الفهرس 
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Abstract
Summary
Dental implants are considered as a first option for replacement of missing teeth as it is proved to have a long term success either functionally or esthetically. Implants have an advantages over the other methods of replacement of missing teeth that, it doesn’t have an effect on the neighboring teeth as in case of fixed bridge or an effect on bone as in case of removable dentures. But still there are complications related to implant placement which may be related to systemic diseases.
obesity is considered as a systemic disease which is increasing worldwide due to consumption of high caloric diet and sedentary life style. we can call the person obese when BMI which is measured as Weight in kg / Height in metres2 is ≥30 kg/m2 and WC which is measured (in cm) in the middle between the 12th rib and the iliac crest at the level of the umbilicus circumference >102 cm (40 inches) in men and >88 cm (35 inches) in women .
obesity can lead to several diseases as diabetes mellitus, cardiovascular disease, osteoarthritis, hypertension. Adipose tissue is composed of brown adipose tissue and white adipose tissue which is considered as an active endocrine organ that secrets several factors including pro-inflammatory cytokines and numerous immunomodulatory factors.
Periodontitis is considered as a destructive disease for the attachment apparatus of the tooth. Many studies have indicated that there is a relationship between obesity and periodontitis. But still patients with good oral hygiene and with a daily hygiene measures are less susceptible to this disease.
So, we hypothesized that patients with obesity have an increase in the inflammatory markers related to dental implants in the peri-implant sulcular fluid which have an effect on bone level and overall implant success.
Twenty patients from the outpatient clinic were chosen for placement of a single delayed implant in lower molar area, ten obese patients and ten with normal weight.
After the final fixed restoration, samples were collected in order to measure both markers TNF-α and IL-1β. Also crestal bone level changes was measured using superimposition technique using data from CBCT. Also clinical parameters which are probing depth, plaque index, bleeding index were measured.
Results showed that regarding the clinical parameters plaque index, probing depth and bleeding index in both groups no significant difference was found. This was explained by the initial intensive phase I treatment and strict oral hygiene instructions that was given to all patients.
Bone level in both groups showed no significant difference.
Regarding the biochemical assessment, the level of TNF-α was decreased gradually by time from 4.5months to 7.5months after implant placement in both groups. The elevation in the first assessment in both groups may be due to the fixed prosthetic procedures.
In case of percent of change of TNF-α levels a greater decrease was found in non-obese group as the levels of TNF-α were elevated systemically in obese individuals due to excess accumulation of adipose tissue so, there was an elevation in PISF.
Regarding IL-1β, a gradual decrease was noted by time as the elevation in the first assessment was due to the fixed prosthetic procedures. Also, the intergroup comparison no significant different was found as the plaque index was the same between groups.
So, obesity is a systemic modifying disease which has a minimal effect on peri-implant condition as long as oral hygiene measures are applied to control dental plaque.