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Studies & Science.

More than 30 years of research make aMMP-8 the oral biomarker of choice. Explore the evidence behind OralFitnessCheck™ — from peer-reviewed studies to the full reference library.

Why aMMP-8 salivary screening?

The biomarker of choice.

dentognostics' patented technology measures the activated form of the enzyme matrix metalloproteinase-8 — hence "aMMP-8" — to determine the breakdown of oral collagen tissue at the cellular level.

When oral collagen breaks down, 90–95% of the collagenolytic activity in gingival crevicular fluid is driven by matrix metalloproteinase-82. Researchers at Sapienza University of Rome showed that 6-month-old implants with elevated aMMP-8 exhibit significantly more bone loss after 2 years than implants with low values3, and confirmed the predictive power of aMMP-8 over a 5-year period in a follow-up study4.

aMMP-8 has been proposed as a biomarker for determining the degree of progression within the AAP stage-and-grade classification of periodontal disease5,6, with high concentrations indicating a high grade of disease progression5. aMMP-8 has been shown to detect periodontitis at a subclinical stage better than bleeding on probing7.

When the oral immune barrier is weakened by progressing periodontal disease8,9, inflammation can spread systemically through the bloodstream10–12. High aMMP-8 values are associated with systemic health risks such as diabetes13–15, cardiovascular disease16,17, and infertility18–20. This connection is known as the oral-systemic link, and aMMP-8 has been proposed as a key biomarker for it21.

30+ yrs

of research behind aMMP-8 as an oral biomarker.

90–95%

of collagenolytic activity in gingival crevicular fluid is driven by MMP-8.

5 min

from sample to result at the point of care.

A patient-management tool, too: personalized biofeedback motivates patients to change their oral-health behavior22. aMMP-8 feedback has been used successfully to set individual recall intervals and achieve better preventive outcomes23,24 — it gives patients a clear goal: get into the green range23. Intrinsically motivated patients visit the dentist more regularly and have better oral health25.
The evidence

The 7 most important studies on aMMP-8.

Tap a study to read the abstract. Each links to the original publication.

1

Active MMP-8 (aMMP-8) as a grading and staging biomarker in the periodontitis classification

Sorsa T. et al. (2020), Diagnostics
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This study investigated the utility of incorporating aMMP-8 as a biomarker into the 2018 periodontitis classification system (stage/grade), testing 150 Greek adults aged 25–78 with an aMMP-8 point-of-care mouthrinse test followed by full-mouth clinical examination. aMMP-8 levels were significantly lower among healthy patients compared with patients in more severe periodontitis stages and grades — and aMMP-8 was more robust to the confounding effects of oral hygiene than bleeding on probing. The test can be used as an adjunctive, preventive diagnostic tool to identify periodontal disease chairside in only 5 minutes.

Read the publication
2

Can peri-implant marginal bone loss progression and aMMP-8 be considered indicators of the subsequent onset of peri-implantitis? A 5-year study

Guarnieri R. et al. (2022), Diagnostics
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This 5-year retrospective study of 80 patients with 80 implants assessed marginal bone loss and peri-implant sulcular fluid levels of aMMP-8 (measured chairside with ImplantSafe® and the ORALyzer® digital reader) at restoration, 6 months, 2 years, and 5 years. Early bone remodeling could not predict peri-implantitis — but implants with aMMP-8 levels above 15.3 ng/mL at 6 months showed a significantly higher probability of developing it. High aMMP-8 levels 6 months after loading have a distinct ability to predict peri-implantitis.

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3

Active MMP-8 point-of-care/chairside mouthrinse test vs. bleeding on probing in diagnosing subclinical periodontitis in adolescents

Räisänen I.T. et al. (2019), Diagnostics
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This cross-sectional study in Finnish adolescents (ages 15–17) compared the aMMP-8 point-of-care mouthrinse test against the conventional bleeding-on-probing (BOP 20%) test for detecting subclinical periodontitis. The aMMP-8 test showed a 2.8–5.3× stronger association with subclinical periodontitis, twice the sensitivity at generally the same specificity, better accuracy, and fewer false negatives — reducing the risk of undertreatment.

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4

The ability of quantitative, specific, and sensitive point-of-care oral fluid immunotests for aMMP-8 to detect periodontal and peri-implant diseases

Alassiri S. et al. (2018), Disease Markers
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This paper describes the practical, convenient, non-invasive, and quantitative lateral-flow aMMP-8 immunoassays (PerioSafe® and ImplantSafe®/ORALyzer®) used to detect, predict, and monitor the course, treatment, and prevention of periodontitis and peri-implantitis. The tests have been independently validated to differentiate periodontal and peri-implant health and disease in Finland, Germany, the Netherlands, Sweden, Turkey, Nigeria, Malawi, and the USA.

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5

Active MMP-8 point-of-care/chairside enzyme-test as an adjunctive tool for early and real-time diagnosis of peri-implantitis

Lähteenmäki H. et al. (2022), Clinical and Experimental Dental Research
▾

In this case-control study, 68 patients in implant maintenance underwent aMMP-8 point-of-care testing of peri-implant sulcular fluid (ImplantSafe®/ORALyzer®). The test promptly recorded and reflected peri-implant disease, clearly differentiating it from health, and was more precise than total MMP-8, calprotectin, IL-6, MMP-2, and MMP-9. Active MMP-8 can be utilized as the point-of-care biomarker of choice in the new classification of peri-implantitis.

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6

Prediabetes/diabetes screening strategy at the periodontal clinic

Grigoriadis A. et al. (2021), Clinical and Experimental Dental Research
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Among 150 dental patients who met CDC screening criteria, 31 (20.7%) were found with unknown hyperglycaemia. The combination of periodontitis stage, increasing age, BMI, and aMMP-8 — without chairside HbA1c assessment — appears to be a viable screening strategy for referring dental patients for prediabetes/diabetes testing, positioning the dental practice as a checkpoint for whole-body health.

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7

Active matrix metalloproteinase-8: a potential biomarker of the oral-systemic link

Umeizudike K. et al. (2022), Clinical and Experimental Dental Research
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This review affirms the oral-systemic link and the contribution of periodontitis to the inflammatory burden in systemic diseases. Host inflammation — including biomarkers such as aMMP-8 — plays a major role as the driving pathological mechanism in both periodontitis and systemic disease. aMMP-8 can be a bridge between oral/periodontal and systemic diseases: a mouth-body connection.

Read the publication
Reference library

The literature.

The peer-reviewed publications behind the science on this page.

  1. Al-Majid, A. et al. Matrix Metalloproteinase-8 as an Inflammatory and Prevention Biomarker in Periodontal and Peri-Implant Diseases. Int. J. Dent. 2018, 1–27 (2018).
  2. Sorsa, T. et al. Analysis of matrix metalloproteinases, especially MMP-8, in gingival crevicular fluid, mouthrinse and saliva for monitoring periodontal diseases. Periodontol. 2000 70, 142–163 (2016).
  3. Guarnieri, R. et al. Correlation between peri-implant marginal bone loss progression and peri-implant sulcular fluid levels of metalloproteinase-8. J. Pers. Med. 12, 58 (2022).
  4. Guarnieri, R. et al. Can Peri-Implant Marginal Bone Loss Progression and a-MMP-8 Be Considered Indicators of the Subsequent Onset of Peri-Implantitis? A 5-Year Study. Diagnostics 12, 2599 (2022).
  5. Sorsa, T. et al. Active MMP-8 (aMMP-8) as a Grading and Staging Biomarker in the Periodontitis Classification. Diagnostics 10, 61 (2020).
  6. Tonetti, M. S., Greenwell, H. & Kornman, K. S. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J. Periodontol. 89 (2018).
  7. Räisänen, I. et al. Active Matrix Metalloproteinase-8 Point-of-Care (PoC)/Chairside Mouthrinse Test vs. Bleeding on Probing in Diagnosing Subclinical Periodontitis in Adolescents. Diagnostics 9, 34 (2019).
  8. Bosshardt, D. D. The periodontal pocket: pathogenesis, histopathology and consequences. Periodontol. 2000 76, 43–50 (2018).
  9. Kinane, D. F., Stathopoulou, P. G. & Papapanou, P. N. Periodontal diseases. Nat. Rev. Dis. Primer 3, 17038 (2017).
  10. Botelho, J. et al. Periodontitis and circulating blood cell profiles: a systematic review and meta-analysis. Exp. Hematol. 93, 1–13 (2021).
  11. Bui, F. Q. et al. Association between periodontal pathogens and systemic disease. Biomed. J. 42, 27–35 (2019).
  12. Vitkov, L. et al. Connection between periodontitis-induced low-grade endotoxemia and systemic diseases: neutrophils as protagonists and targets. Int. J. Mol. Sci. 22, 4647 (2021).
  13. Grigoriadis, A. et al. Prediabetes/diabetes screening strategy at the periodontal clinic. Clin. Exp. Dent. Res. 7, 85–92 (2021).
  14. Grigoriadis, A. et al. Prediabetes/Diabetes Can Be Screened at the Dental Office by a Low-Cost and Fast Chair-Side/Point-of-Care aMMP-8 Immunotest. Diagnostics 9, 151 (2019).
  15. Umeizudike, K. A. et al. Prediabetes Associates with Matrix Metalloproteinase-8 Activation and Contributes to the Rapid Destruction of Periodontal Tissues. Eur. J. Dent. (2024).
  16. Sorsa, T. et al. Collagenase-2 (MMP-8) as a point-of-care biomarker in periodontitis and cardiovascular diseases. Pharmacol. Res. 63, 108–113 (2011).
  17. Tuomainen, A. M. et al. Serum Matrix Metalloproteinase-8 Concentrations Are Associated With Cardiovascular Outcome in Men. Arterioscler. Thromb. Vasc. Biol. 27, 2722–2728 (2007).
  18. Nwhator, S. et al. Could periodontitis affect time to conception? Ann. Med. Health Sci. Res. 4, 817 (2014).
  19. Nwhator, S. O. Association between aMMP-8 Chairside Test for Chronic Periodontitis and Selected Reproductive Health Parameters (2018).
  20. Nwhator, S. O. et al. Another Reason for Impeccable Oral Hygiene: Oral Hygiene-Sperm Count Link. J. Contemp. Dent. Pract. 15, 352–358 (2014).
  21. Umeizudike, K. et al. Active matrix metalloproteinase-8: A potential biomarker of oral systemic link. Clin. Exp. Dent. Res. 8, 359–365 (2022).
  22. Chapple, I. L. & Hill, K. Getting the message across to periodontitis patients: the role of personalised biofeedback. Int. Dent. J. 58, 294–306 (2008).
  23. Neefs, D. An aMMP-8 use case — Predictive biomarkers in molecular dentistry. ConsulTand 17, 14–17 (2024).
  24. Raivisto, T. et al. Active Matrix Metalloproteinase-8 Chair Side Mouth Rinse Test, Health Behaviour and Oral Health in Finnish Adolescent Cohort. J. Clin. Diagn. Res. (2020).
  25. Münster Halvari, A. E. et al. Motivation and anxiety for dental treatment: Testing a self-determination theory model of oral self-care behaviour and dental clinic attendance. Motiv. Emot. 34, 15–33 (2010).

The 100 newest publications on aMMP-8

Research on aMMP-8 is ongoing. Browse the most recent publications, updated continuously on PubMed.

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