# Impact of Peri-Implant Inflammation on Metabolic Syndrome Factors: A Systematic Review
###### Abstract  
This systematic review aims to evaluate the impact of peri-implantations on the components of metabolic syndrome, and to provide suggestions on the management of peri-implantations patients with metabolic disorders. A search for relevant records was performed in MEDLINE, EMBASE, and Global Health on 1 st September 2023. Clinical trials, cohort studies, cross-sectional studies, and case-control studies containing comparisons of metabolic factors between patients with and without peri-implantations were considered eligible. Study quality was assessed using the Newcastle-Ottawa scale. Out of 1158 records identified, 5 cross-sectional studies were eligible for final inclusion. Two studies reported significant differences in the lipid profile of patients with peri-implantitis, one of which reported higher total cholesterol and LDL cholesterol levels, while the other reported higher triglyceride levels. Another study reported significantly higher HbA1c levels in patients with peri-implantitis. The remaining two studies containing comparisons of BMI between patients with and without peri-implantations indicated no significant differences. Overall, there are suggestions that peri-implantitis is associated with altered metabolic factors, including lipid profile and HbA1c level. However, there is not enough evidence to support these clinical implications due to the paucity of related literature and the low evidence level of the included studies. More investigations with stronger evidence levels are needed to narrow this gap of knowledge. peri-implantitis; metabolic syndrome; metabolism; systematic review +
Footnote †: journal: Medical  
increased peri-implant marginal bone loss [11]. There are shared serum risk markers between CVD and peri-implantitis, including high triglyceride and uric acid levels [12]. Obesity is also considered to increase the risk of developing peri-implantitis [13]. It compromises the efficiency of the immune response in the periodontitis by increasing the systemic inflammatory burden [14]. Obese patients exhibited worse clinical parameters including plaque index, bleeding on probing, and probing depth, and significantly higher proinflammatory biomarkers such as interleukin-1\(\beta\) (IL-1\(\beta\)), interleukin-6 (IL-6), and C-reactive protein (CRP) [15; 16; 17; 18; 19]. Hyperglycemia in poorly controlled diabetes is associated with significantly higher peri-implant probing depth and crestal bone loss [20; 21; 22; 23]. Impairment of bone healing after implant placement has also been reported in animal models of diabetes mellitus [24]. A recent retrospective cohort study assessed 216 implants with a mean duration of maintenance of 7 years and 4 months [25]. They found a significant difference in the onset of peri-implantitis between patients with and without systemic disorders. More specifically, they found that the presence of hypertension, diabetes mellitus, or osteoporosis have significant impacts on the onsets of peri-implantitis. A possible mechanism for the link between systemic disorders and peri-implantitis is via the reduced vascular supply and the emergence of cellular dysfunction, which further leads to the decreased immune robustness towards oral pathogens [26]. The above systemic conditions are all related to metabolic syndrome (MetS), which refers to the co-existence of several clinical metabolic findings including hypertension, hyperglycemia, abdominal obesity, and dyslipidemia [27; 28]. The concept of MetS was formalized in 2001 [29]. According to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) in the United States, MetS can be diagnosed when 3 of the following criteria are met:  
* Waist circumference (WC) \(\geq\)102 cm for males or \(\geq\)99 cm for females. * High-density lipoprotein cholesterol (HDL-C) <1.0 mmol/L (40 mg/dL) for males or <1.3 mmol/L (50 mg/dL) for females. * Triglyceride \(\geq\) 1.69 mmol/L (150 mg/dL). * Fasting plasma glucose \(\geq\) 110 mg/dL (6.1 mmol/L). * Blood pressure \(\geq\) 130/85 mmHg.