Heterogeneity of systemic inflammatory responses to periodontal therapy

Abstract

Aims: We investigated the effect of comprehensive periodontal therapy on the levels of multiple systemic inflammatory biomarkers.

Material and methods: Thirty patients with severe periodontitis received comprehensive periodontal therapy within a 6-week period. Blood samples were obtained at: 1-week pre-therapy (T1), therapy initiation (T2), treatment completion (T3), and 4 weeks thereafter (T4). We assessed the plasma concentrations of 19 biomarkers using multiplex assays, and serum IgG antibodies to periodontal bacteria using checkerboard immunoblotting. At T2 and T4, dental plaque samples were analysed using checkerboard hybridizations.

Results: At T3, PAI-1, sE-selectin, sVCAM-1, MMP-9, myeloperoxidase, and a composite summary inflammatory score (SIS) were significantly reduced. However, only sE-selectin, sICAM, and serum amyloid P sustained a reduction at T4. Responses were highly variable: analyses of SIS slopes between baseline and T4 showed that approximately 1/3 and 1/4 of the patients experienced a marked reduction and a pronounced increase in systemic inflammation, respectively, while the remainder were seemingly unchanged. Changes in inflammatory markers correlated poorly with clinical, microbiological and serological markers of periodontitis.

Conclusions: Periodontal therapy resulted in an overall reduction of systemic inflammation, but the responses were inconsistent across subjects and largely not sustainable. The determinants of this substantial heterogeneity need to be explored further.

Figure 1

Study flow chart

Figure 2

Subgingival bacterial levels before initiation and after completion of periodontal therapy. ** denotes p<0.01.

Figure 3

Serum IgG antibody levels at the four blood sampling occasions (T1 and T2 pre- treatment; T3 and T4 post-treatment). No statistically significant differences were noted.

Figure 4

Graphic illustration of Summary Inflammatory Scores at Baseline (average of T1 and T2) and T4. Red lines represent patients with markedly increased overall levels of systemic inflammation after therapy, green lines patients with reduced levels of inflammation, and yellow lines patients with seemingly stable levels. The blue line denotes the average SIS response in the entire patient group.