Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BIOMATCELL, VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, Sweden.
Clin Implant Dent Relat Res. 2017 Aug;19(4):681-693. doi: 10.1111/cid.12486. Epub 2017 May 3.
Smoking is a risk factor for dental implants. The mechanisms behind the impact of smoking on osseointegration are not fully understood.
To investigate the initial molecular and clinical course of osseointegration of different titanium implants in smokers and nonsmokers.
Smoker (n = 16) and nonsmoker (n = 16) patients were included. Each patient received three implant types: machined, oxidized and laser-modified surfaces. After 1, 7, 14, and 28 days, the peri-implant crevicular fluid (PICF) was sampled for gene expression analysis of selected factors involved in early processes of osseointegration. Furthermore, pain-score (VAS), resonance frequency analysis (RFA) and baseline clinical assessments were performed.
Early failure of osseointegration, associated with a high and sustained perception of pain, was encountered in 3/32 patients. In general, high pain scores were reported during the first days after implantation, irrespective to smoking habit, which correlated to high levels of pro-inflammatory cytokines during the first days after implantation. Higher ISQ values were found in smokers compared to nonsmokers. In smokers exclusively, ISQ values correlated to harder and less atrophic bone quality and quantity, respectively. Smokers displayed a higher expression of osteocalcin (OC), but later peak and lower expression of bone morphogenetic protein (BMP-2) (at 7 days) compared to nonsmokers. In comparison to machined implants, surface-modified implants were associated with higher expression of alkaline phosphatase (ALP) and cathepsin K (CatK) at 28 days in nonsmokers.
During the early phase of osseointegration, postoperative pain is linked to the inflammatory cell response and, may tentatively serve as an indicator of biological complication and implant loss. The present study suggests that smokers have an altered bone composition and (ultra)structure based on the observations that ISQ values are higher and correlate to recipient bone quality and quantity in smokers.
吸烟是种植牙的一个风险因素。吸烟对骨整合影响的机制尚未完全阐明。
研究不同钛种植体在吸烟者和非吸烟者中骨整合的初始分子和临床过程。
纳入吸烟者（n=16）和非吸烟者（n=16）患者。每位患者接受三种种植体类型：机械加工、氧化和激光改性表面。在 1、7、14 和 28 天，采集种植体周围龈沟液（PICF），用于分析与早期骨整合过程相关的选定因子的基因表达。此外，还进行了疼痛评分（VAS）、共振频率分析（RFA）和基线临床评估。
32 例患者中有 3 例发生早期骨整合失败，伴有持续的高疼痛感知。一般来说，植入后前几天疼痛评分较高，与植入后前几天促炎细胞因子水平较高有关。与非吸烟者相比，吸烟者的 ISQ 值更高。仅在吸烟者中，ISQ 值与更硬和更少萎缩的骨质量和数量分别相关。吸烟者的骨钙素（OC）表达较高，但与非吸烟者相比，BMP-2（第 7 天）的峰值较低，表达时间较晚。与机械加工种植体相比，在非吸烟者中，表面改性种植体在第 28 天时碱性磷酸酶（ALP）和组织蛋白酶 K（CatK）的表达更高。
在骨整合的早期阶段，术后疼痛与炎症细胞反应有关，可能暂时作为生物并发症和种植体丢失的指标。本研究表明，吸烟者的骨成分和（超）结构发生改变，这是基于观察到 ISQ 值较高，并且与吸烟者的受植骨质量和数量相关。
