bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Aging on Functional Changes of Periodontal Tissue Cells
Authors: Abiko Yoshimitsu , Shimizu Noriyoshi , Yamaguchi Masaru , Suzuki Hiroshi , Takiguchi Hisashi
Published: October 2010

Although the severity of periodontal disease is known to be affected by age, functional changes of periodontal tissue cells during the aging process are not well characterized. It is important to define how cellular aging affects the progression of periodontal diseases associated with the aging process. In vitro aging of human gingival fibroblast (HGF) and periodontal ligament fibroblast (HPLF) cells was prepared by sequential subcultivations (5 to 6 passages as young, 18 to 20 passages as old). GFs were also prepared from gingiva of Down's syndrome patients and 60‐week‐old rats. Fetal rat calvarial osteoblasts were prepared by sequential digestion with collagenase. HGF and HPLF cells were treated with lipopolysaccharide (LPS) and cyclic tension force, respectively. Amounts of PGE2, interleukin (IL)‐1β, IL‐6, and plasminogen activator (PA) in conditioned media were measured. Total RNA was extracted, and mRNA expression was analyzed by reverse transcription Polymerase chain reaction (RT‐PCR). LPS‐stimulated PGE2, IL‐1β, IL‐6, and PA production was increased in “old” HGF compared to younger cells. According to RT‐PCR analysis, gene expression of COX‐2, IL‐1β, IL‐6, and tissue type (t) PA was higher in old cells than in young cells. Cyclic tension force to HPLF also stimulated phenotypic and gene expression of IL‐1β, PGE2 (COX‐2 gene) and tPA. These findings suggest that aging in both HGF and HPLF may be an important factor in the severity of periodontal disease through higher production of inflammatory mediators in response to both LPS and mechanical stress. In addition, oxygen radical‐treated fibronectin (FN) as substratum diminished bone nodule formation by osteoblasts when compared with intact FN. This finding suggests that FN plays an important role in osteoblast activity and that FN damaged by oxygen radicals during the aging process may be related to less bone formation. Ann Periodontol 1998;3:350–369.
Periodontal Disease and Diabetes Mellitus: A Two‐Way Relationship
Authors: Grossi Sara G. , Genco Robert J.
Published: October 2010

Severe periodontal disease often coexists with severe diabetes mellitus. Diabetes is a risk factor for severe periodontal disease. A model is presented whereby severe periodontal disease increases the severity of diabetes mellitus and complicates metabolic control. We propose that an infection‐mediated upregulation cycle of cytokine synthesis and secretion by chronic stimulus from lipopolysaccharide (LPS) and products of periodontopathic organisms may amplify the magnitude of the advanced glycation end product (AGE)‐mediated cytokine response operative in diabetes mellitus. In this model, the combination of these 2 pathways, infection and AGE‐mediated cytokine upregulation, helps explain the increase in tissue destruction seen in diabetic periodontitis, and how periodontal infection may complicate the severity of diabetes and the degree of metabolic control, resulting in a 2‐way relationship between diabetes mellitus and periodontal disease/infection. This proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection is essential for achieving long‐term control of diabetes mellitus. Evidence is presented to support the hypothesis that elimination of periodontal infection by using systemic antibiotics improves metabolic control of diabetes, defined by reduction in glycated hemoglobin or reduction in insulin requirements. Ann Periodontol 1998;3:51–61.
New Concepts Regarding the Pathogenesis of Periodontal Disease in HIV Infection
Authors: Lamster Ira B. , Grbic John T. , Mitchell‐Lewis Dennis A. , Begg Melissa D. , Mitchell Aaron
Published: October 2010

Periodontal manifestations of human immunodeficiency virus (HPV) infection were first described in 1987. Initially, the lesions receiving attention were HW‐associated gingivitis (now known as linear gingival erythema [LGE]) and HTV‐associated periodontitis (now known as necrotizing ulcerative periodontitis [NUP]). The true prevalence of LGE was difficult to determine due to variable diagnostic criteria. Recently, LGE has been associated with intraoral Candida infection. The prevalence of NUP is low (≤ 5%), and this lesion is associated with pronounced immunosuppression. Current focus on the periodontal manifestations of HIV infection centers on rapid progression of chronic adult periodontitis in HIV+ patients. Attempts to identify the pathogenesis of the increased progression of periodontitis have not proven successful. For example, analysis of subgingival plaque for the presence of bacterial pathogens has failed to detect differences between HIV+ and HIV− patients. Recently our laboratory has identified alterations in the host response in the gingival crevice of HIV+ patients. Comparing HIV+ and HIV− injecting drug users (IDU), levels of the proinfiammatory cytokine interleukin‐1 β (IL‐1β) in gingival crevicular fluid (GCF) were slightly elevated at sites with a probing depth of 1 to 3 mm. At deeper sites (≥ 4 mm), total IL‐1β in GCF was significantly greater in HIV+ individuals. Using the lysosomal acid glycohydrolase β‐glucuronidase (βG) as a measure of the influx of polymorphonuclear leukocytes (PMN) into the gingival crevice, our data indicated a significant correlation of total βG in GCF and probing depth in the HIV–IDU (r = 76; P = .02). This result was similar to what we have observed in other studies. In contrast, for HIV+ subjects, total βG was not associated with probing depth (r = .20; NS). These data suggest that HIV+ patients have altered regulation of PMN recruitment into the gingival crevice. We have begun to investigate the conditions under which subgingival Candida may contribute to periodontal lesions in HIV+ individuals. Candida from subgingival sites has been cultured in HIV+ individuals. Subgingival Candida was distinct from Candida isolated from tongue and buccal mucosal surfaces (as indicated by genomic fingerprinting). We hypothesize the absence of adequate priming of PMN by HIV+ patients. This may be due to a reduced Th1 lymphocyte response. The inability of HIV+ individuals to adequately prime PMN may allow Candida to colonize the subgingival environment. In that milieu, it may act directly or in concert with subgingival bacterial pathogens, or as a cofactor (by inducing production of proinflammatory cytokines) to increase the occurrence of periodontal attachment loss. Ann Periodontol 1998;3:62–75.
Periodontal Status of Patients With Abnormalities of the Immune System: II. Observations Over a 2‐Year Period
Authors: Robertson P. B. , Mackler B. F. , Wright T. E. , Levy B. M.
Published: October 2010

Patients with IgA deficiency and agammaglobulinemia were pair‐matched to immunocompetent subjects by age and Plaque Index. Clinical examinations performed initially and after 2 years included the Plaque Index, Gingival Index, Periodontal Disease Index, caries experience (DMF‐T) and full mouth radiographie surveys. Therapy during the 2‐year period included oral hygiene instructions, prophylaxis and indicated restorative treatment. Immunodeficient patients manifested consistently lower levels of gingival inflammation than matched immunocompetent patients at both examination periods. Caries experience of immunodeficient patients was also less during the study interval, and five of these patients demonstrated DMFT scores of zero. No developmental abnormalities, acute gingival or mucosal lesions, or attachment loss associated with periodontitis was observed in either group.
Four Types of Periodontal Treatment Compared Over Two Years
Authors: Hill R. W. , Ramfjord S. P. , Morrison E. C. , Appleberry E. A. , Caffesse R. G. , Kerry G. J. , Nissle R. R.
Published: October 2010

Results of various modalities of periodontal therapy were studied in 90 subjects (mean age 45 years) with moderate to severe periodontitis. Initial measurements of pocket depth and clinical attachment levels were compared with measurements obtained after the initial hygienic phase of the treatment and measurements of the same areas 1 and 2 years after four different types of periodontal treatment had been applied on a randomized basis to each of the four quadrants of the dentition. These treatments were: (1) surgical pocket elimination or reduction, (2) modified Widman flap surgery, (3) subgingival curettage, (4) scaling and root planing only. The patients were recalled for prophylaxis every 3 months, and rescored annually. One‐way analysis of variance and Scheffe's method were used to test the hypothesis of equal treatment effects. The results were analyzed both with initial pocket depth as the baseline and with pocket depth at the hygienic phase as the baseline using a grouping of pockets 1 to 3 mm, 4 to 6 mm, and ≥7 mm. For the 1 to 3 mm pockets there was a slight reduction in depth at the hygienic phase, with only minor changes after the various modalities of treatment over 2 years. However, significant losses of attachment after all modalities of periodontal therapy, including scaling alone, were observed at both the 1‐year and 2‐year intervals. For pockets 4 to 6 mm deep, the main reduction in pocket depth occurred at the hygienic phase, but the pockets also were reduced by further treatment, most by pocket elimination and modified Widman surgery. However, this reduction in pocket depth after surgery had no beneficial influence on maintenance of the attachment level, which actually was maintained best by scaling alone. For deep pockets ≥7 mm, significant reduction in pocket depth occurred both at the hygienic phase and 1 to 2 years after treatment, with the greatest initial reduction after pocket elimination surgery. However, again there was no significant difference in attachment results among the four methods.
Neutrophil Chemotaxis in Individuals With Advanced Periodontal Disease and a Genetic Predisposition to Diabetes Mellitus
Authors: McMullen J. A. , Van Dyke T. E. , Horoszewicz H. U. , Genco R. J.
Published: October 2010

In the present study the function of the neutrophil, which exerts a major role in protection against bacterial infections, was assessed in patients with a family history of diabetes mellitus and severe periodontitis. The neutrophil chemotactic function of two groups of patients was compared, both exhibited severe periodontitis. One group had a family history of diabetes and is therefore classified as individuals with potential for abnormal glucose tolerance (Pot‐AGT Group). The other group had comparable levels of severe periodontal disease but did not have a family history of diabetes. Neither group showed evidence of systemic disease as assessed by an extensive medical history and a battery of clinical laboratory tests including CBC, SMA‐12, prothrombin time, urinalysis and glycosylated hemoglobin levels. The peripheral blood neutrophil chemotactic response of patients in both groups was measured using Boyden chambers charged with the standard chemotactic agents; endotoxin activated serum, E. coli culture supernate and formylmethionylleucylphenylalanine (FMLP), a synthetic chemotactic agent. Patients in both groups were compared on a day‐to‐day basis to systemically and periodontally healthy, age and sex matched controls. Thirteen of the 24 patients in the Pot‐AGT Group exhibited depressed neutrophil chemotaxis. In contrast, neutrophil chemotaxis was either normal or elevated in 19 of 20 patients who had no family history of diabetes, but had severe periodontal disease. One in this group showed depressed chemotaxis. The difference in neutrophil chemotactic function between these two groups was significant at the P < 0.001 level. Hence, the relationship of a positive family history of diabetes and depressed neutrophil chemotaxis was demonstrated. These results support the concept that in subjects with depressed neutrophil function or numbers, severe periodontitis is likely to be seen. These results also raise the possibility that among individuals with adult periodontitis there may be heterogeneity; some may have an underlying host protective dysfunction such as depressed neutrophil chemotactic activity which predisposes them to more severe periodontal disease. Other adults may have normal neutrophil chemotaxis and still have severe periodontal disease which may result from factors such as long term exposure to more virulent periodontopathic organisms, or they may be afflicted with some, as yet undefined, host protective abnormality.
A Randomized Four‐Year Study of Periodontal Therapy
Authors: Pihlstrom Bruce L. , Ortiz‐Campos Cesar , McHugh Richard B.
Published: October 2010

The purpose of this study was to compare the long term effectiveness of scaling and root planing alone to scaling and root planing followed by periodontal surgery. Seventeen subjects with moderate to advanced periodontitis received thorough scaling and root planing as well as oral hygiene instruction. A modified Widman flap was then randomly performed for one‐half of each subject's dentition. Recall prophylaxis and oral hygiene reinforcement were administered for 4 years after completion of therapy. Shallow crevices (1–3 mm) subjected to either procedure tended to increase slightly in depth and exhibit a slight loss of attachment when compared to pretreatment measurements. Moderately deep pockets (4–6 mm) treated by either procedure were reduced and demonstrated a sustained gain or maintenance of attachment level. Pockets initially ≥7 mm exhibited the greatest reduction in depth and attachment gain. Gingivitis was reduced following either procedure for moderate and deep pockets. No difference in supragingival plaque retention was noted and both procedures reduced calculus. The results indicate that both procedures were effective in treating moderate to advanced periodontitis. However, the additional flap procedure tended to result in greater pocket reduction and attachment gain for deeper pockets.
Factors Influencing Periodontal Repair and Regeneration
Authors: Polson A. M. , Caton J.
Published: October 2010

The purpose of the present study was to evaluate independently the regeneration capacity of a reduced periodontium, and the potential for new connective tissue attachment to a periodontally exposed root surface. A reduced periodontium was produced around a maxillary central incisor in two Rhesus monkeys using orthodontic elastics. The regeneration capacity of this reduced peridontium was investigated by extracting the periodontally involved tooth and transplanting into the socket the contralateral incisor which had a normal periodontium. The potential for new connective tissue attachment to a periodontally exposed root surface was evaluated by transplanting an exposed root into a normal periodontium. These exposed roots were the incisors extracted from the reduced peridontium. Control specimens were obtained by extracting and reimplanting or transplanting the remaining maxillary and mandibular incisors. Forty days after the experimental procedures, block sections were removed and prepared for histologic analysis. The exposed root surface that had been put into the normal periodontium was lined with epithelium interposed between root surface and alveolar bone. The normal root surface that had been put into the reduced periodontium had connective tissue reattachment in the periodontal ligament and supracrestal regions. Areas of ankylosis and root resorption were present in all specimens, as was new cementum in the periodontal ligament region. The results indicated that root surface alterations, rather than presence of a reduced periodontium, inhibited new connective tissue attachment.
The Bacteriology of Acute Necrotizing Ulcerative Gingivitis
Authors: Loesche Walter J. , Syed Salam A. , Laughon Barbara E. , Stoll Janice
Published: October 2010

Plaque samples from 22 ulcerated sites in eight patients with ANUG were cultured using quantitative anaerobic procedures and were examined microscopically. The partial characterization of the predominant cultivable flora revealed a constant flora comprised of a limited number of bacterial types and a variable flora composed of a heterogeneous array of bacterial types. This constant flora would appear to be pathognomonic of acute necrotizing ulcerative gingivitis (ANUG) and included the various Treponema and Selenomonas sp., which comprised about 32 and 6%, respectively, of the microscopic count; B. melaninogenicus ssp. intermedius and Fusobacterium sp., which averaged 24 and 3%, respectively, of the viable count. One week of metronidazole treatment caused a prompt resolution of clinical symptoms, which coincided with a significant reduction in the plaque proportions of the Treponema sp., B. melaninogenicus ssp., intermedius and Fusobacterium sp. for at least 2 to 3 months following treatment. Thus, the same anaerobic species which were numerically associated with the ANUG lesion were also selectively reduced in the plaque flora following resolution of the infection. This supports a role for the above species in the ulcerative stage of the lesion but does not demonstrate that these specific anaerobes initiated the infection. Although not confirmed by the data, it was proposed that these particular anaerobic species gained ascendency in the plaque as a result of being selected through the availability of host‐derived nutrients in individuals who had undergone certain physiological and psychological stresses.
The Use of Blade Implants in a Selected Population of Partially Edentulous Adults: A Ten‐Year Report
Authors: Smithloff Milton , Fritz Michael E.
Published: October 2010

In order to provide longitudinal data for endosteal bladevent implants, a continuing study is being conducted. The present work evaluated 32 bladevent implants in 22 patients for periods of 10 years or more. Two basic patterns were observed 10 years postoperatively: 1) In 14 of 32 implants, there was clinical and radiographic evidence of health; and 2) in 18 of 32 implants, there was a radiolucency 2 to 3 mm square around the neck and shoulder of the implants, sulcular depths capable of being probed and evidence of bleeding on probing. These results indicate that bladevent endosteal implants can be maintained in the mouth for periods of 10 years, although bony breakdown will be seen in approximately 50% of the implants.
Relationship Between the Percentage of Subgingival Spirochetes and the Severity of Periodontal Disease
Authors: Armitage G. C. , Dickinson W. R. , Jenderseck R. S. , Levine S. M. , Chambers D. W.
Published: October 2010

The purpose of this study was to determine the correlations between various clinical assessments of inflammatory periodontal disease and the percentage of motile bacteria in the subgingival flora of sites representing widely varying states of periodontal disease. Darkfield microscopy was used to determine the percentage of spirochetes and other motile bacteria at two sites from each of 60 volunteers. For each site the following clinical assessments were recorded: Plaque Index (PII), gingival exudate (GE), Gingival Index (GI), bleeding tendency (BT), pocket depth (PD), connective tissue attachment loss (AL) and Periodontal Disease Index (PDI). Statistically significant (P < 0.001) positive correlations (r) were found between the percentage of subgingival spirochetes and PlI (r = 0.54), GE (r = 0.61), GI (r = 0.57), BT (r = 0.59), PD (r = 0.56), AL (r = 0.54) and PDI (r = 0.61). Clinically healthy sites harbored much lower percentages of motile bacteria than did clinically diseased sites. Most of the observed variation in the percentage of motile bacteria could be accounted for by variations in the percentage of spirochetes. The most significant increases in the relative percentages of subgingival spirochetes occurred when bleeding upon probing was observed as a sign of inflammation and/or when pocket depth and attachment loss exceeded 3 mm.
The Potential for Increase in the Periodontal Diseases of the Aged Population
Authors: Douglass Chester , Gillings Dennis , Sollecito William , Gammon Marilie
Published: October 2010

The periodontal disease trends in the nation's older adults aged 55 to 74 years are assessed using National Center for Health Statistics data spanning an approximate 12‐year period. Both the 1960 to 1962 Health Examination Survey and the 1971 to 1974 Health and Nutrition Examination Survey I surveys used similar multistaged stratified probability samples. Examinations were calibrated and the collection of periodontal disease (PI), oral hygiene (OHI) and tooth loss scores were standardized. Data were collected on 1567 persons in 1960 to 1962 and 4746 persons in 1971 to 1974. The mean PI scores between the two surveys were not statistically different. However, when the periodontal diseases were divided into individuals with or without pockets, there was a significant decline in the per cent without pockets (P < 0.001) while the per cent with pockets remained unchanged or increased. The significant reduction in OHI scores (P < 0.02) seems to validate the decrease in gingivitis. The improvement in tooth loss was reflected by both the greater proportion of dentulous adults, and among the dentulous, a retention of more than two teeth per person by 1971 to 1974. A hypothesis is discussed regarding tooth retention and the periodontal diseases with projections for the year 2000.
Rapidly Progressive Periodontitis: A Distinct Clinical Condition
Authors: Page Roy C. , Altman Leonard C. , Ebersole Jeffrey L. , Vandesteen G. Edward , Dahlberg William H. , Williams Betsy L. , Osterberg Stig K.
Published: October 2010

We report radiographic, clinical, historical, and laboratory observations on seven patients selected to illustrate the features and characteristics of rapidly progressive periodontitis, with the aim of establishing this disease as a distinct clinical entity. This form of periodontitis is seen most commonly in young adults in their twenties, but it can occur in postpubertal individuals up to approximately 35 years of age. During the active phase, the gingival tissues are extremely inflamed and there is hemorrhage, proliferation of the marginal gingiva, and exudation. Destruction is very rapid, with loss of much of the alveolar bone occurring within a few weeks or months. This phase may be accompanied by general malaise, weight loss, and depression, although these symptoms are not seen in all patients. The disease may progress, without remission, to tooth loss, or alternatively, it may subside and become quiescent with or without therapy. The quiescent phase is characterized by the presence of clinically normal gingiva that may be tightly adapted to the roots of teeth with very advanced bone loss and deep periodontal pockets. The quiescent phase may be permanent, it may persist for an indefinite period, or the disease activity may return. Most patients with rapidly progressive periodontitis have serum antibodies specific for various species of Bacteroides, Actinobacillus, or both, and manifest defects in either neutrophil or monocyte Chemotaxis. Affected patients generally respond favorably to treatment by scaling and open or closed curettage, especially when accompanied by standard doses of antibiotics for conventional time periods. A small minority of patients do not respond to any treatment, including antibiotics, and the disease progresses inexorably to tooth loss even in the presence of aggressive periodontal therapy and maintenance. At the present time it is not possible to distinguish prior to treatment which individuals will respond to therapy and which will not.
Fibroblast Cytotoxicity Associated With Plasma Cells and Lymphocytes in Chronic Periodontitis Lesions in Rats
Authors: Garant Philias R. , Paik Ki‐Suk , Cho Moon‐Il
Published: October 2010

Interdental periodontitis lesions in rats 20 to 27 months of age were found to contain large aggregations of plasma cells and lymphocytes. Fibroblasts in areas of dense immunocyte infiltration appeared damaged. The close juxtaposition of both plasma cells and lymphocytes to the altered fibroblasts suggests that a cytotoxic effect of immunocyte origin might be a significant element in connective tissue alteration in advanced periodontitis lesions in older rats.

At the ultrastructural level, the damaged fibroblasts exhibited alteration of the nucleus, loss of cytoplasmic content including microfilaments and microtubules, swelling and degeneration of mitochondria and Golgi vesicles and cisternae. Dilation of the rough endoplasmic reticulum, including the perinuclear cisterna, along with vesiculation of the cytoplasmic membranes, suggests osmotic dysfunction in various cellular organelles.
Compliance with Maintenance Therapy in a Private Periodontal Practice
Authors: Wilson Thomas G. , Glover Mark E. , Schoen Jan , Baus Cathy , Jacobs Theresia
Published: October 2010

The purpose of this study was to determine patient compliance with suggested maintenance schedules. All patients eligible for maintenance therapy in a private periodontal practice were included. The study covered a period of 8 years. All patients had chronic inflammatory periodontal disease and had been eligible for at least 1 year of maintenance therapy before the close of data collection. A total of 961 patients were studied; only 16% complied with recommended maintenance schedules. Erratic compliance was found in 49% of the patients and 34% never reported for any maintenance therapy.
Covering Localized Areas of Root Exposure Employing the “Envelope” Technique
Authors: Raetzke Peter B.
Published: October 2010

A new method for covering localized areas of root exposure with free connective tissue grafts uses connective tissue obtained from the depth of the hard palate, leaving only a narrow surface defect at the donor site. The graft is positioned directly over the exposed root, but its major part is placed in an “envelope” previously created by an undermining partial thickness incision in the tissues surrounding the defect. In this way, both sides of the graft are in intimate contact with these tissues which offer support and nourishment. Clinical results 2 to 8 months postoperatively are favorable.
Clinical and Microbiological Evaluation of Therapy for Juvenile Periodontitis
Authors: Kornman Kenneth S. , Robertson Paul B.
Published: October 2010

Eight patients (mean age 15.6 yrs) with severe molar‐incisor bone loss and pocket formation characteristic of juvenile periodontitis were entered into a clinical protocol of three sequential stages: (1) scaling and root planing (S/RP); (2) S/RP concurrent with systemic tetracycline therapy (1 gm/day for 28 days); (3) periodontal surgery concurrent with systemic tetracycline therapy. Clinical and microbiological examinations were scheduled at baseline, at 1 to 2 months after Stage I, at 1 to 2 months after completion of tetracycline therapy in Stages II and III, and during recall. A decision to progress to the next stage or to place the patient on a 3‐month recall was based solely on clinical findings (suppuration, bleeding upon probing and pocket depth) at the deepest site in each patient. Paperpoint subgingival plaque samples from representative affected sites were analyzed for percentage of total cultivable microflora composed of black‐pigmented Bacteroides species (BPB), surface translocating bacteria (STB) and Actinobacillus actinomycetemcomitans (Aa). At baseline, all sites bled to probing, seven of eight sites showed suppuration, and deepest pocket depths averaged 8.0 mm. STB were detected in one and BPB in four sites, respectively, and all sites demonstrated Aa, which constituted approximately 40% of the total cultivable flora.

S/RP alone had essentially no effect on either clinical or microbiological findings, and all patients progressed to Stage II. Five went on to Stage III. S/RP with tetracycline was clinically and microbiologically more effective at sites in which Aa was predominant. Surgery was required in all sites containing high levels of both BPB and Aa. These results suggest that microbiological diagnosis may be useful in selecting and monitoring treatment for juvenile periodontitis.
Osseointegrated Oral Implants
Authors: Albrektsson Tomas , Dahl Evert , Enbom Lars , Engevall Sigfrid , Engquist Bo , Eriksson Anders R. , Feldmann Günther , Freiberg Nils , Glantz Per‐Olof , Kjellman Olof , Kristersson Lars , Kvint Sven , Köndell Per‐Åke , Palmquist Jan , Werndahl Lars , Åstrand Per
Published: October 2010

Fourteen Swedish teams outside the University of Gothenburg, each with minimally three years' experience in the Nobelpharma osseointegrated implant participated in a retrospective multiclinic study. The total number of consecutively inserted implants at the 14 clinics was 8139. The outcome of every implant was reported and all implant failures, irrespective of when they occurred, were published. The success criteria included absence of implant mobility, absence of radiolucent zones on x‐rays, and an annual bone loss after the first year of less than 0.2 mm. In the mandible 334 implants were followed for five to eight years, with only three failures, for a success rate of 99.1 %. In the maxilla 106 implants were followed for five to seven years, with a success rate of 84.9%. In irradiated and grafted mandibles, 56 implants were inserted and none was lost during a follow‐up of up to five years. In the irradiated maxilla there were 16 implants inserted with three reported failures and in the grafted upper jaw 71 implants were inserted with 12 failures. The proportions of mandibular and maxillary sleeping implants were 0.8 and 0.3%, of patient drop‐out implants 0.3 and 0.6%, and of patient death implants 0.9 and 1.2%, respectively. It was concluded that the osseointegrated implant, if inserted according to the guidelines of Brånemark, results in a very high degree of clinical success, thereby meeting any published oral implant success criteria.
Histologic Evaluation of New Attachment Apparatus Formation in Humans
Authors: Bowers Gerald M. , Chadroff Brian , Carnevale Robert , Mellonig James , Corio Russel , Emerson Jane , Stevens Mark , Romberg Elaine
Published: October 2010

There is conflicting evidence regarding the value of graft materials in enhancing the formation of new bone, cementum, and periodontal ligament (new attachment apparatus). Part II of this study compared the healing of intrabony defects with and without the placement of decalcified freeze‐dried bone allograft (DFDBA) in a submerged environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Biopsies were obtained at 6– months and evaluated histometrically by two investigators unaware of the treatment performed. Data from 9 patients with 30 grafted defects and 13 nongrafted defects were submitted for statistical analysis. Results indicate that in a submerged environment significantly more new attachment apparatus (P <.05) and new bone (P <.05) formed in grafted than nongrafted sites. Significantly greater loss of alveolar crest height occurred in nongrafted than grafted defects (P <.05); regeneration of new attachment apparatus, new bone, and new cementum occurred more frequently in grafted than nongrafted defects. There was a greater chance for the regeneration of a connective tissue attachment in nongrafted intrabony defects than in grafted defects; new cellular cementum formed equally well on old cementum, dentin, or both old cementum and dentin in the same defect. The periodontal ligament was oriented parallel, perpendicular, or both parallel and perpendicular in the same defect; and, no extensive root resorption, ankylosis, or pulp death was observed in grafted or nongrafted defects. (Journal of Periodontology, 1989; 60: 675–682)
Prevalence and Risk Indicators for Periodontal Attachment Loss in a Population of Older Community‐Dwelling Blacks and Whites
Authors: Beck James D. , Koch Gary G. , Rozier R. Gary , Tudor Gail E.
Published: October 2010

The extent and severity of periodontal attachment loss are described for a random sample of 690 dentate community‐dwelling adults, aged 65 or over, residing in five counties in North Carolina. In addition, risk indicators for serious levels of loss of attachment and pocket depth in this population are presented. Pocket depths and recession were measured on all teeth by trained examiners during household visits. Blacks had an average of 78% of their sites with attachment loss and the average level of loss in those sites was approximately 4 mm, as compared to 65% and 3.1 mm for whites. Because the extent and severity scores in this population were much higher than in younger groups, a serious condition in this group was defined as having 4 + sites of loss of attachment of 5 + mm with one or more of those sites having a pocket of 4 + mm. Bivariate analyses identified a large number of explanatory variables that were associated with increased likelihood of having the more serious periodontal condition. The logistic regression model for blacks includes the following important explanatory variables and associated odds ratios: use of tobacco (2.9), colony counts of B. gingivalis greater than 2% (2.4) and B. intermedius greater than 2% (1.9), last visit to the dentist greater than 3 years (2.3), and gums bleeding in the last 2 weeks (3.9). The model for whites indicated that tobacco use (6.2), presence of B. gingivalis (2.4) and the combined variable of having not been to the dentist in the last 3 years and having a high BANA score (16.8) were important explanatory variables. These epidemiological analyses confirm that microorganisms are associated with periodontal disease. However, other factors also are associated with serious periodontal conditions and the relationship between potential predictors of serious conditions may be complex in older adult populations. J Periodontol 1990; 61:521–528.
Early Onset Periodontitis in the United States of America
Authors: Löe Harald , Brown L. Jackson
Published: October 2010

A national survey of the oral health of U.S. children aged 5 to 17 was conducted by the National Institute of Dental Research during the 1986‐87 school year. Eleven thousand and seven adolescents aged 14 to 17 years received a periodontal assessment. Their patterns of loss of periodontal attachment as assessed by probing at mesial sites were used to classify adolescents as cases of early onset periodontitis. Approximately 0.53% of adolescents nation‐wide were estimated to have localized juvenile periodontitis (LJP), 0.13% to have generalized juvenile periodontitis (GJP), and 1.61% to have incidental loss of attachment (LA) (≥3 mm on 1 or more teeth). The total number of adolescents affected were not trivial. Close to 70,000 adolescents in the U.S. were estimated to have LIP in 1986‐87. More destructive GJP affected an estimated 17,000 adolescents. Another 212,000 adolescents were estimated to have incidental LA. Blacks were at much greater risk for all forms of early onset periodontitis than whites. Males were clearly more likely (4.3 to 1) to have GJP than females when other variables were statistically controlled. Gender associations were more complicated for LJP because gender interacted with race. Black males were 2.9 times as likely to have LJP as black females. In contrast, white females were more likely than white males to have the disease by about the same odds. When interactions among demographic variables exist, caution must be taken in comparing results from different studies. J Periodontol 1991; 62:608– 616.
Clinical Evaluation of the Use of Decalcified Freeze‐Dried Bone Allograft With Guided Tissue Regeneration in the Treatment of Molar Furcation Invasions
Authors: Anderegg Charles R. , Martin Steven J. , Gray Jonathan L. , Mellonig James T. , Gher Marlin E.
Published: October 2010

The purpose of this study is to evaluate the potential of decalcified freeze‐dried bone allograft (DFDBA) combined with a barrier material in the treatment of human molar furcation defects (experimental) as compared to the barrier technique alone (control). Fifteen pairs of Class II or III furcation invasion defects comprised the study group. Measurements with calibrated periodontal probes were made to determine soft tissue recession, probing depth, and attachment levels. Defects from each pair were randomly selected to be treated with an expanded polytetrafluoroethylene membrane (e‐PTFE) and DFDBA or the membrane alone. Additional measurements were made during surgery to determine eresiai resorption, and vertical and horizontal open probing attachment. The membrane was removed 4 to 6 weeks post‐insertion. Six months post‐treatment, each site was surgically reentered and measurements repeated. Following either treatment, recession was minimal with statistically significant improvement in probing depth reduction and clinical attachment level gain favoring the combined technique. Hard tissue changes were comparable for alveolar crestal resorption, however, there was a distinct difference, statistically, for both horizontal and vertical bone repair favoring the use of the demineralized bone graft in combination with the e‐PTFE membrane. J Periodontol 1991; 62:264–268.
Refractory Periodontitis Associated With Abnormal Polymorphonuclear Leukocyte Phagocytosis and Cigarette Smoking
Authors: MacFarlane Gordon D. , Herzberg Mark C. , Wolff Larry F. , Hardie Nancy A.
Published: October 2010

To learn if refractory periodontitis may be associated with defects in peripheral blood polymorphonuclear leukocyte (PMN) function, phagocytosis and chemotaxis were analyzed in 31 otherwise healthy patients and 12 unaffected controls. When compared to controls, no chemotactic defects to 10 nM f‐Met‐Leu‐Phe (fMLP) were detected. In contrast, phagocytosis was significantly impaired (P < 0.001). The mean rates of adhesion and ingestion of opsonized Staphylococcus aureus by PMNs were 7.1 ± 1.7 (± SD) and 1.4 ± 0.5 bacteria/100 PMNs/minute respectively for patients, and 11.0 ± 2.4 and 3.1 ± 0.6 for unaffected, healthy controls. While the quality of oral hygiene and access to dental care were high, a retrospective search for associated environmental variables showed that 90% (28 of 31) of the refractory patients were smokers. The frequency of smokers is particularly striking, since only 21% of adults in Minnesota use tobacco regularly. These data suggest that there is a strong association between a peripheral blood PMN defect and refractory periodontitis. Furthermore, these studies suggest that tobacco use may contribute to this association. J Periodontol 1992; 63:908– 913.
The Effect of the Distance From the Contact Point to the Crest of Bone on the Presence or Absence of the Interproximal Dental Papilla
Authors: Tarnow Dennis P. , Magner Anne W. , Fletcher Paul
Published: October 2010

This study was designed to determine whether the distance from the base of the contact area to the crest of bone could be correlated with the presence or absence of the interproximal papilla in humans. A total of 288 sites in 30 patients were examined. If a space was visible apical to the contact point, then the papilla was deemed missing; if tissue filled the embrasure space, the papilla was considered to be present. The results showed that when the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was 6 mm, the papilla was present 56% of the time, and when the distance was 7 mm or more, the papilla was present 27% of the time or less. J Periodontol 1992; 63:995–996.
Evidence for Cigarette Smoking as a Major Risk Factor for Periodontitis
Authors: Haber Jerome , Wattles Julianne , Crowley Maureen , Mandell Robert , Joshipura Kaumudi , Kent Ralph L.
Published: October 2010

The role of smoking as a risk factor for Periodontitis was assessed separately in diabetic and nondiabetic study groups. Subject listings stratified for age (19 to 40 years) and sex were obtained for subjects with insulin‐dependent diabetes mellitus (IDDM) and nondiabetic subjects. For both the IDDM group (n = 132) and the nondiabetic group (n = 95), age and sex stratified samples were constructed by random selection of subjects from each subject listing. Patients were recruited by phone, examined, and their medical and dental histories obtained. Among nondiabetic subjects, the prevalence of Periodontitis was markedly higher among current smokers compared with never smokers (P ≤ 0.005) in both the 19 to 30 year‐old (46% vs. 12%) and 31 to 40 year‐old groups (88% vs. 33%). The subject mean percent of sites with gingival pocket depth ≥4 mm was higher among current smokers than never smokers (P = 0.001) in the 19 to 30 (8.2% vs. 3.4%) and 31 to 40 (14.3% vs. 4.3%) age groups. The effects of smoking among IDDM subjects were similar to that observed in the nondiabetic population. There were no differences between current and never smokers in the proportion of sites positive for plaque. Attributable risk percents from prevalence data suggest that among nondiabetic subjects, a large proportion, perhaps as much as 51% of the Periodontitis in the 19 to 30 year old group and 32% of the Periodontitis in the 31 to 40 year old group, is associated with smoking. These findings suggest that smokers are a high risk group for Periodontitis, and that smoking may be the single most important environmental risk factor for Periodontitis. J Periodontol 1993; 64:16–23.
Association Between Cigarette Smoking, Bacterial Pathogens, and Periodontal Status
Authors: Stoltenberg Jill L. , Osborn Joy B. , Pihlstrom Bruce L. , Herzberg Mark C. , Aeppli Dorothee M. , Wolff Larry F. , Fischer George E.
Published: October 2010

The purposes of this study were to determine if: 1) an association exists between cigarette smoking and signs of periodontal disease after controlling for the confounding variables of age, sex, plaque, and calculus; 2) the prevalence of 5 bacteria commonly associated with periodontal disease differs between smokers and non‐smokers; and 3) the presence of any of these bacteria or smoking are associated with a mean proximal posterior probing depth ≥ 3.5 mm. Plaque, calculus, gingivitis, and probing depth were measured at the proximal surfaces of all teeth in one randomly selected posterior dental sextant in 615 adults. Subgingival plaque was sampled from the same sites and assayed for the presence of Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Eikenella corrodens, and Fusobacterium nucleatum. A subsample of non‐smokers (n = 126), who were similar to smokers (n = 63) with respect to age, sex, plaque, and calculus, was randomly drawn from the original sample. These two groups were then compared on the basis of clinical and microbial parameters. The results indicated that the odds of having a mean probing depth ≥ 3.5 mm were 5 times greater for smokers than the non‐smoker subsample (odds ratio = 5.3; 95% CI = 2.0 to 13.8). No statistically significant difference in the prevalence of any of the bacteria was found between smokers and the non‐smoker subsample. Based on logistic regression analyses of each of the 5 bacteria and smoking, mean probing depth ≥ 3.5 mm was significantly associated with the presence of A. actinomycetemcomitans, P. intermedia, E. corrodens, and smoking (P < 0.05). For this sample of medically healthy, middle‐aged adults, it is concluded that cigarette smoking is a stronger risk indicator for the presence of a mean posterior proximal probing depth ≥ 3.5 mm than any of the 5 bacteria. J Periodontol 1993;64:1225–1230.
Current View of Risk Factors for Periodontal Diseases
Authors: Genco Robert J.
Published: October 2010

Periodontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre‐existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co‐risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors‐smoking and diabetes‐which demand attention in current management of periodontal disease. J Periodontol 1996;67:1041–1049.
Biologic Width Around Titanium Implants. A Histometric Analysis of the Implanto‐Gingival Junction Around Unloaded and Loaded Nonsubmerged Implants in the Canine Mandible
Authors: Cochran David L. , Hermann Joachim S. , Schenk Robert K. , Higginbottom Frank L. , Buser Daniel
Published: October 2010

The use of endosseous dental implants as transmucosal devices necessitates the successful integration of three different tissues: bone, connective tissue, and epithelium. So far, studies have predominantly focused on hard tissue integration. Much less is known about soft tissues. This study examined the dimensions of the implantogingival junction in relation to clinically healthy unloaded and loaded nonsubmerged implants. In total, 69 titanium plasma‐sprayed (TPS) and sandblasted acid‐etched (SLA) implants were placed in an alternating fashion in six foxhounds and allowed to heal for 3 months. Two dogs were sacrificed after the initial healing period. The remaining four dogs had crowns fabricated that were allowed to function for up to 12 months. These animals were sacrificed after 3 and 12 months of loading. Histometric analysis of undecalcified histologic sections included the evaluation of the sulcus depth (SD), the dimensions of the junctional epithelium (JE), and the connective tissue contact (CTC). Mean values in the 3 month unloaded group were 0.49 mm for SD, 1.16 mm for JE, and 1.36 mm for CTC. These dimensions were 0.50 mm for SD, 1.44 mm for JE, and 1.01 mm for CTC for the 3 month loaded group. After 12 months of loading, these values were 0.16 mm for SD, 1.88 mm for JE, and 1.05 mm for CTC. The sum of these measurements was similar for the different time points and similar to the same dimensions around teeth. TPS and SLA surfaces had no influence on the evaluated parameters (P > 0.05). The data suggest that a biologic width exists around unloaded and loaded nonsubmerged one‐part titanium implants and that this is a physiologically formed and stable dimension as is found around teeth. J Periodontol 1997;68:186–198.