bluuebunny/crossref_metadata_2025 huggingface dataset:
Opsonophagocytic Effect of Antibody Against Recombinant Conserved 40‐kDa Outer Membrane Protein of Porphyromonas gingivalis
Authors: Saito Shigeno , Hayakawa Mitsuo , Takiguchi Hisashi , Abiko Yoshimitsu
Published: February 2005

Background: Porphyromonas gingivalis is associated with the initiation and progression of adult periodontitis. The outer membrane proteins of the bacteria are potentially important targets for interaction with host defense systems. A 40‐kDa outer membrane protein (40‐kDa OMP) is conserved among many strains of P. gingivalis. We have cloned the gene for 40‐kDa OMP from P. gingivalis 381 and produced a recombinant protein. For the development of recombinant 40‐kDa OMP as a component of a vaccine for passive immunization, the elucidation of the roles of the anti‐recombinant 40‐kDa OMP antibody in the host defense against P. gingivalis is essential. The objective of this study was to determine the opsonic capacity of the antibody for phagocytosis by neutrophils which play a key role in the immune response to microbial infections.

Methods: To test the opsonic activity of a rabbit polyclonal antibody against r40‐kDa OMP (r40‐kDa OMP Ab) on human neutrophils to phagocytize P. gingivalis, we constructed a reproducible in vitro model of P. gingivalis‐neutrophil interaction using the human promyelocytic cell line HL‐60.

Results: We demonstrated that r40‐kDa OMP Ab in the presence of human complement successfully opsonized [3H]‐thymidine‐labeled P. gingivalis as a target for phagocytosis by HL‐60 cells differentiated with dimethyl sulfoxide. The phagocytized bacteria were then intracellularly killed and lysed, and the radioactive degradation debris egested into the culture medium.

Conclusions: We conclude that antibody against r40‐kDa OMP has opsonic activity on human neutrophil function for phagocytosis of P. gingivalis. Subgingival bacteria are coated in vivo with immunoglobulin and complement. When the antibody is specific for crevicular bacteria, immunological interactions can be expected in the crevice. Our observations suggest that the anti‐recombinant 40‐kDa OMP antibody in concert with the crevicular complement may prevent P. gingivalis colonization r40‐kDa OMP may contribute to the development of a local immunotherapy when applied to the crevice of a patient with P. gingivalis‐related periodontitis which relates to susceptibility for certain systemic diseases such as diabetes mellitus, cardiovascular disease, and preterm labor.J Periodontol 1999;70:610‐617.
Acoustic Microstreaming: Detection and Measurement Around Ultrasonic Scalers
Authors: Khambay B.S. , Walmsley A.D.
Published: February 2005

Background: Acoustic microstreaming (AMS) may be useful to the clinician when using the ultrasonic scaler to remove particulate matter from the teeth. The aim of this study was to detect and measure the effects of AMS produced by ultrasonic scalers.

Methods: For the study, an ultrasonic generator was selected with 4 differently shaped scaling tip inserts (TFI‐3, TFI‐9, TFI‐1, and P‐12). A plaque substitute (0.2 mm thick soft cream cheese) was coated onto a microscope slide and immersed in water. The ultrasonic scaler tip was placed in the water and orientated either perpendicular or parallel to the slide. The instrument was operated both contacting the slide under a load of 0.3 N and non‐contacting at various distances from the slide surface. This was repeated with the tip parallel to the slide. The area of medium removed was quantified by digital image analysis.

Results: It was found that AMS removed the plaque substitute from around the tip. The TFI‐9 insert significantly removed more material with increasing displacement amplitude (P <0.05). Significantly larger areas of plaque substitute were removed when the tips of the TFI‐3, TFI‐9, and P‐12 inserts were orientated perpendicularly to the slide compared to the parallel orientation (P <0.05). Of the 4 inserts used, the TFI‐9 insert removed the most material while the straight tip produced no apparent removal. Removal by AMS required the presence of a water medium and such forces were found to decrease with distance from the scaling tip. No plaque substitute removal was seen at a distance of 7 mm for the TFI‐9 insert at 37.5 µm displacement with the tip orientation parallel to the slide.

Conclusions: It is concluded that AMS occurs around ultrasonic scalers and this depends on the displacement amplitude, tip orientation, and presence of a water medium. AMS may play a role in disruption of subgingival biofilms associated with periodontal disease. J Periodontol 1999;70:626‐631
One Stage Full‐ Versus Partial‐Mouth Disinfection in the Treatment of Chronic Adult or Generalized Early‐Onset Periodontitis.
Authors: Quirynen Marc , Mongardini Claudio , Pauwels Martine , Bollen Curd M.L. , Van Eldere Johan , Van Steenberghe Daniel
Published: February 2005

Background: Recent studies showed the clinical benefits of a one stage full‐mouth disinfection, when compared to the worldwide standard treatment strategy of consecutive root planings per quadrant without proper disinfection of the remaining intraoral niches. The purpose of this study was to investigate the microbiological benefits of such a one stage full‐mouth disinfection with special attention to all intraoral niches for periodontopathogens and to evaluate the perception by the patients of the new treatment strategy.

Methods: Sixteen patients with early‐onset periodontitis and 24 patients with severe adult periodontitis were randomly assigned to test and control groups. The control group was scaled and root planed, per quadrant, at 2‐week intervals and given oral hygiene instructions. The test group received the one stage full‐mouth disinfection treatment. At baseline and after 1, 2, 4, and 8 months, microbiological samples were taken from all niches (tongue, mucosa, saliva, and pooled samples from single‐ and multi‐rooted teeth). The samples were cultured on selective and non‐selective media. Patient perception of the treatment was evaluated using a questionnaire.

Results: In comparison to the standard therapy, the one stage full‐mouth disinfection resulted in significant additional microbial improvements. The test group showed larger reductions in the proportions of spirochetes and motile organisms in the subgingival flora, and more significant reductions in the density of key pathogens, with even the eradication of P. gingivalis. The beneficial effects in the other niches were primarily restricted to the number of colony‐forming units/ml of black‐pigmented bacteria, especially on the mucosa and in the saliva and to a lesser extent on the tongue. Both treatments were well tolerated by the patients and the overall severity rating for both therapies was comparable, although 4 quadrants were treated within 24 hours in the test group versus only 1 in the control group. The full‐mouth disinfection approach resulted more frequently in a slight increase of body temperature, especially after the second day.

Conclusions:These findings support the benefit of a one stage full‐mouth disinfection in the treatment of patients with either chronic adult or early‐onset periodontitis. J Periodontol 1999;70:646‐656.
Multi‐Layered Periodontal Pocket Epithelium Reconstituted In Vitro: Histology and Cytokeratin Profiles
Authors: Papaioannou William , Cassiman Jean‐Jacques , Oord Joost Van den , De Vos Rita , van Steenberghe Daniel , Quirynen Marc
Published: February 2005

Background: In order to study inter‐individual differences in bacterial adhesion/invasion of periodontal tissues, an in vitro model for culturing multi‐layered pocket epithelium without feeder layers or stromal equivalents (including the evaluation of their cytokeratin profiles) was developed.

Methods: Pocket epithelium was collected and grown until confluent in Falcon flasks using keratinocyte‐serum free medium (KSFM), without a feeder layer. In the second passage, oral keratinocytes were re‐grown in a 2 compartment system using either a clear polyester (transwell‐clear [TCL]) or a collagen (transwell‐col [TCO]) membrane as culture surface. After the first week, the calcium concentration was raised to 1.2 mM and in half the wells, the KSFM was supplemented with 10% fetal calf serum (FCS). Histology and immunohistochemistry were performed after 1, 2, and 3 weeks of additional growth.

Results: In general, all conditions resulted in a structured epithelium consisting of 3 to 5 layers, but important differences were observed between the membrane types and between the media. CK4 was rarely and only lightly expressed while CK18 and 19 (characteristic of junctional epithelium) were very strongly expressed in the older (2 and 3 weeks) cultures. CK13 and 14 (characteristic of any stratifiable epithelial cell) also tended to increase over time; CK13 seemed to be stronger in KSFM with FCS while the contrary was true for CK14. The multi‐layer created by the combination TCL/KSFM + 10% FCS resembled a junctional epithelium most, while that grown on TCO without FCS mimicked the sulcular epithelium.

Conclusions: It seems possible to create a histiotypic culture resembling either periodontal pocket or junctional epithelium without the use of stromal equivalents or feeder layers which make this approach more cumbersome. This multi‐layered culture offers a model to investigate the permeability of pocket epithelium and the adhesion and penetration of bacteria under well‐defined environmental conditions. J Periodontol 1999;70:668‐678.
A Classification System for Sinus Membrane Perforations During Augmentation Procedures With Options for Repair
Authors: Vlassis James M. , Fugazzotto Paul A.
Published: February 2005

A classification system for sinus membrane perforations encountered during a sinus augmentation procedure is presented. Five of the perforations are discussed, as are the therapeutic options for their repair. Class I and Class II perforations are most easily repaired, while Class IV is the most difficult to successfully treat. In addition, the effect of the sinus membrane perforation on the course of proposed therapy is discussed. When classified and managed appropriately, sinus membrane perforations are not an absolute indication for aborting the augmentation procedure which is in progress. This paper provides a system of classification that can be used by clinicians to collect data on membrane perforations and repair results. J Periodontol 1999;70:692‐699.
The Relationship Between the Interleukin– 1 Periodontal Genotype and Implant Loss. Initial Data
Authors: Wilson Thomas G. , Nunn Martha
Published: February 2005

Background: This study investigated the relationship of the interleukin‐1 (IL‐1) genotype, smoking status, and the patient's age to the survival of osseointegrated dental implants.

Methods: Twenty‐seven patients with 33 implants that had been lost or who had at least 50% bone loss on radiographs were compared to a group of 38 patients who had experienced no bone or implant loss. All lost implants in a private practice were included in the data, except those that had fractured with no previous bone loss.

Results: Smoking was demonstrated to increase the risk of implant failure by a factor of almost 2.5.

Conclusions: Statistical testing failed to provide evidence of an increased risk for implant failure for patients who are positive for the IL‐1 genotype. There was no apparent relationship between the patient's age at the time of placement and implant loss. This study raises several questions concerning the etiology of implant loss and the comparative biology of tissues surrounding implants when compared to those surrounding natural teeth. J Periodontol 1999;70:724‐729.
Periodontal Ligament Cells From Insulin‐Dependent Diabetics Exhibit Altered Alkaline Phosphatase Activity in Response to Growth Factors
Authors: Hobbs Hana C. , Rowe Dorothy J. , Johnson Paul W.
Published: February 2005

Background: Insulin‐dependent or Type 1 diabetes mellitus (IDDM) has been associated with an increased severity of periodontal disease. Because periodontal ligament (PDL) cells play a significant role in maintenance and regeneration of mineralized tissue, the success of procedures, such as guided tissue regeneration, is directly related to the ability of these cells to augment mineralized tissue. The objective of this study was to examine the ability of PDL cells from long‐standing IDDM patients to form mineralized tissue and to determine whether these cells would exhibit altered responses to exogenously added growth factors.

Methods: PDL cells were isolated from 4 patients with IDDM treated with insulin for at least 5 years and from systemically healthy donors. The cell isolates were tested for their ability to form mineralized nodules in vitro and to express alterations in alkaline phosphatase activity in response to exogenously added growth factors (transforming growth factor‐beta (TGF‐β), platelet‐derived growth factor‐BB (PDGF‐BB), and insulin‐like growth factor‐1 (IGF‐1). Alkaline phosphatase activity was determined spectrophotometrically.

Results: Although all PDL cell isolates formed mineralized nodules in vitro, PDL cells from diabetics formed mineralized nodules more slowly than did the controls. Alkaline phosphatase activity was not altered by exposure of diabetic PDL cells to TGF‐β for 9 days. In contrast, non‐diabetic isolates exhibited increased levels of activity with increasing concentrations, from 0.5 to 1.0 ng/ml. Alkaline phosphatase activity was significantly higher in non‐diabetic, but not in diabetic, cell isolates exposed to TGF‐β at 1.0 ng/ml, when compared to non‐treated controls. Diabetic cell isolates exhibited significantly lower alkaline phosphatase activity than the non‐diabetic isolates when exposed to either TGF‐β, PDGF‐BB, IGF‐1 or a combination of PDGF‐BB and IGF‐1.

Conclusions: These results suggest that the populations of PDL cells in insulin‐dependent diabetics may be altered in their ability to form mineralized tissue and to respond to growth factors, functions affecting the maintenance and regeneration of the periodontium. J Periodontol 1999;70:736‐742.
The Influence of General Health and Socio‐Cultural Variables on the Periodontal Condition of Pregnant Women
Authors: Machuca Guillermo , Khoshfeiz Omid , Lacalle Juan R. , Machuca Carmen , Bullón Pedro
Published: February 2005

Background: There has been speculation as to whether hormonal changes during pregnancy or pre‐existing conditions of general, oral, and dental health and socio‐cultural background have a greater impact on the development of periodontal disease during pregnancy.

Methods: This study evaluates the periodontal status of 130 pregnant women (plaque index, bleeding index, probing depth, and clinical attachment level) and its relationship to demographic (age, professional level, education, and urban or rural residence) and clinical variables (gestation period, previous pregnancy, health status, previous live births, previous periodontal maintenance). The hospital in which the study was conducted was selected during a prior pilot study. All records were compiled by the same trained examiner with a calibrated manual probe. Statistical tests used were ANOVA and ANCOVA.

Results: Results showed a mean plaque index of 58.7±2.79%, which increased with statistical significance when the professional level was lower (P <0.014), education was lower (P <0.01), previous periodontal maintenance was less frequent (P <0.00001) and patients lived in rural areas (P <0.0003). The mean bleeding index was 68.8±2.44% and was significant in relation to lower professional level (P <0.025), less frequent previous periodontal maintenance (P <0.029), and an urban residence (P <0.0011). A mean clinical attachment level of 0.84±0.65 mm was observed and was related significantly with age (26 to 30 years) (P <0.001) and the third trimester of gestation period (P <0.0025). The mean probing depth was 1.71±0.3 mm, which related significantly with age (36 to 42 years) (P <0.0002), lower professional level (P <0.0013), rural residence (P <0.0025), 2 or more previous live births (P <0.0001), and non‐attendance for previous periodontal maintenance (P <0.0023). Using ANCOVA testing and adjusting by age, the differences relating to previous live births disappeared.

Conclusions: Gingivitis due to accumulation of plaque was the most characteristic periodontal condition in this sample and was related to professional level, level of education, and previous periodontal maintenance. These results illustrate the importance of establishing periodontal preventive measures for pregnant women, even though their demographic and clinical characteristics do not differ from those of the general population. J Periodontol 1999;70:779‐785.
Factors Contributing to Adverse Soft Tissue Reactions Due to the Use of Tartar Control Toothpastes: Report of a Case and Literature Review
Authors: DeLattre Veronique F.
Published: February 2005

Tetrasodium and/or tetrapotassium pyrophosphate (Ppi) is the anticalculus component of most tartar control dentifrices on the market today. While pyrophosphates alone are not responsible for hypersensitivity reactions, several modifications which may lead to adverse oral manifestations may occur when pyrophosphates are added to a dentifrice. First, tetrasodium pyrophosphate in a dentifrice forms a slightly alkaline solution upon oral use which could irritate oral membranes. Second, increased concentrations of flavoring agents, known to be sensitizers, are needed to mask the strong bitter taste of pyrophosphates. Third, increased concentrations of detergents, capable of producing hypersensitivity reactions, are necessary to allow the pyrophosphates to become soluble in the dentifrice. Fourth, a pre‐existing condition of reduced salivary flow may augment hypersensitivity to tartar control toothpastes. While pyrophosphates have been approved as additives in dentifrices, these compounds along with the increased concentrations of flavorings and detergents and their higher intraoral alkalinity are strongly implicated as the causative factor in certain hypersensitivity reactions. J Periodontol 1999;70:803‐807.
Gingival Lesions Diagnosed as Pemphigus Vulgaris in an Adolescent. Case Report
Authors: Navarro Cláudia M. , Sposto Maria R. , Onofre Mirian A. , Scully Crispian
Published: February 2005

Desquamative gingivitis (DG) is a fairly common disorder in which the gingivae show chronic desquamation. Originally considered to be related to hormonal changes at menopause, since many of the patients are middle‐aged women, DG is now recognized to be mainly a manifestation of a number of disorders ranging from vesiculobullous diseases to adverse reactions to a variety of chemicals or allergens. Desquamative gingivitis can be an important early clinical manifestation of serious systemic diseases such as pemphigus vulgaris. The authors present a case that illustrates the importance of a specific diagnosis in patients with desquamative gingival lesions previously treated for 6 months as classical gingivitis. Gingival biopsy showed histologic patterns typical of pemphigus vulgaris. The patient was treated with systemic and topical corticosteroids in association with miconazole. The patient is now under control with low‐dose systemic corticosteroids. Proper recognition of lesions in the oral mucosa leads, in several situations, to an early diagnosis of a systemic disease. J Periodontol 1999; 70:808‐812.
Human Histologic Evaluation of Root Coverage Obtained With a Connective Tissue With Partial Thickness Double Pedicle Graft. A Case Report
Authors: Harris Randall J.
Published: February 2005

The use of a connective tissue graft combined with a pedicle graft has been proven an effective method to achieve root coverage. However, little is known about the histologic results in humans. A connective tissue with partial thickness double pedicle graft was performed on 2 teeth scheduled for extraction for prosthetic reasons. The procedures were clinically successful (100% and 83.3% root coverage). At 6 months postoperative, the teeth were extracted with conservative block sections and analyzed histologically. Two different healing patterns were seen. The first was characterized by a long junctional epithelial attachment that extended well beyond the original gingival margin and occasionally almost to the original bone level with minimal connective tissue adjacent to the tooth. The other pattern was a short junctional epithelium that stopped at the previously exposed root surface. In this pattern, there was predominately connective tissue adjacent to the tooth with some isolated areas of epithelium. No new bone or cementum was seen in any section. The use of a technique that combines a connective tissue graft with a pedicle graft can produce root coverage and a successful clinical result. However, the histological evaluation of this case report revealed that true regeneration was not seen in this study, only repair. J Periodontol 1999;70:813‐821.
Influence of Estrogen and Osteopenia/Osteoporosis on Clinical Periodontitis in Postmenopausal Women
Authors: Reinhardt Richard A. , Payne Jeffrey B. , Maze Connie A. , Patil Kashinath D. , Gallagher Steven J. , Mattson John S.
Published: February 2005

Background: In Western societies, more than one‐third of the female population above age 65 suffers from signs and symptoms of osteoporosis, a disorder characterized by low bone mass. Estrogen deficiency is the dominant pathogenic factor for osteoporosis in women. The impact of estrogen deficiency and osteopenia/osteoporosis on periodontitis is unclear, partially due to the lack of longitudinal studies evaluating clinical signs of gingival inflammation and periodontitis progression. The purpose of this investigation was to analyze prospectively the influence of serum estradiol levels and osteopenia/osteoporosis on common clinical measurements of periodontal disease over a 2‐year period.

Methods: Fifty‐nine moderate/advanced adult periodontitis patients and 16 non‐periodontitis subjects, all within 5 years after menopause at baseline, completed the study. Serum estradiol levels (E2) were measured yearly by 125I radioimmunoassay, and osteopenia/osteoporosis was determined by dual energy x‐ray absorptiometry of the lumbar spine. Posterior interproximal clinical measurements were obtained every 6 months for the periodontitis patients, including explorerdetectable supragingival plaque, bleeding on probing (BOP) and relative clinical attachment level (RCAL). Baseline probing depths, smoking history, and demographic data also were collected.

Results: Data indicated that baseline demographic measurements and bone mineral density (BMD) of the lumbar spine were not different between E2‐deficient and E2‐sufficient subjects. Smoking activity (packs smoked/day, years smoked) was higher in periodontitis patients (P=0.0001) . E 2‐sufficient periodontitis subjects had a higher frequency of supragingival plaque without increasing gingival inflammation. E2 status did not influence the percentage of sites losing RCAL for either periodontitis or non‐periodontitis groups, but when non‐smoking osteopenic/osteoporotic periodontitis patients were evaluated, E2‐deficient subjects had more BOP (43.8% versus 24.4%, P<0.04) and a trend toward a higher frequency of ≥ 2.0 mm RCAL loss (3.8% versus 1.2%, 2 P<0.1) than E ‐sufficient subjects.

Conclusions: These data suggest that E2 supplementation (serum E2>40 pg/ml) is associated with reduced gingival inflammation and a reduced frequency of clinical attachment loss in osteopenic/osteoporotic women in early menopause. J Periodontol 1999;70:823‐828.
Vascular Endothelial Growth Factors and Progression of Periodontal Diseases
Authors: Johnson R.B. , Serio F.G. , Dai X.
Published: February 2005

Background: Tissues become hemorrhagic and edematous coincident to periodontal diseases; however, there is little information concerning the biologic mechanisms which may produce these changes. Vascular endothelial growth factor (VEGF) is a macromolecule which enhances blood vessel growth and permeability. However, there is no information concerning gingival VEGF concentrations within normal or diseased gingiva. The purpose of this study was to assess changes in gingival concentrations of VEGF during initiation and progression of periodontal diseases and compare them to changes in the number of blood vessel profiles and concentration of recognized markers of periodontal disease severity (interleukin‐6[IL‐6]).

Methods: Normal (non‐hemorrhagic gingiva adjacent to a ≤3 mm gingival sulcus) and inflamed gingiva (hemorrhagic gingiva adjacent to a ≤3 mm, 4 to 6 mm, or >6 mm periodontal pocket) were studied. VEGF and IL‐6 concentrations were assessed by ELlSA and the number of blood vessels determined by histomorphometric techniques. Data were placed into one of the following groups: ≤3 mm, normal; ≤3 mm, diseased; 4 to 6 mm, diseased; and >6 mm, diseased. These groups were compared by factorial ANOVA and Scheffé comparisons. In addition, groups were compared by simple and multiple regression and regression ANOVA to determine possible correlations between them.

Results: VEGF and IL‐6 concentrations were significantly lower within normal than within diseased gingiva. The number of blood vessel profiles and mean IL‐6 concentrations were highest in diseased tissues adjacent to >6 mm sulci and were significantly correlated with sulcular depth (P <0.001). In contrast, VEGF concentrations were highest within diseased gingiva adjacent to 4 to 6 mm periodontal pockets (P <0.001) and were not correlated with sulcular depth.

Conclusions: VEGF may be a factor in initiation and progression of gingivitis to periodontitis, possibly by promoting expansion of the vascular network coincident to progression of the inflammation. J Periodonto1 1999; 70:848‐852.
Microbiological Response of Localized Sites with Recurrent Periodontitis in Maintenance Patients Treated with Tetracycline Fibers
Authors: Wong Man‐Ying , Lu Chia‐Lin , Liu Cheing‐Meei , Hou Lein‐Tuan
Published: February 2005

Background: Whether adjunctive tetracycline fibers can provide an additive effect to scaling and root planing in treating non‐responsive sites in maintenance subjects is still controversial. Recolonization of the bacteria from untreated sites or from the extracrevicular region may explain the insignificant response to local therapy. The purpose of the present study was to evaluate the microbiological response of sites treated with tetracycline fibers combined with scaling and root planing.

Methods: The study was conducted in a split‐mouth design. Thirty patients on maintenance therapy having at least 2 non‐adjacent sites in separate quadrants with probing depths between 4 to 8 mm with bleeding on probing, or aspartate aminotransferase enzyme levels > 800 μlU in the gingival crevicular fluid, were treated with scaling and root planing plus tetracycline fibers or with scaling and root planing only. Subgingival plaque samples were collected at baseline, and 1, 3, and 6 months following treatment. A. actinomycetemcomitans, C. rectus, B. forsythus, E. corrodens, F. nucleatum, P. gingivalis, and P. intermedia were detected by culture, immunofluorescence, or PCR technique.

Results: There was a reduction of total bacterial cell count, as well as of certain periodontal pathogens, following treatment. The prevalence of A. actinomycetemcomitans, B. forsythus, and P. gingivalis and the mean proportions of C. rectus, P. intermedia, F. nucleatum, and P. gingivalis decreased after therapy, but there was no statistically significant difference between the 2 treatment groups with respect to bacterial proportions or the number of positive sites. Besides, the pathogens could not be eliminated from the periodontal pocket, and recolonization of the pocket was noted at 3 months post‐treatment.

Conclusions: Bacteria located within the cheek, tongue mucosa, saliva, or untreated sites may contribute to reinfection of the pockets and explain the insignificant response to local tetracycline therapy. J Periodonto1 1999;70:861‐868.
Improvement of Multiple Facial Gingival Recession by Non‐Surgical and Supportive Periodontal Therapy: A Case Report
Authors: Ando Kazunari , Ito Koichi , Murai Seidai
Published: February 2005

We report a case of multiple facial gingival recession which was improved by non‐surgical and supportive periodontal therapy. The patient, a 28‐year‐old Japanese woman, presented for treatment of multiple facial gingival recession ranging from 1 to 4 mm on teeth 5 through 12 and 19 through 30. Periodontal plastic surgery to cover the exposed multiple root surfaces was suggested. However, because of emotional problems, the patient did not wish to undergo the procedures and instead accepted non‐surgical periodontal therapy including oral hygiene instruction, scaling, and root planing. The exposed root sites were monitored at periodic maintenance visits, and gradual improvement through a coronal increase of the gingival margin was noted. The possible etiologic factors and healing process associated with this case are discussed. J Periodontol 1999;70:909‐913.
Maintenance of Soft Tissue Closure Following Guided Bone Regeneration: Technical Considerations and Report of 723 Cases
Authors: Fugazzotto Paul A.
Published: February 2005

The purpose of this paper is to present simple clinical techniques which have been utilized in a significant number of consecutive cases to maintain primary closure throughout the course of regeneration. The maintenance of soft tissue primary closure following guided bone regeneration (GBR) therapy, while considered a considerable challenge, is recognized as contributing to the maximization of therapeutic results. A retrospective analysis of the maintenance of such soft tissue primary closure following the utilization of specific mucoperiosteal flap designs during GBR surgery in 723 consecutively treated cases was carried out. Soft tissue closure was maintained over the membranes for the course of regeneration (a minimum of 6 months) in 695 cases (96.1%). The maintenance of soft tissue primary closure following GBR therapy may be predictably attained through proper surgical planning, technical care, and appropriate postoperative management. J Periodontol 1999;70:1085‐1097.
Treatment of Molar Furcation Involvement Using Root Separation and a Crown and Sleeve‐Coping Telescopic Denture. A Longitudinal Study
Authors: Hou Guey‐Lin , Tsai Chi‐Cheng , Weisgold Arnold S.
Published: February 2005

Because of the inconsistent results of periodontal and prosthetic therapy, periodontists may choose to treat maxillary molar furcation involvements (FI) with poor root morphology utilizing a root resection technique (RRT). In addition, poor root morphology of the remaining root following RRT is usually considered a high risk factor for long‐term periodontal and prosthetic success. The purpose of this retrospective study was to investigate the differences in the clinical periodontal parameters between molar abutments with and without molar root separation and/or resection (RSR) before and after periodontal and prosthetic therapy, using a crown and sleevecoping telescopic denture (CSCTD). A total of 85 molars (47 maxillary and 38 mandibular) were treated in 25 subjects. There were 33 abutments without root separation/resection and 52 abutments with RSR. Forty‐three CSCTD were placed, 23 in the maxillary arch and 20 in the mandibular arch. The mean observation period was 6.7 ±1.9 years (range, to 13 years). The plaque index, gingival index, probing depth, clinical attachment level, and alveolar bone change were recorded. The differences in these parameters before and after periodontal and prosthetic therapy between the advanced furcationinvolved molars with and without RSR were evaluated. The results revealed a remarkable improvement in the periodontal parameters in advanced Class II and Class III FI in molars with RSR as compared to those without RSR. It was, therefore, concluded that molar abutments with RSR in conjunction with a specifically designed telescopic device provide a modified approach for treating molars with advanced Class II and III FI. J Periodontol 1999;70:1098‐1109.
Effectiveness of Periodontal Therapy in Patients With Drug‐Induced Gingival Overgrowth. Long‐Term Results
Authors: Ilgenli Tunç , Atilla Gül , Baylas Haluk
Published: February 2005

Background: Drug‐induced gingival overgrowth (DGO) is one of the well‐recognized side effects of cyclosporin A (CsA) or nifedipine (Ni). After surgical periodontal therapy, the incidence of DGO recurrence is not known. The aim of this study was to evaluate the results of surgical periodontal therapy in patients receiving CsA or Ni and who exhibit severe long‐term DGO. In addition, the relationship between various variables and the recurrence of severe DGO after periodontal surgery was investigated.

Methods: A total of 38 patients, 22 with CsA‐induced DGO and 16 with Ni‐induced DGO, were included in this study. At baseline, patients received initial periodontal therapy, after which either the upper or lower anterior segment in each patient was surgically treated. Surgical periodontal therapy consisted of the flap technique with a 90° gingivectomy incision. Following surgery, patients were placed on a maintenance therapy recall program and were monitored for 18 months. Patients were seen once a month for the first 3 months and once every 3 months for the following 15 months. Plaque index (PI), papilla bleeding index (PBI) and DGO scores in the treated segments were recorded at each recall appointment. Attendance at recall appointments was also noted for each patient.

Results: Recurrence of severe DGO was observed in 13 of the 38 patients (34%) 18 months following periodontal surgery. Multiple regression analysis indicated that age, gingival inflammation, and attendance at recall appointments were significant determinants of the recurrence of severe DGO.

Conclusions: This study suggests that regular re‐motivation and professional care at frequent recall appointments after periodontal surgery are of great importance in patients receiving CsA or Ni. By maintaining periodontal health, the life quality of these patients may be raised. J Periodontol 1999;70:967‐972.
The Association Between Osteopenia and Periodontal Attachment Loss in Older Women
Authors: Weyant Robert J. , Pearlstein Marc E. , Churak Anthony P. , Forrest Kimberly , Famili Pouran , Cauley Jane A.
Published: February 2005

Background: Recent research suggests that osteopenia may be a predisposing factor for periodontal tissue destruction. If so, then a relationship should exist between measures of systemic bone mineral density and periodontal tissue destruction. The purpose of the present cross‐sectional study was to evaluate the association between systemic bone mineral density and the clinical signs of periodontal tissue destruction in a large population of elderly dentate women.

Methods: A total of 292 dentate women (average age 75.5 years) were randomly selected for a cross‐sectional periodontal substudy from participants at the Pittsburgh Field Center of the Study of Osteoporotic Fractures (SOF), a prospective study of a cohort of elderly women (age ≥65 years at baseline) to determine risk factors for fractures. Bone mineral density (BMD) was measured using single photon absorptiometry (radius, calcaneus) and dual energy x‐ray absorptiometry (hip, spine). Oral health examinations, including periodontal probings and an assessment of bleeding on probing, were made using an NIDR probe at 3 buccal sites of all teeth. Multiple regression models were used to assess the association between bone mineral density and measures of periodontal disease status while controlling for potential confounders. Periodontal status variables examined included: average loss of periodontal attachment (LOA); number of sites with at least 4 mm LOA; number of sites with at least 6 mm LOA; number of sites with bleeding on probing; and deepest probing depth per person.

Results: This study found no statistically significant association between the 5 indicators of periodontal disease and measures of systemic BMD at 8 anatomic sites after controlling for age, smoking, and number of remaining natural teeth. Some suggestive findings support a weak association between generalized osteopenia and periodontal disease.

Conclusions: Systemic osteopenia is, at best, only a weak risk factor for periodontal disease in older non‐black women. J Periodontol 1999;70:982‐991.
Glycosaminoglycans in Gingival Crevicular Fluid of Patients With Periodontal Class II Furcation Involvement Before and After Guided Tissue Regeneration. A Pilot Study
Authors: Yan Fuhua , Marshall Rod , Wynne Susan , Xiao Yin , Mark Bartold P.
Published: February 2005

Background: The levels of glycosaminoglycans in gingival crevicular fluid (GCF) are good indicators of underlying tissue turnover. We hypothesize that connective tissue elements in GCF may be used as indicators of tissue maturation underneath barrier membranes. Therefore, we investigated the levels of sulfated glycosaminoglycans in GCF at sites before and after guided tissue regeneration (GTR).

Methods: Six patients were selected on the basis of having at least one Class II buccal furcation involvement on a molar tooth. Each molar furcation was treated with the standard GTR surgical protocol using a non‐resorbable expanded polytetrafluoroethylene membrane. Gingival crevicular fluid samples were taken at baseline (immediately prior to insertion of the membrane) and at 1, 2, 3, 4, 5, and 6 weeks (immediately prior to removal of the membrane). Glycosaminoglycan levels were determined using an Alcian blue dye detection system.

Results: The mean levels of chondroitin sulfate and total sulfated glycosaminoglycans in GCF significantly decreased during the first 4 weeks after GTR surgery. By week 5, the levels began to rise, and by week 6 the levels had returned to baseline levels.

Conclusions: Sulfated glycosaminoglycans can be monitored in GCF at healing GTR sites. It is proposed that this is a useful means of monitoring the status of the regenerating tissues. However, further longitudinal studies are required to assess if the sulfated glycosaminoglycans can be used as indicators of tissue maturation under guided tissue membranes used to treat periodontal defects. J Periodontol 2000;71:1‐7.
Gingival Metastasis From a Medullary Thyroid Carcinoma: Case Report
Authors: Piattelli Adriano , Fioroni Massimiliano , Rubini Corrado
Published: February 2005

Background: Metastatic tumors to the oral cavity are rare, representing about 1% of oral tumors, and they affect jaws more often than the oral soft tissues.

Methods: Fifteen cases of metastases to the jaw bones from thyroid carcinoma were found in a recent review, with no cases located in the oral mucosa.

Results: The authors describe the first cases of gingival metastasis from a thyroid medullary carcinoma.

Conclusions: Periodontists must recognize oral soft tissue metastases because they can be the first sign of an undiscovered malignancy, and they can be easily mistaken with several different benign lesions. J Periodontol 2000;71:112‐116.
Primary Gingival Malignant Melanoma. Report of 3 Cases
Authors: Ardekian Leon , Rosen Daren J. , Peled Micha , Rachmiel Adi , Machtei Eli E. , Abu el Naaj Imad , Laufer Dov
Published: February 2005

Background: Malignant melanoma is rare in the oral cavity and accounts for less than 1% of all melanomas. Nevertheless, the disease can be fatal, and early diagnosis and treatment may improve prognosis dramatically. The purpose of this paper is to report 3 new cases of primary malignant melanoma of the oral cavity arising in the gingiva, and to review the literature regarding intraoral melanoma.

Methods: Three cases are presented. One case was in the right mandibular molar area; the second in the right maxillary canine‐premolar area; and the third in the left mandibular canine‐premolar region. All patients were treated surgically, with postoperative radiotherapy.

Results: The first patient lived for 2 years and the second for 3 years before distant metastases were diagnosed from which they subsequently died. The third patient was lost from follow‐up after 18 months.

Conclusion: Primary oral malignant melanoma is a deadly disease. Early suspicion of this disease will allow prompt treatment and increase the prognosis for these patients. J Periodontol 2000;71:117‐120.
Persistence Patterns of Porphyromonas gingivalis, Prevotella intermedia/ nigrescens, and Actinobacillus actinomycetemcomitans After Mechanical Therapy of Periodontal Disease
Authors: Mombelli Andrea , Schmid Bruno , Rutar Alexandra , Lang Niklaus P.
Published: February 2005

Background: The aim of this study was to determine the distribution patterns of Porphyromonas gingivalis, Prevotella intermedia/nigrescens, and Actinobacillus actinomycetemcomitans in periodontitis patients after standard mechanical periodontal therapy, and to determine factors increasing the odds to detect these target organisms in treated sites.

Methods: Eight hundred fifty‐two (852) separate subgingival microbial samples were taken from the mesial and distal aspects of every tooth in 17 patients. Target organisms were identified culturally.

Results: The 3 microorganisms showed different persistence patterns: P. gingivalis was detected in a high percentage of subjects (59%), but in a low proportion of sites (5.4%). P. intermedia/nigrescens was detected in all subjects except one, and in 40.6% of the tested sites. Only 5 subjects were A. actinomycetemcomitans positive, but 2 of them showed a very high number of positive sites (44% and 75%, respectively). A highly significant relationship was found between a subject's tendency to bleed upon sampling and the number of P. intermedia/nigrescenspositive sites. A significant portion of the variation in frequency of persisting P. gingivalis could be explained by the frequency of persisting pockets deeper than 4 mm. No similar relationship could be established between clinical parameters and A. actinomycetemcomitans. On a site level, the odds of detecting P. gingivalis increased by a factor of 2.47 (P = 0.0001) for every millimeter of residual probing depth; the odds of detecting P. intermedia/nigrescens increased by a factor of 1.84 (P = 0.0001).

Conclusions: If, after standard mechanical periodontal therapy, a large number of sites continue to bleed, one may expect an increased number of sites positive for P. intermedia/nigrescens. If many deep pockets persist, a greater number of P. gingivalis‐positive sites can be expected. J Periodontol 2000; 71:14‐21.
Effect of Cigarette Smoking on Oral Elastase Activity in Adult Periodontitis Patients
Authors: Pauletto Nathalie C. , Liede Kirsti , Nieminen Anja , Larjava Hannu , Uitto Veli‐Jukka
Published: February 2005

Background: We have previously reported that elastase activity in oral fluids is significantly increased in most adult periodontitis patients. In some patients, however, elastase levels remain low despite the presence of deep periodontal pockets. In this study we explored whether or not smoking is related to the unexpected low elastase values in these patients.

Methods: We determined what proportion of the periodontitis patients that showed low oral elastase values were smokers. Paraffin‐stimulated saliva or oral rinse samples (3 ml of water, 30 second rinse) were assayed for elastase activity by incubating with 1 mM succinyl‐alanyl‐alanyl‐valine‐p‐nitroanilide for 20 hours at 37°C, and the color formation read with a spectrophotometer. Neutrophil numbers were analyzed by staining the cells in the oral rinse smear samples.

Results: In 2 patient groups, one in Helsinki, Finland (n = 46) and the other in Vancouver, British Columbia (n = 25), 63% and 83%, respectively, of the adult periodontitis patients who had one or more pockets ≥6 mm and had low oral elastase values (increase of optical density <0.5) were smokers. Non‐smoking periodontitis patients had elevated neutrophil numbers compared to healthy subjects, while the smoking patients showed no significant change. Next we analyzed elastase levels in stimulated whole saliva in a group of smokers (n = 300) and those who had quit smoking (n = 102). Smokers had significantly lower oral elastase levels than former smokers in both advanced and moderate periodontitis groups. In this subject group, 56% of all smokers with periodontitis (at least one pocket ≥6 mm) had oral elastase values less than 0.5 U while only 31% of those patients who had quit smoking had low values.

Conclusions: Cigarette smoking leads to lowered elastase and neutrophil levels in the oral cavity. The oral neutrophil elastase assay, therefore, cannot be used to measure the periodontal status of smokers. J Periodontol 2000;71:58‐62.
Relationship of Blood Glucose Level to Community Periodontal Index of Treatment Needs and Body Mass Index in a Permanent Israeli Military Population
Authors: Katz Joseph , Chaushu Gavriel , Sgan‐Cohen Harald D.
Published: February 2005

Background: The goal of this study was to find a possible link between blood glucose levels and periodontal disease.

Methods: In a prospective study the dental health of 10,590 military service men and women was examined. The relationships of periodontal condition, expressed as CPITN index, and blood glucose levels were tested. The effect of gender, body mass index (BMI), and smoking was also evaluated.

Results: Blood glucose levels were significantly and positively associated with severe periodontal disease, men, and higher BMI. Smoking did not affect blood glucose levels.

Conclusions: Blood glucose levels might be associated with severe periodontal disease. J Periodontol 2000;71:1521‐1527.
Effects of Roxithromycin on Tumor Necrosis Factor‐Alpha‐Induced Vascular Endothelial Growth Factor Expression in Human Periodontal Ligament Cells in Culture
Authors: Oyama Tohru , Sakuta Tetsuya , Matsushita Kenji , Maruyama Ikuro , Nagaoka Shigetaka , Torii Mitsuo
Published: February 2005

Background: Aberrant angiogenesis is associated with lesion formation in chronic periodontitis. However, little is known about the mediators that contribute to angiogenesis or about therapeutic agents that control the production of the mediators. Roxithromycin (RXM), which is a new 14‐member macrolide antibiotic, has a wide antibacterial spectrum against oral pathogens and an immunomodulatory effect. In the present study, we examined the effects of RXM on tumor necrosis factor (TNF)‐α‐induced vascular endothelial growth factor (VEGF) in human periodontal ligament (HPDL) cells. In addition, the effect of RXM on VEGF expression in HPDL cells was examined.

Methods: HPDL cells were plated at 5 × 105 cells/ml in 150 cm2 cell culture dishes. The confluent‐stage cells were pretreated with or without 10 μg/ml of RXM or other antibiotics in 1% FBS‐containing α‐MEM for 24 hours, followed by simultaneous treatment with 10 ng/ml of TNF‐α and 10 μg/ml of these antibiotics. After incubation for various periods, the culture supernatants and sediments were collected and analyzed by ELISA, Northern blot, and gel shift assays.

Results: VEGF mRNA and its protein were constitutively expressed in HPDL cells, and the level of expression was markedly enhanced by stimulation with TNF‐α. RXM strongly inhibited the expression of VEGF mRNA and the production of VEGF. Furthermore, RXM suppressed activation of transcription factors AP‐1 and SP‐1, which were critical factors in VEGF transcription, in TNF‐α‐stimulated HPDL cells.

Conclusion: These results indicate that TNF‐α, one of the proinflammatory cytokines implicated in the pathogenesis of periodontitis, induces excess induction of VEGF in HPDL, which may account for increased angiogenesis in periodontitis lesions. Interestingly, the antibiotic roxithromycin inhibits TNF‐mediated VEGF induction, suggesting its possible therapeutic utility in periodontitis and other chronic inflammatory conditions involving VEGF induction. J Periodontol 2000; 71:1546‐1553.