title: Leakage of Microbial Endotoxin through the Implant-Abutment Interface in Oral Implants: An In Vitro Study.
abstract: Background. Endotoxin initiates osteoclastic activity resulting in bone loss. Endotoxin leakage through implant abutment connections negatively influences peri-implant bone levels.Objectives. (i) To determine if endotoxin can traverse different implant-abutment connection (IAC) designs; (ii) to quantify the amount of endotoxins traversing the IAC; (iii) to compare the in vitro comportments of different IACs.Materials and Methods. Twenty-seven IACs were inoculated withE. coliendotoxin. Six of the twenty-seven IACs were external connections from one system (Southern Implants) and the remaining twenty-one IACs were made up of seven internal IAC types from four different implant companies (Straumann, Ankylos, and Neodent, Southern Implants).Results. Of the 27 IACs tested, all 6 external IACs leaked measurable amounts of endotoxin. Of the remaining 21 internal IACs, 9 IACs did not show measurable leakage whilst the remaining 12 IACs leaked varying amounts. The mean log endotoxin level was significantly higher for the external compared to internal types (p= 0.015).Conclusion. Within the parameters of this study, we can conclude that endotoxin leakage is dependent on the design of the IAC. Straumann Synocta, Straumann Cross-fit, and Ankylos displayed the best performances of all IACs tested with undetectable leakage after 7 days. Each of these IACs incorporated a morse-like component in their design. Speculation still exists over the impact of IAC endotoxin leakage on peri-implant tissues in vivo; hence, further investigations are required to further explore this.
authors.affiliation: Department of Oral Medicine & Periodontology, School of Oral Health Sciences, Faculty of Health Science, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
authors.forename: Rhoodie
authors.identifier: 0000-0002-1403-2893
authors.initials: R
authors.lastname: Garrana
authors.affiliation: Clinical Unit, Department of Oral Medicine & Periodontology, School of Oral Health Sciences, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Govindrau
authors.initials: G
authors.lastname: Mohangi
authors.affiliation: Malo Clinic Health and Wellness, Av. dos Combatentes 43A, 1600-042 Lisbon, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Malo
authors.affiliation: Research and Development Department, Malo Clinics, Av. dos Combatentes 43A, 1600-042 Lisbon, Portugal; Oral Hygiene Department, Malo Clinics, Av. dos Combatentes 43A, 1600-042 Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Nobre
mesh_terms: D000044:Dental Abutments / Q000382:microbiology*; D015921:Dental Implants / Q000382:microbiology*; D017267:Dental Prosthesis Design / Q000379:methods; D004731:Endotoxins / Q000633:toxicity*; D004926:Escherichia coli / Q000378:metabolism; D006801:Humans
chemical_list: D015921:Dental Implants; D004731:Endotoxins