bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Periodontal Disease in Pregnant Women and the Nutritional Condition of Their Newborns
Authors: Romero Belkys C. , Chiquito Claudio S. , Elejalde Luis E. , Bernardoni Cecilia B.
Published: February 2005

Background: The purpose of this study was to determine whether maternal periodontal disease (PD) could be associated with the nutritional condition of newborns.

Methods: After controlling for traditional risk factors for premature childbirth and low birth weight, 69 mothers were selected: 13 were periodontally healthy and 56 had varying stages of PD. They and their newborns formed the study population. PD presence and severity were clinically determined using Russell's periodontal index. The nutritional evaluation of the newborns was determined by Lubchenco's modified growth patterns.

Results: A decrease in the average newborn's weight and gestational age was observed as the mother's level of PD increased. Correlation analysis demonstrated a highly significant clinical relationship between more severe PD and lower birth weight (r = –0.49; P <0.01); a highly significant relationship was also clinically demonstrated between increasing PD severity and decreasing gestational age of the newborn babies (r = –0.59; P <0.01). There were significant differences in the weight and gestational age of the newborns of mothers with PD.

Conclusions: These data suggest that PD in pregnant women could be a clinically significant risk factor for preterm deliveries and low birth weight. There was considerable variability in the results, and these preliminary findings need to be confirmed in larger studies. J Periodontol 2002;73:1177‐1183.
Maximal Bite Force in Patients With Reduced Periodontal Tissue Support With and Without Splinting
Authors: Kleinfelder Jörg W. , Ludwig Klaus
Published: February 2005

Background: Chewing and biting forces are supposed to be limited by sensory input from periodontal mechanoreceptors. This is why the threshold level of those receptors should be lower in teeth with reduced periodontal tissue support. The purposes of the present study were to evaluate the influence of reduced periodontal tissue support on maximal bite force in natural dentitions and to study the effect of splinting on maximal bite force.

Methods: In 10 patients with reduced periodontal tissue support (test), as well as in 10 periodontally healthy subjects (control), maximal bite force was measured. The remaining periodontal ligament area in the test group was calculated from x‐rays. Bite force was assessed at 4 mm mouth opening in the premolar region without and following splinting of the posterior teeth and transduced using a strain‐gauge (full‐bridge circuit). Maximal bite force measured with and without splinting was compared between test and control subjects, and within each group.

Results: In test subjects, the mean periodontal ligament area was 48.5% (SD = 10.1) across first premolars and 50.0% (SD = 12.2) across posterior teeth (control: 100%). In test subjects, the mean maximal bite force without splinting was 357 N (SD = 70), and in control subjects, 378 N (SD = 66; P >0.05). After splinting, the bite force in test subjects was 509 N (SD = 75), and in control subjects, 534 N (SD = 49; P >0.05). Bite force before and after splinting was P <0.05 within each group.

Conclusions: Reduced periodontal tissue support does not seem to limit bite force with maximal strength in natural dentitions as measured by a device that opens the bite by 4 mm. Furthermore, maximal biting forces at 4 mm mouth opening are increased when molar teeth are included in a posterior splint. J Periodontol 2002;73:1184‐1187.
Clinical Application of Spiral Tomography in Anterior Implant Placement: Case Report
Authors: Dixon Douglas R. , Morgan Rudolf , Hollender Lars G. , Roberts Frank A. , O'Neal Robert B.
Published: February 2005

Background: Placement of endosseous dental implants in edentulous areas of the anterior maxilla poses a unique challenge due to variations in the amount of residual alveolar bone. Implant position becomes crucial in cases demanding high esthetic results but possessing minimal ridge width or in cases requiring augmentation. Recent advances in spiral tomography have allowed for more precise planning and placement of endosseous implants in these challenging areas.

Methods: The purpose of this report is to describe a series of clinical cases in which spiral tomography was utilized in the planning and placement of endosseous dental implants. Two cases will be described utilizing initial spiral tomographic radiographs for implant planning and surgical guide fabrication, followed by post‐insertion tomography to evaluate the results of implant position and inclination.

Results: Preimplant spiral tomograms revealed that the initial prosthetic trajectory through the proposed incisal edge of each tooth replacement would result in a final osteotomy site that would compromise the overall thickness of the facial cortical plate. After adjusting for magnification and distortion factors, new prosthetic/surgical trajectories were fabricated into the surgical guide, and this information was utilized to prepare the final implant osteotomy site. This adjustment resulted in 2 mm of residual crestal facial bone postimplant insertion, which became wider at more apical measurements. These findings were verified in the postimplant serial tomograms.

Conclusions: Spiral tomography was a valuable adjunct in the treatment planning phases of endosseous dental implant placement especially in cases with minimal crestal width, high esthetic demands, or where exact implant placement is critical for successful treatment outcomes. J Periodontol 2002;73:1202‐1209.
Pharmacokinetic Profile of a Locally Administered Doxycycline Gel in Crevicular Fluid, Blood, and Saliva
Authors: Kim Ti‐Sun , Bürklin Thomas , Schacher Beate , Ratka‐Krüger Petra , Schaecken Matthijs T. , Renggli Heinz H. , Fiehn Walter , Eickholz Peter
Published: February 2005

Background: With the help of so‐called controlled release delivery systems, the half‐life period of locally administered antibiotics in gingival crevicular fluid (GCF) can be extended significantly. The aim of this study was to characterize the delivery profile of a new one‐component 14% doxycycline free amine gel for local application. Pharmacokinetics of doxycycline (DOXY) were analyzed in GCF, saliva, and serum.

Methods: Twenty patients with persisting or recurring pockets (probing depths ≥5 mm and bleeding on probing) after mechanical treatment (surgical or non‐surgical) took part in the study. In each patient 1 periodontal defect was treated with DOXY gel. Samples of GCF, saliva, and serum were obtained before application of DOXY gel; 15 minutes after application; at 2 and 5 hours; and at 1, 2, 3, 4, 7, 9, and 11 days after application. Separation and quantitative measurement of DOXY was performed with high performance liquid chromatography and UV detection at λ = 260 nm.

Results: Coefficients of variation were lower than 2% (intraassay) and 4% (interassay), respectively. For concentrations between 50 to 1000 μg/ml, we found a linear relationship between expected and measured DOXY values (linear coefficient of correlation: r = 0.998). Within the first 5 hours after application, concentration of DOXY in GCF (maximum after 15 minutes 19.97 ± 5.85 mg/ml) and saliva (maximum after 15 minutes 17.83 ± 2.84 mg/ml) was similar. Then concentration fell to a lower level (28.90 ± 19.44 μg/ml) compared to GCF (577.41 ± 127.34 μg/ml) after 3 days. Up to 10 days after application, the concentration of DOXY in GCF was 34.24 μg/ml. With the exception of 1 patient, all serum samples were DOXY‐negative.

Conclusions: 1) After subgingival application of biodegradable 14% doxycycline gel, mean doxycycline levels in GCF that exceeded 16 μg/ml could be maintained for at least 12 days. Thus, the antimicrobial agent may be classified as a controlled release device. 2) The antibiotic effect was limited mainly to the subgingival sites of application of the doxycycline gel. 3) The doxycycline gel possesses the pharmacokinetic and clinical properties to deliver efficacious levels of antibiotics to the periodontal pocket and to maintain these levels for at least 1 week without the need of further drug retention by a periodontal dressing. J Periodontol 2002;73:1285‐1291.
Effects of CO2 Laser Treatment on Fibroblast Attachment to Root Surfaces. A Scanning Electron Microscopy Analysis
Authors: Crespi R. , Barone A. , Covani U. , Ciaglia R.N. , Romanos G.E.
Published: February 2005

Background: The aim of this study was to analyze the CO2 laser effects on root surfaces affected by periodontal disease in comparison to scaling and root planing for fibroblast attachment.

Methods: Thirty single‐rooted human teeth extracted because of advanced periodontal disease were included in this study. A total of 60 specimens, obtained from all selected teeth, were randomly assigned to 3 groups: 1) control (untreated); 2) hand scaling and root planing (SRP); or 3) laser (CO2 defocused pulsed) and ultrasonic scaling. All the specimens were incubated in Petri dishes with fibroblast suspension, and then observed by scanning electron microscopy (SEM).

Results: The control group showed the lowest number of attached cells, with no tightly attached fibroblasts. The laser plus scaling group showed the highest number of attached fibroblasts, with the tightly attached fibroblast prevailing. The lasertreated and scaled root specimens did not show any damage or morphologic alteration of the root surfaces.

Conclusion: CO2 laser treatment in defocused, pulsed mode with a low power of 2W combined with mechanical instrumentation constitutes a useful tool to condition the root surface and increase fibroblast attachment to root surfaces. J Periodontol 2002;73:1308‐1312.
Expression of Matrix Metalloproteinases in Cyclosporin‐Treated Gingival Fibroblasts Is Regulated by Transforming Growth Factor (TGF)‐β1 Autocrine Stimulation
Authors: Cotrim P. , de Andrade C.R. , Martelli‐Junior H. , Graner E. , Sauk J.J. , Coletta R.D.
Published: February 2005

Background: Gingival overgrowth is a common side effect following the administration of cyclosporin A (CsA). The pathogenesis of this condition is not fully understood; however, recent studies show that CsA regulates the transcription of several cytokines including transforming growth factor‐β1 (TGF‐β1). The aim of this study was to investigate the potential role of TGF‐β1 in the pathogenesis of CsA‐induced gingival overgrowth, exploring a possible autocrine stimulation of TGF‐β1 as a cellular regulator of synthesis of matrix metalloproteinases (MMPs) and its tissue inhibitors (TIMPs).

Methods: Gingival fibroblasts from human normal gingiva were incubated with increasing concentrations of CsA, cultured for 24 hours, and the expression and production of TGF‐β1 determined by semiquantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR) and enzyme‐linked immunosorbent assay (ELISA), respectively. MMP and TIMP mRNA expression levels were also analyzed by RT‐PCR. To determine the effect of TGF‐β1 on the expression of MMP and TIMP by human gingival fibroblasts under CsA treatment, human gingival fibroblast cultures were treated with sense oligonucleotides (SON) or antisense oligonucleotides (AON).

Results: CsA simultaneously stimulated TGF‐β1 expression and production and inhibited expression of MMP‐1 and MMP‐2 by human gingival fibroblasts, whereas CsA has a slight effect on TIMP‐1 and TIMP‐2 expression. AON reduced TGF‐β1 production as demonstrated by ELISA, whereas TGF‐β1 mRNA expression levels were not significantly modified. The inhibition of TGF‐β1production byAONmodulated MMP expression, demonstrating the autocrine inhibitory effect of TGF‐β1 in CsA‐treated human gingival fibroblasts.

Conclusions: The data presented here suggest that TGF‐β1 in an autocrine fashion may contribute to a reduction of proteolytic activity of human gingival fibroblasts in CsA‐induced gingival overgrowth, which favors the accumulation of extracellular matrix. J Periodontol 2002;73:1313‐1322.
Macrophage Subpopulations in Gingival Overgrowth Induced by Nifedipine and Immunosuppressive Medication
Authors: Nurmenniemi Petri K. , Pernu Hilkka E. , Laukkanen Päivi , Knuuttila Matti L.E.
Published: February 2005

Background: The immunomodulating effects of both immunosuppressive and nifedipine medication have been associated with druginduced gingival overgrowth. The aim of the study reported here was to evaluate the presence of macrophage subpopulations in normal human gingiva and in gingival overgrowth induced by nifedipine and immunosuppressive medication.

Methods: Gingival samples were taken from 11 nifedipine‐medicated cardiac outpatients (nifedipine group), 11 triple‐medicated organ‐transplant recipients also taking nifedipine (immunosuppression plus nifedipine group), 12 triple‐medicated organ‐transplant recipients (immunosuppression group), and 20 generally healthy individuals (control group). Cryostat sections were stained with mAbs for inflammatory 27E10, reparative RM3/1, and resident 25F9 macrophages using an avidinbiotin enzyme complex method. Total numbers of mAb‐labeled cells were determined in connective tissue beneath sulcular epithelium, connective tissue beneath oral epithelium, and middle connective tissue. Expression of 27E10 was determined in keratinocytes in the oral epithelium. Statistics analyses were undertaken using the chi‐square test, the Mann‐Whitney U test, the independent samples t test, analysis of variance, and analysis of covariance.

Results: Greater numbers of inflammatory 27E10‐positive macrophages were found in all 3 medicated groups and counting zones than in the control group except in connective tissue beneath sulcular epithelium in the immunosuppression group. The incidence of specimens expressing 27E10 antigen throughout the oral epithelium was significantly higher in the immunosuppression group (8 of 12) than in the control group (4 of 20) and the nifedipine group (2 of 11). Numbers of reparative RM3/1‐positive macrophages were significantly greater in the immunosuppression group in connective tissue beneath oral epithelium than in the control group. The effect was markedly associated with degree of inflammation. Numbers of resident 25F9‐positive macrophages were lower in connective tissue beneath sulcular epithelium in the immunosuppression group, and higher in middle connective tissue in the nifedipine group than in the control group.

Conclusion: Our results show that the nature of drug‐induced gingival overgrowth differs somewhat between immunosuppressive and nifedipine medications. J Periodontol 2002;73:1323‐1330.
Coping With Stress: Its Influence on Periodontal Disease
Authors: Wimmer Gernot , Janda Michaela , Wieselmann‐Penkner Karin , Jakse Norbert , Polansky Raoul , Pertl Christof
Published: February 2005

Background: Various forms of stress behavior were documented and in patients with periodontitis their relationship with periodontal disease was investigated.

Methods: Eighty‐nine patients with different forms of chronic periodontitis were included in this retrospective case‐control study. They were all undergoing periodontal treatment at the Department of Dental Prosthetics, University of Graz, or a private dental practice. The control group consisted of 63 persons employed in health care at the Clinic of Graz. All participants completed a stress coping questionnaire of 114 items and 19 actional and intrapsychic stress coping modes. The questionnaire served as a psychodiagnostic survey aimed at collecting data on stress coping strategies. Clinical attachment loss (CAL) served as the clinical parameter.

Results: With the help of a factor analysis with α factorization and Varimax rotation, 5 factors were extracted from the 19 subtests. The reliability of the questionnaire was less than 0.70 only for subtests “escape” and “pharmaceutical drugs.” Otherwise the internal consistency ranged between 0.74 and 0.92, and the retest reliability between 0.72 and 0.84. Subsequent assessment with the t test for independent random samples at the 5% level showed that patients differ significantly from controls in regard of factor 2 (active coping, P = 0.40) and 3 (distractive coping, P = 0.033), and that they differ very significantly from controls in regard of factor 4 (defensive coping, P = 0.000) and 5 (coping through aggression and pharmaceutical drugs, P = 0.007). In the statistical analysis of factors with regard to the severity of periodontal disease, the patients were divided into 2 groups (mild to moderate and severe). The t test for independent random samples showed significance for factor 4 (defensive coping) in that patients with a defensive coping style had greater attachment loss (pF4 = 0.04).

Conclusions: The data corroborate the thesis that periodontitis patients with inadequate stress behavior strategies (defensive coping) are at greater risk for severe periodontal disease. However, further investigations are required to confirm the significance of inappropriate coping styles with respect to the advancement of periodontal disease. J Periodontol 2002;73:1343‐1351.
Medical Grade Calcium Sulfate Hemihydrate Versus Expanded Polytetrafluoroethylene in the Treatment of Mandibular Class II Furcations
Authors: Couri Christopher J. , Maze Glenn I. , Hinkson David W. , Collins Byran H. , Dawson Deborah V.
Published: February 2005

Background: Guided tissue regeneration (GTR) techniques have been reported to enhance bone regeneration of molar furcation defects. The current trends in therapy encourage the use of a bioabsorbable barrier. The efficacy of the bioabsorbable barrier needs to be equal to, if not better than, the non‐absorbable barrier.

Methods: This clinical study compared the bone regeneration capacity of a commonly used GTR procedure (demineralized freezedried bone allograft [DFDBA] and an expanded polytetrafluoroethylene [ePTFE] membrane) to DFDBA and an exclusion barrier of medical grade calcium sulfate hemihydrate [MGCSH]). Thirteen pairs of mandibular molar Class II furcation defects were evaluated in 13 patients. Clinical measurements of keratinized gingival width, probing depth, and recession were recorded prior to treatment. Following flap elevation and furcation defect debridement, an occlusal reference stent and periodontal probes were used to measure vertical, horizontal, and intrabony defect dimensions to the nearest millimeter. Paired defects were randomly assigned to receive either DFDBA/ePTFE or DFDBA/MGCSH. At 6 months, study sites were surgically re‐entered and the treated furcations were debrided to a firm bone surface. Intraoperative measurements were repeated. Clinical measurements were repeated at 12 months.

Results: The MGCSH‐treated furcations demonstrated mean probing depth reduction between baseline and 6 months (1.00 ± 0.82 mm, P <0.05) and baseline and 12 months (1.31 ± 0.85 mm, P <0.05). There was no statistically significant change in probing depth in the ePTFE group at any time interval. The horizontal defect fill was significantly greater for ePTFE (36.7%) versus MGCSH (23.8%) (P <0.02).

Conclusions: In selected defects, improved clinical measurements were achieved with DFDBA/MGCSH as well as DFDBA/ePTFE. Both treatments obtained significant horizontal defect fill at 6 months. DFDBA/ePTFE showed a significantly greater horizontal defect fill compared to DFDBA/MGCSH. Attachment level gains achieved with MGCSH held for 12 months, whereas ePTFE attachment level gains did not. J Periodontol 2002;73:1352‐1359.
Treatment of Intrabony Periodontal Defects With Enamel Matrix Derivative: A Literature Review
Authors: Kalpidis Christos D.R. , Ruben Morris P.
Published: February 2005

The enamel matrix derivative (EMD) has been recently introduced in the periodontal field to overcome shortcomings associated with currently available regenerative techniques. Information accumulated over the past years with application of EMD guided regeneration (EGR) in intrabony periodontal defects allowed a thorough evidence‐based retrospective analysis. Clinical data from EMD controlled studies were pooled for meta‐analysis and weighted according to the number of treated defects. Clinical attachment gain amounted to 3.2 ± 0.9 mm (33% of the original attachment level) and probing reduction averaged 4.0 ± 0.9 mm (50% of the baseline probing depth) for a total of 317 lesions with a mean baseline depth of 5.4 ± 0.8 mm. Improvements in clinical parameters achieved with EMD were statistically significant in reference to preoperative measurements. However, despite the overall efficacy of EGR therapy, a significant variation in clinical outcomes was observed. Similar therapeutic results were reported in studies where EGR was compared directly to guided tissue regeneration. However, the controlled clinical trials did not have adequate statistical power to firmly support superiority or equivalency between the 2 regenerative therapies. The statistical superiority of EGR over treatment with open flap debridement has been established. Preliminary histologic investigations with surgically created defects and experimental periodontal lesions demonstrated the ability of EGR to induce formation of acellular cementum and promote significant anaplasis of the supporting periodontal tissues. The potential of EMD to encourage periodontal regeneration was also confirmed in human intrabony defects. However, recent human histologic studies have questioned both the consistency of the histologic outcomes and the ability of EGR to predictably stimulate formation of acellular cementum. Identifying clinical modifying parameters and understanding cellular interactions are apparently essential for the development of methodologies to enhance predictability and extent of EGR clinical and histologic results. J Periodontol 2002;73:1360‐1376.
Acute Streptococcal Infection of the Gingiva, Lower Lip, and Pharynx—A Case Report
Authors: Katz Joseph , Guelmann Marcio , Rudolph Matthew , Ruskin James
Published: February 2005

Background: Streptococcal gingivostomatitis is a rare phenomenon in a non‐compromised host and not commonly reported in the dental literature. Early diagnosis and distinction from viral infections, especially HSV infection, are of the utmost importance. The early use of penicillin is essential in preventing a cascade of events, resulting in severe fascitis, destruction of tissues, and subsequent rheumatic fever and rheumatic heart disease.

Methods: A unique case of group A beta‐hemolytic streptococcal infection affecting the pharynx, lower lip, and gingiva of a healthy 19‐year‐old male is presented.

Results: The streptococcal infection was responsive to penicillin treatment.

Conclusions: In view of the increased use of antibiotics and the development of aggressive strains, the dental clinician has to consider streptococcal infection in the differential diagnosis of gingival and soft tissue infections. J Periodontol 2002;73:1392‐1395.
Detection of Human Viruses in Patients With Chronic Periodontitis and the Relationship Between Viruses and Clinical Parameters
Authors: Saygun Işil , Şahin Sermet , Özdemir Atilla , Kurtiş Bülent , Yapar Mehmet , Kubar Ayhan , Özcan Gönen
Published: February 2005

Background: Recent studies have demonstrated that various human viruses, especially cytomegalovirus (HCMV), Epstein‐Barr virus type‐1 (EBV‐1), and herpes simplex virus (HSV), seem to play a part in the pathogenesis of human periodontitis. Little information is available on the relationship between these viruses and clinical periodontal parameters in patients with chronic periodontitis. This study examined the occurrence of HCMV, EBV‐1, and HSV in patients with chronic periodontitis and the relationship between these viruses and clinical parameters.

Methods: A nested polymerase chain reaction (PCR) method determined the presence of HCMV, EBV‐1, and HSV. Subgingival plaque samples from 30 patients with chronic periodontitis and 21 randomly selected healthy controls were collected by paper points, and clinical measurements were recorded from both sampling sites and entire dentition. The following indices were measured: plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (CAL).

Results: HCMV was detected in 44.3% of chronic periodontitis patients and 14.3% of healthy persons (P <0.05); EBV‐1 in 16.7% of chronic periodontitis patients and 14.3% of healthy persons (P = 1.00); and HSV in 6.7% of chronic periodontitis patients and in no healthy persons. HCMV and EBV‐1 detected and undetected sites in patients with periodontitis showed statistically significant differences in sampling clinical depth (SPD) and sampling clinical attachment loss (SCAL). Differences in the measurements of PI of entire dentition and GI of entire dentition between HSV detected and undetected sites were statistically significant.

Conclusions: Findings of the present study confirm the frequent presence of HCMV in crevicular samples of chronic periodontitis lesions, and suggest a strong relationship between the presence of HCMV and EBV‐1 in subgingival areas and the measurements of probing depth and probing attachment loss. J Periodontol 2002;73:1437‐1443.
IgG Subclass Specific Antibody Response to Periodontopathic Organisms in HIV‐Positive Patients
Authors: Yeung Stephen C.H. , Taylor Barbara A. , Sherson Wayne , Lazarus Ross , Zhao Zhen Z. , Bird Philip S. , Hamlet Stephen M. , Bannon Michael , Daly Christopher , Seymour Gregory J.
Published: February 2005

Background: We previously reported an increased rate of progression of periodontal disease over an 18‐month period in human immunode‐ficiency virus (HIV)‐positive subjects compared to controls. The mechanism for disease progression and rapid tissue loss was unknown. Data on the microbiological studies failed to show any significant difference in the microbial characteristics of the periodontal lesions in HIV‐positive patients compared to HIV‐negative controls. Immunological analysis had identified neutrophils as an important component of the host defense against periodontal infection, especially against raPid tissue loss. Serum IgG reactivities to periodontal pathogens in HIV‐positive patients with periodontitis were reduced. Other data provided circumstantial evidence to suggest that IgG subclass (IgG2) specific antibody might assist bacterial clearing in periodontal infection. The aim of the current study was to examine the specific IgG subclass antibody response to a panel of periodontopathic organisms: Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Fusobacterium nucleatum (Fn), Campylobacter rectus (Cr), and Bacteroides forsythus (Bf) in HIV‐positive patients compared to HIVnegative controls.

Methods: Sera from 120 HIV‐positive patients (40 periodontitis, 69 gingivitis, and 11 no oral diseases) were tested for IgG subclass specific antibody response to the above listed 6 organisms using enzymelinked immunosorbent assay. Data were compared with those obtained from 40 HIV‐negative control subjects (35 periodontitis, 2 gingivitis, and 3 no oral diseases).

Results: In the HIV‐positive group, a consistently high response rate was found in IgG1 to all the bacteria tested. In addition, high levels of IgG3 and IgG4 to Pg and IgG1 and IgG2 to Pi were also present. However, no significant difference was detected among the periodontitis, gingivitis, and no oral disease subgroups. When the periodontitis patients from the HIV‐positive group were compared to the HIV‐negative group, no difference in the antibody levels and response rates was noted.

Conclusion: We conclude that in HIV‐positive patients, the specific IgG subclass antibody response to periodontopathic organisms was similar to that of HIV‐negative subjects. J Periodontol 2002;73:1444‐1450.
The Effect of Safflower Seed Extract on Periodontal Healing of 1‐Wall Intrabony Defects in Beagle Dogs
Authors: Kim Hyun‐Young , Kim Chang‐Sung , Jhon Gil‐Ja , Moon Ik‐Sang , Choi Seong‐Ho , Cho Kyoo‐Sung , Chai Jung‐Kiu , Kim Chong‐Kwan
Published: February 2005

Background: Recent interest in naturally based products has increased. Various herbal extracts are known to have a variety of medicinal properties. Among the various natural medicines, safflower seeds have beneficial effects on various bone diseases such as bone fracture, osteoporosis, and osteodysplasia. In addition, they are known to have anti‐inflammatory effects. The objective of this study was to evaluate the effect of a safflower seed extract (SSE) on the regeneration of periodontal tissue in a preclinical 1‐wall model in dogs.

Methods: Preclinical 1‐wall periodontal defects were surgically created in the mesial aspect of the maxillary third and mandibular fourth premolar and in the distal aspect of the maxillary first and mandibular second premolar, and were randomly assigned to receive SSE/collagen (SSE/Col), phosphate‐buffered saline/collagen (buffer control), or root planing only (surgical control). The created 1‐wall defect configuration was 4 mm in depth by 4 mm in width. We selected the segment showing the best activity to the osteoblast cells that was sensitive to the formation of calcified nodules among the SSE fractions extracted from various organic solvents. The animals were euthanized at 8 weeks postsurgery, and block sections of the defects were collected for histologic and histometric analysis.

Results: The junctional epithelium migration did not show any statistically significant differences among the treatments. In connective tissue adhesion, the SSE/Col group and the buffer control group showed significant differences compared to the surgical control group. New cementum averaged 3.84 ± 0.57 mm, 3.75 ± 0.24 mm, and 1.53 ± 1.22 mm for the SSE/Col group, the buffer control group, and the surgical control group, respectively, with the SSE/Col and buffer control groups significantly different from the surgical control group (P <0.05). The amount of intrabony cementum in the SSE/Col group was significantly different (P <0.01) from the surgical control group, but the amount of suprabony cementum did not demonstrate any statistical difference between the different treatments. The amount of new alveolar bone averaged 2.93 ± 0.70 mm, 2.10 ± 0.63 mm, and 1.20 ± 0.65 mm for the SSE/Col group, the buffer control group, and the surgical control group, respectively. The difference in alveolar bone regeneration between the SSE/Col group and the surgical control group was significantly different (P <0.01). Root resorption was often observed, but no ankylosis was present.

Conclusion: Wound conditioning with safflower seed extracts may contribute to bone formation but appears to have unpredictable potential for stimulating periodontal regeneration including new cementum. J Periodontol 2002;73:1457‐1466.
The Cost‐Effectiveness of Interleukin‐1 Genetic Testing for Periodontal Disease
Authors: Higashi Mitchell K. , Veenstra David L. , Aguila Michael Del , Hujoel Philippe
Published: February 2005

Background: A genetic test for a composite interleukin‐1 (IL‐1) genotype is being marketed to predict risk for progression of periodontal disease. The objective of this study was to determine the clinical scenario required to produce cost‐effective results with the use of IL‐1 testing to identify high‐risk patients.

Methods: A disease simulation model was developed using decision‐analytic techniques and a 30‐year time frame.

Results: Using different modeling scenarios, the genetic test produced results ranging from cost savings of $830,140 and 52.8 fewer cases of severe periodontitis to increased costs of $300,430 and 3.6 additional cases of severe periodontitis (per 1,000 patients). Three parameters in the analysis were highly influential: 1) the compliance rate for maintenance therapy in test positive versus non‐tested patients; 2) the effectiveness of non‐surgical therapy; and 3) the relative risk of disease progression for test positive patients.

Conclusion: The model produced a wide range of outcomes reflecting our incomplete understanding of the biology, optimal treatment, and genetic susceptibility of periodontal diseases. However, the model demonstrates that three clinical parameters are highly influential in determining if IL‐1 testing can be implemented in a primary care setting in a cost‐effective manner. J Periodontol 2002;73:1474‐1484.
Combined Therapy of Mineral Trioxide Aggregate and Guided Tissue Regeneration in the Treatment of External Root Resorption and an Associated Osseous Defect
Authors: White Cecil , Bryant Nathaniel
Published: February 2005

Background: The treatment of external root resorption and associated periodontal defects can be challenging to the most astute clinician. In this case report, a multidisciplinary approach was performed to treat a maxillary central incisor that presented with a sinus tract. An amalgam restoration had been placed approximately 10 years earlier to repair an area of external root resorption.

Methods: A full‐thickness mucoperiosteal flap was reflected from teeth #8 to #9. Following degranulation of the area, an amalgam restoration was found on the distal root surface of tooth #8. A 2‐wall osseous lesion was also associated with the distal surface of #8. The amalgam was removed and the defect was restored with mineral trioxide aggregate (MTA). The root surface was chemically conditioned with tetracycline, and the osseous defect was grafted with decalcified freeze‐dried bone allograft (DFDBA) and a calcium sulfate barrier.

Results: An 8 mm gain in clinical attachment, well as an increase in radiodensity, was noted on the distal surface of tooth #8 at 15 months postsurgery. The patient was also asymptomatic, with no clinical signs of inflammation present.

Conclusions: A combined approach utilizing MTA for root surface repair, and DFDBA and calcium sulfate to address an associated osseous lesion, appears to be a viable modality in the treatment of chronic endodontic/periodontal lesions. J Periodontol 2002; 1517‐1521.73:
Langerhans' Cell Histiocytosis Diagnosed Through Periodontal Lesions: A Case Report
Authors: Muzzi Leonardo , Prato Giovan Paolo Pini , Ficarra Giuseppe
Published: February 2005

Background: Langerhans' cell histiocytosis (LCH) is a rare disorder in which a neoplastic proliferation of cells similar to the Langerhans' cell of the epidermis is observed. The disease may affect different organs as solitary or multiple lesions with a complete dissemination in different organs such as the bone (jaws), lung, hypothalamus, skin and mucous membranes, lymph nodes, liver, and other tissues. Although LCH is considered a childhood or juvenile disease, the diagnosis is often made in adults, and in many cases, a juvenile form progresses into adult life. Hand‐Schuller‐Christian disease (HSCD) is an LCH form in which the typical lesions involve the cranial bones, the eyes, and the pituitary gland.

Methods: This article describes a case of a patient diagnosed, through periodontal lesions and diabetes insipidus, as having Langerhans' cell histiocytosis.

Conclusion: As far as LCH lesions appearing in periodontal tissues, the periodontist should be involved in the detection of oral lesions. J Periodontol 2002;73:1528‐1533.
The Effect of Removable Partial Dentures on Periodontal Health of Abutment and Non‐Abutment Teeth
Authors: Knezović Zlatarić Dubravka , Čelebić Asjâ , Valentić‐Peruzović Melita
Published: February 2005

Background: A removable partial denture (RPD) is a common treatment available for restoration of partially edentulous ridges. Longitudinal studies indicate that RPDs have been associated with increased gingivitis, periodontitis, and abutment mobility.

Methods: A total of 205 patients with RPDs participated in this study. There were 80 males and 125 females aged 38 to 89, with 123 maxillary and 138 mandibular RPDs. Patients were wearing existing RPDs for different periods ranging from 1 to 10 years. A two‐part questionnaire was devised for this study. In the first part, patients answered questions on gender; age; smoking habits; denture age; denture wearing habits; mouth odor; and problems with food accumulating under the denture base, on the outside surface of the denture, and on the outside surface of remaining teeth after eating. The Kennedy classification, material, denture support, denture base shape, and number of teeth in contact, number of existing clasps, and occlusal rests were categorized. The quality of denture construction was also evaluated. In the second part of the questionnaire, baseline recordings of plaque (PI), gingival (GI), and calculus (CI) indexes were made, and Tarbet index (TI), as well as probing depth PD), gingival recession (GR), and tooth mobility (TM) were measured, both on abutment and non‐abutment teeth.

Results: Significant differences (P <0.01) were noted for PI, CI, GI, PD, TM, and GR between abutment and non‐abutment teeth, with abutment teeth showing more disease.

Conclusions: RPD design plays an important role in the state of the periodontium. Appropriate design and good oral hygiene may decrease the appearance of periodontal disease. J Periodontol 2002;73:137‐144.
Comparison of Conventional Periodontal Maintenance Versus Scaling and Root Planing With Subgingival Minocycline
Authors: Meinberg Trudy A. , Barnes Caren M. , Dunning David G. , Reinhardt Richard A.
Published: February 2005

Background: Alternative regimens using subgingival antimicrobials compared to conventional periodontal maintenance (PM) may lead to more efficient protocols. The purpose of this study was to evaluate treatment time and clinical and radiographic outcomes in 2 periodontitis cohorts, one receiving conventional PM and the other receiving scaling and root planing (SRP) and multiple doses of subgingival minocycline.

Methods: Moderate to advanced chronic periodontitis patients were concurrently treated with either: 1) scaling and root planing and 4 subgingival doses of minocycline microspheres in all ≥5 mm pockets over a 6‐month period (RP/M; n = 24 patients); or 2) conventional 3‐month periodontal maintenance (PM; n = 24 patients). Clinical and radiographic measurements, including probing depth (PD), clinical attachment level (CAL), and interproximal bone height (BH), were analyzed in 2 premolar/molar interproximal ≥5 mm pockets at baseline and 1 year using paired t tests, analysis of variance, chi‐square analysis, and correlation coefficients.

Results: Baseline clinical and radiographic data were similar between RP/M and PM patients. Probing depths showed greater mean improvement in RP/M (0.9 ± 0.1 versus 0.4 ± 0.1 mm, P = 0.02), with 25% of subjects in RP/M gaining ≥2 mm compared to 4.2% in PM (differences were statistically significant). The mean loss in bone height and percent subjects losing bone height were less in RP/M (0.05 ± 0.05 mm; 12.5%) than PM (0.09 ± 0.08 mm; 16.7%), but bone height differences were not statistically significant. A subset of RP/M molar furcation sites responded with similar PD reduction and no BH loss over 1 year. While cross‐sectional RP/M data between CAL and BH, or PD and CAL were highly correlated, changes over 1 year were not correlated among any of these parameters.

Conclusions: Scaling and root planing and subgingival minocycline in experimental sites took little time (<5 minutes/appointment), but resulted in more probing depth reduction and less frequent bone height loss than conventional periodontal maintenance. J Periodontol 2002;73:167‐172.
The Effects of Varying Degrees of Allograft Decalcification on Cultured Porcine Osteoclast Cells
Authors: Herold Robert W. , Pashley David H. , Cuenin Michael F. , Niagro Frank , Hokett Steven D. , Peacock Mark E. , Mailhot Jason , Borke James
Published: February 2005

Background: Demineralized freeze‐dried bone allograft (DFDBA) is widely used in periodontal therapy as a scaffold for new bone formation in periodontal defects. It is demineralized, theoretically, to expose osteoinductive or osteoconductive bone matrix proteins that should facilitate osteogenesis. The degree of DFDBA demineralization varies between tissue banks and may affect clinical regeneration. A 2% residual calcium level in DFDBA has been shown to result in the highest alkaline phosphatase activity levels in cultured human periosteal cells and is optimally osteoinductive or osteoconductive for new bone formation. The purpose of this study was to evaluate the effect of 4 different residual calcium levels in commercially available DFDBA samples on porcine osteoclast activity as measured by resorption on calcium phosphatecoated disks.

Methods: Bone marrow was harvested from the femurs of 3‐week‐old farm pigs and cultured for 3 weeks. Hematopoietic stem cells were allowed to differentiate into mature active polykaryons displaying genuine osteoclast characteristics. The osteoclast cells displayed a dense actin band inside the margins of the cytoplasm under light microscopy. Culture media was decanted and collagenase added to free the attached cells. Equal cell samples were pipetted onto calcium phosphate‐coated disks in 24‐well plates. DFDBA samples with 1.44%, 2.41%, and 5.29% residual calcium; FDBA (30% residual calcium); and control cultures without allograft samples were prepared and all samples incubated for 1 week. Cells were fixed and stained for tartrate‐resistant acid phosphatase (TRAP), Oregon Green 488‐phalloidin, a stain for cytoskeletal proteins, and counterstained with propidium iodide. Specimens were examined by light and fluorescence microscopy using epi‐illumination. Calcium phosphate disks were then rinsed in 5% sodium hypochlorite to remove adherent osteoclasts, and substrate surface changes were measured by white light interferometry and image analysis.

Results: A higher yield of TRAP‐positive cells was produced without DFDBA; however, resorptive activity appears to be significantly increased in the presence of 2.41% residual calcium as compared to all other experimental groups (P <0.0065).

Conclusion: In this in vitro model, porcine osteoclasts show significantly more resorptive activity as measured on calcium phosphate‐coated disks in the presence of 2.41% residual calcium in DFDBA than in other DFDBA residual calcium levels. J Periodontol 2002;73:213‐219.
Disodium Chlodronate Prevents Bone Resorption in Experimental Periodontitis in Rats
Authors: Alencar Veruska B.M. , Bezerra Mirna M. , Lima Vilma , Abreu André Luis C. , Brito Gerly Anne C. , Rocha Francisco Airton C. , Ribeiro Ronaldo A.
Published: February 2005

Background: Periodontitis is a chronic disease characterized by alveolar bone loss and inflammatory changes. We studied the effect of disodium chlodronate (CD), a bisphosphonate used in metastatic and metabolic bone disease as a bone resorbing drug, in an experimental periodontitis model (EPD) focusing on anti‐resorptive and anti‐inflammatory parameters.

Methods: A nylon thread ligature was placed around the left maxillary molars of 72 male Wistar rats who were sacrificed after 7 or 11 days. Groups were treated daily with CD (1, 5, or 25 mg/kg/sc) starting at day 0 until day 7 (prophylactic CD) or from day 5 until day 11 (curative CD) after periodontitis induction. Non‐treated group (NT) consisted of rats subjected to periodontitis that received no pharmacological treatment. Alveolar bone loss (ABL) was measured as the distance between the cuspid tips and the alveolar bone. The right jaw was used as control. The hemiarcades were processed for histopathologic analysis.

Results: In NT group there was significant ABL, severe mononuclear cells influx, and increase in osteoclast numbers. Prophylactic CD treatment decreased the ABL 25.8%, 61.6%, and 75.5% as compared to NT for the 1, 5, and 25 mg/kg CD doses, respectively. Curative CD treatment decreased the ABL 20%, 62%, and 69% as compared to NT for the 1, 5 and 25 mg/kg CD doses, respectively. Both prophylactic and curative CD decreased histological changes, as compared to NT rats (P<0.01).

Conclusions: CD has both bone sparing and anti‐inflammatory activity in EPD in rats when administered as a pretreatment or in an ongoing process. The possibility of using CD as an alternative treatment in human periodontitis should be considered. J Periodontol 2002;73:251‐256.
Histomorphometrical Analysis of Bone Formed After Maxillary Sinus Floor Augmentation by Grafting With a Combination of Autogenous Bone and Demineralized Freeze‐Dried Bone Allograft or Hydroxyapatite
Authors: Boëck‐Neto Rodolfo Jorge , Gabrielli Mário Francisco Real , Lia Raphael Carlos Comelli , Marcantonio Elcio , Shibli Jamil Awad , Marcantonio Elcio
Published: February 2005

Background: Maxillary sinus floor augmentation procedures are currently the treatment of choice when the alveolar crest of the posterior maxilla is insufficient for dental implant anchorage. This procedure aims to obtain enough bone with biomaterial association with the autogenous bone graft to create volume and allow osteoconduction. The objective of this study was to histologically and histometrically evaluate the bone formed after maxillary sinus floor augmentation by grafting with a combination of autogenous bone, from the symphyseal area mixed with DFDBA or hydroxyapatite.

Methods: Ten biopsies were taken from 10 patients 10 months after sinus floor augmentation using a combination of 50% autogenous bone plus 50% demineralized freeze‐dried bone allograft (DFDBA group) or 50% autogenous bone plus 50% hydroxyapatite (HA group). Routine histological processing and staining with hematoxylin and eosin and Masson's trichrome were performed.

Results: The histomorphometrical analysis indicated good regenerative results in both groups for the bone tissue mean in the grafted area (50.46 ± 16.29% for the DFDBA group and 46.79 ± 8.56% for the HA group). Histological evaluation revealed the presence of mature bone with compact and cancellous areas in both groups. The inflammatory infiltrate was on average nonsignificant and of mononuclear prevalence. Some biopsies showed blocks of the biomaterial in the medullary spaces close to the bone wall, with absence of osteogenic activity.

Conclusions: The results indicated that both DFDBA and HA associated with an autogenous bone graft were biocompatible and promoted osteoconduction, acting as a matrix for bone formation. However, both materials were still present after 10 months. J Periodontol 2002;73:266‐270.
Relationships Between Clinical Attachment Level and Spine and Hip Bone Mineral Density: Data From Healthy Postmenopausal Women
Authors: Pilgram Thomas K. , Hildebolt Charles F. , Dotson Mary , Cohen Sheldon C. , Hauser Jay F. , Kardaris Eugenia , Civitelli Roberto
Published: February 2005

Background: There are physiological reasons to expect an association between bone mineral density of the spine and hip and attachment loss. To this point, however, most studies have found no correlation.

Methods: The 135 patients in this report were part of a randomized controlled trial of estrogen replacement. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure sensitive probe at 6 sites on each tooth. Bone mineral density was measured with dual‐energy x‐ray absorbtiometry at the lumbar spine (anterior‐posterior and lateral) and proximal femur (neck, trochanter, intertrochanter, Ward's triangle, and total area). These procedures were performed at baseline and at annual intervals for 3 years.

Results: Correlations between cross‐sectional measurements of clinical attachment level and bone mineral density were very weak, and did not approach statistical significance (–0.06 ≤r ≤0.10, 0.15 ≤P ≤0.75). A few somewhat stronger correlations were found between longitudinal changes in bone mineral density and attachment (–0.20 ≤ r ≤–0.02, 0.02 ≤ P ≤0.81). Although the correlations in the longitudinal changes were weak, they were consistently in the direction of greater bone mineral density being associated with less attachment loss.

Conclusions: There is no clear association between clinical attachment level and bone mineral density of the lumbar spine and proximal femur, whether examined on a cross‐sectional or longitudinal basis. Patterns in the data suggest there may be a weak association in the longitudinal changes. J Periodontol 2002;73:298‐301.