Modern and Future aMMP-8 Point-of-Care/Chairside Diagnostic and Treatment Modalities in Periodontitis and Peri-Implantitis

Chronic periodontitis and peri-implantitis are complex inflammatory conditions in the periodontium. Periodontal tissues are mainly made up of type I collagen, which is a major component of the extracellular matrix of both soft and hard periodontal tissues, and collagen breakdown is one of the main events in periodontal destructive lesions. Oral bacteria and their metabolites can penetrate peri-implant tissues more easily than permanent teeth tissues, and the inflammatory state progresses more rapidly to destruction of bone tissue in peri-implantitis. This is mainly due to differences between natural dental tissues and peri-implant tissues. The treatment of periodontitis and peri-implantitis is challenging, and therefore, prevention and early diagnoses are crucial. Traditional methods are used to assess the health status of periodontal and implant tissues. However, these measures assess past disease rather than the present pathology of these tissues. Current clinical assays do not work properly in the early diagnosis of peri-implant diseases. This thesis demonstrated the active form of matrix metalloproteinase (aMMP-8) is possible to be determined from the gingival crevicular fluid (GCF)/peri-implant sulcus fluid (PISF) in the initial and real-time diagnosis. Elevated levels of aMMP-8 occur at the onset of periodontal tissue inflammation and can found in GCF/PISF or saliva, contributing to the progression of the disease. Study I aimed to investigate the strongest possible biomarker that can be linked to periodontitis and peri-implantitis. This study confirmed that the elevated level of aMMP-8 is associated with connective tissue diseases, with Study II subsequently focusing on the validation of the aMMP-8 enzyme test in PISF. The hypothesis was that the aMMP-8 enzyme assay provides reliable results for detection of early inflammation in patients and for determination of the rate of progression of peri-implant disease. Studies III and IV investigate whether the aMMP-8 point-of-care (PoC) /chairside test can be implemented beyond the dentist´s office. Studies V and VI investigate the applicability of the aMMP-8 enzyme test in evaluation of the health effects of different home therapies such as fermented lingonberry and dual-light therapy. This thesis showed that aMMP-8 PoC tests used to diagnose periodontal disease can reliably detect and predict both early and ongoing disease and monitor the efficacy of various substances or devices used at home.