal plate. The area to be sampled will be insulated with cotton rolls and air-dried. The paper will be advanced with the strip until it shows slight resistance and held in the sample area for 30 seconds. Samples will be stored at -70˚C.

TNF-α, RANKL, OPG and MiRNA 223 and MiRNA 27a evaluations of the peri-implant crevicular fluid (PIGF) collected from the patients will be performed. TNF-α, RANKL and OPG will be evaluated by the Enzyme-Linked ImmunoSorbent Assay (ELISA) method. MiRNA 223 and MiRNA 27a evaluations will be performed using Real-Time Polymerase Chain Reaction (RT-PCR).

Marginal bone loss and biomarker levels will be compared between the groups.

• Study Type: Observational
• Enrollment (Actual): 87

Contacts and Locations

• Study Contact: Name: zeynep taştan eroğlu; Phone Number: 00905065857095; Email: dt.zeyneptastan@gmail.com

Study Locations

• Turkey
  • Konya, Turkey
    • Necmettin Erbakan University, dentistry Faculty

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The participants will be selected from among the patients whose implant placement was performed by the same periodontologist (E.Ö) at Necmettin Erbakan University, Department of Periodontology between 2020 and whose radiographic and clinical follow-up is still ongoing for 6 months. Of each selected study patient, those who signed the written informed consent form and met the inclusion and exclusion criteria will be included in the study.

80 implants in approximately 40 patients are planned to be included in the trial.

Description

Inclusion Criteria:

• Have at least one fixed restoration on a titanium dental implant in the mouth
• Over-implant restoration, functioning for at least 12 months
• Attending our preventive care regularly (≥1/year)
• Non-smokers

Exclusion Criteria:

• Receiving head or neck radiation in the last 6 months
• Bisphosphonate users
• Those who have received antibiotic treatment in the last 3 months
• Patients with diabetes mellitus (hemoglobin A1c ≥7.0) that may affect the outcome of implant therapy
• implants with peri-implantitis
• Pregnant or breastfeeding mothers
• Those with metabolic bone disorders
• Those who have a history of periodontitis and have undergone any periodontal treatment in the last year
• Those whose implant positions are not suitable
• Implants using soft or hard tissue grafts before, during, or after implant placement
• Those with a restoration that did not allow accurate probing depth recording were excluded from the study.

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Retrospective

Number of groups / cohorts

6

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Adequate KMT; Keratinized mucosal thicknesses (KMT) on their buccal surfaces are 2 mm and above.	Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; samples of peri-implant groove fluid will be taken with paper strips and RANKL assessment will be made; Diagnostic test: Osteoprotegerin (OPG) analysis; samples of peri-implant groove fluid will be taken with paper strips and OPG assessment will be made; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; samples of peri-implant groove fluid will be taken with paper strips and TNF-α assessment will be made; Diagnostic test: MicroRNA-223 analysis; samples of peri-implant groove fluid will be taken with paper strips and MicroRNA-223 assessment will be made; Diagnostic test: Microrna-27a analysis; samples of peri-implant groove fluid will be taken with paper strips and Microrna-27a assessment will be made
inadequate KMT; Keratinized mucosal thicknesses (KMT) on their buccal surfaces are less than 2 mm.	Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; samples of peri-implant groove fluid will be taken with paper strips and RANKL assessment will be made; Diagnostic test: Osteoprotegerin (OPG) analysis; samples of peri-implant groove fluid will be taken with paper strips and OPG assessment will be made; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; samples of peri-implant groove fluid will be taken with paper strips and TNF-α assessment will be made; Diagnostic test: MicroRNA-223 analysis; samples of peri-implant groove fluid will be taken with paper strips and MicroRNA-223 assessment will be made; Diagnostic test: Microrna-27a analysis; samples of peri-implant groove fluid will be taken with paper strips and Microrna-27a assessment will be made
adequate KGW; keratinized gingival width (KGW) on their buccal surfaces are 2 mm and above.	Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; samples of peri-implant groove fluid will be taken with paper strips and RANKL assessment will be made; Diagnostic test: Osteoprotegerin (OPG) analysis; samples of peri-implant groove fluid will be taken with paper strips and OPG assessment will be made; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; samples of peri-implant groove fluid will be taken with paper strips and TNF-α assessment will be made; Diagnostic test: MicroRNA-223 analysis; samples of peri-implant groove fluid will be taken with paper strips and MicroRNA-223 assessment will be made; Diagnostic test: Microrna-27a analysis; samples of peri-implant groove fluid will be taken with paper strips and Microrna-27a assessment will be made
inadequate KGW; keratinized gingival width (KGW) on their buccal surfaces are less than 2 mm.	Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; samples of peri-implant groove fluid will be taken with paper strips and RANKL assessment will be made; Diagnostic test: Osteoprotegerin (OPG) analysis; samples of peri-implant groove fluid will be taken with paper strips and OPG assessment will be made; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; samples of peri-implant groove fluid will be taken with paper strips and TNF-α assessment will be made; Diagnostic test: MicroRNA-223 analysis; samples of peri-implant groove fluid will be taken with paper strips and MicroRNA-223 assessment will be made; Diagnostic test: Microrna-27a analysis; samples of peri-implant groove fluid will be taken with paper strips and Microrna-27a assessment will be made
Peri-implant health; The absence of signs of inflammation (redness, swelling, bleeding on probing) in the peri-implant soft tissue, probing depth (PD) ≤5 mm with mild force (approximately 0.25 N), and no further bone loss following initial healing are defined as "peri-implant health".	Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; samples of peri-implant groove fluid will be taken with paper strips and RANKL assessment will be made; Diagnostic test: Osteoprotegerin (OPG) analysis; samples of peri-implant groove fluid will be taken with paper strips and OPG assessment will be made; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; samples of peri-implant groove fluid will be taken with paper strips and TNF-α assessment will be made; Diagnostic test: MicroRNA-223 analysis; samples of peri-implant groove fluid will be taken with paper strips and MicroRNA-223 assessment will be made; Diagnostic test: Microrna-27a analysis; samples of peri-implant groove fluid will be taken with paper strips and Microrna-27a assessment will be made
peri-implant mucositis; "Peri-implant mucositis" is defined as clinically observable signs of inflammation (swelling, redness and soft consistency of tissue), bleeding on probing (lines or drops) and/or signs of suppuration in the absence of bone loss greater than 2 mm, the threshold for initial bone remodulation.	Diagnostic test: Nuclear Factor-Kappa B Ligand (RANKL) analysis; samples of peri-implant groove fluid will be taken with paper strips and RANKL assessment will be made; Diagnostic test: Osteoprotegerin (OPG) analysis; samples of peri-implant groove fluid will be taken with paper strips and OPG assessment will be made; Diagnostic test: Tumor Necrosis Factor Alpha (TNF-α) analysis; samples of peri-implant groove fluid will be taken with paper strips and TNF-α assessment will be made; Diagnostic test: MicroRNA-223 analysis; samples of peri-implant groove fluid will be taken with paper strips and MicroRNA-223 assessment will be made; Diagnostic test: Microrna-27a analysis; samples of peri-implant groove fluid will be taken with paper strips and Microrna-27a assessment will be made

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparison of alveolar bone loss between adequate Keratinized mucosal thickness (KMT) and inadequate KMT groups	The bone level measurement will be made by measuring between the bone-implant first contact point and the reference point in the coronal part of the implant body selected for different implant systems in both the mesial and distal directions of the implants. In order to evaluate the marginal bone loss (MBL), the measurements obtained will be compared with the measurements on the radiographs taken after the delivery of the prosthesis.	It will be done at the start of the study, immediately after the control radiograph is taken.
Comparison of alveolar bone loss between between adequate keratinized gingival width (KGW) and inadequate KGW groups	The bone level measurement will be made by measuring between the bone-implant first contact point and the reference point in the coronal part of the implant body selected for different implant systems in both the mesial and distal directions of the implants. In order to evaluate the marginal bone loss (MBL), the measurements obtained will be compared with the measurements on the radiographs taken after the delivery of the prosthesis.	It will be done at the start of the study, immediately after the control radiograph is taken.
Comparison of mean Receptor Activator Of Nuclear Factor-Kappa B Ligand (RANKL) level between adequate KMT and inadequate KMT groups	The RANKL levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Receptor Activator Of Nuclear Factor-Kappa B Ligand (RANKL) level between adequate KGW and inadequate KGW groups	The RANKL levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Osteoprotegerin (OPG) level between adequate Keratinized mucosal thickness (KMT) and inadequate KMT groups	The OPG levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Osteoprotegerin (OPG) level between between adequate keratinized gingival width (KGW) and inadequate KGW groups	The OPG levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Tumor Necrosis Factor Alpha (TNF-α) level between adequate Keratinized mucosal thickness (KMT) and inadequate KMT groups	The TNF-α levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Tumor Necrosis Factor Alpha (TNF-α) level between between adequate keratinized gingival width (KGW) and inadequate KGW groups	The TNF-α levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean MicroRNA-223 level between adequate Keratinized mucosal thickness (KMT) and inadequate KMT groups	The MicroRNA-223 levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via real-time polymerase chain reaction. The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean MicroRNA-223 level between between adequate keratinized gingival width (KGW) and inadequate KGW groups	The MicroRNA-223 levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via real-time polymerase chain reaction. The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean MicroRNA-27a level between adequate Keratinized mucosal thickness (KMT) and inadequate KMT groups	The MicroRNA-27a levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via real-time polymerase chain reaction. The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean MicroRNA-27a level between between adequate keratinized gingival width (KGW) and inadequate KGW groups	The MicroRNA-27a levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via real-time polymerase chain reaction. The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Receptor Activator Of Nuclear Factor-Kappa B Ligand (RANKL) level between peri-implant health and peri-implant mucositis groups	The RANKL levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Osteoprotegerin (OPG) level between peri-implant health and peri-implant mucositis groups	The OPG levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean Tumor Necrosis Factor Alpha (TNF-α) level between peri-implant health and peri-implant mucositis groups	The TNF-α levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via Enzyme-Linked ImmunoSorbent Assay . The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean MicroRNA-223 level between peri-implant health and peri-implant mucositis groups	The MicroRNA-223 levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via real-time polymerase chain reaction. The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Comparison of mean MicroRNA-27a level between peri-implant health and peri-implant mucositis groups	The MicroRNA-27a levels in the peri-implant crevicular fluid (PIGF) collected from the patients will be measured via real-time polymerase chain reaction. The difference between the groups will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Correlation between MBL amounts and TNF-α	The correlation MBL amounts and TNF-α will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Correlation between MBL amounts and RANKL	The correlation MBL amounts and RANKL will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Correlation between MBL amounts and OPG	The correlation MBL amounts and OPG will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Correlation between MBL amounts and MicroRNA-223	The correlation MBL amounts and MicroRNA-223 will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.
Correlation between MBL amounts and MicroRNA-27a	The correlation MBL amounts and MicroRNA-27a will be evaluated.	this will be done at the beginning of the study, after samples have been collected from all implants in the study.

Collaborators and Investigators

• Sponsor: Necmettin Erbakan University
• Investigators: Study Director: zeynep taştan eroğlu, Necmettin Erbakan University; Principal Investigator: dilek özkan şen, Necmettin Erbakan University; Principal Investigator: elif öncü, Lokman Hekim Üniversitesi

Study record dates

Study Major Dates

• Study Start (Actual): December 2, 2022
• Primary Completion (Actual): January 15, 2023
• Study Completion (Actual): January 15, 2023

Study Registration Dates

• First Submitted: November 25, 2022
• First Submitted That Met QC Criteria: November 28, 2022
• First Posted (Actual): December 7, 2022

Study Record Updates

• Last Update Posted (Actual): January 25, 2023
• Last Update Submitted That Met QC Criteria: January 24, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: dental implants; MicroRNA; periimplantitis; soft tissue phenotype; alveolar bone loss
• Additional Relevant MeSH Terms: Metabolic Diseases; Musculoskeletal Diseases; Stomatognathic Diseases; Periodontal Diseases; Mouth Diseases; Bone Diseases; Periodontal Atrophy; Bone Resorption; Bone Diseases, Metabolic; Peri-Implantitis; Alveolar Bone Loss
• Other Study ID Numbers: periimplantmicrorna

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No