| Objective: By detecting of multiple indexes at different time intervals after implant denture loading,the modification of the surrounded tissues was analyzed in order to explore and select the most effective inspection indexes for diagnosing the inflammation around implant denture.Methods:A total of 51 patients who accepted dental implant therapy in the Stomatological Hospital of Dalian Medical University were included in the study,in which a total of 76 dental implants were placed.All the patients were divided into four groups according to the interval after the denture was loaded: 3,6,12 and 24 months.During the patients' scheduled postoperative check in the clinic,the probing depth(PD),modification sulcus bleeding index(mBI),the peri-implant crevicular fluid(PICF)level,and the alkaline phosphatase(ALP)and aspartate transaminase(AST)levels in the gingival crevicular fluid were characterized and photographed by the X-ray.Quantification of ALP and AST contents in gingival crevicular fluid of implant was analyzed with automatic biochemical analyzer.At the same time,a total of 76 natural teeth from the same patient but locating on the opposite side of the implanted teeth were selected as controls for comparison.SPSS.20 software package was used for statistical analysis.Results:1.Clinical indicators(1)Probing depth(PD)The PD value of implant denture was significantly higher than that of the natural teeth by 0.89~1.9mm at each post-surgery interval(P<0.01).Moreover,the PD value increased along with the loading interval.The PD value of the 6-month group increased by 0.07 mm compared with the 3 month group,and the average PD value of the12-month group was 0.21 mm higher compared with the 6-month group,and the average PD value of the 24-month group was 0.59 mm higher compared with the 12-month group.Compared with the 24-month group,the PD values of implant dentures in3-month and 6-month groups were statistically significant(P<0.05).(2)Modification sulcus bleeding index(mBI)In the earlier stage after the denture loading,the inflammation rate in the soft tissue was relatively low,approximately 15.8% of the patients showed inflammation in the group of 3 months with degrees of mBI=1 or lower.The inflammation rate increased along with the post-surgery intervals and there was 35.2% of the patients in the group of24 months showed inflammation with mBI=2 or higher.(3)Gingival crevicular fluid volumeThe gingival crevicular fluid volume of the implant denture was higher than that of the control natural teeth in all four groups,and the highest value was detected in the group of 3 months.Compared with the control natural tooth group at the same period,the statistical analysis showed a significant difference(P<0.05).From 6 months to 12 months,the volume of gingival crevicular fluid showed a gradually decreasing trend,which tended to be stable,and there was no significant difference compared with the control natural teeth(P>0.05).In the 24-month group,the gingival crevicular fluid volume increased again by 0.53?l compared with the 12-month group,and it was naturally increased compared with the control group.The statistical analysis showed a very significant difference(P <0.01).2.Imaging IndexCompared with X-ray image took immediately after the dental implantation,no significant bone resorption was observed within half a year of loading;After12 months of loading,the level of bone resorption was slightly higher.After 24 months,approximately 47.1% of the investigated implants showed bone resorption in the surrounding bone tissues,in which two cases showed more serious bone absorption towards to the end of the tread.3.Biochemical Indicators(1)ALP ratio: ALP ratio(calculated by ALP levels in implants/ ALP levels in control tooth)was highest at 3 months after implant denture loading,and then gradually decreased,and the ALP ratio was approximately close to 1 after 12 months of loading.However,in the 24-month load group,the ALP ratio of implants increased again(ALP ratio>1),which was significantly different from that in the 3-month group(P<0.01).(2)AST ratio: AST ratio(implants AST/control AST)was greater than 1 at any stages after implant denture loading.During the post-surgery healing,the AST ratio gradually increased,with the highest performance was shown at 24 months,but there was no significant difference among the four groups(P>0.05).(3)Relationship between mBI and ALP ratios: The ALP ratio tends to increase with increasing mBI.The ALP ratios for both the mBI=1 and mBI=2 groups were >1.Compared with the mBI=0 group,the mBI=2 group showed a statistically significant difference(P<0.01).(4)The relationship between m BI and AST ratio: The AST ratio tends to increase with increasing m BI.The AST ratio was significantly higher in the mBI=2 group than in the mBI=0 and mBI=1 groups,and there was no significant difference between the mBI=1 group and the mBI=0 group(P>0.05).However,the statistical analysis showed a significant difference(P<0.05)in the m BI=2 group compared to the mBI=0 group.Conclusion :1.Denture implants have inflammatory susceptibility,as evidenced by higher levels of PD,mBI,PICF,ALP,and AST than natural teeth and the surrounding tissues are more prone to inflammatory reactions.2.After 12 months of implant denture loading,the hard tissue tended to be stabilized,and after 24 months of implant denture load,mucous inflammation around the implant occurred extensively.3.m BI,ALP,and AST are closely related.ALP and AST in implant dentures increased along with the aggravation of inflammation in soft tissues.A higher level of ALP was detected in denture implants with mBI = 2 compared with the implants with mBI = 1,suggesting that bone destruction may occur around implant denture when mBI=2.4.This study suggested that PICF,ALP and AST levels could be used as reference indexes for detecting the early stage inflammation after implant denture loading. |
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