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    • NO is an important mediator for

    2023-02-01

    NO is an important mediator for maintaining bone integrity since it plays a role in the bone remodeling process. It was shown that mechanical strain and shear stress induce NO synthesis in osteoblasts and osteocytes (van't Hof & Stuart, 2001). It was reported that mechanical loading influences its activity and results in a greater increase in NO production in osteocytes (van't Hof & Stuart, 2001). On the other hand, its production is also affected by the clinical Q-VD-Oph around implants (Tözüm et al., 2007a). The loading pattern has a significant impact on NO production around endosseous dental implants; early and delayed loaded implants present different patterns of nitrite generation, which is an end product of NO metabolism (Tözüm, Turkyilmaz, Yamalik, Karabulut, & Eratalay, 2007b). Güncü et al. (Sculley & Langley-Evans, 2002) reported that the nitrite pattern was not the same with different loading protocols. In order to prevent the effect of loading type on NO production, a delayed loading protocol was utilized in the present study. Although PISF-related measures do not provide a means for the routine assessment of dental implants, this biologic fluid is believed to have considerable diagnostic potential. To evaluate the subclinical events that take place at dental implant sites, especially bone-related mechanisms, PISF monitoring and the profile of this biologic fluid may be considered to have promising potential for the early diagnosis of an inflammation’s status before it produces clinical symptoms (Güncü et al., 2009). Ramseier et al. (2016) evaluated host-derived biomarkers in PISF and CGF from the adjacent teeth 10 years after loading, however no differences of host-derived biomarker levels were detected between teeth and implant. Similar results were shown by Nogueira-Filho et al. (2014) who reported similar cytokine levels around healthy implants and teeth over a 12-months period. Therefore, in the present study CGF samples were collected at baseline once in addition to clinical indices to evaluate the overall periodontal health and to compare the baseline NO and arginase levels between PISF and GCF. In the present study, unstimulated saliva samples, which represent the whole oral environment, were collected to provide information on oral health. Stimulated saliva was not used because stimulation may increase the expulsion of GCF from the periodontal pocket through the mastication process (Sculley & Langley-Evans, 2002). In our study, clinical measurements between teeth and implants at baseline were found to be similar. GI and PD values were maintained over time, PI scores decreased over time around the implants, and the lowest values were observed in month 6 at the end of the study period. Plaque is considered the most significant etiological factor in peri-implant disease (Ferreira et al., 2009). Ferreira et al. (2009) showed a significant correlation between PI and histologic evaluation, suggesting that plaque accumulation may be a useful parameter for monitoring peri-implant health. In the present study, the decreased PI values might be due to the satisfactory self-performed, plaque control. All patients were informed about the importance of the oral hygiene performance and in each follow-up visit, oral hygiene instructions were repeated. Probing around teeth is an excellent way to assess the health of natural teeth; however, probing around dental implants is of little value because of the structural differences between natural teeth and dental implants (Misch et al., 2008). Structural differences between peri-implant and periodontal tissues are mainly represented by the parallel disposition of collagen fibers to the implant surface and the absence of connective tissue insertion (Berglundh et al., 1991). Therefore, when probing the peri-implant sulcus, the probe goes beyond the epithelial seal and causes injury to subjacent connective tissues (Misch et al., 2008). This causes bleeding even if the inflammation is absent, thus affecting the results of clinical examinations of the inflammation. On the other hand, Farina, Filippi, Brazzioli, Tomasi, & Trombelli, (2017) reported the association between the increased BOP levels and the increased PD. When the shallow and unchanged sulcus depth and the lower levels of other clinical parameters around implants were taken into consideration, it was thought that the increase in BOP values might be due to the above mentioned characteristics of peri-implant tissues.