Microbiota and crevicular fluid collagenase activity in the osseointegrated dental implant sulcus: a comparison of sites in edentulous and partially edentulous patients.
The soft tissues adjacent to osseointegrated dental implants (OII) were investigated using clinical, biochemical and microbiological methods. Tooth and implant crevices were compared in 15 partially edentulous patients, examining 28 peri-implant and 19 periodontal sites, and in 6 edentulous patients, examining 13 implant sites. Sites were classified by standard periodontal indices; the crevicular fluid flow determined; crevicular fluid was collected for collagenase assays; and the subgingival bacterial flora was examined and cultured. Differences in clinical parameters were noted in that implants had significantly less keratinized gingiva and deeper probing depths. Crevicular fluid was present in the OII sulcus but the crevicular fluid flow did not differ from that observed from tooth sites either in the partially edentulous or edentulous patients. Tissue collagenase activity and collagenase inhibitor were detected in the implant crevicular fluid and, as in periodontal sites, a strong inverse relationship was found between the levels of active collagenase and collagenase inhibitor. Microbiology included darkfield microscopy, anaerobic culturing for total colony forming unit counts and identification of black pigmented Bacteroides (BPB). Few differences were observed between implants and teeth in partially edentulous patients, indicating that crevices around teeth may act as reservoirs of bacteria which can colonize implant sites. A higher percentage of BPBs and wet spreaders (Capnocytophaga) was noted at partially edentulous implant sites when compared with edentulous implant sites, perhaps reflecting the lower numbers of periodontal pathogens present in edentulous mouths. Overall, the characteristics of implant sulci appear to be similar to periodontal sulci with respect to crevicular fluid flow and microflora.