bluuebunny/crossref_metadata_2025 huggingface dataset:
Five‐Year Clinical, Microbiological, and Radiological Outcome Following Treatment of Peri‐Implantitis in Man
Authors: Leonhardt Åsa , Dahlén Gunnar , Renvert Stefan
Published: February 2005

Background: The aim of this study was to evaluate the longterm outcome of a combined surgical and antimicrobial treatment of peri‐implantitis lesions in humans.

Methods: Nine partially dentate individuals with titanium implants demonstrating a marginal bone loss of ≥ three threads as compared to baseline measurements made from 1‐year intraoral radiographs, bleeding on probing, and/or suppuration from the peri‐implant sulci were included in the study. In each individual, subgingival bacterial samples were obtained and subjected to microbiological analysis by culture. Surgical exposure of the lesions and cleaning of the implants using hydrogen peroxide were performed. The patients were given systemic antibiotics according to a susceptibility test of target bacteria. The treatment was evaluated clinically, microbiologically, and radiograpically at 6 months, 1 year, and 5 years.

Results: Seven out of 26 implants with peri‐implantitis at baseline were lost during the 5‐year follow‐up period despite a significant reduction in the presence of plaque and gingival bleeding. Four implants continued to lose bone, 9 had an unchanged bone level, and 6 gained bone. Five of the patients were treated with antibiotics directed against putative periodontopathogens, i.e.,A. actinomycetemcomitans, P. intermedia, or P. gingivalis; three patients were treated for presence of enterics (E. coli and E. cloace); and, in one patient, treatment was directed against S. aureus.

Conclusions: Despite treatment and retreatment, seven implants were lost. However, the applied surgical and antimicrobial treatment strategy for advanced peri‐implantitis lesions was successful in 58% of the implants treated during the 5‐year follow‐up period. Smoking seemed to be a negative risk factor for treatment success. J Periodontol 2003;74:1415‐1422.
Amelogenin: A Potential Regulator of Cementum‐Associated Genes
Authors: Viswanathan Hema L. , Berry Janice E. , Foster Brian L. , Gibson Carolyn W. , Li Yong , Kulkarni Ashok B. , Snead Malcolm L. , Somerman Martha J.
Published: February 2005

Background: Studies suggest that enamel matrix proteins induce differentiation and mineralization of a variety of mesenchymal cells, including odontoblasts, osteoblasts, and cementoblasts. It has been postulated that this activity could be due to amelogenin‐like proteins, known to be present in some mixtures of enamel matrix derivatives. Amelogenins have been reported to induce expression of a mineralized tissue‐specific marker, bone sialoprotein (BSP), indicating that epithelial products can regulate the activity of mesenchyme‐derived cells.

Methods: To explore the molecular mechanisms involved in BSP regulation, a clonal population of immortalized murine cementoblasts (OCCM‐30) was exposed to full‐length murine amelogenin protein (rp(H)M180), 0.1 µg/ml to 10.0 µg/ml, for 8 days in vitro. To further investigate the potential epithelial‐mesenchymal interaction, an amelogenin knockout mouse model was used to examine expression of BSP and other markers, including Type I collagen, in tissue samples.

Results: The lowest dose of amelogenin slightly enhanced BSP expression, whereas at the highest dose, a dramatic decrease (three‐fold) in BSP expression was observed. Parallel experiments showed a corresponding decrease in mineral nodule formation in vitro for cells treated with the higher dose of rp(H)M180. In situ hybridization and immunohistochemical analysis of sections from amelogenin null mice revealed a dramatic reduction in expression of BSP mRNA and protein in cementoblasts and surrounding osteoblasts in comparison to age‐matched controls. In contrast, the expression of Type I collagen was not significantly different from controls.

Conclusion: These data suggest that amelogenin may be a critical signaling molecule required for appropriate development of the periodontium. J Periodontol 2003;74:1423‐1431.
Antibody Responses of Periodontitis Patients to Gingipains of Porphyromonas gingivalis
Authors: Inagaki Satoru , Ishihara Kazuyuki , Yasaki Yuriko , Yamada Satoru , Okuda Katsuji
Published: February 2005

Background: Arginine‐ and lysine‐specific cysteine proteinases (arg‐gingipain: Rgp, lys‐gingipain: Kgp) are major virulence factors of Porphyromonas gingivalis. Recent reports have suggested that antibodies against gingipains can play a protective role against infection by P. gingivalis. The purpose of this study was to evaluate the IgG responses of patients with periodontitis to functional domains of gingipains.

Methods: A group of 29 periodontitis patients and 10 periodontally healthy subjects (control group) were recruited into this study. We prepared three recombinant fragments of rgp A (catalytic domain; r‐Rgp CAT) and two hemagglutinin domains (r‐Rgp 44, and r‐Rgps 15‐27) corresponding to amino acid residues 228 to 719, 720 to 1136, and 1137 to 1704, respectively. One fragment of the Kgp catalytic domain (r‐Kgp CAT) corresponding to amino acid residues 229 to 737 and expressed in Escherichia coli was also used. IgG antibody levels to these recombinant proteins in sera from the subjects were determined by an enzyme‐linked immunosorbent assay (ELISA).

Results: We found that IgG levels against r‐Rgp 44 and r‐Rgps 15‐27 in sera obtained from the patients were significantly higher than those in the healthy group (P <0.01). In contrast, no significant differences in IgG levels against r‐Rgp CAT and r‐Kgp CAT were found between the control and patient groups. The IgG responses to P. gingivalis sonic extracts, r‐Rgp 44 and r‐Rgps 15‐27, were related to probing depth in sera from patients, but those to r‐Rgp CAT and r‐Kgp CAT were not.

Conclusion: The present findings suggest that the low responsiveness of IgG antibody against the catalytic domains of gingipain, r‐Rgp CAT, and r‐Kgp CAT is a key factor in infection by P. gingivalis. J Periodontol 2003;74:1432‐1439.
Associations of Periodontal Status with General Health Conditions and Serum Antibody Titers for Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans
Authors: Furuichi Yasushi , Shimotsu Akihiro , Ito Hiroo , Namariyama Yukari , Yotsumoto Yukiharu , Hino Youichi , Mishige Yukie , Inoue Masakazu , Izumi Yuichi
Published: February 2005

Background: The purpose of the present study was to evaluate associations of periodontal status with general health conditions and with serum antibody titers for Porphyromonas gingivalis (Pg) and Actinobacillus actinomycetemcomitans (Aa) in a Japanese population.

Methods: Subjects (1,314) aged 40 years or older were recruited for the study. Their periodontal status was evaluated using the community periodontal index of treatment needs (CPITN). Records from general health examinations were used for the present analyses, including data on age, gender, body mass index, systolic and diastolic blood pressure (SBP/DBP); levels of serum alkaline phosphatase, total cholesterol, high‐density lipoprotein cholesterol, triglyceride, fasting blood glucose, and C‐reactive protein (CRP); counts of white blood cells (WBC) and platelets; smoking habit; and electrocardiogram recordings. Serum IgG antibody titers for Pg fimbrial antigens (IgG.Pg.Fim.), Pg whole‐cell antigens (IgG.Pg.whol.), and Aa whole‐cell antigens (IgG.Aa.whol.) were determined using enzymelinked immunosorbent assay. The subjects were divided, according to their maximum CPITN codes, into four periodontal groups: max.CPITN‐0/1/2, ‐3, ‐4, or ‐MS (missing sextant).

Results: Multivariable logistic regression analyses revealed significant associations of the max.CPITN–4 subjects who were males (odds ratio, OR: 2.03) or smokers (OR: 1.73), or who had high diastolic blood pressure (OR: 1.27), high WBC (OR: 1.24), high serum CRP level (OR: 2.39) and high serum IgG.Pg.Fim. (OR: 1.17), IgG.Pg.whol. (OR:1.54), and IgG.Aa.whol. (OR: 1.19) titers.

Conclusion: Significant associations between periodontal status and several health conditions were found in the adult population examined, including gender, smoking habit, diastolic blood pressure, white blood cell counts, C‐reactive protein, and serum IgG antibodies to P. gingivalis fimbriae, IgG P. gingivalis whole cell, and IgG A. actinomycetemcomitans whole cell titers. J Periodontol 2003;74:1491‐1497.
Guided Tissue Regeneration‐Based Root Coverage: Meta‐Analysis
Authors: Al‐Hamdan Khalid , Eber Robert , Sarment David , Kowalski Charles , Wang Hom‐Lay
Published: February 2005

Background: The goal of guided tissue regenerationbased root coverage (GTRC) is to repair gingival recession via new attachment formation. Numerous clinical trials have been conducted utilizing the concept of GTR to promote root coverage. Most GTRC studies have had relatively small sample sizes and have not utilized power calculations to determine appropriate sample size; therefore, it is difficult to draw strong conclusions from them. Hence, the purpose of this study is to combine data from currently available GTRC studies and to use meta‐analysis to determine whether GTRC provides significantly improved clinical outcomes compared to conventional periodontal plastic surgical approaches for the treatment of marginal tissue recession.

Methods: Studies were identified that used GTR approaches to treat gingival recession from January 1990 to October 2001. Information from each study was entered into a database. Data were analyzed according to the following criteria: GTRC versus conventional mucogingival surgery (CMGS); membrane type; root conditioning; pretreatment recession depth; adjunctive use of bone replacement graft (BRG); and source of funding. Studies were ranked independently, and mean data from each were weighted accordingly. Meta‐analysis was performed using the weighted means for each group. Paired t tests were used to determine statistical significance between each pair of groups.

Results: Forty papers were included for analysis. GTRC resulted in an average of 74% recession depth reduction, 41% complete root coverage, 3 mm AL gain, and 1 mm KG gain. Both GTRC and CMGS produced significant (P <0.05) improvement compared to baseline measurements. Compared to GTRC, CMGS resulted in significantly (P<0.05) increased KG (2.1 mm vs. 1.1 mm), root coverage (81% vs. 74%), and percentage of defects with complete root coverage (55% vs. 41%). Use of absorbable membranes, root conditioning, shallow pretreatment recession (<4 mm), and corporate sponsorship all resulted in significantly (P<0.05) improved percentages of sites with complete root coverage but had no effect on other parameters.

Conclusions: Based on this meta‐analysis, guided tissue regeneration‐based root coverage can be used successfully to repair gingival recession defects. Conventional mucogingival surgery, however, resulted in statistically better root coverage, width of keratinized gingiva, and complete root coverage. J Periodontol 2003;74:1520‐1533.
Gingival/Soft Tissue Abscess Following Subepithelial Connective Tissue Graft for Root Coverage: Report of Three Cases
Authors: Vastardis Sotirios , Yukna Raymond A.
Published: February 2005

Background: The subepithelial connective tissue graft (SCTG) is a predictable technique for root coverage. The small number of potential postoperative problems make SCTG the current treatment of choice for reversing gingival recession.

Methods: The purpose of this article is to report three cases of complications after the use of an SCTG where an abscess occurred following the initial healing phase. The surgical technique that was used and the treatment that was provided for the abscesses are reported, and the possible causes of these complications are discussed.

Results: The abscesses were treated conservatively, and no recurrence has been observed after treatment.

Conclusions: Possible causes of the abscesses include “stitch abscess” or reaction to the suture material used for the submerged sutures, or a possible role of epithelium implanted during the procedure. The clinical outcome of the root coverage procedure was not affected. J Periodontol 2003;74:1676‐1681.
Association Between Alveolar Bone Loss and Elevated Serum C‐Reactive Protein in Japanese Men
Authors: Saito Toshiyuki , Murakami Masatoshi , Shimazaki Yoshihiro , Oobayashi Kyoko , Matsumoto Sumihisa , Koga Toshihiko
Published: February 2005

Background: Moderate elevation of C‐reactive protein (CRP) is thought to predict type 2 diabetes and cardiovascular disease (CVD), both of which are associated with periodontitis. Recent studies indicate that periodontal disease is associated with moderate elevation of CRP; however, the relationship between alveolar bone loss (ABL) and CRP elevation is unclear.

Methods: A total of 179 Japanese men aged 50 to 54 years old, with at least 10 teeth, were examined as part of a comprehensive health examination before retirement from the Japan Self‐Defense Force. ABL was measured at proximal sites of posterior teeth on a panoramic x‐ray film. The relationship between the mean ratio of ABL to root length and serum CRP level and other variables was analyzed.

Results: ABL was significantly correlated with serum CRP level (P = 0.008), alkaline phosphatase (P = 0.008), high‐density lipoprotein (HDL) cholesterol (P = 0.04, inversely), white blood cell count (P <0.001), erythrocyte sedimentation rate (P = 0.002), age (P = 0.03), and smoking history (P <0.001). In a multiple logistic regression model adjusted for age, smoking history, systolic blood pressure, body‐mass index, triglyceride, and HDL cholesterol, subjects in the highest tertile of ABL had an increased risk for CRP elevation ≥1.3 mg/l (odds ratio [OR] = 8.20; 95% confidence interval [CI], 1.6 to 40.7; P = 0.01) when compared to the lowest tertile of ABL.

Conclusion: ABL around posterior teeth was associated with elevated CRP in Japanese men, suggesting an association between periodontal disease and increased risk of type 2 diabetes and CVD. J Periodontol 2003;74:1741‐1746.
Effects of Nd:YAG and CO2 Laser Treatment and Ultrasonic Scaling on Periodontal Pockets of Chronic Periodontitis Patients
Authors: Miyazaki Akira , Yamaguchi Toshikazu , Nishikata Jun , Okuda Kazuhiro , Suda Satoru , Orima Kazuko , Kobayashi Tetsuo , Yamazaki Kazuhisa , Yoshikawa Eiji , Yoshie Hiromasa
Published: February 2005

Background: The aim of the present study was to compare the effectiveness of Nd:YAG and CO2 laser treatment to that of ultrasonic scaling used as monotherapies by examining clinical parameters, subgingival microflora, and interleukin‐1 beta (IL‐1β) in gingival crevicular fluid (GCF).

Methods: Eighteen patients, each of whom had 2 or more sites with probing depth measuring >5 mm, were included this clinical trial. The 41 sites were randomly assigned treatment with either Nd:YAG laser alone (n = 14, 100 mj, 20 pps, 2.0 W, 120 seconds), CO2 laser alone (n = 13, 2.0 W, 120 seconds), or ultrasonic scaling alone (n = 14, maximum power, 120 seconds). At baseline and at 1, 4, and 12 weeks, clinical measurements (plaque index, PI; gingival index, GI; probing depth, PD; clinical attachment level, CAL; and bleeding on probing, BOP) were performed and subgingival plaque and GCF sampled. A quantitative analysis of Porphyromonas gingivalis was carried out using real‐time polymerase chain reaction (PCR) procedures. The amounts of IL‐1β were estimated by an enzyme‐linked immunosorbent assay (ELISA).

Results: Decreased inflammation and PD were observed in all 3 groups after treatment. A microbiological analysis indicated significant decreases in P. gingivalis in the Nd:YAG and scaling groups at 1, 4, and 12 weeks compared to baseline (P <0.05). The amount of GCF significantly decreased in the Nd:YAG and scaling groups at 12 weeks. The amount of IL‐1β increased in the CO2 group from baseline to 1 week (P <0.05). The Nd:YAG group tended to show a decrease in IL‐1β from 1 to 12 weeks, although these data were not statistically significant.

Conclusions: Our data suggest that Nd:YAG laser and ultrasonic scaling treatments showed significant improvements regarding the clinical parameters and subgingival microflora compared to the baseline, but no significant difference was observed between the 3 groups. J Periodontol 2003;74:175‐180.
Gene Therapy of Bone Morphogenetic Protein for Periodontal Tissue Engineering
Authors: Jin Q‐M. , Anusaksathien O. , Webb S.A. , Rutherford R.B. , Giannobile W.V.
Published: February 2005

Background: The reconstruction of lost periodontal support including bone, ligament, and cementum is a major goal of therapy. Bone morphogenetic proteins (BMPs) have shown much potential in the regeneration of the periodontium. Limitations of BMP administration to periodontal lesions include need for highdose bolus delivery, BMP transient biological activity, and low bioavailability of factors at the wound site. Gene transfer offers promise as an alternative treatment strategy to deliver BMPs to periodontal tissues.

Methods: This study utilized ex vivo BMP‐7 gene transfer to stimulate tissue engineering of alveolar bone wounds. Syngeneic dermal fibroblasts (SDFs) were transduced ex vivo with adenoviruses encoding either green fluorescent protein (Ad‐GFP or control virus), BMP‐7 (Ad‐BMP‐7), or an antagonist of BMP bioactivity, noggin (Ad‐noggin). Transduced cells were seeded onto gelatin carriers and then transplanted to large mandibular alveolar bone defects in a rat wound repair model.

Results: Ad‐noggin treatment tended to inhibit osteogenesis as compared to the control‐treated and Ad‐BMP‐7‐treated specimens. The osseous lesions treated by Ad‐BMP‐7 gene delivery demonstrated rapid chrondrogenesis, with subsequent osteogenesis, cementogenesis and predictable bridging of the periodontal bone defects.

Conclusion: These results demonstrate the first successful evidence of periodontal tissue engineering using ex vivo gene transfer of BMPs and offers a new approach for repairing periodontal defects. J Periodontol 2003;74:202‐213.
Immediate Functional and Non‐Functional Loading of Dental Implants: A 2‐ to 60‐Month Follow‐Up Study of 646 Titanium Implants
Authors: Degidi Marco , Piattelli Adriano
Published: February 2005

Background: The aim of this study was the evaluation, from a clinical point of view, of implants subjected to immediate functional loading (IFL) and to immediate non‐functional loading (INFL) in various anatomical configurations.

Methods: The study included 152 patients who had given their informed consent. A total of 646 implants were inserted. The implants were placed in 39 totally edentulous mandibles, 14 edentulous maxillae, 23 edentulous posterior mandibles, 16 edentulous anterior mandibles, 16 edentulous anterior maxillae, and 15 edentulous posterior maxillae. Fifty‐eight implants were used to replace single missing teeth. In 65 cases, IFL was carried out for 422 implants. INFL was carried out in 116 cases, (224 implants).

Results: In the IFL group 6 of 422 implants failed (1.4%); in the INFL group 2 of 224 implants failed (0.9%). All the other implants appeared, from clinical and radiographic observations, to have successfully osseointegrated and have been functioning satisfactorily since insertion. All failures were observed in the first few months after implant loading.

Conclusion: Immediate functional and non‐functional loading seems to be a technique that gives satisfactory results in selected cases. J Periodontol 2003;74:225‐241.
An Autologous Cell Hyaluronic Acid Graft Technique for Gingival Augmentation: A Case Series
Authors: Prato Giovan Paolo Pini , Rotundo Roberto , Magnani Cristina , Soranzo Carlo , Muzzi Leonardo , Cairo Francesco
Published: February 2005

Background: An autologous cell hyaluronic acid graft was used for gingival augmentation in mucogingival surgery.

Methods: Seven sites from 6 patients were used in this study. Five patients (5 sites) needed gingival augmentation prior to prosthetic rehabilitation, and one patient (2 sites) needed augmentation because of pain during daily toothbrushing. Full‐mouth plaque score (FMPS), full‐mouth bleeding score (FMBS), probing depth (PD), and clinical attachment level (CAL) were recorded for the sites at baseline and 3 months after surgery. The amount of keratinized tissue (KT) was measured in the mesial, middle, and distal sites of each involved tooth. A small 2 ×1 ×1 mmportion of gingiva (epithelium and connective tissue) was removed from each patient, placed in a nutritional medium, and sent to the laboratory. The gingival tissue was processed: keratinocytes and fibroblasts were separated and only fibroblasts were cultivated. They were cultured on a scaffold of fully esterified benzyl ester hyaluronic acid (HA) and returned to the periodontal office under sterile conditions. During the gingival augmentation procedure, the periosteum of the selected teeth was exposed, and the membrane containing cultivated fibroblasts was adapted to and positioned on the site.

Results: Three months after surgery, an increased amount of gingiva was obtained, and the histological examination revealed a fully keratinized tissue on all the treated sites.

Conclusion: Tissue engineering technology using an autologous cell hyaluronic acid graft was applied in gingival augmentation procedures and provides an increase of gingiva in a very short time without any discomfort for the patient. J Periodontol 2003;74: 262‐267.
Subgingival Plaque Removal at Interdental Sites Using a Low‐Abrasive Air Polishing Powder
Authors: Petersilka Gregor J. , Tunkel Jochen , Barakos Katerina , Heinecke Achim , Häberlein Ingo , Flemmig Thomas F.
Published: February 2005

Background: The aim of the study was to test the efficacy of a novel low‐abrasive air polishing powder in subgingival plaque removal at interdental sites during periodontal maintenance therapy (PMT).

Methods: Using a split mouth design, subgingival plaque was removed in 23 PMT patients using a low abrasive powder using a standard air polishing unit (test) or curets (positive control). Before and immediately after treatment, subgingival plaque samples were taken from interdental sites with 3 to 5 mm probing depth (PD) at 2 test teeth and 2 positive control teeth. To evaluate the influence of sampling on the microflora, plaque samples were also taken twice at 2 teeth without therapy with PD of 3 to 5 mm (negative control). PMT treatment and plaque sampling were repeated 3 times at quarterly intervals. Anaerobe cultivation was utilized to assess the mean reduction of total colony forming units (CFU) immediately after treatment.

Results: Test treatment resulted in a significantly greater reduction in subgingival bacterial counts (log 1.9 ± 0.7) than positive control treatment (log 1.1 ± 0.6) and subgingival plaque sampling alone (log 0.5 ± 0.5; P <0.05). Differences between positive and negative control were not significant (P <0.05).

Conclusion: The novel low‐abrasive air polishing powder is superior to curets in removing subgingival plaque at interdental sites with up to 5 mm probing depth in PMT. J Periodontol 2003;74:307‐311.
Can Toothpaste or a Toothbrush with Antibacterial Tufts Prevent Toothbrush Contamination?
Authors: Quirynen Marc , De Soete Marc , Pauwels Martine , Gizani Sotiria , Van Meerbeek Bart , van Steenberghe Daniel
Published: February 2005

Background: Periopathogens and cariogenic species survive more than 48 hours on toothbrushes even under dry storage. This study examined a decontamination of toothbrushes by means of the bactericidal effect of different toothpastes or special coating of the tufts.

Methods: Eight untreated periodontitis patients were professionally brushed, using a new toothbrush per quadrant and 3 different toothpastes containing either amine/stannous fluoride (AmF/SnF2),amine fluoride (AmF), or a mild surfactant as major antibacterial component (excipient), or no paste (C). The brushes were rinsed and stored dry at room temperature. At different time intervals, 4 tufts per toothbrush were processed for selective and non‐selective culturing procedures. The protocol was repeated comparing AmF/SnF2 and C with 2 toothbrushes with coated tufts (coat1 and coat2).

Results: At baseline, C brushes (n = 16) harbored 107, 108, and 106 colony forming units (CFU) of aerobic, anaerobic, and black pigmented species, respectively. After 24 hours 106 CFU of aerobic and anaerobic species could still be cultured from 14 of the 16 brushes. Black‐pigmented species remained detectable up to 4 hours; detection frequencies for Fusobacterium nucleatum and Streptococcus mutans at 24 hours were 5/16. With AmF/SnF2 and AmF toothpaste the number of adhering bacteria was already 2 log lower at baseline (P <0.05), but not for the excipient (0.5 log, P = 0.7). With AmF/SnF2 no vital species could be detected after 8 hours. AmF reduced the bacterial survival rate significantly more than the excipient, but less than AmF/SnF2 (P<0.05). The bactericidal effect of coat1 and coat2 was negligible when compared to C (P >0.20), and clearly inferior to the AmF/SnF2paste (P <0.0001). After 24 hours these brushes still harbored >105 CFU.

Conclusions: Toothpastes can significantly reduce contamination of toothbrushes, but their bactericidal activity is dependent on their composition. Coated tufts failed to limit the bacterial contamination. J Periodontol 2003;74:312‐322.
Effects of 2.94 µm Er:YAG Laser Radiation on Root Surfaces Treated In Situ: A Histological Study
Authors: Folwaczny Matthias , Benner Klaus‐Ulrich , Flasskamp Barbara , Mehl Albert , Hickel Reinhard
Published: February 2005

Background: Previous scanning electron microscopy (SEM) studies using extracted teeth have shown the potential of infrared Er:YAG laser radiation to remove subgingival calculus without causing severe thermal changes, e.g., charring or fusion, to the irradiated root surface. The purpose of the present study was to examine the morphologic changes on root surfaces following Er:YAG laser irradiation in situ using histological observation.

Methods: The periodontal pockets of 6 premolars, canines, and incisors that remained in situ in the jaws of human corpses were irradiated with Er:YAG laser radiation at 60 mJ, 100 mJ, or 180 mJ. The pockets were treated in a similar manner to normal clinical circumstances with a total amount of either 50 or 100 laser pulses. Following laser treatment, the entire tooth, marginal gingiva, and underlying alveolar bone were removed from the jaw. The sections were embedded in methyl‐methacrylate, serially cross‐sectioned, stained with hematoxylin and eosin or gallamine blue, and examined under a light microscope. Additionally, the extension of the thermally changed tissue areas was determined using digital images and histometry.

Results: The histological examination revealed two kinds of thermal changes within the laser‐treated root surface. Firstly, a thin superficial layer 5 to 10 µm in width was observed. The surface of this layer showed ultrastructural irregularities. Secondly, a semicircular more deeply stained area close to the apical end of the scaling track beneath the irradiated cementum was observed. The depth of this area ranged from 255 µm to 611 µm and appeared to be independent of the radiation energy.

Conclusion: In contrast to previous SEM studies, the histological examination indicated thermal changes within the hard tissue bordering the periodontal pocket following Er:YAG laser irradiation. J Periodontol 2003;74:360‐;365.
The Influence of Nacre Surface and Its Modification on Bone Apposition: A Bone Development Model in Rats
Authors: Bahar Hila , Yaffe Avinoam , Binderman Itzhak
Published: February 2005

Background: Bone graft substitutes are currently used individually or in various combinations in reconstructing bone defects. Nacre, marine mineralized structure, was recently proposed as a very biocompatible and osteoinductive material for use in periodontal and implant surgery. Our aim was to investigate the interaction between natural nacre and fresh bone marrow, during bone development, in an ectopic site of DA rats. Surface modifications of nacre were tested.

Methods: Demineralized bone matrix (DBM) cylinders (demineralized cortex of diaphysis) prepared from rat femurs were filled with fresh marrow, which was removed from other 2‐month old DA rat femurs. Natural nacre particle or nacre which was treated with HCl, phosphate buffer saline (PBS), and Ca(OH)2 to modify its surface was placed into the DBM cylinders. The cylinders were implanted subcutaneously at the thoracic region of growing DA rats. After 4 weeks the cylinders were surgically removed, fixed in buffered formalin, and x‐rayed. Scans of the microradiographs and histological evaluation of the DBM cylinders including bone developed at the interface of nacre and its surface modifications were compared to marrow controls.

Results: The results show that natural nacre is a poor conductive biomaterial in a bone developmental environment. Nacre surface treated with Ca(OH)2 and PBS was found to be most biocompatible. In this group, new bone was apposed directly on the nacre surface and the total amount of bone was highest in comparison to other treatment groups.

Conclusions: This study does not support previous observations that nacre is osseoinductive. Our model system seems to be very sensitive and capable of testing interaction between surface modifications of biomaterials and fresh marrow in the process of new bone development. J Periodontol 2003;74:366‐371.
Clinical Outcome Observed in Subjects with Recurrent Periodontal Disease Following Local Treatment with 25% Metronidazole Gel
Authors: Jansson H. , Bratthall G. , Söderholm G.
Published: February 2005

Background: The aim of this study was to evaluate the clinical outcome in patients with recurrent periodontal disease following treatment with 25% metronidazole gel.

Methods: Twenty subjects in a maintenance care program but with recurrent periodontal disease participated. Three months after scaling and root planing, a total of 40 sites, 2 in each patient, with probing depth ≥5 mm were selected. One site randomly selected was treated with metronidazole gel (test) and the other site with a placebo gel (control). Baseline and follow‐up measurements included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL).

Results: There were no statistically significant differences in PI, GI, BOP, PD, or CAL between test and control sites.

Conclusion: This study showed that local treatment with 25% metronidazole gel did not seem to influence the clinical healing in this group of subjects with recurrent periodontal disease. J Periodontol 2003;74:372‐377.
Permeability and Morphology of Dentin after Erosion Induced by Acidic Drinks
Authors: Prati Carlo , Montebugnoli Lucio , Suppa Pietro , Valdrè Giovanni , Mongiorgi Romano
Published: February 2005

Background: The aims of this study were to evaluate 1) the alterations of dentin permeability after single exposure of dentin to several acidic soft drinks with different acid composition; 2) the effectiveness of smear layer on dentin surface to prevent erosion of sound dentin; and 3) the role of brushing procedures.

Methods: Dentin discs from human third molars were prepared. Each disc was treated with 0.5 M neutral EDTA for 5 minutes to remove the smear layer and to calculate the maximum fluid flow rate for each disc (to which an arbitrary value of 100% was assigned) using a pressure apparatus working at 1.0 psi. An homogeneous thin smear layer was then recreated with an abrasive paper under water. The following acidic drinks were applied for 5 minutes onto dentin surface: cola drink (phosphoric acid), orange fruit juice (ascorbic + citric acid), white wine (tartaric acid), vinegar (acetic acid), and mucolytic syrup (benzoic and tartaric acid). Each sample was then brushed for 3 minutes. Finally, each sample was brushed with a toothpaste and, as the final step, etched with phosphoric acid for 1 minute. Permeability was measured after each step.

Results: All acidic drinks were able to statistically increase dentin permeability and to open dentinal tubules by removing the smear layer.

Conclusions: The study demonstrated that acidic drinks increased dentin permeability by removing and dissolving the smear layer and smear plugs. The erosion of peritubular dentin and smear plug removal is the main agent responsible for the increase in dentin permeability and probably for clinical dentin hypersensitivity. Brushing procedures reduced dentin permeability, creating a new fine and thin smear layer. Toothpaste may play a protective role in preventing complete smear layer removal and reducing dentin hypersensitivity by producing a new artificial smear layer and deposit inside tubules. The use and the abuse of acidic drinks may damage dentin and increase the risk for dentin hypersensitivity. J Periodontol 2003;74:428‐436.
Transforming Growth Factor‐Beta 1 Expression in the Peri‐Implant Soft Tissues of Healthy and Failing Dental Implants
Authors: Cornelini Roberto , Rubini Corrado , Fioroni Massimiliano , Favero Gian Antonio , Strocchi Rita , Piattelli Adriano
Published: February 2005

Background: Transforming growth factor‐beta (TGF‐β) is composed of a family of multifunctional polypeptide growth factors involved in embryogenesis, inflammation, regulation of immune response, angiogenesis, wound healing, and extracellular matrix formation. TGF‐β1 is the most common isoform found in human tissues. A role of TGF‐β in the pathogenesis of periodontal disease has been suggested. The aim of the present study was a comparative immunohistochemical evaluation of TGF‐β1 in normal keratinized gingiva and in the peri‐implant soft tissues surrounding failing non‐submerged implants.

Methods: Twenty patients participated in this study. Ten biopsies from healthy keratinized mucosa and 10 biopsies from periimplant soft tissues surrounding failing implants were obtained (one biopsy per patient). The biopsies were obtained from different patients.

Results: In 5 cases of healthy mucosa, the stromal cells were positive between 1 to 5. In 7 cases, the epithelial layers were positive, between 1 and 18 cells. The superficial epithelial layer was negative in all cases. In 9 cases, there was a positivity of the vascular component, between 2 and 16 vessels. In failing implants, the stromal cells were positive in 6 cases, between 1 and 4. In all cases, cells of the epithelial layers were positive, between 15 and 40. The vascular component was positive in all cases, between 12 and 30 vessels. The differences between TGF‐β1 expression in the epithelium around healthy and failing implants were statistically significant (P<0.0001). The differences between TGF‐β1 expression in the blood vessels in the soft tissues around healthy and failing implants were also statistically significant (P <0.0001). No statistically significant difference was observed between the 2 groups in the TGF‐β1 expression in the stromal cells (P = 0.88).

Conclusion: TGF‐β1 may be one of the most important factors in the regulation of the infiltrate, and in the production of tissue repair with a stimulation of fibroblasts and endothelial cells. J Periodontol 2003;74:446‐450.
Surgical Crown Lengthening: Evaluation of the Biological Width
Authors: Lanning Sharon K. , Waldrop Thomas C. , Gunsolley John C. , Maynard J. Gary
Published: February 2005

Background: Previous surgical crown lengthening studies have investigated positional changes of the free gingival margin but not the biological width. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biological width. However, very little work has been done in humans. Therefore, the purpose of this study was to evaluate the positional changes of the periodontal tissues, particularly the biological width, following surgical crown lengthening in human subjects.

Methods: Twenty‐three (23) patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening) and adjacent teeth with adjacent and non‐adjacent sites: plaque and gingival indexes, free gingival margin, probing depth, attachment level, bone level, direct bone level, and biological width. During surgery, the bone level was reduced based on the future prosthetic margin and predetermined biological width; flaps were placed at the bony crest. Patients were examined at baseline and at 3 and 6 months postoperatively.

Results: Eighteen patients completed the study. Overall, the amount of bone resected was 1 to 5 mm. At 90% of treated sites, ≥3 mm of bone was removed. At 3 months, the apical displacement of the free gingival margin at non‐adjacent, adjacent, and treated sites was 2.46 ± 0.25 mm, 2.68 ± 0.20 mm, and 3.07 ± 0.16 mm, respectively. There was no significant change in the position of the free gingival margin from 3 to 6 months. The biological width at all sites was smaller at 3 and 6 months compared to baseline (P<0.05) except for the treated sites, which were not significantly different from baseline at 6 months.

Conclusions: During surgical crown lengthening, the bone level was lowered for placement of the prosthetic margin and reestablishment of the biological width. The biological width, at treated sites, was reestablished to its original vertical dimension by 6 months. In addition, a consistent 3 mm gain of coronal tooth structure was observed at the 3‐ and 6‐month examinations.J Periodontol 2003;74:468‐474.
Mutations of F110 and C126 of the Formyl Peptide Receptor Interfere with G‐Protein Coupling and Chemotaxis
Authors: Jones Barbara E. , Miettinen Heini M. , Jesaitis Algirdas J. , Mills John S.
Published: February 2005

Background: Localized aggressive periodontitis (LAgP) is a disease characterized by rapid loss of alveolar bone in teeth of otherwise healthy patients. Neutrophils from LAgP patients have been shown to exhibit diminished chemotaxis and low levels of formyl peptide receptor (FPR) surface expression. A recent study has associated LAgP with 2 polymorphisms in the FPR: 110Phe→Ser and 126Cys→Trp.

Methods: We transfected Chinese hamster ovary cells with wtFPR, FPR‐110Phe→Ser, FPR‐126Cys→Trp, or FPR‐110 Phe→Ala and determined their surface expression of FPR, their ligand binding affinity, their G‐protein coupling, and their chemotaxis toward N‐formyl‐methionyl‐leucyl‐phenylalanine (FMLP).

Results: FPR‐110Phe→Ser mutants failed to show any significant surface expression or chemotaxis toward FMLP. FPR‐126Cys→Trp mutants exhibited slightly lower than normal binding affinity, markedly lower G‐protein coupling response, and markedly lower chemotaxis toward FMLP than that observed with wtFPR. We also analyzed another FPR‐Phe110 mutant, FPR‐110Phe→Ala, to ascertain what the effect of mutating this residue might be in a mutant that could be expressed on the cell surface. The FPR‐110Phe→Ala mutant demonstrated markedly lower surface expression, normal ligand binding affinity, markedly lower G‐protein coupling, and markedly lower chemotaxis toward FMLP.

Conclusions: Our data substantiate the hypothesis that the chemotactic defects observed in LAgP patients are due at least in part to molecular alterations in the FPR. The FPR‐110Phe→Ser polymorphism appears to be more defective than the FPR‐126Cys→Trp polymorphism, indicating that patients with the former polymorphism might be expected to exhibit a more severe form of aggressive periodontitis. J Periodontol 2003; 74:475‐484
A Pilot Study on Antiplaque Effects of Mastic Chewing Gum in the Oral Cavity
Authors: Takahashi Keiso , Fukazawa Munemoto , Motohira Hitoshi , Ochiai Kuniyasu , Nishikawa Hirofumi , Miyata Takashi
Published: February 2005

Background: Chemical plaque control is a useful aid in mechanical oral hygiene, and various chemical agents have been evaluated as antiplaque agents. It has been shown that mastic chewing gum has antibacterial effects on Helicobacter pylori. In this study, the antiplaque effect of mastic chewing gum was investigated.

Methods: Twenty dental students who were both systemically and periodontally healthy participated in this study. The effects of mastic gum were assessed from 2 double‐blinded, randomized studies. In the first trial, after mechanical toothbrushing, the inhibitory effect of mastic gum on bacteria in saliva following its use was compared to a placebo gum. Saliva samples were collected at the end of 1, 2, 3, and 4 hours; diluted; inoculated onto 10% horse blood chocolate agar plates; and cultured anaerobically at 37°C for 48 hours. The total number of bacterial colonies on each plate was calculated (n = 20). In the second trial, the effects of mastic gum on de novo plaque formation on tooth surfaces and gingival inflammation were evaluated over a 7‐day period without mechanical oral hygiene following random use of either mastic or placebo chewing gum. The degree of plaque accumulation and gingival inflammation were compared between the 2 groups (n = 10).

Results: The total number of bacterial colonies was signifi‐cantly reduced during the 4 hours of chewing mastic gum compared to the placebo gum (P<0.05, Student t test). The mastic group showed a significantly reduced plaque index (2.69 ± 0.29 versus 3.15 ± 0.24; P = 0.001, Student t test) and gingival index (0.44 ± 0.15 versus 0.66 ± 0.23, P = 0.021, Student t test) compared to the placebo group.

Conclusion: These results suggest that mastic chewing gum is a useful antiplaque agent in reducing the bacterial growth in saliva and plaque formation on teeth. J Periodontol 2003;74:501‐505.
Evaluation of p53, bcl‐2, and Interleukin‐15 Levels in Gingival Crevicular Fluid of Cyclosporin A‐Treated Patients
Authors: Buduneli Eralp , Genel Ferah , Atilla Gül , Kütükçüçler Necil
Published: February 2005

Background: Apoptosis plays an important role in the maintenance of tissue homeostasis. Considering that apoptosis mediators may play a role in the pathogenesis of drug‐induced gingival overgrowth, this study was conducted to evaluate p53, bcl‐2, and interleukin‐15 (IL‐15) levels in gingival crevicular fluid (GCF) of cyclosporin A (CsA)‐treated patients.

Methods: Twenty renal transplant patients exhibiting CsA‐induced gingival overgrowth and 15 systemically healthy gingivitis patients were included in the study; 15 systemically and periodontally healthy volunteer subjects served as the healthy control group. GCF samples were obtained from one interdental site with gingival overgrowth (GO+) and one site without (GO–) from each CsA‐treated patient; hyperplasia index, probing depth, papilla bleeding index, and plaque presence were recorded. One site from each gingivitis patient and healthy control was selected, GCF samples were obtained, and the same clinical parameters were recorded. GCF p53, bcl‐2, and IL‐15 levels were analyzed by enzyme‐linked immunosorbent assay. The results were tested statistically.

Results: p53 and bcl‐2 levels were below the minimum detectable level in all GCF samples analyzed. CsA GO+ and CsA GO– sites, as well as gingivitis sites, exhibited significantly higher GCF levels of IL‐15 compared to healthy controls (P <0.05). The difference between CsA GO+ sites and gingivitis sites was not statistically significant, although the total amount of IL‐15 in CsA GO+ sites was lower than gingivitis sites (P >0.05). The total amount of IL‐15 in CsA GO– sites was significantly lower than gingivitis sites (P <0.05). No significant correlation was found between the clinical parameters and GCF IL‐15 levels (P>0.05).

Conclusions: The pathogenesis of CsA‐induced gingival overgrowth is multifactorial. The findings of the present study indicate that IL‐15 may play a role in the pathogenesis of CsA‐induced gingival overgrowth due to its interactions with CsA and its role in apoptosis and inflammation. J Periodontol 2003;74:506‐511
Reliability of Clinical Attachment Level Recordings: Effects on Prevalence, Extent, and Severity Estimates
Authors: López Rodrigo , Retamales Carolina , Contreras Carolina , Montes José L. , Marín Alejandro , Væth Michael , Baelum Vibeke
Published: February 2005

Background: Although unreliability of periodontal measurements is considered mainly to concern attempts to detect true changes in longitudinal studies, it is also a source of variability that may substantially decrease the precision of estimates obtained in cross‐sectional studies. This study assessed the effects of measurement errors on estimates of prevalence, extent, and severity of clinical attachment loss.

Methods: Four examiners performed repeat attachment level recordings in 128, 122, 134, and 133 adolescents, respectively, who participated in a study of clinical attachment loss among 9,162 high school students from Santiago, Chile. A total of 48,954 duplicate recordings were made. Two examiner teams carried out repeat examinations among 292 and 254 subjects, respectively, corresponding to a total number of 51,600 duplicate recordings for interexaminer reliability assessment.

Results: A sizeable imprecision was noted regarding prevalence estimates, particularly at the ≥1 mm level, whereas examiners were reasonably consistent in the assessment of the number of sites with clinical attachment loss. Ninety‐five percent of the differences regarding the number of sites with clinical attachment loss ≥1 mm were in the range from –5 to 5 sites for intraexaminer comparisons, and from –9 to 8 sites for interexaminer comparisons. These differences should be seen in light of the number of sites affected, which ranged from 0 to 85 sites.

Conclusions: Examiner variation may preclude comparisons of prevalence estimates between studies. Valid comparisons may be made between studies of extent estimates provided that uniform parameters are used to express the extent of periodontal breakdown. J Periodontol 2003;74:512‐520.
Peri‐Implant Soft Tissue Integration of Immediately Loaded Implants in the Posterior Macaque Mandible: A Histomorphometric Study
Authors: Siar Chong Huat , Toh Chooi Gait , Romanos George , Swaminathan Dasan , Ong Ah Hup , Yaacob Hashim , Nentwig Georg‐Hubertus
Published: February 2005

Background: Today, one critical goal in implant placement is the achievement of optimal soft tissue integration. Reports thus far have demonstrated successful soft tissue preservation in delayed loaded implants placed in anterior jaws. The aim of this study was to histomorphometrically examine the soft tissues around immediately loaded implants placed in the macaque posterior mandible.

Methods: Splinted crowns on screw‐shaped titanium implants (8 mm length, 3.5 mm diameter) were utilized. Three implants each were placed in the premolar‐molar edentulous mandibular segments of 6 adult monkeys (Macaca fascicularis); one side served as the control (delayed loading) and the other as the test sites (immediate loading). The animals were sacrificed after 3 months of loading. Histomorphometry of 6 soft tissue indices including the sulcus depth (SD), junctional epithelium (JE), connective tissue contact (CTC), biologic width (BW = SD + JE + CTC), DIM (distance between the implant top and coronal gingiva), and DIB (distance between the implant top and first implant‐to‐bone contact) was performed on nondecalcified sections.

Results: No significant differences in the mean soft tissue scores (mm) between the test (SD = 0.68 ± 0.63; JE = 1.71 ± 1.04; CTC = 1.51 ± 1.14; DIM = 2.27 ± 1.18; DIB = 1.32 ± 1.21; BW = 3.9) and control (SD = 0.88 + 0.57; JE = 1.66 + 0.77; CTC = 1.24 ± 0.92; DIM = 2.38 ± 0.81; DIB = 1.19 ± 0.91; BW = 3.78) groups were observed (P >0.01).

Conclusion: These findings suggest that the dimensions of the peri‐implant soft tissues were within the biologic range and were not influenced by immediate functional loading or posterior location of the implants in the macaque mandible. J Periodontol 2003;74:571‐578.