Increased Levels of Dissolved Titanium Are Associated With Peri-Implantitis - A Cross-Sectional Study

Microbial Dysbiosis, Titanium Release, and Peri-implantitis

The peri-implant mucosal barrier is a unique microenvironment where host-microbiome interactions take place on the surface of an implanted biomaterial. Therefore, peri-implant immunity not only is quintessential to oral health but also contributes to the maintenance of the biomaterial-tissue equilibrium in health. This review delves into the intricate interplay between host factors, biomaterial properties, and the microbiome with a focus on the mechanisms underlying peri-implant dysbiosis. Investigations into this complex milieu have led to the emerging understanding of titanium particles released from the implant as significant exposomes. When biomaterial breakdown occurs, implant degradation products form particles that are released in the peri-implant crevice, exerting profound effects on the local immune surveillance. Comparative analyses with natural dentition highlight the distinct immune responses elicited by titanium particles, thereby implicating them as a key modulator of peri-implant dysbiosis that differentiates peri-implant from periodontal inflammation. Nonetheless, disruptions in the homeostatic balance of host-biomaterial interactions are linked to pathogenic shifts of the peri-implant microbiome that are correlated with titanium particles in humans. Collectively, it is now well established that to elucidate the mechanisms governing peri-implant dysbiosis, this triangle of host-microbiome-biomaterial has to be conjointly investigated. This review highlights findings from studies that have underscored the multifaceted nature of peri-implant dysbiosis, emphasizing the intricate crosstalk between host immunity, biomaterial characteristics, and microbial ecology. These findings suggest that the titanium particle exposome may alter key inflammatory cascades in the peri-implant tissues including toll-like receptor activation and inflammasome and complement signaling, which lead to nonresolving destructive inflammation. The presence of abiotic danger signals in the form of implant degradation products in peri-implant tissues may make antimicrobial monotherapies largely ineffective for managing peri-implantitis. In turn, the future of peri-implantitis therapy seems to lie in the development of targeted host modulatory interventions against titanium-mediated inflammatory pathways.

Impact of High Insertion Torque on Implant Surface Integrity

INTRODUCTION

The long-term success of dental implants depends on the preservation of supporting tissues over time. Recent studies have highlighted the release of titanium particles as a potential etiology for the onset and progression of peri-implant diseases modulated by inflammatory biomarkers. This study provides a comprehensive analysis of surface changes associated with high insertion torque placement.

METHODS

Three groups of cylindrical threaded dental implants, each representing different surface topographies produced by anodization or a combination of grit-blasting and acid-etching processes, were inserted into fresh cow rib bone blocks used to mimic human jaws. Individual bone blocks were fabricated with a dimension of 20 × 15 × 15 mm, randomly assigned to the three implant groups. Prior to dental implant placement, the bone blocks were divided in half to facilitate implant removal without introducing additional damage. The drilling protocol was modified, excluding the final drill recommended by the manufacturer to ensure higher insertion torque values during the procedure. Dental implants were removed from the bone blocks and processed for analysis. Surface roughness was characterized using interferometry on the same area before and after insertion. Scanning electron microscopy (SEM) with a back-scattered electron detector (BSD) was employed to identify the implant surface and loose particles at the bone block interface.

RESULTS

The high insertion torque protocol used in this study resulted in higher insertion torque values compared to manufacturers' protocol, but no difference was observed when comparing the three implant groups. Surface roughness characterization revealed that amplitude and hybrid roughness parameters for all three groups were lower after insertion. The surfaces exhibiting a predominance of peaks (Ssk [skewness] > 0) associated with higher structures (height parameters) showed greater damage at the crests of the threads, while no changes were observed in the valleys of the threads. SEM-BSD images revealed loose titanium particles at the bone blocks interface, predominantly at the crestal cortical bone level.

CONCLUSIONS

High insertion torque resulted in surface damage at the crests of threads, which subsequently led to the release of titanium particles primarily at the bone crest. The initial release of titanium particles during implant insertion at the bone-implant interface warrants further exploration as a potential cofactor for marginal bone loss.

Effect of Tribocorrosion on Mechanical Behavior of Titanium Dental Implants: An In Vitro Study

BACKGROUND/OBJECTIVES

Peri-implantitis often necessitates surgical intervention, with implantoplasty being proposed as a decontamination method in resective surgeries. This mechanical cleaning technique aims to halt disease progression by removing bacterial colonies. However, implantoplasty may compromise mechanical properties, reduce corrosion resistance, and lead to cytotoxic effects due to titanium particle release. This study aimed to evaluate the corrosion and mechanical resistance of implantoplasty-treated dental implants, with and without bacterial contamination.

METHODS

Twenty dental implants were divided into three groups: control (C), implantoplasty (IP), and implantoplasty with bacterial contamination (IPC) using Streptococcus aureus and Porphyromonas gingivalis. Scanning electron microscopy was used to assess surface morphology. Fatigue life curves were obtained using a Bionix servohydraulic machine, and electrochemical corrosion tests were conducted to measure corrosion potentials and intensities.

RESULTS

The IPC group demonstrated significantly lower fatigue resistance and higher susceptibility to corrosion compared to the control and IP groups. Fatigue life decreased by 21.7%, and corrosion current density (ICORR) increased from 0.025 μA/cm2 (control) to 0.089 μA/cm2 (IP) and 0.122 μA/cm2 (IPC). Corrosion potential (ECORR) shifted from -380 mV (control) to -450 mV (IP) and -495 mV (IPC). Surface defects caused by bacterial colonization facilitated stress concentration and crack initiation during fatigue testing.

CONCLUSIONS

Dental implants treated with implantoplasty and exposed to bacterial contamination exhibit significantly reduced mechanical and corrosion resistance. Bacterial activity exacerbates surface vulnerability, leading to titanium loss and pitting corrosion. These findings highlight the clinical implications of bacterial colonization on implantoplasty-treated surfaces.

The impact of biocorrosion and titanium ions release on peri-implantitis

OBJECTIVES

Biofilm accumulation is considered the primary cause of peri-implant inflammation. Still, metallosis caused by an increased concentration of titanium ions at the site of peri-implantitis site cannot be ignored. Whether titanium ions alone or in concert with bacterial biofilm trigger inflammation and bone destruction in peri-implant tissues remains unproven.

MATERIALS AND METHODS

Articles were retrieved from PubMed/Medline, Web of Science. All studies focusing on titanium ions release in peri-implant reactions were included and evaluated.

RESULTS

Titanium implants are considered non-inert and may release titanium ions in the intraoral microenvironment, the most important of which is the acidic environment created by bacterial biofilms. Although the correlation between titanium ion release and the incidence or progression of peri-implantitis is controversial, several studies have confirmed the potential role of titanium ions. Diffusion or entry of titanium ions into the circulation may be a scavenging effect on local titanium ions but can cause systemic adverse effects. However, existing measures are not yet able to balance reducing biocorrosion and maintaining osteogenic results, and the exploration of new materials requires long-term clinical data.

CONCLUSIONS

Titanium ions have potential impacts on peri-implant tissue and systemic circulation. Titanium ions are closely associated with bacterial biofilms in the occurrence and development of periimplantitis. The preventive strategies for the release and action of titanium ions remain to be explored.

CLINICAL RELEVANCE

Our findings may provide the hope of shedding light on the pathogenesis of peri-implantitis and its treatment.

Peri-Implant Bone Necrosis: Clinical Considerations and Histological Evaluation

Peri-implant bone necrosis (PIBN) is a rare yet potentially serious phenomenon contributing to implant failure. It can be challenging to determine the exact etiology, especially when multiple intricate factors are involved. This case series reports on the successful management of PIBN during early and late implant placement and peri-implantitis-associated bone necrosis, with likely causes being bone overcompression during implant placement or a consequence of peri-implantitis. This case series presents 5 cases of peri-implant bone necrosis, with 3 cases occurring immediately after implant placement and the other 2 presenting a delayed inflammatory process of peri-implantitis between 1 and 5 years after implant placement. Clinical presentation and histopathological evaluation data present 10 failed implants managed with the removal of implants and the associated necrotic bone. All the cases were successfully managed without any signs of recurrence. Two cases confirmed bone necrosis via biopsy, illustrating the typical pattern of bone necrosis: multiple nonvital bone fragments surrounded by acute and chronic inflammatory cells and empty lacunae. All cases were successfully managed by removing necrotic bone and associated implants, with no indication of bone necrosis recurrence. This case series report highlights the unusual early and delayed implant failure associated with peri-implant bone necrosis. This condition most likely results from bone overcompression during implant placement or is a sequela of the inflammatory process of peri-implantitis.

Titanium particle-induced inflammasome in human gingival epithelial cells

Background/purpose

Peri-implantitis remains a substantial challenge. This study investigated the effect of titanium particles on human oral epithelial cells, focusing on the nucleotide-binding domain and leucine-rich repeat protein (NLRP) 3 inflammasome.

Materials and methods

The Ca9-22 human gingival epithelial cell line was subjected to incubation with titanium particles. To evaluate cell viability, the MTT assay was employed. Total RNA was extracted, and messenger RNA (mRNA) expressions of COX2, TGF-β1, NLRP1, NLPR3, CASP1, and AIM2 were analyzed. The concentration of interleukin (IL)1β in cell supernatants was quantified through enzyme-linked immunosorbent assay. Intracellular reactive oxygen species (ROS) were visualized using an ROS assay Kit.

Results

Ca9-22 cells treated with titanium particles showed >75% cell viability across all concentrations tested, with consistent results. mRNA expressions of inflammation-related genes (COX2 and TGF-β1) significantly increased in a dose-dependent manner. The mRNA expression of NLRP3 and CASP1, as well as the secretion of IL1β, increased after 6-h incubation with titanium particles. Moreover, the ROS assay results showed increased production of ROS after treatment with titanium particles, whereas NLRP3 expression and IL1β secretion reduced after treatment with N-acetyl-l-cysteine (ROS scavenger).

Conclusion

Our findings indicate that titanium particles possess a distinct ability to trigger the NLRP3 inflammasome, partly by producing ROS.

Potential Impact of Microbial Variations After Peri-Implantitis Treatment on Peri-Implant Clinical, Radiographic, and Crevicular Parameters: A Systematic Review

Objectives: This systematic review evaluated concomitant trends in microbial (total biofilm load and pre-dominant pathogens' counts) and clinical, radiographic, and crevicular variations following (any) peri-implantitis treatment in partially vs. totally edentulous, systemically healthy, non-smoking adults and compared them to peri-implant mucositis treated sites. Methods: The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521). Findings from six randomized controlled trials (RCTs), evaluated through the ROBINS-2 tool, were qualitatively synthesized. Results: No data concerning total edentulism and treated peri-implant mucositis sites were retrieved from the included RCTs. Instead, as expected, in the partially edentulous subjects, peri-implantitis treatments effectively provided biofilm control, although Plaque Index (PI) tended to increase again over time. Notably, Bleeding on Probing (BoP) rose slightly after treatment but decreased markedly by three months, indicating, at least, a partial resolution of the infective-inflammatory process. Probing Depth (PD) showed a slower but consistent improvement throughout. Despite a return of PI levels by twelve months, BoP and PD continued to improve, underscoring the successful long-term outcomes of peri-implantitis treatment. Over time, variations in PI did not consistently reflect changes in predominant pathogenic species, especially at the 1-month follow-up; BoP aligned with predominant pathogens rather than total microbial biofilm load at the 1- and 3-month follow-ups, and PD did the same at the 3- and 6-month follow-ups, likely affecting peri-implantitis-associated microbiota. No data concerning crevicular parameters were retrieved in the included RCTs, and the extracted radiographic outcomes were not comparable. Conclusions: The impact of the microbial variations after peri-implantitis treatment on peri-implant clinical parameters highlight the critical role of dysbiosis, rather than total microbial load, in influencing inflammation and tissue destruction, emphasizing the need for targeted approaches to manage persistent pathogens and improve treatment efficacy.

Investigation of the relationships between peri-implant diseases, periodontal diseases, and conditions: a cross-sectional study

Introduction

Peri-implant and periodontal conditions share common underlying factors, including risk factors, microbiology, immunology, and treatment approaches.

Aims

This study aims to investigate the potential co-occurrence of peri-implant and periodontal conditions.

Design

One hundred twenty-three implants were divided into three groups: peri-implantitis (41 implants), peri-implant mucositis (41 implants), and peri-implant health (41 implants). Peri-implant and periodontal statuses were assessed using the 2017 AAP/EFP World Workshop on Classification of Periodontal and Peri-implant Diseases and Conditions. All measurements were performed by a single clinician (T.Ş.). One-way analysis of variance was used to compare the study groups according to the data. An assessment was conducted regarding the coexistence of periodontal and peri-implant conditions.

Results

Patients with peri-implant mucositis predominantly had gingivitis, whereas those with peri-implant health exhibited periodontal health. In contrast, patients with peri-implantitis mostly had gingivitis, with a lower occurrence of periodontitis. A significant difference was observed between the peri-implant and periodontal groups (p = 0.003). Significant differences were observed between peri-implant and periodontal evaluations for plaque indices, gingival indices, probing depth, gingival recession, and clinical attachment level (p = 0.001), (p = 0.006).

Conclusions

The findings of this study underscore the intricate influence of implant treatment on periodontal health. This observation emphasizes the importance of elucidating the underlying factors to improve clinical management and outcomes in patients with periodontal and peri-implant diseases, highlighting the relevance and potential impact of this research in the field.

The systemic and local interactions related to titanium implant corrosion and hypersensitivity reactions: a narrative review of the literature

Both commercially pure titanium and titanium alloys are established biomaterials for implantation in bone and are widely used today in dentistry. Titanium particulates have been shown in some patient clusters to induce cellular immune mediators responsible for type I and IV hypersensitivity reactions, causing amplified corrosion, osteolysis, and increased odds of implant failure. Systemically, titanium particles were found to affect varying organ tissues and cause potentially harmful effects. In vivo and vitro studies have shown that titanium dental implant corrosion can be induced by factors relating to bio-tribocorrosion. In this literature review, the consequences of titanium implant corrosion and particulate dissemination are discussed and later juxtaposed against a promising novel implant material, zirconia. Zirconia offers characteristics similar to titanium along with additional advantages such as being non-corrosive and having a lower propensity for inducing immune responses. From the mounting evidence discussed in this article, metal allergy testing would be advantageous for choosing an appropriate implant material to minimize potential adverse effects on cellular functions of local and diffuse tissues. Objective: This literature review aims to elucidate and describe mechanisms in which titanium implants may become corroded and induce cellular aberrations both locally and systemically in vivo. Implications of this study provide supportive evidence regarding the selection of appropriate biomaterials for implant patients susceptible to mounting a hypersensitivity reaction to titanium.

Identification of susceptibility modules and genes for peri-implantitis compared to periodontitis within the same host environment using weighted gene co-expression network analysis

PURPOSE

This study aimed to identify new susceptibility modules and genes by analyzing the transcriptional profiles of peri-implantitis and periodontitis within the same host environment, using weighted gene co-expression network analysis (WGCNA).

METHODS

Gingival tissue samples were collected from 10 patients, each presenting with both periodontitis and peri-implantitis sites, and were used for RNA sequencing. We conducted WGCNA to identify key modules that showed distinct transcriptional expression profiles between periodontitis and peri-implantitis. Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analyses were carried out using R software. Genes with an adjusted P value greater than 0.05 were excluded from gene selection using the Pearson correlation method.

RESULTS

A total of 2,226 regulated genes were identified, and those with similar expression patterns were grouped into 5 color-coded functional modules using WGCNA. Among these, 3 modules showed distinct differences in expression profiles between peri-implantitis and periodontitis. The turquoise and yellow modules were associated with upregulation in peri-implantitis, while the blue module was linked to periodontitis. This finding suggests that peri-implantitis and periodontitis have significantly different transcriptional signatures. Over-representation analysis was conducted to explore the component genes of the established modules. The top-ranked genes, selected based on their network connectivity within the modules, were identified using DESeq2 and were considered hub genes.

CONCLUSIONS

WGCNA revealed distinct modular gene patterns in peri-implantitis and periodontitis, highlighting transcriptional differences between the 2 conditions. Notably, we identified 10 key genes from each of the 3 modules-the blue module associated with periodontitis-dominant pathways, and the turquoise and yellow modules associated with peri-implantitis-dominant pathways. The hub genes and pathways unveiled in this research are likely key contributors to the progression of peri-implantitis and warrant further exploration as promising candidates.

Patient Centricity-An Empirical Research on Titanium Dental Implants and Their Adverse Effects on Health Condition

BACKGROUND/OBJECTIVES

Titanium dental implants are considered to be the most modern and effective solution for replacing lost teeth. These medical devices not only restore the chewing and aesthetic functionality of the smile but also provide a stable support for crowns, bridges or dentures. The aim of this study was to identify the perceptions of patients about titanium dental implants and their effects on the human body.

METHODS

A structural equation model (SEM) was conducted to study how a series of independent variables have the ability to influence the perception and intention of the patients regarding these medical devices. A data analysis was performed using WarpPLS 8.0 software. This research was conducted on a sample of 162 respondents.

RESULTS

The results illustrated that patients' perception of titanium dental implants is explained by 71% of the independent variables analysed, and their intention to have a new implant in the next period is explained by 61%. The proposed econometric model was validated, with seven hypotheses accepted out of nine.

CONCLUSIONS

Although titanium has long been used in implant dentistry, in recent years, experts have identified a number of adverse effects that can arise from its use. This study has added value both at the practical and theoretical level. Perception is influenced by respondents' perceived advantages, by the problems perceived by the respondents regarding titanium dental implants, by the degree of awareness of the risks of titanium dental implants, and by the adverse effects experienced by respondents regarding titanium dental implants.

Primary Stability of Zirconia Dental Implants with Cylindrical and Tapered Designs Across Varying Bone Densities: An In Vitro Evaluation

Background: While titanium implants are widely recognized for their clinical success, zirconia implants have emerged as a metal-free alternative. This study aimed to evaluate the influence of zirconia implant macrogeometry and bone density on primary implant stability. Methods: Two types of zirconia implants were tested-the Neodent® Zi Ceramic Implant and the Straumann® PURE Ceramic Implant, that were placed into polyurethane foam blocks mimicking different bone densities (10 PCF, 15 PCF, 20 PCF, 30 PCF, and 40 PCF). Each implant type was inserted and removed multiple times, with primary stability measured using resonance frequency analysis via the Osstell® Beacon device. Statistical tests, including the Shapiro-Wilk test, t-tests, the Mann-Whitney U test, and the Kruskal-Wallis test, were applied, with significance set at 5% (p < 0.05). Results: The tapered Neodent® Zi Ceramic Implant consistently showed higher ISQ values across all foam densities compared to the Straumann® PURE Ceramic Implant (p = 0.035). Additionally, lower-density foams exhibited lower stability scores (p < 0.05). Conclusion: The study concludes that both the macrogeometry of zirconia implants and bone density significantly affect primary implant stability. Specifically, tapered implants demonstrated higher stability than cylindrical designs, suggesting that implant macrogeometry and bone density should be considered for optimal primary stability in clinical settings.

Dynamic assessment of titanium surface oxides following mechanical damage reveals only partial passivation under inflammatory conditions

Motivated by clinical problems of titanium implant degradation, we developed a workflow that enabled assessment of surface oxide dynamics as a function of clinical interventions and inflammation conditions. We found that mechanical damage led to decrease of stoichiometric TiO2 ratio in the passivation oxide film and further resulted in accelerated degradation under inflammatory anaerobic conditions. This method can be employed for the assessment of surface oxides to monitor implant safety.

Effect of Repeated Moist Heat Sterilization on Titanium Implant-Abutment Interface-An In Vitro Study

OBJECTIVES

 Sterilization eliminates microbial viability by decreasing the biological load, but likewise have the ability to deteriorate the mechanical properties of an implant material. This study intended to evaluate the effect of repeated moist heat sterilization on implant-abutment interface using two different implant systems.

MATERIALS AND METHODS

 Forty screw-retained titanium implant-abutment combinations (fixture 3.5 ×10 mm, abutment 2 mm diameter), twenty each from Genesis (Aktiv Implant Systems, United States) and Bredent (SKY, Germany), were divided into four different groups (n = 10) and placed in a computer-aided diagnostic model. The abutments from each group were exposed to first and second autoclave cycle (121°C for 30 minutes), connected back to the fixture and analyzed under scanning electron microscope for marginal gap and surface roughness.

RESULTS

 Genesis group showed higher marginal gaps on both sides (buccal/mesial [2.8 ± 0.47]; lingual/distal [2.8 ± 0.33]), while Bredent implant-abutment system (IAS) did not show any changes in marginal gaps after autoclaving. Differences within and between the group were found to be statistically significant. Surface roughness for Genesis (243.7 ± 70.30) and Bredent groups (528.9 ± 213.19) was highest at second autoclave, with Bredent implant-abutment showing higher values for surface roughness than Genesis IAS.

CONCLUSION

 Marginal vertical gap increased with autoclaving for Genesis IAS, while Bredent implant abutments were more stable. Surface roughness increases with autoclaving for both Genesis and Bredent group of IAS.

Fracture Resistance of a Bone-Level Two-Piece Zirconia Oral Implant System-The Influence of Artificial Loading and Hydrothermal Aging

Preclinical and clinical research on two-piece zirconia implants are warranted. Therefore, we evaluated the in vitro fracture resistance of such a zirconia oral implant system. The present study comprised 32 two-piece zirconia implants and abutments attached to the implants using a titanium (n = 16) or a zirconia abutment screw (n = 16). Both groups were subdivided (n = 8): group T-0 comprised implants with a titanium abutment screw and no artificial loading; group T-HL was the titanium screw group exposed to hydro-thermomechanical loading in a chewing simulator; group Z-0 was the zirconia abutment screw group with no artificial loading; and group Z-HL comprised the zirconia screw group with hydro-thermomechanical loading. Groups T-HL and Z-HL were loaded with 98 N and aged in 85 °C hot water for 107 chewing cycles. All samples were loaded to fracture. Kruskal-Wallis tests were executed to assess the loading/bending moment group differences. The significance level was established at a probability of 0.05. During the artificial loading, there was a single occurrence of an implant fracture. The mean fracture resistances measured in a universal testing machine were 749 N for group T-0, 828 N for group Z-0, 652 N for group T-HL, and 826 N for group Z-HL. The corresponding bending moments were as follows: group T-0, 411 Ncm; group Z-0, 452 Ncm; group T-HL, 356 Ncm; and group Z-HL, 456 Ncm. There were no statistically significant differences found between the experimental groups. Therefore, the conclusion was that loading and aging did not diminish the fracture resistance of the evaluated implant system.

Mettl3‑mediated m6A RNA methylation regulates osteolysis induced by titanium particles

Peri‑prosthetic osteolysis (PPO) induced by wear particles is considered the primary cause of titanium prosthesis failure and revision surgery. The specific molecular mechanisms involve titanium particles inducing multiple intracellular pathways, which impact disease prevention and the targeted therapy of PPO. Notably, N6‑methyladenosine (m6A) serves critical roles in epigenetic regulation, particularly in bone metabolism and inflammatory responses. Thus, the present study aimed to determine the role of RNA methylation in titanium particle‑induced osteolysis. Results of reverse transcription‑quantitative PCR (RT‑qPCR), western blotting, ELISA and RNA dot blot assays revealed that titanium particles induced osteogenic inhibition and proinflammatory responses, accompanied by the reduced expression of methyltransferase‑like (Mettl) 3, a key component of m6A methyltransferase. Specific lentiviruses vectors were employed for Mettl3 knockdown and overexpression experiments. RT‑qPCR, western blotting and ELISA revealed that the knockdown of Mettl3 induced osteogenic inhibition and proinflammatory responses comparable with that induced by titanium particle, while Mettl3 overexpression attenuated titanium particle‑induced cellular reactions. Methylated RNA immunoprecipitation‑qPCR results revealed that titanium particles mediated the methylation of two inhibitory molecules, namely Smad7 and SMAD specific E3 ubiquitin protein ligase 1, via Mettl3 in bone morphogenetic protein signaling, leading to osteogenic inhibition. Furthermore, titanium particles induced activation of the nucleotide binding oligomerization domain 1 signaling pathway through methylation regulation, and the subsequent activation of the MAPK and NF‑κB pathways. Collectively, the results of the present study indicated that titanium particles utilized Mettl3 as an upstream regulatory molecule to induce osteogenic inhibition and inflammatory responses. Thus, the present study may provide novel insights into potential therapeutic targets for aseptic loosening in titanium prostheses.

Fracture strength of screw-retained zirconia crowns assembled on zirconia and titanium implants

PURPOSE

This in vitro study evaluated the fracture strength of screw-retained zirconia crowns connected to zirconia (Zr) and titanium (Ti) implants after undergoing a simulation of 5 years of clinical use.

MATERIALS AND METHODS

Forty-eight screw-retained zirconia crowns were fabricated and assembled on four implant systems, with 12 in each group: (1) Zr implant (pure ceramic; Straumann AG) (PZr); (2) Zr implant (NobelPearl; Nobel Biocare) (NPZr); (3) Ti-Zr implant (Bone Level Roxolid; Straumann AG) (RSTiZr); (4) Ti implant (Conical Connection PMC; Nobel Biocare) (NRTi). Crowns were luted to their associated abutments using resin cement and then torqued to their assigned implants at the recommended torque value. Specimens were subjected to dynamic loading for 1,200,000 loading cycles. Fracture strength, measured in Newtons (N), was tested under static compression load using a universal testing machine at an angle of 30°. One-way ANOVA and Tukey's multiple comparisons post hoc test were used to compare the mean fracture values between the groups at a significance level of 0.05.

RESULTS

The average fracture strengths for the RSTiZr and NRTi groups were 1207 ± 202 and 1073 ± 217 N, respectively, which was significantly (p < 0.0001) higher than the PZr and NPZr groups (712 ± 76 and 571.6 ± 167 N, respectively). However, no significant difference was found between the fracture strength value of RSTiZr and NRTi (p = 0.260) or PZr and NPZr (p = 0.256) groups.

CONCLUSIONS

Zirconia crowns connected to Zr implants have the potential to withstand the average physiological occlusal forces which occur in the anterior and premolar regions.

Impact of surface characteristics on the peri-implant microbiome in health and disease

BACKGROUND

Because little is known about the impact of implant surface modifications on the peri-implant microbiome, we aimed to examine peri-implant communities in various surface types in order to better understand the impact of these surfaces on the development of peri-implantitis (PI).

METHODS

One hundred and six systemically healthy individuals with anodized (AN), hydroxyapatite-coated (HA), or sandblasted acid-etched (SLA) implants that were >6 months in function were recruited and categorized into health (H) or PI. Peri-implant biofilm was analyzed using 16S rRNA gene sequencing and compared between health/disease and HA/SLA/AN using community-level and taxa-level metrics.

RESULTS

Healthy implants did not demonstrate significant differences in clustering, alpha- or beta-diversity based on surface modification. AN and HA surfaces displayed significant differences between health and PI (p < 0.05); however, such a clustering was not evident with SLA (p > 0.05). AN and HA surfaces also differed in the magnitude and diversity of differences between health and PI. Six species belonging to the genera Shuttleworthia, Scardovia, and Prevotella demonstrated lower abundances in AN implants with PI, and 18 species belonging to the genera Fretibacterium, Tannerella, Treponema, and Fusobacterium were elevated, while in HA implants with PI, 20 species belonging to the genera Streptococcus, Lactobacillus, Veillonella, Rothia, and family Ruminococcaceae were depleted and Peptostreptococcaceae, Atopobiaceae, Veillonellaceae, Porphyromonadaceae, Desulfobulbaceae, and order Synergistales were enriched.

CONCLUSIONS

Within the limitations of this study, we demonstrate that implant surface can differentially modify the disease-associated microbiome, suggesting that surface topography must be considered in the multi-factorial etiology of peri-implant diseases.

A Mapping Review of the Pathogenesis of Peri-Implantitis: The Biofilm-Mediated Inflammation and Bone Dysregulation (BIND) Hypothesis

This mapping review highlights the need for a new paradigm in the understanding of peri-implantitis pathogenesis. The biofilm-mediated inflammation and bone dysregulation (BIND) hypothesis is proposed, focusing on the relationship between biofilm, inflammation, and bone biology. The close interactions between immune and bone cells are discussed, with multiple stable states likely existing between clinically observable definitions of peri-implant health and peri-implantitis. The framework presented aims to explain the transition from health to disease as a staged and incremental process, where multiple factors contribute to distinct steps towards a tipping point where disease is manifested clinically. These steps might be reached in different ways in different patients and may constitute highly individualised paths. Notably, factors affecting the underlying biology are identified in the pathogenesis of peri-implantitis, highlighting that disruptions to the host-microbe homeostasis at the implant-mucosa interface may not be the sole factor. An improved understanding of disease pathogenesis will allow for intervention on multiple levels and a personalised treatment approach. Further research areas are identified, such as the use of novel biomarkers to detect changes in macrophage polarisation and activation status, and bone turnover.

Emerging factors affecting peri-implant bone metabolism

Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.

The effect of three dental cement types on the corrosion of dental implant surfaces

Statement of problem

One of the main challenges facing dental implant success is peri-implantitis. Recent evidence indicates that titanium (Ti) corrosion products and undetected-residual cement are potential risk factors for peri-implantitis. The literature on the impact of various types of dental cement on Ti corrosion is very limited.

Purpose

This study aimed to determine the influence of dental cement on Ti corrosion as a function of cement amount and type.

Materials and methods

Thirty commercially pure Ti grade 4 discs (19 × 7mm) were polished to mirror-shine (Ra ≈ 40 nm). Samples were divided into 10 groups (n = 3) as a cement type and amount function. The groups were no-cement as control, TempBond NE (TB3mm, TB5mm, and TB8mm), FujiCEM-II (FC3mm, FC5mm, and FC8mm), and Panavia-F-2.0 (PC3mm, PC5mm, and PC8mm). Tafel's method estimated corrosion rate (icorr) and corresponding potential (Ecorr) from potentiodynamic curves. Electrochemical Impedance Spectroscopy (EIS) data was utilized to obtain Nyquist and Bode plots. An equivalent electrical circuit estimated polarization resistance (Rp) and double-layer capacitance (Cdl). Inductively coupled plasma mass spectrometry (ICP-MS) analysis was conducted to analyze the electrolyte solution after corrosion. pH measurements of the electrolyte were recorded before and after corrosion tests. Finally, the corroded surface was characterized by a 3D white-light microscope and scanning electron microscope. Statistical analysis was conducted using either one-way ANOVA followed by Tukey's Post Hoc test or Kruskal-Wallis followed by Dunn's test based on data distribution.

Results

Based on cement amount, FC and PC significantly increased icorr in higher amounts (FC8mm-icorr = 8.22 × 10-8A/cm2, PC8mm-icorr = 5.61 × 10-8A/cm2) compared to control (3.35 × 10-8A/cm2). In contrast, TB3mm decreased icorr significantly compared to the control. As a function of cement type, FC increased icorr the most. EIS data agrees with these observations. Finally, corroded surfaces had higher surface roughness (Ra) compared to non-corroded surfaces.

Conclusion

The study indicated that cement types FC and PC led to increased Ti-corrosion as a function of a higher amount. Hence, the implant stability could be impacted by the selection, excessive cement, and a potentially increased risk of peri-implantitis.

Correlation between Inflammasomes and Microbiota in Peri-Implantitis

The activation of inflammasomes is thought to induce the inflammatory process around dental implants. No information is available on the correlation between microbiota and inflammasomes in clinical samples from patients suffering peri-implantitis. For this cross-sectional study, 30 biofilm samples were obtained from 19 patients undergoing surgical treatment for peri-implantitis because of the presence of bleeding on probing, probing depth higher than 6 mm, and radiographic bone loss higher than 3 mm. Then, soft tissue samples from around the implant were also collected. The relative abundance of bacteria and alpha-diversity indexes were calculated after analyzing the 16S rRNA gene using next-generation sequencing. The soft-tissue samples were processed for evaluation of the inflammasomes NLRP3 and AIM2 as well as caspase-1 and IL-1β. The relative abundance (mean (SD)) of specific species indicated that the most abundant species were Porphyromonas gingivalis (10.95 (14.17)%), Fusobacterium vincentii (10.93 (13.18)%), Porphyromonas endodontalis (5.89 (7.23)%), Prevotella oris (3.88 (4.94)%), Treponema denticola (2.91 (3.19)%), and Tannerella forsythia (2.84 (4.15)%). Several correlations were found between the species and the immunohistochemical detection of the inflammasomes NLRP3 and AIM2 as well as caspase-1 and IL-1β, both in the epithelium and the lamina propria. A network analysis found an important cluster of variables formed by NLRP3 in the lamina propria and AIM2, caspase-1, and IL-1β in the lamina propria and the epithelium with Prevotella dentalis, Prevotella tannerae, Tannerella forsythia, or Selenomonas timonae. Thus, it could be concluded that inflammasomes NLRP3 and AIM2 and their downstream effectors caspase-1 and interleukin-1β can be significantly associated with specific bacteria.

Wear at the implant-framework interface between titanium implant platform and the additively manufactured titanium and cobalt-chromium frameworks

PURPOSE

To measure the wear at the implant interface between the Grade 4 titanium (Ti) of the implant and frameworks fabricated using two additively manufactured alloys (Ti alloy and cobalt-chromium [Co-Cr]) pre- and post-artificial aging.

MATERIAL AND METHODS

Three-unit frameworks supported by two implants were additively manufactured (Atlantis; Dentsply Sirona) using Ti and Co-Cr dental alloys. Two implants (OsseoSpeed EV, Astra Tech; Dentsply Sirona) were torqued on each non-engaging framework. The assembled implant-frameworks were secured into polyurethane foam blocks. Groups were created based on the material and surface assessed: framework (Ti-framework and Co-Cr-framework groups) and implant (Ti-implant group). Two subgroups were created depending on the location: premolar (PM) and molar (M). Computed tomography images were obtained pre- (as manufactured) and post-simulated mastication procedures. The pre- and post-simulated mastication files of each specimen were aligned using the best-fit algorithm using a metrology program. Wear was measured by calculating the volumetric discrepancies at the implant interface on 64 measurement points per area analyzed. Three-way ANOVA and Tukey tests were used to analyze the data (α = 0.05).

RESULTS

The mean volumetric discrepancy values ranged from 0.8 to 3.1 µm among all the subgroups tested. The group (framework vs. implant) (p < 0.001) and tooth location (p < 0.001) were significant factors of the mean volumetric discrepancy values obtained. The framework group presented with significantly lower volumetric discrepancy mean values (1 µm) compared with the implant group (3 µm), whereas the premolar area obtained significantly lower mean volumetric discrepancy values (1.9 µm) compared with the molar location (2.3 µm).

CONCLUSIONS

Volumetric discrepancies were found at the implant-framework interface tested between the pre- and post-artificial aging measurements ranging from 1 to 3 µm after 1,200,000 cyclic loading that simulated approximately 12 months of function.

Effect of functionalized titanium particles with dexamethasone-loaded nanospheres on macrophage polarization and activity

OBJECTIVE

The aim of this study was to determine the effect of titanium micro particles (TiP) previously functionalized with nanoparticles doped with dexamethasone (Dex) and doxycycline (Dox), on macrophage polarization and activity.

METHODS

Macrophages RAW264.7 were cultured in the presence TiP loaded with dexamethasone -NPs (Dex)- and doxycycline -NPs (Dox)-, and as control, TiP with or without doped NPs. Cells were tested with and without previous bacterial lipopolysaccharide endotoxin (LPS) stimulation. Their morphology, proliferation, cytotoxicity, phenotypic change, and cytokines release were assessed by LIVE/DEAD, DNA release, metabolic activity, brightfield and scanning electron microscopy. The test Kruskall-Wallis was used for comparisons, while the cytokine expression profiles were examined by hierarchical clustering (p < 0.05).

RESULTS

Upon exposure with TiP macrophages were activated and polarized to M1, but without depicting cytotoxic effects. The particles were phagocytised, and vacuolized. When exposed to functionalised TiP with NPs(Dex) and NPs(Dox), the ratio M1/M2 was up to forty times lower compared to TiP alone. When exposed to LPS, TiP reduced cell viability in half. Functionalised TiP with NPs(Dex) inhibited the cytokine release exerted by TiP on macrophages. When macrophages were exposed to functionalised TiPs with NPs(Dex) with and without LPS, the effect of TiP on cytokine secretion was inhibited.

SIGNIFICANCE

Functionalised TiPs with NPs(Dex) and NPs(Dox) may potentially have beneficial effects on modulating titanium and LPS-related inflammatory reactions.

Osseointegration and osteoimmunology in implantology: assessment of the immune sustainability of dental implants using advanced sonographic diagnostics: research and case reports

OBJECTIVE

Bone marrow defects of the jaw (BMDJ) surrounding dental implants, in combination with impaired bone-to-implant contact (BIC), are difficult to detect in X-rays. This study evaluated BMDJ surrounding titanium (Ti-Impl) and ceramic (Cer-Impl) dental implants and incomplete BIC using a new trans-alveolar ultrasonography device (TAU) with numerical scaling for BIC.

METHODS

The titanium stimulation test (Ti-Stim) was used to detect immune overactivation in response to titanium. Bone density surrounding implants was measured using TAU. We also validated osteoimmune dysregulation.

RESULTS

TAU values showed reduced BIC and decreased osseointegration for Ti-Impl. Moreover, TAU values in the Cer-Impl group were more than twice those in the Ti-Impl cohort. The multiplex analysis of C-C motif chemokine 5 (CCL5, also known as RANTES) expression revealed a 20-fold increase in BMDJ surrounding Ti-Impl. Higher levels of CCL5 inflammation were present in the positive Ti-Stim group.

CONCLUSIONS

Our data indicate that Cer-Impl have an osteoimmune advantage over Ti-Impl. The key determinant for osteoimmune sustainability appears to be the absence of inflammation at the implant site. We therefore recommend the use of TAU to assess the implant site prior to implantation.

Bioelectric device for effective biofilm inflammation management of dental implants

Dental implant inflammation is primarily caused by oral biofilms, which form within 8 h, particularly at 37 °C, thereby requiring diligent cleaning. Considering the complex management of dental implants, a novel technology based on the bioelectric effect (BE) to combat inflammation has emerged. A BE-integrated toothbrush was developed and clinically tested on patients with dental implants (N = 36). Our findings revealed a significant average plaque index reduction of 67% with BE technology compared with that at baseline (P < 0.05), whereas non-BE did not yield statistical significance even after 4 weeks of use (P > 0.05). The bleeding index demonstrated a 59% average reduction in all surfaces with BE technology (P < 0.05), whereas the non-BE group exhibited no significant change. Substantial reductions in total plaque and bleeding indices suggest that using BE toothbrushes can help effectively remove oral biofilms and treat bleeding symptoms.

Toward Elimination of Electrochemical Corrosion in Dental Implants: A Zirconia-Titanium Composite Prototype

Background Titanium dental implants (e.g., Nobel Biocare, Switzerland) are routinely used as support for dental restoration. Titanium has been the material of choice due to its corrosion resistance and ability to integrate with bone. Nevertheless, corrosion and titanium dissolution do occur. Compared to control, peri-implantitis tissue biopsies have been shown to contain high concentrations of dissolved titanium as well as metal particles. Dissolved titanium species have been found to be associated with the structure/diversity of the subgingival plaque microbiome and the extent of global methylation. Of note, peri-implantitis and peri-implant mucositis are common biological complications of implant therapy. Microorganisms and local inflammation together with a gradient of oxygen have been proven to form an electrochemical fuel cell, which generates the current that flows through the body of the titanium implant. Effectively, the fuel cell reduces oxygen and oxidizes titanium that turns into a soluble form. We are proposing a new zirconia-titanium composite implant design whereby the electrical current is disrupted while other properties are still conducive to osseointegration. Methodology Biocompatible zirconia bolts were treated with hydrofluoric acid (HF) and coated with titanium in a vacuum evaporator. The coating was masked with nail polish, and unmasked areas were etched with HF followed by mask removal with a solvent. Microbial challenges were conducted with a volunteer's plaque. Regular implant (control) and the prototype were inserted into simulated peri-implant environments implemented as a fiberglass sleeve immersed into a growth medium. After a five-day growth, samples were taken and HNO3 digested. Dissolved titanium was evaluated by inductively coupled plasma mass spectrometry. Results Proof-of-concept implant prototypes were successfully created. Vacuum deposition results in reproducible stable titanium coating. The thickness of the titanium coating was estimated using atomic force microscopy. A microbial challenge revealed that compared to the commercial titanium implant, the new implant prototype showed decreased amounts of corrosion-leached titanium. Conclusions We demonstrate a path forward toward a new design of a dental implant, whereby corrosion-induced electrical currents are interrupted resulting in a decreased amount of dissolved titanium.

Dental implant material related changes in molecular signatures in peri-implantitis - A systematic review of omics in-vivo studies

OBJECTIVE

Titanium particles have been shown in in-vitro studies to lead to the activation of specific pathways, this work aims to systematically review in- vivo studies examining peri-implant and periodontal tissues at the transcriptome, proteome, epigenome and genome level to reveal implant material-related processes favoring peri-implantitis development investigated in animal and human trials.

METHODS

Inquiring three literature databases (Medline, Embase, Cochrane) a systematic search based on a priori defined PICOs was conducted: '-omics' studies comparing molecular signatures in healthy and infected peri-implant sites and/or healthy and periodontitis-affected teeth in animals/humans. After risk of bias assessments, lists of differentially expressed genes and results of functional enrichment analyses were compiled whenever possible.

RESULTS

Out of 2187 screened articles 9 publications were deemed eligible. Both healthy and inflamed peri-implant tissues showed distinct gene expression patterns compared to healthy/diseased periodontal tissues in animal (n = 4) or human studies (n = 5), with immune response, bone metabolism and oxidative stress being affected the most. Due to the lack of available re-analyzable data and inconsistency in methodology of the eligible studies, integrative analyses on differential gene expression were not applicable CONCLUSION: The differences of transcriptomic signatures in between peri-implant lesions compared to periodontal tissue might be related to titanium particles arising from dental implants and are in line with the in-vitro data recently published by our group. Nevertheless, limitations emerge from small sample sizes of included studies and insufficient publication of re-analyzable data.

Titanium particles in peri-implantitis: distribution, pathogenesis and prospects

Peri-implantitis is one of the most important biological complications in the field of oral implantology. Identifying the causative factors of peri-implant inflammation and osteolysis is crucial for the disease's prevention and treatment. The underlying risk factors and detailed pathogenesis of peri-implantitis remain to be elucidated. Titanium-based implants as the most widely used implant inevitably release titanium particles into the surrounding tissue. Notably, the concentration of titanium particles increases significantly at peri-implantitis sites, suggesting titanium particles as a potential risk factor for the condition. Previous studies have indicated that titanium particles can induce peripheral osteolysis and foster the development of aseptic osteoarthritis in orthopedic joint replacement. However, it remains unconfirmed whether this phenomenon also triggers inflammation and bone resorption in peri-implant tissues. This review summarizes the distribution of titanium particles around the implant, the potential roles in peri-implantitis and the prevalent prevention strategies, which expects to provide new directions for the study of the pathogenesis and treatment of peri-implantitis.

Mechanical and Biological Properties of Titanium and Its Alloys for Oral Implant with Preparation Techniques: A Review

Dental implants have revolutionised restorative dentistry, offering patients a natural-looking and durable solution to replace missing or severely damaged teeth. Titanium and its alloys have emerged as the gold standard among the various materials available due to their exceptional properties. One of the critical advantages of titanium and its alloys is their remarkable biocompatibility which ensures minimal adverse reactions within the human body. Furthermore, they exhibit outstanding corrosion resistance ensuring the longevity of the implant. Their mechanical properties, including hardness, tensile strength, yield strength, and fatigue strength, align perfectly with the demanding requirements of dental implants, guaranteeing the restoration's functionality and durability. This narrative review aims to provide a comprehensive understanding of the manufacturing techniques employed for titanium and its alloy dental implants while shedding light on their intrinsic properties. It also presents crucial proof-of-concept examples, offering tangible evidence of these materials' effectiveness in clinical applications. However, despite their numerous advantages, certain limitations still exist necessitating ongoing research and development efforts. This review will briefly touch upon these restrictions and explore the evolving trends likely to shape the future of titanium and its alloy dental implants.

Subgingival titanium wire implantation induces weak inflammatory responses but does not promote substantial T cell activation

Titanium is a biocompatible material commonly used for dental treatments. However, the detailed mechanism underlying the weak biological activity of titanium has not been elucidated. We investigated both the inflammatory responses and T cell activation induced by solid titanium in the gingiva in mice. Both titanium and nickel wire implantation promoted neutrophil infiltration into the gingiva on day 2. Nickel, but not titanium, wire implantation enhanced proinflammatory cytokine expression and dendritic cell activity in gingival tissue by day 2. Nickel wire implantation enhanced the activity of T cells in draining lymph nodes on day 5. Moreover, T cell and neutrophil infiltration and elevated proinflammatory cytokine expression in the gingival tissue were still observed on day 5. However, no such augmented biological responses were observed after titanium wire implantation. These findings suggest that, unlike nickel, solid titanium does not induce sufficient inflammatory responses leading to T cell activation in gingival tissue.

Unpredictable Electrochemical Processes in Ti Dental Implants: The Role of Ti Ions and Inflammatory Products

Peri-implantitis is a substantially prevailing condition. A potential risk factor for peri-implantitis is Ti implant corrosion. During inflammation, substantial quantities of reactive oxygen species (ROS) secretion and local acidification occur. Little is known about the interaction between the inflammatory and corrosion products on Ti surface corrosion. Therefore, the objective of the current study was to evaluate the synergistic effect of hydrogen peroxide (H2O2), lactic acid, and Ti ions on Ti corrosion. Twenty-seven commercially pure Ti samples were polished (Ra ≈ 45 nm) and divided into 9 groups as a function of electrolyte: (1) artificial saliva (AS) as control (C), (2) AS + Ti ions 20 ppm (Ti), (3) AS + lactic acid (pH = 5.5) (L), (4) AS + lactic acid + Ti ions 20 ppm (TiL), (5) AS + H2O2 0.5 mM (HP0.5), (6) AS + H2O2 1.0 mM (HP1.0), (7) AS + H2O2 0.5 mM + Ti ions 20 ppm (HP0.5Ti), (8) AS + H2O2 0.5 mM + lactic acid (HP0.5L), and (9) AS + H2O2 0.5 mM + Ti ions 20 ppm + lactic acid (HP0.5TiL). Electrochemical tests were performed following ASMT guidelines. Based on Tafel's method, current density (icorr) and corresponding potential (Ecorr) were acquired from potentiodynamic curves. Using electrochemical intensity spectroscopy (EIS), Nyquist and Bode plots were derived. Using a modified Randles circuit, charge transfer resistance (Rct) and capacitance (Cdl) were estimated. Based on open-circuit potential data, groups C and Ti had the lowest potentials (around -0.3 and -0.4 V vs SCE, respectively), indicating a lower passivation tendency compared to the other groups. From potentiodynamic curves, groups HP0.5 and HP1.0 increased icorr the most. From EIS data, groups HP0.5 and HP1.0 demonstrated the lowest impedance and phase angle on the Bode plot, indicating the highest corrosion kinetics. Based on EIS modeling, the combination of Ti ions, lactic acid, and H2O2 (group HP0.5TiL) significantly decreased Rct (p < 0.05). In conclusion, the concurrent presence of Ti ions, lactic acid, and H2O2 in the vicinity of the Ti surface increased the corrosion kinetics. High corrosion may produce more Ti products in the peri-implant tissues, which may increase the potential risk of peri-implantitis.

Assessment of titanium release following non-surgical peri-implantitis treatment: A randomized clinical trial

BACKGROUND

Peri-implantitis is a frequent finding. Initial treatment involves non-surgical debridement of the implant surface. Recent studies have found a correlation between titanium (Ti) particle release and peri-implantitis, yet there is a dearth of information regarding the effect of various non-surgical instrumentation on particle release or peri-implantitis resolution.

METHODS

Patients with peri-implantitis were recruited for a randomized, blinded, parallel-group clinical trial. The implants were randomized to treatment composed of Ti curettes ("Mech" group) or implant-specific treatment composed of rotary polymer microbrushes ("Imp" group). Ti release in submucosal peri-implant plaque pre- and 8 weeks posttreatment was assessed as the primary outcome. Peri-implant probing depth, bleeding on probing, and suppuration on probing were evaluated and compared between groups.

RESULTS

Thirty-four participants completed treatment; 18 were randomized to the Mech group and 16 to the Imp group. The groups were comparable for Ti levels and probing depths at baseline. A trend was noted for 10-fold greater Ti dissolution in the Mech group posttreatment compared to the Imp group (p = 0.069). The Imp group had a significant reduction in probing depth posttreatment (p = 0.006), while the Mech group reduction was not significant.

CONCLUSION

Peri-implantitis treated non-surgically with implant-specific instruments (Imp group) had a significantly greater decrease in probing depth versus the Mech treatment group. This improvement was linked with a trend for less Ti release to the peri-implant plaque by the non-abrasive treatment.

In vitro evaluation of different protective techniques to reduce titanium particle contamination during implantoplasty

OBJECTIVES

Our aim is to study titanium remains in a bone model during standardized implantoplasty under different isolation and protective modalities.

MATERIAL AND METHODS

Forty implants were placed in artificial spongy bone blocks mimicking a horizontal bone loss and implant neck protrusion of 5 mm. Samples were randomly divided into four groups (n = 10), which were treated as follows: rubber dam (A), a dental adhesive paste (B), bone wax (C), and an unprotected positive control (D). Implantoplasty was performed using carbide and diamond burs under strict water cooling and standardized suction. After removal of the respective isolation materials, the bone blocks were thoroughly rinsed with tap water for 3 min and titanium chips were collected using a filter integrated in the model. The filter paper was removed and dissolved in 37% hydrochloric acid for 2 h at 120 °C and the titanium remnants were quantified using atomic absorption spectrometry.

RESULTS

None of the test groups were able to completely prevent titanium particle contamination. Rubber dam (691 ± 249 µg) and bone wax (516 ± 157 µg) were found to be significantly more protective than the positive control (2313 ± 747 µg) (p < 0.001) with respect to the amount of titanium particles that remained in the bone model after implantoplasty. The adhesive paste group (1863.5 ± 538 µg) was not significantly different from the positive control (p = 0.19).

CONCLUSIONS

Despite some limitations of the present study, titanium particles resulting from a standardized implantoplasty can be assumed to be significantly reduced when the tissues/bone were protected with rubber dam and bone wax, or a combination, depending on individual accessibility.

CLINICAL RELEVANCE

Tissue protective measures to reduce or avoid particle contamination during implantoplasty is possible and should be considered and further clinically assessed to avoid iatrogenic inflammatory reactions.

Quantification of titanium and zirconium elements in oral mucosa around healthy dental implants: a case-control pilot study

OBJECTIVES

Metallic particles are detected in different sites of the oral cavity, mainly in patients with peri-implantitis lesions. The aim of this pilot study was to analyze the levels of titanium and zirconium elements in the oral mucosa around healthy implants and to investigate the impact of titanium exogenous contamination on the measurements.

MATERIALS AND METHODS

Forty-one participants were included in this three-phase study. Two groups of subjects were defined according to presence of titanium or zirconia implants (n: 20) or without any implants nor metallic restorations (n:21). Thirteen patients (n: 5 with zirconia implant; n: 3 with titanium implants; n: 5 control group) took part to the first part designed to optimize and validate the method of detecting titanium (Ti) and zirconium (Zr) elements in the oral mucosa and gingival tissues by the Inductively Coupled Plasma Mass Spectrometry (ICPMS). The second phase compared the levels of Ti and Zr concentrations in patients with implants (n: 12) and without implants (n: 6) who were controlled for their intake of titanium dioxide (TiO2). The last step included ten control subjects without any metallic devices to measure the concentration of Ti and Zr before and after having candies containing TiO2.

RESULTS

In the first phase, concentrations of Ti and Zr were below the limit of detection (LOD) in most cases, 0.18 μg/L and 0.07 μg/L respectively. In the titanium group, two out of three subjects displayed concentrations above the LOD, 0.21 μg/L and 0.66 μg/L. Zr element was only found in patients with zirconia implants. After controlling the intake of TiO2, all concentrations of Ti and Zr were below the limit of quantification (LOQ). Moreover, in patients with no implants, the Ti concentration in gingiva cells was superior for 75% of the samples after having a TiO2 diet.

CONCLUSIONS

Zirconium was only found in patients with zirconia implants, whereas titanium was detected in all groups even in subjects with no titanium implants. Zirconium and titanium elements were not detected in patients who were controlled for their intake of food and their use of toothpaste irrespective of the presence of implants or not. For 70% of the patients, the titanium detection was directly influenced by the intake of TiO2 contained candies.

CLINICAL RELEVANCE

When analyzing titanium particles, it is necessary to pay attention to the risk of contamination bias brought by external products. When this parameter was controlled, no titanium particles were detected around clinically healthy implants.

Titanium Particles Modulate Lymphocyte and Macrophage Polarization in Peri-Implant Gingival Tissues

Titanium dental implants are one of the modalities to replace missing teeth. The release of titanium particles from the implant's surface may modulate the immune cells, resulting in implant failure. However, little is known about the immune microenvironment that plays a role in peri-implant inflammation as a consequence of titanium particles. In this study, the peri-implant gingival tissues were collected from patients with failed implants, successful implants and no implants, and then a whole transcriptome analysis was performed. The gene set enrichment analysis confirmed that macrophage M1/M2 polarization and lymphocyte proliferation were differentially expressed between the study groups. The functional clustering and pathway analysis of the differentially expressed genes between the failed implants and successful implants versus no implants revealed that the immune response pathways were the most common in both comparisons, implying the critical role of infiltrating immune cells in the peri-implant tissues. The H&E and IHC staining confirmed the presence of titanium particles and immune cells in the tissue samples, with an increase in the infiltration of lymphocytes and macrophages in the failed implant samples. The in vitro validation showed a significant increase in the level of IL-1β, IL-8 and IL-18 expression by macrophages. Our findings showed evidence that titanium particles modulate lymphocyte and macrophage polarization in peri-implant gingival tissues, which can help in the understanding of the imbalance in osteoblast-osteoclast activity and failure of dental implant osseointegration.

Antimicrobial photodynamic therapy against oral biofilm: influencing factors, mechanisms, and combined actions with other strategies

Oral biofilms are a prominent cause of a wide variety of oral infectious diseases which are still considered as growing public health problems worldwide. Oral biofilms harbor specific virulence factors that would aggravate the infectious process and present resistance to some traditional therapies. Antimicrobial photodynamic therapy (aPDT) has been proposed as a potential approach to eliminate oral biofilms via in situ-generated reactive oxygen species. Although numerous types of research have investigated the effectiveness of aPDT, few review articles have listed the antimicrobial mechanisms of aPDT on oral biofilms and new methods to improve the efficiency of aPDT. The review aims to summarize the virulence factors of oral biofilms, the progress of aPDT in various oral biofilm elimination, the mechanism mediated by aPDT, and combinatorial approaches of aPDT with other traditional agents.

Long-term in vivo degradation of Mg-Zn-Ca elastic stable intramedullary nails and their influence on the physis of juvenile sheep

The use of bioresorbable magnesium (Mg)-based elastic stable intramedullary nails (ESIN) is highly promising for the treatment of pediatric long-bone fractures. Being fully resorbable, a removal surgery is not required, preventing repeated physical and psychological stress for the child. Further, the osteoconductive properties of the material support fracture healing. Nowadays, ESIN are exclusively implanted in a non-transphyseal manner to prevent growth discrepancies, although transphyseal implantation would often be required to guarantee optimized fracture stabilization. Here, we investigated the influence of trans-epiphyseally implanted Mg-Zinc (Zn)-Calcium (Ca) ESIN on the proximal tibial physis of juvenile sheep over a period of three years, until skeletal maturity was reached. We used the two alloying systems ZX10 (Mg-1Zn-0.3Ca, in wt%) and ZX00 (Mg-0.3Zn-0.4Ca, in wt%) for this study. To elaborate potential growth disturbances such as leg-length differences and axis deviations we used a combination of in vivo clinical computed tomography (cCT) and ex vivo micro CT (μCT), and also performed histology studies on the extracted bones to obtain information on the related tissue. Because there is a lack of long-term data regarding the degradation performance of magnesium-based implants, we used cCT and μCT data to evaluate the implant volume, gas volume and degradation rate of both alloying systems over a period of 148 weeks. We show that transepiphyseal implantation of Mg-Zn-Ca ESIN has no negative influence on the longitudinal bone growth in juvenile sheep, and that there is no axis deviation observed in all cases. We also illustrate that 95 % of the ESIN degraded over nearly three years, converging the time point of full resorption. We thus conclude that both, ZX10 and ZX00, constitute promising implant materials for the ESIN technique.

Do Titanium Dioxide Particles Stimulate Macrophages to Release Proinflammatory Cytokines and Increase the Risk for Peri-implantitis?

PURPOSE

Titanium dioxide (TiO₂) particles detached from titanium dental implants by tribocorrosion can be phagocytosed by macrophages, releasing various proinflammatory cytokines at the implant sites that may trigger peri-implantitis. The study objective was to measure the association between peri-implantitis and the presence of non-allergy-related proinflammatory cytokines associated with TiO₂ particles.

METHODS

The investigators implemented a retrospective cross-sectional study and enrolled a sample of 60 subjects from a dental practice. Subjects were excluded if the plaque index was grade 3 (Silness and Löe). The predictor variable was a positive or negative TiO₂ stimulation test, an in vitro macrophage proinflammatory response test. The outcome variable was peri-implantitis status defined as present or absent. Three groups were considered: control group with 20 patients without dental implants (group 1), 2 groups of patients with titanium dental implants, one without peri-implantitis (group 2), and the other with peri-implantitis (group 3) (n = 20 each). For patients with implants, depth of the gingival pockets of the implants were measured, and existing bleeding and suppuration were determined to assess peri-implantitis. Radiographs were taken if one or more factors applied to confirm the diagnosis of peri-implantitis. Further covariates were age, sex, duration of implant wear, and number of implants which were analyzed descriptively. Inferential analyses were undertaken using χ² test, Kruskal-Wallis-, Wilcoxon-two-sample tests, and logistic regressions.

RESULTS

The sample was composed of 35 female and 25 male patients with a mean age of 54.2 years (standard deviation = 14.76). The overall TiO₂ stimulation test positivity frequency was 28.3% and were 30.0%, 5.0%, and 50.0% in the control, implants without peri-implantitis, and implants with peri-implantitis groups. No statistically significant differences could be seen in the frequencies of the TiO₂ stimulation test results between control group and combined groups 2 and 3 (P-value = .84). The risk for positive TiO₂ patients with a titanium implant of developing peri-implantitis was statistically significant and higher compared to negative TiO₂ patients (odds ratio, 19.0 with 95% confidence interval [2.12,170.38]; P-value< .01).

CONCLUSIONS

The data in this study showed a statistically significant relationship between a positive TiO₂ stimulation test and peri-implantitis. Further studies with larger numbers of subjects are recommended to confirm this result.

Dental implant material related changes in molecular signatures in peri-implantitis - A systematic review and integrative analysis of omics in-vitro studies

OBJECTIVE

Since peri-implantitis differs clinically and histopathologically from periodontitis, implant wear debris is considered to play a role in the destructive processes. This work aims to systematically review if titanium particles affect oral-related cells through changes in molecular signatures (e.g., transcriptome, proteome, epigenome), thereby promoting peri-implantitis.

METHODS

Leveraging three literature databases (Medline, Embase, Cochrane) a systematic search based on a priori defined PICOs was conducted: '-omics' studies examining titanium exposure in oral-related cells. After risk of bias assessments, lists of differentially expressed genes, proteins, and results of functional enrichment analyses were compiled. The significance of overlapping genes across multiple studies was assessed via Monte Carlo simulation and their ranking was verified using rank aggregation.

RESULTS

Out of 2104 screened articles we found 12 eligible publications. A significant overlap of gene expression in oral-related cells exposed to titanium particles was found in four studies. Furthermore, changes in biological processes like immune/inflammatory or stress response as well as toll-like receptor (TLR) and mitogen-activated protein kinase (MAPK) signaling pathways were linked to titanium in transcriptome and proteome studies. Epigenetic changes caused by titanium were detected but inconsistent.

CONCLUSION

An influence of titanium implant wear debris on the development and progression of peri-implantitis is plausible but needs to be proven in further studies. Limitations arise from small sample sizes of included studies and insufficient publication of re-analyzable data.

Immunopathological Inflammation in the Evolution of Mucositis and Peri-Implantitis

The purpose of this study was to provide an immuno-mediated substantiation of the etiopathogenesis of mucositis and peri-implantitis based on the results of experimental, laboratory and clinical studies. The biopsy material was studied to identify impregnated nanoscale and microscale particles in the structure of pathological tissues by using X-ray microtomography and X-ray fluorescence analyses. Electron microscopy with energy-dispersive analysis identified the composition of supernatants containing nanoscale metal particles obtained from the surfaces of dental implants. The parameters of the nanoscale particles were determined by dynamic light scattering. Flow cytometry was used to study the effect of nanoscale particles on the ability to induce the activation and apoptosis of immunocompetent cells depending on the particles' concentrations during cultivation with the monocytic cell line THP-1 with the addition of inductors. An analysis of the laboratory results suggested the presence of dose-dependent activation, as well as early and late apoptosis of the immunocompetent cells. Activation and early and late apoptosis of a monocytic cell line when THP-1 was co-cultured with nanoscale metal particles in supernatants were shown for the first time. When human venous blood plasma was added, both activation and early and late apoptosis had a dose-dependent effect and differed from those of the control groups.

Impact of Metal Particles Released during Ultrasonic Scaling of Titanium Surfaces on Human Gingival Fibroblasts

PURPOSE

Metal particles found in tissues around dental implants have been proposed to play a pathogenic role in peri-implantitis. Ultrasonic scaling has been suggested as a mechanism by which these particles can be inadvertently released into surrounding tissues. Furthermore, risk factors like diabetes can result in exacerbation of this inflammatory condition. The current study aimed to analyze metal particles released from titanium surfaces during ultrasonic scaling and their impact on pro-inflammatory cytokine production by human gingival fibroblasts.

METHODS

Metal particles generated from ultrasonic scaling of titanium discs using two different tips (metal and poly-etheretherketone tips) were characterized using scanning electron microscopy and elemental analysis. Endotoxin levels and Human gingival fibroblast viability, in the presence commercial and ultrasonically generated particles were determined. Fibroblasts, cultured in high or low glucose growth medium, were incubated with commercial titanium particles or ultrasonically generated particles in the presence or absence of interluekin-1β. Interleukin 6 and interleukin 8 production were then quantified using Enzyme linked immunosorbent assay.

RESULTS

Analysis of particles after scaling of titanium discs showed significant levels of titanium particles. Commercial titanium particles and generated particles had no effect of fibroblast viability. Endotoxin levels of all particles were too low to stimulate HGF cells. IL-1β significantly stimulated IL-6 and IL-8 production. However, commercial, and generated particles generally had no significant effect on IL- 6 and IL-8 production.

CONCLUSION

Our study concluded that particles generated during ultrasonic scaling had no significant effect on viability of HGF cells and cytokine production.

Effect of Silicon Carbide Coating on Osteoblast Mineralization of Anodized Titanium Surfaces

The objective of this study was to evaluate the influence of the titanium nanotube diameter and the effect of silicon carbide (SiC) coating on the proliferation and mineralization of pre-osteoblasts on titanium nanostructured surfaces. Anodized titanium sheets with nanotube diameters of 50 and 100 nm were used. The following four groups were tested in the study: (1) non-coated 50 nm nanotubes; (2) SiC-coated 50 nm titanium nanotubes; (3) non-coated 100 nm nanotubes and (4) SiC-coated 100 nm nanotubes. The biocompatibility and cytotoxicity of pre-osteoblasts were evaluated using a CellTiter-BlueCell Viability assay after 1, 2, and 3 days. After 3 days, cells attached to the surface were observed by SEM. Pre-osteoblast mineralization was determined using Alizarin-Red staining solution after 21 days of cultivation. Data were analyzed by a Kruskal−Wallis test at a p-value of 0.05. The results evidenced biocompatibility and non-cytotoxicity of both 50 and 100 nm diameter coated and non-coated surfaces after 1, 2 and 3 days. The statistical analysis indicates a statistically significant higher cell growth at 3 days (p < 0.05). SEM images after 3 days demonstrated flattened-shaped cells without any noticeable difference in the phenotypes between different diameters or surface treatments. After 21 days of induced osteogenic differentiation, the statistical analysis indicates significantly higher osteoblast calcification on coated groups of both diameters when compared with non-coated groups (p < 0.05). Based on these results, we can conclude that the titanium nanotube diameter did not play any role on cell viability or mineralization of pre-osteoblasts on SiC-coated or non-coated titanium nanotube sheets. The SiC coating demonstrated biocompatibility and non-cytotoxicity and contributed to an increase in osteoblast mineralization on titanium nanostructured surfaces when compared to non-coated groups.

The Effect of Amino Sugars on the Composition and Metabolism of a Microcosm Biofilm and the Cariogenic Potential against Teeth and Dental Materials

Amino sugars N-acetylglucosamine (GlcNAc) and glucosamine (GlcN) are abundant sources of carbon and nitrogen in the oral cavity. The aim of this study was to investigate the effects of GlcNAc metabolism on the genomics and biochemistry of a saliva-derived microbial community, and on the surface integrity of human teeth and restorative surfaces. Pooled cell-containing saliva (CCS) was used to establish a microcosm biofilm in vitro in a biofilm medium (BM) containing 5 different carbohydrates. The microbial composition of each biofilm was analyzed by 16S rRNA amplicon sequencing, and the concentrations of eight organic acids were determined for selected sugars by targeted metabolomics. Meanwhile, extracted human teeth and polished titanium and ceramic disks were submerged in BM supplemented with 1% of glucose or GlcNAc, inoculated with CCS and Streptococcus mutans UA159, and incubated for 30 days. To mimic the effects of other microbial byproducts, the specimens were immersed in 10 mM hydrogen peroxide and 10 mM ammonium hydroxide for 30 days. The surface of each specimen was evaluated by profilometry for roughness (Ra) and imaged by scanning electron microscopy. The pH of the biofilm supernatant was significantly higher for the medium containing GlcNAc (p < 0.0001), and was higher in samples containing teeth than the two restorative disks for media containing the same sugar. For both teeth and titanium specimens, the samples treated with glucose-biofilm presented higher roughness values (Ra) than those with GlcNAc-biofilm and every other group. SEM images of the teeth and titanium disks largely supported the profilometry results, with glucose-biofilm samples demonstrating the largest deviation from the reference. For ceramic disks, slightly higher Ra values were obtained for the ammonia group. These findings provide the first direct evidence to support the ability of amino sugars to significantly reduce the cariogenic potential of oral biofilms by altering their biochemistry and bacterial composition. Additionally, amino sugar metabolism appears to be less detrimental to teeth and restorative surfaces than glucose metabolism.

Bio-Tribocorrosion of Titanium Dental Implants and Its Toxicological Implications: A Scoping Review

Bio-tribocorrosion is a phenomenon that combines the essentials of tribology (friction, wear, and lubrication) and corrosion with microbiological processes. Lately, it has gained attention in implant dentistry because dental implants are exposed to wear, friction, and biofilm formation in the corrosive oral environment. They may degrade upon exposure to various microbial, biochemical, and electrochemical factors in the oral cavity. The mechanical movement of the implant components produces friction and wear that facilitates the release of metal ions, promoting adverse oro-systemic reactions. This review describes the bio-tribocorrosion of the titanium (Ti) dental implants in the oral cavity and its toxicological implications. The original research related to the bio-tribo or tribocorrosion of the dental implants was searched in electronic databases like Medline (Pubmed), Embase, Scopus, and Web of Science. About 34 studies included in the review showed that factors like the type of Ti, oral biofilm, acidic pH, fluorides, and micromovements during mastication promote bio-tribocorrosion of the Ti dental implants. Among the various grades of Ti, grade V, i.e., Ti6Al4V alloy, is most susceptible to tribocorrosion. Oral pathogens like Streptococcus mutans and Porphyromonas gingivalis produce acids and lipopolysaccharides (LPS) that cause pitting corrosion and degrade the TiO2. The low pH and high fluoride concentration in saliva hinder passive film formation and promote metal corrosion. The released metal ions promote inflammatory reactions and bone destruction in the surrounding tissues resulting in peri-implantitis, allergies, and hyper-sensitivity reactions. However, further validation of the role of bio-tribocorrosion on the durability of the Ti dental implants and Ti toxicity is warranted through clinical trials.

Preventing Peri-implantitis: The Quest for a Next Generation of Titanium Dental Implants

Titanium and its alloys are frequently the biomaterial of choice for dental implant applications. Although titanium dental implants have been utilized for decades, there are yet unresolved issues pertaining to implant failure. Dental implant failure can arise either through wear and fatigue of the implant itself or peri-implant disease and subsequent host inflammation. In the present report, we provide a comprehensive review of titanium and its alloys in the context of dental implant material, and how surface properties influence the rate of bacterial colonization and peri-implant disease. Details are provided on the various periodontal pathogens implicated in peri-implantitis, their adhesive behavior, and how this relationship is governed by the implant surface properties. Issues of osteointegration and immunomodulation are also discussed in relation to titanium dental implants. Some impediments in the commercial translation for a novel titanium-based dental implant from "bench to bedside" are discussed. Numerous in vitro studies on novel materials, processing techniques, and methodologies performed on dental implants have been highlighted. The present report review that comprehensively compares the in vitro, in vivo, and clinical studies of titanium and its alloys for dental implants.

The role of foreign body response in peri-implantitis: What is the evidence?

Historically, there has been broad consensus that osseointegration represents a homeostasis between a titanium dental implant and the surrounding bone, and that the crestal bone loss characteristic of peri-implantitis is a plaque-induced inflammatory process. However, this notion has been challenged over the past decade by proponents of a theory that considers osseointegration an inflammatory process characterized by a foreign body reaction and peri-implant bone loss as an exacerbation of this inflammatory response. A key difference in these two schools of thought is the perception of the relative importance of dental plaque in the pathogenesis of crestal bone loss around implants, with obvious implications for treatment. This review investigates the evidence for a persistent foreign body reaction at osseointegrated dental implants and its possible role in crestal bone loss characteristic of peri-implantitis. Further, the role of implant-related material release within the surrounding tissue, particularly titanium particles and corrosion by-products, in the establishment and progression in peri-implantitis is explored. While it is acknowledged that these issues require further investigation, the available evidence suggests that osseointegration is a state of homeostasis between the titanium implant and surrounding tissues, with little evidence that a persistent foreign body reaction is responsible for peri-implant bone loss after osseointegration is established. Further, there is a lack of evidence for a unidirectional causative role of corrosion by-products and titanium particles as possible non-plaque related factors in the etiology of peri-implantitis.

Electrophoretic-deposited MXene titanium coatings in regulating bacteria and cell response for peri-implantitis

Background: Two-dimensional(2D)MXenes have continued to receive increasing interest from researchers due to their graphene-like properties, in addition to their versatile properties for applications in electronic devices, power generation, sensors, drug delivery, and biomedicine. However, their construction and biological properties as titanium coatings to prevent peri-implantitis are still unclear.

Materials and methods: In this work, few-layer Ti₃C₂T_x MXene coatings with different thicknesses at varied depositing voltages (30, 40, and 50 V) were constructed by anodic electrophoretic deposition without adding any electrolytic ions. In vitro cytocompatibility assay was performed on preosteoblasts (MC3T3-E1) cell lines after the characterization of the coating. Meanwhile, the antibacterial activity against bacteria which are closely related to peri-implantitis including Staphylococcus aureus (S. aureus) and its drug-resistant strain MRSA was further investigated.

Results: MXene-coated titanium models with different thicknesses were successfully assembled by analyzing the results of characterization. The compounding of Ti₃C₂T_x could significantly improve the initial adhesion and proliferation of MC3T3-E1 cells. Moreover, the coating can effectively inhibit the adhesion and cell activity of S. aureus and MRSA, and MRSA expressed greater restricting behavior than S. aureus. The ability to promote antibacterial activity is proportional to the content of Ti₃C₂T_x. Its antioxidant capacity to reduce ROS in the culture environment and bacterial cells was first revealed.

Conclusion: In summary, this work shows a new avenue for MXene-based nano-biomaterials under the clinical problem of multiple antibiotic resistance.

Asperuloside Prevents Peri-Implantitis via Suppression of NF-κB and ERK1/2 on Rats

Peri-implantitis is characterized by inflammatory cell infiltration and hyperactivation of the osteoclasts surrounding dental implants which can result in bone resorption and ultimately implant failure. Therefore, coordinating the activity of inflammatory response and bone-resorbing osteoclasts is crucial for the prevention of peri-implantitis. Asperuloside (ASP), an iridoid glycoside, has significant anti-inflammatory activities, suggesting the great potential in attenuating peri-implantitis bone resorption. A ligature-induced peri-implantitis model in the maxilla of rats was established, and the effects of ASP on preventing peri-implantitis were evaluated after four weeks of ligation using micro-CT and histological staining. RT-PCR, western blotting, tartrate-resistant acid phosphatase (TRAP), and immunofluorescent staining were conducted on osteoclasts to confirm the mechanisms of ASP on osteoclastogenesis. The results show that ASP could lead to attenuation of alveolar bone resorption in peri-implantitis by inhibiting osteoclast formation and decreasing pro-inflammatory cytokine levels in vivo. Furthermore, ASP could inhibit osteoclastogenesis by downregulating expression levels of transcription factors nuclear factor of activated T-cell (NFATc1) via restraining the activations of nuclear factor kappa beta (NF-κB) and the phosphorylation of extracellular signal-related kinase 1/2 (ERK1/2). In conclusion, ASP could significantly attenuate bone resorption in peri-implantitis via inhibition of osteoclastogenesis by suppressing NF-κB and ERK1/2 signaling pathways activations.