Evaluation of Salivary Caspase-3 as a Biomarker for Peri-implantitis in Type 2 Diabetic Patients with Full-arch Implant-supported Prostheses: A Cross-sectional Study

Aim: The study aimed to evaluate the potential of salivary caspase-3 levels as a noninvasive biomarker for the early detection and monitoring of peri-implantitis (PI) in type 2 diabetic patients with full-arch implant-supported prostheses.Materials and methods: A total of 42 participants were included, divided into three groups (n = 14 each) based on glycemic status (HbA1c ≥ 6.5% for diabetics) and presence of PI (probing depth ≥ 6 mm and radiographic bone loss exceeding one thread).Group A included patients with PI with presence of diabetes mellitus (DM + PI), group B with PI but absence of diabetes mellitus (NDM + PI), and group C periodontally healthy and absence of diabetes mellitus (NDM + PH).Unstimulated whole saliva (10 mL) was collected over 5 minutes in sterile polypropylene tubes.Samples were centrifuged at 3000-10000 rpm for 10 minutes; the supernatant was stored at -80° C. Salivary caspase-3 levels were quantified using a commercially available Human Caspase-3 enzyme-linked immunosorbent assay kit following the manufacturer's protocol.Data were analyzed using nonparametric tests (Kruskal-Wallis and Mann-Whitney U) with significance set at p < 0.05.Results: The salivary caspase-3 levels were significantly higher in diabetic patients with PI (80.36 ± 0.35 pmol/L) compared with nondiabetic patients with PI (58.10 ± 0.26 pmol/L) and healthy controls (41.30± 0.11 pmol/L), with a statistically significant difference among the groups (χ² = 37.865, p < 0.001).Conclusion: Elevated salivary caspase-3 levels were associated with PI, especially in patients with type 2 diabetes mellitus.This suggests that caspase-3 could serve as a noninvasive salivary biomarker for early detection and monitoring of PI inflammation in high-risk populations. Clinical significance:The identification of a salivary molecular marker linked to inflammation and PI tissue breakdown offers clinicians a valuable diagnostic adjunct, enabling earlier detection, personalized intervention, and improved long-term outcomes of implant therapy in systemically compromised patients.