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Gene expression in peri-implant crevicular fluid of smokers and nonsmokers. 1. The early phase of osseointegration

Journal article
Authors Shariel Sayardoust
Omar Omar
Peter Thomsen
Published in Clinical Implant Dentistry and Related Research
Volume 19
Issue 4
Pages 681-693
ISSN 1523-0899
Publication year 2017
Published at Institute of Clinical Sciences, Department of Biomaterials
Pages 681-693
Language en
Keywords bone quantity, bone quality, gene expression, implant surface, osseointegration, pain, peri-implant, marginal bone loss, titanium implants, adherent cells, smoking, nicotine, periodontitis, metaanalysis, trial, pcr, Dentistry, Oral Surgery & Medicine
Subject categories Biomaterials Science


BackgroundSmoking is a risk factor for dental implants. The mechanisms behind the impact of smoking on osseointegration are not fully understood. PurposeTo investigate the initial molecular and clinical course of osseointegration of different titanium implants in smokers and nonsmokers. Materials and MethodsSmoker (n=16) and nonsmoker (n=16) patients were included. Each patient received three implant types: machined, oxidized and laser-modified surfaces. After 1, 7, 14, and 28 days, the peri-implant crevicular fluid (PICF) was sampled for gene expression analysis of selected factors involved in early processes of osseointegration. Furthermore, pain-score (VAS), resonance frequency analysis (RFA) and baseline clinical assessments were performed. ResultsEarly failure of osseointegration, associated with a high and sustained perception of pain, was encountered in 3/32 patients. In general, high pain scores were reported during the first days after implantation, irrespective to smoking habit, which correlated to high levels of pro-inflammatory cytokines during the first days after implantation. Higher ISQ values were found in smokers compared to nonsmokers. In smokers exclusively, ISQ values correlated to harder and less atrophic bone quality and quantity, respectively. Smokers displayed a higher expression of osteocalcin (OC), but later peak and lower expression of bone morphogenetic protein (BMP-2) (at 7 days) compared to nonsmokers. In comparison to machined implants, surface-modified implants were associated with higher expression of alkaline phosphatase (ALP) and cathepsin K (CatK) at 28 days in nonsmokers. ConclusionsDuring the early phase of osseointegration, postoperative pain is linked to the inflammatory cell response and, may tentatively serve as an indicator of biological complication and implant loss. The present study suggests that smokers have an altered bone composition and (ultra)structure based on the observations that ISQ values are higher and correlate to recipient bone quality and quantity in smokers.

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