Peri-implantitis ve Periodontitiste İnflamatuvar ve Koruyucu Yanıt: Dişeti Islaklığı, Dişeti Oluğu Sıvısı ve Peri-implant Oluk Sıvısının TNF-, IL-10 ve MUC4 Düzeylerinin İncelenmesi

Abstract

ABSTRACT MOUSTAFA, Z.G. Inflammatory and Protective Responses in Peri-implantitis and Periodontitis: Investigation of TNF-α, IL-10, and MUC4 Levels in Gingival Wetness, Gingival Crevicular Fluid, and Peri-implant Crevicular Fluid. Hacettepe University, Faculty of Dentistry, Department of Periodontology, Specialty Thesis, Ankara, 2026. The balance among components of the immunoinflammatory response plays a critical role in the pathogenesis of periodontal and peri-implant diseases. The site-specific characteristics of these diseases highlight the need for a more comprehensive understanding of the dynamics and characteristics of the local biological response. The aim of this study was to compare TNF-α, IL-10, and MUC4 levels in gingival crevicular fluid (GCF), peri-implant crevicular fluid (PICF), and local saliva among periodontal health, periodontitis, peri-implant health, and peri-implantitis groups, to evaluate the relationships between these biomarkers and clinical periodontal/peri-implant parameters, and to investigate the potential biological role of gingival wetness. A total of 80 teeth/implants from 38 individuals were included and allocated to four groups: periodontal health (n=20), periodontitis (n=20), peri-implant health (n=20), and peri-implantitis (n=20). Clinical periodontal and peri-implant parameters were recorded in all participants, and GCF/PICF volume and gingival wetness were assessed. TNF-α, IL-10, and MUC4 levels in GCF, PICF, and local saliva samples were analyzed using ELISA method. Non-parametric statistical methods were used for comparisons among groups. Independent predictors of disease status were evaluated using logistic regression analysis, while the relationships between biomarkers and clinical parameters were assessed using Spearman correlation analysis. All clinical periodontal and peri-implant parameters differed significantly among the groups (p<0.001). Disease groups exhibited greater probing depth, clinical attachment level, plaque index, gingival index, bleeding on probing, and GCF/PICF volume, whereas keratinized gingival width was significantly lower. GCF and salivary MUC4 levels were significantly lower in the periodontal health group than in the periodontitis and peri-implantitis groups, while PICF MUC4 levels were significantly higher in the peri-implantitis group than in the periodontitis group (p<0.05). GCF/PICF and salivary IL-10 levels were higher in the periodontal health group than in the other groups and were also higher in the periodontitis group than in the peri-implantitis group (p<0.05). Although GCF/PICF TNF-α levels did not differ significantly among the groups, salivary TNF-α levels were significantly higher in the peri-implantitis group than in both the peri-implant health and periodontitis groups (p<0.05). Multivariable logistic regression analysis identified GCF/PICF MUC4 level as an independent predictor of periodontitis, whereas the presence of systemic disease was identified as an independent predictor of peri-implantitis. Correlation analyses demonstrated group-specific association patterns between biomarkers and clinical inflammatory parameters. These findings suggest that although periodontal and peri-implant diseases exhibit similar inflammatory clinical characteristics, they may differ in terms of their local biological responses. Keywords: Periodontitis, peri-implantitis, gingival crevicular fluid, peri-implant crevicular fluid, gingival wetness, biomarkers