Periodontopathogen and Epstein-Barr virus contamination affects transplanted bone volume in sinus augmentation

Bone microbial contamination can impair osteogenesis. Human herpesviruses-associated vasculitis can cause vascular damage within the osseous graft and host. This study is conducted to substantiate specific contamination and assess the impact 6 months after sinus augmentation.

Culture- and polymerase chain reaction (PCR)-based identification were done on harvested bone particles and unstimulated whole saliva in a group of 30 patients undergoing maxillary sinus augmentation. Patients were divided into two groups: those with and those without a history of periodontitis. Radiographic evaluation was done to assess and compare bone healing and volume gain at baseline and 6 months post-transplantation.

Seventeen patients had a history of periodontitis, and 13 did not. Ten showed culture- and PCR-negative results and belonged to the periodontally healthy group. The 17 patients with periodontitis showed culture- or PCR-positive results for the targeted periodontal pathogens. Patients with periodontitis were 2.3 times more likely to have positive salivary Epstein-Barr virus type 1 (EBV-1) than those with no history of periodontitis. The likelihood of having moderate to pronounced bone volume loss 6 months postaugmentation was 7.5 times greater in those patients presenting contamination with ≥3 specific pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, or Prevotella intermedia) versus those with only one (P <0.05). The odds ratio (OR) of pronounced volume loss was 16.3 times higher in those contaminated with a combination of salivary EBV-1 and ≥3 of the previously mentioned species versus only EBV-1 (P <0.05). Individuals showing positive salivary EBV-1 had bone bacterial contamination associated 57% of the time. The OR of having bone microbial contamination in patients with a history of periodontitis was 37.5 times higher than in individuals without periodontitis.

This study confirms contamination of bone, harvested intraorally, with key periodontopathogens in individuals undergoing sinus augmentation. Specific microbial contamination can impair osteogenesis. Saliva may act as a vehicle to transport EBV and other pathogens into the sinus. Increased bone volume loss seems to be associated with the occurrence of specific periodontal anaerobic species, salivary EBV-1, or the combination of both.