Peri-Implant Sulcus Fluid Stress Markers in Health and Disease

Peri-implant diseases are inflammatory conditions affecting the soft and hard tissues surrounding dental implants and represent a major cause of implant failure. Psychosocial stress is known to influence immune function through activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulting in altered secretion of stress-related hormones such as cortisol and dehydroepiandrosterone (DHEA). These hormonal changes may modulate inflammatory processes in peri-implant tissues.

This cross-sectional clinical study included 62 patients with dental implants, who were divided into three groups based on clinical and radiographic criteria: peri-implant health (PH, n=18), peri-implant mucositis (PM, n=22), and peri-implantitis (PI, n=22). Depression and anxiety levels were assessed using the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).

Clinical peri-implant parameters, including plaque index, gingival index, bleeding on probing, probing depth, clinical attachment level, and keratinized tissue width, were recorded. Marginal bone loss was evaluated using standardized periapical radiographs. Peri-implant sulcular fluid samples were collected and analyzed for cortisol, DHEA, and interleukin-6 (IL-6) levels using enzyme-linked immunosorbent assay (ELISA). Biomarker results were expressed as both concentration and total amount.

The study evaluates the associations between psychosocial stress markers, inflammatory biomarkers, and clinical peri-implant parameters to better understand the psychoneuroimmunological mechanisms involved in peri-implant diseases.

Inclusion criteria

• Being volunteer to participate in the study
• Adults aged 18 to 65 years.
• Systemically healthy individuals.
• No periodontal treatment within the past 6 months.
• No self-reported psychiatric disorders.
• No use of antibiotics within the past 6 months.
• No use of steroid, immunosuppressive, or psychiatric medications.
• No clinically evident oral infection.
• Not pregnant and not breastfeeding.
• Not smoking
• Maintaining oral hygiene

Exclusion criteria

• Age younger than 18 years or older than 65 years.
• History of periodontal treatment within the past 6 months.
• Use of antibiotics within the past 6 months.
• Inadequate or contaminated peri-implant sulcular fluid samples.
• Pregnancy or breastfeeding.
• Long-term corticosteroid usage.