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Different Contribution of BRINP3 Gene in Chronic Casado et al. BMC Oral Health (2015) 15:33 DOI 10.1186/s12903-015-0018-6 RESEARCH ARTICLE Open Access Different contribution of BRINP3 gene in chronic periodontitis and peri-implantitis: a cross- sectional study Priscila L Casado1,2, Diego P Aguiar2, Lucas C Costa3, Marcos A Fonseca3, Thays CS Vieira2,4, Claudia CK Alvim-Pereira5, Fabiano Alvim-Pereira6, Kathleen Deeley7, José M Granjeiro1,9, Paula C Trevilatto8 and Alexandre R Vieira7,10* Abstract Background: Peri-implantitis is a chronic inflammation, resulting in loss of supporting bone around implants. Chronic periodontitis is a risk indicator for implant failure. Both diseases have a common etiology regarding inflammatory destructive response. BRINP3 gene is associated with aggressive periodontitis. However, is still unclear if chronic periodontitis and peri-implantitis have the same genetic background. The aim of this work was to investigate the association between BRINP3 genetic variation (rs1342913 and rs1935881) and expression and susceptibility to both diseases. Methods: Periodontal and peri-implant examinations were performed in 215 subjects, divided into: healthy (without chronic periodontitis and peri-implantitis, n = 93); diseased (with chronic periodontitis and peri-implantitis, n = 52); chronic periodontitis only (n = 36), and peri-implantitis only (n = 34). A replication sample of 92 subjects who lost implants and 185 subjects successfully treated with implants were tested. DNA was extracted from buccal cells. Two genetic markers of BRINP3 (rs1342913 and rs1935881) were genotyped using TaqMan chemistry. Chi-square (p < 0.05) compared genotype and allele frequency between groups. A subset of subjects (n = 31) had gingival biopsies ΔΔCT harvested. The BRINP3 mRNA levels were studied by CT method (2 ). Mann–Whitney test correlated the levels of BRINP3 in each group (p < 0.05). Results: Statistically significant association between BRINP3 rs1342913 and peri-implantitis was found in both studied groups (p = 0.04). The levels of BRINP3 mRNA were significantly higher in diseased subjects compared to healthy individuals (p = 0.01). Conclusion: This study provides evidence that the BRINP3 polymorphic variant rs1342913 and low level of BRINP3 expression are associated with peri-implantitis, independently from the presence of chronic periodontitis. Keywords: Chronic periodontitis, Peri-implantitis, Genetic polymorphism, Gene expression Background smoking, and history of chronic periodontitis [2], has been Peri-implantitis represents a collective term for chronic related to the development of peri-implantitis [3]. Individ- inflammatory processes affecting the tissues surrounding uals with a history of periodontitis and loss of supporting osseointegrated dental implants and resulting in loss of bone may experience more implant loss and complica- supporting bone [1]. A series of risk indicators for im- tions around implants than non-periodontitis patients [4]. plant survival, such as lack of oral hygiene, diabetes, Periodontal pathogens transmitted from residual dentition to the implant sites can be detected around an implant one month after reopening surgery [5]. * Correspondence: [email protected] 7Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA Studies concerning the etiopathogenesis of peri- 10Department of Oral Biology, School of Dental Medicine, University of implantitis are based on the development of the peri- Pittsburgh, 3501 Terrace Street, Pittsburgh, PA 15261, USA odontal disease. In periodontitis, the local inflammatory Full list of author information is available at the end of the article © 2015 Casado et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Casado et al. BMC Oral Health (2015) 15:33 Page 2 of 10 reaction to bacterial infection activates the innate im- smoking habit and alcohol consumption recorded. The mune system, resulting in the release of an array of me- exclusion criterion was implant failure before osseointe- diators that propagate the inflammation throughout the gration period. The inclusion criteria were: to have at gingival tissues [6,7]. Previous studies indicated that least one osseointegrated endosseous implant, immedi- chronic periodontitis [8,9], as well as peri-implantitis ate postoperative radiography showing the vertical bone [10-15], may have a genetic background. However, there level around implant in order to compare bone level is no definitely identified genetic polymorphism that ex- after osseointegration period, periapical radiography plains biological complications in dental implants [16]. showing periodontal status before implant placement, In addition, studies considering the association between and to be under maintenance care annually for both a genetic predisposition and implant failure have a weak clinical and radiographic examination. All implants were point: the lack of data reporting the periodontal status of placed in a submerged modality (two-stage concept) in the patients. sites previously showing favorable bone quality and Carvalho et al. [17] have shown that aggressive peri- quantity. Either single crowns or short span fixed partial odontitis is associated with markers in BRINP3 (bone dentures supported implants. morphogenetic protein/ retinoic acid inducible neural- specific 3, previously referred as FAM5C). BRINP3 is re- Diagnosis of peri-implantitis lated to several cellular functions, such as proliferation, All peri-implant regions were clinically and radiograph- migration, and programmed cell death, and is related to ically evaluated. Clinical examination of the peri-implant several diseases, including invasion of pituitary tumors, sites consisted of visual inspection and palpation, ana- atherosclerosis [18], and myocardial infarction [19]. The lysis of mucosa inflammation, edema, probing pocket BRINP3 single nucleotide polymorphism rs1935881 was depth, bleeding on probing and spontaneous bleeding in associated with norepinephrine change during exercise four aspects (mesial, buccal, distal and lingual/palatine), [20]; the same BRINP3 variant we found to be associated plaque index, peri-implant phenotype [21], and implant to aggressive periodontitis in 389 subjects evaluated from mobility. One single examiner (P.L.C.) performed all 55 pedigrees [17]. Motivated by the evidence that BRINP3 evaluations according to the same guidelines. No calibra- contributes to aggressive periodontitis we decided to in- tion protocol was implemented. Conventional periapical vestigate the role of BRINP3 in peri-implantitis. Our radiography, using the paralleling technique, was used to research group raised two questions: (i) Do BRINP3 poly- assess the presence of vertical bone loss around the im- morphisms predispose to peri-implantitis in patients with plants by measuring the height of peri-implant bone chronic periodontitis? (ii) Does the genetic background as- compared to initial radiography immediate after implant sociated to BRINP3 gene predispose to chronic periodon- placement. According to the clinical and radiographic titis and peri-implantitis by the same way? In the present characteristics of the peri-implant sites, subjects were work, we looked for evidence that BRINP3 may contribute characterized as having healthy sites-no clinical signs of to peri-implantitis and chronic periodontitis by testing for inflammation in the peri-implant mucosa and no signs association between genetic markers in BRINP3 and den- of bone loss–or peri-implantitis–radiographic signs of tal implant failure. pathologic bone loss in at least one region (Table 1). Physiological bone loss was characterized considering Methods the normal bone loss of 1 mm at the first year after im- Discovery sample plant placement and 0.2 mm for subsequent years [22]. Subject selection According to the implant osseointegration period, the Two hundred and fifteen individuals, presenting 754 total amount of bone loss was calculated based on the osseointegrated endosseous implants, were randomly re- difference between immediate postoperative radiography cruited for the study from the patients’ pool at the Den- and diagnosis radiography (at the moment of peri- tal Clinics of the Faculty of Dentistry, Fluminense implant examination). If the total of bone loss was su- Federal University, Niterói, and Veiga de Almeida Uni- perior to 1 mm and 0.2 mm for year, the patient was versity, Rio de Janeiro, Rio de Janeiro, Brazil, during one considered to have peri-implantitis. year. Clinical procedures were conducted according to recommendations from both Universities’ Research Eth- Diagnosis of chronic periodontitis ics Boards (Registration number 238/10 and 0070621 Subjects were characterized as healthy (without history 2.9.0000.5243 12/09, respectively). Informed consent was of chronic periodontitis) or with chronic periodontitis obtained from all participants. The baseline clinical pa- (with history of chronic periodontitis). rameters for the subject population are shown in Table 1. The diagnosis of chronic periodontitis was established Subjects answered a personal, medical, and dental his- on the basis of radiographic
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