Wound healing and PMN function at hydrophilic-surface titanium-zirconium implants in diabetic and healthy patients

CVYCL ePOSTER CLINICAL RESEARCH – PERI-IMPLANT BIOLOGY

Background: Diabetes mellitus II (DM II) patients exhibit impaired microcirculation and reduced neutrophil (PMN) function, causing higher susceptibility to periimplantitis and increased risk of wound infection. Shorter treatment regimens with reduced complexity are recommended. Hydrophilic-surface titanium-zirconium implants allow for shortened healing time. Increased mechanical strength permits use of reduced-diameter implants, resulting in less invasive surgery and reduced need for bone augmentation.

Aim/Hypothesis: To investigate wound healing and PMN function at reduced-diameter hydrophilic titanium-zirconium implants in diabetic and healthy patients

Materials and Methods: 16 DM II patients (HbA1C>6.5%) and 19 NO-diabetic patients (HbA1C≤6.0%) received one hydrophilic-surface reduced-diameter titanium-zirconium implant each (Tissue level SP, Roxolid SLActive, Institut Straumann AG, Basel, CH) following the standard protocol for transmucosal healing without bone augmentation. As a parameter for outcome of wound healing, mucosal microcirculation was recorded using a Laser Doppler flowmeter (Periflux 5010, Perimed AB, Sweden) equipped with a PF 416 probe. Microcirculation was assessed before treatment, after local anesthesia, after completion of surgery, 3 days, 7 days, 10 days, 4 weeks, 3 and 6 months after surgery. Samples of peri-implant fluid (PIF) and gingival crevice fluid (GCF) were collected at implants and healthy control teeth after 7 days, after 4 weeks, and after 6 months. Fluid levels of pro-/anti-inflammatory cytokines IL-1β, Gm-CSF, IL-17a, and IL-23 were determined using a multiplex immunoassay (MAGPIX, Luminex, Merck, GER).

Results: In both groups, local anaesthesia and surgery caused immediately similar significant reductions of mucosal blood flow. Microcirculation increased significantly again 1 day after surgery and returned to unimpaired baseline levels. Cytokine levels at teeth were constant throughout the study. Cytokine profiles differed significantly between teeth and implants. Expression of pro-inflammatory cytokines was significantly higher after implant placement in diabetics, but decreased significantly to levels comparable to healthy patients.

Conclusions and Clinical Implications: Initially, diabetic patients showed a more pro-inflammatory cytokine profile. However, wound healing and - at longer term - PMN response at implants appeared similar in diabetic and NO-diabetic patients. Hydrophilic-surface titanium-zirconium implants with reduced diameter may be considered for implant therapy of Diabetes mellitus type II patients.

Acknowledgements: Supported by Institut Straumann AG, Basel, CH.

Keywords: Diabetes mellitus, cytokines, peri-implant fluid, implants, wound healing