Major approaches of inflammatory processes and peri-implant infections in the cellular and molecular scenario of mesenchymal stem cells, exosomes, and microRNAs: a systematic review
Authors: Paladino Danilo Martins , Vidoto João Antônio Figueiredo , Lopes Rafael Bertelli , Idalgo Fabio Alarcon , Cicareli Alvaro José , Kassis Elias Naim 
Published: March 2024

Introduction: Bone diseases are denoted by fractures, osteoporosis, and osteoarthritis that affect a large number of individuals, with a rising prevalence of osteopenia for 64.3 million American individuals and osteoporosis for 11.9 million by the year 2030. Dental implants are not free from possible complications with consequent failure, the causes of which are still the subject of debate in the dental scientific community. In particular, peri-implant infections are multifactorial pathological conditions characterized by inflammation of the peri-implant mucosa with or without progressive loss of supporting bone. Specific expression profiles of microRNAs (miRNAs) extracted from peri-implant tissues are predictive of specific clinical outcomes of dental implants and can be used as biomarkers in implant dentistry for diagnostic and prognostic purposes. Objective: It was to address the main approaches to inflammatory processes and peri-implant infections and dental implants in the cellular and molecular scenarios of mesenchymal stem cells, exosomes, and microRNAs, emphasizing the main biomarkers in the therapeutic control of harmful dental implant processes. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 138 articles were found, 44 articles were evaluated in full and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 26 studies with a high risk of bias and 24 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=67.9%>50%. It was concluded that specific expression profiles of miRNAs extracted from peri-implant tissues are predictive of specific clinical outcomes of dental implants and can be used as biomarkers in implant dentistry for diagnostic and prognostic purposes. Studies have shown that many of the miRNAs extracted from the implant's peri-crevicular fluid were common to those detected in soft tissues taken from the same peri-implant sites. Evidence suggests that exosomes derived from adipose-derived stem cells exhibit similar functions to those cells, with low immunogenicity and no tumorization. Insufficient bone volume directly impacts the placement of dental implants. Adipose-derived stem cells can accelerate bone healing when combined with dental implants. An increase in the concentration of exosomes with negative expression of miRNA-21-3p and miRNA-150-5p may be related to the development of peri-implantitis.