bluuebunny/crossref_metadata_2025 huggingface dataset:
Myospherulosis Complicating Cortical Block Grafting: A Case Report
Authors: Fisher Steven C. , Horning Gregory M. , Hellstein John W.
Published: February 2005

Background: Myospherulosis of the oral cavity is an inflammatory, granulomatous lesion historically associated with the use of petrolatum‐based antibiotic ointment placed in third molar extraction sites to prevent postoperative infection.

Methods: A case of bilateral myospherulosis is presented, in which large lesions complicated the procurement of a cortical block graft used to prepare a mandibular molar edentulous space for implant placement. By obtaining the block graft from a more lateral location on the mandible, an adequate graft was procured and was successfully grafted into an atrophic edentulous ridge.

Results: The cortical block graft was successfully incorporated by the recipient site, which received a wide‐body, threaded dental implant 6 months later. Healing was uncomplicated, and a functional implantsupported restoration was successfully achieved.

Conclusions: Myospherulosis, though rare today, may present a significant obstacle to the procurement of cortical block grafts. In this case, thorough debridement of the material resulted in subsequent healing of the myospherulosis defect, but prevented procurement of the cortical graft from the planned site. The dimension and volume of the neighboring cortical bone were adequate, and the augmented edentulous space was subsequently restored with a functional endosseous implant. The success seen in these 2 sites would seem to confirm the assumption that size and location of myospherulosis defects are critical factors in obtaining a successful clinical result in implant patients. J Periodontol 2001;72:1755‐1759.
Clinical Comparison of Bioactive Glass Bone Replacement Graft Material and Expanded Polytetrafluoroethylene Barrier Membrane in Treating Human Mandibular Molar Class II Furcations
Authors: Yukna Raymond A. , Evans Gerald H. , Aichelmann‐Reidy Mary Beth , Mayer Elizabeth T.
Published: February 2005

Background: Class II furcations present difficult treatment problems and historically several treatment approaches to obtain furcation fill have been used.

Methods: The response of mandibular Class II facial furcations to treatment with either bioactive glass (PG) bone replacement graft material or expanded polytetrafluoroethylene (ePTFE) barrier membrane was evaluated in 27 pairs of mandibular molars in 27 patients with moderate to advanced periodontitis. Following initial preparation, full thickness flaps were raised in the area being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically prepared and chemically conditioned. By random allocation, PG or ePTFE was placed into or fitted over the furcations, packed or secured in place, and the host flap replaced or coronally positioned with sutures. Postsurgical deplaquing was performed every 10 days leading up to ePTFE removal at about 6 weeks. Continuing periodontal maintenance therapy was provided until surgical reentry at 6 months for documentation and any further necessary treatment.

Results: Direct clinical measurements demonstrated essentially similar clinical results with both treatments for bone and soft tissue changes. There were no statistically or clinically significant differences (e.g., mean horizontal furcation fill 1.4 mm PG, 1.3 mm ePTFE; mean percent horizontal furcation fill 31.6% PG, 31.1% ePTFE, both P >0.85). Seventeen of the PG treated and 18 of the ePTFE furcations became Class I clinically and 1 furcation completely closed clinically with each treatment. Intrapatient comparisons showed similar horizontal furcation responses with both treatments.

Conclusion: The findings of this study suggest essentially equal clinical results with PG bone replacement graft material and e‐PTFE barriers in mandibular molar Class II furcations. PG use was associated with simpler application and required no additional material removal procedures. J Periodontol 2001;72:125‐133.
Systemic Neutrophil Response Resulting From Dental Plaque Accumulation
Authors: Kowolik Michael J. , Dowsett Sherie A. , Rodriguez Jessica , De La Rosa R Manuel , Eckert George J.
Published: February 2005

Background: There is considerable current interest in putative relationships between oral and systemic diseases. Since the host response to oral bacteria may be the critical link in this association, our hypothesis was that dental plaque accumulation in healthy subjects would elicit a systemic inflammatory response.

Methods: Twenty‐three healthy subjects, aged 18 to 25, participated in a 4‐phase study. An initial hygiene phase was followed by a 21‐day experimental phase (the so‐called experimental gingivitis model) in which subjects refrained from all oral hygiene practices, thus permitting the accumulation of bacterial plaque. At days 0, 7, and 21 total and differential peripheral white blood cell (wbc) counts, together with full mouth plaque and gingivitis scores, were recorded. Following a 28‐day recovery phase, in which normal oral hygiene practices were resumed, subjects entered the final 21‐day control phase which mirrored the experimental phase but with subjects maintaining normal oral hygiene practices.

Results: The experimental model performed as anticipated with a correlation between plaque and gingivitis scores of 0.95, also reflecting subject compliance. Total wbc and neutrophil counts increased during the experimental phase. Furthermore, comparison of neutrophil counts between the experimental and control phases demonstrated a significantly higher cell count for the experimental phase on both days 7 and 21 (P = 0.0301 and 0.009, respectively). For total wbc, this was significant on day 21 (P = 0.0262).

Conclusion: The results of this study support the hypothesis that the accumulation of dental plaque can result in a measurable systemic inflammatory response, providing further in vivo data to support a mechanistic relationship between oral and systemic pathology. J Periodontol 2001;72:146‐151.
Mitotic Activity of Keratinocytes in Nifedipine‐ and Immunosuppressive Medication‐Induced Gingival Overgrowth
Authors: Nurmenniemi Petri K. , Pernu Hilkka E. , Knuuttila Matti L. E.
Published: February 2005

Background: The purpose of the study was to compare mitotic activity in the basal cell layer of normal human gingiva and in nifedipine‐ and immunosuppressive medication‐induced gingival overgrowth.

Methods: Gingival samples were collected from 19 generally healthy individuals, 12 nifedipine‐medicated cardiac patients, and 22 immunosuppression‐medicated (azathioprine, prednisolone, and cyclosporin A) organ transplant recipients. The transplant recipients were divided into those not taking nifedipine and those taking nifedipine. Cryostat sections were stained with monoclonal antibody for Ki‐67, using an avidin‐biotinenzyme complex method. The mitotic activities of epithelial cells were determined as percentages of Ki‐67 labeled cells in relation to total numbers of epithelial cells in the basal layer of oral, oral sulcular, and sulcular epithelium.

Results: Mitotic activities were significantly higher in all 3 medication groups in the oral epithelium (P ≤0.003), and in the immunosuppression group in the sulcular epithelium (P = 0.032) than in the controls. In the oral sulcular epithelium, mitotic activity was fairly similar in all medication groups. In the nifedipine group a significant negative correlation was found between duration of nifedipine medication and the percentage of Ki‐67 labeled cells in the oral epithelium (P = 0.025).

Conclusions: The results suggest that the increased epithelial thickness observed in nifedipine‐ and cyclosporin A‐induced gingival overgrowth is associated with increased mitotic activity, especially in the oral epithelium. J Periodontol 2001;72:167‐173.
The Effect of Postsurgical Antibiotics on the Healing of Intrabony Defects Following Treatment With Enamel Matrix Proteins
Authors: Sculean Anton , Blaes Anja , Arweiler Nicole , Reich Elmar , Donos Nikolaos , Brecx Michel
Published: February 2005

Background: Regenerative treatment with enamel matrix proteins has been shown to promote healing in intrabony defects. However, up to now various postoperative antibiotic regimens have been used in combination with enamel matrix proteins and therefore it cannot be excluded that the results may also be attributable to the effect of the antibiotic treatment. The aim of this randomized, controlled, blinded, clinical investigation was to determine the effect of postsurgical administration of antibiotics on the healing of intrabony periodontal defects treated with enamel matrix proteins.

Methods: Thirty‐four patients each of whom exhibited one deep intrabony defect were randomly treated with either enamel matrix proteins plus antibiotics (test: EMD + AB) or with enamel matrix proteins alone (control: EMD). The antibiotic regimen consisted of a combination of 3 × 375 mg amoxicillin and 3 × 250 mg metronidazole daily for 7 days. The following parameters were recorded at baseline and at 1 year by the same calibrated and blinded investigator: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Power analysis to determine superiority of antibiotic treatment showed that the available sample size would yield 85% power to detect a 1 mm difference.

Results: No statistically significant differences in any of the investigated parameters between the 2 groups were observed at baseline. No serious adverse events such as allergic reactions or abscesses after any of the treatments were observed during the entire study period. The results have shown that in the EMD + AB group the PD decreased from 9.1 ± 1.5 mm to 4.5 ± 1.1 mm (P <0.0001) and the CAL changed from 11.0 ± 1.6 mm to 7.5 ± 1.4 mm (P <0.0001). In the EMD group the PD decreased from 9.0 ± 1.7 mm to 4.3 ± 1.7 mm (P <0.0001) and the CAL changed from 10.6 ± 1.6 mm to 7.3 ± 1.5 mm (P <0.0001). There were no significant differences in any of the investigated parameters between the 2 groups.

Conclusions: It can be concluded that the systemic administration of amoxicillin and metronidazole adjacent to the use of EMD for the surgical treatment of intrabony periodontal defects does not produce statistically superior PD reduction and CAL gain when compared to treatment with EMD alone. Hence, the present results do not support the routine administration of amoxicillin and metronidazole following regenerative treatment with EMD. J Periodontol 2001;72:190‐195.
Esthetic Management of Multiple Recession Defects in a Patient With Cicatricial Pemphigoid
Authors: Lorenzana Eduardo R. , Rees Terry D. , Hallmon William W.
Published: February 2005

Cicatricial pemphigoid is one of a number of mucocutaneous disorders that can present in the oral cavity with desquamation, pain, and bleeding of the gingiva and oral mucosa. This case report describes the management of cicatricial pemphigoid in a patient with multiple sites of gingival recession using connective tissue grafting to alleviate root surface sensitivity and improve esthetics. The treatment rationale is presented and discussed in terms of timing of therapy and implications for wound healing in patients who present with desquamative gingivitis. J Periodontol 2001;72:230‐237.
Bioabsorbable Materials for Guided Bone Regeneration Prior to Implant Placement and 7‐Year Follow‐Up: Report of 14 Cases
Authors: Brunel Gérard , Brocard Daniel , Duffort Jean François , Jacquet Edmond , Justumus Pierre , Simonet Thierry , Benqué Edmond
Published: February 2005

Background: The purpose of the present study was to evaluate the efficacy of a guided bone regeneration (GBR) procedure prior to implant placement and the long‐term outcome of the inserted implants.

Methods: Prior to dental implant placement, GBR procedure was performed on 14 patients (mean age 48 years) using a synthetic hydroxyapatite (HA) spacer under a collagen membrane. After a mean healing period of 8 months, bone biopsies were obtained during the placement of 14 implants. The specimens were processed for histology without demineralization in order to assess bone quality and quantity of the regenerated bone.

Results: Both the bone density and the resorption degree of HA particles were relatively varied between samples. The different phenotypes of osteoclasts and multinucleated giant cells and the individual host response could partially explain the unpredictable results in terms of bone remodeling and biomaterial resorption. However, the presence of HA particles in the regenerated bone had no influence on the osseointegration of implants presenting a success rate of 86% after a 7‐year observation period.

Conclusions: These results confirm the possibility of regenerating bone by means of bioabsorbable materials, assuring at the same time the long‐term success for implants inserted in regenerated sites. J Periodontol 2001;72:257‐264.
Management of Soft Tissue Ridge Deformities With Acellular Dermal Matrix. Clinical Approach and Outcome After 6 Months of Treatment
Authors: Batista Eraldo L. , Batista Felipe C. , Novaes Arthur B.
Published: February 2005

Background: Soft tissue ridge defects often hamper ideally shaped artificial crowns and are basically treated using autogenous soft tissue grafts or alloplastic materials. These approaches present disadvantages such as the necessity of creating additional surgical fields to harvest the graft and the requirement of primary closure, which may reduce ridge height. This investigation evaluated the use of acellular dermal matrix (ADM) in the treatment of soft tissue ridge defects.

Methods: Eight patients, non‐smokers with noncontributory medical history, provided 18 sites corresponding to missing teeth in the anterior maxillary arch. The ideal horizontal gain (desired gain) was waxed up in study casts, which served as templates for construction of modified acrylic stents with orthodontic wires. These stents served as references for ideal horizontal gain and also as fixed reference points for further evaluation. The distance from the orthodontic wire to the buccal plate of the defect also represented its baseline horizontal component. Vertical variations were evaluated with another stent and, in this case, no desired gain was considered. After raising partial‐thickness flaps, the ADM material was rehydrated and folded to fill the defect and reproduce the desired gain. Flaps were sutured with no tension, and part of the material was intentionally left exposed to avoid pressure on the incision line and prevent height loss. Patients used local and systemic antimicrobials, and the sutures were removed at 7 days.

Results: Evaluations were carried out at 30 days, and 3 and 6 months, and all sites healed uneventfully. Neither infection nor significant pain was reported by the patients, and the material was covered by tissue at about 21 days. Mean horizontal gain of 1.72 ± 0.59 mm (58.5%) at 6 months and mean shrinkage of 1.22 ± 0.46 mm (41.4%) were observed. There was a mean improvement in vertical gain of only 0.61 ± 0.77 mm, although 66.7% of the treated sites showed a 1 to 2 mm gain. Clinically, the total gain in the subjects was very effective and matched the receptor tissues nicely.

Conclusions: ADM may be a suitable material for the treatment of soft tissue ridge deformities due to its biocompatibility, color matching, and horizontal gain. Additional controlled, comparative trials are necessary to establish its advantages and potential compared to autogenous soft tissue techniques. J Periodontol 2001;72:265‐273.
A 2‐Step Non‐Surgical Procedure and Systemic Antibiotics in the Treatment of Rapidly Progressive Periodontitis
Authors: Sigusch B. , Beier M. , Klinger G. , Pfister W. , Glockmann E.
Published: February 2005

Background: In the last few years knowledge about periodontal infections has increased enormously, nevertheless practitioners are still seeking guidelines for suitable treatment concepts.

Methods: The aim of this study was to examine the effect of doxycycline, metronidazole, and clindamycin used adjunctively in a 2‐step nonsurgical procedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant using 4 to 5 visits. The second step included full‐mouth enhanced root planing (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty‐eight patients (mean age 32.4 years) with generalized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivalis were randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibiotic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at baseline (BL), 3 weeks after SRP, and 6 and 24 months after RP.

Results: After the first step (SRP), we observed an improvement of PI and SBI in all 4 groups, but did not see any statistically significant PD reduction 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to groups 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 mm and >9 mm. PI showed no significant difference between the groups throughout the period after SRP until 24 months, compared to 3 weeks after SRP. SBI decreased most in the metronidazole and clindamycin groups. P. gingivalis and Actinobacillus actinomycetemcomitans were almost completely eradicated in these 2 groups 24 months after RP. In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step.

Conclusions: The present results show that metronidazole and clindamycin are effective antibiotics when used adjunctively in a 2‐step nonsurgical procedure of scaling and root planing in RPP patients. J Periodontol 2001;72:275‐283.
Matrix Metalloproteinases (MMP‐8 and ‐9) and Neutrophil Elastase in Gingival Crevicular Fluid of Cyclosporin‐Treated Patients
Authors: Atilla Gül , Sorsa Timo , Rönka Hanne , Emingil Gülnur
Published: February 2005

Background: Gingival overgrowth (GO) is one of the most important side effects of cyclosporin A (CsA) medication, but its pathogenesis is not completely understood. The aim of this study was to identify and compare collagenase‐2 (MMP‐8), gelatinase‐B (MMP‐9), and neutrophil (PMN)‐elastase levels in gingival crevicular fluid (GCF) from 15 renal transplant patients receiving CsA therapy and exhibiting CsA GO, 14 patients with gingivitis, and 10 periodontally healthy subjects.

Methods: Clinical data were obtained on plaque index, papilla bleeding index, and hyperplastic index from each site studied. GCF samples and clinical data were collected from: 2 sites exhibiting CsA GO (CsA GO+) and 2 sites not exhibiting CsA GO (CsA GO‐) in each CsA‐treated patient; 2 diseased sites in each patient with gingivitis; and 2 healthy sites in each subject with clinically healthy periodontium. CsA GO+ and CsA GO‐ sites were divided into 2 subgroups as clinically not inflamed (PBI = 0) and inflamed (PBI ≥1). GCF MMP‐8, MMP‐9, and PMN‐elastase levels were analyzed by immunofluorometric assay.

Results: GCF MMP‐8 and ‐9 levels and clinical degrees of gingival inflammation in CsA GO+ sites were similar to those in diseased sites. However, GCF elastase levels were significantly lower in CsA GO+ sites compared to those in diseased sites. GCF MMP‐8, ‐9 and PMN‐elastase levels were not different between CsA GO‐ sites and healthy sites. Additionally, GCF MMP‐8 and ‐9 levels in inflamed CsA GO+ sites were higher but not statistically significantly than those in diseased sites. In contrast, GCF PMN‐elastase levels in inflamed CsA GO+ sites were significantly lower than the levels in diseased sites.

Conclusions: These results show that CsA therapy does not have a significant effect on GCF MMP‐8 and MMP‐9 levels, but the gingival inflammation seems to be the main reason for their elevations. However, low GCF PMN‐elastase levels can be an important factor in the pathogenesis of CsA‐induced gingival overgrowth. CsA therapy does not eliminate the potential use of GCF MMP‐8 and ‐9 as future diagnostic markers of gingival inflammation. J Periodontol 2001;72:354‐360.
Periodontal Treatment With an Er:YAG Laser Compared to Scaling and Root Planing. A Controlled Clinical Study
Authors: Schwarz F. , Sculean A. , Georg T. , Reich E.
Published: February 2005

Background: The aim of the present study was to compare the effectiveness of an Er:YAG laser to that of scaling and root planing for non‐surgical periodontal treatment.

Methods: Twenty patients with moderate to advanced periodontal destruction were treated under local anesthesia and the quadrants were randomly allocated in a split‐mouth design to either Er:YAG laser using an energy level of 160 mJ/pulse and 10 Hz or scaling and root planing (SRP) using hand instruments. Clinical assessments of plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL) were made prior to and at 3 and 6 months after treatment. Subgingival plaque samples were taken at each appointment and analyzed using darkfield microscopy for the presence of cocci, non‐motile rods, motile rods, and spirochetes. Differences in clinical parameters and prevalence of bacterial species were analyzed using the paired t‐test.

Results: The PI remained nearly unchanged while a significant reduction of the GI occurred in both groups after 6 months (P ≤0.001, P ≤0.001, respectively). The mean value of BOP decreased in the laser group from 56% at baseline to 13% after 6 months (P ≤0.001) and in the SRP group from 52% at baseline to 23% after 6 months (P ≤0.001). The mean value of the PD decreased in the laser group from 4.9 ± 0.7 mm at baseline to 2.9 ± 0.6 mm after 6 months (P ≤0.001) and in the SRP group from 5.0 ± 0.6 mm at baseline to 3.4 ± 0.7 mm after 6 months (P ≤0.001). The mean value of the CAL decreased in the laser group from 6.3 ± 1.1 mm at baseline to 4.4 ± 1.0 mm after 6 months (P ≤0.001) and in the SRP group from 6.5 ± 1.0 mm at baseline to 5.5 ± 1.0 after 6 months (P ≤0.001). The reduction of the BOP score and the CAL improvement was significantly higher in the laser group than in the SRP group (P ≤0.05, P ≤0.001, respectively). Both groups showed a significant increase of cocci and non‐motile rods and a decrease in the amount of motile rods and spirochetes.

Conclusions: An Er:YAG laser may represent a suitable alternative for non‐surgical periodontal treatment. J Periodontol 2001;72:361‐367.
Treatment of Aggressive Periodontitis by Osseointegrated Dental Implants. A Case Report.
Authors: Yalçın Serdar , Yalçın Funda , Günay Yumuşhan , Bellaz Berk , Önal Şevket , Firatli Erhan
Published: February 2005

Background: Generalized aggressive periodontitis is described as a clinical entity affecting both deciduous and permanent dentition with extensive alveolar bone loss, mobility, and exfoliation of all or many teeth. Controversy exists on dental implant use to restore missing dentition in younger patients.

Methods: This case report presents a patient diagnosed with aggressive periodontitis who has lost all but 4 of her teeth. Her personal and functional desires led us to include implant therapy in her treatment plan. The hematological data are presented with an analysis of the immunological profile.

Results: Dental implants were placed, and following 3 months of osseointegration, an implant‐supported prosthesis was completed. The patient was followed up for 36 months.

Conclusions: This case report presents an alternative treatment for rehabilitating dentition in a young patient treated for aggressive periodontitis. Similar case studies may help eliminate some of the controversy that exists regarding the use of dental implants in aggressive periodontitis patients. J Periodontol 2001;72:411‐416.
Histological Evaluation of Healing and Revascularization of the Subepithelial Connective Tissue Graft
Authors: Guiha Rami , Khodeiry Soheir El , Mota Luis , Caffesse Raul
Published: February 2005

Background: The goal of this investigation was to histologically evaluate the healing and revascularization of the subepithelial connective tissue graft in dogs.

Methods: Six beagle dogs were used in this study. Recession defects were surgically created on maxillary left P2 and right P2, and maxillary and mandibular left central and lateral incisors. The defects were left untreated for 35 days. After elevating a split thickness flap, the graft was harvested from the palate and placed over the denuded root surfaces. The flap was then coronally repositioned and sutured. Three dogs provided the specimens for 7‐ and 14‐day time points and 3 dogs for 28‐ and 60‐day time points. The animals were sacrificed and the blocks obtained were divided in half. One half was processed following the Spalteholtz method and the other was processed for routine histologic examination.

Results: At 7 days, a clot was present at the demarcation zones and it was more organized at 14 days. At 28 days, the junctional epithelium was formed and the demarcation zones could not be delineated. At 60 days, the oral epithelium had regained its normal appearance. The attachment of the graft to the root surface was mediated by a combination of epithelial downgrowth and connective tissue attachment. Minimal new bone and cementum formation was observed. The vascularization of the graft at 7 days originated from the periodontal plexus and the overlying flap. At 14 days, the graft was completely vascularized. At 28 and 60 days, normal vascularization was present.

Conclusions: The vascularization of the connective tissue graft originates from the periodontal plexus, the supraperiosteal plexus, and the overlying flap. The attachment of the graft to the root surface appears to be mediated by a combination of epithelial downgrowth and connective tissue attachment. There is little potential for new cementum and new bone formation. J Periodontol 2001;72:470‐478.
Clinical Evaluation and Comparison of 2 Topical Anesthetics for Pain Caused by Needle Sticks and Scaling and Root Planing
Authors: Carr Michele P. , Horton John E.
Published: February 2005

Background: Pain generated by needle sticks (Ns) for the delivery of local anesthetic and/or scaling and root planing (SRP) instrumentation is commonly addressed by the use of topical anesthetics, such as a benzocaine‐gel preparation (BGP). Pain suppression following such use has been highly variable. Development of medicine‐containing patches and adhesives for intraoral use have led to a new approach for topical anesthesia in the form of a transoral lidocaine delivery system (LDS). The purpose of this double‐blind study was to evaluate the efficacy of the LDS and also to compare LDS with BGP for pain suppression to Ns and SRP.

Methods: One group of 20 subjects randomly received in both maxillary and mandibular molar‐bicuspid areas LDS or BGP on one side and non‐anesthetic control on the other side. A second group of 20 subjects compared the effectiveness of LDS directly with BGP in molar‐bicuspid areas of both arches. Random order determined the selection for each anesthetic tested between the arches and bilateral. Pain perception was separately scored to a pain‐inducing Ns simulation without anesthetic injection at each area and subsequently also to SRP using both a verbal pain scale (VPS) and a visual analog scale (VAS).

Results: VPS and VAS results analyzed by Bonferroni‐adjusted Wilcoxon matched‐pairs signed‐rank tests found pain suppression scores significantly (P <0.005) reduced for Ns by LDS to controls and to BGP. Comparing LDS directly with BGP, LDS was significantly (P <0.05) more effective in reducing pain to Ns in both arches, to SRP in the maxillary arch, and equally effective as BGP in the mandibular arch.

Conclusions: LDS is more effective than BGP for topical pain suppression to Ns and SRP in both arches. J Periodontol 2001;72:479‐484.
Peri‐Implant Bone Reactions to Immediately Loaded Implants. An Experimental Study in Monkeys
Authors: Romanos George , Toh Chooi Gait , Siar Chong Huat , Swaminathan Dasan , Ong Ah Hup , Donath Karl , Yaacob Hashim , Nentwig Georg‐Hubertus
Published: February 2005

Background: There are reports which demonstrate that immediately loaded splinted implants can be osseointegrated when they are placed in the anterior part of the lower jaw. The concept of immediate loading has not been well investigated in the posterior mandible. The aim of this study was to evaluate the bone reactions around immediately loaded implants placed in the posterior region of the lower jaw in the monkey model.

Methods: Six adult Macaca fascicularis monkeys were used in this study. A total of 36 implants were placed after extraction of the second premolars, first and second molars, and complete healing of the sockets. Three control (C) group implants were placed in one quadrant of the lower jaw of each monkey. After a delay of 3 months to allow osseointegration to take place, the implants were loaded for 1 month using temporary resin bridges and later for 2 months using metal splinted crowns. In the contralateral region of the lower jaw, 3 test (T) group implants were placed and loaded immediately with the same sequence as carried out for the C implants. Specimens were examined and evaluated histologically after sacrifice.

Results: All of the implants were osseointegrated. Compact, cortical bone in contact with the implant surface without any gaps or connective tissue formation was observed.

Conclusions: It was concluded that immediately loaded, splinted implants can be osseointegrated with a similar hard and soft tissue peri‐implant response as delayed‐loaded implants in the posterior mandible. J Periodontol 2001;72:506‐511.
Evaluation of Transforming Growth Factor‐β1 Level in Crevicular Fluid of Cyclosporin A‐Treated Patients
Authors: Buduneli Nurcan , Kütükçüler Necil , Aksu Güzide , Atilla Gül
Published: February 2005

Background: The aim of the present study was to investigate the level of transforming growth factor‐β1 (TGF‐β1) in gingival crevicular fluid (GCF) samples of cyclosporin A (CsA)‐treated patients and to compare the results with control groups.

Methods: Fourteen renal transplant patients exhibiting severe CsA‐induced gingival overgrowth, 10 patients with chronic gingivitis, and 10 subjects with clinically healthy periodontium were included in the study. In CsA‐treated patients, GCF samples were harvested from sites exhibiting gingival overgrowth (CsA GO+) and sites not exhibiting gingival overgrowth (CsA GO‐). The TGF‐β1 levels in a total of 96 GCF samples from the 34 participants were analyzed by enzyme‐linked immunosorbent assay. The results were expressed in terms of total amount (pg/2 sites) and concentration (ng/ml).

Results: TGF‐β1 total amounts in CsA GO+ and CsA GO− sites were similar and significantly higher than that of healthy sites (P <0.02 and P <0.01, respectively). The total amount of TGF‐β1 was also higher in gingivitis sites compared to the healthy sites, but the difference was not statistically significant (P >0.05). CsA GO+ and CsA GO‐ sites exhibited higher total amount and concentration of TGF‐β1 than that of gingivitis sites, but the differences were insignificant (P >0.05).

Conclusions: The results of the present study support the theory that CsA increases the synthesis of TGF‐β1 in GCF. However, since the difference between CsA GO+ and CsA GO‐ sites was not statistically significant, it seems unlikely that GCF TGF‐β1 level is the sole factor responsible for the CsA‐induced gingival overgrowth. Complex interactions between various mediators of inflammation and tissue modeling are possibly involved in the pathogenic mechanisms of this side effect. J Periodontol 2001;72:526‐531.
Combined Mechanical and Antibiotic Periodontal Therapy in a Case of Papillon‐Lefèvre Syndrome
Authors: Eickholz Peter , Kugel Birgit , Pohl Sabine , Näher Helmut , Staehle Hans J.
Published: February 2005

Background: Papillon Lefèvre syndrome (PLS) is rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study. The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case. The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS.

Methods: A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years. He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively. Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week. Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment. Selective cultures for A. actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens.

Results: Prior to combined mechanical and antibiotic treatment, all teeth but one harbored Actinobacillus actinomycetemcomitans subgingivally. However, at 7 and 26 months after therapy A. actinomycetemcomitans could be detected neither by culture nor by DNA probes. Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period.

Conclusions: Eradication (suppression beneath detection levels) of A. actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS. J Periodontol 2001;72:542‐549.
Protease‐Active Extracellular Protein Preparations From Porphyromonas gingivalis W83 Induce N‐Cadherin Proteolysis, Loss of Cell Adhesion, and Apoptosis in Human Epithelial Cells
Authors: Chen Zhuo , Casiano Carlos A. , Fletcher Hansel M.
Published: February 2005

Background: The protease‐induced cytotoxicity of P. gingivalis may partly result from alteration of the extracellular matrix and/or surface receptors that mediate interaction between the host cells and their matrix. While P. gingivalis‐induced degradation of E‐cadherin has been documented, there is no information on the effects of P. gingivalis proteases on other members of this family of cell adhesion proteins.

Methods: Human epithelial KB cells were exposed to proteaseactive extracellular protein preparations from isogenic mutants of P. gingivalis. Quantification of apoptosis was performed by visualization of nuclei stained with 4,6′‐diamidino‐2‐phenylindole. Alteration of cell adhesion proteins was examined by immunoblotting of cell lysates using monoclonal antibodies to those proteins.

Results: Treated cells exhibited loss of cell adhesion properties with apoptotic cell death subsequently observed. These effects correlated with the different levels of cysteine‐dependent proteolytic activities of the isogenic mutants tested. Cleavage of N‐cadherin was observed in immunoblots of lysates from detached cells. There was a direct correlation between the kinetics of N‐cadherin cleavage and loss of cell adhesion properties. Loss of cell adhesion, as well as N‐cadherin cleavage, could be inhibited by preincubation of P. gingivalis protease active extracellular protein preparations with the cysteine protease inhibitor TLCK. In control experiments, the cleavage of N‐cadherin was detected after treatment of KB cells with trypsin but not after cell dissociation by a non‐enzymatic method.

Conclusions: These results suggest that extracellular proteases from P. gingivalis can induce degradation of N‐cadherin, which could have implications for the pathogenicity of this bacterium. J Periodontol 2001;72:641‐650.
Hyaluronan Supports Recombinant Human Bone Morphogenetic Protein‐2 Induced Bone Reconstruction of Advanced Alveolar Ridge Defects in Dogs. A Pilot Study
Authors: Hunt Dennis R. , Jovanovic Sascha A. , Wikesjö Ulf M.E. , Wozney John M. , Bernard George W.
Published: February 2005

Background: Prosthetic‐driven implant dentistry requires predictable procedures for alveolar ridge augmentation. The objective of this pilot study was to evaluate bone regeneration in mandibular, full‐thickness, alveolar ridge, saddle‐type defects following surgical implantation of recombinant human bone morphogenetic protein‐2 (rhBMP‐2) in a novel hyaluronan (HY) sponge carrier. This sponge was fabricated from auto‐crosslinked HY.

Methods: Alveolar ridge defects (∼15 × 10 × 10 mm), 2 per jaw quadrant, were surgically prepared in each of 3 young adult American fox hounds. Four defects were immediately implanted with rhBMP‐2/HY. Three defects were implanted with rhBMP‐2 in an absorbable collagen sponge (ACS) carrier (positive control). The rhBMP‐2 solution (1.5 ml at 0.2 mg/ml) was soak‐loaded onto the HY and ACS sponges. Three defects were implanted with HY sponges soak‐loaded with buffer without rhBMP‐2 (negative control), while 2 defects served as surgical controls. The animals were euthanized at 12 weeks postsurgery for histometric analysis.

Results: Clinically, alveolar ridge defects receiving rhBMP‐2/ACS exhibited a slight supracrestal expansion, while defects receiving rhBMP‐2/HY were filled to contour. In contrast, the HY and surgical controls exhibited ridge collapse. rhBMP‐2/HY‐treated defects exhibited a dense bone quality without radiolucent regions observed in defects treated with rhBMP‐2/ACS. The histometric analysis showed 100% bone fill for the rhBMP‐2/ACS defects and 94%, 58%, and 65% bone fill for the rhBMP‐2/HY, HY, and surgical control defects, respectively.

Conclusions: The conclusions are based on data from 2 of 3 animals in the study. In one animal, no response to rhBMP‐2 was observed with either carrier, and the animal may have been a non‐responder of unknown nature. With this limitation, the observations herein suggest that: 1) HY supports significant bone induction by rhBMP‐2; 2) the rhBMP‐2–induced bone assumes qualities of the immediate resident bone; 3) HY alone exhibits no apparent osteoconductive potential; and 4) HY appears to resorb within a 12‐week healing interval in the absence or presence of rhBMP‐2. Thus, HY appears to be a suitable candidate carrier for rhBMP‐2. J Periodontol 2001;72:651‐658.
Sucralfate: A Help During Oral Management in Patients With Epidermolysis Bullosa
Authors: Marini Ida , Vecchiet Federico
Published: February 2005

Background: Epidermolysis bullosa (EB) is a group of genetic disorders that lead to blister formation at variable depths in skin and mucosa. Vesicles may arise spontaneously or be caused by friction or trauma. Oral tissue fragility and blistering is common in all EB types. The majority of patients with mild forms of EB are able to receive dental treatment. The prevention of dental caries is most challenging in subjects with severe mucosal involvement, as they are least able to routinely undergo correct preventive procedures. The aim of this study was to evaluate the effectiveness of a sucralfate suspension in reducing both pain and the number of blisters in patients with EB, and to obtain improved oral hygiene and a lower incidence of caries.

Methods: Five patients with dystrophic EB were treated with sucralfate suspension for the prevention and management of oral blisters. Oral blisters were assessed using a quantitative scale, while pain was assessed using visual analogue scale (VAS), and hygiene was evaluated through plaque and gingival indexes.

Results: The number of blisters, oral pain, and plaque decreased in all cases.

Conclusions: Oral prophylaxis with sucralfate prevented oral blisters and oral discomfort. The procedure proved to be cost effective and easy to administer. It did not show significant side effects and may be used routinely in patients with EB. J Periodontol 2001;72:691‐695.
Human Gingival Fibroblast Cytoskeleton Is a Target for Volatile Smoke Components
Authors: Rota Massimo T. , Poggi Paola , Boratto Renata
Published: February 2005

Background: Several in vitro investigations have indicated that the particulate phase of cigarette smoke as nicotine affects many cell types including gingival fibroblasts, but few studies have examined the effect of volatile fraction on cellular structures involved in cell functions such as adhesion and proliferation. Since gingival fibroblast survival and reproduction are fundamental to maintaining the oral connective tissue as well as to wound healing, the effects of acrolein and acetaldehyde, volatile fractions of cigarette smoke, on cytoskeleton were examined in human gingival fibroblasts (HGFs) in vitro.

Methods: Human gingival fibroblast (HGF) strains from healthy subjects with non‐inflamed gingiva were utilized. The cells were incubated in different concentrations of acrolein and acetaldehyde. Cell adhesion was evaluated after 3 hours. The influence of both substances on cytoskeletal structures, tubulin and vimentin intermediate filaments (VIF), was investigated using indirect immunofluorescence technique.

Results: The results show that both substances produced similar effects, resulting in a dose‐dependent inhibition of HGF adhesion. Disturbance of HGF cytoskeleton consisted of a disruption of microtubules and vimentin microfilaments with alterations in cell shape.

Conclusions: Our experimental findings suggest that volatile fractions of cigarette smoke such as acrolein and acetaldehyde, because their ability to bind and interact with the cytoskeleton, prevent HGF adhesion. Consequently the maintenance of the oral connective tissue and integrity and remodeling could be impaired. According to our morphological evidence, these findings confirm other clinical and epidemiological investigations reporting that volatile components of cigarette smoke could lead to the initiation and progression of periodontal disease. J Periodontol 2001;72:709‐713.
Retrospective Evaluation of the Influence the Interleukin‐1 Genotype on Radiographic Bone Levels in Treated Periodontal Patients Over 10 Years
Authors: Cattabriga Marcello , Rotundo Roberto , Muzzi Leonardo , Nieri Michele , Verrocchi Guerina , Cairo Francesco , Prato Giovanpaolo Pini
Published: February 2005

Background: A difference in genetic susceptibility to plaque accumulation has been advocated to explain different responses to periodontal therapy. The purpose of this study is to assess the role of the interleukin‐1(IL‐1) polymorphism on the rate of bone and tooth loss in non‐smoking periodontally treated patients during maintenance.

Methods: Sixty consecutive non‐smoking patients (mean age 46.8 ± 5.0) with moderate to severe periodontitis, treated and maintained for over 10 years were selected. At baseline (T0), radiographic evaluation (cementoenamel junction [CEJ]‐root apex, CEJ‐bottom of defect mesial and distal, CEJ‐bone crest mesial and distal, crown‐root ratio) was performed. All patients received scaling and root planing; 36 patients then underwent surgical therapy. Subsequently, all patients were enrolled in a periodontal maintenance program with recall visits every 3.4 ± 1.0 months for at least 10 years. At the latest recall visit (T2) the same radiographic measurements evaluated at baseline were taken and a DNA sample for IL‐1 genetic susceptibility testing was collected and sent for analysis.

Results: Twenty‐three of the 60 patients (38.3%) were IL‐1 genotype positive. A total of 52 teeth (3.3%) out of 1,566 were lost due to periodontitis between T0 and T2; 28 of 957 (2.9%) in the IL‐1 genotype negative group and 24 of 609 (3.9%) in IL‐1 genotype positive group. The mean variation in bone defect level (ΔBD) averaged ‐0.04 mm in IL‐1 genotype negative patients and 0.01 mm in IL‐1 genotype positive patients. The mean variation in bone crest level (ΔBC) averaged ‐0.24 mm in IL‐1 genotype negative patients and ‐0.28 mm in IL‐1 genotype positive patients. However, a few patients showed significant differences in response to therapy based on initial bone levels and genotype. IL‐1 negative patients who showed minimal initial bone loss responded to the therapy better than the IL‐1 positive patients. IL‐1 positive patients with severe initial bone loss showed a better response to the therapy than IL‐1 negative patients.

Conclusions: On average, there were no significant differences related to IL‐1 genotype in tooth loss after 10 years in a non‐smoking, well‐maintained periodontal population. On an individual patient basis, the IL‐1 genotype, in combination with the initial bone level, seems useful at the beginning of therapy for predicting bone level variation. J Periodontol 2001;72:767‐773.
The Dento‐Epithelial Junction: Cell Adhesion by Type I Hemidesmosomes in the Absence of a True Basal Lamina
Authors: Hormia Marketta , Owaribe Katsushi , Virtanen Ismo
Published: February 2005

Background: The junctional epithelium (JE) is a unique structure that makes contact with both a non‐renewable hard tooth surface and with a basement membrane (BM) facing the connective tissue. Ultrastructurally, this attachment occurs through hemidesmosomes (HD) and a basal lamina‐like extracellular matrix which, on the tooth side, is termed the internal basal lamina. In this study we investigated the expression of basal cell markers in the tooth‐facing (TF) cells of JE.

Methods: Samples of healthy marginal gingiva were removed by careful dissection. The expression of laminin‐5 was used to indicate TF cell preservation in double immunofluorescence labeling and confocal laser scanning microscopy.

Results: The results show that integrin α6β4 and laminin‐5 colocalize unequivocally in the TF cells. The results also show the specific expression of the basal cytokeratin 14 and the αv integrin subunit in the TF cells. All 3 major hemidesmosomal components BP180, BP230, and HD1 antigen are likewise present. On the other hand, type IV collagen, laminin‐1/10, type VII collagen, and the BM proteoglycan perlecan are all absent from the dento‐epithelial junction.

Conclusions: The results indicate that the epithelium‐tooth interface is a unique structure wherein epithelial cells adhere by means of bona fide hemidesmosomes to an epithelium‐derived extracellular matrix lacking most of the common BM components. Moreover, TF cells differ from connective tissue facing (CTF) cells, not only by their cell surface molecules and their production of extracellular matrix, but also by their cytoskeletal architecture. J Periodontol 2001;72:788‐797.