Salivary Titanium Level as a Non-invasive Biomarker for Peri-Implantitis: A Prospective Study

Dental implants are widely used for tooth replacement owing to their biocompatibility and long-term stability. Titanium released from implants into surrounding tissues and saliva may reflect corrosion and disease activity. This study aimed to evaluate salivary titanium ion levels in patients with healthy implants versus those with peri-implantitis one year after implant placement, and to assess their relationship with clinical parameters of peri-implant health.

A prospective cohort study was conducted in 30 patients who received single titanium implants in the posterior region in the Department of Oral Pathology at Jawahar Medical Foundation's Annasaheb Chudaman Patil Memorial Dental College, Dhule, Maharashtra, India, from November 2022 to November 2023. Patients were divided into three groups (n = 10 each): no implant (control), healthy peri-implant mucosa, and peri-implantitis diagnosed using standardized clinical and radiographic criteria. Unstimulated whole saliva was collected at the 12-month follow-up using a standardized kit. The titanium concentration of the samples was analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Clinical parameters, including probing depth and marginal bone loss, were recorded at six sites per implant. Data were compared between the groups using appropriate statistical tests.

Salivary titanium levels were lowest in the no-implant group (3.3 ± 1.49 µg/L), significantly higher in patients with healthy implants (127 ± 13.32 µg/L), and highest in the peri-implantitis group (235.3 ± 17.94 µg/L). Probing depth and marginal bone loss followed a similar pattern, increasing from the control (0.21 ± 0.04 mm and 0.29 ± 0.07 mm) to healthy implant (3.14 ± 0.48 mm and 0.77 ± 0.13 mm) and peri-implantitis groups (4.87 ± 0.55 mm and 1.49 ± 0.23 mm). Statistical analysis confirmed significant differences in titanium levels, probing depth, and marginal bone loss across the groups (p = 0.001 for all). Post-hoc tests showed that peri-implantitis was associated with markedly greater values in all measured parameters compared with healthy implants and controls (p = 0.001 for all pairwise comparisons).

Salivary titanium ion concentration increased with the severity of peri-implant disease and correlated with the clinical indicators of inflammation and bone resorption. This non-invasive biomarker reflects implant surface degradation and may serve as an early diagnostic tool for peri-implantitis. Regular monitoring of salivary titanium could enhance risk assessment and support timely clinical intervention, thereby improving long-term implant outcomes.