aMMP-8 test: early detection preserves teeth & implants
Do you have a new implant and want to keep it? A pious wish - which sometimes goes unheard. The loss of implants is still part of everyday life in dentistry. A simple saliva test, the aMMP-8 test, could prevent this. How do you prevent implant loss? Find out!
Implants: Trust is good, control preserves teeth
The big problem with implants and teeth in general is inflammation. They cause the tissue to shrink - not only do the gums recede, the bone also weakens. The tooth wobbles and has to be extracted. Dentistry is constantly making progress in the field of implants. Nevertheless, the removal of implants is part of everyday practice.
Periodontitis, or peri-implantitis in the case of implants, is your enemy. This technical jargon refers to chronic inflammation that makes the tooth bed unsafe. Regular checks using a simple enzyme test could prevent the loss of implants - but as always with official matters, the well-known German proverb applies here too: good things take time.
Current diagnostic methods inadequate
Diagnostic methods in dentistry in this country still leave a lot to be desired. This is the result of several studies. The fifth edition of the German Oral Health Study (DMS 5) shows (1): 13.2 million teeth have to be extracted every year. Two out of three tooth losses are due to subclinical collagenolysis - the technical term.
Collagenolysis simply refers to the breakdown of tissue by splitting collagen. In this context, subclinical means that the breakdown of tissue occurs slowly and painlessly. Collagenolysis typically leads to periodontitis or peri-implantitis.
From gingivitis to peri-implantitis
Gingivitis is the first step on the way to periodontitis. Your gums bleed frequently - then off to the dentist you go! If gingivitis remains untreated, it will lead to periodontitis. The inflammation spreads from the gums to the tooth bed. The entire periodontium is affected. This process is called peri-implantitis when it occurs in the area of implants.
According to the DMS 5 study, on average one in ten Germans loses a tooth every year due to periodontitis. Around five percent of implants are still lost due to peri-implantitis. This deserves a poor rating, as 70 percent of all Germans have their teeth checked by a dentist once or twice a year.
The reason: current diagnostic methods primarily detect existing damage. However, they fail to detect signs of periodontitis in good time. This is according to the 2017 dental report by Barmer Krankenkasse (2). They therefore do not help to prevent the disease.
PSI measures existing damage
For regular diagnostics in the dental practice, there are two services that can be billed to health insurance companies. 01 refers to the normal findings that the dentist makes at every visit. PSI, on the other hand, is the abbreviation for the Periodontal Screening Index. The dentist uses a special probe to measure the depth of the gum pockets.
A depth of 3.5 millimeters or more is currently considered to be in need of treatment. Apart from the fact that we could argue about this value: The dentist is poking around in your gums just to determine the amount of tissue loss that has already occurred. Prevention? Not really.
aMMP-8: Enzyme provides information in real time
Fortunately, there are clever scientists who have developed a new method. A simple saliva test provides a diagnosis in real time. It therefore has the potential to revolutionize oral health measures - just as the measurement of long-term glucose levels significantly improved the health of diabetes patients years ago.
Scientists at the University of Helsinki have developed a saliva test that measures the amount of activated MMP-8. This abbreviation stands for activated matrix metalloproteinase 8, an enzyme that your body produces itself. aMMP-8 can break down type I and type III collagen.
Collagen is the most abundant protein in the human body. It provides stability and structure to various types of tissue. Poor oral hygiene and the resulting dental plaque allow aMMP-8 to run riot in your oral cavity.
Information on severity
This test has proven to be much more efficient than the previous procedure of probing to provoke bleeding - a seemingly archaic process compared to the saliva test (4). Instead of pricking your gums, the dentist applies some saliva to a strip of paper. The aMMP-8 test is able to provide information about the progress of collagenolysis or periodontitis (5).
Bacteria and other germs in dental plaque irritate the gums. The immune system reacts with inflammation. This in turn causes neutrophil granulocytes (white blood cells), fibroblasts and endothelial cells to accumulate at the inflamed site. They activate MMP-8.
Danger: Unstable tooth bed
If inflammation persists over a long period of time, these processes become noticeable at the cellular level in the visible area. Bleeding gums develop into receding gums. The entire periodontium becomes unstable.
The activity of aMMP-8 is particularly threatening in implants. The neck part of a dental implant is particularly smooth so that the oral mucosa can form a tight seal. This prevents germs from penetrating into deeper tissue.
Mucosa barrier perforated
If activated MMP-8 is not recognized in large quantities, 'holes' are created in the so-called mucosa barrier (mucosa = mucous membrane) due to the splitting of collagen. Pathogens penetrate and lead to inflammation in the supporting tissue.
It seems logical that this process cannot be detected by measuring a periodontal pocket. If the gums have already visibly receded, the periodontitis - or peri-implantitis in the case of an implant - is already well advanced.
Incidentally, losing the implant is not even the worst-case scenario for peri-implantitis or periodontitis. Pathogenic germs can enter the bloodstream from the oral cavity. Via the blood, they reach the entire body, including the brain. This is how they can trigger serious diseases such as Alzheimer's, heart disease or cancer (6) (7) (8).
aMMP-8 test: How expensive and how often?
According to current findings, it is sufficient to measure the stability of collagen in the mouth once or twice a year using the aMMP-8 test. The test costs 49 euros and is not yet covered by health insurance.
It can be carried out in saliva for the entire oral cavity or for individual teeth as required. The result with the PerioSafe/ImplantSafe measuring system is available after just a few minutes.
Target: The aMMP8 value should be less than 20 ng/ml.
Regularly checking your aMMP-8 levels helps you to nip inflammation in the bud. If your value is too high, you can take immediate countermeasures. In the case of gingivitis, improved dental hygiene is often sufficient. Dental biofilm, in plain language plaque, is the main cause of gingivitis.
Hope: aMMP-8 test becomes standard
Numerous experts in the field of dentistry hope that the aMMP-8 test will be recognized as a standard procedure. They compare its importance with blood glucose self-monitoring. Previously, diabetes sufferers often had kidney damage. They often lost limbs with poor circulation or went blind.
This test only became part of standard therapy in the 1990s. Only by measuring blood glucose before and after meals is it possible to determine the exact amount of insulin required. On an empty stomach it should be between 65 and 100, after a meal between 80 and 126, while the long-term glucose value (hbA1c) should be between 6.5 and 7.5.
The story of self-monitoring blood glucose levels confirms this: Prevention is better than cure - or losing an implant. Here you will find a list of dentists who already use the MMP8 test. The following universities also use the test:
- Charité Berlin
- Uni Bonn
- Uni Witten Herdecke
- Uni Marburg
- Uni Basel
- Uni Zürich
- (1) https://www.bzaek.de/ueber-uns/daten-und-zahlen/deutsche-mundgesundheitsstudie-dms.html
- (2) https://www.barmer.de/presse/infothek/studien-und-reports/zahnreporte/barmer-zahnreport-2017-105414
- (3) Balasubramanian, Preethi & Prabhakaran, Molamma & Sireesha, Merum & Ramakrishna, Seeram. (2013). Collagen in Human Tissues: Structure, Function, and Biomedical Implications from a Tissue Engineering Perspective. Fortschritte der Hochpolymeren-Forschung. 251. 173. 10.1007/12_2012_176. (https://www.researchgate.net/publication/258843486_Collagen_in_Human_Tissues_Structure_Function_and_Biomedical_Implications_from_a_Tissue_Engineering_Perspective)
- (4) Räisänen IT, Sorsa T, van der Schoor GJ, Tervahartiala T, van der Schoor P, Gieselmann DR, Heikkinen AM. Active Matrix Metalloproteinase-8 Point-of-Care (PoC)/Chairside Mouthrinse Test vs. Bleeding on Probing in Diagnosing Subclinical Periodontitis in Adolescents. Diagnostics (Basel). 2019 Mar 23;9(1). pii: E34. doi: 10.3390/diagnostics9010034. PubMed PMID: 30909530; PubMed Central PMCID: PMC6468891. (https://www.ncbi.nlm.nih.gov/pubmed/30909530)
- (5) Schmalz G, Hübscher AE, Angermann H, Schmidt J, Schmickler J, Legler TJ, Ziebolz D. Associations of chairside salivary aMMP-8 findings with periodontal parameters, potentially periodontal pathogenic bacteria and selected blood parameters in systemically healthy adults. Diagn Microbiol Infect Dis. 2019 Oct;95(2):179-184. doi: 10.1016/j.diagmicrobio.2019.05.006. Epub 2019 May 10. PubMed PMID: 31174997. (https://www.ncbi.nlm.nih.gov/pubmed/31174997)
- (6) Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, Nguyen M, Haditsch U, Raha D, Griffin C, Holsinger LJ, Arastu-Kapur S, Kaba S, Lee A, Ryder MI, Potempa B, Mydel P, Hellvard A, Adamowicz K, Hasturk H, Walker GD, Reynolds EC, Faull RLM, Curtis MA, Dragunow M, Potempa J. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019 Jan 23;5(1):eaau3333. doi: 10.1126/sciadv.aau3333. eCollection 2019 Jan. PubMed PMID: 30746447; PubMed Central PMCID: PMC6357742. (https://www.ncbi.nlm.nih.gov/pubmed/30746447)
- (7) Dhadse P, Gattani D, Mishra R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ? J Indian Soc Periodontol. 2010 Jul;14(3):148-54. doi: 10.4103/0972-124X.75908. PMID: 21760667; PMCID: PMC3100856. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100856/)
- (8) Michaud DS, Lu J, Peacock-Villada AY, Barber JR, Joshu CE, Prizment AE, Beck JD, Offenbacher S, Platz EA. Periodontal Disease Assessed Using Clinical Dental Measurements and Cancer Risk in the ARIC Study. J Natl Cancer Inst. 2018 Aug 1;110(8):843-854. doi: 10.1093/jnci/djx278. PubMed PMID: 29342298; PubMed Central PMCID: PMC6093423. (https://www.ncbi.nlm.nih.gov/pubmed/29342298)