bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Actinobacillus actinomycetemcomitans Serotype b to Aggressive Periodontitis: Frequency in Pure Cultured Isolates
Authors: Yang H. W. , Asikainen S. , Doğan B. , Suda R. , Lai C. H.
Published: February 2005

Background: To our knowledge, the association of the five serotypes of Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans) to the new diagnostic classification scheme defined by the American Academy of Periodontology in 1999 has not yet been described. The goal of this study was to characterize the frequencies of the five serotypes of A. actinomycetemcomitans in A. actinomycetemcomitans isolates from various forms of periodontitis using both old and new diagnostic classifications and to determine the relationships between serotype and age and clinical diagnosis.

Methods: A total of 345 A. actinomycetemcomitans isolates from 115 A. actinomycetemcomitans culture‐positive subjects (mean age 38.0 ± 18.3 years, 59% female) were collected. Based on the new classifications, 33 subjects had aggressive periodontitis and 82 chronic periodontitis. According to old classifications, there were six prepubertal periodontitis (PPP), 12 localized juvenile periodontitis (LJP), 15 post‐localized juvenile periodontitis (PLJP), 28 refractory periodontitis (Ref‐P), and 54 adult periodontitis (AP) cases. Serotypes of A. actinomycetemcomitans were determined by an indirect immunofluorescence assay using serotype‐specific polyclonal antisera to A. actinomycetemcomitans strains ATCC 29523, ATCC 43728, ATCC 33384, IDH 781 and IDH 1705 (serotype a, b, c, d, and e, respectively). Proportions of serotype b were examined between different diagnostic and age groups with a Z‐test for proportions.

Results: Most subjects (n = 100, 86.96%) were infected with a single serotype (22 serotype a, 44 serotype b, 30 serotype c, 1 serotype d, and 3 serotype e). There were 11 subjects (9.57%) with two serotypes and two subjects (1.74%) with 3 serotypes. Two individuals had isolates lacking any detectable serotype antigen. Serotype b was the predominant serotype in children under 18 years of age and young adults between 19 to 35 years, although serotype b status was not significantly associated with age. Serotypes d and e were not found in patients under 35 years old. In 62 adult patients, one subject had serotype d and three had serotype e. Serotype b was the most common serotype in aggressive periodontitis (60.61%). The proportion of cases with serotype b was significantly higher in aggressive periodontitis compared to chronic periodontitis (P = 0.031). Other serotypes were not significantly associated with new diagnostic categories. Serotypes d and e were not detected in aggressive periodontitis.

Conclusion: The results of this study show that proportions of serotype b of A. actinomycetemcomitans are significantly greater in culture‐positive patients with aggressive periodontitis than those with chronic periodontitis. J Periodontol 2004;75:592‐599.
Successful Treatment of Oral Lichen Planus‐Like Chronic Graft‐Versus‐Host Disease With Topical Tacrolimus: A Case Report
Authors: Sánchez Andrés R. , Sheridan Phillip J. , Rogers Roy S.
Published: February 2005

Background: Bone marrow transplantation (BMT) is a common treatment used for deficiencies of host marrow or in the control of blood malignancies. Post‐allogeneic BMT complications include graft‐versus‐host disease (GVHD). GVHD occurs when immunologically active T lymphocytes are transplanted into an immunosuppressed recipient who is genetically disparate from the donor. In this case report we describe the occurrence of oral lichen planus‐like lesions as the first manifestation of chronic GVHD (c‐GVHD) and the subsequent management of this disease with topical tacrolimus.

Methods: Diagnostic aids included routine histology and direct immunofluorescence studies to rule out immunobullous diseases and to confirm the c‐GVHD. Treatment consisted of topical application of 0.1% tacrolimus ointment three times a day.

Results: Routine histology confirmed the clinical diagnosis of oral lichen planus‐like c‐GVHD. Treatment with tacrolimus ointment completely resolved the oral lesions after 2 months of therapy.

Conclusions: Topical tacrolimus at low concentrations (0.1%) shows promise in the management of oral lichen planus‐like c‐GVHD. Controlled studies are necessary to assess the efficacy, the duration of therapy required for effective results, and the safety of this treatment over the long‐term. J Periodontol 2004;75:613‐619.
A Method to Enhance Determining the Clinical Relevance of Periodontal Research Data: Number Needed to Treat (NNT)
Authors: Greenstein Gary , Nunn Martha E.
Published: February 2005

It would be advantageous if clinical trials reported both statistical and clinically meaningful results. In this regard, determination of the number of sites that would need to be treated in a test group to provide a benefi‐ cial result or prevent an adverse event at one additional site beyond the control group would provide useful information. This editorial addresses the use of NNT (number needed to treat) calculations to enhance determining the clinical relevance of periodontal research findings. The application, requirements for use, benefits, and limitations of employing NNT calculations are discussed. J Periodontol 2004;75:620‐624.
A Technique for Standardized Evaluation of Soft and Hard Peri‐Implant Tissues in Partially Edentulous Patients
Authors: Meijndert Leo , Meijer Henny J.A. , Raghoebar Gerry M. , Vissink Arjan
Published: February 2005

Background: There is a growing need to evaluate the esthetics of implant‐supported crowns and bridges. An important tool for such an evaluation is standardized assessment of the soft and hard peri‐implant tissue levels.

Methods: A simple acrylic device has been developed for reliable and reproducible assessment of soft and hard periimplant tissues using standardized color slides and standardized dental x‐rays. With this device, changes in both the soft and hard tissues around implant‐supported crowns can be evaluated as a function of time. The reproducibility of the technique was tested on color slides as well as on dental x‐rays in a series of implant‐supported crowns and their neighboring teeth. Results: The reproducibility of this technique was excellent. The measuring errors for repeated measurements of the soft and hard tissues were 0.14 ± 0.02 mm and 0.13 ± 0.01 mm, respectively.

Conclusions: The device is a reliable tool to assess changes in both soft and hard tissues around crowns and implants over time. Likewise, it is suggested that this technique also can be used to objectively assess soft and hard tissue changes around natural teeth with or without prosthetic restorations. J Periodontol 2004;75:646‐651.
Assessment of Peripheral Dual‐Energy X‐Ray Absorptiometry Measurements in Peri‐Implant Bone Defects in Dogs
Authors: Sánchez Andrés R. , Sheridan Phillip J. , Lohse Christine , Weaver Amy
Published: February 2005

Background: The goal of this study was to assess the variability of peripheral dual‐energy x‐ray absorptiometry (pDEXA) measurements in peri‐implant bone defects in dogs.

Methods: Ninety dental implants were inserted in edentulous areas of nine foxhound dogs and standardized peri‐implant bone defects were created on the mesial and distal aspect of each fixture (N = 144 total). The animals were sacrificed at 1, 2, and 3 months, respectively. Bone mineral density measurements (BMD) were performed with the use of pDEXA. The calibration of the system was determined by generating four quality control plots using a phantom of known density value. A series of three repeated measurements of the peri‐implant sites were made with repositioning of the region of interest. The measurements were performed at the mesial and distal peri‐implant sites. The variability of the three BMD measurements was expressed as the coefficient of variation (CV), which is calculated as ([SD/mean] × 100). The difference in the CV between the mesial and distal sites was evaluated using an analysis of variance model for repeated measures accounting for timing of sacrifice (month 1, 2, 3), dog (1 through 9), side (left, right), and adjacent defect regions between implants (1 through 4).

Results: The calibration of the pDEXA measured by means of the phantom resulted in a deviation of 0.17%, 0.52%, –0.17%, and 0.00%, respectively, for each of the four assessments. The average CV for the 72 mesial and 72 distal peri‐implant sites was 5.22% ± 4.22% (median 3.50%; range 0.46% to 18.83%) and 5.37% ± 3.54% (median 4.64%; range 0.22% to 15.35%), respectively. After accounting for timing of sacrifice, dog, side, and position, there was not a statistically significant difference in the CV between the mesial and distal peri‐implant sites (P = 0.75). This indicates that the peri‐implant site did not significantly affect the variability of the BMD measurements.

Conclusions: This study demonstrated that the pDEXA is a non‐invasive, convenient, and fast method to assess BMD around dental implants in animal studies. Limitations of the technique may have a negative impact in the precision of pDEXA when measuring small regions. J Periodontol 2004;75:658‐662.
Long‐Term Tooth Survival Following Regenerative Treatment of Intrabony Defects
Authors: Cortellini Pierpaolo , Tonetti Maurizio S.
Published: February 2005

Background: The longevity of the clinical benefits of guided tissue regeneration (GTR) has not been fully explored. The aim of this investigation was to assess the long‐term survival of GTR treated sites in terms of clinical attachment level (CAL) stability and tooth loss.

Methods: A total of 175 patients with one deep intrabony defect were selected for a retrospective investigation of tooth retention and CAL stability. All sites had been treated with GTR more than 2 years previously and had received full periodontal examinations every 2 years for up to 16 years. Definitions of events for survival analyses were tooth loss, loss of ≥2 mm compared with the CAL observed before GTR treatment, and loss of ≥2 mm compared with the CAL observed 1 year after completion of GTR.

Results: Teeth were severely compromised by the presence of CAL loss of 10.7 ± 2.4 mm, probing depths of 8.7 ± 2.3 mm and deep intrabony defects (average depth 6.6 ± 2.1 mm). After GTR, CAL gains were 4.6 ± 2 mm. Average follow up was 8 ± 3.4 years; 66.9% of subjects strictly complied with a periodontal maintenance program. Tooth survival was greater than 96% more than 10 years after GTR. CAL was equal or coronal with respect to pretreatment in 92% of cases followed for 15 years after treatment, while loss of CAL compared to the 1‐year post‐GTR result was observed in 37.8% of cases. Cox proportional hazard models indicated that incidence‐free survival was negatively affected by smoking and positively affected by full compliance with a periodontal maintenance program in a specialist practice.

Conclusions: Within the limits of this study, data suggest that tooth retention and clinical improvements following GTR treatment of intrabony defects can be maintained long term in the great majority of cases and thus that regenerative periodontal treatment represents an important alternative for the management of severely compromised teeth. J Periodontol 2004;75:672‐678.
Effect of Recombinant Human Bone Morphogenetic Protein‐2 in an Absorbable Collagen Sponge With Space‐Providing Biomaterials on the Augmentation of Chronic Alveolar Ridge Defects
Authors: Barboza Eliane Porto , Caúla André Luis , Caúla Fernanda de Oliveira , de Souza Rogério Oliveira , Neto Luiz Geolás , Sorensen Rachel G. , Li X. Jian , Wikesjö Ulf M.E.
Published: February 2005

Background: Recombinant human bone morphogenetic protein‐2 (rhBMP‐2) in an absorbable collagen sponge (ACS) carrier has been shown to support significant bone formation in the craniofacial skeleton. When used as an onlay, however, rhBMP‐2/ACS may become compressed with limited resulting bone formation. The objective of this study was to evaluate the effect of two space‐providing biomaterials, bioactive glass (BG) and demineralized/mineralized bone matrix (DMB), on rhBMP‐2/ACS induced alveolar ridge augmentation.

Methods: Bilateral alveolar ridge defects were produced in the mandible in six mongrel dogs. rhBMP‐2/ACS with biomaterials was surgically implanted into contralateral defects in four animals. Treatments were alternated between jaw quadrants in consecutive animals. Two animals received rhBMP‐2/ACS or sham‐surgery in contralateral defects. The animals were injected with fluorescent bone labels to monitor bone formation. Clinical evaluations were made at ridge augmentation and 12 weeks post‐implantation when the animals were euthanized and block biopsies collected for histopathologic evaluation.

Results: Sham‐surgery produced limited horizontal alveolar augmentation (0.1 ±0.6 mm). Implantation of rhBMP‐2/ACS resulted in alveolar augmentation amounting to 2.2 ±1.8 mm. Alveolar augmentation in sites receiving rhBMP‐2/ACS with DMB or BG was 2‐fold greater compared to rhBMP‐2/ACS alone averaging 4.4 ±1.3 and 4.6 ±1.5 mm, respectively. The DMB biomaterial appeared substituted by newly formed bone. The BG particles were observed imbedded in bone or encapsulated in dense connective tissue without associated bone metabolic activity. Fluorescent light microscopy suggested that the new bone was formed within 4 weeks.

Conclusion: The bioglass and demineralized/mineralized bone matrix biomaterials utilized in this study in combination with rhBMP‐2/ACS supported clinical and histological ridge augmentation. J Periodontol 2004;75:702‐708.
Subgingival Microbiota of Chilean Patients With Chronic Periodontitis
Authors: López Néstor J. , Socransky Sigmund S. , Da Silva Isabel , Japlit Michelle R. , Haffajee Anne D.
Published: February 2005

Background: An association between race/ethnicity and the composition of the subgingival microbiota has been found in chronic periodontitis. A study was undertaken to determine the characteristics of the subgingival microbiota of chronic periodontitis in Chileans residing in Santiago.

Methods: Twenty‐six subjects (mean age 45±7 years) with chronic periodontitis, mean probing depth (PD) 2.63 ± 0.5 mm, mean attachment level (AL) 3.70 ± 0.77 mm, and without a history of periodontal therapy were selected. Measurements of PD, AL, bleeding on probing, and plaque accumulation were recorded at six sites per tooth. Subgingival plaque samples were taken from the mesial aspect of every tooth and evaluated for the presence, levels, and proportions of 40 bacterial taxa using whole genomic DNA probes and checkerboard DNA‐DNA hybridization. The microbial data of the Chileans were compared with data from 115 chronic periodontitis patients from Boston, Massachusetts. Since several clinical and demographic parameters differed between the two populations, significance of differences for each species was determined using analysis of covariance, adjusting for age, plaque level, mean PD, gender, and smoking status.

Results: Each of the individual test species was present in at least 25 of the 26 subjects, and 12 subjects (46.1%) harbored all 40 test species. With the exception of Prevotella intermedia, all test species colonized more than 75% of sites, and 25 species colonized ≥90% of sites including the co‐colonizing species of advanced periodontal lesions, termed the red complex, composed of the three species Porphyromonas gingivalis, Tannerella forsythensis (formerly Bacteroides forsythus), and Treponema denticola as well as Fusobacterium nucleatum subspecies, Campylobacter rectus, Peptostreptococcus micros, and Treponema socranskii. Sixteen of the 40 species differed significantly between Chilean and U.S. subjects. Red, yellow, and other complexes were significantly higher in the Chileans, while the Actinomyces were higher in the U.S. subjects.

Conclusions: The composition of the subgingival plaque differs among different subject populations. Thus, care should be taken when extrapolating the findings of one study to different ethnic groups. J Periodontol 2004;75:717‐725.
The Effectiveness of InGaAsP Diode Laser Radiation to Detect Subgingival Calculus as Compared to an Explorer
Authors: Folwaczny Matthias , Heym Richard , Mehl Albert , Hickel Reinhard
Published: February 2005

Background: The aim of the present study was to compare the ability of the diode laser to detect residual calculus with that of an explorer.

Methods: The root surface of 40 extracted human teeth, each partially covered with subgingival calculus, was instrumented with curets under simulated clinical conditions in a manikin. The samples were randomly assigned to two study groups. In group A, the root surface was treated with an explorer until it appeared free of mineralized deposits upon examination. The samples in group B were instrumented until the relative intensity of fluorescence as induced with diode laser radiation was below a threshold value of 5. The root surface of each sample was then examined for residual calculus using standardized digital images. The statistical analysis was performed with a non‐paired t test at a level of significance of 5% (P <0.05).

Results: The root surface of single‐rooted teeth showed residual calculus on 0.19 ± 0.37 × 107 µm2 in the laser group and on 0.11 ± 0.26 × 107 µm2 in the explorer group (P = 0.19). For multirooted teeth, the mean calculus‐covered area was 0.50 ± 0.48 × 107 µm2 for the teeth evaluated with an explorer and 0.27 ± 0.43 × 107 µm2 for the diode laser group (P = 0.02).

Conclusion:The present findings indicate that the detection of subgingival calculus is significantly improved using 655 nm diode laser radiation compared to an explorer for molars but not for single‐rooted teeth. J Periodontol 2004;75:744‐749.
Histologic Analysis of Alveolar Bone Following Guided Bone Regeneration
Authors: Ersanli S. , Olgac V. , Leblebicioglu B.
Published: February 2005

Background: Questions on new bone quality following guided bone regeneration (GBR) with various graft materials and its importance in osseointegration have been raised. This study reports histologic analysis of bone sections from future implant sites at upper and lower jaws that were augmented with bovine porous bone mineral graft material plus a porcine collagen membrane.

Methods: Due to severe atrophy of the alveolar crest, GBR prior to implant placement was indicated in 11 patients (mean age 45.5 years). Following an average of 7 months of healing, implant placement surgery was performed. Bone sections from implant beds were fixed in formalin, decalcified in sodium citrate and formic acid, and placed in paraffin. Sections 5 to 7 µm thick were prepared, stained with hematoxylin and eosin, and analyzed under light microscopy. Results for 27 implant sites are presented.

Results: Compared to the lower jaw, segments from the upper jaw had a lower percentage of bone and higher percentage of residual material and vascularization.

Conclusions: Within the limits of this study, we concluded that osteogenesis is completed and the rate of vascularization and osteoclastic activity was reduced by 7 months. Also, the upper jaw significantly differed from the lower jaw in bone formation, vascularization, and the amount of residual material. Thus, the anatomical location of the defect may be as important as the properties of the graft material used in obtaining successful osteogenesis using guided bone regeneration techniques. J Periodontol 2004;75:750‐756.
Prevention of Gingival Recession Following Flap Debridement Surgery by Subepithelial Connective Tissue Graft: Consecutive Case Series
Authors: Hirsch Ariel , Brayer Laurentiu , Shapira Lior , Goldstein Moshe
Published: February 2005

Background: Surgical debridement with flap repositioning may result in significant gingival recession. This manuscript reports on a series of cases that were treated for deep periodontal pockets by flap debridement surgery combined with subepitheial connective tissue graft for the prevention of postoperative recession.

Methods: Fourteen patients (27 teeth) with deep periodontal pockets and bone loss in the mandibular central incisors area underwent flap debridement combined with subepithelial connective tissue graft. Probing depth, recession depth, and clinical attachment levels were recorded prior to surgery, 6 months postsurgery, and again 19 to 58 months post‐surgery.

Results: Mean probing depth at baseline was 6.20 mm, while 6 months post‐surgery it was 1.97 mm (P <0.0001), and 19 to 58 months after surgery it was 1.32 mm. Clinical attachment level measurements followed the same pattern (baseline 9.37 mm, 6 months 3.29 mm, final examination 2.00 mm). While the mean recession depth at baseline was 3.17 mm, 6 months post‐surgery it was reduced to 1.30 mm (P <0.0001). Additional reduction in recession depth was recorded over time.

Conclusion: Within the limitations of a single group study, the results suggest that flap debridement combined with subepithelial connective tissue graft, followed by maintenance therapy, is an effective procedure for maintaining long‐term periodontal health and for prevention of postoperative gingival recession in the mandibular anterior dentition. J Periodontol 2004;75:757‐761.
Relationship of Periodontal Disease and Tooth Loss to Prevalence of Coronary Heart Disease
Authors: Elter John R. , Champagne Catherine M.E. , Offenbacher Steven , Beck James D.
Published: February 2005

Background: Studies relating periodontal disease to coronary heart disease (CHD) have provided equivocal results using tooth loss and/or clinical signs of periodontal disease as measures of periodontal exposure.

Methods: The purpose of this cross‐sectional study was to evaluate the relationship of tooth loss and periodontitis to prevalent CHD at the Atherosclerosis Risk in Communities (ARIC) visit 4 using both tooth loss and clinical signs of disease in a population‐based sample of 8,363 men and women aged 52 to 75 years from four U.S. communities. Each subject participated in a complete periodontal examination, assessment of missing teeth, assessment of prevalent CHD, and a number of laboratory tests and questionnaires. High attachment loss was defined as ≥10% of sites with attachment loss >3 mm and high tooth loss was defined as fewer than 17 remaining teeth.

Results: Individuals with both high attachment loss and high tooth loss (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1 to 2.0) and edentulous individuals (OR 1.8, CI 1.4 to 2.4) had elevated odds of prevalent CHD compared to individuals with low attachment loss and low tooth loss, while controlling for a number of traditional risk factors for CHD.

Conclusions: These results suggest that tooth loss and periodontal disease are associated with prevalent CHD, but only when both are present. The weaker relationships between periodontal disease and CHD that have been found among older adults may be due to older adults having fewer teeth. Future longitudinal studies should be designed to ascertain the cause of tooth loss during follow‐up. J Periodontol 2004;75:782‐790.
The Effects of Ovulation Induction During Infertility Treatment on Gingival Inflammation
Authors: Haytaç M. Cenk , Cetin Turan , Seydaoglu Gulash
Published: February 2005

Background: Ovulation induction is the most common method of infertility treatment in which the ovaries are stimulated to produce multiple follicles. The aim of this study was to assess the effects of three drug protocols of ovulation induction: clomiphene citrate (CC) alone, CC combined with follicle stimulating hormone (FSH), and CC combined with human menopausal gonadotropin (HMG) on the gingival tissues of women who were undergoing infertility treatment.

Methods: Study population was composed of 18 women using CC for three menstrual cycles or less and 16, women using CC for more than three cycles; 21 women using CC‐FSH; and 24 women using CC‐HMG who had at least four cycles of CC alone the previous year. All subjects were clinically examined for plaque levels (plaque index), gingival inflammation (gingival index), bleeding on probing, and gingival crevicular fluid volume. The results were compared with a control group of 20 women matched for age, education and professional level, and oral habits and who had never used ovulation drugs.

Results: Despite similar plaque levels (P >0.05), women using CC for more than three cycles and combined protocols of CC‐FSH and CC‐HMG had higher levels of gingival inflammation (P <0.01, P <0.001 and P <0.001, respectively), bleeding (P <0.001), and GCF volume (P <0.001) when compared to the control group and to the users of CC for three cycles or less

Conclusions: The results of this study have shown that ovulation induction, which is the most common method in the management of infertility, exacerbates gingival inflammation, bleeding, and GCF volume and that the duration of the usage of these drugs is strongly associated with the severity of gingival inflammation.J Periodontol 2004;75:805‐810.
Polyamines in Nickel‐Titanium Archwire‐Induced Gingivitis in Adolescents
Authors: Venza M. , Visalli M. , Cicciù D. , Valenti A. , Passi P. , Teti D.
Published: February 2005

Background: Polyamines spermine, spermidine, and putrescine are involved in a number of inflammatory diseases, but their role in the development of gingivitis and periodontitis has not been fully investigated. The goal of this investigation was to study the levels and the variations of these amines, and the main enzymes related to their metabolism, during archwire orthodontic treatment, a condition which may induce gingivitis.

Methods: Sixty patients (age range: 11 to 27 years) were examined for gingivitis occurring during nickel‐titanium (Ni‐Ti) archwire orthodontic treatment. Plaque and gingival indexes (PI, GI) as well as salivary polyamine metabolism before the archwire insertion (T0) and at 3 (T1), 6 (T2), and 12 (T3) months of treatment were measured.

Results: In patients in the age range of 14 to 17 years, spermine and spermidine, but not putrescine contents, as well as ornithinedecarboxylase (ODC) and S‐adenosylmethionine‐decarboxylase (SAMDC) activities, significantly rose at 3 months after insertion, without any change in periodontal parameters, and further increased at 6 months reaching the maximum at 12 months. GI increased later, from 6 to 12 months, while PI did not significantly change. Spermidine/ spermine‐N1‐acetyltransferase (SSAT) activity remained unchanged from T0 to T3. On the contrary, in patients whose age was 11 to 13 or over 18 years, no significant variations in polyamine metabolism and periododontal parameters were observed at any examination time.

Conclusion: These data support the hypothesis that salivary polyamines might be earlier indicators of gingivitis than the gingival index score in adolescents wearing archwire appliances. J Periodontol 2004;75:877‐885.
Alterations in Location of the Mucogingival Junction 5 Years After Coronally Repositioned Flap Surgery
Authors: Gürgan Cem A. , Oruç A. Murat , Akkaya Murat
Published: February 2005

Background: The aim of this clinical study was to evaluate whether the mucogingival junction (MGJ) reverts back towards its original location following coronally repositioned flap (CRF) procedure over a 5‐year follow‐up period.

Methods: Thirteen systemically healthy patients with 26 Miller Class I buccal gingival recessions were treated using the CRF technique. At baseline, and 1, 6, 12, and 60 months after surgery, location of gingival margin (LGM), probing depth (PD), clinical attachment level (CAL), width of keratinized gingiva (WKG), and location of mucogingival junction (LMGJ) were recorded. The alterations in the clinical measurements at the different evaluation times were analyzed using the Friedman and the repeated measure analysis of variance (ANOVA) tests, where applicable. Degree of association between continuous variables was calculated by the Pearson's correlation coefficient.

Results: The mean percentage of root coverage obtained at the end of 1 month was 68.26% ± 30.37% (P <0.05) and at 60 months, it was reduced to 44.86% ± 33.91% (P <0.01). LGM (r = 0.592, P <0.001), CAL (r = 0.590, P <0.01), WKG (r = 0.442, P <0.05), and LMGJ (r = 0.653, P <0.001) were found to be significantly correlated with the 60‐month postoperative values of LMGJ. At the end of the 60‐month follow‐up period, the mean apical displacement of LGM was 0.67 ± 0.72 mm and the same mean apical displacement value for LMGJ was 0.98 ± 1.19 mm.

Conclusions: Within the limits of this study, the 60‐month follow‐up findings indicated that the CRF procedure failed to maintain the gingival tissue in a coronal position and that the observed movement of the MGJ back to its original position was partially dependent on the apical movement of gingival margin.J Periodontol 2004;75:893‐901.
A Multicenter Study Evaluating the Sensitization Potential of Enamel Matrix Derivative After Treatment of Two Infrabony Defects
Authors: Froum Stuart , Weinberg Mea , Novak John , Mailhot Jason , Mellonig James , Van Dyke Thomas , McClain Pamela , Papapanou Panos N. , Childers Gail , Ciancio Sebastian , Blieden Tim , Polson Alan , Greenstein Gary , Yukna Raymond , Wallace Marshall Lynn , Patters Mark , Wagener Charles
Published: February 2005

Background: Several studies reported some success toward regeneration in infrabony defects using enamel matrix derivative (EMD). Clinically and statistically significant improvements in probing depth reduction, clinical attachment levels, and bone fill have been demonstrated. This multi‐center study evaluated the potential for sensitization to EMD in a subgroup of periodontal patients treated at least twice with at least 2 months between treatments.

Methods: Three hundred seventy‐six (376) patients in 11 university‐based postgraduate periodontics programs and five private practices were selected. Surgeries were performed on infrabony defects. Following reflection of mucoperiosteal flaps and debridement of the root surface and defect, root conditioning (either citric acid pH = 1 or 24% EDTA) was performed and the site was irrigated with sterile saline. Enamel matrix derivative was reconstituted and applied to the exposed root surface and the bony defect. Flaps were sutured and pressure applied for 5 minutes. The second test defect was treated in a similar manner at least 8 weeks after the first surgery. The patient was given a diary card where any subjective adverse events (erythema, swelling, itching, headache, root hypersensitivity, or pain) were recorded at weeks 1 and 2 post‐surgery. In addition, objective adverse events (gingival inflammation, ulcers, abscess, cratering, and lesions) were recorded by the investigator on an adverse event form.

Results: No clinical adverse reactions to multiple applications of EMD were noted. Of 376 patients, two were referred to a dermatologist for evaluation, but neither had signs indicating any adverse events due to EMD treatment. Instead their reactions were classified as a small local abscess and tinea cruris. The single immunoassay performed (on the patient with a small local abscess) did not demonstrate any EMD‐reactive antibodies, neither IgE nor IgG. Other subjective/objective reactions that occurred during this study were of the type that are commonly experienced by patients immediately following periodontal surgery, but were not related to EMD. They included headache, swelling, itching, pain, and root hypersensitivity.

Conclusions: This study demonstrated a lack of clinical adverse reactions following two separate applications of EMD. Any subjective/objective adverse reactions experienced by the patient were typical complications following routine periodontal surgery and were not directly related to the use of enamel matrix derivative. J Periodontol 2004;75:1001‐1008.
Relationship of Subgingival and Salivary Microbiota to Gingival Overgrowth in Heart Transplant Patients Following Cyclosporin A Therapy
Authors: Romito Giuseppe Alexandre , Pustiglioni Francisco Emílio , Saraiva Luciana , Pustiglioni Alessandro Nautili , Lotufo Roberto Fraga Moreira , Stolf Noedir Antônio Groppo
Published: February 2005

Background: Severe gingival overgrowth (GO) is induced in patients taking cyclosporin A (CsA) following organ transplantation. Determining which patient will develop GO is still not possible. The purpose of this study was to establish an association between CsA and gingival overgrowth in heart transplant patients taking into account periodontal and microbiological conditions.

Methods: Thirty patients (10 female, 20 male; range: 13 to 67 years; mean age: 44.89) undergoing CsA treatment were evaluated using the gingival index (GI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Subgingival samples collected from the deepest site of each quadrant and saliva samples were submitted to microbial analysis. All patients had at least 12 teeth. Exclusion criteria were the use of antibiotics and/or having undergone periodontal treatment 6 months prior to the study. Patients were divided in two groups: with gingival (GO+) and without gingival overgrowth (GO−).

Results: There were no statistically significant differences between the GO+ and GO− groups when CsA dosage, time since transplant, GI, PI, PD, and CAL were compared. Microbiological examination of the subgingival samples detected the following microorganisms: Actinobacillus actinomycetemcomitans (23%), Porphyromonas gingivalis (36%), Prevotella intermedia (93%), Fusobacterium sp. (66%), Campylobacter rectus (30%), Micromonas micros (66%), enteric rods (0%), and yeasts (30%). A positive association between M. micros and the GO+ group was found (P <0.001). Yeasts were detected in 30% of the subgingival and saliva samples.

Conclusions: Clinical parameters were not sufficient to determine which patients would develop GO. However, colonization by M. micros might play a role in the etiology of GO. J Periodontol 2004; 75:918–924.
A Comparative Study of Coronally Advanced Flaps With and Without the Addition of Enamel Matrix Derivative in the Treatment of Marginal Tissue Recession
Authors: Cueva Marco A. , Boltchi Farhad E. , Hallmon William W. , Nunn Martha E. , Rivera‐Hidalgo Francisco , Rees Terry
Published: February 2005

Background: The primary aim of this randomized, controlled, clinical investigation was to evaluate the differences in clinical parameters of root coverage procedures utilizing coronally advanced flaps (CAF) with and without enamel matrix derivative (EMD). Another aim was to evaluate if EMD can influence keratinization of tissues utilizing these procedures.

Methods: Fifty‐eight contralateral sites in 17 patients with ≥2 mm of Miller Class I, II, and III buccal marginal tissue recession were treated. Test sites received CAF plus EMD while control sites were treated with CAF only, with each patient serving as his own control. Patients were followed for 3 and 6 months. All data were analyzed using the method of generalized estimating equations. A P value <0.05 was considered significant (α = 0.05).

Results: There was a mean increase in keratinized tissue of 0.60 mm for test sites and a mean decrease of 0.05 mm for control sites. Test sites demonstrated significantly better root coverage (P <0.001), 89.7% and 92.9% root coverage after 3 months and 6 months, respectively, while control sites had 56.6% and 66.8% root coverage after 3 months and 6 months, respectively. There was significantly more root coverage among test sites compared to control sites, regardless of arch or Miller classification.

Conclusions: Based on the results of this study, the application of enamel matrix derivative to denuded root surfaces receiving coronally advanced flaps significantly increased the percentage of root coverage compared to CAF without EMD. In addition, EMD application was accompanied by a significant increase in keratinized tissue 6 months after surgery. J Periodontol 2004;75: 949‐956.
Guided Tissue Regeneration With Bioabsorbable Barriers. II. Long‐Term Results in Infrabony Defects
Authors: Eickholz Peter , Krigar Diana‐Maria , Pretzl Bernadette , Steinbrenner Harald , Dörfer Christof , Kim Ti‐Sun
Published: February 2005

Background: The aim of this 5‐year randomized controlled clinical trial was to evaluate the long‐term results after guided tissue regeneration (GTR) therapy of infrabony defects using two bioabsorbable barriers.

Methods: Fifteen pairs of contralateral infrabony defects in 15 patients with moderate to severe periodontitis were treated. Each patient received one polydioxanon (test: T) and one polylactide acetyltributyl citrate (control: C) barrier by random assignment. At baseline, 12, and 60 ± 3 months after surgery clinical parameters and standardized radiographs were obtained. Vertical bone levels (PBL‐V) were measured during surgery and 60 ± 3 months later by transgingival bone sounding.

Results: Thirteen patients were available for the 60‐month examinations. Twelve and 60 ± 3 months after GTR, statistically significant (P ≤0.001) vertical attachment (CAL‐V) gain was found in both groups (T12: 3.5 ± 1.5 mm; T60: 2.2 ± 1.8 mm; C12: 4.0 ± 0.9 mm; C60: 2.4 ± 1.0 mm). However, from 12 to 60 months after therapy both groups experienced significant CAL‐V loss (P <0.05): two defects in the test group and three in the control group had CAL‐V loss >2 mm compared to the 12‐month reexamination. Twelve and 60 ± 3 months after surgery, statistically significant (P <0.05) radiographic bony fill was found in both groups (T12: 1.2 ± 1.3 mm; T60: 1.5 ± 2.2 mm; C12: 0.9 ± 1.4 mm; C60: 1.0 ± 1.6 mm). Further, 60 months after surgery significant (P <0.05) PBL‐V gain was found in both groups (test: 1.8 ± 2.3 mm; control: 2.2 ± 1.8 mm). The study failed to show statistically significant differences between test and control regarding CAL‐V and PBL‐V gain 60 months after surgery.

Conclusion: CAL‐V gain achieved after GTR therapy in infrabony defects using both bioabsorbable barriers was stable after 5 years in 21 of 26 defects (81%). J Periodontol 2004;75:957‐965.
One‐ and 3‐Minute Plaque Removal by a Battery‐Powered Versus a Manual Toothbrush
Authors: Williams Karen , Ferrante Anita , Dockter Kathy , Haun Jan , Biesbrock Aaron R. , Bartizek Robert D.
Published: February 2005

Background: A new battery‐powered toothbrush with a fundamentally different design than other powered toothbrushes has recently been introduced. The new toothbrush has a powered oscillating round head and a second powered head that translates back and forth. This study compared the plaque removal efficacy of a manual toothbrush to this new powered toothbrush.

Methods: This randomized, controlled, examiner‐masked, four‐period cross‐over study examined plaque removal with the two toothbrushes following a single use in 40 subjects. Plaque was scored before brushing and after 1 and 3 minutes of brushing using the Turesky modification of the Quigley‐Hein index.

Results: Baseline plaque scores were 2.98 prior to using the powered toothbrush and 2.99 prior to using the manual toothbrush. The powered toothbrush delivered a covariance‐adjusted mean plaque score change from baseline of 0.61 after 1 minute of brushing and 0.93 after 3 minutes of brushing. The adjusted mean changes for the manual toothbrush were 0.43 and 0.62, respectively. The differences between treatment groups were statistically significant (P <0.001) after both 1 and 3 minutes of brushing. The powered toothbrush had, on average, 42.1% and 49.6% greater plaque removal scores after 1 minute and 3 minutes of brushing, respectively. Both toothbrushes had statistically significantly greater plaque removal scores after 3 minutes than after 1 minute of brushing (P <0.001). Plaque removal scores for each toothbrush after 3 minutes of brushing were about 50% higher than the scores after 1 minute of brushing.

Conclusions: The powered toothbrush delivered statistically significantly superior plaque removal after both 1 and 3 minutes of brushing compared to the manual toothbrush. Both toothbrushes showed statistically significantly greater plaque removal following 3 minutes of brushing than following 1 minute of brushing, and the difference between the toothbrushes was greater following 3 minutes of brushing than following 1 minute of brushing. J Periodontol 2004;75:1107‐1113.
Coronally Positioned Flap With or Without Acellular Dermal Matrix Graft in the Treatment of Class I Gingival Recessions: A Randomized Controlled Clinical Study
Authors: De Queiroz Côrtes Antonieta , Martins Ângela Guimarães , Nociti Francisco H. , Sallum Antonio Wilson , Casati Marcio Z. , Sallum Enilson A.
Published: February 2005

Background: The aim of this study was to clinically evaluate the treatment of Class I gingival recessions by coronally positioned flap with or without acellular dermal matrix allograft (ADM).

Methods: Thirteen patients with comparable bilateral Miller Class I gingival recessions (≥3.0 mm) were selected. The defects were randomly assigned to one of the treatments: coronally positioned flap and acellular dermal matrix (ADM group) or coronally positioned flap alone (CPF group). The clinical parameters included: probing depth (PD), clinical attachment level (CAL), recession height (RH), recession width (RW), height of keratinized tissue (HKT), thickness of keratinized tissue (TKT), plaque index (PI), and gingival index (GI). The measurements were taken before the surgeries and after 6 months.

Results: The mean baseline recession was 3.4 mm and 3.5 mm for ADM group and CPF group, respectively. After 6 months, both treatments resulted in significant root coverage (P <0.01), reaching an average of 2.6 mm (76%) in the ADM group and 2.5 mm (71%) in the CPF group. The difference in recession reduction between treatments was not statistically significant. There were no statistically significant differences between the treatments in PD, CAL, RH, RW, and HKT. However, the mean TKT gain was 0.7 mm for the ADM group and 0.2 mm for the CPF group (P <0.01).

Conclusion: It can be concluded that both techniques could provide significant root coverage in Class I gingival recessions; however, a greater keratinized tissue thickness can be expected with ADM. J Periodontol 2004;75:1137‐1144.
A Randomized Clinical Trial Comparing Enamel Matrix Derivative and Membrane Treatment of Buccal Class II Furcation Involvement in Mandibular Molars. Part I: Study Design and Results for Primary Outcomes
Authors: Jepsen Søren , Heinz Bernd , Jepsen Karin , Arjomand Mehrdad , Hoffmann Thomas , Richter Steffen , Reich Elmar , Sculean Anton , Gonzales José R. , Bödeker Rolf H. , Meyle Jörg
Published: February 2005

Background: The objective of this multicenter, randomized trial was to compare enamel matrix derivative (EMD; test) with barrier membranes (control) for the treatment of mandibular buccal Class II furcation defects.

Methods: Forty‐five patients with 90 comparable defects on contralateral molars were included. Defects were randomly assigned to EMD or bioabsorbable barrier membrane; the contralateral defect received the alternative treatment. Assessments at baseline and 8 and 14 months included gingival margin levels, probing depths, bleeding on probing, vertical attachment levels, and vertical bone sounding from a stent at five buccal sites/ tooth. Defect dimensions were recorded at surgery and during reentry at 14 months. Change of open horizontal furcation depth was the primary outcome variable. Adverse reactions and patient perceptions were also noted.

Results: Both treatment modalities led to significant clinical improvements. The median reduction of open horizontal furcation depth was 2.8 mm with the corresponding interquartile interval (1.5 mm, 3.5 mm) at test sites compared with 1.8 mm (1.0 mm, 2.8 mm) at control sites. The Hodges‐Lehmann estimator of the advantage (reduction test versus control) was 0.75 mm (95% confidence interval [CI]: 0.125 mm, 1.375 mm, P = 0.033, Wilcoxon). The frequency of complete furcation closure was 8/45 (test) and 3/45 (control); partial closure, 27/45 in both groups; no change, 9/45 and 11/45, respectively; and deterioration, 1/45 and 4/45, respectively. The frequency of no pain or no swelling at 1 week post‐surgery was 62% and 44%, respectively, at the test sites and 12% and 6% at the control sites.

Conclusion: There was a significantly greater reduction in horizontal furcation depth and a comparatively lower incidence of postoperative pain/swelling following enamel matrix derivative compared to membrane therapy. J Periodontol 2004;75:1150‐1160.
Periodontal Changes in Patients Undergoing Radiotherapy
Authors: Marques Marisa Alvarez Corazza , Dib Luciano Lauria
Published: February 2005

Background: The purpose of this study was to evaluate changes in the periodontium in patients who received head and neck radiation therapy.

Methods: Periodontal clinical parameters (probing depth, clinical attachment level, gingival recession, plaque index, and bleeding on probing) were assessed on 27 patients before and 6 to 8 months following radiation therapy in the head and neck area.

Results: The greatest changes occurred in clinical attachment level: overall, 70.3% of the patients showed a loss, with 92% evincing loss in the mandible. Attachment loss was directly related to the field of radiation and was greater when the jaws were actually included in the irradiated area.

Conclusion: Periodontal status should be evaluated prior to and following radiation therapy in the oral‐maxillary‐facial region to help ensure that periodontal health is maintained in oncology patients. J Periodontol 2004;75:1178‐1187.
Gingival Crevicular Fluid Levels of Interleukin‐1β and Glycemic Control in Patients With Chronic Periodontitis and Type 2 Diabetes
Authors: Engebretson Steven P. , Hey‐Hadavi Judith , Ehrhardt Fernando J. , Hsu Dan , Celenti Romi S. , Grbic John T. , Lamster Ira B.
Published: February 2005

Background: Patients with diabetes have increased incidence and severity of periodontal disease not accounted for by differences in the subgingival microbial infection. Poor glycemic control has been consistently associated with periodontal disease severity. Also, recent evidence suggests that hyperglycemia may induce inflammatory cytokine production. Few studies, however, have examined local biochemical measures of periodontal inflammation in patients with type 2 diabetes. The aim of this study was to determine whether glycemic control was related to gingival crevicular fluid (GCF) levels of interleukin‐1β (IL‐1β).

Methods: GCF samples were collected from 45 patients with type 2 diabetes and untreated chronic periodontitis. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and attachment level (AL) were recorded at six sites per tooth. IL‐1β levels were determined from individual GCF samples by enzyme‐linked immunoabsorbent assay (ELISA). Individual site and mean patient values were calculated. Glycated hemoglobin (HbA1c) levels were measured from anticoagulated whole blood using an automated affinity chromatography system. Serum glucose was also determined.

Results: Clinical periodontal measures (PD, AL, BOP) and measures of glycemic control (HbA1c, random glucose) were signifi‐ cantly correlated with GCF IL‐1β. Patients with greater than 8% HbA1c had significantly higher mean GCF IL‐1β levels than patients with less than 8% HbA1c. In a multivariate model adjusting for age, gender, PD, AL, BOP, and PI, HbA1c and random glucose were independent predictors of high GCF IL‐1β.

Conclusions: Poor glycemic control is associated with elevated GCF IL‐1β. These data are consistent with the hypothesis that hyperglycemia contributes to an heightened inflammatory response, and suggests a mechanism to account for the association between poor glycemic control and periodontal destruction. J Periodontol 2004;75:1203‐1208.