Discussion
periodontitis, infection, CVD
SYSTEMIC DISEASE, CVD, PERIODONTITIS, CHRONIC INFLAMMATORY DISEASE, INFECTION, PERIODONTAL INFLAMMATION, INFLAMMATORY RESPONSE
In the last decade, an increasing amount of evidence has found that the chronic inflammatory stimulus linked to its pathogenic biofilm load is the real factor that directly connects periodontitis to many systemic diseases. Due to these factors, periodontal treatment, through its various approaches, has been shown to be of vital importance as a primary factor in managing the reduction of risk of development or aggravation of systemic diseases and endothelial damage. In this regard, a number of non-surgical instrumentation approaches that allow a stable reduction over time of possible early biomarkers of the risk of developing systemic chronic inflammatory diseases have been developed [At 6-months of treatment, both groups of patients demonstrated, compared to baseline, a significant improvement of all analyzed biomarkers. However, compared to FMD, Q-SRP treatment produced a greater decrease in serum GDF-15, hs-CRP, and SP-D levels associated with increased GPx-1 levels. In this regard, several studies evidenced that, during periodontitis, imbalanced serum GDF-15 levels may influence the innate host defences against periodontal pathogens [However, the therapeutic significance in reducing several systemic CVD and inflammatory risk biomarkers among various non-surgical periodontal treatment approaches is still poorly understood.In this regard, it has been shown a possible correlation between markers of low-grade periodontal inflammation and the etiology of CVD in patients with periodontitis, characterized by the periodontal microbial infection that stimulates the local and systemic production of pro-inflammatory cytokines such as TNF-, IL-1, and IL-6 [Furthermore, the important clinical indicators of CVD include, among others, CRP, interleukin-6 (IL-6), lipid index, fibrinogen, tumor-necrosis factor-α (TNF-α) and GCF-15 [In this regard, the present study has achieved significant results with Q-SRP approach with a positive correlation between serum GDF-15, GPx-1, hs-CRP and SP-D with the extent of periodontitis, evaluated through the association with the several periodontal parameters examined. Therefore, the reduction in serum GDF-15, hs-CRP and SP-D levels 6 months after periodontal therapy with Q-SRP implies that this therapy was able to determine a more effective breakdown of the bacterial biofilm and a superior host response compared to the FMD approach.Furthermore, the two-way ANOVA analysis of the present investigation demonstrated that Q-SRP significantly improved and impacted serum GDF-15, GPx-1 and SP-D after six months of therapy. In addition, the same analysis demonstrated that at six months follow-up, patients who harboured high levels of GDF-15 and SP-D and low levels of GPx-1 before periodontal treatment positively benefited from the periodontal treatment efficacy at 180 days follow-up. In this regard, it has been demonstrated that periodontal treatment can induce a short-term inflammatory response resulting in a progressive and consistent reduction in systemic inflammatory biomarkers [The present study had some limitations that should be addressed, such as the monocentric design and the short-term evaluation timing. More specifically, a longer follow-up and a higher number of enrolled patients would have been beneficial to assess the positive impact on differential clinical results for stable periodontal outcomes. Furthermore, a test group of CVD patients may have been needed to better determine the impact of periodontal treatment in reducing biomarkers linked with CVD. For these reasons, further analyses are required to better understand the benefits of non-surgical periodontal treatments on serum GDF-15 GPx-1, hs-CRP and SP-D.In conclusion, the findings of the present randomized controlled trial demonstrated that, in all analyzed patients, both Q-SRP and FMD treatments were efficacious, at 6 months, in reducing periodontal parameters as well as serum CVD biomarkers. However, periodontal treatment performed with Q-SRP determined a better decrease in clinical periodontal parameters and improved GDF-15, GPx-1, hs-CRP and SP-D in patients with periodontitis. In addition, there is a tendency towards a more beneficial effect of periodontal treatment at 6 months if patients presented higher GDF-15 and SP-D and lower GPx-1 concentrations at baseline.