ABSTRACT
Background:
Assessment of correlation between peri-implant parameters and C-reactive protein levels among patients with different obesity levels.
Materials and Methods:
Evaluation of 60 subjects was performed who were scheduled to undergo dental implant therapy for missing mandibular first molars. Three study cohorts were formed, namely, Group A: obese group (BMI between 30 Kg/m2 and 34.9 Kg/m2), Group B: high obese group (BMI over 34.9 Kg/m2), and Group C: non-obese group (BMI under 25 Kg/m2). Each cohort comprised 20 subjects. Dental implant therapy was carried out in all the patients. Peri-implant variables were evaluated in all the patients. Blood samples were obtained, and C-reactive protein levels in subjects having different obesity levels. Statistical analysis was performed using SPSS software.
Results:
Mean serum C-reactive protein levels among patients of groups A, B, and C occurred to be 3.28 mg/L, 3.65 g/L, and 3.61 g/L, respectively. On comparing numerically, noticeable outcomes were achieved. Mean probing depth among subjects of groups A, B, and C occurred to be 2.9 mm, 3.2 mm, and 1.3 mm, respectively. Mean marginal bone loss among subjects of groups A, B, and C occurred to be 2.1 mm, 2.7 mm, and 0.8 mm, respectively. On comparing numerically, noteworthy outcomes were gathered.
Conclusion:
There were significantly higher deranged peri-implant inflammatory variables among patients with higher levels of obesity.
KEYWORDS: C-reactive proteins, implant, obesity
INTRODUCTION
Overweight along with obesity is mentioned by the WHO as abnormal or excessive fat buildup that might harm one’s health. According to recent research, the prevalence of obesity has increased by about thrice since 1975. According to global estimates, diseases linked to obesity or overweight account for almost three million deaths annually, and this is seen as an epidemic in high-, middle-, and low-income nations. By the end of this decade, it is anticipated that around 50% of the world’s population would be obese.[1,2]
High mortality rates and morbidities such as atherosclerosis, type II diabetes, and hypertension are linked to obesity. The relationship between this illness and a low-grade inflammatory state, indicated by an increase in circulating inflammatory markers, has recently been theorized. The immune system is altered as a result of this systemic inflammation, and levels of C-reactive protein (CRP), a marker of systemic inflammation, are elevated.[3-5]
Even after 15 years of follow-up, dental implants placed in healthy patients under ideal circumstances have success rates of over 95%. Despite this fantastic result, there can still be technical, biological, and aesthetic issues. Also, if dental implants are inserted in people with systemic disorders or other compromising factors, the results may not be as desirable. For instance, immunological deficiencies or metabolic problems may contribute to surgical complications or hinder bone remodeling at the implant-bone contact.[6,7] Hence, this study was conducted for evaluating peri-implant parameters and C-reactive protein concentrations in subjects having various obesity levels.
MATERIALS AND METHODS
Evaluation of 60 subjects was performed who were scheduled to undergo dental implant therapy for missing mandibular first molars. Three study groups were formed as follows:
Group A: obese group (BMI between 30 Kg/m2 and 34.9 Kg/m2),
Group B: high obese group (BMI more than 34.9 Kg/m2),
Group C: non-obese group (BMI less than 25 Kg/m2).
All the study groups consisted of 20 patients each. Dental implant therapy was carried out in all the patients. Per-implant variables were evaluated in all the patients. Blood samples were obtained and C-reactive protein levels among patients with different obesity levels. A pro forma was framed, and complete clinical along with medical details of all the subjects was recorded. Compilation of results was in Microsoft excel sheet followed by statistical analysis using SPSS software. ANOVA test was used for the evaluation of results.
RESULTS
Average age of patients of groups A, B, and C was 51.3 years, 50.9 years, and 48.3 years, respectively. The mean BMI of subjects of groups A, B, and C was 33.7 Kg/m2, 37.9 Kg/m2, and 23.1 Kg/m2, respectively. Mean serum C-reactive protein levels among subjects of groups A, B, and C were 3.28 mg/L, 3.65 g/L, and 3.61 g/L, respectively. On comparing numerically, considerable outcomes were gathered. The mean probing depth among subjects of groups A, B, and C was 2.9 mm, 3.2 mm, and 1.3 mm, respectively. The mean marginal bone loss among subjects of groups A, B, and C was 2.1 mm, 2.7 mm, and 0.8 mm, respectively. On comparing numerically, noteworthy outcomes were gathered [Tables 1-3].
Table 1.
Clinical variables
| Variables | Group A | Group B | Group C | |||
|---|---|---|---|---|---|---|
|
|
|
|
||||
| n | % | n | % | n | % | |
| Mean age (years) | 51.3 | 50.9 | 48.3 | |||
| Males | 12 | 60 | 13 | 65 | 12 | 60 |
| Females | 8 | 40 | 7 | 35 | 8 | 40 |
| Mean BMI (Kg/m2) | 33.7 | 37.9 | 23.1 | |||
Table 3.
Peri-implant variables
| Peri-implant variables | Group A | Group B | Group C | P |
|---|---|---|---|---|
| Mean probing depth (mm) | 2.9 | 3.2 | 1.3 | 0.0000 (significant) |
| Mean marginal bone loss (mm) | 2.1 | 2.7 | 0.8 | 0.0000 (significant) |
Table 2.
C-reactive proteins
| Groups | Mean C-reactive protein levels (mg/L) | SD | P |
|---|---|---|---|
| Group A | 3.28 | 0.82 | 0.0001 (significant) |
| Group B | 3.65 | 0.95 | |
| Group C | 3.61 | 0.51 |
DISCUSSION
Before reading the dental implant literature, a warning is necessary. Upwards of 95% success rates have frequently been reported in recent clinical investigations. These findings provide the idea that the difficulties in dental implantology have mostly been overcome; however, that perception is erroneous. In those studies, the “cumulative survival rate” (CSR) is frequently substantially lower than the stated “success rate.” These two success metrics differ significantly from one another.[7,8] A typical study would indicate a 92% success rate if 60 implants were monitored for 2 years and five of them failed. Yet, it is likely that some of those implants should have their data points suppressed (dropouts, deaths, relocations, and so forth). Although CSR would (more accurately) exclude censored implants from the denominator, a simple success rate would incorrectly include the censored implants in the denominator of the failure rate calculation. Also, some of the implants would be inserted after the study’s first month, meaning that they would not be monitored for the full 2 years. Even though it is frequently not the case, a simple success rate assumes that all implants were monitored for 2 years.[8-10]
Mean serum C-reactive protein levels among subjects of groups A, B, and C had been 3.28 mg/L, 3.65 g/L, and 3.61 g/L, respectively. On comparing numerically, substantial outcomes were gathered. The mean probing depth among subjects of groups A, B, and C occurred to be 2.9 mm, 3.2 mm, and 1.3 mm, respectively. The mean marginal bone loss among subjects of groups A, B, and C was 2.1 mm, 2.7 mm, and 0.8 mm, respectively. On comparing numerically, noticeable outcomes were achieved. Vohra F et al.[10] assessed CRP levels with clinical and radiological peri-implant inflammatory variables in individuals with various levels of obesity. In their research, 84 subjects got enrolled, and they were split into four groups according to their level of obesity: class I, class II, class III, and non-obese people. Subjects in groups 1, 2, and 3 had considerably greater peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mesiobuccal length (MBL) when contrasted to non-obese people. In comparison with obese individuals in group 1, obese participants in groups 2 and 3 had substantially greater peri-implant PI, BOP, PD, and MBL values. Subjects in groups 2 and 3 had equivalent means for PI, BOP, PD, and MBL. In group 3, a substantial negative association was discovered for MBL and a considerable positive association was discovered among CRP concentrations, as well as BOP and PD. Individuals exhibiting an extreme type of obesity had considerably higher serum CRP and clinical and radiographic peri-implant inflammatory markers. In obese subjects, peri-implant hemorrhage and serum CRP levels were associated.[10]
The risk variance for implant failure and the mean difference for marginal bone loss, probing depth, and bleeding on probing were calculated using a meta-analysis conducted by Monteiro JLGC et al.[11] Six studies comprising a maximum of 746 subjects and 986 implants were chosen for review; 377 of these subjects belonged within the optimum weight range, whereas 609 were overweight or obese. Given that there was no numerically substantial variation in implant survival rates among people with overweight/obesity and those within the optimal weight range, the results of this systematic review suggest that the first hypothesis must be adopted. The review found a discrepancy in marginal bone loss, probing depth, and bleeding around dental implants; hence, the second hypothesis was rejected.[11]
CONCLUSION
There were significantly higher deranged peri-implant inflammatory variables among patients with higher levels of obesity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Suvan JE, Petrie A, Nibali L, Darbar U, Rakmanee T, Donos N, et al. Association between overweight/obesity and increased risk of periodontitis. J Clin Periodontol. 2015;42:733–9. doi: 10.1111/jcpe.12421. [DOI] [PubMed] [Google Scholar]
- 2.Pradeep AR, Nagpal K, Karvekar S, Patnaik K. Levels of lipocalin-2 in crevicular fluid and tear fluid in chronic periodontitis and obesity subjects. J Investig Clin Dent. 2016;7:376–82. doi: 10.1111/jicd.12165. [DOI] [PubMed] [Google Scholar]
- 3.Maciel SS, Feres M, Gonçalves TED, Zimmermann GS, da Silva HDP, Figueiredo LC, et al. Does obesity influence the subgingival microbiota composition in periodontal health and disease? J Clin Periodontol. 2016;43:1003–12. doi: 10.1111/jcpe.12634. [DOI] [PubMed] [Google Scholar]
- 4.Keller A, Rohde JF, Raymond K, Heitmann BL. Association between periodontal disease and overweight and obesity:A systematic review. J Periodontol. 2016;86:766–76. doi: 10.1902/jop.2015.140589. [DOI] [PubMed] [Google Scholar]
- 5.Vissink A, Spijkervet F, Raghoebar GM. The medically compromised patient:Are dental implants a feasible option? Oral Dis. 2018;24:253–60. doi: 10.1111/odi.12762. [DOI] [PubMed] [Google Scholar]
- 6.Cândido FG, Valente FX, Grzeskowiak ŁM, Moreira APB, Rocha DMUP, Alfenas RCG. Impact of dietary fat on gut microbiota and low-grade systemic inflammation:Mechanisms and clinical implications on obesity. Int J Food Sci Nutr. 2018;69:125–43. doi: 10.1080/09637486.2017.1343286. [DOI] [PubMed] [Google Scholar]
- 7.Akram Z, Abduljabbar T, Abu Hassan MI, Javed F, Vohra F. Cytokine profile in chronic periodontitis patients with and without obesity:A systematic review and meta-analysis. Dis Markers. 2016;2016:4801418. doi: 10.1155/2016/4801418. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Thanakun S, Izumi Y. Effect of periodontitis on adiponectin, C-reactive protein, and immunoglobulin G against Porphyromonas gingivalis in Thai people with overweight or obese status. J Periodontol. 2016;87:566–76. doi: 10.1902/jop.2015.150583. [DOI] [PubMed] [Google Scholar]
- 9.Zimmermann GS, Bastos MF, Dias Goncalves TE, Chambrone L, Duarte PM. Local and circulating levels of adipocytokines in obese and normal weight individuals with chronic periodontitis. J Periodontol. 2013;84:624–33. doi: 10.1902/jop.2012.120254. [DOI] [PubMed] [Google Scholar]
- 10.Vohra F, Alkhudhairy F, Al-Kheraif AA, Akram Z, Javed F. Peri-implant parameters and C-reactive protein levels among patients with different obesity levels. Clin Implant Dent Relat Res. 2018;20:130–6. doi: 10.1111/cid.12556. [DOI] [PubMed] [Google Scholar]
- 11.Monteiro JLGC, Pellizzer EP, Araújo Lemos CA, de Moraes SLD, do Egito Vasconcelos BC. Is there an association between overweight/obesity and dental implant complications?A systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2019;48:1241–9. doi: 10.1016/j.ijom.2019.01.015. [DOI] [PubMed] [Google Scholar]
