Are there any ways to analyze objectively if any good changes happen to the bodies for the patients with acquired edentulous by getting a treatment to recover occlusion? In this study, we focused on interleukin 6 (IL-6) as inflammatory cytokine, cortisol known as a stress related substance and secretory immune globulin A (SIgA) related to immune reaction, and chose 14 patients who had occlusion reconstructed by the immediately loaded dental implants because occlusion contact with maxillary and mandibular dentition was lost caused by edentulous jaws or maxillary and mandibular teeth crossing each other and their jaw position and central occlusion position could not settle, and verified the relationship with changes of patients’ physical and mental states during the 6 months of the treatment and the effect of the immediately loaded implants treatment by using saliva which was non-invasive and easy to sample in biomarkers in saliva. Moreover for female subjects, the changes of facial color tones were measured by using Robo Skin Analyz-er ?, a digital image analyzer, to measure the condition of their skin. In conclusion, the positive correlation between the amount of IL-6 and cortisol was not admitted. However, it was admitted that IL-6 tended to increase when a systemic change which interrupted curing such as the interruption of fusion of the implant and the bone was observed even though the patient did not notice any particular symptoms and cortisol tended to increase when the patient noticed discomfort and mentioned any events under stress on his or her medical record. Moreover with the skin color analysis by Robo Skin Analyzer?, the possibility that the occlusion treatment by the immediate implant had an effect on physical and psychological health promotion through the acquisition of the masticatory function and the aesthetic recovery was indicated.
Recently, in the choices of prosthesis treatments for patients with edentulous to recover the masticatory function and the sensuousness, the recovery of occlusional function (oral rehabilitation) applying dental implant is becoming common besides the treatment with removal dentures which has been the mainstay for a long time. The reconstruction of occlusion with implant fixture which made it possible to recover the function disorder caused by the deficit of a tooth and a jawbone and the morphological disorder which were once considered difficult to do with a removal denture because it loaded the oral mucosa absorbability instantly became the focus of the research and the development as a new trend of dental care, and grew to the reliable treatment method keeping its technical stability. On the other hand, there are several problems regarding patients’ physical and psychological burdens, such as costs and surgical stress, and especially to shorten the duration of treatment which is required until the occlusion function recovers has been expected. It makes the immediately loaded implants by All-on-4 reality to meet the patients’ desire [
This resistance does not only avoid the each patient’s unique habitual lateral movement of jaw causing fibrous healing which blocks the fusion of the implant fixtures and the bone and the tiny movement caused by traumatic occlusal force, but also obtains the strength against occlusion. This uniqueness of All-on-4 makes the immediate functional loading which reconstructs occlusion by dentition with 12 artificial teeth for both upper and low jaws possible for edentulous patients just after the dental implant surgery.
In this study, we targeted patients with a provisional bridge which was the therapeutic upper structure applied for six months until the final form of the implant super structure was completed, focused on interleukin 6 (IL-6), cortisol and SIgA in saliva and verified the relationship with the effect of obtaining the occlusional function and the changes of patients’ physical and psychological states during the immediate load dental implant treatment. Moreover for female subjects, their skin colors were measured with the color information from the digital image of the skin taken by a CCD camera using Robo Skin Analyzer®, a digital image analyzer, and measured the changes of their facial skin tones.
The subjects were 14 patients (64.1 ± 5.8 years), 7 males (68.7 ± 4.5 years) and 7 females (59.4 ± 2.1 years), who visited Ebina Lion Implant Center with complaints that the contact with the maxillary and mandibular dentition was lost because of edentulous jaws or maxillary and mandibular teeth crossing each other and their mandibular positions could not settle and requested for occlusion recovery with immediate load dental implants to July 2014 from January 2013. The subjects were obtained consent by a purpose of this study and this research was performed according to the ethic official regulation that nonprofit foundation Japanese Society of Oral Implantology to belong to of the Ebina Lion Implant Center established.
Patients who received a diagnosis when in condition not to be able to take the centric occlusion for completely losing occlusal contact were chosen as a subject. After obtaining consent by a purpose of this study, they started taking saliva before and right after the implant placement surgery and at the monthly follow-ups after the surgery. The subjects were placed a provisional bridge as the upper structure right after the implant placement surgery, and occlusion of the upper and lower jaws were recovered. Replace Select Tapered RP® (Nobel Biocare Japan K.K.) was used as the implant fixture, and tightening torque over 35 N cm for all of the placed implant fixtures were confirmed. The temporary bridge was composed with the resin artificial tooth and dental polymerized resin, and Temporary Cylinder Plastic® (DCA468-0) and Prosthetic Screw® (29285) (Nobel Biocare Japan K.K.) were used as its connector.
As for collecting saliva for the test, the duration was determined for six months which was required for ISQ, the bone fusion indicator that implant prosthetics recommend, to get over 70 until paradentium stabilized and the provisional bridge transited to the final prosthesis [
After putting bland and innocuous Salimetrics Oral Swab (Salimetrics, USA) into the subject’s mouth for 5 minutes in a sitting posture, it was collected and the saliva was taken by centrifugation (1500 rpm × 40 minutes, 4˚C). The saliva was stored at −20˚C until the measurement. The time of collection was determined from 11:30 to 17:30 at which the value of cortisol stabilizes in consideration of the circadian variation of cortisol value [
SALIVARY IL-6 ELISA KIT (Salimetrics, USA) for the amount of IL-6, High Sensitivity SALIVARY CORTISOL ENZYME IMMUNOASSAY KIT (Salimetrics, USA) for the amount of cortisol, and Salivary Secretory IgA Indirect Enzyme Immuoassay kit (Salimetrics, USA) for the amount of SIgA were used for the measurement.
For seven female subjects, skin color was measured using Robo Skin Analyzer® (MM & NiiC Co., Ltd.) besides collecting saliva at the monthly follow-ups from before the implant surgery and to six months after the surgery. Robo Skin Analyzer® is a measurement device for skin color with images taken by a CCD camera, and expresses the colors of skin as three attributions of hue, brightness, and intensity by measuring skin reflectivity [
As the measurement conditions, after the subject washed her face to take her makeup off, three facial images (right 45˚-front-left 45˚) were taken with the built-in CCD camera keeping the distance from the object and the camera constant by fixing the forehead and the jaw in the box of Robo Skin Analyzer® which was blocked the surrounding environmental colors and kept the shooting condition constant.
(The correlation between the amount of IL-6, cortisol and SIgA and the facial color tones were discussed.)
All the data are presented as mean ± SEM. The data were analyzed by the Wilcoxon Rank Sum Test to evaluate the difference between pre-surgery and post-surgery. p values of < 0.05 were defined as statistically significant.
The transition of the amount of IL-6 in saliva for six months was shown in
IL-6 increased rapidly after the treatment and kept high value repeating the increase and the decrease. However, it presented the comparable value as the one before the treatment at the measurement after six months when it changed to the final prosthesis. Comparing the changes in males to females, for males it remained high value after the treatment and presented the comparable value as the one before the treatment after six months when it changed to the final prosthesis (
The transition of the amount of cortisol in saliva for six months was shown in
As for SIgA, no change was shown during the six month treatment (
The transition of three components of colors, hue, brightness, and intensity of seven female patients in six month was measured and its change was shown in
The clinical application of All-on-4 initiated in Japan from 2005, however, quite a lot of dental implant specialists inside and outside the country had objections to its innovation at the beginning. The goal of the oral implant
technology before All-on-4 was just to replace the lost natural tooth with the artificial dental root as a substitute and to make it work. It is so to speak the biomimetics which is faithful to anatomical science [
occlusion using the system really make the patients happy. For example, how the patient’s mind and body who had replaced his or her teeth with artificial substitutes in a large ratio will change right after the implant surgery? What kinds of reactions will happen to the patient with the adjusting provisional bridge during the six months until the final prosthesis is completed? The patients’ physical and psychological changes before and right after the implant surgery and during the six months of the treatment were examined through the correlation of the secretion concentration of the stress related substances in saliva.
In this study, the correlation between IL-6 in saliva and inflammation caused by surgical stress was proven as the amount of the measured value of IL-6 as inflammatory cytokine always increased remarkably after surgery and decreased to the comparative level of the one before surgery one month after the surgery although the difference of the values between the one before surgery and after surgery was concerned at first (
The results of the present study demonstrated the correlation between IL-6 and surgical stress [
On the other hand, as the performance needed for therapeutic dentures until it gets to the final prosthesis, the provisional bridge is recommended to be designed to avoid excessive occlusal pressure such as biting something hard. Differences among individuals reflected to the change of the graph in some degree, however the amount of IL-6 originated the process to infuse the implant body and the bone. It is reported that the implant stability decreased for a while after surgery and recovered six months later by the research of the remodeling process of the implant fixture immediately loaded and the bone right after the placement to the molar area on the upper jaw [
The amount of cortisol did not indicate the extreme increase after surgery (
In this study, IL-6 indicated that systemic abnormalities about the jawbones which built the basic part to support artificially reconstructed occlusion, implant fixture, and the surrounding tissue, and cortisol could be considered as something to alert the mechanical problems about the implant superstructure which played a role of a fixed over denture with implant fixtures and screws. The information is extracted from two aspects, periodontological and prosthesis by using both for the measurement. By evaluating this data and the implant stability obtained from clinical x-ray images or by resonance frequency analysis, there is a possibility that it will help modifying the provisional bridge more accurately, designing the final prosthesis and for the post operational management. Moreover, as the amount of IL-6 and cortisol both indicated the lowest value in six months, the clinically recommended guide that the timing to transit to the final prosthesis was six months after the implant replacement when the bone fusion stabilized was confirmed.
For the female subjects, it was measured by using Robo Skin Analyzer® how it affected to the skin condition by recovering the occlusional function. The anti-aging theory that recovering occlusion can gain their youth is commonly known. The measuring intention here, however is to discuss how the occlusion recovery spills over to the rejuvenation effect not only around the mouth and the lips but also on physical appearance of a whole body by measuring freshness and moisture of women’s skin condition with the image analysis and by comparing the amount of IL-6 as inflammatory cytokine, cortisol as a stress related biomarker, and SIgA related to immune competence. Three components of colors, hue, brightness, and intensity, were measured as an indicator by Robo Skin Analyzer®. All of hue, brightness and intensity gently increased in six months after surgery and the improvement of skin tone color was observed. In conclusion, statically, the provisional restoration recovered maxillary and mandibular occlusion at first, set the jaw position to the central occlusion point, and counterbalanced and stabilized the mandibular position by masseter muscle, temporal muscle and internal and external pterygoid muscle, which organized the back and forth and lateral movement on lower jaw, keeping moderate load. It also maintained moderate stress on the mimic muscle group gathered in a lip and a mouth, consists of orbicularis oris muscle, cheek muscle, laughing muscle, mentalis muscle, musculus levator anguli oris, depressor anguli oris muscle, greater zygomatic muscle, lesser zygomatic muscle, elevator muscle of upper lip, depressor muscle of lower lip, etc., by compensating the lost dentition and alveolar part artificially. Dynamically, moreover, the movement of the masseter muscle group promoted as the masticatory function became active. As for the effect of esthetic recovery, the actions with positive expression, such as smiling with teeth, became diverse. Therefore it promoted the movement of the mimic muscle group which spread to the whole face, such as frontalis muscle, orbicularis oculi muscle and corrugator muscle leading from the mimic muscle of a mouth, and stimulated lymphatic circulation. It is considered that these results were reflected to the skin condition. Furthermore, it is expected that daily stress will be relived if the irritation on eating and the frustration with the physical appearance are removed. However regarding the correlation of the graph of the amount of cortisol for the subjected seven female patients, their facial hue, brightness, and intensity increased in contradiction to the amount of cortisol gradually decreased every time at the follow-ups after surgery. The decrease of the amount of cortisol and the improvement of their facial color tone observed six months after the surgery suggested the possibility that the recovery of the occlusion function by the immediate load dental implants did not only make the patients expressive for their physical appearance health but also brought their skin firmness and moisture by making their “feeling” balanced and affected deeply to the physical and psychological health promotion through the acquisition of masticatory function and the aesthetic recovery.
It is a purpose to measure how an effect of the oral rehabilitation applied immediate loading implant system affects the body as for this study, but, about the physical influence except the oral area, does not lecture in particular. The consideration about the influence that the physical factor except the oral area caused by health condition and the psychology situation of the subject and a lifestyle affects measurement data is a future research.
Facing an aging society, the demand for the treatment applying the immediate load dental implants will grow. Along with it, however, the situations that patients who take the dental implant treatment would visit other branches or they would need a long-term hospitalization are concerned as well. Originally strict and periodic maintenances by professionals are necessary to maintain the restructured occlusion with the implant treatment [
Moreover, the decrease of stress reactant hormones and the improvement of skin color tones obtained from the analysis by Robo Skin Analyzer® indicated that the occlusion recovery released the patients from physical and psychological stress, such as the decrease of masticatory function and aesthetical complex, and enriched their “feeling”. It is expected that the restructure of occlusion by the immediate load dental implants brings the patients smile back and recuperates their sociability and positive attitude, and enhances their quality of life.
MasakazuAzuma,SenichiSuzuki,MasakiSawa,TomokoYoshizawa,AilingHu,TakujiYamaguchi,HiroyukiKobayashi, (2016) Search of Biomarker in the Oral Rehabilitation. Health,08,83-92. doi: 10.4236/health.2016.81010