Peri-Implant Hypoxia as a Potential Barrier Against Ferroptotic Mechanisms During Peri-Implant Diseases

Peri-implant diseases are characterized by an inflammatory response leading to progressive bone loss around dental implants. While microbial biofilms and host immune responses contribute to disease progression, recent studies have suggested that programmed cell death pathways, including ferroptosis, may also play a role. Ferroptosis is an iron-dependent form of non-apoptotic cell death that is regulated by GPX-4, a key enzyme that prevents lipid peroxidation, and MDA, a biomarker of oxidative damage. Hypoxia, a common feature in peri-implant disease, is known to modulate oxidative stress and inflammatory responses through HIF-1α, but its role in ferroptosis remains unclear.

This cross-sectional study aims to evaluate the relationship between hypoxia and ferroptosis in peri-implant diseases by measuring the levels of HIF-1α, GPX-4, and MDA in peri-implant crevicular fluid (PICF). A total of 45 participants with 62 dental implants were included in the study, categorized into peri-implant health (PH), peri-implant mucositis (PM), and peri-implantitis (PP) groups. PICF samples were collected using standardized paper strips, and biomarker levels were quantified via enzyme-linked immunosorbent assay (ELISA). Statistical analyses, including Kruskal-Wallis and Spearman correlation tests, were performed to assess differences among groups and potential associations between biomarkers.

The findings demonstrated that MDA levels were significantly lower in the peri-implantitis and peri-implant mucositis groups compared to peri-implant health, while GPX-4 levels were elevated in peri-implant mucositis and decreased in peri-implantitis. HIF-1α levels showed no significant differences among groups, but a positive correlation was observed between HIF-1α and GPX-4, suggesting a potential interaction between hypoxia and ferroptotic regulation in peri-implant tissues. These results imply that hypoxic conditions in peri-implant diseases may inhibit ferroptosis by modulating GPX-4 activity and reducing lipid peroxidation.

The study provides novel insights into the pathophysiology of peri-implant diseases, suggesting that the peri-implant microenvironment may exhibit unique regulatory mechanisms affecting ferroptotic pathways. While these findings contribute to our understanding of peri-implant disease pathogenesis, further longitudinal studies are needed to establish causal relationships and explore potential therapeutic strategies targeting hypoxia-ferroptosis interactions.