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Peri-Implant Indices of Remodeling As a Response to Mechanical Loading THESIS

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Peri-Implant Indices of Remodeling As a Response to Mechanical Loading THESIS Peri-implant Indices of Remodeling as a Response to Mechanical Loading THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Michael Lynn Gurney Graduate Program in Dentistry The Ohio State University 2012 Dissertation Committee: Dr. Binnaz Leblebicioglu D.D.S. PhD “Advisor” Dr. Edwin McGlumphy D.D.S. M.S. Dr. John Walters D.D.S. M.Med.Sci. i Copyright by Michael Lynn Gurney 2012 i Abstract Background: The current study aims to detect peri-implant tissue changes that may occur due to bone and soft tissue remodeling as a response to mechanical loading. Material and methods: Systemically healthy, non-smoking adults with a single posterior edentulous space with intact proximal natural teeth were recruited. Inclusion criteria were: adult patient, systemic health, periodontal health, single tooth posterior edentulous space, non- smoking, no grafting needed, and ability to consent to treatment. Exclusion criteria included presence of parafunctional habits and implants placed with significant angle precluding screw retained implant crowns. Peri-implant tissue changes were recorded prior to crown delivery and 1, 3, 6 and 12 weeks in function. Clinical parameters were: plaque and gingival indices (PI and GI), Resonance Frequency Analysis (RFA), and crevicular fluid (CF) samples of the implant and adjacent teeth. CF volume was determined using a calibrated electronic volume quantification unit. Samples were stored at -80C. Multiplex assay was performed for cytokine detection. Polymerase Chain Reaction was used to detect the presence of eight putative microflora. Data was analyzed using multiple model regression analysis corrected with Bonferroni adjustment. Correlation analysis was conducted by calculating Spearman correlation coefficient, statistical significance was accepted at p<0.05. ii Results: Sixteen patients were recruited and fifteen completed the study. Mean healing time prior to loading was 6.1±0.3 months. Implant Stability Quotient (ISQ) increased from 76.5±1.7 to 83.7±1.7 units (P<0.001). Peri-implant plaque accumulation was statistically lower than adjacent periodontal plaque accumulation at baseline (P=0.02) and this difference between groups stayed significant throughout the observation weeks (P<0.004). Peri-implant gingival index was statistically lower compared to adjacent periodontal gingival index before loading and at 1 week following loading (P<0.05). No difference between implant and adjacent tooth sites for GI at follow-up appointments (P>0.05). Peri-implant GI increased observed by 12 week was statistically significant compared to baseline (P=0). Gingival crevicular fluid (GCF) was statistically higher than peri-implant crevicular fluid (PICF) prior to loading (P=0.03). PICF increased following loading and was significantly greater than GCF at 1, 3, 6 and 12 weeks (P<0.04). Post-loading peri-implant crevicular fluid was statistically higher than pre-loading crevicular fluid when compared to baseline value (P=0.004). No significant differences in periodontal and peri-implant probing depths or the keratinized tissue width throughout the study (P>0.05). Cytokines: PDGF, IL-4, IL-6, IL-7, IL-10, IL-12, IL-17, Eotaxin, FGFb, IFN and TNFα were expressed at detectable but low levels at both PICF and GCF samples with no significant differences throughout the observation period. IL-1, IL-8, G-CSF, IP-10 and VEGF presented higher expression levels in gingival crevicular fluid samples compared to PICF samples prior to loading with no statistically significant difference. Following one week of loading, there was approximately a two fold increase in peri-implant crevicular fluid IL-1, IL-8 and MIP-1b levels although the differences were not statistically significant. VEGF and MCP-1 levels showed a iii trend towards increased expression at one week (P>0.05). Other cytokines, G-CSF and IP-10, were expressed at higher levels at both PICF and GCF samples following 3 weeks of loading compared to before loading values. The differences were not statistically significant (P>0.05). Microbiology data showed the presence of certain putative periodontal pathogens throughout observation period in a transient fashion. Conclusion: Within the limits of this study, it appears that mechanical loading following a traditional osseointegration period has significant effect on implant stability and peri-implant clinical indices used to evaluate soft tissue healing and health. However, the expression of pro- inflammatory cytokines and the presence of certain putative periodontal pathogens show significant variations among individuals. iv Dedication This document is dedicated to my family. They had to sacrifice a lot to allow me to complete this project. v Acknowledgments The greatest of thanks and appreciation for her guidance and mentorship needs to be given to my wonderful advisor Dr. Binnaz Leblebicioglu D.D.S. PhD of The Ohio State University College of Dentistry Graduate Periodontics Program. Thank you! I appreciate and offer my sincere thanks the help from my thesis committee, Dr. Edwin McGlumphy D.D.S M.S. of The Ohio State University College of Dentistry Implant Clinic and Dr. John Walters D.D.S. M.Med.Sci. of The Ohio State University College of Dentistry Periodontics Department. Special thanks are in need for the help of Dr. Julie Holloway D.D.S. M.S., now at the University Of Iowa College Of Dentistry, for input with the study protocols. Thanks to Dr. Tim Eubank PhD of the Ohio State University College of Medicine for helping with the Multiplex assays. Thanks to Dr. Purnima Kumar D.D.S. PhD of The Ohio State University College of Dentistry Periodontics Department for her help with the bacterial PCR detection procedures. vi Thanks to Mr. Vedat Yildiz M.S. from the Ohio State University Biostatistics Department for the statistical analysis. A special thanks needs to be extended to the graduate residents of the Graduate Periodontics Residency program for the recruitment of patients and their help with surgical placement of dental implant. Thanks are in need for the faculty and staff of the Graduate Prosthodontics Residency Clinic for their help and support throughout the treatment period of the patients in the study. This research project was funded by a grant through NIDCR: NIDCR R21DE018718 to Dr. Leblebicioglu vii Vita June 1998 ............................................................. Emmett Senior High School April 2005 ............................................................. B.S. Biology, BYU – Idaho May 2009 ............................................................. D.D.S. Creighton University 2009 to Present ................................................... Graduate Prosthodontics Resident – ............................................................................. The Ohio State University College of Dentistry Fields of Study Major Field: Dentistry Publications AADR Abstract – 2012 Gurney M; Eubank T, Holloway JA, McGlumphy E, Walters J, Leblebicioglu B. Peri- implant indecies of Remodeling as a Response to Mechanical Loading. Abstract #168, AADR 2012 viii Table of Contents Peri-implant Indices of Remodeling as a Response to Mechanical Loading ..................................... i THESIS ............................................................................................................................................... i Abstract ............................................................................................................................................ ii Dedication ........................................................................................................................................ v Acknowledgments .......................................................................................................................... vi Vita .................................................................................................................................................viii Fields of Study ................................................................................................................................viii Publications ....................................................................................................................................viii Table of Contents ............................................................................................................................ ix List of Figures ................................................................................................................................. xiii CHAPTER 1: INTRODUCTION ........................................................................................................... 1 Wound healing during early phases of osseointegration ....................................................... 2 Bone Response to Load ......................................................................................................... 4 Clinical parameters used to evaluate peri-implant tissue health ............................................ 6 CHAPTER 2: MATERIAL AND METHODS ........................................................................................ 15 Study Population Study Design ........................................................................................... 15 ix Initial Comprehensive Oral Exam and Details on Surgical /Restorative Phases of Treatment ..................................................................................................................................................
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