Evaluation of the Effects of Routine Phase I Periodontal Therapy on Clinical Parameters and Levels of Gremlin-1, CTHRC1, and Tenascin-C in Gingival Crevicular Fluid and Peri-Implant Sulcular Fluid in Individuals With Periodontitis and Peri-Implantitis

The primary objective of this study is to compare the mechanisms of tissue destruction between natural teeth with periodontitis and implants with peri-implantitis within the same individual, and to evaluate the effects of routine Phase I periodontal therapy (scaling and root planing, and oral hygiene instruction)-performed in accordance with standard protocols-on these pathological processes.

Individuals concurrently diagnosed with both periodontitis and peri-implantitis will be included in the study. In our study, the tissue biomarker levels of Gremlin-1, which inhibits bone regeneration via BMP antagonist activity; CTHRC1, which induces osteogenic differentiation by activating the Wnt/β-catenin signaling pathway; and Tenascin-C, which reflects extracellular matrix degradation during the inflammatory process, will be investigated.

Gingival crevicular fluid (GCF) and peri-implant sulcular fluid (PISF) samples will be collected from these subjects prior to treatment (T0) and at the one-month post-treatment follow-up visit (T1). The obtained biomarker levels will be quantitatively analyzed using the enzyme-linked immunosorbent assay (ELISA) method. Through the acquired data, it is aimed to elucidate the differences in bone remodeling (coupling) dynamics around implants compared to the bone metabolism around natural teeth, thereby providing a scientific rationale for the development of novel diagnostic approaches and targeted therapeutic strategies.

Inclusion criteria

• Aged between 18 and 65 years and providing written informed consent.
• Systemically healthy (absence of diabetes, osteoporosis, immunological diseases, etc.).
• Having a dental implant with prosthetic loading that has been in function for at least 1 year.
• No history of periodontal treatment within the last 6 months.
• No use of medications that could affect study outcomes (mouthwashes, antibiotics, non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids) in the 3 months prior to sampling.
• For the Test Group: Concurrent presence of both Peri-implantitis (bleeding on probing/suppuration, PD >= 5mm, radiographic bone loss >= 2mm) and Periodontitis (Generalized Stage III-IV, presence of bleeding on probing and clinical attachment loss) in the same oral cavity.
• For the Control Group: Completely healthy periodontal and peri-implant tissues (negative bleeding on probing, PD <= 3mm, no bone loss), with a low plaque index score (<20%) and good oral hygiene.

Exclusion criteria

• Current use of smoking and tobacco products (or having quit within the last 5 years).
• History of any periodontal or peri-implant surgical/non-surgical treatment within the last 6 months.
• Use of antibiotics, anti-inflammatory drugs (NSAIDs), or immunosuppressive drugs within the last 3 months.
• Pregnancy, lactation (breastfeeding), or use of oral contraceptives.
• Presence of faulty restorations, overhanging fillings, or removable prosthesis clasps that increase plaque accumulation on the tooth or implant to be examined (to eliminate local factors).
• Detection of mobility in the implant to be examined (this is considered implant failure/loss, not just peri-implantitis).
• Presence of active orthodontic treatment (brackets/wires) in the regions where samples will be collected.