bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the microbiota of supra‐ and subgingival plaque in health and periodontitis
Authors: Ximénez‐Fyvie Laurie Ann , Haffajee Anne D. , Socransky Sigmund S.
Published: March 2003

Background, aims: The purpose of the present investigation was to compare the microbial composition of supra and subgingival plaque in 22 periodontally healthy (mean age 32±16 years) and 23 adult periodontitis subjects (mean age 51±14 years).

Methods: A total of 2358 supra and separately subgingival plaque samples were collected from the mesial aspect of all teeth excluding 3rd molars in each subject. Samples were examined for the presence and levels of 40 bacterial taxa using whole genomic DNA probes and checkerboard DNA‐DNA hybridization. Clinical assessments including dichotomous measures of gingival redness, bleeding on probing, plaque accumulation and suppuration, as well as duplicate measures of pocket depth and attachment level, were made at 6 sites per tooth. Mean counts (×105), % DNA probe count and % sites colonized for each species were determined separately for supra and subgingival samples in each subject and then averaged across subjects in the 2 clinical groups. Significance of differences between healthy and periodontitis subjects was determined using the Mann‐Whitney test and adjusted for multiple comparisons.

Results: Mean total DNA probe counts (×105, ±SEM) for healthy and periodontitis subjects in supragingival plaque were 72.1±11 and 132±17.5, respectively (p<0.01), and in subgingival plaque 22.1±6.6 and 100.3±18.4, (p<0.001). Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola could be detected in supragingival plaque samples of both healthy and periodontitis subjects. Actinomyces species were the dominant taxa in both supra‐ and subgingival plaque from healthy and periodontitis subjects. 4 Actinomyces species accounted for 63.2% of supragingival and 47.2% of subgingival plaque in healthy subjects and 48.1% and 37.8% in periodontitis subjects respectively. Increased proportions of P. gingivalis, B. forsythus, and species of Prevotella, Fusobacterium, Campylobacter and Treponema were detected subgingivally in the periodontitis subjects. P. gingivalis, B. forsythus and T. denticola were significantly more prevalent in both supra‐ and subgingival plaque samples from periodontitis subjects.

Conclusions: The main differences between supra and subgingival plaque as well as between health and disease were in the proportions and to some extent levels of Actinomyces,“orange” and “red” complex species.
Periodontal repair in dogs: effect of transforming growth factor‐β1 on alveolar bone and cementum regeneration
Authors: Tatakis Dimitris N. , Wikesjö Ulf M. E. , Razi Saghi S. , Sigurdsson Thorarinn J. , Lee Michael B. , Nguyen Tue , Ongpipattanakul Boonsri , Hardwick Ross
Published: March 2003

Background, aim: Transforming growth factor‐β (TGF‐β) represents a family of growth‐modulating proteins with fundamental rôles in connective tissue and bone development. The objective of this study was to evaluate the potential for regeneration of alveolar bone and cementum following surgical implantation of recombinant human TGF‐β1 (rhTGF‐β1).

Method: Bilateral, critical size, supra‐alveolar periodontal defects in 5 beagle dogs were surgically implanted with rhTGF‐β1 in a calcium carbonate carrier (CaCO3) or with carrier alone. The animals were euthanized at 4 weeks post‐surgery and block‐biopsies of the defects were processed for histologic and histometric analysis.

Results: Surgical implantation of rhTGF‐β1 resulted in minimal, if any, stimulation of alveolar bone or cementum regeneration. Linear bone and cementum regeneration in rhTGF‐β1‐treated defects was 1.2±0.6 and 0.01±0.01 mm, respectively. Correspondiong values for the controls were 1.0±0.6 and 0.01±0.03 mm.

Conclusions: The results suggest that, under the conditions (dose, carrier, defect type) evaluated here, treatment of periodontal defects in beagle dogs with rhTGF‐β1 may be of limited clinical benefit.
Antibody responses against Porphyromonas gingivalis infection in patients with early‐onset periodontitis
Authors: Guo Shujuan , Takahashi Keiso , Kokeguchi Susumu , Takashiba Shogo , Kinane Denis F. , Murayama Yoji
Published: March 2003

Background, aims: The aim of this study was to evaluate antibody responses against Porphyromonas gingivalis (P. gingivalis) infection in early‐onset periodontitis (EOP) patients to elucidate further the host‐parasite interactions in the pathogenesis of EOP.

Method: 16 P. gingivalis‐infected EOP and 20 adult periodontitis (AP) patients, and 18 periodontally healthy subjects (HS) participated in this study. Serum immunoglobulin G (IgG) antibody levels and avidities against extracted P. gingivalis whole cells were measured. The components of P. gingivalis outer membrane antigens (OMA) reacting to patients' sera were analysed from the molecular weights by Western blotting. Serum antibody levels against P. gingivalis lipopolysaccharide (LPS) were also measured. The ability of the patients' sera to block interleukin‐1 β (IL‐1β) production by human mononuclear cells in response to P. gingivalis LPS was examined.

Results: Antibody levels were positively correlated with antibody avidities in both EOP and AP patients (r=0.91, r=0.72, p<0.0005, respectively), while not significantly so in HS (r=0.09). There was variability in the antigen recognition of P. gingivalis OMA in EOP and AP patients. Smear and 53‐kDa protein were more frequently recognized by sera of EOP and AP patients rather than that of HS (p<0.05). The smear was partly diminished by absorption with P. gingivalis LPS, indicating the smear antigen was partly composed of LPS. There was high correlation between antibody levels against P. gingivalis whole‐cell extracts and LPS in EOP and AP patients (r=0.81, p=0.0002, r=0.87, p<0.0001, respectively), while not significant in HS (r=0.22). The sera of EOP and AP patients with high IgG titre to P. gingivalis LPS blocked IL‐1β production more effectively than that of the patients with low IgG titre to P. gingivalis LPS.

Conclusions: These results indicate that EOP patients' antibody response against P. gingivalis infection does not differ significantly from that of AP patients. The person‐to‐person heterogeneous antibody production against P. gingivalis LPS could contribute to our understanding of the relationship between the defensive ability of EOP patients and their chronic infection with this pathogen.
Initial extractions and tooth loss during supportive care in a periodontal population seeking comprehensive care
Authors: Tonetti Maurizio S. , Steffen Patricia , Muller‐Campanile Veronique , Suvan Jean , Lang Niklaus P.
Published: March 2003

Background/aims: This retrospective survey was aimed at determining the prevalence of tooth extractions and the dental pathologies associated with them during both the active and maintenance phase of periodontal therapy in a periodontal population seeking comprehensive dental care.

Methods: A total of 273 randomly selected subjects from the oral prophylaxis clinic of the University of Berne were included. All subjects had received comprehensive care consisting of periodontal and restorative treatment and participated in a supervised maintenance program for an average of 67±46 months (range 5 to 278 months). The population consisted of 39.6% current smokers and 27.8% previous smokers. 6.2% of the patients had gingivitis, 20.5% mild periodontitis, 48.4% moderate and 24.9% severe periodontitis. The average frequency of the recall visits was 4.4±1.5 appointments/year (range 1.7–12 appointments/year).

Results: Results indicated that 574 out of a total of 6503 teeth were extracted; 311 teeth were extracted during active therapy and 263 during the supportive periodontal care (SPC) phase of therapy. 46% of patients received tooth extractions as part of their active treatment and 41% during their participation in the secondary prevention program. In the subgroup whose treatment plan included extractions the average number was 2.5±1.6 teeth per patient. Likewise, the patients who received extractions during recall lost an average of 2.35±1.9 teeth per subject with an incidence of 0.4±0.37 teeth per patient per year. These data reinforce the concept that a minority of the population is responsible for the majority of tooth extractions, both during active therapy and SPC. Periodontal disease was the only pathology observed at 57% of the extracted teeth; while caries, endodontic pathology and technical problems in the absence of periodontitis were observed in 29% of cases.

Conclusions: These observations indicate that the rendered treatment was effective in the long‐term maintenance of the dentition of these subjects and suggest that advanced periodontal disease represented the major cause of tooth loss in this population.
Local delivery of liposome‐encapsulated superoxide dismutase and catalase suppress periodontal inflammation in beagles
Authors: Petelin Milan , Pavlica Zlatko , Ivanuša Teodora , Šentjurc Marjeta , Skalerič Uroš
Published: March 2003

Background, aims: The purpose of this study was to evaluate the influence of oxygen free radical scavengers on periodontal inflammation and healing process.

Method: Experimental periodontitis was induced by elastic ligatures around premolares (P2, P3, P4) and 1st molares (M1) in the upper and lower jaws of 15 beagle dogs. 9 months after the beginning of the experiment, the ligatures were removed. After 3 weeks of stabilization period, all teeth were supragingivally scaled. The animals were divided into 3 groups of 5 dogs. The 1st group received a liposome‐encapsulated superoxide dismutase (SOD), the 2nd group a liposome‐encapsulated catalase (CAT) and the 3rd group received both enzymes encapsulated in liposomes. 4 treatment modalities were tested in each group; i.e., supragingival scaling only (1), supragingival scaling and enzymes (2), supra‐ and sub‐gingival scaling and root planing (3) and supra‐ and sub‐gingival scaling and root planing with subgingival application of enzymes (4). Enzymes were delivered subgingivally on a daily basis for a period of 6 weeks. Gingival index (GI), probing depth (PD), clinical attachment level (CAL), radiographic analysis and the histological evaluation were performed.

Results: Around the teeth with scaling and root planing followed by the application of SOD, the greatest suppression of gingival inflammation (GI=1.8±0.1 before versus GI=1.2±0.2 after treatment) (p<0.003), the smallest size of connective tissue infiltrate (5.5±4.3%) (p<0.01), the greatest reduction of PD (PD=3.2±1.0 mm before versus 2.0±0.7 mm after treatment) (p<0.001), and gain of CAL (CAL=3.0±1.7 mm before versus CAL=2.4±1.1 mm after treatment) (p<0.001) were observed. In addition, radiographic analysis showed the greatest alveolar bone apposition in the group of teeth treated with scaling and root planing followed by subgingival application of SOD or both enzymes (p<0.001).

Conclusion: In conclusion, we demonstrated that scaling and root planing with subgingival application of liposome‐encapsulated SOD suppress peridontal inflammation on experimentally induced periodontitis in beagle dogs.
Some local and systemic immunological features of prepubertal periodontitis
Authors: Berglundh T. , Wellfelt B. , Liljenberg B. , Lindhe J.
Published: March 2003

Objectives: The aim of the present investigation was to study local (gingival) and systemic host defense characteristics in a sample of children exhibiting local prepubertal periodontitis (LPP).

Material and methods: 2 groups of subjects were included in the present study. One group consisted of 11 children (9.5±2.0 years) with signs of periodontal disease (LPP group). A 2nd group comprised 21 adults (48.1±5.8 years) with advanced periodontal disease: adult periodontitis (AP) group. Gingival biopsies and a sample of peripheral blood were obtained in each individual of the AP group and in 7 out of the 11 subjects in the LPP group. The biopsies were prepared for morphometrical and immunohistochemical analysis and the blood samples prepared for immunohistochemical analysis.

Results: The cellular infiltrates in the biopsies of the LPP group contained a larger proportion of lymphocytes and, in particular B cells, than was the case in the AP group. The TCR Vα/Vβ gene expression in the lesions in the AP group was dominated by Vβ 17 and in the LPP group by Vα 2. The content in peripheral blood of various lymphocyte sub‐populations and TCR Vα/Vβ gene expression in the 2 groups was almost similar.

Conclusion: It is suggested that (i) the systemic host response in children with prepubertal periodontitis has many features in common with that seen in adult patients but that (ii) local defense mechanisms in the periodontitis lesion of LPP differ from those in adult periodontitis.
Expression of matrix metalloproteinases in healthy and diseased human gingiva
Authors: Dahan Maurice , Nawrocki Béatrice , Elkaïm René , Soell Martine , Bolcato‐Bellemin Anne‐Laure , Birembaut Philippe , Tenenbaum Henri
Published: March 2003

Background, aims: The aim of our study was to investigate the patterns of several metalloproteinases (MMP‐1, MMP‐2 and MT1‐MMP) mRNAs expression using a semi‐quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR) and to correlate them with clinical parameters and bacteriological diagnosis in healthy versus diseased human gingiva.

Methods: To identify the cell origin of MMP production, in situ hybridization (ISH) was also performed for the MMPs on the same samples. 17 gingival biopsies were collected (13 affected by advanced periodontitis and 4 healthy used as controls) and plaque index, gingival index, pocket depth and bleeding on probing were measured. Subgingival microbial samples were also collected to be analysed by a DNA probe technique. The biopsies were processed both for RT‐PCR and ISH. We also investigated a model for bacterial induced MMP expression in human gingival fibroblasts (HGF) infected by Eikenella corrodens.

Results: We found an expression of the mRNA encoding MMP‐1 only in diseased gingiva but at low levels relative to β‐actin (mean±SD: diseased versus healthy: 0.013±0.024 versus 0). Although the frequencies and levels of mRNA encoding for MMP‐2 or MT1‐MMP are not significantly different between each group (mean±SD: 0.329±0.344 versus 0.137±0.219 for MMP‐2; 0.485±0.374 versus 0.466±0.296 for MT1‐MMP), using ISH, we observed an expression of both mRNAs in fibroblasts of pathological specimens at sites that histologically showed signs of chronic inflammation and connective tissue remodelling. In vitro infection of HGF by Eikenella corrodens stimulated 3‐fold the production of the mRNA encoding MMP‐2 while other mRNAs remained unchanged.

Conclusion: Our results did not reveal significant differences in the expression of mRNAs encoding for the MMPs between healthy and periodontitis‐affected patients, reflecting the great heterogeneity in the periodontal status of individuals. However, they indicate that gingival fibroblasts are an active source of MMP‐2 production in response to a periopathogen.
Self‐preventive oral behavior in an Italian university student population
Authors: Rimondini Lia , Zolfanelli Brunella , Bernardi Federico , Bez Cristina
Published: March 2003

Background, aim: The aim of this study was to assess the oral hygiene attitude and the professional preventive examination compliance in Italian university students.

Method: A sample of 202 students attending the University of Bologna was randomly selected and interviewed about their preventive oral health attitude and compliance. All students reported using toothpaste and most of them (92.1%) brushed their teeth at least 2× a day using artificial, medium stiffness bristles. The toothbrush was generally (81.6%) replaced within 3 months. Few subjects (14.9%) said they used dental floss daily or utilized other devices. A majority of subjects (59.9%) had a dental examination within the year previous to the interview. Cluster analysis was performed.

Results: 4 groups were identified with homogeneous oral hygiene behavior and compliance toward professional preventive examination. Only one cluster, representing 33.6% of the sample, showed consistent frequency and modalities of oral hygiene habits. The other clusters seemed to be defective with interproximal cleaning procedures and compliance toward professional preventive care. Since the sample was characterized by a young, urbanized, homogeneous group with a high educational level and frequently from an upper middle class social status, the analysis probably gives a supra‐estimation of the positive behavior.

Conclusion: It is rational to suppose that strategies to promote dental service utilization, patients’ compliance and a professional style oriented toward prevention may be useful to improve the oral health condition in the young adult Italian population.
Relationship of cigarette smoking to attachment level profiles
Authors: Haffajee A. D. , Socransky S. S.
Published: March 2003

Abstract Objectives: The present investigation examined clinical features of periodontal disease and patterns of attachment loss in adult periodontitis subjects who were current, past or never smokers.

Material and Methods: 289 adult periodontitis subjects ranging in age from 20–86 years with at least 20 teeth and at least 4 sites with pocket depth and/or attachment level >4 mm were recruited. Smoking history was obtained using a questionnaire. Measures of plaque accumulation, overt gingivitis, bleeding on probing, suppuration, probing pocket depth and probing attachment level were taken at 6 sites per tooth at all teeth excluding 3rd molars at a baseline visit. Subjects were subset according to smoking history into never, past and current smokers and for certain analyses into age categories <41, 41–49, >49. Uni‐ and multi‐variate analyses examined associations between smoking category, age and clinical parameters.

Results: Current smokers had significantly more attachment loss, missing teeth, deeper pockets and fewer sites exhibiting bleeding on probing than past or never smokers. Current smokers had greater attachment loss than past or never smokers whether the subjects had mild, moderate or severe initial attachment loss. Increasing age and smoking status were independently significantly related to mean attachment level and the effect of these parameters was additive. Mean attachment level in non smokers <41 years and current smokers >49 years was 2.49 and 4.10 mm respectively. Stepwise multiple linear regression indicated that age, pack years and being a current smoker were strongly associated with mean attachment level. Full mouth attachment level profiles indicated that smokers had more attachment loss than never smokers particularly at maxillary lingual sites and at lower anterior teeth.

Conclusions: In accord with other studies, smokers had evidence of more severe periodontal disease than past or never smokers. At all levels of mean attachment loss, smokers exhibited more disease than never smokers. Difference in mean attachment level between smokers and never smokers at individual sites was not uniform. Significantly more loss was observed at maxillary lingual sites and lower anterior teeth suggesting the possibility of a local effect of cigarette smoking.
Longitudinal evaluation of GCF MMP‐3 and TIMP‐1 levels as prognostic factors for progression of periodontitis
Authors: Alpagot T. , Bell C. , Lundergan W. , Chambers D. W. , Rudin R.
Published: March 2003

Abstract Background: To determine whether matrix metalloproteinase‐3 (MMP‐3) and tissue inhibitor of metalloproteinases‐1 (TIMP‐1) in gingival crevicular fluid (GCF) could serve as prognostic factors for the progression of periodontitis, we monitored GCF MMP‐3 and TIMP‐1 and periodontal status of selected sites in 40 medically healthy subjects over a 6‐month period.

Method: Clinical measurements including gingival index (GI), plaque index, bleeding on probing, suppuration, probing depth (PD), attachment loss (AL), and GCF samples were taken from 2 healthy sites (including sites with gingival recession, GI=0; PD 3 mm; AL 2 mm) and 2 periodontitis sites (GI 1 ; PD 5 mm ; AL 3 mm) of each patient at baseline, 3‐month and 6‐month visits by means of sterile paper strips. GCF levels of MMP‐3 and TIMP‐1 were determined by sandwich ELISA assays.

Results: The mean amounts of MMP‐3 and TIMP‐1 in diseased sites were significantly higher than in healthy sites (p<0.0001). Significantly higher GCF levels of MMP‐3 and TIMP‐1 were found at progressing sites than in nonprogressing periodontitis sites (0.001<p<0.01). A progressing site was defined as a site which had 2 mm loss of attachment during 6‐ month study period. GCF levels of MMP‐3 were highly correlated with clinical measurements taken at baseline, 3‐month and 6‐month visits (p<0.001). TIMP‐1 levels were only moderately correlated with probing depth and attachment level (p<0.01). Step‐wise multiple regression analysis was performed to construct models for the prediction of probing depth and attachment loss increases. The most parsimonious regression models which had the best R2 values included the following variables and accounted for the indicated % of variability. The regression model for the prediction of probing depth increase included MMP‐3, smoking pack‐years, TIMP‐1 and accounted for 53% of the variability. The best model for the prediction of attachment loss increase included MMP‐3, smoking pack‐years, age, TIMP‐1 and explained 59% of the variability.

Conclusion: These data indicate that sites with high GCF levels of MMP‐3 and TIMP‐1 are at significantly greater risk for progression of periodontitis.
Palatal radicular multigrooves associated with severe periodontal defects in maxillary central incisors
Authors: Nanba Koichi , Ito Koichi
Published: March 2003

Abstract Background: This case report describes a rare condition of palatal radicular multigrooves on teeth 11 and 21 with severe periodontal defects and the findings at 3‐year follow‐up.

Method: Radiculoplasty using hand curettes and rotary burs were used to remove the multigrooves on the root surfaces and change the wrinkled root form to the relatively flat and smooth normal root morphology. Minor tooth movement and frenotomy were performed for a diastema between teeth 11 and 21. Supportive periodontal therapy started immediately after completion of the active treatment.

Results: Improved healthy periodontal tissues and adequate plaque control have been maintained.
The long‐term effect of systemic tetracycline used as an adjunct to non‐surgical treatment of advanced periodontitis
Authors: Ramberg P. , Rosling B. , Serino G. , Hellström M.K. , Socransky S. S. , Lindhe J.
Published: March 2003

Aim: In the present study both the short‐ and the long‐term effects were evaluated of a treatment that, during the phase of basic therapy, included administration of systemic tetracycline and non‐surgical intervention.

Material and Methods: 35 adult human subjects with advanced periodontitis, 19 females and 16 males, aged between 24 and 60 years, were included in a test group. 80 age‐ and sex‐matched adult periodontitis subjects were recruited for a control group (42 females and 38 males). A baseline examination included assessment of the following parameters: number of teeth, plaque, bleeding on probing, probing attachment level, probing pocket depth. In radiographs, the distance between the cemento‐enamel junction and the alveolar bone crest was determined at all interproximal sites. The subjects were given oral hygiene instruction. The members of the test group were provided with tablets with 250 mg of tetracycline hydrochloride and were instructed to take 1 tablet 4× per day for a period of 3 weeks. No antibiotic was given to the subjects in the control group. During the 3‐week interval, all participants received 4–6 sessions of non‐surgical periodontal therapy. All subjects were subsequently enrolled in a maintenance care program and were provided with supportive periodontal therapy (SPT) 3–4× per year. Clinical re‐examinations were performed after 1, 3, 5 and 13 years.

Results: The present investigation demonstrated that tetracycline administered during a 3‐week period concomitant with non‐surgical treatment enhanced the outcome of mechanical therapy. At the re‐examination 1 year after active therapy, there was in the test group an average gain in probing attachment that was almost 3× higher than the gain that occurred in an age and sex matched Control group. Re‐examinations after 3, 5, and 13 years of SPT disclosed that this short‐term benefit was not maintained in the longer perspective.

Conclusion: The beneficial effect of systemically administered tetracycline on probing attachment level occurred in the first year post‐therapy. Annual rates of probing attachment level change from 1 to 13 years did not differ between groups.
Effects of academic stress on oral hygiene – a potential link between stress and plaque‐associated disease?
Authors: Deinzer Renate , Hilpert Daniel , Bach Katharina , Schawacht Michael , Herforth Armin
Published: March 2003

Background: While there seems to be a common belief that psychosocial stress affects oral hygiene behavior, this assumption has rarely been proved. The present study thus aims to analyse stress effects on oral hygiene.

Material and Methods: 16 matched pairs of medical students each consisting of 1 student participating in a major academic exam and 1 control without current academic stress, were formed on the basis of baseline plaque levels. At baseline, a professional tooth cleaning was performed. On the last day of exams, students answered questionnaires about oral hygiene during the exams and were afterwards asked to attend for a 2nd dental examination, of which they had no prior knowledge.

Results: On the last day of exams, approximately 6 weeks after professional tooth cleaning, 20.9±18.3% of control students’ sites but only 10.5±9.3% of exam students’ sites were found to be free of any plaque (p=0.022). Differences were most obvious at oral, as compared to vestibular, sites. Exam students reported a reduction in thoroughness (p=0.019) but not of frequency of oral hygiene behavior.

Conclusion: The study strongly supports the assumption that psychosocial stress may induce neglect of oral hygiene and increase of plaque accumulation.
Immunization to Porphyromonas gingivalis enhances the local pro‐inflammatory response to subcutaneous bacterial challenge
Authors: Houri‐Haddad Yael , Soskolne W. Aubrey , Shapira Lior
Published: March 2003

Background, aims: Human and animal studies have suggested that immunization to P. gingivalis might be beneficial for controlling periodontitis, by the induction of protective antibody response. The present study was designed to examine the effect of immunization on the local cellular, cytokine and antibody response to P. gingivalis in mice.

Methods: Subcutaneous chambers were implanted in 3 groups of mice. 2 groups were then immunized with P. gingivalis in either incomplete Freund’s (IFA) or an Alum‐based adjuvant. The 3rd group served as the control. At baseline, all mice were challenged with an intra‐chamber injection of P. gingivalis. Chamber exudates were sampled at baseline, 1 and 7 days post‐challenge, following by determination of leukocyte counts and the cytokines TNF‐α, IFNγ (pro‐inflammatory) and IL‐10 (anti‐inflammatory). IgG levels to P. gingivalis were analyzed in both the exudates and serum.

Results: Leukocyte accumulation increased in the chambers over the study period and was more marked in the immunized groups. P. gingivalis challenge induced the expression of the tested cytokines in all groups. Levels of IFNγ showed a significantly greater increase in the immunized groups on day 1 post‐challenge. By day 7, the levels in the controls had reached those of the immunized groups. IL‐10 levels were significantly higher in the control group compared to the immunized groups on day 1 and by day 7 they were reduced significantly in all groups to barely detectable levels. While there were no significant differences in TNF‐α levels between IFA and control groups, they were significantly higher in the Alum group on day 0 and 7. Both immunization protocols induced anti‐P. gingivalis IgG. The Alum group achieved the highest antibody levels, which were due to the increased expression of IgG1, a marker of a Th2‐response.

Conclusions: The results suggest that immunization to P. gingivalis results in enhanced expression of pro‐inflammatory, tissue‐destructive cytokines in the inflammatory site. The nature of the adjuvant used for immunization allows manipulation of the T‐cell response, and alum was more effective in reducing the inflammatory response than IFA.
Nitric oxide synthesis is decreased in periodontitis
Authors: Aurer Andrej , Aleksić Jos˘ko , Ivić‐Kardum Marija , Aurer Jelena , Čulo Filip
Published: March 2003

Objectives: In order to study the possible rôle of nitric oxide (NO) in the development of periodontitis, we measured the concentration of its stable metabolite nitrite (NO2−) in the saliva of patients with periodontitis and healthy subjects.

Materials and methods:

We have analysed salivary NO2− concentrations in 25 subjects with rapidly progressive periodontitis (RPP), 25 with adult periodontitis (AP) and in 25 periodontally‐healthy persons. The concentrations of NO2− were determined by the Griess reaction in microtitration plates. Periodontal tissue destruction was determined by measuring the attachment level loss using standard methods.

Results: Subjects with periodontitis had significantly less NO2− in saliva than healthy subjects. Subjects with RPP had lower NO2− concentrations than those with AP. Parotid gland saliva contained less NO2− than sublingual gland or total saliva.

Conclusions: Local NO production is decreased in patients with periodontitis. This effect is more pronounced in those with severe types of disease.
Tobacco smoking and periodontal hemorrhagic responsiveness
Authors: Bergström Jan , Boström Lennart
Published: March 2003

Objective: The influence of smoking on the periodontal hemorrhagic responsiveness was investigated in 2 different populations, one exclusively consisting of patients with established periodontal disease, the other of dental hospital admissions in general.

Material and Methods: The hemorrhagic responsiveness of the patient was clinically found from “bleeding on gentle probing” expressed as the relative frequency of bleeding sites (%). In the periodontal patient population, gingival bleeding was assessed by 1 examiner with known probing force, whereas in the dental hospital admissions population assessments were done by a great number of non‐calibrated examiners with unknown probing force.

Results: Smokers exhibited a significantly lower hemorrhagic responsiveness than non‐smokers. This held principally true for both populations but the effect was much more clearly detectable in periodontal patients than in dental hospital patients in general. A dose‐reponse effect was typically evident in the periodontal patient population. Accounting for the periodontal disease severity, however, the effect of smoking became clearly detectable also in the general patient population.

Conclusion: Tobacco smoking is associated with a clinically suppressed hemorrhagic responsiveness of the periodontium.
Lower numbers of erythrocytes and lower levels of hemoglobin in periodontitis patients compared to control subjects
Authors: Hutter J. W. , Velden U. van der , Varoufaki A. , Huffels R. A. M. , Hoek F. J. , Loos B. G.
Published: March 2003

Background: Anemia of chronic disease (ACD) is defined as the anemia occurring in chronic infections and inflammatory conditions, that is not due to marrow deficiencies or other diseases and in the presence of adequate iron stores and vitamins. The purpose of the present study was to investigate whether periodontitis patients show signs of anemia.

Method: 39 patients with severe periodontitis, 71 patients with moderate periodontitis and 42 controls, all with good general health, participated in this study. The mean age of all groups was 42 years. Several red blood cell parameters were determined from peripheral blood samples.

Results: Overall data analysis indicated that periodontitis patients have a lower hematocrit, lower numbers of erythrocytes, lower hemoglobin levels and higher erythrocyte sedimentation rates. These results were adjusted for the following possible confounders: gender, age, smoking, ethnicity and level of education. Further, more periodontitis patients (23%) than controls (7%), had hemoglobin levels below the normal reference range.

Conclusions: The present study provides further evidence that periodontitis has systemic effects and that periodontitis may tend towards anemia. This phenomenon may be explained by a depressed erythropoiesis.
Prevalence and extent of lifetime cumulative attachment loss (LCAL) at different thresholds and associations with clinical variables: changes in a population of young male military recruits over 3 years
Authors: Griffiths G. S. , Duffy S. , Eaton K. A. , Gilthorpe M. S. , Johnson N. W.
Published: March 2003

Aim: The aims of this study were to monitor the prevalence and progression of lifetime cumulative attachment loss (LCAL) in a group of young British male military recruits over a 3‐year period, and to determine the relationship between signs of LCAL and selected periodontal variables.

Methods: 100 subjects, aged 16–20 years (mean 17 years) at baseline, were examined at 0 (baseline), 12 and 30 months. LCAL, probing depth, plaque, bleeding on probing, gingival colour and supra‐ and subgingival calculus were assessed on the mesio‐buccal, disto‐buccal, mesio‐lingual and disto‐lingual surfaces of all teeth present, excluding third molars. Data were analysed cross‐sectionally at each examination.

Results: Over the period of the study, the prevalence of LCAL 1 and 2 mm ranged from 95–100%, whereas LCAL 3 mm ranged from 40–47%. The extent of LCAL 1 mm ranged from 76–86%. However, the extent of LCAL 2 mm was dramatically lower (10.5–12.7%), and LCAL 3 mm was uncommon (0.5–0.9%). Examining the number of subjects according to the number of sites affected above a threshold, showed that a small number of subjects have a large number of sites above threshold. Using Pearson’s rank correlation coefficient a significant correlation (p<0.05) was found between LCAL and the periodontal variables of gingival bleeding and supra‐ and subgingival calculus.

Conclusions: These data suggest that the onset and progression of chronic periodontitis can be seen in young adults, and in this group gingival bleeding and supra‐ and subgingival calculus are the variables most strongly associated with early periodontitis.
Salivary cystatin activity and cystatin C in natural and experimental gingivitis in smokers and non‐smokers
Authors: Lie M. A. , Loos B. G. , Henskens Y. M. C. , Timmerman M. F. , Veerman E. C. I. , Velden U. van der , Weijden G. A. van der
Published: March 2003

Background: Recent studies show that subjects with natural gingivitis or periodontitis have elevated levels of salivary cystatins compared to periodontally healthy individuals. Increased glandular output of cystatins in inflammatory conditions suggests an active, most likely protective, rôle for these proteins in inflammatory processes. Furthermore, it has been shown that the development of gingival inflammation is suppressed in smokers during experimental gingivitis.

Aims: The purpose of the present study was to investigate whether (i) the levels of salivary cystatins in natural gingivitis are related to smoking status, and (ii) to study whether experimentally induced gingivitis is associated with changes in salivary cystatin levels, in both smokers and non‐smokers.

Material and Methods: Whole saliva samples were taken in relation to natural gingivitis, gingival health and 14‐day experimental gingivitis in 25 non‐dental students (14 non‐smokers and 11 smokers). The salivary flowrate was determined. Samples were analyzed for levels of protein, cystatin and cystatin‐C.

Results: Salivary flow and protein concentrations in cleared human whole saliva samples of non‐smokers and smokers were not different from each other at any timepoint during the trial. With regard to cystatins, the results showed that in the state of natural gingivitis cystatin activity is lower in smokers as compared to non‐smokers. In smokers, the resolution of natural gingivitis to the state of gingival health did not result in a change of cystatin activity and levels of cystatin C. At the end of the 14‐day experimental gingivitis period, smokers showed a decrease in cystatin activity and cystatin C as well as lower outputs of cystatin activity and cystatin C.

Conclusion: Smoking is associated with lower cystatin activity and output of cystatin C during gingival inflammation.
Subgingival polishing with a teflon‐coated sonic scaler insert in comparison to conventional instruments as assessed on extracted teeth
Authors: Kocher T. , Rosin M. , Langenbeck N. , Bernhardt O.
Published: March 2003

Aim: To assess the root surface roughness and topography on extracted teeth using different instruments.

Material and Methods: In the present study, laser profilometry was used to examine the 3‐D roughness values Ra and Rz and topography of root surfaces of periodontally‐involved teeth instrumented in vivo with curette, conventional ultrasonic device, conventional or teflon‐coated sonic scaler insert, or the Periotor instrument (12 teeth per instrument type), and compare these with uninstrumented cementum surfaces.

Results: The roughness values Ra and Rz of the roots treated with the different instruments showed a similar pattern: curettes and the Periotor instrument produced the smoothest surfaces (Ra about 1.5 μm, Rz 30 μm); the 4 other instruments created similar Ra values of approximately 2–3 μm and Rz roughness of about 50–70 μm, which equals the untreated root surface. For Ra, the difference between the curette or the Periotor instrument and the teflon‐coated sonic insert or ultrasonic insert was significant, and for Rz, a significant difference was found between the curette or the Periotor instrument and ultrasonic insert. As opposed to surfaces debrided with the Periotor and teflon‐coated sonic scaler, it appears that hand instruments markedly reconfigure surfaces.

Conclusion: The lowest root‐surface roughness values were obtained with hand instruments. The teflon tubing on the sonic scaler insert effected no change of topography or roughness as compared to uninstrumented, control surfaces. However, it must be pointed out that hard‐tissue removal was not investigated.
Some effects of enamel matrix proteins on wound healing in the dento‐gingival region
Authors: Wennström Jan L. , Lindhe Jan
Published: March 2003

Objective: The aim of the present study was to evaluate by clinical means the effect of enamel matrix proteins on the healing of a soft tissue wound produced by periodontal pocket instrumentation.

Material and methods: The study was performed as an intra‐individual, longitudinal trial of 3 weeks duration with a double‐masked, split‐mouth, placebo‐controlled and randomized design. The patient material was comprised of 28 subjects with moderately advanced, chronic periodontitis. Each patient presented with 3 sites in each of 2 jaw quadrants with a probing pocket depth (PPD) of 5 mm and bleeding following pocket probing (BoP). Baseline examination, including assessments of plaque, gingival inflammation, PPD, BoP and root dentin sensitivity, was carried out one week after oral hygiene instruction and careful self‐performed plaque control. All experimental sites were scaled and root planed, and the soft tissue wall of the pocket was curetted to remove the pocket epithelium and adjacent granulation tissue. The site was carefully irrigated with saline. When the bleeding from the pocket had ceased, a 24% EDTA gel was applied in the site and retained for 2 min. This was followed by careful irrigation with saline. Left and right jaw quadrants were then randomized to subgingival application of enamel matrix derivative (Emdogain®) or vehicle‐control. All sites were re‐examined after 1, 2 and 3 weeks. In addition, a visual analogue scale (VAS) was used to score the degree of post‐treatment discomfort. The primary endpoints of treatment success were defined as (i) pocket closure (PPD 4 mm), (ii) no bleeding following pocket probing, (iii) no sign of gingival inflammation (GI score =0) and (iv) low degree of post‐treatment discomfort (VAS 20). Statistical analyzes of intra‐individual differences between the test and control treatments were performed by the use of Wilcoxon signed rank test. For comparison of the proportions of sites reaching the defined endpoints of treatment success, a site‐based analysis was performed using 2×2 tables and the Fisher exact test.

Results: The endpoint “GI score =0” was reached at 16% of the sites subjected to application of Emdogain® at 1 week and at 2% of the control sites (p=0.001). At 2 weeks, the corresponding figures were 25% versus 12% (p=0.028). Absence of BoP was at 1 week 57% for the Emdogain® treated sites compared to 35% for the control sites (p=0.003). At 2 weeks, this endpoint was reached in 73% and 59% of the test and control sites, respectively (p=0.051). In terms of the endpoint defined for probing pocket depth, PPD 4 mm, no differences between test and control sites were found. At 1 week, the proportion of patients reporting a VAS score 20 was significantly higher for the Emdogain® treated quadrants than for controls (p=0.002).

Conclusion: The results indicated that Emdogain® topically applied in instrumented pockets enhance the early healing of periodontal soft tissue wounds.
Comparative study of Emdogain® and coronally advanced flap technique in the treatment of human gingival recessions
Authors: Hägewald Stefan , Spahr Axel , Rompola Eirini , Haller Bernd , Heijl Lars , Bernimoulin Jean‐Pierre
Published: March 2003

Objectives: Various surgical techniques have been proposed for coverage of denuded root surfaces. The aim of this study was to evaluate a comparison of coronally repositioned flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects.

Material and methods: This study was an intra‐individual longitudinal test of 12 months duration conducted as a blinded, split‐mouth, placebo‐controlled and randomised design. It was performed in 2 dental schools. 36 patients, aged 22–62 years, with 2 paired buccal recession defects of at least 3 mm participated. Surgical recession coverage was performed as coronally‐advanced flap technique at both sites in the same session. One site was additionally treated with commercially‐available enamel matrix proteins (Emdogain®) and the other site with placebo (propylene glycol alginate) in accordance with the randomisation list. A blinded examiner assessed pre‐ and post‐surgical measurements. Clinical measurements and photographs were taken pre‐surgically and after 1 week, 3 weeks, 3 months, 6 months and 12 months, postoperatively. Measurements comprised height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing pocket depth and alveolar bone level by periodontal probe, Florida Probe® or caliper to the nearest 0.5 mm.

Results: 12 months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.7 mm to 0.8 mm for the Emdogain® treated sites and from 3.9 mm to 1.0 mm for the control sites, corresponding to mean root coverages of 80% and 79%, respectively. This difference was not significant. With the exception of keratinized tissue gain, which was significantly higher (p=0.003) in the Emdogain® group, all other clinical variables were not different in the between‐group comparison.

Conclusions: As the additional use of Emdogain® together with coronally advanced flap technique for recession coverage showed no difference in the overall clinical outcome, there is no clear benefit to combine Emdogain® with this surgical technique.
Effect of interleukin‐1 gene polymorphism in a periodontally healthy Hispanic population treated with mucogingival surgery
Authors: Caffesse Raul G. , De La Rosa R. M. , De La Rosa G. M. , Weltman Robin
Published: March 2003

Objectives: A genetic test for susceptibility of periodontal disease has been introduced. A positive test indicates a risk factor for more severe periodontal destruction. The prevalence of genotype positive subjects has been reported around 30%. In a Mexican population, we have found a 26% prevalence of genotype positive individuals. Few studies have reported the response to therapy in these individuals. The purpose of this study was to assess the response to mucogingival surgery in an otherwise periodontally healthy Hispanic population.

Materials and methods: 22 subjects (7 male and 15 female) with a mean age of 45 years participated. They were treated 3 years prior for the treatment of Types I and II recession defects using connective tissue grafts. No other active periodontal treatment was required, except for preventive maintenance. A full‐mouth clinical evaluation was performed which included assessment of gingival inflammation and measurements of probing pocket depth and clinical attachment levels. Mean values per patient were determined. A finger stick blood sample was collected using specially provided DNA filter paper, let dried, and mailed for processing.

Results: Results indicated that 5 out of the 22 subjects were genotype positive. The genotype positive subjects presented the following values: GI 1.13±0.17, PPD 2.48±0.46, and CAL 3.38±0.66. The values for the genotype negative subjects were GI 1.06±0.14, PPD 2.38±0.31 and CAL 3.11±0.53. No statistical significant differences were found when both groups were compared (p>0.05). Furthermore, the treatment of the localized recessions was effective and provided similar amount of coverage in genotype positive and negative subjects. However, more genotype negative subjects showed complete coverage of the recession than genotype positive individuals.

Conclusions: Within the limits of this study it is concluded that (1) periodontal health can be maintained with proper preventive maintenance irrespective of the genotype present, (2) the mean response to mucogingival surgery to cover localized gingival recessions is similar irrespective of the IL‐1 periodontal genotype, however, full coverage is achieved more frequently in genotype negative subjects.
Hereditary gingival fibromatosis: a case report
Authors: Baptista Isabel Poiares
Published: March 2003

Background/Aims: Hereditary gingival fibromatosis is characterized by various degrees of attached gingival overgrowth. It usually develops as an isolated disorder but can be one feature of a syndrome. A case of a 38‐year‐old female is reported who presented a generalized severe gingival overgrowth, involving the maxillary and mandibular arches and covering almost all teeth. The clinical differential diagnosis included drug‐induced overgrowth as well as idiopathic gingival fibromatosis.

Treatment: Excess gingival tissue was removed by conventional gingivectomy. As the gingival enlargement was generalized to all quadrants, on both sides, the surgery was carried out under general anaesthesia. The postoperative course was uneventful and the patient's appearance improved considerably. Post‐surgical follow‐up after 20 months demonstrated a slight recurrence

Conclusions: Hereditary gingival fibromatosis is a rare disorder characterized by the proliferative fibrous overgrowth of the gingival tissue. Resective surgery of the excess tissue is the treatment available. However, recurrence is a common feature.