INTERNO_Igiene e Sanità 4_2015.pmd

IL CASO I CE B UCKET C HALLENGE : ANALISI
E RIFLESSIONI SULLE POTENZIALITÀ DELL ’ USO
DEI SOCIAL NETWORK PER PROMUOVERE INTERVENTI DI
SANITÀ P UBBLICA
Ig. Sanità Pubbl. 2015; 71: 369-385
Efficacy of the ND:YAG laser therapy on EBV and
HSV1 contamination in periodontal pockets
Francesco Saverio Martelli1, Giovanni Bacci2 , Maria Laura Martelli1,
Piero Nobili 3, Anna Boddi1, Claudio Rosati 1, Elena Fanti1
1
2
3
Microdentistry Florence, Italy
Department of Biology, University of Florence, Italy
Istituto Stomatologico Italiano, Reparto di Odontoiatria Biologica Milano
Key words
Herpesvirus, Periodontal disease, Nd:YAG laser, EBV, HSV1,
Periodontal treatment, PERIOBLAST
Summary
Aim: The aim of this retrospective multicenter study was to verify the
efficacy of Nd:YAG laser in the treatment of periodontal pockets infected by Epstein-Barr
Virus (EBV) and Herpes Simplex Virus 1 (HSV1).
Methods: Subgingival plaque samples of 291 Italian periodontal patients were analyzed by
Real Time PCR to evaluate the frequency of both viruses before and after Nd:YAG laserassisted periodontal treatment.
Results: Before treatment, EBV and HSV1 were observed in 29.9% and in 3.8% of periodontal
patients respectively, while co-infection with both viruses was detected in 1.7% of cases.
Periodontal Nd:YAG laser treatment ("Periodontal Biological Laser-Assisted Therapy",
PERIOBLAST) produced statistical significant benefits, especially in EBV periodontal
infection: 78.2% of EBV positive patients became EBV-negative following treatment.
Conclusions: Results of this preliminary study highlight that EBV is found in periodontal
pockets more frequently than HSV1, supporting the theory of the potential role of EBV in
the onset and progression of periodontal disease. Moreover, our data showed that Nd:YAG
laser-assisted periodontal treatment (Perioblast) is also effective in case of viral infection,
validating evidences that it represents a successful alternative approach to traditional
periodontal protocols.
Efficacia del trattamento laser Nd:YAG in presenza di contaminazione da EBV
e HSV1 nelle tasche parodontali
Parole chiave
Herpesvirus, Malattia parodontale, ND:YAG laser, EBV, HSV1,
Trattamento parodontale, PERIOBLAST
Riassunto
Oggetto dello studio: L’obiettivo di questo studio retrospettivo multicentrico
era quello di valutare l’efficacia del trattamento parodontale Nd:YAG laser assistito, sulla
presenza di Epstein-Barr Virus e Herpes Simplex Virus 1 nelle tasche parodontali.
Materiali e metodi: Campioni di placca subgengivale prelevati da 291 pazienti parodontali
italiani, sono stati analizzati mediante metodica Real Time PCR al fine di verificare la
frequenza di entrambi i virus nelle tasche parodontali prima e dopo il trattamento parodontale
laser assistito.
Risultati: Precedentemente al trattamento parodontale, il 29.9% dei pazienti è risultato
EBV-positivo, il 3.8% HSV1-positivo, mentre la coinfezione è stata rilevata solo nell’1.7%
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dei casi. A seguito della terapia parodontale, il 78.2% dei pazienti EBV positivi prima del
trattamento laser diventa EBV-negativo evidenziando in maniera statisticamente significativa
l’efficacia dell’utilizzo del Nd:YAG laser nel protocollo terapeutico parodontale.
Conclusioni: I risultati di questo studio preliminare hanno evidenziato una maggiore frequenza
nelle tasche parodontali del virus EBV rispetto a HSV1, avvalorando l’ipotesi del ruolo
potenziale degli herpesvirus nell’insorgenza e nella progressione della malattia parodontale.
Inoltre, i dati ottenuti mostrano che l’utilizzo del Nd:YAG laser nel trattamento parodontale
risulta efficace anche nella risoluzione delle infezioni virali e rappresenta un’alternativa di
successo ai tradizionali protocolli terapeutici.
Introduction
Periodontal disease refers to a wide group of alterations of periodontal tissues,
which include: alveolar bone, root cement, periodontal ligament and gums.
Periodontitis affects more than 60% of Italian population and it is considered a
chronic inflammatory disease primarily caused by many strains of bacteria, but
different co-factors, related to individual genomic profiles, can play an important
role in modulate the onset and the progression of the disease. This is particularly
clear in the aggressive cases, representing 10% of the total, easy to relapse and
without an effective therapy (Rhemrev et al. 2009; Rhemrev et al. 2006; Colombo
et al. 2012). Several studies show evidence of a strong correlation between
periodontal disease and the onset of important systemic pathologies, such as
respiratory and cardiovascular diseases, rheumatoid arthritis, diabetes mellitus
and adverse pregnancy outcomes, as a results of bacteraemia and toxins spread
into the bloodstream (Seymour et al. 2007; Marakoglu et al. 2008; Beck et al.
2001; Scannapieco et al. 1999).
According to a recent statistical survey, only the 31.2% of Italian populations has an
adequate knowledge about periodontitis and just 10.8% of people knows that this
disease affects all periodontal tissues and not only the gums. Moreover, only 2.5% of
people are aware that periodontitis is an inflammation provoked by a polimicrobial
bacterial infection (by Astra Ricerche for Microdentistry 2013). More than 700 bacterial
species found in the plaque, but periodontal disease is related to a subset of bacteria,
predominantly gram-negative and anaerobic, that can be used as diagnostic markers.
However, this traditional concept of periodontitis is often unable to explain the clinical
complexity of the disease while there are increasing evidences about a periodontopathic
role of herpesvirus that, infecting tissue cells and host defense cells of the periodontium,
may reduce the ability of periodontal tissues to withstand the bacterial infection,
cooperating with periodontal bacteria in the etiopathogenesis of periodontitis (Ambili
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EFFICACY
OF THE
ND:YAG
LASER THERAPY ON OF
EBV
AND
HSV1
CONTAMINATION IN PERIODONTAL POCKETS
et al. 2014). While scientific literature shows the antimicrobial efficacy of periodontal
laser treatment, there are no evidences about the effectiveness of Nd:YAG laser
application in the viral decontamination of periodontal pockets. In the present
retrospective multicenter study we aimed to clarify the effects of Nd:YAG laser
treatment on the presence of Epstein-Barr Virus (EBV) and Herpes Simplex Virus 1
(HSV1) in disease sites in Italian subjects.
Herpes simplex viruses
The herpes simplex viruses is a large family of DNA viruses (Herpesviridae) that
includes 8 different viruses affecting human classified into three groups (á, â, ´)
based on tissue tropism and pathogenicity.
The subgroup of Alphaherpesvirinae includes:
•
herpes simplex type 1 (oral herpes, HSV-1)
•
herpes simplex type 2 (genital herpes, HSV-2)
•
human herpes virus 3 (varicella zoster virus, HHV-3)
The members of this subfamily are neurotropic, have a short replication cycle
(about 18 hours) with efficient cells destruction and variable host range.
The viruses belonging to the Betaherpesvirinae are:
•
human herpesvirus 5 (Citomegalovirus, HHV-5)
•
human herpesvirus 6 and 7 (mild early childhood roseola, HHV-6, HHV-7)
Betaherpesvirinae are lymphotropic with a long reproductive cycle and a restricted
host range.
The third subgroup is Gammaherpesvirinae and includes:
•
human herpesvirus 4 (Epstein-Barr virus, HHV-4: the etiologic factor of
infectious mononucleosis; it’s associated with several malignant diseases including
Burkitt’s lymphoma, nasopharyngeal carcinoma etc)
•
human herpesvirus 8 (HHV-8: the underlying infectious cause of Kaposi
sarcoma) (Levy JA, 1995).
Gammaherpesvirinae is a subfamily with an high latency rates for infection
induced and specific to either T-lymphocytes or B-lymphocytes and typically attack
lymphoid tissues in vertebrates (Grinde B, 2013).
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All Herpesvirus have same biological characteristics such as: viral reproduction
by lytic cycle; DNA replication, assembly of new capsids and DNA packaging
occur in the nuclei of infected cells; expression of a large number of enzymes
involved in metabolism of nucleic acid (e.g. thymidine kinase), DNA synthesis
(e.g. DNA helicase/primase) and processing of proteins (e.g. protein kinase)
(Boehmer et al. 2003); ability in establish and maintain a latent state in their host
ensuring survival of the herpesviral genome; latency involves stable maintenance
of the viral genome in the nucleus with limited expression of a small subset of viral
genes.
Herpesviral reactivation can be triggered by stress, hormonal changes, infections
or by other systemic conditions impairing cellular immunity. Reactivation of
herpesviruses may cause both clinically symptomatic and asymptomatic infection.
Herpes simplex virus and periodontal disease
Epstein-Barr Virus (EBV) (Ebstein et al. 1964) is a B-lymphotropic gammaherpesvirus that infects more than 95% of the world population. Upon infection,
the subject remains a lifelong carrier of the virus and saliva represents the main
vehicle for EBV transmission from individual to individual. In primary viral
infection, EBV replicates in the oropharyngeal epithelium and establishes a latent
infection in B lymphocytes that is necessary for virus persistence. EBV causes
infectious mononucleosis, oral hairy leukoplakia and is also associated with various
types of lymphoid and epithelial malignancies such as Burkitt’s lymphoma,
nasopharyngeal carcinoma, B cell lymphoproliferative disorders, Hodgkin’s disease
and leiomyosarcomas (Klein et al. 2007).
Although the relationship between the detection of EBV in oral infection and severity
of periodontal disease has not yet been explained, numerous studies have established
a positive and synergic association between the presence of virus in periodontal pockets
and a more elevated occurrence of periodontopathic bacteria such as P. gingivalis and
T. forsythia (Nishiyama et al.2008; Chalabi et al. 2010). In particular, the presence of
P.gingivalis seems to promote the EBV reactivation (Sugano et al. 2004). Moreover, the
combination of the presence of periodontal bacteria and EBV seems to induced also
an increased bone volume mass loss, since the infection impair osteogenesis (Verdugo
et al. 2012). EBV DNA was found in patients with endodontic disease such as
irreversible pulpitis, primary apical periodontitis and previously treated with apical
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EFFICACY
OF THE
ND:YAG
LASER THERAPY ON OF
EBV
AND
HSV1
CONTAMINATION IN PERIODONTAL POCKETS
periodontitis in high percentages compared with incidence in healthy. These data
suggests that EBV may represent a cofactor with other microorganisms in developing
endodontic pathoses (Li et al. 2009).
Herpes simplex virus type 1 is a neurotropic herpesvirus mainly transmitted by saliva
and frequently associated with oropharingeal infection. The primary infection could be
or not symptomatic and after the virus replication within mucosal epithelial cells, HSV1
establishes latency into neuronal cells without clinical manifestation or production of
viral antigens. In case of reactivation, HSV1 re-enter the normal lytic cycle gene expression
program with production of new viral particles and herpetic relapses. In periodontal
patients, the presence of HSV1 was associated with an increased of clinical attachment
loss and was found most frequently in chronic periodontal patients (Ling et al. 2004;
Bilichodmath 2009). Moreover the presence of HSV1 and periodontal pathogens like
Treponema denticola and Tannerella forsithya was predominant in patients showing
necrotic pulp and the association of HSV1 and periodontal bacteria promotes progression
of periodontal disease (Nishiyama et al. 2008).
On the contrary of EBV, in patients affected by irreversible pulpitis or apical
periodontitis both primary and previously treated, HSV-1 was found in slightly
higher percentages, not statistically significant compared with the viral incidence
in healthy group (Li et al. 2009).
The herpesvirus infection may interferes with healthy periodontal tissues with a
series of elaborate mechanisms to impair the local host immune response, affecting
proinflammatory cytokine production in macrophages and lymphocytes or divert
potent antiviral pathways such as that of interferon (Slots and Contreras 2000;
Alcami et Koszinowski, 2000 a,b,c). This trigger of cytokine production may also
favor the reactivation of other latent herpesvirus with consequent increase of
severity of periodontitis. Periodontal herpesvirus infection can also stimulate/
promove a bacterial overgrowth, also by affecting the adhesion potential of
periodontal bacteria (Slots J, 2005).
Periodontal laser therapy
The use of laser treatment in periodontal therapy is a serious option in adjunct to the
mechanical, chemical/pharmacological and surgical treatments in order to control the
bacterial contamination (Cobb et al. 1992; Sjöström and Friskopp 2002), and the
inflammation of periodontal tissues in a less invasive and painful way (Qadri et al. 2011).
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The main effects of the Nd:YAG radiation on the biological tissues are, at the
setting parameters of 100 mJ, 20 Hz, 50 micro seconds pulse duration:
1 deep and lasting decontamination, especially effective for the dentinal tubules
decontamination once that no vessels are present into this tissue, and the
antiseptics are not able to penetrate whereas the Nd : YAG radiation penetrates
more than 1 mm in depth
2 biostimulation, rising the levels of ATP available for the protein synthesis of
the cells
3 biomodulation, as inhibition of the inflammation
The application of Nd:YAG laser in the pockets is able to kill microorganisms and
inactive bacterial endotoxins, in periodontal pockets with a minimal rise of the
temperature because the peak power of energy that such extra short pulse duration is
transmitting to the membrane of viruses and bacteria. Moreover, the use of laser
promotes fibroblasts and osteoblasts with consequent increase of collagen production
in periodontal healing phase (Lins et al. 2010). The laser treatment in the management
of periodontal therapy allows also to overcome the resistances of subgingival biofilm
communities to antibiotics traditionally used in dental practice (Berutti et al.
1997;Klinke et al. 1997). In particular, Nd:YAG laser device is employed only in soft
periodontal tissue surgery (White et al. 1991; Gold and Vilardi 1994; Fornaini et al.
2007), because it can be absorbed intensely by soft tissue and particularly attaches to
chromophores, such as melanin or hemoglobin, and is transferred through water, which
is contained in a proportion of 90% within soft tissues (Coleton 2004). On the other
hand, Nd: YAG laser is absorbed by hard dental tissues to a limited extent. Hence,
Nd:YAG laser may be used within the dento-gingival sulcus, where chromofore bacteria
are usually present, without causing any damage on dental hard tissues (Jeng et al.
1999;Coluzzi 2000,2004; Coleton 2004; Raffetto 2004; Cobb 2006).
The aim of this study was to assess in a large dataset of Italian periodontal
patients, the prevalence of HSV1 and EBV in samples of subgingival plaque
evaluating also in a reduced dataset of patients positive to at least one of the two
virus, the efficacy of Nd: YAG laser treatment on viral infection.
Materials and methods
Microbiological analysis of subgingival plaque.
Subgingival plaque samples were collected from Italian periodontal patients from
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OF THE
ND:YAG
LASER THERAPY ON OF
EBV
AND
HSV1
CONTAMINATION IN PERIODONTAL POCKETS
EDN clinics. Sampling was carried out following the procedures reported in the
BPA kit (Bacterial Periodontal Assessment, Biomolecular Diagnostic, Firenze Italy)
after drying the area and removing supragingival plaque. Subgingival plaque
samples were collected with sterile paper points introduced to the bottom of pockets
(choosing at least one pocket for each quadrant) and left in situ at least one
minute. When removing, the paper points are stored at 4°C in a sterile tube before
sending to Biomolecular Diagnostic laboratory (Firenze, Italy) for microbiological
analysis. The DNA extraction was performed by QIASymphony (QIAGEN) and
the presence/absence of EBV and HSV1, was evaluated by Kit Artus EBV-HSV-1
QS-RGQ PCR KIT (QIAGEN). A first computation of virus frequency by Real
Time PCR was performed on a random pool of 1710 periodontal patients of which
980 that were not yet undergone to periodontal laser therapy (first visit) and 730
that was taken after therapy (controls). We have then selected a new group of 291
patients (Table 1) which undergoing both to microbiological test prior to laser
irradiation and to control microbiological test after periodontal laser therapy (about
2 months since the first laser irradiation), in order to evaluate the frequency of
EBV/HSV1 first and before laser treatment.
Periodontal Laser Therapy
Laser irradiation of periodontal pockets. Periodontal patients are treated with
mechanical treatment before Nd:YAG laser therapy (frequency 20 Hz; 2 Watt,
100mJoule; fibre diameter: 320 ìm) (DEKA/DMT) for at least 4 cycles or until the
requirements of lack of clinical inflammation are not satisfied. Laser treatment
was performed by introducing the optic fiber into the deepest point of each pocket
following the long axis of the tooth root and delivering the energy with a constant
movement of the optical fiber. The procedure was repeated so that each lower or
upper full arch received in total at least 3000 joules during each treatment. During
the treatment the gingival sulcus was alternatively irrigated with betadine and
hydrogen peroxide solution.
About 2 months since the first laser treatments, a new sampling of subgingival
plaque was performed in the same pockets analyzed in the start microbiological
test, in order to verify how the microbial and viral composition changed after laser
therapy. During the recall sessions, the laser treatment is reserved only for teeth
showing periodontal pockets with PPD>2 mm. In accordance with the
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F.S. MARTELLI, G. BACCI, M. MARTELLI, A. BODDI, C. ROSATI, E. FANTI
recommended precautions for working with lasers, both the patient and the
operator wore goggles and the area in which the treatment took place was marked
appropriately.
Statistical analysis
Virus tests independence
To check if the two virus tests were independent from each other, a “goodness of
fit” test was performed on the whole patient dataset (first visit data and control
data were not divided; Figure 1). A number of iterations of 10’000 was used to
compute the p-value associated with the test. The resulting p-value was 0.009 and
so the two tests were considered not independent. However if we repeat these
analyses splitting the data according to the first visit and the control, the
independence test ends with a p-value less than 0.05 only in the control group
(data not shown). These could be due to the different patient distribution in the
two dataset, as reported in Figure 2.
Analysis on paired data
In order to test the efficiency of the treatment, a new dataset was built by
selecting only patients with paired visits, in other words patients were included in
the dataset only if they had been screened both previously and after periodontal
laser treatment. To inspect changes in the test outcome a McNemar test has been
performed on the paired dataset and the results were reported in Table 1.
All statistical analyses were performed using the R software (R Core Team (2013).
R: A language and environment for statistical computing. R Foundation for Statistical
Computing, Vienna, Austria. URLhttp://www.R-project.org/) and the R package
“vegan” (Jari Oksanen, F. Guillaume Blanchet, Roeland Kindt, Pierre Legendre, Peter
R. Minchin, R. B. O’Hara, Gavin L. Simpson, Peter Solymos, M. Henry H. Stevens and
Helene Wagner (2013). vegan: Community Ecology Package. R package version 2.010. http://CRAN.R project.org/package=vegan).
Results
Of 980 patients submitted to microbiological test before periodontal laser
treatment, EBV and HSV1 were detected in 27.35% and 3.57% of the patients,
respectively. Co-infection of both viruses was found only in 1.43% of subjects
(Figure 3). Those percentages have been confirmed also after the analysis of a
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EFFICACY
OF THE
ND:YAG
LASER THERAPY ON OF
EBV
AND
HSV1
CONTAMINATION IN PERIODONTAL POCKETS
reduced dataset that includes only 291 patients (Table 2) which have been tested
for the presence of viruses before and after periodontal therapy: the 29.9% were
EBV-positive, the 3.8% were HSV1-positive, while co-infection of both viruses was
detected only in 1.7% of cases (Figure 4). As shown in Table 3 EBV-positive
patients showed clinical index values comparable to those obtained with the reduced
dataset. Interestingly, the 78.2% of the patients found positive for EBV virus before
periodontal laser therapy, became EBV-negative after the treatment. Periodontal
laser therapy successfully interferes also with the presence of HSV1: the 90.9% of
patients positive to the virus presence in the first visit turned HSV1-negative in
the control test. The 80% of subjects positive to the EBV and HSV1 co-infection
became negative to both viruses after periodontal treatment (p-value < 0.0001
computed with a McNemar test) (Figure 5). EBV and HSV1 viruses are not to be
considered independently distributed in the whole patient dataset. However if
we divide the dataset according to the visit the dependence of the two viruses can
be ascribed only at the control group. This could be due to the different patient
distribution in the two visits. Moreover, if we test the efficacy of the treatment
using a paired dataset, we can see that the EBV virus shows a lower degree of
infection in the control visit in respect with the first visit (p-value < 0.0001
computed with a McNemar test). On the contrary, the percentage of patients
HSV1-positive do not seems to change after periodontal therapy. However, HSV1
related data might be affected by the low presence of positive patients to the virus.
Those data highlighted that periodontal Nd:YAG laser treatment produces
statistical significant benefits, especially in EBV periodontal infection, promoting
resolution of both inflammation and periodontal tissues regeneration.
Discussion
Periodontal disease represents the first cause of tooth loss in industrialized world.
Increasingly evidences show that periodontal bacteria cooperate with herpesviruses
in promoting the onset of disease and a rapid periodontium destruction. The host
immune system reacts activating polymorphonuclear leukocytes that, thanks to
their accumulation in epithelial tissues and to the release of enzymes and oxygen
metabolites, can cause tissue damage. Moreover, macrophages, fibroblasts, plasma
cells and T lymphocytes produce cytokines and inflammatory mediators such as
IL-1, TNF-á, PGE2 and TGF-â that trigger inflammatory disease (Paludan and
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Mogensen, 2001) and promote osteoclastic activation with consequent bone loss
(Fracon et al. 2008; Kawashima and Stashenko, 1999; Lader and Flanagan, 1998).
The goal of periodontal treatments is to define a personalized therapeutic plain in
order to maximize the efficacy of periodontal therapy and avoid the tooth loss. The
routinely use of microbiological test in periodontal practice, represents a useful approach
in order to elaborate a personalized periodontal management also monitoring the
effectiveness of therapy. To this purpose, it should be noted that the severe clinical,
functional and esthetical damages we can observe in periodontal patients, are the
result of an insufficient knowledge of the complexity of this multifactorial disease and
the immunological and physiological changes produced by microbial and viral infection.
Commonly, antibiotic therapy represent the main tool in periodontal treatment
undervaluated that bacteria present in the biofilm can undergo mechanisms that
improve resistance to antimicrobic substances such as the increase expression of multiple
drug resistance pumps, activates quorum-sensing systems or changing profile of outer
membrane proteins (Mah and O’Toole, 2001; Xu et al. 2000; Lewis, K, 2000). Moreover,
periodontal bacterial can reach up to 1100 µm into dentin (Kouchi et al. 1980), a not
vascularized tissue, which is a difficulty target for traditional antibiotic/chemical agents
that can only penetrate up to 130 µm into the dentin (Berutti et al. 1997) while
Nd:YAG laser can penetrate more than 1000 µm into the dentin (Klinke et al. 1997).
Nd:YAG laser can be used for non-surgical therapy of periodontitis, either as a
monotherapy or as an adjunct to conventional staged scaling and root planing or
ultrasonic debridement. The use of Nd:YAG laser in periodontal management promotes
mitochondrial ATP production with consequent activation of a series of cellular
mechanisms that enhanced cellular cycle, proteins and collagen biosynthesis and also
stimulates microcirculation and local host immune response. The biostimulation
induced by laser stimulates regeneration of bone, tissues and connective improving
clinical and radiographic parameters related to affected teeth (Yukna et al. 2007; Lins
et al. 2010; Ebrahimi et al. 2012). The presence of herpesviruses impaires the host
immune response and causes direct alterations in fibroblasts and periodontal cells
reducing their regenerative potential of periodontal tissues and hampering periodontal
recovery phase. The herpesviruses infection promotes also the overgrowth of
periodontopathic bacteria with consequent overproduction and release of inflammatory
mediators that in a vicious circle can activate other latent herpesviruses further
aggravating periodontal disease (Contreras et al. 1999; Contreras and Slots 2000).
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EFFICACY
OF THE
ND:YAG
LASER THERAPY ON OF
EBV
AND
HSV1
CONTAMINATION IN PERIODONTAL POCKETS
The results of this preliminary study highlighted that in random group of Italian
patients, EBV is found in periodontal pockets more frequently than HSV1 and that
the use of ND:Yag laser in periodontal treatment is useful in eradicate viral infection.
Moreover, laser therapy promotes periodontal recover by its bactericidal effect, the
ability in remove the infected sulcular epithelium and the granulation tissue in addition
to the anti-inflammatory, anti-edema and bio-stimulant effects.
The results of this study support the theory of the potential role of herpesviruses in
the onset and progression of periodontal disease and brought evidences that the use of
Nd:YAG laser represents an alternative successful methodology to the traditional
scalpel and surgical protocols, provides a less invasive, less painful and more accurate
treatment, ensuring a thorough decontamination by bacteria and viruses in periodontal
pockets. Those data need to be further confirmed in a larger dataset also considering
microbiological and genetic assessment of patients included in the study, but they
seem to be promising in a wider perspective of human health, considering that the
presence of herpesvirus in various stages of B-cell development and its ability to infect
certain epithelial cells have severe pathogenic consequences, and can contribute to
the development of a diverse group of lymphomas and carcinomas.
Figure 1 - EBV and HSV1 distribution in whole patients dataset that includes first visit
and control data
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Figure 2 - Distribution of patients of whole dataset and occurrence of EBV and HSV1
DNA in subgingival samples
Figure3 - EBV and HSV1 distribution in complete dataset of 980 patients before
periodontal ND:YAG laser treatment
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EFFICACY
OF THE
ND:YAG
LASER THERAPY ON OF
EBV
AND
HSV1
CONTAMINATION IN PERIODONTAL POCKETS
Figure 4 - EBV and HSV1 distribution in the reduced dataset of 291 patients with pre
and post-treatment microbiological test
Figure 5 - Variation of number of patients EBV and HSV1 positive before and after
ND:YAG laser periodontal treatment
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Table 1-Association between presence of EBV and
efficiency of periodontal ND: YAG laser teraphy
TEST
Chi_squared
pvalue
OR
EBV
17,5824
0,0000
23,4960
HSV1
0,0556
0,8137
337,5000
Table 2 -Characteristics of study subjects. Mean value of age, PPD, REC (±SD) and
the percentage of females, smokers, sites positive to bleeding on probing and
suppuration of 291 caucasian subjects (1346 sites)
Variable
Mean
Age (mean±SD)
53.48±11.2
Females (percentage)
175 (62.05%)
Smokers (percentage)
111(39.36%)
Ethnicity (percentage)
Caucasian
282 (100%)
PPD (mm) (mean±SD)
6.51±1.87
REC (mm) (mean±SD)
1.7±1.05
BOP (percentage)
1263(93.82%)
PUS (percentage)
721(53.56%)
*SD, standard deviation. PPD, probing pocket depth; REC, recession; BOP, bleeding on probing;
PUS, suppuration
Table 3 -Characteristics of dataset of 82 patients EBV positive . Mean value of age,
PPD, REC (±SD) and the percentage of females, smokers, sites positive to bleeding on
probing and suppuration (n=82; 392 sites)
Variable
Mean
Age (mean±SD)
52.25±10.73
Females (percentage)
49 (59.75%)
Smokers (percentage)
Ethnicity (percentage)
25(30.48%)
Caucasian
82 (100%)
PPD (mm) (mean±SD)
6.55±1.88
REC (mm) (mean±SD)
1.63±1.01
BOP (percentage)
364(92.85%)
PUS (percentage)
211(53.82%)
*SD, standard deviation. PPD, probing pocket depth; REC, recession; BOP, bleeding on probing;
PUS, suppuration
382 • LXXI.4.2015
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Corresponding Author
Dott. Francesco Saverio Martelli
Microdentistry - Via dell’Ariento, 4 - 50123 Florence, Italy
Tel: +39 055281619
[email protected]
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