\r\n\tAn update on clinical manifestations, their assessment, monitoring, and imagiology, including peripheral arthritis, enthesopathy, and extra-articular findings, and, the differential diagnosis with other diseases which evolves with axial and peripheral calcifications will be provided.
\r\n
\r\n\t \r\n\tAn important component of this book must be dedicated to the more recent treatments namely with biologic therapies but focusing also on new small molecule inhibitors and experimental therapies.
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1. Introduction
It is known that cell or tissue damage is related to free reactive oxygen radicals (ROS; reactive oxygen species) and associated nitrogen degradation products [1, 2, 3, 4, 5]. These radicals are high-energy molecules that have free electrons in their outer orbits, and can easily interact with other molecules and cause DNA damage. These molecules are continuously produced in the human body secondary to some detoxification processes, phagocytosis and energy production. Although the healthy human body has the capacity to neutralize these radicals, the balances may change in the direction of increasing the ROS ratio and reducing the antioxidant capacity due to the reasons such as environmental conditions and diet, so oxidative stress develops [6]. There are many different types of ROS, and many cellular and organ system level pathologies occur in the body depending on these products [2, 7, 8]. Various antioxidant compounds are used in medicine to prevent these pathologies [1, 2, 9, 10]. These compositions include various immunological and pharmacological agents, vitamins, fruits, vegetables, food supplements, herbal products, or spices [1, 2, 4, 11].
Many types of herbs and spices have generally safe ingredients for human health and their benefits have been known for a long time [10, 11, 12, 13]. These benefits include facilitation of digestion, anti-inflammatory, antirheumatic, antisclerotic, antimalarial, antimicrobial, antiviral, immunomodulatory, antiallergic, antiaging, antidiabetic, radioprotective, antioxidant, and antiproliferative/anticarcinogenic effects [4, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]. Because of these benefits, they are used in many acute and chronic diseases (diabetes, dyslipidemia, hypertension, cancer, cardiovascular and neurodegenerative disease, liver cirrhosis, arthritis, asthma, obesity, metabolic syndrome, etc.) [9, 10, 12, 13, 14, 19, 21, 22]. In addition, herbs and spices are used in order to increase the nutritional value, flavor and aroma of foods, have protective properties during storage and extend the shelf life of foods [3, 5, 9, 11, 12, 13, 14, 21, 23, 24, 25, 26]. Thanks to the spices added to foods, the lipids in the food are protected against oxidative deterioration and the formation of oxidant substances is delayed.
Antioxidant materials can be classified under two main headings, which are synthetic and natural [5, 12]. Synthetic antioxidants are widely used in the market. However, it has been determined that these synthetic products have harmful effects on human health in the long term, and cause teratogenic/carcinogenic effects. Therefore, consumers prefer foods that contain natural antioxidant agents. Concordantly, over time, herbs and spices with natural antioxidant properties were replaced by synthetic products [4]. These so-called “natural antioxidants” are claimed to be more effective than synthetic ones. The origins and uses of natural antioxidants are diverse. In this review, the main properties of herbs and spices with known antioxidant properties are studied to be presented.
2. General properties of herbs and spices with natural antioxidant effects
Many bioactive foodstuffs originate from herbs [2]. These substances are generally called as “phytochemicals” [2, 5]. Most of these phytochemicals are redox active molecules so that they have antioxidant features [2].
Many herbs and spices with antioxidant effects are from the “labiatae (lamiaceae)” family. Most of the herbs in this family have been used in traditional treatments to cure various diseases from ancient times until today. Besides, it has areas of use in the food, cosmetics and perfumery industries [27].
Herbs and spices contain organic sulfur, tannin, alkaloid, phenolic diterpene, diketone, polyphenol, polyphenylpropanoid, vitamin, flavonoid and anthocyanin compounds, and they have a protective effect against oxidizing agents [12, 13, 14, 27, 28, 29]. It is stated that this protective effect is mostly related to the “flavonoid” and “phenolic” content of the herbs and spices [3, 4, 9, 12, 13].
It has been suggested that being fed with a flavonoid-containing diet efficiently reduces the risk of chronic diseases [9, 10, 21]. These effects of flavonoids have been reported to be related to oxidative stress defense at the molecular level [9, 30, 31, 32]. Flavonoids scavenge and neutralize free radicals [32]. Numerous articles have been published on this subject, especially in the last two decades. In these studies, very detailed investigations have been made especially on the structures and biological activities of flavonoids [4, 9, 21, 33, 34, 35].
Phenolic compounds act with redox reactions [32]. The ratio of phenolic component is an important variable on the antioxidant activity of the product [3, 4, 5, 9, 10, 12, 26].
It has been reported that the antioxidant capacity of these products is approximately 10 times higher than that of fresh fruits and vegetables [9, 32]. Parallel to the progress made by modern medicine in the last decade, studies to determine the bioactive components in herbs have gained momentum. Although the chemical structures of most herbal components have been described in detail, tests and molecular studies on their bioactive roles are still ongoing [9, 21, 36, 37, 38, 39].
3. Antioxidant-affected plants
In the Figure 1, natural herbs with potent antioxidant features and which are most commonly used are listed.
Figure 1.
Natural herbs with potent antioxidant features and which are most commonly used.
3.1 Rosemary (Rosemarinus officinalis)
This plant, in the “lamiaceae/labiatae” family, is a polyphenol-containing plant with small pointed leaves, which grows particularly in the Mediterranean region [9, 12, 13, 14, 21, 27, 40]. The plant can reach 1–2 meters in height. It has an aromatic structure and does not shed its leaves in winter. Especially in spring, white-blue flowers bloom with leaves [14, 27]. Its leaves taste bitter [27]. It is used in making salads or tea [40].
This plant is used as an antioxidant and preservative, especially in the food industry [12, 14, 27, 41, 42, 43]. In addition, it can be consumed in the form of soap, perfume and lotion [27]. Its use for food preservation is for the lipid component in food. When used as a food preservative, it has been determined that rosemary does not spoil the organoleptic contents of foods [12].
There are studies indicating that the antioxidant capacity of rosemary is closely related to the techniques in production [44]. It has been reported that the antioxidant effect of rosemary depends primarily on its type, harvest time, type of treatment, environmental and ecological characteristics of the environment it grows [27]. The way rosemary is given is also an important parameter in its effectiveness. It has been reported that the encapsulated form of rosemary essential oil exhibited more antimicrobial effects compared to the standard essential oil form [12].
Carnosol, carnosic acid, phenolic diterpene, phenolic acid, rosmanol, epirosmanol, rosmarinic acid, caffeic acid ester, tosemaridiphenol, 3- (3,4 dihydroxyphenyl) lactic acid, flavonoids (apigenin, diosmin, luteolin), tannins provide antioxidant properties to the plant [9, 11, 12, 13, 27, 40, 45]. Rosemary also contains essential oils (cineole, pinene, camphor) [13]. The dominant components in its structure are rosmarinic and carnosic acid [12, 13, 27]. Carnosic acid and carnosol are responsible for 90% of the antioxidant effect. These components reduce cell membrane damage by 40–50%. Both components also reduce DNA damage due to dietary oxidant agents [13]. The antioxidant activity of carnosic acid has been compared with synthetic antioxidants such as butylated hydroxytoluene (BHT), butylated hydroxyanisole (BHA) and tertiary butyl hydroquinone (TBHQ), and it has been proved that carnosic acid has a stronger antioxidant effect than these molecules [12].
There are many studies on rosemary in the literature. Akgül et al. determined that rosemary is among the most powerful antioxidants [46]. It has been stated that rosemary extract increases the antioxidant status and defense of aged rats [13]. Similarly, in another study, the antioxidant effect of 32 different plants and spices on lard was investigated, and rosemary was detected to be among the most important antioxidants [47]. In another study in which 15 different types of spices were tried in sausages, it was observed that one of the products with the most important antioxidant effect was rosemary [48]. In a study examining the effect of rosemary on foods prepared with some fish species, it was observed that rosemary significantly reduced the level of malondialdehyde in fish-containing foods. In a study on the oxidative stability of ground sardines, rosemary extract was determined to have an antioxidative effect over a 5-month period [27]. Rıznar et al. examined the antioxidant activity at 3 different temperatures (4, 12, 25 °C) by adding rosemary extract to chicken sausages, and observed high antioxidant effects during storage at all temperatures [49]. Lopez-Bote et al. indicated that rosemary extract is highly effective in preventing lipid peroxidation in chicken meat stored at −20 ° C for 6 days [50]. In a study of alloxan-induced diabetic rats, intraperitoneal injection of rosemary for 7 days decreased in blood glucose levels [40]. In a similar study, after administration of 100 mg/kg rosemary extract in diabetic rat models, a significant decrease in blood glucose level and an increase in serum insulin concentration were achieved [13].
The properties of rosemary include hepatoprotective, antiangiogenic, anti-inflammatory, antioxidant, antimicrobial, antidiabetic, antihypertensive, antithrombotic, antiproliferative, and anticarcinogenic effects [4, 13, 14, 40]. Its anti-inflammatory effect is thought to be because of decreased macrophage viability, inducible nitric oxide synthase (iNOS) protein expression and nitric oxide (NO) production. Rosemary can also contribute to the treatment of hypertension. Increased urinary volume and excretion of sodium, potassium, and chloride were found in healthy rats given rosemary extract daily for 7 days orally [40]. It also improves endothelial function with its antithrombotic effect [13]. Carnocic acid has an inhibitory effect on liver fibrosis [14]. Rosemary extract has been determined to have detoxifying properties on toxic chemical-related liver damage and cirrhosis in experimental animal models. In the experiments performed in mice, it was observed that fatty liver associated with obesity was decreased by giving 200 mg/kg of rosemary leaves after the diet with high fat content [13]. Another effect of rosemary is that it is hypolipidemic. In a study conducted on obese rats, it was evaluated that feeding a rosemary-rich diet for 64 days caused a decrease in body weight [40]. Rosemary extract reduces low density lipoprotein (LDL) cholesterol oxidation. In cell culture tests, it has been detected to reduce lipid peroxidation by 38–89% under oxidative stress. In a randomized clinical study conducted with rosemary inhalation in 140 subjects, it was observed that cognitive assessment and self-assessment mood scale levels and cognitive functions increased. In vivo and in vitro studies, rosemary extract has been reduced oxidative damage in fat cells on the skin surface. Rosemary is therefore a potential candidate for skin treatment. However, clinical studies with large series are needed on this subject [13]. Amoah et al. reported that this ingredient is also used in the treatment of atopic dermatitis and seasonal allergic rhinoconjunctivitis [51].
3.2 Coriander (Coriandrum sativum)
It is a plant with a flavonoid structure [9]. Coriander leaves and roots are used in cooking. Especially the coriander leaf type known as “cilantro” is frequently used for this purpose [40].
The roots of this plant contain high levels of chlorogenic acid, caffeoyl derivatives, quercetin-3-O-rutinoside and p-coumaric acid [9, 40].
Several potential benefits of chlorogenic acid have been reported [9]. These include antidiabetic, anticarcinogenic, anti-inflammatory and antiobesity effects [9, 52, 53]. In streptozotocin-induced diabetic rats, intraperitoneal injection of coriander seed extract significantly decreased serum glucose and increased insulin secretion in pancreatic β-cells. It was also observed that lipid peroxidation and protein oxidation decreased in the subjects given coriander. Coriander roots also have a hypolipidemic effect. In a study conducted in obese and hyperlipidemic rats, it was presented that total cholesterol, LDL and triglyceride levels were reduced in the group given coriander extract orally for 30 days. Additionally, serum and erythrocyte antioxidant parameters have been detected to be increased [40].
3.3 Dill (Anethum graveolens)
Dill has a flavonoid structure [4, 6]. It is generally consumed during feeding with seafood [40]. Fresh dill contains high levels of flavonol glucuronides, chlorogenic acid quercetin and isorhamnetin [9, 40].
It has antidiabetic potential. Dill given orally for 15 days in diabetic rats induced by dexamethasone has been determined to cause a decrease in serum glucose and insulin levels. Dill is also hypolipidemic. In rats fed a high-fat diet for 3 weeks, daily oral dill was found to cause a decrease in blood total cholesterol, triglyceride and LDL levels after 2 weeks [40].
3.4 Bacil (Osimum basilicum)
It is a medium density plant with flavonoid and polyphenol content [9, 40]. Bacil leaves are used in the form of a salad or cake dressing [40].
Bacil extract contains significant rosmarinic acid and catechin [40].
In studies on bacil extract, it has been determined that bacil is highly effective in preventing metabolic syndrome. Its antidiabetic and anti-inflammatory properties are known. The bacil extract also prevents the accumulation of intracellular sorbitol by providing aldose reductase inhibition. In this way, it is suggested that it reduces vascular osmotic pressure and oxidative stress, which are among diabetic complications. Due to its dense polyphenol content, it has also been closely associated with the reduction of advanced glicosylation products that occur in oxidative stress. It is also effective in the regulation of blood pressure. It increases renal function in hypertensive rats. Subjects treated with bacil had a decrease in blood urea nitrogen concentration and a decrease in creatinine and angiotensin compared to the hypertensive control group [40]. In an experimental study in which cerebral hypoperfusion and ischemia/reperfusion damage was performed in the brain in mice, it was found that it reduced the size of cerebral infarct with its antioxidant effect, but also increased short-term memory and motor coordination [21].
3.5 Fennel
This plant species belonging to the “foenicuum vulgare” species and often called “fennel” belongs to the “apiaceae” family [14]. It is consumed in salads, sauces, bread making, together with fish products and in the form of tea [40]. This product is a type of plant that is used quite often in alternative medicine. Although it often grows in the Mediterranean, it is known that it grows in different parts of the world today [14].
It contains fenchone, estragole, anise aldehyde, trans-anethole, and essential oils [14]. This ingredient gives fennel its unique smell and taste [5]. The most concentrated flavonoid in its composition is quercetin [40].
It has antibacterial, antifungal, antioxidant, hepatoprotective, antidiabetic, antineoplastic, and anti-inflammatory effects [14, 40, 54]. Anise aldehyde content of fennel is responsible for the hepatoprotective effect [14]. The reducing effect of fennel consumption on systemic complications of diabetes is through aldose and aldehyde reductase inhibition [40]. Studies have proved that F. vulgare accelerates the removal of harmful waste from the body by increasing body excretion. The anticancer potential of fennel seed methanolic extract (FSME) has been observed to be due to its reduction in oxidative stress in human MCF-7 and HepG-2 cell lines [14]. Fennel bulb has an antihyperlipidemic effect. In a study conducted on mice, it was observed that 24 hours after fennel bulb administration, a decrease was achieved in total cholesterol, triglyceride, LDL and ApoB levels [40]. In the experimental study conducted on Swiss albino mice by Mohamad et al., it was reported that oxidative stress decreased in subjects who were given 100 mg/kg FSME intraperitoneally, and they were protected from Ehrlich Ascites Carcinoma (EAC) associated with ROS [55]. In another study, it has been proved that fennel extract administered orally to mice reduces arachidonic acid-related ear edema [40].
3.6 Bay leaves (Laurus nobilis)
Laurus nobilis is a plant that is often grown in southern Europe and used in cooking. It contains flavonoids such as quercetin, kaempferol and sesquiterpen in particular [40].
It is especially known for its antidiabetic effect. Its hypolipidemic effect has been demonstrated in several in vivo studies. Bay leaf extract has been increased glucose uptake in rat epididymal adipocytes by acting like insulin. Besides, it causes a decrease in total plasma cholesterol level in hypercholesterolemic people. It inhibits ApoA1 glycation, oxidation of LDL particles and uptake of oxidized LDL particles from macrophages, in in vitro studies. Bay leaf additionally has an anti-inflammatory effect. Bay leaf extract reduces interleukin-6 (IL-6) production and cyclooxygenase-2 (COX-2) protein expression, particularly in stimulated macrophages [40]. It has also been detected to reduce the rate of cell death and cerebral infarction after cerebral ischemia in rats [21].
3.7 Sage (Salvia officinalis)
It is in the fragrant herbs class that forms the “salvia” genus from the “lamiacea” family. It is also known as “Ammi majus” and “salvia”. It grows a lot in Asian and European countries [27]. The dried form of the leaves, which are furry and whitish, can be boiled like tea and can be used to add taste and flavor to meat dishes [27, 40].
It is dense in terms of polyphenols. It is particularly rich in phenolic and rosmarinic acid [40]. The most important phenolic components in the structure of sage, which has antioxidant effect, are carnosol, carnosic acid and rosmanol [27].
It has an antihyperlipidemic effect [40]. Fasseas et al. reported that lipid peroxidation decreased in meats treated with sage extract, but this effect may vary depending on storage temperature and time [56]. In streptozotocin-induced diabetic rats, it was observed that sage extract given intraperitoneally caused a decrease in serum glucose level after 3 hours, but it was shown that it did not cause any change in serum insulin level. However, it has been shown to contribute positively to glucose management in healthy subjects. Serum glucose levels have been decreased in healthy subjects given oral sage for 14 days. Experimental studies have been conducted on the potential anti-inflammatory effect of sage and positive results have been obtained. Inflammation at the injection site was observed to be reduced by administering sage one hour before injection of carrageenan or formalin to rats [40]. In a study conducted on people between the ages of 65 and 80 with mild or moderate Alzheimer’s disease, another type of salvia called “salvia lavandulaefolia” was used for 4 months and significant improvement was obtained in cognitive functions. Thus, this product is thought to have the feature of increasing “speed of memory” in healthy volunteers. In a comparative study conducted between “Salvia officinalis” (aroma form) and “salvia lavandulaefolia” (oil form), it was detected that Salvia officinalis increased cognitive and emotional characteristics and memory quality more [21].
In a study of industrial microwave exposure of sage, it was examined that there was no change in the antioxidant properties of this plant [50].
3.8 Green tea
It is an antioxidant and anti-inflammatory product with flavonol structure [21]. It is an important component of many diets, due to its high antioxidant content [2].
Major flavonoids in green tea are monomer catechins, epigallocatechin gallate (EGCG), epigallotechin, epicatechin (EC), epicatechin-3-gallate (ECG) and epicathechin (EGC) [2, 26]. EGCG is the most active and the most concentrated component in green tea [26]. It makes up 43% of total phenol [4, 26]. Most of the stated effects of green tea are related to the EGCG component. EGCG presents its antioxidant, anti-inflammatory effect by reducing COX-2 overexpression. The polyphenol content constitutes approximately 35% of its dry weight. Compared to black tea, green tea has a higher proportion of catechins [26].
Green tea is a herb known to have positive effects on age-related chronic diseases, cardiovascular diseases, cancer, obesity, diabetes, and neurodegenerative pathologies. In many epidemiological studies, it has been suggested that green tea consumed daily reduces morbidity and mortality due to chronic diseases [26].
It is an antioxidant herb with a very high flavonoid content [9, 21, 40]. It mainly contains apigenin [40].
It was observed that parsley, which was given parsley extract and administered orally to streptozotocin-induced diabetic rats for 28 days, caused a decrease in the level of glucose in the circulation. In addition, parsley also has an anti-inflammatory effect. One hour after oral administration of parsley extract in rats with paw edema induced by carrageenan, a decrease in edema was observed in the area where carrageenan injection was applied. Another benefit of parsley consumption is that it contributes to the treatment of hypertension. In a study conducted on healthy rats, it has been presented that oral administration of parsley extract leads to an increase in urinary output after 5 hours and an increase in excretion of sodium, potassium and chlorine with urine [40].
3.10 Garlic/Chive (Allium schoenumprasum)
It is a herb that has always had a place in traditional and modern diets [21]. Garlic, also known as “Allium sativum”, is a plant belonging to the “amaryllidaceae” family that can be used prophylactically or in treatment in both the food industry and alternative medicine [14, 21].
Bioactive ingredients include organosulfide compounds such as allicin, ajoene, S-allyl-L-cysteine, dallyltrisulfide (DATS) [13]. Dallyltrisulfide (DATS), which is found in the composition of garlic, is also an important phenolic component [14].
It has various pharmacological activities accepted in the medical literature [14]. These include antioxidant, immunostimulant, antineoplastic, anti-inflammatory, antihypertensive, antithrombotic, antibacterial, antifungal and antiviral activities [13, 14, 21].
Its anti-inflammatory property is due to inhibition of nuclear factor κB (NFκB) (transcription factor regulating inflammatory response) activation, iNOS and COX-2 expression. In in vitro and in vivo animal studies, garlic has been determined to strengthen immune function, stimulate lymphocyte proliferation, increase interferon-γ (IFN-γ) release, increase macrophage phagocytosis function and natural killer (NK) cell activity [13]. Garlic has been reduced TNFα-induced ROS and NFκB activation on human umbilical vein endothelial cells. It has been proved that the anti-inflammatory effect of garlic or garlic oil derivatives is due to NO suppression in induced macrophages. However, it has reduced endotoxin-induced iNOS activity in rat intestinal mucosa and weaken monocyte chemoattractant protein-1 by IL-6 induced by macrophage-secreted factors in human preadipocytes [21].
In some studies, it has been observed that garlic has positive effects, especially in cardiovascular diseases [13, 14]. It is known that it slows down the atherosclerotic process, reduces the risk of heart attack and infarction, prevents fat accumulation in blood vessels, inhibits LDL cholesterol oxidation, reduces total cholesterol, increases HDL, and has positive effects on endothelial function [10, 13]. There are studies reporting the antioxidant effect of garlic, especially in elderly and hypertensive persons [10, 21]. It has reduced systolic blood pressure by 5.5% [10]. Garlik extracts have also reduced oxidative stress and contribute to vascular remodeling in rats given sucrose-containing water [21]. Other effects include decreasing blood glucose levels [10, 13, 21]. In a study conducted on rats fed with fructose for 8 weeks, it was demonstrated that the metabolic syndrome was attenuated, insulin sensitivity was increased, and oxidative stress was reduced by giving garlic homogenized with water. In addition, garlic has neuroprotective effects in Alzheimer’s disease [21]. In rats, it reduces the infract size in rats following edema and ischemia/reperfusion injury after transient global brain ischemia [13, 21]. It has a learning and memory strengthening effect. Garlic has been detected to prevent Abeta-induced neurotoxicity and apoptosis and protect neurons [13]. In the absence of any stress environment, a significant increase in memory was observed in rats given garlic after 21 days of oral use [21]. It is known that garlic has beneficial effects on respiration and digestion. Garlic is also used in some skin diseases and parasitic infections. DATS, which is in the composition of garlic, has an effect that inhibits tumorigenesis. It achieves this effect through the Wnt/β-catenin signaling pathway. Thus, it is known to affect SW480 and DLD-1 colorectal cancer cells [14].
Clove (Eugenia caryophyllata) comes from the “mirtaceae” family, a medium-sized (8–12 m) tree that grows on the Maluku Islands in Eastern Indonesia. It consists of leaves and buds. It is a widely used herb that is often combined with foods. Cloves are generally used in meat and rice dishes. In North Indian cuisine, cloves are used in almost every side dish, often mixed with curry. Previously used only as a food preservative, this herb continues to be used increasingly due to its antioxidant properties [57].
The biocomponents of this plant, which has a dominant scent, are phenolic compounds (ferulic, caffeic, ellagic, and salicylic acids) such as flavonoids (quercetin and kaempferol), β-caryophyllene, eugenol, hydroxybenzoic acids, hydroxynamic acids and hydroxyphenyl propenes [57, 58].
Its most prominent effect as a food preservative is its antibacterial and antioxidant effect. In addition, its antifungal, antiviral, spasmolytic, sedative, analgesic, local anesthetic and anticarcinogenic effects are also important. There are literature data indicating that clove increases microcirculation, lowers body temperature, provides a hypotensive effect, and may reduce cardiovascular risks and arterial sclerosis [59]. Local anesthetic effects are among the reasons that are frequently recommended by dentists. It is thought to act by depressing nociceptors, which are sensory receptors that play a role in pain perception [60]. Clove also inhibits prostaglandin biosynthesis and the release of leukotrienes in the inflammatory pathway through its potent COX-1 and 2 inhibitory activity [61].
Clove oil has antibacterial activity thanks to its β-caryophyllene and eugenol content. Bacteria with which it is effective include campylobacter jejuni, Escherichia coli, salmonella enteritica, Listeria monocytogenes and Staphylococcus aureus. Antifungal effects have also been reported on Candida albicans, trichophyton rubrum, microsporum canis, tricophyton mentagrophytes, fusarium monoliforme, microsporum gypseum, fusarium oxysporum, epidermophyton floccosum, mucor species, microsporum gypseum and aspergillus [58, 62].
It is a member of the “lamiaceae” family. Although there are many species of the thymus genus, the more common one is “Thymus vulgaris”, native to Italy and the Western Mediterranean. Oregano grows largely in temperate regions and is rare in Africa. Different studies have concluded that the use of oregano improves stability and reduces lipid oxidation throughout the shelf life of foods (meat, meat products, milk, fish or fish products). This property makes thyme an enriched functional food source [63].
Thyme includes monoterpene polyphenols such as thymol and p-cymene, with the most particular component being carvacrol, and other monoterpenes such as -pinene, 1,8-cineol, camphor, linalool and borneol [9, 21, 63]. Flavonoid content is quite high [21]. The common feature of the thyme types widely used in the industry is that they contain essential oil and the main components of these essential oils are thymol and carvacrol. These substances are phenolic compounds that give thyme its unique scent and give it antioxidant properties [27].
Thyme is a nutritional antioxidant that stands out with its antidiabetic, antibacterial and anticarcinogenic effects. The basis of its antimicrobial activity is the free hydroxyl group, its hydrophobicity and the presence of a phenol moiety [64]. Similarly, the presence of phenol is responsible for its antispasmodic and antitussive effects. There are also both animal studies and in vitro studies on its anthelmintic effects [65]. In in vitro studies, the effect of thyme oil on antibiotic-resistant enterococcus and escherichia strains, especially staphylococcus and pseudomonas strains has been presented. It is highly effective on biofilms, and its antibacterial effects are associated with direct penetration into the cell wall and matrix [66].
4. Antioxidant-affected spices
In the Figure 2, natural spices with potent antioxidant features and which are most commonly used are listed.
Figure 2.
Natural spices with potent antioxidant features and which are most commonly used.
4.1 Saffron (Crocus)
Saffron, also known as “Crocus sativus”, is a spice belonging to the “iridaceae” family. It is also called as “red gold” since it is a very precious spice in food and medicine. It is among the most valuable spices in the world [14]. It is one of the most important phytochemical carotenoids [14, 21].
Crocin/Crocetin is the most important bioactive molecule in substance of saffron. This molecule has the effect of reducing tumor growth [14].
It has potent antioxidative and anti-inflammatory effects. It has been observed that crocetin significantly reduces insulin resistance, corrects hyperinsulinemia, dyslipidemia and hypertension in rats that are given fructose. It reduces the oxidative damage associated with ischemia/reperfusion in the rat hippocampus. After chronic cerebral hypoperfusion in rats, it has been determined that the extracts of crocin and crocetin increase spatial cognitive abilities. A double-blind study reported significant improvement in cognitive function in individuals with Alzhemier’s disease after 16 weeks of saffron use [21].
4.2 Curcumin (Turmeric/Eugenol/Curcuma longa)
Its use in traditional medicine, especially in dermatological diseases, in eastern societies, especially in China and India, is based on approximately 4,000 years. This product, which is accepted as a combination of plants that have a place in religious rituals in ancient times, is collected in its roots and stems and then reproduces by giving seeds again [20]. Originally, this spice, which comes from the ginger family, has been recognized to have a healing effect on many disease progression, although some remained only in the clinical trial phase. However, the transition from traditional medicine to modern plug was not difficult. This spice with flowers and broad leaves grows in tropical climates. Its color and taste are used by putting it in pasta, rice, vegetables, meat dishes and salads. The Food and Drug Administration (FDA) has confirmed that curcumin is a compound “generally considered safe”. Curcumin has been proven to be sensitive to light, so it is recommended that biological samples containing curcumin should be protected from light [67]. Studies are underway to increase its bioavailability after oral ingestion, as its absorption from the gastrointestinal tract is poor and most of it is excreted in the feces [68].
Biologically active component of “Curcuma longa” is lipophilic, yellow-orange colored curcumin (diferuloylmethane). It is also referred to “Indian saffron” because of its specific color. Its antioxidant properties are due to the methoxy, phenoxy and carbon–carbon double bonds in its structure. Even though its metabolic rate and elimination are high, its bioavailability is limited. However, in the development phase of many diseases, cytokines, it plays an important role by regulating growth factors, kinases, transcription factors and enzymes. Its molecular activity on signal transduction and redox reactions has always been a curiosity. High-level methoxylation and low-level hydrogenation of curcumin content increase free radical scavenging ability [68].
Curcumin is one of the spices with the highest antioxidant and anti-inflammatory component [2, 12]. The antioxidant effect of curcumin is based on reducing TNFα and IL-1 expression and establishing balance with ROS. Curcumin, other than being beneficial for wound healing, also has an antibacterial effect by controlling the inflammatory response. Curcumin induces apoptosis of inflammatory cells and thus shortens the inflammatory phase. It accelerates healing by increasing collagen synthesis and fibroblast migration in the early phase of wound healing. However, forms suitable for topical use are not yet available. In vivo and in vitro studies on this subject continue. Therefore, it is much more effective to add oral forms of curcumin to the diet for wound healing at this stage [69]. Studies have shown that the effects of curcumin on the processes of Alzheimer’s, diabetes mellitus, obesity, neurodegenerative diseases, osteoarthritis, and oncogenesis give promising results [20]. There are studies showing that curcumin reduces the proliferation and invasion of tumor cells [70]. It has been examined that curcumin is a biologically active agent that increases cancerous cell apoptosis in head–neck, pancreatic and colorectal cancer patients [70, 71, 72, 73]. Curcumin is also a good source of ω-3 fatty acids and α-linolenic acid. It prevents atherosclerosis by reducing the level of LDL in the blood, preventing lipoperoxidation, and reducing cholesterol levels [74]. It is mostly because of this effect that it is used as a common cooking spice in developed countries where the consumption of saturated fatty acids is greatly increased. Curcumin supplementation is recommended for foods during both prevention and treatment of cardiovascular diseases in which atherosclerosis plays a major role. Curcuminoids reduced blood sugar, partly due to their effect of reducing free fatty acids, and in addition, in studies on rodent models, they prevent the reduction in antioxidant capacity caused by diabetes. As a result, it has been reported to have an antidiabetic effect in patients with insulin-resistant type-II diabetes and in in-vivo studies [75, 76].
4.3 Cumin (Cumin aldehyde/Cuminum cyminum)
Cumin (Cuminum cyminum) is a well-known culinary spice that is often used in mealtimes. It is a small herbaceous product belonging to the “apiaceae” family. Its oblong-shaped seeds have a strong aromatic scent and a warm bitter flavor. It is widely grown in Central Asia, Pakistan, India, Iran and China. It is traditionally used as an antiseptic agent. It is also widely used in digestive disorders such as dyspepsia and diarrhea [72].
Its bioactive components are terpenes, phenols and flavonoids. Thanks to these components, it has been proven that it has free radical scavenging and metal chelating properties [77].
It is a spice with anti-inflammatory and antioxidant properties [12]. Animal studies are available showing the hypolipidemic and antidiabetic effects of cumin [78]. Experimental studies have been conducted to support the effect of cumin on renal ischemia–reperfusion injury [79, 80]. It also has antibacterial and potent antimicrobial activity [66, 77]. Cumin seeds also have immunostimulating, gastric protective, hepatoprotective, nephroprotective, and neuroprotective activities [81].
Cinnamon comes from the “lauraceae” family, and its leaves and shells as a spice have been in the world trade for centuries. Cinnamon is mostly obtained from the bark of the “Cinnamomum zeylanicum” tree originating from South and Southeast Asia. The most specific feature of cinnamon, which is an evergreen tree, is its aromatic scent. Cinnamon, which is also widely traded, is frequently consumed in Iran in the form of traditional tea. It is used to prevent lipid oxidation of bakery products such as cakes, so that it prevents the taste of foods [82].
The antioxidant activity is estimated to be due to the polysaccharide known as “daruchini” derived from cinnamon bark. Thanks to “arabinogalactan” and “glucan” in its structure, it loses protons and gives a radical scavenging effect [83].
It is a spice with a pronounced antioxidant and anti-inflammatory effect [12]. It has been observed that consuming it especially in tea form is beneficial in the treatment of diseases related to oxidative stress. It has also been presented to have a sedative effect in many human studies [83]. Cinnamon, acting like insulin, increases insulin receptor kinase activity and stimulates glycogen synthase activity. Thus, it exerts antidiabetic effect [82, 84]. Spices such as cinnamon have started to be included in prescriptions as an additional treatment, due to the toxic side effects of diabetes medications and balance problems due to long-term use. In these studies, which accelerated the development of multiple antibiotic resistances, antibacterial effects on factors such as bacillus subtilis, Staphylococcus aureus, Bacillus cereus, Escherichia coli, salmonella typhi, Pseudomonas aeruginosa, Listeria monocytogenes, and fungal effects such as aspergillus monocytogenes, aspergillus monocytogenes are also known [85]. In addition, NF-κB, which is known to be effective in cancer development acts an anticancer by inhibiting the production of IL-1β and TNF-α. Cinnamon is beneficial in lowering triglycerides and LDL cholesterol by affecting the blood lipid profile through the poliphenols in its structure [86]. The effect of polyphenols here is achieved by inhibiting hepatic lipid peroxidation. In this way, by cleaning hydroxy and fatty acid radicals and chelates, providing the metabolic balance of fat and carbohydrates, cinnamon has turned into a functional nutrition.
4.5 Ginger (Zingiber officinale roscoe):
Ginger (Zingiber officinale roscoe) comes from the “zingiberaceae” family, and especially its roots are among the most widely used functional spices in the world. With a slightly bitter but strong aroma, this root can be used in powder or ground form. It can be consumed in brine, drying, canned or fresh [20].
“Oleoresin” obtained from its roots contains various bioactive molecules. Among these are terpenes, polysaccharides, lipids, but especially gingerol, physiological effects are the most intense [20, 87]. The proportion of gingerol is higher in fresh ginger than the dried form, so consuming fresh is more important for its antioxidant effect [20]. Ginger extract is also a natural and potent antioxidant compared to synthetic antioxidants, with a high Fe+3-effective chelating capacity [88].
Studies mention the effects of ginger on cardioprotective, anti-inflammatory, neuroprotective, antinausea and antiobesity. Its anti-inflammatory effects have been demonstrated in the treatment of osteomyelitis, arthritis and rheumatism [89]. Ginger, which has increased glutathione levels and suppress lipid peroxidation during its anti-inflammatory effects, is widely used as a food flavor in developed countries for colds, migraine attacks and gastrointestinal disorders. Its antimicrobial effects are related to its lipophilic property, making the fungal walls and cytoplasmic membrane permeable. Antibacterial effects on species such as Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae and haemophilus have been proved on various animal and human studies. The most stable metabolite, 6-gingerol derivative, has been observed to have an antinause effect by blocking 5-hydroxy tryptophan and serotonin-mediated vagal afferent neurons in patients used after chemotherapy, nephrectomy and cesarean operations [90, 91].
4.6 Black Pepper (Piper nigrum)
Black pepper is a product that belongs to the “piparaceae” family and is called as “Piper nigrum” [14]. It is obtained from the ripe fruits of Piper nigrum L [27]. Black pepper has a very common pharmaceutical use in the world [14]. It is cultivated in tropical regions, especially in India, Malaysia, Asia and Indonesia [12, 27]. It is among the best-selling spices on the market in some countries like India [14, 92].
Black pepper contains five phenolic acids (piperettine, piperanine, piperylin A, piperolein B and pipericine) amide with antioxidant effects [12, 13, 27]. Additionally, it contains alkamides, piptigrine, wisanine and dipiperamide [13]. These phenolic components have a damaging effect by preventing the growth of the bacterial membrane, and their antimicrobial activity occurs through this mechanism [12]. These compounds are non-greasy, odorless, tasteless and exhibit stronger antioxidant activity than α-tocopherol [27]. The composition in the form of essential oil has antimicrobial activity [12]. The quality of black pepper varies depending on piperine causing bitterness and the essential oils responsible for its aroma [12, 27]. Piperine is a green crystalline clear substance that was first isolated in 1819. This alkaloid is a compound that gives the pepper its bitterness. The nature of piperine, which is its active basic component, is known in detail, and its effectiveness in alternative medicine has been clearly proven [13, 14, 21]. Its content, piperine, is a bioactive component with known beneficial effects on human health [13, 14]. Piperine is absorbed by passive diffusion in the gastrointestinal tract and has a short clearance time [13]. In a study of industrial microwaving of black pepper, it was determined that no change was observed in the antioxidant properties of this herb [50].
It has antioxidant, antimicrobial and antipyretic properties [27]. Antidepressant, antifungal, anti-inflammatory, analgesic, anticarcinogenic, antithyroid activities are some of the important pharmacological effects of black pepper [13, 14, 93]. Its anti-inflammatory effect has been detected on rats in many experimental studies. Black pepper accelerates the digestion process, increases digestive enzymes, gastric acid and bile acid secretion, and shortens the food transit time. It has anti-depressant-like effect by regulating neurotransmitter metabolism, causing an increase in behavioral/cognitive effects [13]. Piperine significantly reduces cell death, brain edema, and post-reperfusion proinflammatory cytokines in rats. It has decreased hippocampal cell death after ethylcholine aziridinium ion administration in rats [21]. Piperine has reduced arthritis pain in animal models. Piperine supplementation reduces muscle damage when given before and after exercise. Piperine reduces histamine release and eosinophil infiltration in animal models. However, it suppresses allergic airway inflammation and airway hypersensitivity. Piperine increases energy expenditure in animal experiments, activates the sympathetic nervous system, causes thermogenesis, increases catecholamine levels, and activates adrenal sympathetic nerves [13]. In a study, it was examined that lipid peroxidation was delayed in pork meat with the addition of black pepper [13, 94]. Piperine prevented lipid accumulation in mouse macrophages. Alternatively, it has been determined to transform into foamy cells in animal studies, which can reduce fat accumulation in the arterial wall [13].
4.7 Red Chili/Chili Pepper (Capsicum annum)
Red chili is a product belonging to the “solanaceae” family [14].
“Capsaicin” is the primary bioactive substance of red chili pepper [14, 21]. Capsaicin is an alkaloid. It constitutes 50–70% of total capsaicinoids. It contains 20–25% dihydrocapsaicin and 0.2–2% capsaicinoid [10]. Among its recently discovered ingredients are capsiate and dihydrocapsiate [13].
The beneficial effects of red pepper have been documented long before. In vitro and experimental studies of red pepper and capsaicin have proved potential antioxidant and anti-inflammatory effects of it against oxidative stress in various tissues and organs [13]. This spice type has the ability to induce apoptosis in major type cancers. It has been presented that capsaicin treatment in gastic cancer cells (MGC-803) and cervical cancer cells (HeLa) prevented the G1 phase in cell cycle analysis. In an experimental study performed in athymic mice, it was indicated that tumor growth in prostate cancer cells (LNCaP) was reduced in subjects given 5 mg/kg orally [14]. In another study conducted in vitro, it has been determined that it has a protective effect on rat hippocampal neurons, reduces hippocampal death after global ischemia, decreases the size of cerebral infarction after bilateral arterial occlusion in mice, and decreases the infraction volume in neonatal rats ligated in unilateral carotid arteries after hypoxia [21]. However, capsaicin regulates energy metabolism and has beneficial effects on the cardiovascular system, with its antioxidant and antiplatelet effects. In a clinical study conducted on humans, it was determined that 5 grams of red pepper (Capsicum frutescens) lowered blood glucose levels and maintained healthy insulin levels. In the short-term use of red pepper, it has been observed that body mass index contributes to management, decreases energy and fat intake, increases body heat production (thermogenesis), increases body metabolic rate, decreases the conversion of fat cells to mature cells (adipogenesis) and increases fat oxidation. Capsaicin has been detected to be gastroprotective in patients with peptic ulcer disease. Capsaicin reduces acid secretion, induces alkaline mucous stimulation (particularly by affecting gastric mucosal blood flow) and contributes to ulcer healing [13].
5. Comparison of natural antioxidant-affected herbs and spices
In a study comparing antioxidant effects, it was stated that the strongest antioxidant effect was in rosemary and curcumin, followed by herbs such as cinnamon, saffron, sage, and thyme [2, 27, 46].
Shahidi et al. asserted that the antioxidant activities of clove, sage, thyme and ginger in meat oil were concentration-dependent [95]. They stated that among these substances, the most effective was clove, and the least effective spices were ginger and thyme [95].
Pizzale et al. found that, on average, the antioxidant activity of sage species (Salvia officinalis and fruticosa) was higher than thyme species (Origanum onites and indercedens) in their study [96].
Another study proved that chloroform extract of dried musk sage (Salvia sclarea) has higher antioxidant activity than acetone extract, and both extracts have higher total antioxidant activities than α-tocopherol [27].
Nakatani et al. determined that black pepper is more effective than synthetic antioxidants such as BHT and BHA [97].
In another study, the antioxidant properties of curcuminoids were investigated, and it was determined that the antioxidant capacity of these extracts was equivalent to ascorbic acid [98].
When evaluated in terms of the density of total phenolic compounds, it has been observed that rosemary and thyme have higher phenolic content than other herbs. Also, it was presented that fresh plants have more intense phenolic content than dried plants [9].
Correspondingly, it is thought that the most potent antioxidants are fresh rosemary and curcumin, and it may be suggested to increase the consumption of these products.
6. Antioxidant combinations
Since each spice contains a wide range of phenols, many of them can provide synergistic effects with each other. The formulations of different herbs and spices were tested in vivo and in vitro, and their antimicrobial effects were compared [12].
It is predicted that the antioxidant effect increases significantly when thyme essential oil and vitamin E are mixed in half so that there is a synergistic effect between thyme essential oil and vitamin E [27].
It has been indicated that meats are effectively protected against Listeria monocytogenes with the combined use of curcumin and thyme [12].
In an experimental animal study, it was observed that when capsaicin (0.015%) was given alone and in combination with curcumin, it reduced triglyceride levels by 12% and 21% in animals given a high fat diet [13].
Since piperine increases the absorption of various drug and food sources, it increases their bioavailability when used with other antioxidants. It increases the absorption of compounds such as coenzyme-Q, curcumin and polyphenol. For example, bioavailability of curcumin increases by 154% when it is given with 20 mg/kg piperine in animal studies. Piperine shows its effect by decreasing the intestinal and hepatic metabolism of curcumin. In some studies, it has been presented that piperine increases the bioavailability of resveratrol in vivo by inhibiting its metabolism. In this way, it ensures that additional resveratrol doses are not required [13].
Therefore, the combined use of herbs and spices with appropriate formulations can be recommended.
7. Conclusion
Herbs and spices used in cooking, increasing the nutritional value of foods and extending the storage time are highly interesting compounds with antioxidant properties due to their bioactive content, showing beneficial effects on human health. Interest in natural antioxidants in plants around the world is increasing day by day, with the widespread use of natural additives in the food industry. Therefore, herbs and spices have become the most important focus of research for the study of natural antioxidants.
Since ancient times, herbs and spices have been used in alternative medical treatments due to their antimicrobial, anti-inflammatory and antioxidative effects. Although the use of herbs and spices in food and treatment has been available for a long time, research on this subject is limited to the recent past. In addition to the poor antioxidant features of animal origin foods, the antioxidant power of plant-based foods is much higher.
There are over 1.000 known antioxidant phytochemicals. Although they are very small in terms of weight and volume, they have a feature of increasing the value and antioxidant content of foods. Thanks to the studies conducted on this subject, the application strategies of phytochemical antioxidants in the diet can be determined, and chronic diseases related to oxidative stress such as cancer, cardiovascular diseases, hypertension, hyperlipidemia, inflammation and diabetes can be prevented or their effects can be reduced.
Various synthetic and natural products are used in the food industry to cope with dietary oxidative stress. Hence, there is a need for optimized studies of natural antioxidant products that can be used as food preservatives in the food industry. Thus, the natural storage times and nutritional values of foods can be increased.
Conflict of interest
The authors declare that there is no conflict of interest, and there have been no sources of funding.
\n',keywords:"antioxidant, food, herb, plant, review, spice, supplement",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/75226.pdf",chapterXML:"https://mts.intechopen.com/source/xml/75226.xml",downloadPdfUrl:"/chapter/pdf-download/75226",previewPdfUrl:"/chapter/pdf-preview/75226",totalDownloads:406,totalViews:0,totalCrossrefCites:0,totalDimensionsCites:0,totalAltmetricsMentions:0,impactScore:0,impactScorePercentile:41,impactScoreQuartile:2,hasAltmetrics:0,dateSubmitted:"October 4th 2020",dateReviewed:"January 21st 2021",datePrePublished:"February 17th 2021",datePublished:"September 8th 2021",dateFinished:"February 12th 2021",readingETA:"0",abstract:"Free radicals are chemicals that play a role in the etiopathogenesis of ischemia–reperfusion injury. To prevent or reduce this damage, many protective or therapeutic antioxidants are used effectively in alternative medicine. These antioxidants include immunological or pharmacological agents, vitamins, food and herbal products, and spices. Herbs and spices have been used for a long time as coloring or preservative agents by adding to the content of foods, and at the same time to increase the nutritional value of foods. More recently, the nutritional effects of herbs and spices have become more perceived and the area of interest for these products has increased. Concordantly, the biological contents of herbs and spices have begun to be studied in more detailed way at the cellular and molecular level. Sample plants are classified according to different chemical families, with the diet. Therefore, they have different levels of antioxidant capacity. These products also have potent anti-inflammatory, antihypertensive, glucoregulatory, antithrombotic, anticarcinogenic and so forth effects. These properties are used in the treatment of some chronic diseases. In this review, the antioxidant properties of various herbs and spices used to add flavor to foods or to extend their shelf life have been examined in the light of large-scale nutritional epidemiological studies, in vitro cellular/animal studies and clinical trials.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/75226",risUrl:"/chapter/ris/75226",book:{id:"10544",slug:"antioxidants-benefits-sources-mechanisms-of-action"},signatures:"Perçin Karakol and Emin Kapi",authors:[{id:"297745",title:"Dr.",name:"Perçin",middleName:null,surname:"Karakol",fullName:"Perçin Karakol",slug:"percin-karakol",email:"ppercin@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null},{id:"346058",title:"Dr.",name:"Emin",middleName:null,surname:"Kapi",fullName:"Emin Kapi",slug:"emin-kapi",email:"eminkapi@gmail.com",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. General properties of herbs and spices with natural antioxidant effects",level:"1"},{id:"sec_3",title:"3. Antioxidant-affected plants",level:"1"},{id:"sec_3_2",title:"3.1 Rosemary (Rosemarinus officinalis)",level:"2"},{id:"sec_4_2",title:"3.2 Coriander (Coriandrum sativum)",level:"2"},{id:"sec_5_2",title:"3.3 Dill (Anethum graveolens)",level:"2"},{id:"sec_6_2",title:"3.4 Bacil (Osimum basilicum)",level:"2"},{id:"sec_7_2",title:"3.5 Fennel",level:"2"},{id:"sec_8_2",title:"3.6 Bay leaves (Laurus nobilis)",level:"2"},{id:"sec_9_2",title:"3.7 Sage (Salvia officinalis)",level:"2"},{id:"sec_10_2",title:"3.8 Green tea",level:"2"},{id:"sec_11_2",title:"3.9 Parsley (Petroselinum crispum/Petroselinum neapolitanum)",level:"2"},{id:"sec_12_2",title:"3.10 Garlic/Chive (Allium schoenumprasum)",level:"2"},{id:"sec_13_2",title:"3.11 Clove (Eugenia caryophyllata/Syzygium aromaticum)",level:"2"},{id:"sec_14_2",title:"3.12 Thyme/Oregano (Thymus vulgaris/Oreganum vulgare)",level:"2"},{id:"sec_16",title:"4. Antioxidant-affected spices",level:"1"},{id:"sec_16_2",title:"4.1 Saffron (Crocus)",level:"2"},{id:"sec_17_2",title:"4.2 Curcumin (Turmeric/Eugenol/Curcuma longa)",level:"2"},{id:"sec_18_2",title:"4.3 Cumin (Cumin aldehyde/Cuminum cyminum)",level:"2"},{id:"sec_19_2",title:"4.4 Cinnamon (Cinnam aldehyde/Cinnamomum zeylanicum):",level:"2"},{id:"sec_20_2",title:"4.5 Ginger (Zingiber officinale roscoe):",level:"2"},{id:"sec_21_2",title:"4.6 Black Pepper (Piper nigrum)",level:"2"},{id:"sec_22_2",title:"4.7 Red Chili/Chili Pepper (Capsicum annum)",level:"2"},{id:"sec_24",title:"5. Comparison of natural antioxidant-affected herbs and spices",level:"1"},{id:"sec_25",title:"6. Antioxidant combinations",level:"1"},{id:"sec_26",title:"7. Conclusion",level:"1"},{id:"sec_30",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Bozkurt M, Kapi E, Kulahci Y, Gedik E, Ozekinci S, Isik FB, Celik Y, Selcuk CT, Kuvat SV. 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Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Research and Training Hospital, University of Health Sciences, Turkey
Department of Plastic, Reconstructive and Aesthetic Surgery, Adana Faculty of Medicine, Health Application and Research Center, University of Health Sciences, Turkey
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1. Introduction
Dental implants have become a well-accepted treatment option for patients with partial or complete edentulism. The long-term success of the endosseous dental implant depends not only on osseointegration, but on the healthy soft tissue interface that surrounds the implant [1]. Dental implants are susceptible to disease, and they might develop inflammatory reactions, which might lead to peri-implant mucositis and/or peri-implantitis.
Peri-implant disease progresses quietly without pain and often starts with marginal bone loss. The factors responsible can be broadly classified as biological factors and biomechanical factors. The biological factors include progressive bone loss, bacterial infections, and microbial plaque [2]. Biological complications are grouped as early biological failures and late implant failures. The early failures are applied to inappropriate aseptic measures of the surgical implant [3], and late complications are typically infections caused by peri-implantitis and bacterial plaque. Peri-implantitis due to biomechanical factors are either prosthesis-related factors such as occlusal overload, residual cement, inadequate prosthetic placement, or inappropriate abutment angle and bruxism [4].
2. Definitions
2.1 Peri-implant mucositis
Peri-implant mucositis is defined as inflammation of the peri-implant mucosa around an osseointegrated implant without loss of the supporting bone. Clinical signs of peri-implant inflammation are bleeding and/or suppuration on probing, with or without increased probing depths [5, 6].
2.2 Peri-implantitis
Peri-implantitis is defined as a pathological condition characterized by inflammation in the peri-implant mucosa/connective tissue and progressive loss of the supporting bone around a dental implant. Clinical signs of peri-implantitis are bleeding and/or suppuration on probing, increasing probing depths, and/or recession of the mucosal margin, in addition to radiographic bone loss compared to previous examinations. When a previous radiograph is not available, the following is indicative for the diagnosis of peri-implantitis: bone loss >3 mm in combination with bleeding on probing and pocket depth > 6 mm [5].
3. Diagnosis of peri-implantitis
The advanced case of peri-implantitis can be identifiable with the evidence of radiographic bone loss, mobility, and clinical signs of infection. The challenge is to diagnose the early stage of peri-implantitis that will aid in the prevention of further bone resorption and subsequent loss of the implant. Diagnosing peri-implant diseases using periodontal probing and radiographs may be inaccurate and only provides a historical record of past disease rather than current disease activity (Figure 1).
Some of the clinical parameters used for the diagnosis are as follows [7]:
Vertical destruction of the crestal bone,
Formation of a peri-implant pocket >4 mm,
Bleeding or suppuration after gently probing,
Tissue redness and swelling,
Mobility.
Figure 1.
The clinical and radiographic appearance of peri-implantitis.
Developing biomarker technologies may offer possibilities in the diagnostic application. Although more research is needed, the assessment of proinflammatory cytokines (IL-1β, TNFα, MMP-8) in the peri-implant crevicular fluid may be of value to diagnose peri-implantitis and peri-implant mucositis but are, at this time, inappropriate to predict peri-implantitis because of the limited evidence of controlled longitudinal clinical trials. MMP-8 is a promising biomarker as an early signal of peri-implant inflammation [8]. Commercially available chair-side diagnostic tests for MMP-8 to detect peri-implant diseases are promising. Elevated levels of MMP-8 in peri-implant crevicular fluid (PICF) are associated with peri-implant inflammation, while low MMP-8 levels (<20 ng/mL) indicate healthy peri-implant tissues. Pathologically elevated levels of MMP-8 (>20 ng/mL) can be detected by a quantitative MMP-8 chair-side device, ImplantSafe® [9].
4. Classification peri-implantitis
Currently, there is no standard classification system to classify the parameters and the severity of the peri-implant disease. Froum and Rosen [10] proposed a classification for peri-implant disease based on the disease severity. This classification includes three clinical stages:
Early: Pocket depth (PD) ≥ 4 mm (bleeding and/or suppuration on probing) Bone loss <25% of the implant length.
Moderate: PD ≥ 6 mm (bleeding and/or suppuration on probing) bone loss 25–50% of the implant length.
Advanced: PD ≥ 8 mm (bleeding and/or suppuration on probing) bone loss >50% of the implant length.
Bleeding on probing should be noted on two or more aspects of the implant, and bone loss is measured on the radiographs from the time of prosthetic loading to the current time. If the radiograph at prosthetic loading is not available, the earliest available radiograph following loading should be used [11].
5. Pattern of bone loss in peri-implantitis
The pattern of bone loss in peri-implantitis is classified into vertical, horizontal, and combined bone loss. The most common pattern of bone loss is vertical (65%) and then horizontal (22%), and the least common pattern is combined (13%) [11].
6. Prevalence of peri-implantitis
The prevalence of peri-implant mucositis and peri-implantitis has ranged from 19 to 65% and 1 to 47%, respectively [12, 13]. A systematic review revealed that the frequency of peri-implant mucositis was 63.4% on the patient level and 30.7% on the implant level. The peri-implantitis prevalence was 18.8 and 9.6%. In smokers, the frequency of peri-implantitis increased to 36.3% [11]. The prevalence of peri-implant mucositis at the patient level varied between 1.1 and 80% [14, 15, 16, 17, 18, 19]. The prevalence of peri-implantitis at the patient level ranged from 1.4 to 53.3% [14, 15, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26].
7. Etiology of peri-implantitis
Peri-implantitis is a result of biofilm-induced inflammation in the soft tissue that subsequently triggers a host response, with possible tissue degradation [27]. Peri-implantits inflammation is initiated by the accumulated bacterial biofilm. The development of disease was initially studied in an experimental gingivitis model in animals (dogs) and humans, and a cause-effect relationship between de novo plaque formation and peri-implant mucositis was observed [28, 29].
Histopathological, the early biofilm-induced inflammatory host response in mucositis is comparable to that in gingivitis, but the lesion of the inflammatory connective tissue (ICT) is larger and extends apically to the junctional epithelium. The established biofilm results in a more pronounced host response, and the extension of the ICT lesion is even larger in size than that in gingivitis, with the increased amounts of inflammatory cells in peri-implant mucositis [30]. The inflammation is reversible after biofilm removal, and no difference between implant systems has been observed [29, 31, 32]. Peri-implantitis lesions investigated in experimental ligature-induced peri-implantitis in a dog model presented more aggressive tissue degradation at the implant site than teeth with periodontitis. A larger inflammatory infiltrate extending close to the crestal bone and more bone-resorbing osteoclasts were observed at the implant site. Spontaneous progression after ligature removal varied with different implant surfaces [33, 34]. Peri-implant inflammation develops when microbes activate the host’s innate and adaptive immune responses. Several cell types, such as epithelial cells, fibroblasts, stromal cells, endothelial cells, and osteoblasts, release pro-inflammatory mediators, such as cytokines and chemokines, to recruit leukocytes. Leukocytes are recruited from blood vessels and tissues. Human biopsies revealed that the proportion of vascular structures was smaller within the peri-implant ICT lesion and greater lateral to the peri-implant ICT than reported for periodontitis lesions. Neutrophil granulocytes (polymorphonuclear neutrophils [PMNs]) and monocytes/macrophages are prevalent close to the sulcus epithelium in the peri-vascular area and the center of the ICT. Although the ICT lesion is dominated by T and B lymphocytes and plasma cells, the inflammatory lesion has a more acute character in peri-implantitis than in chronic periodontitis, with a larger proportion of PMNs and macrophages [35, 36, 37].
8. Risk factors associated with peri-implantitis
8.1 Poor plaque control and lack of regular supportive therapy
Poor plaque control and a lack of regular supportive therapy constitute the risk factors for developing peri-implantitis. A 5-year follow-up revealed a lower incidence of peri-implantitis with regular supportive care [20]. A 10-year follow-up study also revealed that patients on a regular maintenance program had less chances of developing peri-implantitis [38].
8.2 History of periodontitis
Patients who have lost teeth from periodontitis are treated with implants, and these patients may be more at risk of peri-implantitis disease. There is strong evidence from longitudinal and cross-sectional studies that a history of periodontitis constitutes a risk factor for peri-implantitis. Systematic reviews have indicated that subjects with a history of periodontitis are at greater risk of peri-implant disease. Long-term follow-up studies also revealed a correlation between peri-implantitis development with periodontitis [38, 39, 40].
8.3 Genetic traits
Genetic trait studies are scarce, and the overall evidence is limited and inconclusive. The most thoroughly investigated genetic factor is interleukin (IL)-1 composite gene polymorphism [41]. The genetic traits can influence susceptibility to peri-implantitis development in periodontitis patients, even if the inflammatory condition is under control at the time of implant placement. IL-1RN gene polymorphism was proposed as a risk factor for peri-implantitis [42]. The IL-1 genotype in combination with smoking was observed to affect implant failure [43]. The vascular endothelial growth factor (VEGF) may play a protective role in marginal bone loss, that is, peri-implantitis [36].
8.4 Diabetes mellitus
Based on the available data, no association was found between diabetes and peri-implantitis. Although the role of distinct physiological mediators in pathogenesis is not fully understood, evidence suggests that pro-inflammatory gene expression in peri-implantitis regions is affected by glycemic control [44]. Patients with diabetes mellitus are more prone to peri-implantitis than non-diabetic subjects, and the poor metabolic control has been shown to provide a more favorable environment for infection and loss of implants [45]. Controlling the blood sugar level is critical in increasing the implant success rate in diabetic patients [46].
8.5 Smoking
Smoking has a detrimental effect on tissue healing. Nicotine can reduce the nutrition to the tissues as a result of its vasoconstrictive effect on the blood vessels during the early osseointegration phase. Based on the available studies, smoking can be considered as a greatest identifiable risk factor for peri-implantitis. The extent of osseointegration as well as the plaque accumulation around dental implants was compromised among csmokers. A 10-year cohort study reported that peri-implantitis developed for 28% of all implants in smokers, while the corresponding incidence was 6% of all implants in non-smokers [39]. Several cross-sectional studies also showed a higher prevalence of peri-implantitis among smokers [15, 47, 48]. A systematic review of prospective and retrospective studies indicated an enhanced risk of biological complications among smokers; similarly, a meta-analysis indicated an enhanced risk of implant failure among smokers [49]. Studies indicate smoking as the greatest identifiable and most often cited risk.
8.6 Keratinized mucosa
Compared to sites with a keratinized mucosa of greater than 2 mm, sites with a keratinized mucosa of less than 2 mm are associated with plaque accumulation followed by peri-implant inflammation in the soft tissue and radiographic bone loss [50]. The evidence is limited and controversial that the absence of a keratinized mucosa is a risk factor for peri-implantitis, but this factor may negatively affect self-performed oral hygiene (Figure 2) [50].
Figure 2.
A. Case showing lack of keratinized gingiva in the implant site. B. After gingival augmentation.
8.7 Excess cement and over-contoured supra-structures
Potential risk indicators that are indirectly related to plaque accumulation have been proposed; for example, constructions with excess cement may result in a higher prevalence of peri-implantitis than screw-retained constructions [51]; similar results were reported for over contoured crowns and supra-structures [52]. A wide emergence profile in the restoration contour was reported to cause an unhealthy state (Figure 3) [53].
Figure 3.
A case of peri-implantitis consequent to over-contoured restoration.
8.8 Implant-related factors
The titanium particles from the implant surface may be present in the tissues after implant placement and may enhance infection-induced inflammation and activate macrophages [54]. Implant surface characteristics vary in terms of topography, surface roughness, and chemical composition. Currently, most implants have a moderately rough surface with improved bone responses during initial healing after implant placement [55]. Marginal bone loss was found to be greater when implants with rough surfaces were used, and turned surfaces generally demonstrated the smallest marginal bone loss [56, 57].
8.8.1 Implant platform switching
The platform switch concept might influence the marginal bone loss. The theory is that the micro-gap is displaced medially causing less bone loss (Figure 4) [58, 59, 60].
Figure 4.
Platform switching to prevent marginal bone loss and peri-implantitis.
8.8.2 Implant installation
It is advisable to have a minimum thickness of 2-mm bone in the anterior region and at least 1 mm in the posterior region to reduce soft and hard tissue loss. The quality of bone in the region of implant placement is an important factor for the success [61].
8.9 Overload
Clinical signs of occlusal overloads, such as abutment fracture, loss of retention and/or signs of abrasive forces on supra-structures, seem to be an indirect but potential risk. The factors related to occlusal overload are probably related to the location of the implant, the deviation of the axis of the implant, and the incompatibility of the implant dimensions and the prosthesis. Occlusal overload can lead to bone loss around the osseointegrated implants [4]. However, the evidence is limited concerning overload and its influence on the onset or progression of peri-implantitis [41, 62]. In a dog model, occlusal overload did not induce marginal bone loss in implants with a healthy mucosa [63].
8.10 Parafunctional habits-bruxism
Bruxism is a movement disorder of the masticatory system that is characterized among others by teeth grinding and clenching during sleep as well as during wakefulness. Since there is no periodontal ligament between the implant and surrounding bone, the occlusal load is directly transmitted [64]. Even though bruxism is likely to be a risk factor for mechanical complications in the implant periphery, it is unlikely to be a potential risk factor for biological complications [65].
8.11 Alcohol consumption
Alcohol consumption was investigated in one prospective study, which showed that an intake of more than 10 g of alcohol per day was related to peri-implantitis bone loss, as well as tobacco use, plaque, and inflammation [66].
8.12 Iatrogenic factors
The proposed potential risk of iatrogenic factors for the initiation and progression of peri-implantitis caused by implant mal-positioning, surgical trauma, and inadequate restoration abutment seating has not yet been clearly investigated [67].
9. Treatment
9.1 Treatment of peri-implant mucositis
The main goal is to detoxify the contaminated implant surface. Peri-implant mucositis can be managed by non-surgical methods. Methods such as mechanical implant cleaning with titanium or plastic curettes, ultrasonics, or air polishing can be used. Photodynamic therapy as well as local antiseptic medication such as chlorhexidine gluconate, hydrogen peroxide, sodium percarbonate, and povidone-iodine can be used [68, 69, 70].
9.2 Treatment of peri-implantitis
The management of peri-implantitis relies on strategies of disinfection such as debridement with curettes and use of local/systemic broad-spectrum antibiotics associated or not with anti-infective solutions, such as used for chemical plaque control. The strategy is to disinfect and to reduce the inflammation as well as restoration of the peri-implant tissue lost due to the disease progression, usually with regenerative approaches using biologics and/or growth factors. The treatment of peri-implant infections comprises conservative and surgical approaches. Depending on the severity of the peri-implant disease, either a nonsurgical therapy alone or a combined with the surgical method can be used to resolve the situation.
9.3 Non-surgical therapy
Manual treatment approaches using curettes, ultrasonic and air polishing systems, laser-supported, and photodynamic therapy are used along with medications.
9.4 Mechanical therapy
The bleeding from the site can be controlled either with piezoelectric scalers as well as with hand instruments [71]. The manual curetting of the area can be done using special curettes made of Teflon, carbon, plastic, and titanium curettes than the conventional curettes to protect the implant surfaces [72, 73]. The efficiency of the ultrasonic curettage can be supplemented with the air polishing systems [74, 75, 76, 77]. Though the abrasive air polishing medium can modify the surface of implants, the cell response and healing were compromised probably due to the contamination of the implant surface [74, 76]. The extent of re-osseointegration of titanium implants after air polishing therapy has been reported between 39 and 46% with increased clinical implant attachment and pocket depth reduction [75]. The air polishing systems such as hydroxylapatite/tricalcium phosphate, hydroxylapatite, glycine, titanium dioxide, water and air, phosphoric acid can be used depending on the surface topography of implants [74, 77].
9.5 Decontamination of the surface of the implant
Decontamination of the root surface is done by various methods such as air powder flow, saline wash, citric acid, laser, and hydrogen peroxide [78]. The electrochemical decontamination of the surface of the implant is an innovative technique that is being tested in preclinical studies [79]. Rubber cups have been shown to smoothen the titanium surface and significantly decrease roughness by removing surface debris. Polishing the implant surfaces with pumice and a rubber cup combined with irrigation with chlorhexidine and systemic antibiotics results in the reduction of anaerobic bacteria and bleeding scores in patients with peri-implantitis [80].
9.6 Laser therapy
Laser treatment using CO2, diode-, Er:YAG- (erbium-doped: yttrium-aluminum-garnet), and Er, Cr: YSGG- (erbium, chromium-doped: yttrium-scandium-gallium-garnet) lasers are used in the treatment of peri-implant diseases [81, 82]. The use of Er:YAG lasers showed significantly better results than mechanical methods in terms of bleeding at peri-implantitis [83]. Er:YAG and Er, Cr: YAG with a wavelength of 3 microns can reduce biofilms up to 90%, but in contrast to most mechanical therapies, any biological compatibilities and cell stimulatory properties cannot be re-induced [84]. The CO2 excimer laser was effective in reducing the anaerobic bacteria [85].
9.7 Photodynamic therapy
Photodynamic therapy has to be considered as an additional treatment option in peri-implantitis. Photodynamic therapy generates reactive oxygen species by multiplicity with help of a high-energy single-frequency light in combination with photosensitizers. In a wavelength range of 580–1400 nm and toluidine blue-concentrations between 10 and 50 μg/mL, photodynamic therapy generates bactericide effects against aerobic and anaerobic bacteria such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Streptococcus mutans, Enterococcus faecalis [86, 87]. An improvement in both clinical attachment and the bleeding index was observed on a moderate and severe peri-implantitis with phototherapy [88]. Photodynamic therapy has been tried as an adjunctive to manual debridement and local chemotherapeutic agents [89].
9.8 Surgical therapy
Surgical techniques may include open flap debridement with removal of the inflammatory tissue as well as mechanical and chemical decontamination of the exposed implant surface. Recontouring of the bony architecture and smoothing of the implant surface may improve infection control [90]. The surgical flap helps in comprehensive debridement and decontamination of the affected implant. The surgical resection is generally confined to implants placed in non-esthetic sites [91].
9.9 Regenerative approaches
Regenerative procedures using a membrane and bone graft substitutes attempting to partially fill the bony defects caused by peri-implantitis can be successful [92]. Therapy of peri-implantitis followed by regular supportive care resulted in favorable clinical improvements and stable peri-implant bone levels in the majority of patients according to a systematic review (Figure 5) [93].
Figure 5.
A case of peri-implantitis treated with bone augmentation.
9.10 Resective therapy
Resective surgery has been shown to be effective in the reduction of BOP, probing depths and clinical signs of inflammation. The basic principles include the elimination of the peri-implant osseous defect using ostectomy and osteoplasty as well as bacterial decontamination. Additionally, smoothening and polishing of the supracrestal implant surface may be done. Surgical pocket elimination and bone recontouring in combination with plaque control before and after surgery showed effective in treating peri-implantitis [94].
10. Prevention and maintenance
Besides, a maintenance program with regular evaluation of the peri-implant probing depths, supportive professional implant cleaning, and oral hygiene training should be an integral part of every post-operative care after implant insertion [95]. The establishment of an adequate oral hygiene should, therefore, be considered as the key issue of the prevention of peri-implantitis infections.
11. Conclusion
Peri-implantitis is an inflammatory disease of microbial origin causing bone loss around the implant, which could lead to the loss of the implant. The etiology of peri-implantitis is associated with a complex microbial biofilm and risk factors such as smoking and diabetes. Occlusal overloading, osteoporosis, and other factors compromising the surgical site might adversely affect the severity of the destruction of the peri-implant tissue. Several surgical and non-surgical therapeutic approaches have been proposed to manage this complex-multifactorial condition. Anti-infective and regenerative therapeutic strategies were used to restore the peri-implant health as well as to achieve new bone-to-implant contact.
Conflict of interest
The authors declare no conflict of interest.
\n',keywords:"dental implant, peri-implant disease, peri-implant mucositis, peri-implantitis, periodontitis, risk factors",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/78829.pdf",chapterXML:"https://mts.intechopen.com/source/xml/78829.xml",downloadPdfUrl:"/chapter/pdf-download/78829",previewPdfUrl:"/chapter/pdf-preview/78829",totalDownloads:85,totalViews:0,totalCrossrefCites:0,dateSubmitted:"June 12th 2021",dateReviewed:"September 4th 2021",datePrePublished:"October 2nd 2021",datePublished:null,dateFinished:"October 2nd 2021",readingETA:"0",abstract:"Dental implants have become a well-accepted treatment option for patients with partial or complete edentulism. The long-term success of the endosseous dental implant depends not only on osseointegration, but on the healthy soft tissue interface that surrounds the implant. Peri-implantitis is defined as an inflammatory process affecting the supporting hard and soft tissue around an implant in function, leading to loss of supporting bone. Peri-implant mucositis has been defined as a reversible inflammatory reaction in the peri-implant mucosa surrounding an osseointegrated dental implant. Peri-implant mucositis is assumed to precede peri-implantitis. Data indicate that patients diagnosed with peri-implant mucositis may develop peri-implantitis, especially in the absence of regular maintenance care. However, the features or conditions characterizing the progression from peri-implant mucositis to peri-implantitis in susceptible patients have not been identified. The most common etiological factors associated with the development of peri-implantitis are the presence of bacterial plaque and host response. The risk factors associated with peri-implant bone loss include smoking combined with IL-1 genotype polymorphism, a history of periodontitis, poor compliance with treatment and oral hygiene practices, the presence of systemic diseases affecting healing, cement left behind following cementation of the crowns, lack of keratinized gingiva, and previous history of implant failure There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of severe periodontitis, poor plaque control, and no regular maintenance care after implant therapy. Management of peri-implantitis generally works on the assumption that there is a primary microbial etiology. Furthermore, it is assumed that micro-organisms and/or their by-products lead to infection of the surrounding tissues and subsequent destruction of the alveolar bone surrounding an implant. A combination of surgical, open debridement, and antimicrobial treatment has been advocated for the treatment of peri-implantitis. Surgical intervention is required once a patient has bleeding on probing, greater than 5 mm of probing depth, and severe bone loss beyond that expected with remodeling. Access flaps require full-thickness elevation of the mucoperiosteum, facilitating debridement and decontamination of the implant surface via hand instruments, ultrasonic tips, or lasers. When necessary, surgical procedures may be used in conjunction with detoxification of the implant surface by mechanical devices, such as high-pressure air powder abrasion or laser.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/78829",risUrl:"/chapter/ris/78829",signatures:"Amer Shatta and Sukumaran Anil",book:{id:"10808",type:"book",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",subtitle:null,fullTitle:"Current Concepts in Dental Implantology - From Science to Clinical Research",slug:null,publishedDate:null,bookSignature:"Prof. Dragana Gabrić and D.Sc. Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-864-4",printIsbn:"978-1-83969-863-7",pdfIsbn:"978-1-83969-865-1",isAvailableForWebshopOrdering:!0,editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:null,sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Definitions",level:"1"},{id:"sec_2_2",title:"2.1 Peri-implant mucositis",level:"2"},{id:"sec_3_2",title:"2.2 Peri-implantitis",level:"2"},{id:"sec_5",title:"3. Diagnosis of peri-implantitis",level:"1"},{id:"sec_6",title:"4. Classification peri-implantitis",level:"1"},{id:"sec_7",title:"5. Pattern of bone loss in peri-implantitis",level:"1"},{id:"sec_8",title:"6. Prevalence of peri-implantitis",level:"1"},{id:"sec_9",title:"7. Etiology of peri-implantitis",level:"1"},{id:"sec_10",title:"8. Risk factors associated with peri-implantitis",level:"1"},{id:"sec_10_2",title:"8.1 Poor plaque control and lack of regular supportive therapy",level:"2"},{id:"sec_11_2",title:"8.2 History of periodontitis",level:"2"},{id:"sec_12_2",title:"8.3 Genetic traits",level:"2"},{id:"sec_13_2",title:"8.4 Diabetes mellitus",level:"2"},{id:"sec_14_2",title:"8.5 Smoking",level:"2"},{id:"sec_15_2",title:"8.6 Keratinized mucosa",level:"2"},{id:"sec_16_2",title:"8.7 Excess cement and over-contoured supra-structures",level:"2"},{id:"sec_17_2",title:"8.8 Implant-related factors",level:"2"},{id:"sec_17_3",title:"8.8.1 Implant platform switching",level:"3"},{id:"sec_18_3",title:"8.8.2 Implant installation",level:"3"},{id:"sec_20_2",title:"8.9 Overload",level:"2"},{id:"sec_21_2",title:"8.10 Parafunctional habits-bruxism",level:"2"},{id:"sec_22_2",title:"8.11 Alcohol consumption",level:"2"},{id:"sec_23_2",title:"8.12 Iatrogenic factors",level:"2"},{id:"sec_25",title:"9. Treatment",level:"1"},{id:"sec_25_2",title:"9.1 Treatment of peri-implant mucositis",level:"2"},{id:"sec_26_2",title:"9.2 Treatment of peri-implantitis",level:"2"},{id:"sec_27_2",title:"9.3 Non-surgical therapy",level:"2"},{id:"sec_28_2",title:"9.4 Mechanical therapy",level:"2"},{id:"sec_29_2",title:"9.5 Decontamination of the surface of the implant",level:"2"},{id:"sec_30_2",title:"9.6 Laser therapy",level:"2"},{id:"sec_31_2",title:"9.7 Photodynamic therapy",level:"2"},{id:"sec_32_2",title:"9.8 Surgical therapy",level:"2"},{id:"sec_33_2",title:"9.9 Regenerative approaches",level:"2"},{id:"sec_34_2",title:"9.10 Resective therapy",level:"2"},{id:"sec_36",title:"10. Prevention and maintenance",level:"1"},{id:"sec_37",title:"11. Conclusion",level:"1"},{id:"sec_41",title:"Conflict of interest",level:"1"}],chapterReferences:[{id:"B1",body:'Bouri A Jr, Bissada N, Al-Zahrani MS, Faddoul F, Nouneh I. 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European Journal of Oral Implantology. 2018;11(Suppl 1):S123-S136'},{id:"B58",body:'Nguyen-Hieu T, Borghetti A, Aboudharam G. Peri-implantitis: From diagnosis to therapeutics. Journal of Investigative and Clinical Dentistry. 2012;3(2):79-94'},{id:"B59",body:'Cappiello M, Luongo R, Di Iorio D, Bugea C, Cocchetto R, Celletti R. Evaluation of peri-implant bone loss around platform-switched implants. The International Journal of Periodontics & Restorative Dentistry. 2008;28(4):347-355'},{id:"B60",body:'Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. The International Journal of Periodontics & Restorative Dentistry. 2006;26(1):9-17'},{id:"B61",body:'Quoc JB, Vang A, Evrard L. Peri-implant bone loss at implants placed in preserved alveolar bone versus implants placed in native bone: A retrospective radiographic study. The Open Dentistry Journal. 2018;12:529-545'},{id:"B62",body:'Klinge B, Meyle J, Working G. Peri-implant tissue destruction. The Third EAO Consensus Conference 2012. Clinical Oral Implants Research. 2012;23(Suppl 6):108-110'},{id:"B63",body:'Heitz-Mayfield LJ, Schmid B, Weigel C, Gerber S, Bosshardt DD, Jonsson J, et al. Does excessive occlusal load affect osseointegration? An experimental study in the dog. Clinical Oral Implants Research. 2004;15(3):259-268'},{id:"B64",body:'Kahramanoglu E, Kulak-Ozkan Y. Marginal and internal adaptation of different superstructure and abutment materials using two different implant systems for five-unit implant-supported fixed partial dentures: An in vitro study. The International Journal of Oral & Maxillofacial Implants. 2013;28(5):1207-1216'},{id:"B65",body:'Zupnik J, Kim SW, Ravens D, Karimbux N, Guze K. Factors associated with dental implant survival: A 4-year retrospective analysis. Journal of Periodontology. 2011;82(10):1390-1395'},{id:"B66",body:'Galindo-Moreno P, Fauri M, Avila-Ortiz G, Fernandez-Barbero JE, Cabrera-Leon A, Sanchez-Fernandez E. Influence of alcohol and tobacco habits on peri-implant marginal bone loss: A prospective study. Clinical Oral Implants Research. 2005;16(5):579-586'},{id:"B67",body:'Lang NP, Berglundh T. Working Group 4 of Seventh European Workshop on P: Periimplant diseases: Where are we now?—Consensus of the Seventh European Workshop on Periodontology. Journal of Clinical Periodontology. 2011;38(Suppl 11):178-181'},{id:"B68",body:'Heitz-Mayfield LJ, Salvi GE, Botticelli D, Mombelli A, Faddy M, Lang NP, et al. Anti-infective treatment of peri-implant mucositis: A randomised controlled clinical trial. Clinical Oral Implants Research. 2011;22(3):237-241'},{id:"B69",body:'Hallstrom H, Persson GR, Lindgren S, Olofsson M, Renvert S. Systemic antibiotics and debridement of peri-implant mucositis. A randomized clinical trial. Journal of Clinical Periodontology. 2012;39(6):574-581'},{id:"B70",body:'Zeza B, Pilloni A. Peri-implant mucositis treatments in humans: A systematic review. Annali di Stomatologia (Roma). 2012;3(3-4):83-89'},{id:"B71",body:'Renvert S, Samuelsson E, Lindahl C, Persson GR. Mechanical non-surgical treatment of peri-implantitis: A double-blind randomized longitudinal clinical study. I: Clinical results. Journal of Clinical Periodontology. 2009;36(7):604-609'},{id:"B72",body:'Augthun M, Tinschert J, Huber A. In vitro studies on the effect of cleaning methods on different implant surfaces. Journal of Periodontology. 1998;69(8):857-864'},{id:"B73",body:'Unursaikhan O, Lee JS, Cha JK, Park JC, Jung UW, Kim CS, et al. Comparative evaluation of roughness of titanium surfaces treated by different hygiene instruments. Journal of Periodontal and Implant Science. 2012;42(3):88-94'},{id:"B74",body:'Tastepe CS, Liu Y, Visscher CM, Wismeijer D. Cleaning and modification of intraorally contaminated titanium discs with calcium phosphate powder abrasive treatment. Clinical Oral Implants Research. 2013;24(11):1238-1246'},{id:"B75",body:'Tastepe CS, van Waas R, Liu Y, Wismeijer D. Air powder abrasive treatment as an implant surface cleaning method: A literature review. The International Journal of Oral & Maxillofacial Implants. 2012;27(6):1461-1473'},{id:"B76",body:'Sahm N, Becker J, Santel T, Schwarz F. Non-surgical treatment of peri-implantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine: A prospective, randomized, controlled clinical study. Journal of Clinical Periodontology. 2011;38(9):872-878'},{id:"B77",body:'Louropoulou A, Slot DE, Van der Weijden F. The effects of mechanical instruments on contaminated titanium dental implant surfaces: A systematic review. Clinical Oral Implants Research. 2014;25(10):1149-1160'},{id:"B78",body:'Ntrouka V, Hoogenkamp M, Zaura E, van der Weijden F. The effect of chemotherapeutic agents on titanium-adherent biofilms. Clinical Oral Implants Research. 2011;22(11):1227-1234'},{id:"B79",body:'Mohn D, Zehnder M, Stark WJ, Imfeld T. Electrochemical disinfection of dental implants—A proof of concept. PLoS One. 2011;6(1):e16157'},{id:"B80",body:'Schwarz F, Schmucker A, Becker J. Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: A systematic review and meta-analysis. International Journal of Implant Dentistry. 2015;1(1):22'},{id:"B81",body:'Schwarz F, Sculean A, Rothamel D, Schwenzer K, Georg T, Becker J. Clinical evaluation of an Er:YAG laser for nonsurgical treatment of peri-implantitis: A pilot study. Clinical Oral Implants Research. 2005;16(1):44-52'},{id:"B82",body:'Mailoa J, Lin GH, Chan HL, MacEachern M, Wang HL. Clinical outcomes of using lasers for peri-implantitis surface detoxification: A systematic review and meta-analysis. Journal of Periodontology. 2014;85(9):1194-1202'},{id:"B83",body:'Persson GR, Roos-Jansaker AM, Lindahl C, Renvert S. Microbiologic results after non-surgical erbium-doped:yttrium, aluminum, and garnet laser or air-abrasive treatment of peri-implantitis: A randomized clinical trial. Journal of Periodontology. 2011;82(9):1267-1278'},{id:"B84",body:'Yamamoto A, Tanabe T. Treatment of peri-implantitis around TiUnite-surface implants using Er:YAG laser microexplosions. The International Journal of Periodontics & Restorative Dentistry. 2013;33(1):21-30'},{id:"B85",body:'Deppe H, Horch HH, Schrodl V, Haczek C, Miethke T. Effect of 308-nm excimer laser light on peri-implantitis-associated bacteria: An in vitro investigation. Lasers in Medical Science. 2007;22(4):223-227'},{id:"B86",body:'Al-Ahmad A, Tennert C, Karygianni L, Wrbas KT, Hellwig E, Altenburger MJ. Antimicrobial photodynamic therapy using visible light plus water-filtered infrared-A (wIRA). Journal of Medical Microbiology. 2013;62(Pt 3):467-473'},{id:"B87",body:'Meisel P, Kocher T. Photodynamic therapy for periodontal diseases: State of the art. Journal of Photochemistry and Photobiology. B. 2005;79(2):159-170'},{id:"B88",body:'Deppe H, Mucke T, Wagenpfeil S, Kesting M, Sculean A. Nonsurgical antimicrobial photodynamic therapy in moderate vs severe peri-implant defects: A clinical pilot study. Quintessence International. 2013;44(8):609-618'},{id:"B89",body:'Bassetti M, Schar D, Wicki B, Eick S, Ramseier CA, Arweiler NB, et al. Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial. Clinical Oral Implants Research. 2014;25(3):279-287'},{id:"B90",body:'Schou S, Berglundh T, Lang NP. Surgical treatment of peri-implantitis. The International Journal of Oral & Maxillofacial Implants. 2004;19(Suppl):140-149'},{id:"B91",body:'Prathapachandran J, Suresh N. Management of peri-implantitis. Dental Research Journal. 2012;9(5):516-521'},{id:"B92",body:'Roccuzzo M, Layton DM, Roccuzzo A, Heitz-Mayfield LJ. Clinical outcomes of peri-implantitis treatment and supportive care: A systematic review. Clinical Oral Implants Research. 2018;29(Suppl 16):331-350'},{id:"B93",body:'Sahrmann P, Attin T, Schmidlin PR. Regenerative treatment of peri-implantitis using bone substitutes and membrane: A systematic review. Clinical Implant Dentistry and Related Research. 2011;13(1):46-57'},{id:"B94",body:'Serino G, Strom C. Peri-implantitis in partially edentulous patients: association with inadequate plaque control. Clinical Oral Implants Research. 2009;20(2):169-174'},{id:"B95",body:'Khammissa RA, Feller L, Meyerov R, Lemmer J. Peri-implant mucositis and peri-implantitis: Clinical and histopathological characteristics and treatment. SADJ. 2012;67(3):122, 124-126'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Amer Shatta",address:"ashatta@hamad.qa",affiliation:'
Department of Dentistry, Oral Health Institute, Hamad Medical Corporation, Qatar
Department of Dentistry, Oral Health Institute, Hamad Medical Corporation, Qatar
College of Dental Medicine, Qatar University, Qatar
'}],corrections:null},book:{id:"10808",type:"book",title:"Current Concepts in Dental Implantology - From Science to Clinical Research",subtitle:null,fullTitle:"Current Concepts in Dental Implantology - From Science to Clinical Research",slug:null,publishedDate:null,bookSignature:"Prof. Dragana Gabrić and D.Sc. Marko Vuletić",coverURL:"https://cdn.intechopen.com/books/images_new/10808.jpg",licenceType:"CC BY 3.0",editedByType:null,isbn:"978-1-83969-864-4",printIsbn:"978-1-83969-863-7",pdfIsbn:"978-1-83969-865-1",isAvailableForWebshopOrdering:!0,editors:[{id:"26946",title:"Prof.",name:"Dragana",middleName:null,surname:"Gabrić",slug:"dragana-gabric",fullName:"Dragana Gabrić"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}}},profile:{item:{id:"297588",title:"Dr.",name:"Twain J.",middleName:null,surname:"Butler",email:"tjbutler@noble.org",fullName:"Twain J. 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Besides, in the chapter, the current production status and needs, the drawbacks of current cultivars, breeding strategies of the crop, novel genomics tools, and sensor technologies that can be used to improve dual-purpose winter wheat cultivars were presented. We will focus on traits that are, in general, not required by cultivars used for grain-only production but are critical for cool-season forage production.",signatures:"Frank Maulana, Joshua D. Anderson, Twain J. Butler and Xue-Feng Ma",authors:[{id:"284944",title:"Prof.",name:"Xue-Feng",surname:"Ma",fullName:"Xue-Feng Ma",slug:"xue-feng-ma",email:"xma@noble.org"},{id:"297586",title:"Dr.",name:"Frank",surname:"Maulana",fullName:"Frank Maulana",slug:"frank-maulana",email:"fmaulana@noble.org"},{id:"297587",title:"Mr.",name:"Joshua D.",surname:"Anderson",fullName:"Joshua D. Anderson",slug:"joshua-d.-anderson",email:"jdanderson@noble.org"},{id:"297588",title:"Dr.",name:"Twain J.",surname:"Butler",fullName:"Twain J. Butler",slug:"twain-j.-butler",email:"tjbutler@noble.org"}],book:{id:"8168",title:"Recent Advances in Grain Crops Research",slug:"recent-advances-in-grain-crops-research",productType:{id:"1",title:"Edited Volume"}}},{id:"70502",title:"Small Grains as Winter Pasture in the Southern Great Plains of the United States",slug:"small-grains-as-winter-pasture-in-the-southern-great-plains-of-the-united-states",abstract:"Small-grain cereals are widely adapted and used as annual cool-season pastures in the Southern Great Plains (SGP) of the United States, where livestock and forage production are the largest contributors to agricultural income. The advantage of growing small grains in the region is evident due to the widespread adoption and flexibility of production for grain only, forage only, or both grain and forage (i.e., dual purpose). Farmers in the SGP often prefer the use of small grains for dual purpose mainly because of alternative income options from livestock and/or grain, ensuring stable income especially when product prices fluctuate with market demands. Small-grain forage is exceptionally important during autumn, winter, and early spring when forage availability from other sources is low. By providing nutritionally high-quality forage, small grains minimize the need for protein and energy supplements. Besides being used for winter pasture, small grains also serve as cool-season cover crops. While small grains offer different advantages in the integrated crop-livestock system in the region, farming management practices can play an important role to maximize the benefit. The objectives of this chapter are to summarize the significance of small grains as winter pasture and highlight the production status of each small-grain species in the SGP of the United States.",signatures:"Tadele T. Kumssa, Joshua D. Anderson, Twain J. Butler and Xue-Feng Ma",authors:[{id:"284944",title:"Prof.",name:"Xue-Feng",surname:"Ma",fullName:"Xue-Feng Ma",slug:"xue-feng-ma",email:"xma@noble.org"},{id:"297587",title:"Mr.",name:"Joshua D.",surname:"Anderson",fullName:"Joshua D. Anderson",slug:"joshua-d.-anderson",email:"jdanderson@noble.org"},{id:"297588",title:"Dr.",name:"Twain J.",surname:"Butler",fullName:"Twain J. Butler",slug:"twain-j.-butler",email:"tjbutler@noble.org"},{id:"302172",title:"Dr.",name:"Tadele",surname:"Kumssa",fullName:"Tadele Kumssa",slug:"tadele-kumssa",email:"ttkumssa@noble.org"}],book:{id:"8088",title:"Grasses and Grassland Aspects",slug:"grasses-and-grassland-aspects",productType:{id:"1",title:"Edited Volume"}}}],collaborators:[{id:"91315",title:"Prof.",name:"Gyuhwa",surname:"Chung",slug:"gyuhwa-chung",fullName:"Gyuhwa Chung",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Chonnam National University",institutionURL:null,country:{name:"Korea, South"}}},{id:"243630",title:"Dr.",name:"Meruyert",surname:"Kurmanbayeva",slug:"meruyert-kurmanbayeva",fullName:"Meruyert Kurmanbayeva",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"284216",title:"Associate Prof.",name:"Nina",surname:"Terletskaya",slug:"nina-terletskaya",fullName:"Nina Terletskaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:'Nina V. Terletskaya\r\nPhD (1996), associate professor (2018), Leader researcher Lab. of Cell Ingeneering Institute of Plant Biology and Biotechnology (IPBB), Almaty, Kazakhstan. \r\nI have more than 25 years of experience working on plant physiology at the Institute of Plant Biology and Biotechnology of Committee of Science Academy of Sciences, Republic of Kazakhstan. \r\nOver the years I am Head Manager of several (including the international) projects of fundamental and applied research towards stress-tolerance of crops. Such as arabidopsis, barley, wheat and its wild congeners. \r\nI am author of more than 110 scientific publications, 5 innovation patents of RK, several methodical recommendations for researchers and students, one drought tolerant sorts of barley "Ak-Zhol", and 2 monographs.',institutionString:null,institution:null},{id:"284944",title:"Prof.",name:"Xue-Feng",surname:"Ma",slug:"xue-feng-ma",fullName:"Xue-Feng Ma",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"287599",title:"Dr.",name:"Sendhil",surname:"Ramadas",slug:"sendhil-ramadas",fullName:"Sendhil Ramadas",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"293064",title:"MSc.",name:"Ulzhan",surname:"Erezhetova",slug:"ulzhan-erezhetova",fullName:"Ulzhan Erezhetova",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"295122",title:"Dr.",name:"T.M. Kiran",surname:"Kumar",slug:"t.m.-kiran-kumar",fullName:"T.M. Kiran Kumar",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"297586",title:"Dr.",name:"Frank",surname:"Maulana",slug:"frank-maulana",fullName:"Frank Maulana",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"297587",title:"Mr.",name:"Joshua D.",surname:"Anderson",slug:"joshua-d.-anderson",fullName:"Joshua D. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null},{id:"297699",title:"Dr.",name:"Gyanendra Pratap",surname:"Singh",slug:"gyanendra-pratap-singh",fullName:"Gyanendra Pratap Singh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:null}]},generic:{page:{slug:"marketing-and-communications-specialist",title:"Social Media Community Manager and Marketing Assistant",intro:"
IntechOpen is the first native scientific publisher of Open Access books, with more than 116,000 authors worldwide, ranging from globally-renowned Nobel Prize winners to up-and-coming researchers at the cutting edge of scientific discovery. Established in Europe with the new headquarters based in London, and with plans for international growth, IntechOpen is the leading publisher of Open Access scientific books. The values of our business are based on the same ones that any scientist applies to their research -- we have created a culture of respect, collegiality and collaboration within an atmosphere that’s relaxed, friendly and progressive.
",metaTitle:"Social Media Community Manager and Marketing Assistant",metaDescription:"We are looking to add further talent to our team in The Shard office in London with a full-time Marketing and Communications Specialist position. The candidate will bring with them a creative and enthusiastic mindset, high level problem-solving skills, the latest marketing and social media platforms skills and strong involvement in community-best practices to engage with researchers and scholars online. The ideal candidate will be a dynamic, forward thinking, approachable team player, able to communicate with all in the global, growing company, with an ability to understand and build a rapport within the research community.",metaKeywords:null,canonicalURL:null,contentRaw:'[{"type":"htmlEditorComponent","content":"
We are looking to add further talent to our team in The Shard office in London with a full-time Social Media Community Manager and Marketing Assistant position. The candidate will bring with them a creative and enthusiastic mindset, high level problem-solving skills, the latest marketing and social media platforms skills and strong involvement in community-best practices to engage with researchers and scholars online. The ideal candidate wll be a dynamic, forward thinking, approachable team player, able to communicate with all in the global, growing company, with an ability to understand and build a rapport within the research community.
\\n\\n
The Social Media Community Manager and Marketing Assistant will report to the Senior Marketing Manager. They will work alongside the Marketing and Corporate Communications team, supporting the preparation of all marketing programs, assisting in the development of scientific marketing and communication deliverables, and creating content for social media outlets, as well as managing international social communities.
\\n\\n
Responsibilities:
\\n\\n
\\n\\t
Assist in developing creative ideas and implementing materials to support marketing campaigns and events. Deliver projects as part of overall company marketing programme
\\n\\t
Play a key part in workshops for current and new programme ideas, collate ideas and recommendations for tactical programme elements
\\n\\t
Support marketing program preparation and wrap up (e.g., agendas, meeting notes, topics for discussion, background research, setting up campaigns, preparing lists)
\\n\\t
Preparation and content building for online and print material.
\\n\\t
Support relationships with external partners from across the scholarly communications and research, including overall research and support of the academic and institutional liaison program
\\n\\t
Social and Community moderation and monitoring to ensure high quality of answers provided via digital communities (e.g. research communities, LinkedIn, forums)
\\n\\t
Identify and implement effective social media coverage and monitoring tools. ie. Social listening
\\n\\t
Create content for different social media platforms (e.g. LinkedIn, Twitter, Facebook, blogs)
\\n\\t
Influencer and community outreach content
\\n\\t
Contribute creative ideas for using social media in existing programmes
\\n
\\n\\n
Essential Skills:
\\n\\n
\\n\\t
2-3 years of experience supporting marketing programme, including social and community experience with an understanding of how digital communication fits into the overall communications and marketing programmes
\\n\\t
Excellent communications skills -- able to write in a clear, explanatory and customer-focused manner, with a demonstrated strong command over the English language.
\\n\\t
Strong copywriting skills -- will be called upon to write online including hard copy content.
\\n\\t
Experience of engaging customers using social media technologies, platforms, listening programs and tracking/analytics. Evidence will be required.
\\n\\t
Experience of leveraging influencer communities and managing content strategies to maximise customer engagement. Examples will be required.
\\n\\t
Superb organisational skills - ability to take ownership and manage time effectively, as well as manage multiple priorities while maintaining a high level of accuracy within an environment of continuous change
\\n\\t
Self-starter able to work to deadlines with minimal supervision
\\n\\t
Team player with a learning and forward-thinking mindset who fosters a strong working environment with flexibility and willingness to work on a variety of different programs
\\n
\\n\\n
Desired Skills:
\\n\\n
\\n\\t
Experience in supporting programs with external partners, including global companies
\\n\\t
Previous experience of working with research, academia or scholarly communications
\\n\\t
Knowledge of open science, open research or open access
\\n
\\n\\n
What makes IntechOpen a great place to work?
\\n\\n
IntechOpen is a global, dynamic and fast-growing company offering excellent opportunities to develop. We are a young and vibrant company where great people do great work. We offer a creative, dedicated, committed, passionate, and above all, fun environment where you can work, travel, meet world-renowned researchers and grow your career and experience.
\\n\\n
\\n\\t
Competitive salary
\\n\\t
Interactions with all areas of our business in all offices, which can lead to opportunities for career advancement
\\n\\t
Collaboration with scientists and publishing experts worldwide
\\n\\t
Insight into book editorial and production processes
\\n
\\n\\n
To apply, please email a copy of your CV and covering letter to hogan@intechopen.com stating your salary expectations.
\\n\\n
Note: This full-time position will have an immediate start. In your cover letter, please indicate when you might be available for a block of two hours. As part of the interview process, all candidates that make it to the second phase will participate in a writing exercise.
\\n\\n
*IntechOpen is an Equal Opportunities Employer consistent with its obligations under the law and does not discriminate against any employee or applicant on the basis of disability, gender, age, colour, national origin, race, religion, sexual orientation, war veteran status, or any classification protected by state, or local law.
We are looking to add further talent to our team in The Shard office in London with a full-time Social Media Community Manager and Marketing Assistant position. The candidate will bring with them a creative and enthusiastic mindset, high level problem-solving skills, the latest marketing and social media platforms skills and strong involvement in community-best practices to engage with researchers and scholars online. The ideal candidate wll be a dynamic, forward thinking, approachable team player, able to communicate with all in the global, growing company, with an ability to understand and build a rapport within the research community.
\n\n
The Social Media Community Manager and Marketing Assistant will report to the Senior Marketing Manager. They will work alongside the Marketing and Corporate Communications team, supporting the preparation of all marketing programs, assisting in the development of scientific marketing and communication deliverables, and creating content for social media outlets, as well as managing international social communities.
\n\n
Responsibilities:
\n\n
\n\t
Assist in developing creative ideas and implementing materials to support marketing campaigns and events. Deliver projects as part of overall company marketing programme
\n\t
Play a key part in workshops for current and new programme ideas, collate ideas and recommendations for tactical programme elements
\n\t
Support marketing program preparation and wrap up (e.g., agendas, meeting notes, topics for discussion, background research, setting up campaigns, preparing lists)
\n\t
Preparation and content building for online and print material.
\n\t
Support relationships with external partners from across the scholarly communications and research, including overall research and support of the academic and institutional liaison program
\n\t
Social and Community moderation and monitoring to ensure high quality of answers provided via digital communities (e.g. research communities, LinkedIn, forums)
\n\t
Identify and implement effective social media coverage and monitoring tools. ie. Social listening
\n\t
Create content for different social media platforms (e.g. LinkedIn, Twitter, Facebook, blogs)
\n\t
Influencer and community outreach content
\n\t
Contribute creative ideas for using social media in existing programmes
\n
\n\n
Essential Skills:
\n\n
\n\t
2-3 years of experience supporting marketing programme, including social and community experience with an understanding of how digital communication fits into the overall communications and marketing programmes
\n\t
Excellent communications skills -- able to write in a clear, explanatory and customer-focused manner, with a demonstrated strong command over the English language.
\n\t
Strong copywriting skills -- will be called upon to write online including hard copy content.
\n\t
Experience of engaging customers using social media technologies, platforms, listening programs and tracking/analytics. Evidence will be required.
\n\t
Experience of leveraging influencer communities and managing content strategies to maximise customer engagement. Examples will be required.
\n\t
Superb organisational skills - ability to take ownership and manage time effectively, as well as manage multiple priorities while maintaining a high level of accuracy within an environment of continuous change
\n\t
Self-starter able to work to deadlines with minimal supervision
\n\t
Team player with a learning and forward-thinking mindset who fosters a strong working environment with flexibility and willingness to work on a variety of different programs
\n
\n\n
Desired Skills:
\n\n
\n\t
Experience in supporting programs with external partners, including global companies
\n\t
Previous experience of working with research, academia or scholarly communications
\n\t
Knowledge of open science, open research or open access
\n
\n\n
What makes IntechOpen a great place to work?
\n\n
IntechOpen is a global, dynamic and fast-growing company offering excellent opportunities to develop. We are a young and vibrant company where great people do great work. We offer a creative, dedicated, committed, passionate, and above all, fun environment where you can work, travel, meet world-renowned researchers and grow your career and experience.
\n\n
\n\t
Competitive salary
\n\t
Interactions with all areas of our business in all offices, which can lead to opportunities for career advancement
\n\t
Collaboration with scientists and publishing experts worldwide
\n\t
Insight into book editorial and production processes
\n
\n\n
To apply, please email a copy of your CV and covering letter to hogan@intechopen.com stating your salary expectations.
\n\n
Note: This full-time position will have an immediate start. In your cover letter, please indicate when you might be available for a block of two hours. As part of the interview process, all candidates that make it to the second phase will participate in a writing exercise.
\n\n
*IntechOpen is an Equal Opportunities Employer consistent with its obligations under the law and does not discriminate against any employee or applicant on the basis of disability, gender, age, colour, national origin, race, religion, sexual orientation, war veteran status, or any classification protected by state, or local law.
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The motor of the society is the industry and the research of this topic has to be empowered in order to increase and improve the quality of our lives.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",keywords:"Machine Learning, Intelligence Algorithms, Data Science, Artificial Intelligence, Applications on Applied Intelligence"},{id:"23",title:"Computational Neuroscience",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. This topic is dedicated to biologically plausible descriptions and computational models - at various abstraction levels - of neurons and neural systems. This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. Particularly interesting are models of various types of more compound functions and abilities, various and more general fundamental principles (e.g., regarding architecture, organization, learning, development, etc.) found at various spatial and temporal levels.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness"},{id:"24",title:"Computer Vision",scope:"The scope of this topic is to disseminate the recent advances in the rapidly growing field of computer vision from both the theoretical and practical points of view. Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR"},{id:"25",title:"Evolutionary Computation",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization"},{id:"26",title:"Machine Learning and Data Mining",scope:"The scope of machine learning and data mining is immense and is growing every day. It has become a massive part of our daily lives, making predictions based on experience, making this a fascinating area that solves problems that otherwise would not be possible or easy to solve. This topic aims to encompass algorithms that learn from experience (supervised and unsupervised), improve their performance over time and enable machines to make data-driven decisions. It is not limited to any particular applications, but contributions are encouraged from all disciplines.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",keywords:"Intelligent Systems, Machine Learning, Data Science, Data Mining, Artificial Intelligence"},{id:"27",title:"Multi-Agent Systems",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Artificial Intelligence",id:"14"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. 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