bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Epidermal Growth Factor, Interleukin‐1, and Phenytoin, Alone and in Combination, on C19 Steroid Conversions in Fibroblasts
Authors: Soory M. , Kasasa S.C.
Published: March 2012

The formation of the biologically active metabolite 5α‐dihydrotestosterone (DHT) from testosterone in response to phenytoin (Ph), interleukin‐1 (IL‐1), and epidermal growth factor (EGF) was investigated. The androgen DHT stimulates matrix synthesis in connective tissue and bone. Duplicate incubations were performed with confluent human gingival fibroblasts, 14C‐testosterone, and optimal stimulatory concentrations of IL‐1. (5 IU/ml), EGF (10 ng/ml), Ph (5 μg/ml), Ph + EGF, and Ph + IL‐1 respectively for 24 hours in Eagle's MEM at 37°C. The medium was then analyzed for radioactive metabolites. Similar incubations were performed with human gingival tissue using 14C‐4‐androstenedione as substrate in the presence or absence of EGF, Ph, and EGF + Ph. In the cell lines studied, EGF stimulated DHT and 4‐androstenedione synthesis by 20% (n = 5; P < 0.01; Wilcoxon signed rank statistic for paired observations). IL‐1 stimulated DHT and 4‐androstenedione synthesis by 2‐fold (n = 6; P < 0.01). Ph stimulated DHT and 4‐androstenedione synthesis by 2‐fold increases (n = 3; P < 0.01). Combinations of phenytoin and EGF stimulated DHT and 4‐androstenedione synthesis by 33% and 37% greater than the effect of phenytoin alone (n = 3; P < 0.01). Combinations of Ph and IL‐1 caused a 45% increase in the amount of DHT formed and a 66% increase in 4‐androstenedione when compared to the effect of phenytoin alone (n = 3; P < 0.01). 14C‐4‐androstenedione was converted to DHT and testosterone by human gingival tissue. There were 2‐fold, 4‐fold, and 2.5‐fold increases in DHT synthesis and 5‐fold, 2‐fold, and 6‐fold increases in the formation of testosterone in response to EGF, Ph, and EGF + Ph respectively (n = 3; P < 0.01). EGF and IL‐1 present in inflammatory exudate may have implications on phenytoin‐induced overgrowth via the steroid metabolic pathway. J Periodontol 1997;68:819–826.
Results of Limited Initial Periodontal Therapy in Smokers and Non‐Smokers
Authors: Pucher Jeffery J. , Shibley Othman , Dentino Andrew R. , Ciancio Sebastian G.
Published: March 2012

Eighty‐seven adult patients (54 non‐smokers and 33 smokers) with moderate to advanced periodontitis were treated with 1‐hour full‐mouth subgingival scaling and root planing, with no maintenance recalls, during this 9‐month study. Clinical parameters assessed at target sites included probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index. Data were collected at baseline, and 3, 6, and 9 months. Baseline probing depth for non‐smokers was 5.46 ±.46 mm and for smokers 5.70 ± 0.66 mm. Data analysis (t test) revealed that both non‐smokers and smokers had a statistically significant decrease (P < 0.05) in probing depth at 3 months which was maintained throughout the study. At 9 months non‐smokers maintained a mean decrease in probing depth of 0.60 mm and smokers a mean decrease of 0.65 mm. Both smokers and non‐smokers displayed a significant gain (P < 0.05) in clinical attachment level after initial therapy when compared to baseline readings. At 9 months the mean gain in clinical attachment level for non‐smokers was 0.47 mm and 0.59 mm for smokers. Plaque index scores remained consistent for smokers and non‐smokers for the duration of the study. The gingival index at baseline was significantly (P < 0.05) lower in smokers (1.32 ± 0.45) than non‐smokers (1.45 ± 0.40). By 9 months only the gingival index of non‐smokers decreased significantly compared to baseline (1.26 ± 0.37). Bleeding on probing was a prerequisite for target sites at baseline. At 9 months both smokers (0.67 ± 0.39) and non‐smokers (0.78 ± 0.30) had a significant decrease in bleeding on probing compared to baseline. At 9 months there were no significant differences between smokers and non‐smokers comparing probing depth, clinical attachment level, plaque index, bleeding on probing, and gingival index. The data have shown that smokers and non‐smokers responded similarly after 9 months to the limited amount of initial therapy provided. J Periodontol 1997;68:851–856.
Periodontal Repair in Dogs: Effect of Allogenic Freeze‐Dried Demineralized Bone Matrix Implants on Alveolar Bone and Cementum Regeneration
Authors: Kim Chong‐Kwan , Cho Kyoo‐Sung , Choi Seong‐Ho , Prewett Annamarie , Wikesjö Ulf M.E.
Published: March 2012

The objective of this study was to evaluate alveolar bone and cementum regeneration following surgical placement of an allogenic, freeze‐dried, demineralized bone matrix (DBM) cortical strip implant. Critical size, supraalveolar periodontal defects were surgically created around the second, third, and fourth mandibular premolar teeth in eight mongrel dogs. Contralateral jaw quadrants in six animals were randomly assigned to receive the DBM implant, or serve as surgical control. Two additional animals received bilateral DBM implants. Flaps were coronally advanced to submerge teeth and implants, and sutured. Three animals were exited from the study due to extensive early wound failure. Remaining animals were sacrificed at 8 weeks postsurgery. Histometric recordings included defect height, bone regeneration/DBM implant height, cementum regeneration height, root resorption, and ankylosis. Large areas of unresorbed DBM exhibiting fragmentation and empty osteocyte lacunae were observed adjacent to new bone formation, or bone formation was observed adjacent to or within the implant, often exhibiting ankylosis. Cementum regeneration appeared enhanced in shelter of the DBM implant. Histometric recordings (mean ± SD) for DBM and control defects, respectively, were: defect height, 4.8±0.2 mm and 4.4±0.2 mm; bone regeneration/DBM implant height, 4.0±1.3 mm and 1.2±0.6 mm; cementum regeneration height, 1.4±0.4 mm and 0.7±0.2 mm; root resorption, 0.5±0.3 mm and 1.2±0.3 mm; and ankylosis, 0.5±0.2 mm and 0.1±0.1 mm without statistically significant differences between experimental conditions (N=3). Within the limitations of this study, the histologic observations suggest that surgical implantation of allogenic, freeze‐dried DBM cortical strip implants may have a potential to support cementum regeneration, possibly by providing conditions for guided tissue regeneration, however, alveolar regeneration appears unpredictable. J Periodontol 1998;69:26–33.
Genotypic Characterization of Actinobacillus actinomycetemcomitans Isolated From Periodontitis Patients by Arbitrarily Primed Polymerase Chain Reaction
Authors: He Tao , Hayashi Joichiro , Yamamoto Matsuo , Ishikawa Isao
Published: March 2012

Actinobacillus actinomycetemcomitans is one of the most suspected pathogens in the initiation and progression of juvenile periodontitis and severe adult periodontitis. The aim of the present study was to investigate the genotypic characterization of A. actinomycetemcomitans using arbitrarily primed polymerase chain reaction (AP‐PCR). AP‐PCR was applied to 143 A. actinomycetemcomitans strains, including 8 reference strains and 135 clinical strains isolated from 43 unrelated Japanese periodontitis patients. The DNA fragment patterns obtained using a single 10‐mer primer with random sequence (OPA‐07) for these strains allowed the recognition of 10 distinct AP‐PCR groups that correlated to some extent with serotypes. AP‐PCR group VIII was significantly (P < 0.05) observed in deep (> 5 mm) periodontal pockets. Group II was exclusively detected in deep pockets. However, a clear relationship was not observed between AP‐PCR genotypes and various periodontal status. Only one genotype was found within individual oral cavity/single‐infected site, except one case in which the patient harbored two AP‐PCR genotypes. The AP‐PCR patterns of the A. actinomycetemcomitans isolates recovered from the site after periodontal treatment remained identical. These results demonstrate genetic diversity among the investigated population and a clonai nature in a periodontal patient of A. actinomycetemcomitans by APPCR. Furthermore, it could be inferred that a certain AP‐PCR genotype(s) of A. actinomycetemcomitans is more important in the pathogenesis of periodontal diseases. J Periodontol 1998;69:69–75.
A Comparison of 2 Patient Populations Using Fractal Analysis
Authors: Shrout Michael K. , Roberson Bradley , Potter Brad J. , Mailhot Jason M. , Hildebolt Charles F.
Published: March 2012

This study was undertaken to demonstrate that the fractal dimensions calculated using digitized non‐standardized, clinical radiographs of mandibular alveolar bone from a population of patients diagnosed with periodontitis are statistically different from fractal dimensions calculated from another population diagnosed as having gingivitis or healthy gingiva. The fractal dimension was calculated using a public domain fractal analysis program distributed by the National Institutes of Health (NIH). Fractal dimensions were calculated from digitized clinical radiographs for 29 patients diagnosed with healthy gingiva and/or gingivitis and 32 patients diagnosed with periodontitis and compared. To estimate the reproducibility of the technique, we recalculated the fractal dimension from images of the gingivitis patients 3 months after the original calculations and compared them to the originals. A 2 sample, 2‐tailed Student t test showed the gingivitis data group to be different from the periodontitis data group (P = 0.0012). The original gingivitis and repeat gingivitis groups fractal dimension calculation were the same and analysis showed the two data sets were not significantly different (P = 0.99). We found that: 1) fractal dimensions could be used to distinguish between gingivitis and periodontitis patient groups; 2) fractal dimensions could be calculated from non‐standardized clinical radiographs; and 3) fractal dimensions for gingivitis patients were reproducible over a 3‐month period. J Periodontol 1998;69:9–13.
Areca Nut Extract Inhibits the Growth, Attachment, and Matrix Protein Synthesis of Cultured Human Gingival Fibroblasts
Authors: Chang Mei‐Chi , Kuo Mark Yen‐Ping , Hahn Liang‐Jiunn , Hsieh Chi‐Chuan , Lin Sze‐Kwan , Jeng Jiiang‐Huei
Published: March 2012

Betel quid chewing is a popular oral habit in India, South Africa, and many Southeast Asian countries. The effects of areca nut (AN) extract on the growth, attachment, and protein synthesis of healthy human gingival fibroblasts (GF) were investigated to determine why betel quid (BQ) chewers have higher prevalence of periodontal disease than non‐chewers. Twenty‐four hour exposure of human GF to AN extract (> 200 μg/ml) in culture led to the formation of numerous intracellular vacuoles. As analyzed by modified MTT [3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl‐tetrazolium bromide] assay, AN extract significantly suppressed the growth of GF over 5 days of incubation in a dose‐dependent manner. At concentrations of 50 and 300 μg/ml, AN extract suppressed the growth of GF with 30% and 57% (P < 0.05), respectively. AN extract also significantly suppressed the synthesis of [3H]proline incorporation into trichloroacetic acid (TCA) precipitated proteins. At concentrations of 200, 400, and 600 μg/ml, AN extract suppressed the protein synthesis with 33%, 58%, and 63% of inhibition (P < 0.05), respectively. Preincubation of cells in a medium containing AN extract for 2 hours inhibits the subsequent attachment of cultured GF to type I collagen at the 50% inhibitory concentration (IC50) which is about 720 to 798 μg/ml. Considering the frequent consumption of BQ throughout the day, impairment of sequential fibroblast functions by BQ ingredients is a potential mechanism through which BQ chewing exert a deleterious effect to the gingival tissues. J Periodontol 1998;69:1092–1097.
Periodontal Conditions and Salivary Immunoglobulins in Individuals With Down Syndrome
Authors: Barr‐Agholme Monica , Dahllöf Göran , Modéer Thomas , Engström Per‐Erik , Engström Gunilla Norhagen
Published: March 2012

Periodontal conditions and salivary levels of Immunoglobulins slgA, IgM, and IgG subclass distribution and albumin, quantified by enzyme‐linked immunosorbent assay, were determined in 20 patients with Down syndrome and 19 healthy controls. Gingival inflammation was more extensive (P < 0.05) among Down syndrome subjects compared to controls as well as the occurrence of periodontal pockets (< 4 mm) (P < 0.05). The immunoglobuhn levels of slgA, IgM, the sum of IgG subclasses, and the concentration of albumin did not differ significantly between the 2 groups. However, the proportion of IgGl expressed as percentage of the sum of total IgG was significantly higher (P < 0.01) in the Down syndrome group compared to controls. On the contrary, the proportion of IgG2, IgG3, and IgG4 subclasses in saliva did not differ between the 2 groups. The results indicate an altered distribution of IgG subclasses in saliva, with a higher proportion of IgGl in Down syndrome individuals compared to controls. J Periodontol 1998;69:1119–1123.
Generalizability of the Added Benefits of Guided Tissue Regeneration in the Treatment of Deep Intrabony Defects. Evaluation in a Multi‐Center Randomized Controlled Clinical Trial
Authors: Tonetti Maurizio S. , Cortellini Pierpaolo , Suvan Jean E. , Adriaens Patrick , Baldi Carlo , Dubravec Dominik , Fonzar Alberto , Fourmousis Ioannis , Magnani Cristina , Muller‐Campanile Veronique , Patroni Stefano , Sanz Mariano , Vangsted Tine , Zabalegui Iohn , Prato Giovanpaolo Pini , Lang Niklaus P.
Published: March 2012

Background: Several studies have shown that GTR therapy of intrabony defects results in significantly better outcomes than access flap alone. Most of the available data, however, have been produced in highly controlled research environments by a small group of investigators. Generalizability of results to different clinicians and different subject populations has not been evaluated so far.

Methods: This parallel group study involved 143 patients recruited in a practicebased research network of 11 offices in 7 countries. It was designed to evaluate: 1) the applicability of the documented added benefits of GTR in the treatment of intrabony defects to different populations, and 2) the generalizability of the expected results to different clinicians. GTR was compared to access flap alone. Defects, one in each patient, were accessed with a previously described papilla preservation flap in both the test and control group. In addition, GTR sites received application of a bioabsorbable poly‐D,L‐lactide‐co‐glycolide membrane. A stringent plaque control regimen was enforced in all patients during the 1‐year observation period. Outcomes included gains in clinical attachment (CAL) and reductions in probing depth.

Results: Observed gains in CAL were 2.18 ± 1.46 mm for access flap and 3.04 ± 1.64 mm for the GTR‐treated group. The treatment‐associated difference was statistically significant (P = 0.03) after correcting for both center effect and defect anatomy. Among the various centers, a 1.73 mm difference in CAL gain was observed. This is a clinically relevant amount, which underlines the significance of center variability in the outcome of periodontal surgical procedures. A frequency distribution analysis of the obtained CAL gains indicated that GTR treatment of deep intrabony defects decreased, with respect to the access flap control, the probability of obtaining only a modest attachment gain at 1 year. Conversely, CAL gains of 4 mm or more were observed in more than 40% of GTR‐treated defects and in less than 20% of the controls (P < 0.0001).

Conclusions: These data indicate that GTR therapy of deep intrabony defects performed by different clinicians on various patient populations resulted in both greater amounts and improved predictability of CAL gains than access flap alone. J Periodontol 1998;69:1183–1192.
Guided Tissue Regeneration With Bioabsorbable and Expanded Polytetrafluoroethylene Barrier Membranes in the Treatment of Naturally Occurring Periodontal Defects in Dogs
Authors: Elharar Frédéric , Rodriguez Hector Juan , Benqué Edmond P. , Caffesse Raul G.
Published: March 2012

The purpose of the present study was to evaluate the healing events and compare the effects of guided tissue regeneration (GTR) using 3 different membranes: a weakly cross‐linked bioabsorbable bovine collagen membrane; a strongly cross‐linked bioabsorbable bovine collagen membrane; and a non‐resorbable ePTFE membrane. Twenty adult female beagle dogs with naturally occurring periodontitis were subjected to periodontal probing and scaling. In both right and left mandibular quadrants, mucoperiosteal flaps were raised, and after debridement, the roots of experimental premolar teeth received apical reference notches. The following treatments were randomly assigned: 1) gingival flap curettage (GFC) + ePTFE membrane, control membrane; 2) GFC + slightly cross‐linked collagen membrane, 1st test membrane; and 3) GFC + strongly cross‐linked collagen membrane, 2nd test membrane. The flaps were sutured in such a manner that the membranes were completely covered. All dogs received a soft diet for a 2‐week period and an oral hygiene program until time of sacrifice. The animals were randomly scheduled for sacrifice at 2, 4, 12, and 24 weeks. The ePTFE membranes still in place were removed at 6 weeks. The jaws were dissected and specimens prepared for descriptive histology and histomorphometry. The early resorption of the 1st test membrane was achieved at 4 weeks, and the 2nd test membrane at 12 weeks, both with normal inflammatory reaction. Measurements of epithelium, connective tissue attachment, new bone, and neocementum were compared within an animal (paired t test). Analyses were performed on data at 4, 12, and 24 weeks post‐healing; little differences were found between these periods. Limited connective tissue repair was favored by the placement of all the membranes (about 20%), with no statistically significant difference. These findings indicate that bioabsorbable collagen membranes with different cross‐linking and ePTFE barriers promote similar new attachment in GTR procedures on naturally occurring periodontal defects in dogs. J Periodontol 1998;69:1218–1228.
Subpedicle Connective Tissue Graft Versus Guided Tissue Regeneration With Bioabsorbable Membrane in the Treatment of Human Gingival Recession Defects
Authors: Trombelli Leonardo , Scabbia Alessandro , Tatakis Dimitris N. , Calura Giorgio
Published: March 2012

The purpose of the present clinical study was to evaluate the effect of guided tissue regeneration (GTR) in comparison to subpedicle connective tissue graft (SCTG) in the treatment of gingival recession defects. A total of 12 patients, each contributing a pair of Miller's Class I or II buccal gingival recessions, was treated. According to a randomization list, one defect in each patient received a polyglycolide/lactide bioabsorbable membrane, while the paired defect received a SCTG. Treatment effect was evaluated 6 months postsurgery. Clinical recordings included full‐mouth and defectspecific oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). Mean RD significantly decreased from 3.1 mm presurgery to 1.5 mm at 6 months postsurgery for the GTR group (48% root coverage), and from 3.0 mm to 0.5 mm for the SCTG group (81% root coverage). RD reduction and root coverage were significantly greater in SCTG group compared to GTR group. Mean CAL gain amounted to 1.7 mm for the GTR group, and 2.3 mm in the SCTG group. No significant differences in PD changes were observed within and between groups. KT increased significantly from presurgery for both treatment groups, however gingival augmentation was significantly greater in the SCTG group compared to GTR group. Results indicate that: 1) treatment of human gingival recession defects by means of both GTR and SCTG procedures results in clinically and statistically significant improvement of the soft tissue conditions of the defect; and 2) treatment outcome was significantly better following SCTG compared to GTR in terms of recession depth reduction, root coverage, and keratinized tissue increase. J Periodontol 1998;69:1271–1277.
Scanning Electron Microscopic Study of the Effects of Er:YAG Laser on Root Cementum
Authors: Fujii Takeo , Baehni Pierre C. , Kawai Osamu , Kawakami Tomofumi , Matsuda Koichi , Kowashi Yusuke
Published: March 2012

Use of Er:YAG laser has been proposed for the removal of microbial deposits and calculus present on teeth affected by periodontal disease. However, the influence of Er:YAG laser irradiation on root surfaces has not yet been fully investigated. The aim of the present study was to evaluate the effects of Er:YAG laser irradiation on root cementum by scanning electron microscopy (SEM). Specimens were obtained from extracted human periodontally‐diseased teeth using a water‐cooled high‐speed bur. An Er:YAG laser beam was then applied at various powers ranging from 25 to 100 mJ/pulse/sec. The laser irradiation was performed under water irrigation, with the tip held perpendicular to the root surface in the contact mode. Following laser exposure, specimens were fixed, dehydrated, and dried at critical‐point in liquid CO2. After mounting on SEM plates and sputter‐coating with gold, the cementum surface was examined by SEM. Observations of the root surface showed a relatively flat surface in control specimens. In Er: YAG exposed specimens, the laser beam created a circular, notchededge, crater‐like defect on the root. The bottom of the lesion showed an irregular and sharp‐pointed surface. Subsequently, the specimens were fractured with a sharp scalpel perpendicularly to the surface. SEM observations of these specimens showed a 15 pm layer of damaged tissue within the laser‐irradiated cementum. The tissue presented an amorphous appearance and the Sharpey's and matrix fiber bundles were not clearly distinguishable. These observations indicate that cementum tissue could be damaged by Er:YAG laser irradiation. J Periodontol 1998;69:1283–1290.
Effects of Metronidazole Plus Amoxicillin in Progressive Untreated Adult Periodontitis: Results of a Single 1‐Week Course After 2 and 4 Months
Authors: López Néstor J. , Gamonal Jorge A.
Published: March 2012

A randomized, double‐blind, clinical study was done to assess the microbiological and clinical effects of metronidazole plus amoxicillin (M+A) as the only therapy in 46 patients with moderate to advanced progressive adult periodontitis. Patients were included in the study after at least 2 sites showed ≥2 mm clinical attachment loss. Bleeding on probing, probing depth, and clinical attachment level were measured using on automated probe. The percentage of surfaces with plaque was recorded at day 0, and at 2 and 4 months after therapy. No effort was made to change the oral hygiene habits of patients. Identification of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia was assessed utilizing DNA technology at day 0 and 2 months after therapy. Twenty‐three patients received metronidazole 250 mg plus amoxicillin 500 mg, 3 times/day for a week and 23 a placebo. Two patients in the placebo group were dropped at 2 months because they had taken antibiotics for medical reasons. Statistical analyses of differences between groups was done using the Mann‐Whitney test, and the differences within each group were tested with ANOVA. There were no significant changes in surfaces with plaque in either group after therapy. The percentage of bleeding sites decreased significantly from baseline to 2 and 4 months in the M+A group (P = 0.001), and increased in the placebo group. Differences in bleeding on probing between groups were significant at 2 (P = 0.018), and 4 months (P = 0.005). The mean attachment level values at 2 and 4 months posttherapy improved significantly in the M+A group compared to the placebo group (P = 0.001). Treatment with M+A resulted in a significant mean reduction in probing depth at 2 and 4 months compared to baseline values (P = 0.001). The M+A group showed a significant reduction of sites with high levels of P g (P = 0.001) at 2 months compared with baseline values, and there was a significant reduction of sites with Pg and Pi in the M+A group compared with the placebo group. The results showed that a combined M+A treatment as the only therapy changes the proportion of some subgingival microorganisms and allows a significant improvement in clinical conditions. J Periodontol 1998;69:1291–1298.
The Correlation of Gingival Crevicular Fluid Interleukin‐8 Levels and Periodontal Status in Localized Juvenile Periodontitis
Authors: Özmeriç Nurdan , Bal Belgin , Baloş Köksal , Berker Ezel , Bulut Şule
Published: March 2012

Localized juvenile periodontitis (LJP) is an early‐onset periodontal disease characterized by progressive bone loss involving the permanent first molar and incisor teeth. Approximately 70% to 75% of LJP patients have impaired neutrophil Chemotaxis towards a number of chemoattractants including N‐formyl‐methionyl‐leucyl‐phenylalanine, complement fragment C5a, leukotriene B4, and interleukin 8 (IL‐8). The aim of the present study was to observe the role of IL‐8 in the pathogenesis of LJP. Fourteen individuals who were systemically and periodontally healthy and 24 systemically healthy individuals diagnosed with LJP (based on the results of clinical periodontal assessments and radiographic examination) were recruited for this study. Gingival crevicular fluid (GCF) samples were obtained from anterior teeth in each subject before treatment. After evaluation of GCF amount from paper strips, enzyme‐linked immunoabsorbent assay was employed to determine the amount of IL‐8 in GCF. The amount and concentration of IL‐8 measured was 894.5 ± 435 pg, and 445.3 ± 468 pg/pl for the experimental group and 747.3 ± 543 pg and 684.7 ± 548 pg/μl, for the control group. The correlation among the levels of cytokine and clinical parameters was assessed. It was observed that the concentration of IL‐8 demonstrated a negative correlation with gingival index in the LJP group. In addition, no significant correlation was found among the total amount and concentration of IL‐8, GCF volume, and clinical parameters in the control group. IL‐8 is thought to enhance host defense mechanisms against Gram‐negative bacteria, thus providing protection against periodontal infections. Our data demonstrate that, when both the total amount and concentration of IL‐8 are taken into consideration, no significant difference between LJP and healthy subjects is shown. This may indicate a less active IL‐8 production compared with healthy subjects in spite of the dense Gram bacterial stimulation in LJP. J Periodontol 1998;69:1299–1304.
Neutrophil Response and Microbiological Findings Around Teeth and Dental Implants
Authors: Hultin Margareta , Boström Lennart , Gustafsson Anders
Published: March 2012

The aim of this study was to compare the neutrophil response, measured as both functional and antigenic elastase, around teeth and titanium implants and to relate these findings to the microbiota. The 31 patients included in the study had been treated successfully for total or partial edentulism with titanium implants. Crevicular fluid and microbiological samples were taken from 3 sites: 1) crevices around teeth and 2) implants in 16 partially edentulous patients and 3) crevices around implants in 15 edentulous patients. All sites sampled showed similar degrees of inflammation assessed by gingival index and total protein concentration. The samples were analyzed for elastase activity and immunoreactive elastase. The elastase activity was significantly higher in crevices surrounding implants in partially edentulous patients compared with implants in edentulous patients. The antigenic elastase showed no difference among the 3 sites. Gram‐positive cocci were the main bacterial species in all 3 groups. Edentulous patients tended to have lower frequency of black pigmenting anaerobes. No correlation of analyzed bacteria and elastase activity was found between the 3 sites. This study indicates that, despite a similar appearance of clinical parameters and absence of significant differences in the microbiota, the inflammation around implants in partially edentulous patients induces a stronger neutrophil response than does the inflammation around implants in edentulous patients. J Periodontol 1998;69:1413–1418.
Interleukin‐1 and Tumor Necrosis Factor Antagonists Inhibit the Progression of Inflammatory Cell Infiltration Toward Alveolar Bone in Experimental Periodontitis
Authors: Graves D.T. , Delima A.J. , Assuma R. , Amar S. , Oates T. , Cochran D.
Published: March 2012

Periodontal disease is a significant cause of tooth loss in humans and is one of the most prevalent diseases associated with bone loss. Following bacterial colonization, the gingiva becomes inflamed and, in some cases, progresses to destruction of alveolar bone. To investigate the temporal movement of inflammatory cells toward alveolar bone and the role of interleukin‐1 (IL‐1) and tumor necrosis factor (TNF) in this process, studies were carried out in a Macaca fascicularis primate model of experimental periodontitis. IL‐1 and TNF activity was inhibited by local application of soluble receptors to IL‐1 and TNF by injection into interdental papillae. The results indicate that following induction of experimental periodontitis, the front of inflammatory cells progresses toward alveolar bone and is associated with osteoclast formation. These processes are inhibited by blockers to IL‐1 and TNF. These studies suggest that the conversion from gingivitis to periodontitis is directly associated with the movement of an inflammatory infiltrate toward alveolar bone, and that this activity is at least partially dependent upon IL‐1 and/or TNF J Periodontol 1998;69:1419–1425.
Histologic Observations on 230 Retrieved Dental Implants: 8 Years' Experience (1989–1996)
Authors: Piattelli A. , Scarano A. , Piattelli M.
Published: March 2012

The histologic examination of dental implants retrieved from humans is important to establish the causal determinants of implant failure, and to compare and validate the results obtained from animal studies. This study presents a retrospective review of the histologic features of 230 implants retrieved in an 8‐year period (1989–1996). All the implants were treated to obtain thin (20 to 30 μm) ground sections. The majority of implants were retrieved because of mobility (n = 56), peri‐implantitis (n = 54), or fractures (n = 90). Peri‐implantitis occurred more frequently before (n = 44) than after (n = 10) abutment connection. A dense fibrous connective tissue with no inflammatory cells was present at the interface in the implants retrieved for mobility; bone was found only in the most apical part. In many of these implants epithelial cells were present. The main histologic features of peri‐implantitis consisted of the presence of a bone sequestrum near the implant, many bacteria present on the implant surface, and an inflammatory infiltrate (macrophages, lymphocytes, and plasma‐cells) nearby. Histology showed that in the implants removed for fracture, there was a very high percentage (80 to 100%) of peri‐implant bone. J Periodontol 1998;69:178–184.
Economic Models to Help Periodontists Evaluate Their Practices: How to Analyze a Practice to Assess the Potential Impact of Managed Care Contracts
Authors: Nash Kent D. , Bramson James
Published: March 2012

The purpose of this article is to examine 10 steps analyzing the financial impact on a periodontal practice accepting a proposed managed care dental plan. It is emphasized that this analysis should be conducted before formally agreeing to accept the proposed plan. The procedures for examining the 10 steps include the use of hypothetical data for a periodontal practice confronted with a discounted fee plan. Each step is identified, discussed, and the hypothetical data are used to develop results presented in a set of tables. The steps in the analysis process include constructing a practice profit and loss statement and developing a dataset of practice characteristics and productivity measures. Other estimates should be made of covered fives, new patient utilization, existing patient utilization, utilization of non‐covered services, estimating other sources of revenue and expense, and the impact on capacity utilization of operatories and practice staff. Results are presented in a set of analysis tables. The importance of multiple analyses is discussed as is the importance of analyzing the impact on results from changing assumptions. Some of the higher risk variables faced by the practitioner are identified for submission to risk evaluation to examine the sensitivity of results. Finally, the relationship between the proposed plan and the additional time required by the periodontist to meet the plan's specifications is examined in light of the data developed in the 10 steps and the results tables. J Periodontol 1998;69:241–253.
Dental Insurance and the Periodontal Patient
Authors: Zackin S. Jerome
Published: March 2012

Approximately one‐half of the United States population is covered by a dental benefit plan. One‐fifth of that group is covered under various types of managed care contracts, and this number is said to be increasing by 15% to 20% per year. However, dentists report that these plans have not had a major impact upon their practices. Only 6% of patients were covered by them, and only 2% of gross receipts were derived from them. Periodontists surveyed were divided in their opinions about how managed care has affected their practices. This paper discusses these changes, particularly with regard to income, referral patterns, treatment decisions, and ethical and legal liability. J Periodontol 1998;69:261–268.
Uncontrolled Diabetes Hinders Bone Formation Around Titanium Implants in Rat Tibiae. A Light and Fluorescence Microscopy, and Image Processing Study
Authors: Takeshita Fumitaka , Murai Kenji , Iyama Shinji , Ayukawa Yasunori , Suetsugu Tsuneo
Published: March 2012

This study examined the influence of diabetes mellitus on bone formation around cylindrical titanium (Ti) implants (1.0 mm in diameter and 1.5 mm in length) inserted transcortically and extending into the medullary canal of rat tibiae using light and fluorescence microscopies and image processing. Forty‐eight male Wistar King A rats (age 5 weeks) were used in this experiment. Streptozotocin was injected intraperitoneally to induce diabetes and the serum glucose concentration was checked to ensure the induction of diabetes prior to implant placement and at the time of sacrifice. The animals were sacrificed 7, 28, 56, or 84 days after placement. Toluidine blue‐stained undecalcified sections were prepared for histological observation and image analysis. The Ti implants in the control group became increasingly encapsulated with a bone layer. The implants in the diabetes‐induced (DI) group were also surrounded with a thin bone layer. Abundant adipocytes were observed in the DI group as compared with the control group. Quantitative evaluation indicated that the control group showed a significantly higher percent of bone contact, and thickness of surrounding bone and area than the DI group. Consequently, the present study suggests that uncontrolled diabetes would hinder bone formation around Ti implants in rats. J Periodontol 1998;69:314–320.
The Effect of a 1‐Stage Full‐Mouth Disinfection on Oral Malodor and Microbial Colonization of the Tongue in Periodontitis Patients. A Pilot Study
Authors: Quirynen M. , Mongardini C. , van Steenberghe D.
Published: March 2012

Oral malodor affects a large proportion of the population and may be the cause of a significant social and psychological handicap. This pilot study aimed to examine whether a 1‐stage full‐mouth disinfection in periodontitis patients (scaling and root planing of all pockets within 24 hours together with the application of chlorhexidine to all intra‐oral niches followed by chlorhexidine mouth rinsing for 2 months) resulted in a significant improvement in malodor when compared to a fractionated periodontal therapy (consecutive root planings per quadrant, at a 1 to 2 week interval). The baseline and outcome data concerning oral malodor were linked to the presence of tongue coating and to its roughness (fissures). Twenty‐four patients with severe periodontitis were randomly allocated to test and control groups. At baseline and after 1 and 2 months, the concentration of volatile sulfur compounds (VSC) in the mouth was measured and organoleptic ratings (expired air and total mouth air) were given. Plaque samples were collected from the dorsum of the tongue to calculate the number of colony forming units (CFU) per ml (anaerobic culturing) as well as the number of pigmented CFU/ml. Both the baseline organoleptic ratings and the VSC scores correlated well with the presence of tongue coating but not with the tongue roughness. Because a correlation between tongue coating and its microbial load could not be detected, it was hypothesized that the tongue coating per se, and not the bacteria, might be responsible for the malodor. The 1‐stage full‐mouth disinfection resulted in a faster and additional reduction in the organoleptic ratings of the oral malodor, even after 2 months. This might be explained by the improved periodontal outcome and/or the more significant reduction in the CFU/ml of pigmented species. In contrast to the organoleptic ratings, which were significantly reduced in both treatment groups (when compared to baseline), the VSC levels remained unchanged. This pilot study indicates that a 1‐stage full‐mouth disinfection has, in comparison to a standard periodontal therapy, additional beneficial effects in the treatment of oral malodor. J Periodontol 1998;69:374–382.
Working Parameters of a Magnetostrictive Ultrasonic Sealer Influencing Root Substance Removal In Vitro
Authors: Flemmig T.F. , Petersilka G.J. , Mehl A. , Hickel R. , Klaiber B.
Published: March 2012

This study assessed defect depth and volume resulting from root instrumentation using a magnetostrictive ultrasonic sealer with a slim scaling tip (P 12) in vitro. Combinations of the following working parameters were analyzed: lateral forces of 0.5 N, 1 N, and 2 N; tip angulations of 0°, 45°, and 90°; power settings of low, medium, and high; and instrumentation time of 10, 20, 40, and 80 seconds. Defects were quantified using a 3‐dimensional optical laser scanner. Lateral force had the greatest influence on defect volume compared to tip angulation and power setting (β‐weights 0.53±0.04, 0.17±0.04, and 0.19±0.04, respectively). Lateral force and tip angulation had similar effects on defect depth, but both effects were greater compared to power setting (βweights 0.43±0.04, 0.49±0.04, and 0.19±0.04, respectively). The various combinations of the assessed working parameters showed synergistic effects resulting in a wide range of defect depths (14.1±1.7 μm to 410.5±51.1 μm) and volumes (0.0084±0.0057 mm3 to 1.3±0.079 mm3). Severe root damage (defect depth >50 μm) at 40 seconds instrumentation time occurred under most combinations of lateral force, angulation, and power settings. The only exceptions were combinations of: 1) 0° angulation, 0.5 N and 1 N lateral force at any power setting and 2) 45° angulation, 0.5 N lateral force at low and medium power setting. The efficacy of the assessed magnetostrictive ultrasonic sealer may be adapted to the various clinical needs by adjusting the lateral force, tip angulation, and power setting. J Periodontol 1998;69:547–553.
Irritant Contact Stomatitis: A Review of the Condition
Authors: Davis Catherine C. , Squier Christopher A. , Lilly Gilbert E.
Published: March 2012

Several different types of interactions are possible between a chemical, a mixture of chemicals, and associated extrinsic factors (i.e., mechanical irritation) in the oral mucosa. These interactions can be broadly classified as irritative or allergenic in nature. In each case, the pathology usually includes mucosal inflammation. The information compiled and reviewed in this article suggests that, given the broad definition of surface lesions/mucosal abnormalities, there may be a continuum of irritation that can be termed “irritant contact stomatitis.” This may be due to the fact that the mouth is lined with highly vascular mucosa that turns over rapidly compared to the skin, and may or may not be covered by keratin. Some regions in the mouth are uniquely sensitive to irritants because they can penetrate through the tissue easily. Key factors involved in the potential development of irritation are: inherent irritation potential of the agent, amount of exposure (concentration, duration, and frequency), ability to penetrate the tissue, and inherent reactivity of the subject as well as other extrinsic factors. Irritation leading to oral mucosal alterations is a common occurrence caused by a wide variety of exposures and insults to the oral cavity. Various irritants such as foods, chemicals, friction, thermal/mechanical injury, metals, spices, and oral care products have been documented to cause irritant reactions in susceptible individuals, particularly if used under exaggerated exposure conditions. It is important to note that most irritation in the oral cavity tends to reverse quickly when the causative agent is removed. Oral irritation is a commonly occurring phenomenon. Thus, it is important that the clinician be aware of the clinical manifestations and etiology of the condition. J Periodontol 1998;69:620–631.
Fibroblast Heterogeneity of Signal Transduction Mechanisms to Complement‐C1q. Analyses of Calcium Mobilization, Inositol Phosphate Accumulation, and Protein Kinases‐C Redistribution
Authors: Bordin Sandra , Costa Lucio G. , Tan Xiaoxia
Published: March 2012

Fibroblasts of healthy and granulation gingiva are phenotypically heterogeneous with regard to binding Clq collagen‐like (cClqR) or Clq globular‐heads (gClqR) regions, respectively. Here, isolated fibroblast subsets, expressing either the cClqR or the gClqR phenotype, were stimulated with Clq, and assessed for changes in cytosolic free calcium [Ca2+]i, accumulation of inositol trisphosphate (IP3), and redistribution of Ca2+‐dependent protein kinases‐C (cPKCs) from cytosol to membranes. Changes in [Ca2+]i were determined using Indo‐1 fluorescence in combination with adhering cell analysis and sorting (ACAS) cytometry. Accumulation of IP3 was quantified using a competitive radioreceptor binding assay. Redistribution of cPKCs was evaluated by immunoblotting with antibodies to PKCa/βI‐βII/γ. Subsets manifested different fluctuations in [Ca2+]i levels 20 seconds after C1q‐stimulation in the presence of millimolar concentrations of external calcium. Whereas cC1qR fibroblasts responded with a 38% over baseline [Ca2+]i increase which was sustained for 20 to 30 minutes, gC1qR fibroblasts responded with a higher (264% over baseline) and more rapid (2 to 3 minutes) transient. Likewise, subsets exhibited different kinetics of IP3 accumulation. Whereas cClqR fibroblasts responded with an IP3 increase of 32 ± 3 pmol/104 cells over baseline after 5 seconds stimulation, gC1qR fibroblasts responded after 15 to 20 seconds with a lower increase (13 ± 0.8 IP3 pmol/104 cells over baseline). Subsets differed in cPKCs redistribution which peaked in gClqR‐membranes 30 seconds after stimulation and remained sustained between 10 and 30 minutes. No cPKC redistribution was detectable in stimulated cClqR‐cells. We conclude that fibroblasts are heterogeneous in phosphoinositide‐Ca2+ signaling and cPKC redistribution to Clq, and suggest that these differences may affect activities of normal and granulation gingiva. J Periodontol 1998;69:642–649.
Equivalence in Periodontal Trials: A Description for the Clinician
Authors: Duke Susan P. , Garrett Steven
Published: March 2012

There has been a tendency by clinicians in periodontal research to confuse lack of significance in a clinical trial designed for superiority for equivalence between the treatment arms. This paper is intended to define for the clinician what equivalency means in statistical terms. To demonstrate equivalence, the hypotheses and analysis specific to equivalence must be carried out; the information cannot be extracted directly from trials designed with superiority hypotheses and analysis. Further, acceptable mean differences in equivalency trials should be determined based not only on statistical considerations, but also on the clinical relevance of the proposed differences. The relationship between superiority and equivalency design and analysis is discussed and an example using a hypothetical clinical study is given. J Periodontol 1998;69:650–654.
Analysis of Desquamative Gingivitis Using Direct Immunofluorescence in Conjunction With Histology
Authors: Yin Wei‐Yung , Maier Tom , Kratochvil F. James , Zieper Monica B.
Published: March 2012

Chronic desquamative gingivitis (DG) is a common condition often first recognized by periodontists. DG is characterized clinically by erythema with epithelial desquamation, ulceration, and/or the presence of vesiculobullous lesions of the free and attached gingiva. However, DG is actually a clinical manifestation of several different disease processes, particularly lichen planus and benign mucous membrane pemphigoid. Correct diagnosis in DG is critical since proper treatment and follow‐up will depend on which disease is involved. However, the diseases that cause DG frequently present diagnostic problems because their lesions often resemble each other clinically and routine histological examination sometimes cannot differentiate between them. Thus, immunohistology, particularly immunofluorescence, is increasingly being used with routine histology to more accurately diagnose DG diseases. This article reviews our experience over the past 10 years in the diagnosis of 72 cases of DG using direct immunofluorescent (DIF) in conjunction with histology and clinical evaluation. Of the 72 DG cases in this study, 30 cases were diagnosed as erosive lichen planus or lichenoid mucositis; 29 cases were diagnosed as benign mucous membrane pemphigoid; 2 cases each of linear IgA disease and pemphigus vulgaris were diagnosed; there was 1 case of bullous pemphigoid; and 1 suspected case of paraneoplastic pemphigus. Even with DIF analysis, 7 cases could not be definitively assigned a particular cause. DIF analysis is not only proving very useful for differential diagnosis, but also adds insight into possible pathogenic mechanisms of DG. J Periodontol 1998;69:678–685.
Treatment of a Previously Placed Autogenous Masticatory Mucosa Graft (Free Gingival Graft). A Case Report
Authors: Harris Randall J.
Published: March 2012

The autogenous masticatory mucosa graft (free gingival graft) has been used to treat various mucogingival conditions. Unfortunately, the esthetics of the procedure are often less than ideal. This case report examines the treatment of an unesthetic free gingival graft. The goal was to create a result so that it was impossible to tell there had ever been a free gingival graft or any surgery performed to correct a problem. To achieve this goal, 3 periodontal plastic surgical procedures were utilized and a crown was placed. This integration of multiple surgical procedures and prosthetics produced an outstanding result. J Periodontol 1998;69:717–723.