Development and internal validation of a titanium ion-integrated diagnostic classification model for peri-implantitis

Area of Science:

• Biomaterials Science
• Dental Implantology
• Clinical Diagnostics

Background:

• Titanium release from dental implants is linked to peri-implantitis.
• Current disease classification models have limited integration of titanium ion data.
• Accurate classification is crucial for managing peri-implantitis.

Purpose of the Study:

• To develop and internally validate a classification model for peri-implantitis.
• To integrate titanium ion levels into a multivariable model for disease classification.
• To assess the discriminative and calibration performance of the titanium-integrated model.

Main Methods:

• Cross-sectional study with 120 participants (60 healthy, 60 peri-implantitis).
• Quantification of titanium ion concentrations in peri-implant crevicular fluid (PICF) and serum via ICP-MS.
• Multivariable logistic regression to derive the Titanium Release Score, validated with bootstrap resampling.

Main Results:

• Elevated PICF and serum titanium concentrations were significantly associated with peri-implantitis (ORs > 1.5).
• The Titanium Release Score model showed good discrimination (AUC = 0.87), with an optimism-corrected AUC of 0.83 after internal validation.
• Model calibration was acceptable (Hosmer-Lemeshow, p = 0.62).

Conclusions:

• The titanium-integrated model effectively discriminates between peri-implantitis and healthy implants.
• Titanium ion levels are independently associated with peri-implantitis, serving as a relevant risk indicator.
• Further external validation and longitudinal studies are needed for clinical application.