bluuebunny/crossref_metadata_2025 huggingface dataset:
Zinc Concentration in Normal and Healing Gingival Tissues in Beagle Dogs
Authors: Williamson Carol E. , Yukna Raymond A. , Gandor Daniel W.
Published: March 2012

Previous studies have shown that the administration of zinc (Zn) may enhance the healing of gingival and other wounds. This study was undertaken to determine if Zn concentration ([Zn]) is increased in healing gingival tissues and if oral supplementation of Zn would result in a local increase in [Zn] within these tissues. On Day 0, biopsies were obtained from the maxillary left buccal gingiva of each of 10 beagle dogs. Gingival biopsies were taken from the healing original biopsy sites on Day 14. On Day 15, oral supplementation of Zn gluconate (250 mg/day, equivalent to 32.5 mg of elemental Zn) was begun in seven dogs. Three dogs remained as unsupplemented controls. Two weeks later (Day 28), normal gingival biopsies were obtained from the right side of the maxilla and on Day 42 final biopsies were taken from the same healing sites. In addition, serum samples were obtained on Days 0, 14, 28 and 42. All samples were analyzed for Zn content using atomic absorption spectrophotometry. The [Zn] of healing tissues was significantly higher (P < 0.0005) than normal tissues. This was also true when healing tissues were compared to normal tissues during the Zn supplementation phase (Day 28 vs. Day 42; P < 0.005). Zn supplementation resulted in significant increases in Zn levels in normal (Day 0 vs. Day 28; P < 0.05) and healing tissues (Day 14 vs. Day 42; P < 0.05). There was no significant difference in serum [Zn] except on Day 14. It was concluded that [Zn] is significantly increased in healing vs. normal gingiva, that Zn supplementation results in an even higher [Zn] in healing tissues and that such supplementation also increases the [Zn] in normal tissue. These findings may be clinically significant in periodontal and other oral wound healing.
Oral and Gingival Changes in Systemic Sclerosis (Scleroderma)
Authors: Eversole L. R. , Jacobsen P. L. , Stone C. E.
Published: March 2012

Nineteen patients with systemic sclerosis, including two with CREST syndrome variant, were clinically evaluated for oral and gingival manifestations of their disease. Subjectively, over 50% complained of xerostomia, limited opening, recurrent “mouth sores” and dysphagia. Four patients indicated that they had been refused dental care due to limited accessibility to the oral cavity. Objectively, physical examination disclosed prominent lingual and buccal mucosal crenations and loss of tongue mobility with fibrotic induration in 25% of the subjects examined. Three patients with advanced disease exhibited foci of severe gingival recession due to fibrous strictures and attached gingiva stripping. None of the patients showed any indication of uncontrolled dental disease secondary to xerostomia.
Plasma‐Cell Gingivitis: Report of a Case
Authors: Lubow Richard M. , Cooley Robert L. , Hartman Kenton S. , McDaniel Raymond K.
Published: March 2012

A well‐documented case of plasma‐cell gingivitis is presented. When viewed in a total perspective, the clinical examination, history of usage of a popular mint, laboratory data and histologic examination provide support for this diagnosis. This patient did not exhibit any evidence of glossitis or Cheilitis as is often reported in the literature; however, a positive history to psoriasis was noted. The occurrence of plasma‐cell gingivitis in a patient with documented psoriasis provides some interesting speculation regarding the etiologic picture of this condition.
Classification of the Vertical Component of Furcation Involvement
Authors: Tarnow Dennis , Fletcher Paul
Published: March 2012

The current classifications of teeth with furcation involvements refer mainly to the horizontal component of bone loss. This article presents a subclassification that measures the probeable vertical depth from the roof of the furca apically. The subclasses being proposed are: A, B and C. “A” indicates a probeable vertical depth of 1–3 mm, “B” 4–6 mm and “C” 7 or more mm of probeable depth from the roof of the furca apically. Furcations would thus be classified as IA, IB, IC, IIA, IIB, IIC and IIIA, IIIB, IIIC.
Effectiveness of Sodium Fluoride on Tooth Hypersensitivity With and Without Iontophoresis
Authors: Lutins Neil D. , Greco George W. , McFall Walter T.
Published: March 2012

Effectiveness of iontophoresis with and without electric current and sodium fluoride on tooth hypersensitivity was evaluated. In eleven volunteers, teeth received a 2% neutral sodium fluoride solution applied using an electrode phoresor. Test teeth received the solution with current and control teeth received the solution without current. The subjects were tested at Day 0 and 7 by means of a mechanical stimulating device and a temperature probe. The data were then analyzed using x2 analysis. Statistically, the test teeth demonstrated more improvement than the control teeth.
Relative Error (Variability) Associated With an Improved Instrument for Measuring Gingival Crevicular Fluid
Authors: Hinrichs James E. , Bandt Carl L. , Smith Judith A.
Published: March 2012

This investigation was undertaken to compare the variability in a new Periotron model 6000 to the variability in the previous Periotron model 600 and to the variability of the ninhydrin area method (NAM) for measuring quantities of fluid collected on filter paper strips. A Hamilton microliter syringe was used to deliver normal human serum to filter paper strips. Strips receiving varying quantities were randomly and blindly assigned to Periotron models 6000 and 600 until 10 strips containing each of 0.15, 0.30, 0.45, 0.60, 0.75, 0.90 and 1.05 μl had been read using model 6000 and 10 strips containing each of 0.15, 0.30 and 0.45 μl had been read using model 600. All strips were subsequently read using the NAM. The entire procedure was repeated using distilled water containing 0.1% methyl green. Coefficients of variation (CV) were computed for all sets of data. In all cases the CVs for the Periotron 6000 were significantly smaller than those for the Periotron 600 or the NAM. Pooled estimates of CVs (0.15–0.45 μl) for the Periotron models 6000 and 600 were 0.054 and 0.116, respectively, (P≥0.005) with serum and 0.059 and 0.095, respectively, (P ≥ 0.05) with distilled water containing 0.1% methyl green. Pooled estimates of CVs (0.15–1.05 μl) for the Periotron model 6000 and the same strips subsequently measured with the NAM were 0.046 and 0.069, respectively, (P ≥ 0.005) with serum and 0.055 and 0.076, respectively, (P ≥ 0.001) with distilled water containing 0.1% methyl green. There were no significant differences between the CVs associated with the different fluids tested regardless of the measurement system used. It was concluded that less variability (CV) exists in measurements with the Periotron model 6000 than with the model 600 or the NAM. It is estimated that 2.25 to 6.25 times as many samples must be measured with the Periotron 600 or the NAM in order to obtain the same precision as that obtained with the Periotron 6000.
Topographic Classification of Deformities of the Alveolar Process
Authors: Karn Kenneth W. , Shockett Howard P. , Moffitt William C. , Gray Jonathan L.
Published: March 2012

A system of nomenclature for deformities of the alveolar process is presented. Descriptive, familiar topographic terms are used (crater, trench, moat, ramp and plane), and specific criteria are given for each term. Two hundred randomly selected osseous deformities in dry skulls were classified by two examiners at independent sessions using the proposed system. One hundred ninety of these defects were given identical descriptions. The nomenclature system is proposed to facilitate communication among practitioners concerning osseous deformities of the alveolar process, as well as to permit comparison of the effectiveness of various therapeutic modalities directed toward bone regeneration in periodontics.
Suggested Solutions for Common Problems in Clinical Periodontics
Authors: O'Leary Timothy J. , Kepic Thomas J. , Detamore Robert J.
Published: March 2012

This short report offers solutions for three common clinical problems. Based on their experience, the authors suggest using a “spoon” type partial denture for the temporary replacement of maxillary anterior teeth. The denture is unique in that it has no clasps and does not contact the marginal gingiva. Also, conventional posterior curets have been modified by lengthening the shanks 5 mm while retaining the original dimensions of the working tip in order to reach relatively inaccessible areas more easily. Finally, to increase the utility of Orban knives in making primary inverse bevel flap incisions, the blade has been lengthened by 5 mm.
Occlusal Relations and Periodontal Status in Human Adults
Authors: Shefter Glenn J. , McFall Walter T.
Published: March 2012

A group of 66 adults provided the population for study of relations between various clinical parameters and periodontal status. Dental and habit histories and plaque scores were acquired. Occlusal features included classification of malocclusion, analysis of centric displacement, establishment of patterns of lateral and protrusive excursions, identification of tooth contacts and presence of wear facets. Periodontal analysis included pocket depths, radiographic manifestations and extent of mobility. Class I malocclusion predominated and the majority of patients did not have coincidental centric relation and centric occlusion. Group function is the most common lateral excursive pattern in the adult. Nonfunctional contacts are common as is enamel attrition. Results indicate no significant deleterious influence on the status of the periodontium by occlusal disharmonies.
Connective Tissue Regeneration to Periodontally Diseased Roots, Planed and Conditioned With Citric Acid and Implanted Into the Oral Mucosa
Authors: López Néstor J.
Published: March 2012

This investigation used autogenous submucosal implants of root sections to study the connective tissue healing to periodontally diseased roots which had previously been planed and demineralized with citric acid.

Eighteen implants were performed, with each being removed 2 to 24 weeks after implantation. The results showed new connective tissue attachment to the old cementum and to the dentin. After 18 weeks, in all specimens new cementum had formed on the dentin, with collagen fibers attached to it. No deposition of new cementum on the old cementum was noted. The formation of new cementum on roots placed in an environment without periodontal ligament cells might be ascribed to the inductive principle of demineralized dentin. The results suggest that a diseased root which has been planed and conditioned with citric acid is likely to form a new connective tissue attachment, even if it is placed in an environment without periodontal ligament cells. They also suggest that the factor inhibiting potential new connective tissue attachment is the condition of the root surface, rather than the lack of an adjacent progenitor cell population.
Comparative Differential Dark‐Field Microscopy of Subgingival Bacteria From Tooth Surfaces With Recent Evidence of Recurring Periodontitis and From Nonaffected Surfaces
Authors: Listgarten Max A. , Levin Sandra , Schifter Catherine C. , Sullivan Pamela , Evian Cyril I. , Rosenberg Edwin S.
Published: March 2012

Ninety‐two subjects with a history of treatment for chronic periodontitis were monitored on a regular basis for an average period of 10.7 months. During this monitoring period, in spite of their participation in a preventive maintenance program, 19 subjects out of 92 showed evidence of significantly increased probing depth (≥ 3 mm from base line measurements) on at least one tooth surface, or approximately 1% of the dental units at risk in this population. A comparison of differential microscopic counts of subgingival bacteria from the affected tooth surfaces with a pooled sample of 6 other surfaces with the greatest probing depth, in the same mouth, taken at the same appointment, revealed no significant differences between proportions of coccoid cells, spirochetes, motile rods or other cell types.

These findings suggest that disease recurrence, as measured by a comparatively rapid increase in probing depth, might be accounted for on the basis of the following hypotheses: (1) an alteration in the host response without a detectable change in the composition of the subgingival microbiota, (2) a qualitative change in the microbial flora not detectable by a microscopic assay, (3) relatively brief episodes of disease activity which may be accompanied by brief, transient, qualitative changes in the local microbiota that cannot be readily detected by biannual examinations.
Digitalis Toxicity: A Case Report
Authors: Milam Stephen B. , Giovannitti Joseph A.
Published: March 2012

Digitalis has a clinically useful therapeutic ratio (LD50/ED50), but doses must be carefully adjusted for each patient to avoid manifestations of toxicity. This paper reviews the pharmacology and toxicology of digitalis and reports an occurrence in which lifethreatening cardiac dysrhythmias occurred as a result of digitalis toxicity in a patient undergoing full mouth gingival curettage. In addition, some recommendations for prevention and management of this problem are discussed.
Influence of Frequent Sugar Intakes on Experimental Gingivitis
Authors: Sidi A. D. , Ashley F. P.
Published: March 2012

Few studies have investigated directly the possible role of dietary sugar in the etiology of periodontal disease, although an association between the amount of plaque formed and the frequency of sugar intake has been demonstrated. The purpose of this study was to examine the influence of frequent sugar intakes on experimental gingivitis in young adults. Twenty male dental students took part in a single blind crossover study which involved two 3‐week experimental periods with random allocation to high or low sugar diets.

The experimental site was the lower anterior area. The labial aspects of the lower anterior teeth were examined at baseline and Weeks 1, 2 and 3. Inflammation was assessed by recording bleeding on probing at 12 sites at 2 levels of severity—“pin prick” and “excess.” In addition gingival crevicular fluid flow was recorded and plaque amount was assessed.

At 3 weeks significantly higher bleeding scores at the two designated levels were found with the high sugar diet but no significant differences were observed with crevicular fluid flow and plaque amount. It was concluded that frequent sugar intakes result in increased gingival inflammation in experimental gingivitis, as measured by gingival bleeding on probing.
The Production of a Root Surface Smear Layer by Instrumentation and its Removal by Citric Acid
Authors: Polson Alan M. , Frederick G. Thomas , Ladenheim Stephen , Hanes Philip J.
Published: March 2012

The purpose of this study was to characterize, using the scanning electron microscope, the nature of root surfaces denuded by (1) root planing alone or (2) root planing plus citric acid treatment. Six teeth were extracted from three squirrel monkeys, and the coronal half of the root surface was planed to remove attached periodontal ligament fibers and cementum. Citric acid, pH 1, was topically applied to the denuded surfaces of 3 teeth. The surface of only root‐planed specimens had an irregular surface which corresponded to a smear layer. Root surfaces that had received acid treatment after root planing exhibited funnel‐shaped orifices of dentinal tubules, and intertubular zones with a fibrillar, mat‐like morphology. The implications of the different root‐surface characteristics are discussed.
Chronic Treatment with Hydrogen Peroxide: Is it Safe?
Authors: Weitzman Sigmund A. , Weitberg Alan B. , Niederman Richard , Stossel Thomas P.
Published: March 2012

The regular application of hydrogen peroxide to gingival tissues is becoming widely used as part of dental hygiene. Since hydrogen peroxide can be toxic under certain experimental conditions, proof of both safety and efficacy of its chronic administration should be available before prescription to the general public.
Oxygen Tension (pO2) in Untreated Human Periodontal Pockets
Authors: Mettraux G. R. , Gusberti F. A. , Graf H.
Published: March 2012

The purpose of this study was to assess the oxygen tension in untreated human periodontal pockets and test the hypothesis that the subgingival environment is anaerobic in nature. Twenty‐six patients with advanced chronic inflammatory periodontal disease participated. A total of 111 untreated pockets, 5 to 10 mm in depth, were selected for the pO2 measurements. Pocket depths, Plaque‐Index and Gingival‐Index were recorded.

The pO2 at the base of the 111 pockets ranged from 5 to 27 mm Hg, with an average of 13.3 mm Hg (1.8% 02). Mean pocket depth was 6.9 mm. Moderately deep pockets (5–6 mm) had a mean p02 of 15.0 mm Hg, whereas deep pockets (7–10 mm) showed a significantly lower pO2 of 11.6 mm Hg. No correlation was found between the pO2 and the Plaque‐Index. Higher Gingival‐Index scores tended to be associated with higher pO2 values.

The pO2 in untreated periodontal pockets was low. However, it does not represent a completely anaerobic environment. Deep pockets contained less oxygen than moderately deep sites.
An Evaluation of Tricalcium Phosphate Implants in Human Periodontal Osseous Defects of Two Patients
Authors: Baldock W. T. , Hutchens L. H. , McFall W. T. , Simpson D. M.
Published: March 2012

This study evaluated the use of tricalcium phosphate (TCP) ceramic implant material in periodontal osseous defects. Thirteen defects in two patients were treated with mucoperiosteal flaps and placement of TCP. The defects were evaluated clinically and radiographically utilizing standardized probe placement and radiographic technique. Clinically, there was a mean probing pocket reduction of 4.5 mm as a result of a mean gain of clinical probing attachment level of 2.0 mm and a mean gingival recession of 2.5 mm. Radiographically, there was a mean “fill” of 1.8 mm. Six teeth were removed by block biopsy for histologic analysis, three at 3 months, one at 6 months and two at 9 months. The TCP particles were well tolerated and encapsulated by fibrous connective tissue, but the particles did not stimulate new bone growth. The junctional epithelium ended 1.62 mm coronal to the apical extent of a reference notch placed at the base of the defect. Although new cementum was observed, there was limited evidence of new attachment.
A Fused Central Incisor: Periodontal Considerations in Comprehensive Treatment
Authors: Blank Barry S. , Ogg R. Randall , Levy Alan R.
Published: March 2012

This report details the treatment of a permanent central incisor fused to a supernumerary tooth. The level of fusion was first determined by radiographs, but surgical visibility indicated a more extensive fusion. The two roots were separated, and the supernumerary tooth was removed. At 10 weeks postoperatively, orthodontic treatment was instituted, bringing the retained tooth through the healing socket left by the supernumerary, and into contact with the interdental septum. After endodontic treatment and splinting, a periodontal re‐entry procedure was necessitated by the persistence of inflammation caused by incomplete removal of the furcation‐like area between the fused teeth. The improved periodontal prognosis of this case at 1‐year follow‐up can be attributed to careful postsurgical evaluation and subsequent removal of this plaque‐retentive area.
Collagen Sponge as a Topical Hemostatic Agent in Mucogingival Surgery
Authors: Stein M. D. , Salkin L. M. , Freedman A. L. , Glushko V.
Published: March 2012

Hemorrhage from palatal donor sites during periodontal mucogingival surgery was controlled by application of Collastat absorbable collagen hemostatic sponges. The use of collagen sponges was evaluated in 20 free‐graft cases. In contrast to microfibrillar collagen, which is normally delivered as clumps of material, a Collastat sponge was applied as a single piece that maintained structural integrity even when wet and was easy to maneuver into place. The highly porous sponges conformed to the wound, absorbed fluid and produced consistently reliable hemostasis with no secondary bleeding. By stemming the seepage of blood into the throat, patient safety and comfort were improved. The sponges were left on the wounds and removed at the 1‐week postoperative visit, revealing well‐formed granulation tissue. Healing proceeded normally with no evidence of infection, tissue reaction or other adverse effects.
Effects of Citric Acid Treatment on Autogenous Free Graft Coverage of Localized Recession
Authors: Ibbott C. G. , Oles R. D. , Laverty W. H.
Published: March 2012

Citric acid root conditioning prior to free gingival autografi (FGA) coverage of denuded roots may increase the likelihood of reattachment, but controlled studies to determine the value of the procedure have not been done on human subjects. This investigation was done to compare the effects of FGA root coverage with and without citric acid pretreatment.

Nineteen patients with 30 affected teeth participated in the study. Fifteen teeth received FGAs without citric acid pretreatment and 15 teeth received FGAs with citric acid pretreatment. Measurements of gingival recession and sulcus depth were made preoperatively and 30, 60 and 90 days following the surgical procedure.

Free gingival autografts with and without citric acid pretreatment each significantly reduced the amount of exposed root, but no differences between groups were found. Except for the 90‐day single tooth control group, mean sulcus depths were significantly decreased at 30, 60 and 90 days, but there were no differences noted between single tooth citric acid and control groups or multiple tooth citric acid and control groups.

Citric acid treatment of affected roots prior to FGA coverage does not appear to be justifiable.
A Morphologic Study of the Mesial Root Surface of the Adolescent Maxillary First Bicuspid
Authors: Booker Brooks W. , Loughlin Dan M.
Published: March 2012

Treating periodontitis which involves the mesial concavity of the maxillary first bicuspid can be very challenging. Fifty extracted adolescent maxillary first bicuspids were sectioned in 2‐mm thick sections apical to the cementoenamel junction (CEJ). The mesial concavity depth and the cementum and dentin thickness were measured in the sections.

The single‐rooted bicuspids have a concavity 0.35 mm deep at the CEJ and a concavity 0.59 mm deep 4.7 mm apical to the CEJ. Two‐rooted bicuspids furcate at 7.9 mm and have a concavity 0.44 mm deep at the CEJ which increases to 1.08 mm at the 4.7 mm level. Cementum thickness averages from 0.9 mm at the CEJ to 1.1 mm at the 9.4‐mm level. Most bicuspids also have a distal concavity which is deepest at the 4.7‐mm level.

The results imply that any attachment loss around the maxillary first bicuspid involves surfaces which are most likely concave. These concave surfaces make both plaque removal and various periodontal therapeutic procedures difficult.
Mycosis Fungoides with Multiple Oral Mucosal Lesions
Authors: Barnett M. L. , Cole R. J.
Published: March 2012

Mycosis fungoides is a cutaneous T‐cell lymphoma which in its later stages affects extracutaneous sites, including the oral mucosa. A case is presented in a 69‐year‐old male in which oral involvement was widespread and rapidly progressive. Although gingival involvement, as seen in this patient, is relatively rare, it is useful for the periodontist to be aware of the oral manifestations of this disease since cutaneous lesions would most likely be covered if the patient were to present for consultation on an ambulatory basis.
The Role of Crevicular Fluid Iron in Periodontal Disease
Authors: Mukherjee Sabyasachi
Published: March 2012

This article presents a brief review of literature on the role of iron in infection and reports the concentration of iron in crevicular fluid (CF) in humans and beagle dogs. Crevicular fluid from human subjects was collected from gingivitis and periodontitis sites. The CF from beagle dogs was collected from gingivitis and active periodontitis (ligature‐induced) sites.

The results showed that the concentration of iron in human CF was often higher than in human serum. Also, a comparison between CF collected from gingivitis sites and periodontitis sites revealed a significantly higher concentration of iron in CF collected from the periodontitis sites. The studies in ligature‐induced periodontitis in beagle dogs revealed at least a 3‐fold increase in iron concentration in CF following ligation compared to the preligation values.

Based on the available literature it is suggested that high concentration of iron in CF is not due to serum transferrin or polymorphonuclear leukocyte lactoferrin. Also, this high concentration of iron in CF might play an important role in enhancement of growth and virulence of microorganisms of the subgingival plaque and the initiation of active periodontitis.
Rapid Identification of Periodontal Pathogens in Subgingival Dental Plaque: Comparison of Indirect Immunofluorescence Microscopy with Bacterial Culture for Detection of Bacteroides gingivalis
Authors: Zambon J. J. , Reynolds H. S. , Chen P. , Genco R. J.
Published: March 2012

A large body of research implicates Bacteroides gingivalis in the etiology of adult periodontitis, however, the application of this information to clinical diagnosis and treatment has been hampered by the need for a simple, rapid, and reliable means of detecting this microorganism. In the present study, indirect immunofluorescence microscopy using species specific, polyclonal antisera and a monoclonal antibody was evaluated in the clinical identification and quantitation of B. gingivalis in human subgingival dental plaque.

One hundred and twenty subgingival plaque samples were obtained from predetermined sites by means of sterile paper points from 20 human subjects including 10 adult periodontitis patients and 10 periodontally normal subjects. The proportions of cultivable B. gingivalis in each sample were determined following anaerobic culture on nonselective blood agar media and selective media containing kanamycin. These results were then compared to quantitative estimates of B. gingivalis by indirect immunofluorescent microscopic evaluation of heat‐fixed plaque smears. Using both immunofluorescence microscopy and bacterial culture, the present study confirms the importance of B. gingivalis in adult periodontitis previously described by culture. The organism was cultivable from 70% of the adult periodontitis patients but not from any of the normal adults. In contrast, indirect immunofluorescence microscopy detected the organism in up to 40% of the subgingival sites in 100% of the adult periodontitis patients as well as four sites in the periodontally normal subjects. The sensitivity of indirect immunofluorescence microscopy compared to culture ranged from 91 to 100% while the specificity varied from 87 to 89%. The numbers of B. gingivalis identified by immunofluorescence microscopy were directly proportional to the severity of periodontal disease as measured by clinical indices. Linear regression analysis of the immunofluorescent data suggests that the probability of a subject having adult periodontitis approaches 100% when B. gingivalis comprises 9% or more of the subgingival microflora.

The present study indicates that indirect immunofluorescence microscopy using speciesspecific serodiagnostic reagents is useful in the clinical detection of B. gingivalis in human subgingival dental plaque. The data also suggests that certain cases of adult periodontitis can be diagnosed solely on the basis of this laboratory test.
Serum and Gingival Fluid Antibodies as Adjuncts in the Diagnosis of Actinobacillus actinomycetemcomitans Associated Periodontal Disease
Authors: Genco Robert J. , Zambon Joseph J. , Murray Patricia A.
Published: March 2012

Serum antibody titers to Actinobacillus actinomycetemcomitans were measured in 200 subjects by an enzyme‐lined immunosorbent assay (ELISA) using whole microorganisms as antigen. Comparisons were made between titers found in periodontally normal subjects and titers in subjects with localized juvenile periodontitis (LJP), postlocalized juvenile periodontitis, generalized juvenile periodontitis or adult periodontitis. It was found that titers to all three serotypes of A. actinomycetemcomitans were elevated in LJP patients' sera, while serum antibody levels in other diseased groups were not significantly elevated to any of the serotypes. Patient sera were also examined for serum antibody to oral Haemophili previously shown to cross‐react with A. actinomycetemcomitans. Similar antibody titers were found in both normal subjects and in patients with various forms of periodontal disease to Haemophilus aphrophilus, H. influenzae and H. parainfluenzae. The A. actinomycetemcomitans antibodies which were elevated in LJP patients could not be correlated with antibody titers to cross‐reacting Haemophili, suggesting that these antibodies are A. actinomycetemcomitansspecific.

Serum antibody responses in six of the LJP patients were assessed to autologous strains of A. actinomycetemcomitans. Each patient was found to be infected with only a single serotype of A. actinomycetemcomitans, and specific antibodies to the infecting serotype were found in the patients' sera. In families, the LJP patients had significantly elevated IgG, IgA and IgM serum antibody titers to A actinomycetemcomitans, while the IgG and IgA antibody titers in periodontally normal siblings were at levels comparable to those found in normal subjects. However, IgM serum antibodies were elevated in the periodontally normal siblings of LJP patients suggesting that the formation of IgM antibodies to A. actinomycetemcomitans may precede the clinical appearance of localized juvenile periodontitis. Gingival crevicular fluid and serum antibody levels to A. actinomycetemcomitans were compared in LJP patients. Comparable titers of IgG, IgA and IgM antibodies were found in serum and gingival fluid in most subjects; however, gingival fluid samples sometimes showed higher titers than serum, likely resulting from local antibody synthesis.

The value of serum antibody determinations to A. actinomycetemcomitans in the diagnosis of Actinobacillus‐associated periodontitis was also assessed. The predictive value of a positive test (significantly elevated anti‐A actinomycetemcomitans IgG) was 86%, while the specificity was 89%. These results suggest that the measurement of serum or gingival crevicular fluid antibodies to A. actinomycetemcomitans may be valuable in the diagnosis of Actinobacillusassociated periodontal disease.
Efficacy of Clindamycin Hydrochloride in Refractory Periodontitis: 12‐Month Results
Authors: Gordon Jeffrey , Walker Clay , Lamster Ira , West Theodore , Socransky Sigmund , Seiger Mia , Fasciano Robert
Published: March 2012

The purpose of this study was to evaluate the use of Clindamycin hydrochloride as an adjunct to conventional periodontal therapy in the treatment of patients who had previously been unsuccessfully treated with scaling, periodontal surgery and the use of tetracycline.

Thirteen patients with a history of “refractory” periodontitis were thoroughly scaled and monitored by repeated attachment level measurements for the presence of active destructive periodontitis. Disease activity was defined as a 3‐mm loss in attachment from baseline measurements or the occurrence of a periodontal abscess. When active disease was detected, each patient was scaled again and placed on Clindamycin hydrochloride 150 mg qid for 7 days.

Following the adjunctive use of Clindamycin in combination with scaling, the incidence of gingival sites demonstrating active disease in the group of 13 patients decreased from an annual rate of 10.7 to 0.5%. Each patient demonstrated a decreased incidence of active sites per unit of time. Clinical parameters such as probing depth, gingival redness, bleeding on probing and suppuration showed dramatic improvement at 12 months after Clindamycin therapy. The percentage of pockets with probing depths greater than 6 mm, 4 to 6 mm and 1 to 3 mm changed from 11 to 2%, 38 to 24% and 51 to 74% respectively, following Clindamycin therapy as compared to scaling alone.

The percentage of sites bleeding on probing decreased from 33% after scaling alone to 8% following Clindamycin and scaling. Gingival redness decreased from 36 to 1% of sites. Suppuration also decreased from 8% of buccal or lingual surfaces after scaling alone to 1% of surfaces following scaling and Clindamycin.

Clindamycin treatment resulted in a significant change in the microbial flora as demonstrated by darkfield microscopy. Prior to Clindamycin therapy, active sites averaged 35% spirochetes, 23% motile rods, 38% nonmotile rods and 4% coccoid cells. At 12 months postclindamycin treatment, spirochetes averaged 8%, motile rods 6%, nonmotile rods 57% and coccoid cells 28% of the organisms present.

Our findings indicate that Clindamycin is useful as a treatment modality in cases which do not respond to conventional treatment methods. Due to possible adverse side effects, Clindamycin should be reserved for those patients for whom treatment modalities of lesser risk have been unsuccessful and in whom the subgingival flora is susceptible to this agent.
Clinical Responses Following Periodontal Treatment by Local Drug Delivery
Authors: Goodson J. M. , Hogan P. E. , Dunham S. L.
Published: March 2012

A 4‐quadrant, single‐blind study was designed to test the efficacy of periodontal disease therapy by local drug delivery. A delivery system made of extruded ethylene vinyl acetate fibers loaded with 25% USP tetracycline hydrochloride was placed and maintained in periodontal pockets for 10 days. The clinical effects of this form of therapy were compared with treatment by periodontal scaling. In addition, the effect of treatment by combined local delivery and scaling was investigated. Untreated quadrants were included as control.

Placement of tetracycline‐loaded ethylene vinyl acetate fibers into periodontal pockets established a drug concentration of approximately 0.06%. By covering the delivery system with a periodontal dressing, this concentration level was maintained throughout the 10‐day therapeutic period. The average tetracycline dose used was 2.4 mg/tooth treated. Following fiber therapy, treated sites improved clinically, as evidenced by a gain in periodontal attachment and a decrease in periodontal pocket depth. The rate of new lesion formation at fiber‐treated sites decreased from a pretreatment rate of 26.5% of sites/year to a posttreatment rate of 4.8% of sites/year.

Periodontal scaling also produced clinical improvement, as indicated by significant attachment gain, pocket depth reduction and a decreased rate of new lesion formation. However, in no case were clinical results by scaling superior to results by local drug delivery, and by several measures local drug delivery was found to provide a better clinical response. Principal measures by which the clinical response using local drug delivery exceeded that by scaling were in early (3–6 months) attachment gain and in the degree of reduction of new lesion formation.

The combination of fiber therapy with scaling reduced the rate of new lesion formation; however, attachment gain appeared delayed in comparison with either scaling alone or fiber therapy alone. This delay in healing was probably due to mechanical interference by the delivery system, which was packed into the periodontal pocket immediately following scaling. Although delayed, the final attachment gain was equal to that of other treatment modalities. Untreated sites exhibited clinical signs of significant improvement which appeared 6 to 12 months after the therapeutic period. Attachment level gains were consistently less than at periodontal sites which had been treated but were nevertheless significant when compared to pretreatment levels. It is suggested that host response mechanisms triggered by periodontal scaling may have been responsible for this effect.
Effects of Mandibular Orthognathic Treatment on Mucogingival Tissues
Authors: Foushee Deborah Galle , Moriarty John D. , Simpson David M.
Published: March 2012

Twenty‐four patients receiving comprehensive Orthognathic care including genioplasty were studied to evaluate the effect of Orthognathic treatment on the mucogingival complex in the mandibular anterior region. Parameters measured prior to and after therapy were: width of keratinized gingiva, width of attached gingiva and gingival recession. A subjective assessment of tissue thickness was accomplished. A statistically significant decrease in width of both keratinized and attached gingiva was noted following Orthognathic therapy in the mandibular anterior area. In six of 24 patients, gingival recession was a clinically significant finding. The actual pretreatment width of keratinized and/or attached tissue did not seem to be the critical factor in development of recession. Risk of recession appeared to increase when genioplasty was combined with mandibular advancement and tended to occur at sites in which the keratinized gingiva and underlying bone appeared thin.
Microscopic Monitoring of Pathogens Associated with Periodontal Diseases
Authors: Greenstein Gary , Polson Alan
Published: March 2012

Microscopic monitoring of the subgingival microbiota to detect pathogens associated with periodontal diseases has been an active area of investigation. Researchers have demonstrated that plaque samples obtained at diseased sites contain more motile bacteria and less coccoid forms than healthy sites. Therapy at diseased locations has resulted in a shift in the microbiota to one that resembles healthy sites. However, the ability to predict disease activity based on morphotype counts still remains unverified. The current literature addressing chairside microscopic assessments as a diagnostic parameter is reviewed and discussed.
The Use of a Porous Hydroxylapatite Implant in Periodontal Defects
Authors: Kenney E. B. , Lekovic V. , Han T. , Carranza F. A. , Dimitrijevic B.
Published: March 2012

Twenty‐five patients with advanced periodontal destruction were used in the study. Following initial therapy, two angular interproximal defects were selected in each patient. During flap surgery a porous hydroxylapatite implant shaped to fit the periodontal defect was placed in one defect, the other defect was used as nonimplanted control. The material used for implantation was a hydroxylapatite replicate of coral from the genus Porites, with a pore size of 190 to 220 μm. Clinical parameters were measured prior to flap surgery for each of the defects. An occlusal acrylic Stent was used to give a stable reference point for pocket depth, attachment level and gingival margin height measurements. Also gingival fluid, gingival inflammation, plaque index and tooth mobility were recorded. Periapical radiographs using a standardized positioning device were also taken. At the time of surgery, the depth of the osseous defect and the height of the alveolar crest were recorded. After 6 months the clinical measurements were repeated and a re‐entry surgery was carried out in 15 selected sites. Results showed that the porous implant produced statistically significant reduction in pocket depth, in the depth of osseous lesion, and a statistically significant gain in attachment level, as compared to control areas.
Flap Technique for Periodontal Bone Implants: Papilla Preservation Technique
Authors: Takei H. H. , Han T. J. , Carranza F. A. , Kenney E. B. , Lekovic V.
Published: March 2012

A new flap design for placement of implants into osseous defects has been described. The flap design can be used in anterior and posterior areas of human subjects. Photographs of representative cases are presented. Wound healing always occurred by primary intention and without evidence of immediate graft exfoliation. Interdental soft tissue craters did not develop, making it easier for patients to maintain optimal oral hygiene. This type of flap design can also be used without grafts in order to improve postoperative soft tissue contour.
The Long‐Term Effectiveness of Periodontal Therapy in a Clinical Practice
Authors: Meador Harold L. , Lane James J. , Suddick Richard P.
Published: March 2012

A retrospective study was conducted of 620 patients in a periodontal practice over the years 1960 to 1982. Various periodontal therapies were assessed by using careful office protocols, meticulous record‐keeping and well‐defined outcome criteria. Four treatment outcome categories were used: two representing satisfactory outcomes (referred to as “STABLE”), and two unsatisfactory outcomes (“UNSTABLE”). The percentages of patients in the STABLE categories following different therapies were: (1) nonsurgical treatment, 63.6%; (2) closed curettage, 73.1%; (3) open curettage, 95.0%; (4) modified Widman flap, 91.6%; (5) full flap and osseous surgery, 71.1%. The major conclusions were that the modified Widman flap and open curettage were more effective than flap and osseous surgery, and much more effective than closed curettage when it was employed as an alternative treatment (54.8% STABLE) to the osseous surgery (71.1% STABLE). Thus, moderate surgical therapies appear to be at least as effective as ostectomy procedures in the treatment of periodontal disease, while nonsurgical and closed curettage therapies appear to be less effective.
Effects of Citric Acid Treatment on Pedicle Flap Coverage of Localized Recession
Authors: Oles R. D. , Ibbott C. G. , Laverty W. H.
Published: March 2012

Citric acid conditioning of denuded roots prior to laterally positioned pedicle flap (LPPF) coverage may increase the likelihood of reattachment, but no controlled studies to determine the efficacy of the procedure in managing naturally occurring defects in humans have been reported. This investigation compared the effects of LPPF root coverage with and without citric acid (pH1) pretreatment in a group of patients with gingival recession and associated denuded roots.

Thirty‐six patients participated in the study. Eighteen received LPPFs without citric acid pretreatment and 18 received LPPFs with citric acid pretreatment. Gingival recession and sulcus depth were measured preoperatively and 30, 60 and 90 days after the surgical procedure.

LPPFs both with and without citric acid pretreatment reduced significantly the amount of exposed root, but no differences between groups were found. For sulcus depth, the 90day value for the citric acid group was significantly increased over the preoperative level, but no other changes were noted.

There appears to be no clinical justification for using citric acid conditioning as an adjunct to LPPF coverage of denuded roots.
Diagnosis of Bone Lesions by Subtraction Radiography
Authors: Rethman M. , Ruttiman U. , O'Neal R. , Webber R. , Davis A. , Greenstein G. , Woodyard S.
Published: March 2012

Examiner diagnostic accuracy and response times were compared using subtraction and conventional radiography in a dog model. Osseous lesions were induced interproximally and through the mandibular buccal bone interradicularly and radicularly. Standardized preoperative and postoperative conventional radiographs of the induced lesions were compared to subtraction images of the same sites by 11 dentists. Examiners using the subtraction technique demonstrated improved diagnostic performance (P < 0.001) and response times (P < 0.001). Additionally, this method yielded a 30% reduction in equivocal diagnostic decisions. Data from this study suggest that subtraction radiography is a sensitive and accurate method to detect osseous lesions associated with periodontal diseases.
Changes of Subgingival Total Colony Forming Units and Black Pigmented Bacteroides after a Single Irrigation of Periodontal Pockets with 1.64% SnF2
Authors: Schmid Ernst , Kornman Kenneth S. , Tinanoff Norman
Published: March 2012

Periodontal pockets of 11 subjects were irrigated once with either 1.64% SnF2 or saline applied by syringe. Changes on the total anaerobic colony forming units (CFU) and black pigmented bacteroides (BPBs) of the irrigated pockets were assessed for 31 days. The results showed little change of the CFUs by either single application of SnF2 or saline. However, SnF2 irrigation produced a decrease in the BPBs for 1 week with the greatest effect (1/2 log reduction) being seen at 3 days after the irrigation. Some subjects had more impressive reductions in BPBs, yet four of the 11 subjects showed no reductions in BPBs in those sites irrigated with SnF2. Further studies with frequent irrigation intervals are necessary to evaluate the potential usefulness of SnF2 for subgingival irrigation.
Freeze‐Dried Bone and Coralline Implants Compared in the Dog
Authors: West Theodore L. , Brustein David D.
Published: March 2012

Partially demineralized, antigen‐extracted, freeze‐dried cadaver bone and a hydroxyapatite replica of a marine coral skeleton were implanted in 30 surgically created two‐wall intrabony pockets in two dogs. Results after 6 and 8 months showed connective tissue encapsulation and some periodontal ligament formation around the cadaver bone. In contrast, the coralline implant was consistently invaded by fibrovascular tissue, showed bone formation on its internal surfaces and had some periodontal ligament formation around it.
Root Resorption Associated with Placement of a Ceramic Implant
Authors: Ibbott Claude G.
Published: March 2012

Ceramic grafting material was used to treat a vertical osseous defect associated with a maxillary left lateral incisor tooth. The area was monitored at maintenance appointments. Root resorption was detected radiographically 12 months after grafting. At 18 months, resorption was evident clinically in the presence of moderate inflammation.
Reaction of Human Sera from Juvenile Periodontitis, Rapidly Progressive Periodontitis, and Adult Periodontitis Patients with Selected Periodontopathogens
Authors: Vincent Jack W. , Suzuki Jon B. , Falkler William A. , Cornett Willy C.
Published: March 2012

The levels of serum antibody reactive to selected periodontopathogens were determined in 182 clinically characterized patients: 35 healthy control, 50 juvenile periodontitis, 42 adult periodontitis and 55 rapidly progressive periodontitis. Reactive antibody levels were determined using an enzyme‐linked immunosorbent assay with whole cell preparations of Bacteroides gingivalis, Capnocytophaga (Bacteroides) ochraceus, Fusobacterium nucleatum and Actinobacillus actinomycetemcomitans (Y‐4) serving as antigens. Increased reactivity to B. gingivalis and F. nucleatum was observed in all three disease groups studied while antibody reactive to A. actinomycetemcomitans was increased in juvenile and rapidly progressive periodontitis. Antibody levels reactive to C. ochraceus in healthy subjects did not differ from those observed in any disease patient groups. Possible implications in the etiology and progression of the diseases coupled with environmental changes which occur in the econiche of the periodontal pocket are described.
A Modification of the “Curtain Technique” Incorporating an Internal Mattress Suture
Authors: Newell Donald H. , Brunsvold Michael A.
Published: March 2012

An internal mattress suture is described for suturing labial papillae to palatal flaps when using the “curtain technique.” The suture is simple to perform and does not violate the intact labial sulci. It gives stability to both the labial papillae and palatal flap while maintaining maximum esthetic results.