bluuebunny/crossref_metadata_2025 huggingface dataset:
A Radiographic Evaluation of Bone Healing Around Submerged and Non‐Submerged Dental Implants in Beagle Dogs
Authors: Fiorellini Joseph P. , Buser Daniel , Paquette David W. , Williams Ray C. , Haghighi Douglas , Weber Hans Peter
Published: February 2005

Background: The rehabilitation of the oral cavity with dental implants has become a predictable treatment modality. However, there have been only a few direct comparisons evaluating the submerged and nonsubmerged placement techniques. The purpose of this study was to characterize radiographic peri‐implant bone changes following the insertion of submerged and nonsubmerged implants in the beagle dog.

Methods: At the end of the extraction healing phase, 19 submerged and 19 nonsubmerged implants were randomly placed in a split‐mouth study design and observed over an 18‐week period. For submerged implants, a second stage surgery and transmucosal abutment attachment was performed at week 12. Standardized dental radiographs taken at baseline, week 12, and week 18 were used to measure peri‐implant bone changes. The radiographs were analyzed with a simple computer assisted method.

Results: A total of 43 standardized radiographs were exposed to evaluate the 38 implants. During the study period, all submerged and nonsubmerged implants demonstrated peri‐implant bone loss. At baseline, both submerged and nonsubmerged implants had similar bone levels (P ≥ 0.05). When the mean peri‐implant bone levels for submerged and nonsubmerged implants were compared from baseline to week 12, nonsubmerged implants had a significantly greater amount and rate of bone resorption than submerged implants (P ≤ 0.05). Following week 12, the initially submerged implant had a significantly higher rate and amount of peri‐implant bone loss than the nonsubmerged implants (P ≤ 0.05). However, by the end of the study period, week 18, both submerged and nonsubmerged implants had comparable bone levels (P ≥ 0.05).

Conclusions: The study indicates that, although the temporal patterns of peri‐implant bone resorption differed, there were no differences between submerged and nonsubmerged implants in the overall amount and rate of peri‐implant bone loss. J Periodontol 1999;70:248‐254.
Interleukin (IL)‐1 and Porphyromonas gingivalis Lipopolysaccharide Stimulation of IL‐6 Production by Fibroblasts Derived From Healthy or Periodontally Diseased Human Gingival Tissue
Authors: Kent Leigh W. , Rahemtulla Firoz , Michalek Suzanne M.
Published: February 2005

Background: Human gingival fibroblasts (HGF) play a key role in tissue repair and destruction. These cells express low levels of interleukin (IL)‐6 constitutively and increased levels after stimulation with lipopolysaccharide (LPS) or the cytokines IL‐1 and tumor necrosis factor‐α (TNF‐α ). However, little information is available on IL‐6 production by fibroblasts derived from diseased tissue. The present study compared constitutive and induced IL‐6 production by human gingival fibroblasts (HGF) derived from healthy and diseased periodontal tissue. We also evaluated whether IL‐1 acted in a synergistic manner with LPS in inducing IL‐6 production by HGF and whether LPS acted via CD14.

Methods: HGF derived from healthy and diseased tissue and foreskin fibroblasts were grown to confluency, photographed, and counted, and their constitutive IL‐6 production was quantitated by ELISA. Healthy and diseased HGF were also pretreated with IL‐1α , followed by incubation with Porphyromonas gingivalis or Escherichia coli LPS. Culture supernatants were assessed for IL‐6 protein by ELISA and cell lysates for mRNA by reverse transcription‐polymerase chain reaction (RT‐PCR). In order to determine if LPS stimulation was mediated through the LPS receptor, CD14, surface receptors on HGF were assessed by flow cytometry and the total RNA CD14 mRNA was assessed.

Results: Higher quantities of IL‐6 were produced by the diseased HGF before and after stimulation than by the healthy HGF. Pretreatment with IL‐1α followed by LPS stimulation of the healthy and diseased HGF cell lines resulted in an additive effect on IL‐6 production. Pretreatment with IL‐1α followed by a second incubation with the same stimulant produced higher amounts of IL‐6 than cultures incubated with LPS alone or following IL‐1α pretreatment. Similar amounts of IL‐6 mRNA were present in unstimulated HGF from either diseased or healthy tissue and in those incubated with IL‐1α only. After incubation with IL‐1α and LPS, diseased HGF produced slightly more mRNA than healthy HGF. CD14 was not expressed by healthy or diseased HGF even after stimulation with either P. gingivalis or E. coli LPS. CD14 message was also undetectable.

Conclusions: Taken together, these results indicate heterogeneity among gingival fibroblasts and an additive effect of IL‐1 and P. gingivalis LPS on IL‐6 production by HGF. Furthermore, the LPS effect on HGF was not mediated by CD14.J Periodontol 1999;70:274‐282.
Combined Effects of Caffeine and Prostaglandin E2 on the Proliferation of Osteoblast‐Like Cells (UMR106‐01)
Authors: Kamagata‐Kiyoura Yusuke , Ohta Mitsuhiro , Cheuk Gina , Yazdani Malektaj , Saltzman Marty J. , Nakamoto Tetsuo
Published: February 2005

Background: The general public widely consumes caffeine (1,3,7‐trimethylxanthine), which is contained in various foods, beverages and over‐the‐counter medications. We have shown previously that caffeine intake could affect bone metabolism in vivo.

Methods: Because prostaglandin E2 (PGE2) is shown to be elevated in the periodontally diseased site, the possible interaction between caffeine and PGE2 was investigated in the present study using UMR106‐01 rat osteoblast‐like cells in vitro.

Results: Although neither 0.1 mM caffeine nor 0.1 µg/ml of PGE2 alone showed any inhibitory effects on cell proliferation, the combination of caffeine and PGE 2showed significant inhibition. However, in order to have inhibitory effects, both caffeine and PGE2 had to be present at least 72 or 96 hours in the medium. Addition of the endogenous PGE2 synthesis inhibitor, indomethacin, showed no effects on cell proliferation. Neither cAMP‐inducing agent IBMX (0.01 mM and 0.1 mM) nor forskolin (0.001 mM) inhibited cell proliferation, but combined with PGE2 these agents strongly inhibited proliferation as was observed with the combination of caffeine and PGE 2 suggesting possibly that the increase of intracellular cAMP concentration plays an important role in the inhibitory effects of cell proliferation.

Conclusions: The present data for the first time demonstrate possible implication of routine caffeine intake in the acceleration of pathological conditions of periodontitis. Thus, we propose that chronic caffeine intake is one of the possible risk factors in the advancement of pathology in the periodontitis patient. Further research in this area is warranted. J Periodontol 1999;70:283‐288.
Supportive Periodontal Therapy in South America. A Retrospective Multi‐Practice Study on Compliance
Authors: Novaes Arthur B. , Novaes Arthur B. , Bustamanti Alberto , Villavicencio B. Juan J. , Muller Ernesto , Pulido E. Julia
Published: February 2005

Background: Supportive periodontal therapy is needed for the success of periodontal therapy but there is little information about the extent of patient cooperation. It is known, however, that cooperation is poor and a matter of concern.

Methods: The present study is part of a more extensive study including information from 5,041 patient records from private periodontal practices in Brazil, Venezuela, Chile, and Argentina. Patient cooperation was measured according to gender, age, type of therapy (surgical or non‐surgical), maintenance period (first year, 5 years, 10 years, 15 years, and 20 years), and level of cooperation (non‐compliant, regular or irregular) for each of the 4 practices.

Results: We observed a great variation in the behavior of the patients from different practices, suggesting that studies on compliance cannot be generalized because differences in culture, economic conditions, knowledge of oral hygiene, and even the philosophy of treatment should be considered. The most significant data were sometimes similar for 2 or 3 of the countries but never for all 4 practices.

Conclusions: Compliance is a very complex matter and findings from individual studies cannot be generalized. J Periodontol 1999;70:301‐306.
Effectiveness of a Sanguinarine Regimen After Scaling and Root Planing
Authors: Tenenbaum Henri , Dahan Maurice , Soell Martine
Published: February 2005

Background: A variety of chemical agents have been evaluated relative to their abilities to inhibit dental plaque and to improve gingival health. Chlorhexidine gluconate is the best known and most widely used member of these agents, but its long‐term use is compromised by different side effects, especially extrinsic tooth and tongue staining. Another agent, sanguinarine, which is currently used in both a mouthrinse and toothpaste, leads in some cases only to a transient burning sensation and could be used on a long‐term basis. The purpose of this 14‐week controlled clinical trial was to assess the effectiveness of a toothpaste and oral rinse containing sanguinaria extract after scaling, root planing and a chlorhexidine regimen.

Methods: Sixty patients diagnosed as having adult periodontitis received initial periodontal therapy including scaling and root planing, followed by a 2‐week oral care regimen which included rinsing with 0.2% chlorhexidine gluconate oral rinse. Upon completion of this 2‐week initial therapy phase, patients were randomly assigned to either sanguinarine toothpaste and oral rinse or to control toothpaste and oral rinse without sanguinarine. Plaque (modified Quigley‐Hein index) and gingivitis (gingival index) were measured prior to periodontal therapy, at the end of the chlorhexidine phase (2 weeks), and after 8 and 14 weeks.

Results: Sanguinarine‐containing toothpaste and oral rinse significantly inhibited the redevelopment of gingivitis through the 12 weeks following the chlorhexidine phase compared to the control toothpaste and rinse. Patients in the test group had 26% fewer bleeding sites at 8 weeks, and 32% fewer at 14 weeks, than the control group.

Conclusions: Our results support the combined use of chlorhexidine mouthrinse for a short term (2 weeks) followed by sanguinaria mouthrinse and toothpaste up to 3 months in order to optimize the effectiveness of chlorhexidine without side effects. Further studies on the long‐term effect of this combination should be established. J Periodontol 1999;70:307‐311.
Anorganic Bovine Bone Supports Osteoblastic Cell Attachment and Proliferation
Authors: Stephan Eugena B. , Jiang Di , Lynch Samuel , Bush Peter , Dziak Rosemary
Published: February 2005

Background: It was the aim of these studies to examine the ability of an anorganic bovine bone matrix material as an alternative to autogenous bone grafts and demineralized cadaver bone to support the attachment, spreading, and proliferation of isolated osteoblastic cells.

Methods: Primary culture osteoblastic cells were isolated from neonatal rat calvaria by sequential collagenase digestion. In the attachment studies, cells which had been labeled with 3H‐leucine were incubated with the matrix material in sterile microfuge tubes for 15, 90, or 180 minutes or 24 hours. The attached cells were released and the radioactivity measured by liquid scintillation spectrometry. In the proliferation experiments, the cells were cultured with the matrix material for 24 hours and 3H‐thymidine was added during the last 2 hours of the incubation. The cells were released and the radioactivity measured by liquid scintillation spectrometry. Scanning electron microscopy (SEM) was employed to observe osteoblastic cell interaction with the anorganic bone matrix. In these studies the cells were seeded on the bone graft material, then the material was removed and processed for SEM after 30, 60 or 120 minutes, or 24 or 48 hours.

Results:The cells attached to the matrix material in a timedependent manner. There were significantly (P < 0.05) more cells attached after 180 minutes than after the 15 and 90 minute incubations. The matrix material also supported proliferation of the attached osteoblastic cells. Cells seeded onto 100 mg of anorganic bovine bone resulted in significantly (P <0.05) more measurable proliferation than cells seeded onto 10 mg of material. The cells appeared to be round as they attached, then flatten and spread over time. There was also evidence of cellular processes extending into the pores of the material.

Conclusions: These results demonstrate that this anorganic bovine bone graft material is able to support the attachment and proliferation of osteoblastic cells. J Periodontol 1999;70:364‐369.
Smoking and Patterns of Bone Loss in Early‐Onset Periodontitis
Authors: Mullally Brian H. , Breen Blanaid , Linden Gerard J.
Published: February 2005

Background:The aims of this study were to investigate the extent and distribution of bone loss in subjects with early‐onset periodontitis (EOP) referred for periodontal care and to study the relationship between smoking and EOP.

Methods: A total of 71 consecutive referrals (21 male, 50 female) under 35 years old, who were otherwise healthy, with a clinical diagnosis of severe periodontitis were recruited for the study. Bone loss was measured from available radiographs using a Schei ruler to identify 2 patterns of destruction: localized (LEOP) in 41 (58%) and generalized early‐onset periodontitis (GEOP) in 30 (42%) subjects.

Results: The study population had a mean of 25.0 (SD 2.4) teeth, excluding third molars, and mean bone loss of 28.7% (SD 13.0). Bone loss was more severe in the maxilla, 30.9% (SD 13.8) compared with 26.6% (SD 14.0) in the lower arch. More than one‐third (36%) of the teeth examined had at least 30% bone loss. Mean smoking experience was 9.2 pack years (SD 5.6), and 39 (55%) of the EOP subjects smoked. Smokers had significantly more maxillary bone loss than non‐smokers. A much higher proportion of GEOP (70%) currently smoked compared with 44% of LEOP, P = 0.029.

Conclusions: It is concluded that young adults with earlyonset forms of periodontitis often have advanced periodontal destruction before they are referred for specialist care. In addition, there was a relationship between smoking and severe bone destruction in subjects with EOP, particularly those with generalized disease. J Periodontol 1999;70:394‐401.
Type 1 Diabetes Mellitus and Oral Health: Assessment of Periodontal Disease
Authors: Moore Paul A , Weyant Robert J. , Mongelluzzo Mary Beth , Myers Daniel E. , Rossie Karen , Guggenheimer James , Block Harvey M. , Huber Heidi , Orchard Trevor
Published: February 2005

Background: The periodontal disease status of 320 dentate adults, diagnosed 23.7 years previously with Type 1 insulin dependent diabetes mellitus, was evaluated. These patients had been monitored at 2‐year intervals as part of a large University of Pittsburgh longitudinal study assessing the medical complications associated with insulin dependent diabetes.

Methods: During one of their regularly scheduled medical examinations, a group of 320 adult dentate subjects (mean age of 32.1 years) received a periodontal examination as part of a comprehensive oral health assessment. The oral health assessment collected data regarding demographics, oral health behaviors, tooth loss, coronal and root caries, salivary functions, and soft tissue pathologies. For the periodontal assessments, 3 facial sites (mesial, midcervical, distal) of the teeth in the right maxillary/left mandibular or left maxillary/right mandibular quadrants were evaluated for calculus, bleeding on probing (BOP) and loss of gingival attachment (LOA).

Results: Attachment loss was significantly greater for older patients whereas BOP and calculus levels were relatively constant across age categories. Univariate analyses of factors possibly related to extensive periodontal disease (LOA ≥4 mm for at least 10% of sites examined) indicated an association with older age; lower income and education; past and current cigarette smoking; infrequent visits to the dentist; tooth brushing less than once per day; older age of onset; longer duration of diabetes; and the diabetic complication of neuropathy. A multivariate regression model of all possibly significant factors found current cigarette use (odds ratio [OR] = 9.73), insulin dependent diabetes onset after 8.4 years of age (OR = 3.36), and age greater than 32 years (OR = 3.00) explained the majority of the extensive periodontal disease in this group of diabetic patients.

Conclusions: Management and prevention of extensive periodontal disease for Type 1 diabetic patients should include strong recommendations to discontinue cigarette smoking. J Periodontol 1999;70:409‐417.
Linkage Disequilibrium of Interleukin‐1 Genetic Polymorphisms With Early‐Onset Periodontitis
Authors: Diehl Scott R. , Wang YueFen , Brooks Carol N. , Burmeister John A. , Califano Joseph V. , Wang Shengbiao , Schenkein Harvey A.
Published: February 2005

Background: Genetic polymorphisms at interleukin (IL)‐1α and IL‐1β were recently suggested to be associated with severity of adult periodontitis. We evaluated whether these polymorphisms might also be associated with early‐onset periodontitis (EOP) in 28 African American families and 7 Caucasian American families with 2 or more affected members.

Methods: Genomic DNA from peripheral blood was amplified, followed by restriction endonuclease digestion and acrylamide gel electrophoresis to distinguish alleles of different fragment sizes. Genetic epidemiological methods suitable for family data were used that are robust to false‐positive findings due to mismatching of cases and controls or mixed subpopulations of different ethnic or geographic origin. The 2 major EOP subtypes, localized juvenile periodontitis (LJP), and generalized early‐onset periodontitis (GEOP, encompassing rapidly progressive periodontitis and generalized juvenile periodontitis), were analyzed both separately and together.

Results: We obtained highly significant evidence of linkage disequilibrium for both African American and Caucasian G‐EOP subjects. A similar trend was noted for LJP. The IL‐1 alleles associated with high risk of EOP had been suggested previously to be correlated with low risk for severe adult periodontitis. Disequilibrium with G‐EOP was equally strong for smoking and non‐smoking subjects. IL‐1α and IL‐1β polymorphisms were in strong disequilibrium with each other in Caucasians, but not in African Americans. Haplotype analyses evaluating both polymorphisms simultaneously indicated that the IL‐1β variant is likely to be most important for EOP risk. Sibpair linkage analyses, by contrast, provided only marginal support for a gene of very major effect on EOP risk attributable to these IL‐1 polymorphisms.

Conclusions: Recent theoretical analyses indicate that our findings are most consistent with an interpretation of EOP as a complex, oligogenic disorder, with IL‐1 genetic variation contributing an important but not exclusive influence on disease risk. J Periodontol 1999;70:418‐430.
Comparative Microbiological Characteristics of Failing Implants and Periodontally Diseased Teeth
Authors: Listgarten Max A. , Lai Chern‐Hsiung
Published: February 2005

Background: The purpose of this report was to compare the distribution of periodontal pathogens recovered from failing implants and teeth with adult and recurrent forms of periodontitis.

Methods: A total of 41 consecutive microbial samples from patients with failing implants (IMP) were received at the Microbiology Testing Laboratory (MTL) of the University of Pennsylvania over a 2‐year period. Paired control samples were selected from samples received concurrently by MTL from 41 patients with a diagnosis of adult periodontitis (AP) and 41 with a diagnosis of recurrent or refractory periodontitis (RP). Patients' mean ages for the 3 categories were 59, 47, and 53 years, respectively. Samples were collected with paper points or scalers and shipped in prereduced medium by express mail to the laboratory where they were processed within 48 hours from the time of collection. Culture was used for detection of A. actinomycetemcomitans, C. rectus, P. intermedia/nigrescens, E. corrodens, P. micros, Capnocytophaga and Fusobacterium sp., enteric Gram‐negative rods, Enterococcus and Staphylococcus sp., and yeast. P. gingivalis and B. forsythus were detected by indirect immunofluorescence. Morphotypes were enumerated by dark‐field microscopy.

Results: The most frequently detected microorganisms from IMP were B. forsythus(59%), spirochetes (54%), Fusobacterium (41%), P. micros (39%), and P. gingivalis (27%). Recovery levels (mean ± SD) were 1±1, 4±5, 4±5, 9±11, 1±2, respectively. The most frequently detected organisms for AP were B. forsythus (83%), Fusobacterium (80%), spirochetes (79%), P. gingivalis (59%), P. micros (51%), and E. corrodens (37%), at levels 2±2, 5±4, 9±6, 4±5, and 6±7, respectively. Corresponding data for RP were B. forsythus (85%), Fusobacterium (83%), P. gingivalis (60%), spirochetes (59%), C. rectus (56%), and P. micros (56%), at levels of 3±2, 8±8, 4±4, 2±2, 1±1, and 9±10, respectively.

Conclusions: These results indicate that the detection frequency and levels of recovery of some periodontal pathogens in failing implants are significantly different from that of teeth with periodontitis; however, the detection frequency and levels of recovery are similar in teeth affected by adult and refractory (recurrent) forms of periodontitis. J Periodontol 1999;70:431‐437.
Aerosol and Splatter Production by Focused Spray and Standard Ultrasonic Inserts
Authors: Rivera‐Hidalgo Francisco , Barnes James B. , Harrel Stephen K.
Published: February 2005

Background: Control of contamination in the dental office has sometimes deterred practitioners from using ultrasonic scalers. Recent studies point to the aerosol and splatter produced during ultrasonic scaling as a vehicle for the possible transmission of bloodborne pathogens. A recently introduced ultrasonic insert that focuses the spray produced during scaling may reduce this aerosol contamination. An aerosol reduction device (ARD) that is attached to the ultrasonic handpiece has been shown to reduce the contamination cloud by placing suction in close proximity to the ultrasonic tip. The purpose of this study was to compare the contamination produced by a standard insert (S) and the new focused spray (F) insert with and without the use of the aerosol reduction device (ARD).

Methods: The testing was conducted in vitro within a plastic enclosure using a dye in the coolant spray. After mock scaling of a dentoform model, the number of contaminated squares on the enclosure was counted and recorded.

Results: Analysis of the data indicated no significant difference (P >0.05, Mann‐Whitney U test) between the S or F inserts in the amount of contamination produced. When the aerosol reduction device was used, there was a significant reduction (P <0.05, Mann‐Whitney U test) in the amount of contamination for both inserts with a greater reduction for the standard insert.

Conclusions: The traditional style of ultrasonic insert (S) and the newer focused coolant water insert (F) produce an equal amount of aerosol contamination. The amount of aerosol contamination produced by both inserts is copious. The ARD significantly reduced contamination with both styles of inserts. These findings support the use of a large bore high‐volume evacuator whenever an ultrasonic scaler is used. J Periodontol 1999;70:473‐477.
Two Multi‐Center Studies Evaluating Locally Delivered Doxycycline Hyclate, Placebo Control, Oral Hygiene, and Scaling and Root Planing in the Treatment of Periodontitis
Authors: Garrett Steven , Johnson Lonnie , Drisko Connie Hastings , Adams Donald F. , Bandt Carl , Beiswanger Bradley , Bogle Gary , Donly Kevin , Hallmon William W. , Hancock E. Brady , Hanes Philip , Hawley Charles E. , Kiger Robert , Killoy William , Mellonig James T. , Polson Alan , Raab Frank J. , Ryder Mark , Stoller Norman H. , Wang Hom‐Lay , Wolinsky Lawrence E. , Evans Gerald H. , Harrold Charles Q. , Arnold Ralph M. , Atack David F. , Fitzgerald Bryan , Hill Margaret , Isaacs Roger L. , Nasi Hisham F. , Newell Donald H. , MacNeil R. Lamont , MacNeill Simon , Spolsky Vladimir W. , Duke Susan P. , Polson Anne , Southard G. Lee
Published: February 2005

Background: The clinical efficacy and safety of doxycycline hyclate (8.5% w/w) delivered subgingivally in a biodegradable polymer (DH) was compared to placebo control (VC), oral hygiene (OH), and scaling and root planing (SRP) in 2 multi‐center studies.

Methods: Each study entered 411 patients who demonstrated moderate to severe periodontitis. Patients had 2 or more quadrants each with a minimum of 4 qualifying pockets ≥5 mm that bled on probing. At least 2 of the pockets were ≥7 mm. Treatment with DH, VC, OH, or SRP was provided at baseline and again at month 4. Clinical parameters were recorded monthly.

Results: DH and SRP resulted in nearly identical clinical changes over time in both studies. Mean 9 month clinical attachment level gain (ALG) was 0.8 mm for the DH group and 0.7 mm for the SRP group in Study 1, and 0.8 mm (DH) and 0.9 mm (SRP) in Study 2. Mean probing depth (PD) reduction was 1.1 mm for the DH group and 0.9 mm for the SRP group in Study 1 and 1.3 mm for both groups in Study 2. Frequency distributions showed an ALG ≥2 mm in 29% of DH sites versus 27% of SRP sites in Study 1 and 31% of DH sites versus 34% of SRP sites in Study 2. PD reductions ≥2 mm were seen in 32% of DH sites versus 31% of SRP sites in Study 1 and 41% of DH sites versus 43% of SRP sites in Study 2. Comparisons between DH, VC, and OH treatment groups showed DH treatment to be statistically superior to VC and OH. Safety data demonstrated a benign safety profile with use of the DH product.

Conclusions: Results of this trial demonstrate that treatment of periodontitis with subgingivally delivered doxycycline in a biodegradable polymer is equally effective as scaling and root planing and superior in effect to placebo control and oral hygiene in reducing the clinical signs of adult periodontitis over a 9‐month period. This represents positive changes resulting from the use of subgingivally applied doxycycline as scaling and root planing was not limited regarding time of the procedure or use of local anesthesia. J Periodontol 1999;70:490‐503.
The Use of 2 Bioabsorbable Barrier Membranes in the Treatment of Interproximal Intrabony Periodontal Defects
Authors: Mattson John S. , Gallagher Steven J. , Jabro Mansoor H.
Published: February 2005

Background: The use of barrier membranes in the treatment of periodontal defects is well documented. There has been an increase in the use of bioabsorbable materials which do not require a second surgical procedure for removal. However, there are little data evaluating the efficacy of bioabsorbable membranes in the treatment of intrabony defects. The purpose of this investigation was to evaluate the regenerative potential of 2 bioabsorbable barrier membranes without the use of grafting materials in the treatment of interdental intrabony defects.

Methods: Twenty‐three 2‐ or 3‐walled intrabony defects were treated in 19 patients with a mean age of 50.4 years. All had completed nonsurgical treatment and a period of supportive periodontal therapy. The sites were randomly chosen to receive a barrier membrane composed of type I bovine collagen (11) or a copolymer of polylactic acid (PGA/PLA;12). A pressure sensitive disc probe was used to evaluate the following criteria at baseline and re‐entry: 1) occlusal surface to the apical depth of probe penetration (OS‐DP); 2) occlusal surface to the gingival margin (OS‐GM); 3) occlusal surface to the alveolar crest (OSAC); and 4) occlusal surface to the base of the osseous defect (OS‐BD). Full thickness mucoperiosteal flaps were reflected to expose the surgical sites. The defects were debrided of the granulomatous tissue, the root surfaces instrumented and conditioned with 4 one‐minute applications of 50 mg/ml of tetracycline. The barrier membranes were adapted to cover the defects and the flaps replaced. The postsurgical healing was uneventful and similar in both treatment modalities.

Results: Twenty‐three sites were surgically re‐entered 6 months from the time of the initial surgery. The deepest probe depth for each site was used for statistical analysis. There was a mean relative attachment gain of 2.58 ± 1.90 mm for the collagen, and 2.77 ± 2.13 mm for the copolymer. There was a decrease in probing depth of 3.27 ± 1.91 mm and 0.69 ± 1.35 mm of recession for the collagen. The PGA/PLA copolymer had 3.55 ± 2.47 mm reduction in probe depth and 0.78 ± 1.14 mm of recession.

Conclusions: The data indicated the bioabsorbable collagen and copolymer membranes resulted in comparable results. A larger sample size would be necessary to determine if one membrane was superior to the other. J Periodontol 1999;70:510‐517.
Effective Periodontal Treatment in a Patient With Type IIA von Willebrand's Disease: Report of a Case
Authors: Izumi Yuichi , Taniguchi Takuro , Maruyama Yoshikazu , Sueda Takeshi
Published: February 2005

von Willebrand's disease (vWD) is one of the most common hereditary hemorrhagic disorders. A mild to moderate deficiency of factor VIII and von Willebrand factor (vWf) often is associated with gingival bleeding. In this case report, the periodontal treatment of a patient with vWD is described. A 45‐year‐old woman with type IIA vWD was referred for periodontal therapy because of an episode of gingival hemorrhage and percussion pain of teeth #18 and #47. The periodontal findings included probing depths ranging from 2 to 6 mm, horizontal bone loss, and Class II furcation involvement of tooth #46. After consultation with a hematologist, apically positioned flap surgery and hemisection were performed on tooth #46 following completion of oral hygiene instruction, scaling and root planing, and endodontic therapy. The patient was given 500 units of factor VIII including vWf multimer 30 minutes before surgery. After healing of the periodontal tissue, prosthodontic treatment was undertaken on the posterior mandibular sextants. At follow‐up, the probing depths ranged from 2 to 3 mm, and gingival bleeding on probing was minimal. The patient's children all had vWD. They had mild to moderate periodontitis with probing depths ranging from 2 to 5 mm and gingival bleeding on probing. With the combined efforts of the periodontist and hematologist, effective periodontal treatment can be provided to patients with von Willebrand's disease. J Periodontol 1999;70:548‐553.
The Influence of Interleukin Gene Polymorphism on Expression of Interleukin–1β and Tumor Necrosis Factor–α in Periodontal Tissue and Gingival Crevicular Fluid
Authors: Engebretson Steven P. , Lamster Ira B. , Herrera‐Abreu Miriam , Celenti Romanita S. , Timms Janine M. , Chaudhary Adeel G.A. , di Giovine Francesco S. , Kornman Kenneth S.
Published: February 2005

Background: A specific composite genotype of the polymorphic interleukin‐1 (IL‐1) gene cluster has recently been associated with severe periodontitis. One polymorphism of the composite periodontitis‐associated genotype (PAG) has been functionally linked with expression of high levels of IL‐1. The purpose of this study was to test whether gingival crevicular fluid (GCF) levels of IL‐1ß and tumor necrosis factor‐alpha (TNFα), and gingival tissue levels of IL‐ 1α, IL‐1β, and TNFα correlate with PAG, and to examine the effec; of conservative periodontal therapy on these levels.

Methods: Twenty‐two adults with moderate to advanced periodontal disease were enrolled. Polymerase chain reaction amplification and restriction enzymes were used to identify specific polymorphisms from peripheral blood samples. GCF samples were collected at baseline and 3 weeks following conservative treatment and analyzed by ELISA for IL‐1ß and TNFα. An interproximal gingival biopsy was collected at baseline and follow‐up and analyzed for IL‐1α, IL‐1β, and TNFα by ELISA.

Results: The genotyping identified 7 as PAG(+) and 15 as PAG(–). The 2 groups were comparable in terms of existing periodontitis and age. In shallow sites (<4 mm), total IL‐1ß in GCF was 2.5 times higher for PAG(+) patients prior to treatment (P = 0.03), and 2.2 times higher after treatment (P = 0.04), while differences were less apparent in deeper sites. Following treatment, a reduction in IL‐1β concentration in GCF was seen for PAG(‐) but not for PAG(+) patients. While not statistically significant, a trend was observed in mean tissue levels of IL‐1β which were 3.6 times higher in PAG(+) versus PAG(–) patients (P = 0.09).

Conclusions: These data suggest that PAG(+) patients may demonstrate phenotypic differences as indicated by elevated levels of IL‐1ß in GCF. J Periodontol 1999;70:567‐573.
Effect of Initial Periodontal Therapy on the Frequency of Detecting Bacteroides forsythus, Porphyromonas gingivalis, and Actinobacillus actinomycetemcomitans
Authors: Takamatsu Nobuhiro , Yano Kazuko , He Tao , Umeda Makoto , Ishikawa Isao
Published: February 2005

Background: Porphyromonas gingivalis, Bacteroides forsythus, and Actinobacillus actinomycetemcomitans have been described as periodontopathic bacteria, and their presence in subgingival pockets can lead to development of periodontal disease. Until now, clinical parameters have been used to evaluate the effect of conventional periodontal treatment without microbiological parameters. The present study examined the microbiological effects of initial periodontal therapy using DNA probes and the polymerase chain reaction (PCR).

Methods: Twenty‐six patients with periodontitis, 10 males and 16 females, were given instructions regarding oral hygiene, then thoroughly treated by conventional scaling and root planing. Bacterial samples were collected on paper points from 4 sites per patient at baseline and after initial therapy (total: 104 sites). Clinical parameters including probing depth, attachment level, and bleeding on probing were also recorded for each site at baseline and after therapy. A DNA probe kit was used to monitor the frequency of B. forsythus, P. gingivalis, and A. actinomycetemcomitans, the last of which was identified by PCR.

Results: At baseline, B. forsythus was the bacterium most frequently detected. DNA probe analysis also showed that more than half of the sites were colonized by both B. forsythus and P. gingivalis. Initial therapy resulted in significant clinical improvement such as significant reduction in the frequency of B. forsythus and P. gingivalis detected using the DNA probe. A.actinomycetemcomitans was difficult to detect using the DNA probe, but PCR indicated that levels of A. actinomycetemcomitans did not significantly decrease.

Conclusions: These results indicate that initial conventional therapy can eliminate B. forsythus and P. gingivalis, but not A. actinomycetemcomitans. When levels of these bacteria decreased to below‐detectable levels, clinical improvement was significant. These results indicate that monitoring levels of these three periodontopathic bacteria may render periodontal therapy more effective and accurate. J Periodontol 1999;70:574‐580.
Clinical Effects of Periodontal Therapy on the Severity of Cyclosporin A‐Induced Gingival Hyperplasia
Authors: Kantarci Alpdoğan , Cebeci Irfan , Tuncer Özen , Çarin Mahmut , Firatli Erhan
Published: February 2005

Background: Gingival hyperplasia (GH) is a major side effect associated with cyclosporin A (CsA) therapy. The condition is further augmented due to the gingival inflammation. In this study, the effects of initial periodontal therapy and gingival curettage are analyzed in a group of patients with clinically significant (>30%) CsAinduced gingival hyperplasia.

Methods: The test group of 15 patients received oral hygiene instructions, supra‐ and subgingival scaling, polishing, and gingival curettage only oral hygiene instructions were given to 16 control subjects. Plaque index (PI), gingival index (GI), calculus index (CI), periodontal probing depth (PD), and gingival hyperplasia were recorded at baseline and repeated 8 weeks after treatment. Current doses of immunosuppressive agents, serum concentrations of CsA, and duration of CsA therapy were recorded as the pharmacological parameters.

Results: Statistical evaluation revealed that all clinical variables showed statistical decreases compared to baseline in the treated patients, while none of the parameters changed significantly in the control group. Initial GH scores of 53.63% in controls and 53.40% in the treated patients were 52.83% and 32.13% following treatment, respectively. A difference of 21.27% in the severity of treated GH was accompanied by a 0.56 decrease in GI scores in the test group.

Conclusions: Compared to the initial observations, the results suggested that nearly 60% of the condition could be of fibrotic origin. Initial periodontal therapy and curettage resulted in the resolution of the inflammation in CsA‐induced GH. Further investigation of the treated patients has shown that 7 out of 15 patients (47%) in the test group responded well and their GH scores decreased below 30% at the end of the study. The treatment in this study was effective in eliminating the necessity of more extensive surgical modes of treatment, such as gingivectomy, in 47% of cases. J Periodontol 1999;70:587‐593
Comparison of Fluorescence Microscopy and Culture Assays to Quantitate Adhesion of Porphyromonas gingivalis to Mono‐ and Multi‐Layered Pocket Epithelium Cultures
Authors: Papaioannou William , van Steenberghe Daniel , Cassiman Jean‐Jacques , Van Eldere Johan , Quirynen Marc
Published: February 2005

Background: The present study compared 2 different methods (direct versus indirect evaluation) for the quantification of the adhesion of Porphyromonas gingivalis strains to in vitro cultured monolayers of pocket epithelium.

Methods: The indirect culture viability assay (calculation of colony forming units) was compared to a direct microscopic evaluation using a novel fluorescent stain. The fluorescent kit was found to stain both bacteria and epithelial cells and enabled a differentiation between dead and living cells.

Results: Comparing the visual to the culture data, a high and significant correlation was found (Pearson's correlation = 0.75; P <0.001). The adhesion capacity was in general higher for dead epithelial cells than for living cells (P <0.01). Although comparable numbers of bacteria of 2 P. gingivalis strains (Pg 4 and Pg 5) were applied, Pg 4 showed a significantly lower adhesion capacity. This intra‐strain variability was observed by the culture assay (2.3 x 106 versus 7.8 x 106 ± 2.7 x 106; P <0.01) and by the direct microscopy (P <0.01) for both live and dead epithelial cells. A second goal was to see whether there was a difference in the amount of bacterial adherence to mono‐ and multi‐layers of in vitro cultured epithelium. No significant differences were found for the 5 examined P. gingivalis strains. However, interstrain differences in adhesion capacity were evident for both tissues.

Conclusions: This study highlights the reproducibility of a direct microscopic evaluation of bacterial adhesion to in vitro cultured epithelial cells, and suggests both intrastrain (P. gingivalis) and inter‐cell (live versus dead) variation in adhesion capacity. Studies are needed to determine the extent to which P. gingivalis strain variation is reflected in variation of other strains in humans. J Periodontol 1999;70:618‐625.
Molecular Diagnosis of Hypophosphatasia With Severe Periodontitis
Authors: Watanabe Hisashi , Goseki‐Sone Masae , Iimura Tadahiro , Oida Shinichiro , Orimo Hideo , Ishikawa Isao
Published: February 2005

Hypophosphatasia (HOPS) is an inherited disorder characterized by the defect of skeletal mineralization due to tissue‐nonspecific alkaline phosphatase (TNSALP) deficiency. In this study we analyzed the TNSALP gene from a Japanese patient with HOPS, his parents, his brother, and unrelated normal controls. The proband is a 25–year–old Japanese male diagnosed with childhood hypophosphatasia. The patient reported premature exfoliation of the deciduous teeth and severe periodontal destruction of the permanent dentition. Genomic DNA was extracted from peripheral leukocytes of subjects. Eleven pairs of the polymerase chain reaction (PCR) primers were used to amplify the coding exons according to the published sequence data of the TNSALP gene. The PCR amplified samples were subjected to PCR‐single strand conformation polymorphism (SSCP) analysis and PCR–allele specific oligonucleotide (ASO) analysis. In PCR–SSCP analysis of the patient's genomic DNA, the fragments containing exons 9 and 10 revealed abnormal mobilities. These abnormal mobilities (exons 9 and 10) were also found from his mother and father's genomic DNA, respectively. The sequencing analysis of the abnormal bands extracted from the SSCP gel showed a T to C transition at nucleotide position 1155 (T1155C) in exon 9 and G1320A in exon 10. PCR–ASO analysis confirmed these missense point mutations. PCR‐ASO analysis also confirmed that mutation‐specific oligonucleotides corresponded to the new mutations and did not hybridize with PCR products from normal control genomic DNAs. These results indicated that theproband was a compound heterozygote who inherited T1155C mutation in exon 9 from the mother and G1320A mutation in exon 10 from the father. Both of them are new missense point mutations and appear to cause significant changes in the structure and function of TNSALP. J Periodontol 1999;70:688‐691.
Root Coverage Employing an Envelope Technique or Guided Tissue Regeneration With a Bioabsorbable Membrane
Authors: Müller Hans‐Peter , Stahl Marianne , Eger Thomas
Published: February 2005

Background: Different treatment modalities have been described for root coverage in cases of gingival recession. The aim of the present study was to evaluate the postsurgical outcome of 2 modes of surgical root coverage of predominantly shallow, Class I or II, gingival recessions.

Methods: Fourteen buccal recession sites in 13 patients were treated with free connective tissue grafts employing a modified envelope technique; 14 sites in 9 patients were subjected to a coronally repositioned flap in combination with a bioabsorbable membrane. Immediately before surgery as well as after 6 months, gingival dimensions, i.e., width and thickness, as well as root coverage and attachment gain, were assessed to the next 0.1 mm employing a caliper, an ultrasonic device, and a pressure calibrated, computerized periodontal probe.

Results: At the outset, mean recession depths amounted to 2.48 ± 1.06 and 3.00 ± 1.95 mm for patients treated with a free connective tissue graft and a bioabsorbable membrane, respectively. With the former technique, 80 ± 24% root surface could be covered after 6 months, while the latter resulted in only 45 ± 40% coverage. The contrast in reduction of recession width was even more pronounced (77 ± 35% versus 18 ± 37%). In both groups, an increase of gingival thickness of 0.6 to 0.7 mm was noticed.

Conclusions: Small recessions may be covered more predictably with the modified envelope technique. J Periodontol 1999;70:743‐751.
Density of CD1a‐Labeled Langerhans' Cells in Normal Human Gingiva and in Nifedipine‐ and Immunosuppressive Medication‐Induced Gingival Overgrowth
Authors: Nurmenniemi Petri K. , Pernu Hilkka E. , Knuuttila Matti L.E.
Published: February 2005

Background: The purpose of this study was to compare the distribution of Langerhans' cells in normal human gingiva and in nifedipine‐ and immunosuppressive medication‐induced gingival overgrowth by means of an immunohistochemical study.

Methods: Gingival samples were collected from 11 nifedipinemedicated cardiac patients, 22 triple‐medicated (azathioprine, prednisolone, and cyclosporin A) renal transplant recipients, and 28 generally healthy individuals. Patients were grouped into the immunosuppression group, the combined immunosuppression and nifedipine group, the nifedipine group, and the generally healthy control group. Five μm‐thick cryostat sections were stained with monoclonal antibody (mAb) for CD1a using an avidin‐biotinenzyme complex (ABC) method. Numbers of CD1a‐labeled cells/mm2 were determined in 6 areas: oral epithelium, oral sulcular epithelium, sulcular epithelium, middle connective tissue, connective tissue beneath the oral epithelium, and connective tissue beneath the sulcular epithelium. Significances of differences between the groups were tested by means of the Kruskall‐Wallis test, and significances of differences between pairs of results by the Mann‐Whitney U‐test and the t test.

Results: Numbers of CD1a‐labeled cells were significantly lower in the medicated groups than in controls in all 3 epithelial areas (P <0.0001) and in the connective tissue beneath the sulcular epithelium (P <0.0021). There were significantly fewer CD1a‐labeled cells in the sulcular epithelium in the nifedipine group than in the other medication groups.

Conclusions: The reduced numbers of CD1a‐labeled cells found in nifedipine‐induced gingival overgrowth were similiar to the reduced numbers of CD1a‐labeled cells in gingival overgrowth associated with immunosuppressive medication. J Periodontol 1999;70:752‐756.
Effects of Sex Hormones on Production of Interleukin‐1 by Human Peripheral Monocytes
Authors: Morishita Masayuki , Miyagi Masaharu , Iwamoto Yoshifumi
Published: February 2005

Background: Interleukin‐1 (IL‐1) is a potent mediator of inflammation and is known to induce bone resorption. We studied the effects of sex hormones on the function of human monocytes and demonstrated that prostaglandin E2 (PGE2) production was enhanced by progesterone and estradiol. As PGE2 has been shown to suppress the production of IL‐1 by monocytes, it was speculated that sex hormones also modify the production of IL‐1 by regulating PGE2 production. Thus, the effects of sex hormones on the production of IL‐1 from human peripheral monocytes and the influence of PGE2 were investigated.

Methods: Mononuclear leukocytes were obtained from 22 healthy adults. Progesterone, 17‐β estradiol (estradiol), and testosterone were used as representative sex hormones. Monocytes were incubated at 37°C in air with 5% CO2 for 24 hours in RPMI 1640 medium with sex hormones at the designated concentrations. LPS (Salmonella typhimurium) was used to stimulate the monocytes at a concentration of 10μg/ml. The concentrations of IL‐1α and IL‐1β in the medium were determined by enzyme‐linked immunosorbent assay kits. The concentration of PGE2 was determined using a direct radio‐immunoassay kit. Indomethacin was used to inhibit the synthesis of PGE2 and eliminate its effect on the production of IL‐1.

Results: Estradiol at concentrations of 0.04 ng/ml or more significantly reduced both IL‐1α and IL‐1β production. Progesterone also reduced IL‐1α and IL‐1β production significantly at concentrations of 0.1 ng/ml or more and 0.02 ng/ml or more, respectively. The reductions in IL‐1α and IL‐1β production by sex hormones were not affected by addition of indomethacin.

Conclusions: Estradiol and progesterone inhibited the production of IL‐1 from human peripheral monocytes. The inhibition was not the result of enhanced production of PGE2. Under conditions in which sex hormone levels are low, monocytes produce IL‐1 more readily in response to stimulation by LPS than high levels of such hormones. Low concentrations of sex hormones may be considered as one of the risk factors for periodontitis. J Periodontol 1999; 70:757‐760.