Periodontopathogen and Epstein-Barr Virus Contamination Affects Transplanted Bone Volume in Sinus Augmentation.

Background: Bone microbial contamination can impair osteogenesis. Human herpesviruses-associated vasculitis can cause vascular damage within the osseous graft and host. This study was conducted to substantiate specific contamination and assess the impact six months after sinus augmentation. Methods: 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. Subjects were divided into two groups: those with past history of periodontitis and those without. Radiographic evaluation was done to assess and compare bone healing and volume gain at baseline and six months after transplantation. Results: Seventeen subjects had history of periodontitis and 13 did not. Ten showed culture and PCR negative results and belonged to the periodontally healthy group. The 17 periodontitis subjects showed culture or PCR positive results for the targeted periodontal pathogens. Periodontitis subjects 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 six months after augmentation was 7.5 times greater in those subjects presenting contamination with ≥ three specific pathogens (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia or Prevotella intermedia) versus those with only one (P<0.05). The OR of pronounced volume loss was 16.3 times higher in those contaminated with a combination of salivary EBV-1 and ≥ 3 of the above 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 past history of periodontitis was 37.5 times higher than in individuals without periodontitis. Conclusions: 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.