Abstract
<title>Abstract</title> <p> Objectives This study aimed to evaluate the potential of salivary and peri-implant crevicular fluid (PICF) advanced glycation end products (AGEs) as non-invasive biomarkers for monitoring peri-implant tissue health in patients with different glycemic status undergoing simultaneous guided bone regeneration (GBR). Methods 20 hyperglycemic and 20 normoglycemic patients receiving implants with simultaneous GBR were evaluated. Cone-beam computed tomography assessed buccal bone thickness reduction (ΔBBT) and marginal bone loss (MBL) at post-surgery (T1), crown placement (T2), and follow-up (T3). Levels of AGEs in saliva and PICF were measured via ELISA and correlated with metabolic parameters (HbA1c, FBG) and clinical indicators (bleeding on probing, BOP). Results Hyperglycemic patients showed reduced peri-implant bone stability at 1 mm and 3 mm below the implant shoulder ( <italic>p</italic> < 0.05). Greater buccal resorption was observed during early remodeling (T1–T2) and post-loading (T2–T3) in the hyperglycemia group, particularly with poor glycemic control (FBG ≥ 7 mmol/L). In addition, AGEs levels in both saliva and PICF were significantly higher in the hyperglycemic group (p < 0.05), and salivary AGEs levels were positively correlated with peri-implant soft tissue glycosylated hemoglobin (HbA1c) and bleeding on probing (BOP%) (p < 0.05). Conclusion Hyperglycemia exacerbates peri-implant bone resorption and worsens soft tissue phenotypes after GBR. The strong correlation between salivary AGEs and metabolic/inflammatory parameters highlights the potential of AGEs as a predictive biomarker for assessing peri-implant prognosis. Strict glycemic control may improve tissue stability by mitigating AGEs accumulation. Clinical relevance: This study underscores the critical impact of glycemic control on the stability of regenerated bone around implants. The findings suggest that monitoring salivary AGEs levels could serve as a non-invasive and practical tool for clinicians to identify hyperglycemic patients at high risk of peri-implant bone loss and soft tissue inflammation. By integrating AGEs assessment into pre- and post-operative evaluations, dental practitioners can better stratify patient risk, optimize timing for implant loading, and implement targeted metabolic interventions to improve long-term implant survival rates in diabetic populations. </p>