bluuebunny/crossref_metadata_2025 huggingface dataset:
Wound‐induced PAL activity is suppressed by heat‐shock treatments that induce the synthesis of heat‐shock proteins
Authors: Kang Ho‐Min , Saltveit Mikal E.
Published: October 2003

Wounding lettuce leaves induces the de novo synthesis of phenylalanine ammonia‐lyase (PAL, EC 4.3.1.5), the accumulation of phenolic compounds, and subsequent tissue browning. A brief heat‐shock at 45°C reduces the rise in wound‐induced PAL, the accumulation of phenolic compounds, and tissue browning. The activity of PAL measured 24 h after wounding and the content of phenolic compounds (absorbance of methanol extract at 320 nm) measured 48 h after wounding was highly correlated (R2 > 0.90) in tissue developing the normal wound response and in tissue subjected to 0–180 s of heat‐shock after wounding. The synthesis of a unique set of proteins called heat‐shock proteins (hsps) is induced by these heat‐shock treatments. Western‐blot analyses of proteins isolated from wounded and heat‐shocked Iceberg and Romaine lettuce mid‐rib leaf tissue was done using antibodies against hsp 23. Only those heat‐shock treatments that were effective at inducing the synthesis of hsp 23 were effective in reducing the activity of PAL induced by wounding and the subsequent accumulation of phenolic compounds. Hsps induced in non‐wounded, whole leaves by exposure to 45°C for 150 s did not significantly interact with PAL previously synthesized in non‐heat‐shocked wounded leaves to limit its activity. The preferential synthesis of hsps over that of wound‐induced PAL, rather than the presence of hsps, may be responsible for the ability of a heat‐shock treatment to reduce the wound‐induced increase in PAL activity. Our results support this novel concept, and the possibility that heat‐shock treatments can have significant physiological effects on the response of the tissue to other stresses, not because of the specific genes they induce or repress, or the products they cause to be synthesized, but by their secondary action of influencing the synthesis of other proteins (e.g. PAL) by the suppression of non‐hsps protein synthesis.
Redox sensing and signalling associated with reactive oxygen in chloroplasts, peroxisomes and mitochondria
Authors: Foyer Christine H. , Noctor Graham
Published: October 2003

Chloroplasts and mitochondria are the powerhouses of photosynthetic cells. The oxidation‐reduction (redox) cascades of the photosynthetic and respiratory electron transport chains not only provide the driving forces for metabolism but also generate redox signals, which participate in and regulate every aspect of plant biology from gene expression and translation to enzyme chemistry. Plastoquinone, thioredoxin and reactive oxygen have all been shown to have signalling functions. Moreover, the intrinsic involvement of molecular oxygen in electron transport processes with the inherent generation of superoxide, hydrogen peroxide and singlet oxygen provides a repertoire of additional extremely powerful signals. Accumulating evidence implicates the major redox buffers of plant cells, ascorbate and glutathione, in redox signal transduction. The network of redox signals from energy‐generating organelles orchestrates metabolism to adjust energy production to utilization, interfacing with hormone signalling to respond to environmental change at every stage of plant development.
The characterization of photoinhibition and recovery during cold acclimation in Arabidopsis thaliana using chlorophyll fluorescence imaging
Authors: Gray Gordon R. , Hope Bradley J. , Qin Xiaoqiong , Taylor Brian G. , Whitehead Carmen L.
Published: October 2003

The responses to photoinhibition of photosynthesis at low temperature and subsequent recovery were examined in Arabidopsis thaliana (ecotype Columbia) developed at 4°C cold‐acclimating conditions, 23°C non‐acclimating conditions and for non‐acclimated plants shifted to 4°C (cold‐shifted). These responses were determined in planta using Chl fluorescence imaging. We show that cold acclimation results in an increased tolerance to photoinhibition in comparison with non‐acclimated plants and that growth and development at low temperature is essential for this to occur. Cold‐shifted plants were not as tolerant as the cold‐acclimated plants. In addition, we demonstrate this tolerance is as a result of growth under high PSII excitation pressure, that can be modulated by growth temperature or growth irradiance. Cold‐acclimated and cold‐shifted plants fully recover from photoinhibition in the dark, whereas non‐acclimated plants show reduced levels of recovery and demonstrate a requirement for light. The role of the PSII repair cycle, PSII quenching centres, and the use of Chl fluorescence imaging to monitor photoinhibitory responses in planta are discussed.
Serum insulin‐like growth factors in normal pregnancy and in pregnancies complicated by preeclampsia
Authors: Hübinette Anna , Lichtenstein Paul , Brismar Kerstin , Vatten Lars , Jacobsen Geir , Ekbom Anders , Cnattingius Sven
Published: October 2003

Background.  Lower levels of insulin‐like growth factor I (IGF‐I) have been shown to be associated with preeclampsia and also with a reduced risk of breast cancer later in life. Lower levels of IGF before clinical signs of preeclampsia could be one possible mechanism in the etiology of preeclampsia as well as for the reduced risk of breast cancer associated with preeclampsia. We have prospectively investigated maternal serum levels of IGF‐I, IGF‐II, and the main binding protein insulin‐like growth factor binding protein 3 (IGFBP‐3) in women with and without preeclampsia.

Methods.  We used maternal serum samples from a Swedish–Norwegian cohort study obtained in the 17th and 33rd gestational week from 30 women who subsequently developed preeclampsia and 128 women who did not develop preeclampsia.

Results.  There were no significant differences in serum concentrations IGF‐I and IGFBP‐3 in the 17th or the 33rd week of gestation between women who developed preeclampsia or not. Compared with nonpreeclamptic women, preeclamptic women had significantly higher serum levels of IGF‐II in week 33, but there was no difference in week 17.

Conclusion.  In women who developed preeclampsia, we found no support for the hypothesis that the disease was preceded by lower serum levels of IGF‐I and IGF‐II, or higher serum levels of IGFBP‐3. However, among women who later developed preeclampsia, serum levels of IGF‐II were significantly higher in the 33rd gestational week.
Physical therapy for pregnancy‐related low back and pelvic pain: a systematic review
Authors: Stuge Britt , Hilde Gunvor , Vøllestad Nina
Published: October 2003

Background.  A systematic review of prospective controlled clinical trials was performed to assess the effectiveness of physical therapy interventions for the prevention and treatment of pregnancy‐related back and pelvic pain. Pregnancy‐related low back and pelvic pain has an impact on daily life for many women. Prevention and treatment of back and pelvic pain is therefore an important issue for all those concerned with women's health.

Methods.  All prospective controlled clinical trials retrieved by systematic searching of electronic databases, checking of reference lists and contacting of authors were examined. Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials. Authors were contacted to obtain missing information.

Results.  Nine trials with a total of 1350 patients were reviewed. Except for three high‐quality studies, the validity of the trials was moderate to low. Two high‐quality studies showed no difference in pain intensity and functional status between the exercise groups and the control groups. In the third high‐quality study significant reduction in sick leave was found in favor of water gymnastics compared with no intervention. Because the included trials were considered heterogeneous with regard to study design, population intervention and outcome, no meta‐analysis was performed.

Conclusions.  Because of heterogeneity and the varying quality of the studies no strong evidence exists concerning the effect of physical therapy interventions on the prevention and treatment of back and pelvic pain related to pregnancy. Future studies should meet current methodological standards, and interventions to be evaluated should be based on established theoretical framework.
Vaginal electrical stimulation of the pelvic floor: A randomized feasibility study in urinary incontinent elderly women
Authors: Spruijt Johan , Vierhout Mark , Verstraeten Rob , Janssens Jannes , Burger Curt
Published: October 2003

Background.  To evaluate the effectiveness of intravaginal electrical stimulation (ES) of the pelvic floor for urinary incontinence in elderly women, and to determine whether ES of the pelvic floor is a preferable treatment for urinary incontinence in elderly women.

Methods.  Postmenopausal women (age 65 years or older) were enrolled in a randomized clinical trial and underwent every‐other‐day ES of the pelvic floor, or a daily Kegel exercise (KE) program. Objective outcome variables were: (1) Urinary leakage (during a standardized PAD test), (2) pelvic muscle strength (measured by a perineometer), and (3) detrusor instability (on ambulant urodynamic registration). Subjective outcome variables were women's subjective assessment of change in urinary symptoms based on the PRAFAB score. Twenty‐four women treated with ES and 11 women treated with Kegel exercises completed the 8‐week study program. The Chi‐square test was used for statistical analysis.

Results.  No significant improvement in objective outcome variables was observed in the population treated with ES compared with the population treated with KE (with 29.2% vs. 36.4% of the women showing objective improvement in measured urinary leakage). Neither was subjective improvement significant, with 29.2% vs. 27.3% of the women reporting improvement in the amount of urinary leakage.

Conclusions.  Although the number of enrolled women was very small this study shows that:

Treating elderly women with vaginal ES of the pelvic floor has a high physical and emotional cost for the individual.

The effectiveness of ES of the pelvic floor in urinary incontinent elderly women is low.

There is no great discrepancy between objective amelioration (PAD test) and subjective amelioration (PRAFAB score/quantity of urinary leakage), if the objective improvement is adequately defined.

It is not reasonable to advise elderly women with urinary incontinence to undertake this treatment procedure. The effectiveness of treatment does not compensate for the long‐lasting and intense treatment protocol.

We terminated this study because of the negative outcome with ES.
Cause and risk of stillbirth in twin pregnancies: a retrospective audit
Authors: Skeie Annelise , FrØen J. Frederik , Vege Åshild , Stray‐Pedersen Babill
Published: October 2003

Background.  The epidemiology of twin pregnancies complicated by stillbirth of one or both fetuses is a scarcely examined area. The risk of perinatal death in twin pregnancies is increased 2–5 times compared to singletons, and the identification of preventable risk factors becomes increasingly important as the number of multiple pregnancies is rising. We report the causes of death in twin pregnancies and their respective risk factors.

Methods.  Twin pregnancies (n = 54) complicated by antepartum or intrapartum stillbirth of one or both twins (n = 68) and twin pregnancies with normal outcome (n = 103) in the counties of Oslo and Akershus, Norway, from 1986 to 1995 were included. The cases were classified and compared to the controls in multiple logistic regression analyses with regard to risk factors.

Results.  The risk of stillbirth increased with monochorionicity, non‐Western origin and assisted reproduction techniques (ART). The cases could be divided into eight different groups according to the primary diagnosis. The groups did not fit any of the existing cause‐of‐death classifications used on singleton stillbirths.

Conclusions.  The identification of monochorionic gestation should be made early in pregnancy to designate the level of risk. Assisted reproduction techniques leading to a high incidence of twins should be avoided. Health care professionals in the immigrant population should address the detrimental effects of consanguinity on reproductive outcome. We emphasize the need of a new cause‐of‐death classification for twin stillbirths.
Vascular endothelial growth factor and leptin: regulation in human cumulus cells and in follicles
Authors: Abbas Maysoon M. , J. Evans John , Sin Iris L. , Gooneratne Anoma , Hill Anne , Benny Peter S.
Published: October 2003

Background.  The factors that determine oocyte competency are poorly understood. It is believed that angiogenic factors are crucial. Modulation of these factors is therefore a central consideration. The adjacent association of cumulus cells to oocytes gives these cells a particular importance in relation to oocyte behavior. We report the effects of gonadotropins on the secretion of VEGF and leptin from cumulus cells; and the concentrations of the proteins in follicular fluid and their relationship to fertilization of oocytes in vitro.

Methods.  The subjects were women undergoing intracytoplasmic sperm injection (ICSI). Oocytes and follicular fluid were collected. Leptin and vascular endothelial growth factor (VEGF) concentrations in incubation supernatants and follicular fluid and leptin in cell lysates were measured. Fertilization of corresponding oocytes were noted. In the present study, cells from individual follicles were incubated, as well as pooled cells from a woman.

Results.  For the first time we demonstrated that VEGF release by human cumulus cells was modulated by gonadotropins in a dose‐related, time‐dependent manner, but no leptin was detected in either the supernatants after cumulus cell incubations or in cell lysates. Mean leptin levels were similar whether from follicles associated with eggs that were fertilized (14.4 ± 1.1 ng/ml, mean ± SEM) or not (12.4 ± 1.1 ng/ml). Mean VEGF levels were also similar (11.1 ± 1.2 ng/ml; 12.8 ± 1.3 ng/ml). A greater proportion of VEGF in follicles was derived from follicular activities, compared with transfer from other physiological compartments, than leptin.

Conclusions.  Whereas it is possible that VEGF is part of the gonadotropin‐mediated network that regulates development of the oocyte, leptin may not be produced in significant quantities by cumulus cells or be related to oocyte competency.
Laboratory animal models in periodontology
Authors: Weinberg Mea A. , Bral Michael
Published: October 2003

Abstract. Animal models are needed to objectively evaluate the pathogenesis of human periodontal diseases and its various treatment modalities. Selection of the appropriate animal model depends on the similarity of the periodontium and the nature of the disease to that of humans. The more commonly used animal models for studying the pathogenesis of periodontal disease, use of implants and guided tissue regeneration have been dogs and nonhuman primates. Periodontal disease in rodents has not been found to be as closely related to the human varieties. Rats and hamsters are best suited for caries and calculus research. Ferrets may be a promising new model for studying periodontal disease and calculus formation. Variables unique to each animal species are manifested by a wide range of clinical and histopathological features. Different species have distinct diets, habits, life spans, tissue structures, host defense mechanisms and genetic traits. This article describes the diversity seen in animal models used to study microbiological, immunological, and clinical features of periodontal disease and its prevention and treatment.
The effect of xylitol and chlorhexidine acetate/xylitol chewing gums on plaque accumulation and gingival inflammation
Authors: Simons D. , Beighton D. , Kidd E. A. M. , Collier F. I.
Published: October 2003

Abstract. Chewing gums may be suitable vehicles for the delivery of xylitol (X) and chlorhexidine acetate (CHX), both of which can aid oral health. The aim of this study was to determine the clinical effectiveness of chewing gums containing X or a combination of X and CHX in a double‐blind, randomised, cross over, 5‐day clinical trial, with a 9‐day washout period in a group of participants over 40 years old. After professional tooth cleaning, 8 subjects (mean age 51.3±10.4 years) used in a random order 2 pieces of ACHX (a liquorice flavoured CHX/X) gum, 2 pieces of BCHX (a chocolate mint flavoured CHX/X), 2 pieces of X (a liquorice flavoured X gum) and 1 piece of ACHX. Gums were chewed 2× daily for 15 min and volunteers refrained from all other oral hygiene procedures. Data were analysed using Friedman nonparametric analysis of variance. Plaque indices for chewing 2 pieces of ACHX gum (0.78±0.15) and BCHX gum (0.52±0.15) were significantly lower (p<0.0006) than for X gum (1.57±0.08). The gingival index was significantly greater (p<0.05) for X containing gum than for the other chewing regimes. The subjects' attitudes to the gums were also assessed by structured questionnaires which showed that all gums were easy to chew, did not adhere to dentures, teeth or restorations and that the subjects preferred to chew 2 pellets rather than 1.
Periodontal repair in dogs: effect of rhBMP‐2 concentration on regeneration of alveolar bone and periodontal attachment
Authors: Wikesjö Ulf M. E. , Guglielmoni Paola , Promsudthi Ananya , Cho Kyoo‐Sung , Trombelli Leonardo , Selvig Knut A. , Jin Lisa , Wozney John M.
Published: October 2003

Abstract. The objective of this study was to evaluate the effect of recombinant human bone morphogenetic protein‐2 (rhBMP‐2) concentration on regeneration of alveolar bone and cementum, and on associated root resorption and ankylosis. Contralateral, critical size, supra‐alveolar, periodontal defects were surgically produced and immediately implanted with rhBMP‐2 in an absorbable collagen sponge (ACS) carrier in 8, young adult, male, beagle dogs. 6 animals received rhBMP‐2/ACS (rhBMP‐2 at 0.05, 0.10, or 0.20 mg/mL; total construct volume/defect ˜4.0 mL) in contralateral defects following an incomplete block design. 2 animals received rhBMP‐2/ACS (rhBMP‐2 at 0 and 0.10 mg/mL) in contralateral defects (controls). The animals were euthanised at 8 weeks post‐surgery and block sections of the defects were collected for histologic and histometric analysis. Supra‐alveolar periodontal defects receiving rhBMP‐2 at 0.05, 0.10, or 0.20 mg/ml exhibited extensive alveolar regeneration comprising 86%, 96%, and 88% of the defect height, respectively. Cementum regeneration encompassed 8%, 6%, and 8% of the defect height, respectively. Root resorption was observed for all rhBMP‐2 concentrations. Ankylosis was observed in almost all teeth receiving rhBMP‐2. Control defects without rhBMP‐2 exhibited limited, if any, evidence of alveolar bone and cementum regeneration, root resorption, or ankylosis. Within the selected rhBMP‐2 concentration and observation interval, there appear to be no meaningful differences in regeneration of alveolar bone and cementum. There also appear to be no significant differences in the incidence and extent of root resorption and ankylosis, though there may be a positive correlation with rhBMP‐2 concentration.
Powered toothbrushes: a review of clinical trials
Authors: Heasman P. A. , McCracken G. I.
Published: October 2003

Abstract. There is now a vast range of powered toothbrushes (PTBs) available on the market and the efficacy of each product is usually determined in one, or a series of controlled clinical trials. This article reviews briefly the design of PTBs, some of the proposed indications for their use, and the principal observations from published studies of these products. The important issues regarding the regulation and design of trials involving PTBs are discussed and some recommendations are proposed with a view to developing a more structured approach to testing these products.
Clinical evaluation of Bio‐Oss®: a bovine‐derived xenograft for the treatment of periodontal osseous defects in humans
Authors: Richardson C. R. , Mellonig J. T. , Brunsvold M. A. , McDonnell H. T. , Cochran D. L.
Published: October 2003

Abstract. The purpose of this study was to compare the bovine derived xenograft (BDX) Bio‐Oss® to demineralized freeze dried bone allograft (DFDBA) in human intrabony defects. 17 healthy patients with no systemic disease with moderate‐severe periodontitis (7 males, 10 females; aged 34–67), were treated. Surgically, defects were included only if the intraosseous defect depth was >3.0 mm. Final selection included 30 defects. The sites were randomly assigned treatment with DFDBA or BDX. Soft tissue and osseous defect measurements were taken the day of surgery and 6 months post‐operatively at re‐entry. Average baseline PD, CAL, and surgical defect depth for the DFDBA group were not statistically different from the BDX group. No adverse healing response occurred. The results showed a statistically significant improvement in PD and AL for both materials at 6 months in 26 defects (4 defects did not respond to therapy). Soft tissue measurements for the DFDBA group included PD reduction of 2.0±1.3 mm, and AL gain of 2.6±1.6 mm, while the BDX group showed a PD reduction of 3.0±1.7 mm, and AL gain of 3.6±1.8 mm. Osseous measurements showed bone fill of 2.4 mm (46.8%) for the DFDBA group and 3.0 mm (55.8%) for the BDX group. Defect resolution was 59.4% for the DFDBA group and 77.6% for the BDX group. Statistical analysis revealed there was no statistical difference between the 2 materials in all measurements.
Topical distribution of FcgRI, FcgRII and FcgRIII in inflamed human gingiva
Authors: Yuan Zuan‐Ning , Schreurs Olav , Gjermo Per , Helgeland Kristen , Schenck Karl
Published: October 2003

Abstract. The topical distribution of Fc gamma receptor types I, II and III (FcγRI–III) was analyzed by means of immunohistochemistry in human gingival tissue obtained from 12 patients with chronic periodontitis. CD68+ macrophages expressing all three classes of FcγR were found throughout the whole gingival connective tissue (CT), whereas dense infiltrates of polymorphonuclear granulocytes (identified by staining for neutrophil elastase) with strong staining for FcγRIII and FcγRII were found subjacent to the apical part of the pocket epithelium (PE) and in the PE itself. CD19+ B lymphocytes with variable staining intensity for FcγRII were observed in clusters subjacent to the PE and extending into the central part of the CT. Only a few scattered CD3+ T lymphocytes stained for FcγRIII. Some spindle‐shaped cells (CD68−, therefore non‐macrophages) and apparently non‐cellular fibrous tissue elements stained for FcγRI and FcγRII. In the epithelium, FcgRII+ dendritic cells were frequently observed in the entire oral gingival epithelium and in the coronal part of the PE. Occasionally, some keratinocytes which stained for FcγII and FcγRIII were found. The observations indicate that FcγR of the various classes are amply expressed on numerous cell types in inflamed gingival tissue. The specific distribution pattern detected suggests that FcγRs may play a role in the mediation of chronic inflammation in the periodontal lesion.
The relationship between tooth cleaning behaviour and flexibility of working time schedule
Authors: Abegg Claides , Marcenes Wagner , Croucher Ray , Sheiham Aubrey
Published: October 2003

Abstract. This study tested whether there is a relationship between levels of flexibility of working time schedule and the pattern (frequency of tooth cleaning), structure (range of items used in tooth cleaning), and performance (relative effectiveness of tooth cleaning measured by levels of dental plaque) of tooth cleaning. 471 Brazilian workers from both sexes aged 24 to 44 years were selected from factories, offices, banks, shops and hospitals. Behavioural, socio‐economic and clinical data were collected through structured interviews and clinical examination. Data analysis included frequency distribution and simple and multiple logistic regression. The response rate was 92.5%. Simple logistic regression showed there was a highly statistically significant relationship between flexibility of the working time schedule and tooth cleaning frequency, the range of oral hygiene aids used and the level of dental plaque. All 3 associations remained highly statistically significant after adjusting for age, sex, socio‐economic status and marital status. Socio‐economic status was statistically significantly associated with tooth cleaning frequency, the use of oral hygiene aids and the level of dental plaque. It was concluded that high flexibility of working time schedule is related to pattern, structure and performance of tooth cleaning.
Option‐4 algorithm for Florida pocket depth probe: reduction in the variance of site‐specific probeable crevice depth measurements
Authors: Breen Harry J. , Rogers Pauline , Johnson Newell W. , Slaney Roger
Published: October 2003

Abstract. Clinical periodontal measurement is plagued by many sources of error which result in aberrant values (outliers). This study sets out to compare probeable crevice depth measurements (PCD) selected by the option‐4 algorithm against those recorded with a conventional double‐pass method and to quantify any reduction in site‐specific PCD variances. A single clinician recorded full‐mouth PCD at 1 visit in 32 subjects (mean age 45.5 years) with moderately advanced chronic adult periodontitis. PCD was recorded over 2 passes at 6 sites per tooth with the Florida Pocket Depth Probe®, a 3rd generation probe. The option‐4 algorithm compared the 1st pass site‐specific PCD value (PCD1) to the 2nd pass sitespecific PCD value (PCD2) and, if the difference between these values was >1.00 mm, allowed the recording of a maximum of 2 further measurements (3rd and 4th pass measurements – PCD3 and PCD4): 4 site‐specific measure‐meets were considered to be the maximum subject and tissue tolerance. The algorithm selected the 1st 2 measurements whose difference was ≤1.00 mm (SPCD1 and SPCD2). If no 2 measurements had a difference ≤1.00 mm, the examiner was required to select the 2 measurements closest to the rules of the algorithm. 4600 sites were available for analysis. 3992 sites (86.8%) required 2 recordings, 564 sites (12.3%) required 3 recordings and 44 sites (1%) required 4 recordings. Correlation coefficients for PCD1 and PCD2 and SPCD1 and SPCD2 were 0.83 and 0.96, respectively (p=0.00). Site‐specific variances were calculated for PCD1 and PCD2 and SPCD1 and SPCD2. The mean of the PCD1/PCD2 site‐specific variances (A) was 0.41 mm2 (range 0.00 mm2 to 33.62 mm2), whilst the mean of the SPCD1/SPCD2 variances (B) was 0.1 mm2 (range 0.00 mm2 to 2.0 mm2): the respective medians were 0.08 mm2 and 0.02 mm2. The study demonstrated high intra‐examiner PCD agreement. The option‐4 algorithm produced a reduction of 75.6% in the mean site‐specific variance of PCD1/PCD2 (Y) (Y=[(A‐B)/A]×100) and a 75% reduction in the median site‐specific variance of PCD1/PCD2.
Root debridement of molars with furcation involvement using diamond‐coated sonic scaler inserts during flap surgery – a pilot study
Authors: Kocher Thomas , Plagmann Hans‐Christian
Published: October 2003

Abstract. In our laboratory, we modified sonic scaler inserts to increase effectivity of root surface instrumentation of molars with furcation involvement during flap surgery. The working end of conventional sonic scaler inserts was thickened ellipsoidally and diamond coated. Inserts with variously angled shafts were designed in order to facilitate insertion into the furcation. A clinical, split‐mouth study examined the debridement of molars with furcation involvement during flap surgery using either hand instruments or diamond‐coated sonic scaler inserts with 15 patients. Average treatment time was cut by ca. 50%, using diamond coated inserts as compared to hand instruments for root surface debridement during surgery. 2 years after surgery, the clinical parameters had not been influenced by type of instrument used.
Granulocyte elastase activity and PGE2 levels in gingival crevicular fluid in relation to the presence of subgingival periodontopathogens in subjects with untreated adult periodontitis
Authors: Jin L. J. , Söder P.‐Ö. , Leung W. K. , Corbet E. F. , Samaranayake L. P. , Söder B. , Davies W. I. R.
Published: October 2003

Abstract. This study aimed to determine the association between the levels of granulocyte elastase and prostaglandin E2 (PGE2) in GCF, and the concomitant presence of periodontopathogens in untreated adult periodontitis (AP). GCF and subgingival plaque were sampled by paper strips and paper points respectively, from various periodontal sites in 16 AP subjects. Granulocyte elastase activity in GCF was analyzed with a low molecular weight substrate specific for granulocyte elastase, pGluProVal‐pNA, and the maximal rate of elastase activity (MR‐EA, mAbs/min/site) was calculated. PGE2 levels in GCF were determined by radioimmunoassay. 5 species‐specific DNA probes were used to detect the presence of A. actinomycetemcomitans (A.a., ATCC 43718), B. forsythus (B.f., ATCC 43037), P. gingivalis (P.g., ATCC 33277), P. intermedia (P.i., ATCC 33563), and T. denticola (T.d., ATCC 35405), with a sensitivity of 103 cells/paper point. No A.a. was detectable from all sites sampled. The predominant combination of species detected was B.f., P.g., P.i. & T.d. and it was significantly higher at periodontitis sites (68%) than at healthy (7%) or gingivitis sites (29%) (p<0.05). Overall, MREA values were strongly correlated with PGE2 levels (r=0.655, p<0.001), especially at these periodontitis sites co‐infected by B.f., P.g., P.i. & T.d. (r=0.722, p<0.001). The periodontitis sites co‐infected by the 4 species were observable from 15 subjects. These sites were sub‐grouped into 8 subjects with a high MREA and 7 subjects with a low MR‐EA. The PGE2 levels in the high MR‐EA group were significantly higher than in the low MR‐EA group (p<0.05). No significant differences in clinical or bacterial data were found between the two groups. While within the high MR‐EA group, similar results were found between the paired periodontitis sites in each subject with highest and lowest MR‐EA values. This study shows that the local host response to bacterial challenge in untreated periodontal pockets is diverse in terms of the intensity of inflammatory response measured by granulocyte elastase and PGE2 levels in GCF. A more thorough evaluation of the risk for active periodontal disease may involve the combined approaches to the test of the dynamic bacteria‐host relations.
Tobacco smoking and supragingival dental calculus
Authors: Bergström Jan
Published: October 2003

Abstract. Supragingival calculus is frequent in all ages from adolescence to old age. The influence of tobacco smoking on the occurrence and severity of supragingival calculus has received surprisingly little attention. The present investigation conducted in a population of 258 dentally aware individuals in the age range 20–69 years, was initiated to elucidate the relationship between tobacco smoking and supragingival calculus, taking into account possible confounding factors such as age, gender, oral hygiene and gingival inflammation. The calculus deposition was bilaterally assessed on the lingual surfaces of the mandibular anteriors and the vestibular surfaces of the maxillary premolars and molars. The overall prevalence of supragingival calculus was 69% ranging from 59% in age group 20–34 years to 84% in age group 50–69 years. The prevalence rates for current smokers, former smokers, and nonsmokers were 86%, 66%, and 65%. The differences between smoking groups were statistically significant (p<0.05). The influence of smoking was independent of age, plaque and gingival inflammation. In former smokers who had stopped smoking in the distant past, the occurrence and severity of supragingival calculus were very close to those in individuals who had never smoked, suggesting that the effect of smoking is reversible. The observations indicate a strong and independent association between tobacco smoking and supragingival calculus deposition. The avoidance of excess deposition of supragingival calculus, therefore, is a further argument for reducing smoking in the population.
Discrimination of refractory periodontitis subjects using clinical and laboratory parameters alone and in combination
Authors: Colombo A. P. , Haffajee A. D. , Smith C. M. , Cugini M. A. , Socransky S. S.
Published: October 2003

Abstract. The purpose of the present investigation was to use baseline clinical and laboratory parameters to distinguish subjects refractory to conventional periodontal therapy. Baseline clinical, microbial and host parameters were compared in 61 successfully‐treated and 27 refractory subjects. Refractory subjects showed mean full‐mouth attachment level (AL) loss and/or >3 sites with new AL loss >2.5 mm within 1 year after both scaling and root planing and surgery with systemic tetracycline. Successfully‐treated subjects showed mean AL gain and no sites with new ALloss>2.5mmafter either regimen. Gingival redness, bleeding on probing, suppuration, supragingival plaque accumulation, pocket depth and AL were measured at 6 sites per tooth in each subject. The levels of 40 subgingival taxa were determined in subgingival plaque samples from up to 28 sites in each subject using checkerboard DNA‐DNA hybridization. Serum antibody (Ab) to 85 subgingival species was determined using checkerboard immunoblotting. Levels of serum IgG2 and Gm23 allotype were measured using radial immunodiffusion; FcγRIIa and FcγRIIIb receptor haplotypes were determined using PCR and allele specific oligonucleotide probes. Odds ratios of a subject being refractory were determined by comparing measured parameters in the 2 subject groups using univariate and multivariate techniques. 17 of 151 clinical, microbial and immunological variableswere significant using χ2 analysis after adjusting for multiple comparisons. For example, the odds ratios of a subject being refractory were 12.2, 5.4 and 6.9 if the subject had Ab >50 μg/ml to >9 species; S. constellatus counts >2.4% of the total DNA probe count or >2.1% of sites with AL >6 mm. The 17 significant predictor variables were used in logistic regression and discriminant analyses. Similar variables were selected using both analyses including the number of serum Ab to subgingival species >50 mg/ml, % S. constellatus in plaque samples and % sites with attachment loss >6 mm. In the logistic regression analysis model, the odds ratios associated with >9 species exhibiting >Ab 50 μg/ml, >2.1% of sites with AL >6 mm and>2.4% S. constellatus in plaque were 8.7, 6.8 and 2.4, respectively, after adjusting for other variables in the model. Discriminant analysis using these variables provided sensitivity, specificity, positive and negative predictive values of 0.66, 0.92, 0.80 and 0.85 respectively. Refractory periodontitis subjects could be distinguished using a subset of clinical, microbiological and immunological parameters.
An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery
Authors: Thomason J. M. , Girdler N. M. , Kendall‐Taylor P. , Wastell H. , Weddel A. , Seymour R. A.
Published: October 2003

Abstract. Organ transplant patients are frequently medicated with triple immunosuppressive therapy that includes both cyclosporin and the corticosteroid, prednisolone. Many of these patients experience gingival overgrowth that necessitates surgical intervention. Chronic dosing with corticosteroids can lead to suppression of the hypothalamic‐pituitary axis, and subsequent adrenocortical suppression. To circumvent possible suppression, supplementary steroids are administered to such patients prior to so‐called ''stressful events''. We have examined the need for supplementary steroids in 20 organ transplant patients undergoing gingival surgery under local anaesthesia to correct their drug‐induced gingival overgrowth. All patients were operated upon in the first half of the morning. Prior to gingival surgery, resting blood pressure (BP) and serum ACTH concentrations were determined. Immediately before surgery patients received either intravenous hydrocortisone 100 mg or placebo in random, double‐blind order. Each patient required 2 gingivectomies and thus acted as their own placebo control. BP was measured at various time points throughout surgery and upto 2 h postoperatively. On completion of surgery, a further blood sample was taken to determine ACTH concentration. There was no significant difference (p>0.05) between placebo and hydrocortisone treatments for BP and ACTH measurements. No patient experienced any symptoms that were suggestive of adrenocortical suppression. One patient did experience postural hypotension prior to gingival surgery, but this is attributed to his antidepressant medication. We can conclude from this study that immunosuppressed organ transplant patients taking the maintenance dose of prednisolone (5–10 mg/day) do not require corticosteroid cover prior to gingival surgery under local anaesthesia. We would however, advocate monitoring of their blood pressure throughout the procedure.
Intraoral persistence ofActinobacillus actinomycetemcomitansin periodontally healthy subjects following treatment of diseased family members
Authors: Kleinfelder J. W. , Müller R. F. , Lange D. E.
Published: October 2003

Abstract. A. actinomycetemcomitans (Aa) can be transmitted among family members. The purpose of the present study was, to evaluate, whether A. actinomycetemcomitans is able to persist for a prolonged period of time in periodontally healthy subjects following elimination of this pathogen from diseased family members. In 14 periodontitis patients harboring Aa as well as in their 37 family members, the clinical (PPD, PAL, PlI, GI) and microbiological status (TSBV) was evaluated. After study patients received mechanical, surgical and antibiotic (3×375 mg amoxicillin+3×250 mg metronidazole/7 d) treatment, they, as well as their family members, were reassessed 3, 6, 9 and 12 months following therapy. From 13 spouses, 4 (31%) had periodontitis associated with Aa, 4 (31%) had periodontitis and no Aa, 2 (15%) were periodontally healthy and harbored Aa, 3 (23%) were healthy with no detection of Aa. From 24 off‐springs, one (4%) had periodontitis associated with Aa, 8 (33%) were healthy and harbored Aa, 15 (63%) were healthy with no detection of Aa. In the 2 spouses and in 7 of the 8 offsprings being healthy, but harboring Aa, this pathogen still persisted at the 12‐month appointment, after it had been eliminated from the diseased family members. Only one child became negative for Aa after 12 months. The results of this study indicate that A. actinomycetemcomitans is able to persist in the oral habitats of periodontally‐healthy subjects for at least 12 months, after this pathogen had been eliminated from diseased family members. This might suggest that also in healthy family members, A. actinomycetemcomitans as a source of transmission should be eliminated to prevent reinfection.
Risk of severe periodontal disease in a Swedish adult population
Authors: Norderyd Ola , Hugoson Anders , Grusovin Gabriella
Published: October 2003

Abstract. The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988–91. In 1973, a random sample of 474 dentate adults living in Jönko ping County was examined clinically and radiographically. A questionnaire on demographic and socio‐economic status, general health, and dental care habits was also used. During the years 1988–1991, 361 of the individuals examined in 1973 were re‐examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20–60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988–91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of >20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of >20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss >20% at ≥6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02–1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non‐progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (≥4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02–1.05), 1.01 (1.00–1.03), and 1.03 (1.00–1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06–1.19)), smoking (odds ratio 20.25 (5.07–80.83)), and % pockets ≥4 mm (odds ratio 1.15 (1.04–1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02–9.97) and 8.46 (CI: 1.97–36.37), respectively.
Microbiological features of Papillon‐Lefèvre syndrome periodontitis
Authors: Velazco C. H. , Coelho C. , Salazar F. , Contreras A. , Slots J. , Pacheco J. J.
Published: October 2003

Abstract. Papillon‐Lefèvre syndrome patients exhibit hyperkeratosis palmoplantaris and severe periodontitis. The syndrome is an autosomal recessive trait, but the mechanism of periodontal destruction is not known. This report presents the clinical and microbiological features of an 11‐year old girl with Papillon‐Lefěvre syndrome. Clinical examination included conventional periodontal measurements and radiographic analysis. In samples from 3 deep periodontal lesions, the occurrence of major suspected periodontopathic bacteria was determined by selective and non‐selective culture and polymerase chain reaction (PCR) identification, and the presence of cytomegalovirus and Epstein‐Barr type 1 virus by a nested‐PCR detection method. 10 of 22 available teeth demonstrated severe periodontal breakdown. Major cultivable bacteria included Actinobacillus actinomycetemcomitans (3.4% of total isolates), Prevotella nigrescens (16.4%), Fusobacterium nucleatum (14.3%) and Peptostreptococcus micros (10.6%). A. actinomycetemcomitans, P. nigrescens, Porphyromonas gingivalis and Eikenella corrodens were identified by PCR analysis. The patient's non‐affected parents and older brother revealed several periodontal pathogens but not A. actinomycetemcomitans. The viral examination demonstrated cytomegalovirus and Epstein‐Barr type 1 virus in the subgingival sample of the Papillon‐Lefèvre syndrome patient. The father and brother yielded subgingival cytomegalovirus but not Epstein‐Barr type 1 virus. We hypothesize that human herpesviruses in concert with A. actinomycetemcomitans play important rǒles in the development of Papillon‐Lefèvre syndrome periodontitis.
Bone formation in furcation defects
Authors: Araújo M. G. , Berglundh T. , Albrekstsson T. , Lindhe J.
Published: October 2003

Abstract. The aim of the present investigation was to study bone formation in an experimentally‐produced furcation defect in the dog. 15 foxhound dogs (group A) and 4 large mongrel dogs (group B) were used. The 2nd and 4th mandibular premolars were extracted and the 3rd lower premolars (3P3) were assigned as experimental teeth. ''Through and through'' furcation defects, about 4 mm high and 3 mm wide, were first produced in the experimental teeth of the dogs in group A. Reconstructive surgery was subsequently performed in group A using a GTR technique. The dogs of group A were scheduled for biopsy 2 weeks (2 dogs), 1 month (2 dogs), 2 months (2 dogs), 4 months (3 dogs), 5 months (3 dogs) and 6 months (3 dogs) after GTR. The dogs in group B (4 animals) represented healthy, untreated pristine furcations and served as positive controls. Biopsies from the 3P3 regions were harvested, embedded in paraffin and prepared for histological analysis. Mesio‐distal sections were cut with the microtome set at 7 μm. The sections were stained in hematoxylin and eosin, and Van Gieson. 3 sections, about 50 μm apart, and representing the central portion of the furcation site were selected for histological measurements. In group A, the proportions of various structures in the newly formed bone and marrow were assessed. In addition, the proportions of primary and secondary osteons, and the number of bone multicellular units (BMU)/mm2 mineralized bone tissue were determined. In the pristine furcations (group B), the histological analyses were performed in a corresponding area to that of the healing furcations. The results demonstrated that the process of bone formation in a large ''suprabony'' furcation defect can be divided into 3 different phases, namely, (i) the formation of a provisional connective tissue, (ii) the development of a primary bone spongiosa (including mainly woven bone), (iii) the replacement of the spongiosa by lamellar bone and bone marrow through processes of modeling and remodeling. The newly‐formed trabeculae of woven bone were reinforced by the deposition of parallel‐fibered bone and lamellar bone, a finding which substantiates the validity of the concept that woven bone possesses poor weight‐bearing properties and, hence, needs to be re‐inforced by a more mature type of bone. The modeling of the newly‐formed bone resulted in the formation of (i) one large marrow space in the center of the furcation and, in addition, (ii) a smaller bone marrow space in the most coronal portion of the defect. At the end of the study (6 months), the bone marrow occupied a much larger space than in the bone tissue of pristine furcations. It was suggested that the process of modeling or remodeling of bone tissue in the furcation defect was not completed at the end of the study.
Factors influencing the success of GBR
Authors: Zitzmann N. U. , Schärer P. , Marinello C. P.
Published: October 2003

Abstract. The aim of this retrospective clinical study was to evaluate the influence of different factors on the outcome of GBR treatment. 75 patients, who were not randomly assigned to the investigated parameters for clinical reasons, were included in the study. They presented with defect sites around implants and were treated with a xenogenic grafting material and a resorbable collagen membrane. The defect morphology was described, its dimension was measured and calculated at the time of implant installation and at re‐entry. The success of GBR treatment was related to several clinical variables and possible correlations were evaluated. Defect sites around maxillary implants showed significantly more bone fill (96%) compared to those in the mandible (78%). The insertion of a provisional restoration during the healing period was also associated with significantly better results than when no provisional was inserted. Immediate and short‐term delayed implant placements showed the best results both with 92% bone fill, when compared with long‐term delayed placements with 80% bone fill (n.s.). In sites with type I bone quality (compact bone), a reduced bone fill was observed (64%). The results indicate that successful bone fill can be achieved with GBR; this is more feasible in the maxilla, when a provisional restoration is used. Early implant placement timings seem to be preferable due to the alveolar ridge preservation, more favorable defect morphologies and a higher regenerative capacity.