In peri-implantitis cases that persist despite standard antimicrobial therapy, it is not clear what prevents the host response from resolving the disease. Implant-derived titanium particles have been implicated in peri-implant inflammation, but how they might contribute to persistent peri-implantitis has remained unclear. A new study from Rutgers School of Dental Medicine has investigated this gap, and reports a mechanism that may help explain why antimicrobial therapy alone can be insufficient in some cases.

The study shifts attention from the microbial component of peri-implantitis to the implant surface. Bacterial biofilms can corrode titanium implant surfaces, releasing microscopic particles into the peri-implant tissue. Titanium particles can be released during maintenance if instruments intended for natural teeth are used on implants and during procedures used to treat established peri-implant inflammation. The researchers examined what these particles do after they enter peri-implant tissue. They found that the particles can interfere with macrophage function, reducing the ability of these immune cells to engulf and destroy bacteria, and promoting a sustained inflammatory response associated with bone destruction.

Senior author Prof. Georgios Kotsakis said: “For the first time, we show why all the antibiotic treatments that work around teeth do not work around implants. Now that we know the cause, we can start developing therapeutics”.

For clinicians, the findings have direct significance for implant maintenance and peri-implantitis treatment. Instrumentation that damages implant surfaces may add to the biological process that treatment is intended to control. The study therefore adds mechanistic support for implant-specific maintenance protocols and careful instrumentation.

The study was published online in PNAS Nexus.

From: https://www.dental-tribune.com/news/titanium-particles-linked-to-antibiotic-failure-in-peri-implantitis/.