bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diagnosis of Periodontal Conditions Associated With HIV Infection
Authors: Robinson Peter G. , Winkler James R. , Palmer Guy , Westenhouse Janice , Hilton Joan F. , Greenspan John S.
Published: March 2012

Objective, reliable, and valid diagnostic criteria are required for studies of HIV‐associated periodontal conditions. A set of diagnostic criteria were devised based on a literature review and the clinical experience of the authors. Validity was assessed by comparison with clinical photographs and the criteria were evaluated and refined for ease of use and objectivity. To assess the reliability of the criteria, 9 experienced examiners were shown 20 clinical photographs accompanied by brief vignettes of clinical information. Each examiner was asked to identify signs evident in a particular area of the photograph and to record a diagnosis. Five examiners were then trained and calibrated in the use of the criteria. Finally, all 9 examiners were shown the original 20 photographs and asked to identify signs and record diagnoses. The examiners showed only fair reliability in the recognition of clinical signs, made diagnoses intuitively, and had only fair agreement on the diagnosis of periodontal diseases. The inter‐examiner reliability of examiners trained and calibrated in the use of the criteria increased and was greater than among untrained examiners. Rigid diagnostic criteria are essential in epidemiologic studies. Inter‐examiner reliability will be increased if examiners are trained in their use and calibrated in the recognition of clinical signs. Diagnostic criteria should be modified as understanding of the diseases they classify increases. The proposed criteria will enhance the value of studies of HIV‐associated periodontal changes and will contribute to that understanding. J Periodontol 1994; 65:236–243.
A Mistaken Health Belief Resulting in Gingival Injury: A Case Report
Authors: Pearlman Braham A.
Published: March 2012

This case report describes extensive ulceration of the gingiva caused by harsh and repetitive toothbrushing. The lesions were localized to several areas of the mouth. Despite considerable pain, the patient had persisted in the causative toothbrushing pattern. He had absorbed an invalid health belief that when pain or bleeding occurred, he should utilize consistent harsh brushing in the affected areas. Following re‐education, this brushing behavior was discarded and healing ensued. The origin of his health belief and its relationship to the behavioral principle of self‐efficacy are discussed. J Periodontol 1994;65:284–286.
Dentin Hypersensitivity. Occlusion of Dentinal Tubules by Brushing With and Without an Abrasive Dentifrice
Authors: Kuroiwa Masaru , Kodaka Tetsuo , Kuroiwa Mie , Abe Masayuki
Published: March 2012

Daily toothbrushing with and without an abrasive dentifrice was performed on the ground surfaces of human cervical dentin attached to resin plates, which had been exposed to the oral cavities of 4 subjects for 8 weeks. Brushing with a dentifrice containing calcium hydrogen phosphate as an abrasive caused most of the dentinal tubules to open. The patency of dentinal tubules is thought to induce dentin hypersensitivity. Brushing without a dentifrice, on the other hand, resulted in occlusion of the dentinal tubules with organic pellicle‐containing minerals. Furthermore, abrasion did not occur; however, no bacterial plaque or dental calculus were retained. The occluded tubules which were distributed over the entire dentin surfaces will likely prevent hypersensitivity. Such organic‐mineral materials occluding the tubules can be derived from saliva and embedded by the brushing. We suggest that use of a non‐abrasive dentifrice will prevent or reduce dentin hypersensitivity in the cervical regions. J Periodontol 1994;65:291–296.
Structural and Functional Changes of Cementum Surface Following Exposure to A Modified Nd:YAG Laser
Authors: Tewfik Hossam M. , Garnick Jerry J. , Schuster George S. , Sharawy Mohamed M.
Published: March 2012

A modified Nd:YAG laser was evaluated for its effect on root cementum topography and fibroblastic attachment. Fifteen extracted human teeth were curetted, sectioned, and divided into 60 areas representing 4 groups. Group I were non‐lased controls, while groups II, III, and IV were lased with the same power (4 watts, 1 second), but at 3 different laser‐target distances (1, 3, and 5 mm), thus delivering 3 different energy levels. Following lasing, 20 areas (5 per group) were examined under SEM for detection of any structural changes. Human gingival fibroblasts were cultured on both experimental and control samples of the remaining 40 areas. Photomicrographs at ×500 were obtained and the number of attached fibroblasts were counted. Results showed that lased cemental surfaces exhibited changes in surface topography which ranged from what appeared to be an apparent fusion of the surface of the covering smear layer (lowest energy level), to cracking and fissuring of the lased surface (highest energy level). When fibroblasts were cultured on the specimens, the results demonstrated the presence of a monolayer of cells on the control surfaces and on the surfaces lased with the lowest energy level (5 mm distance). Specimens lased at the mid‐energy level (3 mm) showed decreased numbers of attached cells, but not significantly different from the controls. On the other hand lasing the cementum surface at the highest energy level (1 mm distance) caused a significant decrease in the number of the attached cells as compared to the controls. The results of the present study suggests that modification of the cemental surface by the laser was dependent on the energy level. Furthermore, the energy level used (4 watts, 1 second) at 3 and 5 mm distance supported cell growth comparable to the controls. J Periodontol 1994; 65:297–302.
Incidence of Attachment Loss in Community‐Dwelling Older Adults
Authors: Brown Louise F. , Beck James D. , Rozier R. Gary
Published: March 2012

Since 1985, only four studies have been published that present data on attachment loss in populations. The purpose of this study was to present the incidence of attachment loss over an 18‐month period in a representative sample of community‐dwelling older adults. In addition, the utility of multivariate prediction models to distinguish between people who will and will not experience disease progression was explored. The Piedmont 65 + Dental Study of the Elderly is a longitudinal investigation of a random sub‐sample of over 1,000 community‐dwelling people over the age of 65 in five contiguous North Carolina counties. The five dentists who conducted the in‐home examinations and interviews at baseline also participated at 18 months and examined the same subjects. The overall attrition rate for blacks was 27% and the rate for whites was 23%. At 18‐months, the baseline attachment level scores for those subjects who were lost from the study were not significantly different from the scores of those who remained in the study. A change in attachment loss of 3 mm or more over the 18 months was set as a conservative estimate of actual change taking place. Blacks were significantly more likely to experience attachment loss irrespective of the number of sites involved (P <.05). Approximately half the people had at least one losing site and about one‐third of the blacks and one‐fourth of the whites had at least two losing sites. A total of 24% of blacks and 16% of whites had 3 or more losing sites. The multivariate etiologic model for blacks implicates the presence of P. gingivalis and P. intermedia in concentrations greater than 2%. In addition, people who indicate that they do not floss regularly, that their memory is getting worse, and had dental visits more than 3 years ago were at higher risk of attachment loss over the 18‐month period. The etiologic model for whites indicates that people who had P. gingivalis present in concentrations greater than 2% were at higher risk for attachment loss than people who did not have P. gingivalis; that people who sought medical care in the last 6 months were at higher risk; that people who felt depressed were at higher risk; and that people who smoke cigarettes regularly were at higher risk. J Periodontol 1994; 65:316–323.
The Inhibition of Interferon‐γ‐Induced Upregulation of HLA‐DR Expression on Cultured Human Gingival Fibroblasts by Interleukin‐1β or Tumor Necrosis Factor‐α
Authors: Takahashi Keiso , Takigawa Masayuki , Ami Hideo , Kurihara Hidemi , Murayama Yoji
Published: March 2012

The purpose of this study was to examine the effect of inflammatory cytokines on IFN‐γ‐induced HLA‐DR expression on cultured human gingival fibroblasts by flow cytometry. Natural human IFN‐γ, recombinant human interleukin‐1β (rhIL‐1β), and rh tumor necrosis factor‐α (rhTNF‐α) were used. IFN‐γ‐induced upregulation of HLA‐DR expression was inhibited by simultaneously adding rhIL‐1β or rhTNF‐α (65.9% and 31.4% inhibition, respectively). Both rhIL‐1β and rhTNF‐α induced endogenous Prostaglandin E2 (PGE2) from gingival fibroblasts, while IFN‐γ did not. The inhibitory effect of rhIL‐1β or rhTNF‐α on IFN‐γ‐induced upregulation of HLA‐DR expression was partially abated in the presence of indomethacin (reductions of 65.9% and 41.7%, respectively). Both rhIL‐1β‐ and rhTNF‐α‐induced endogenous PGE2 synthesis were completely inhibited by adding indomethacin (P < 0.001). The addition of exogenous PGE2 inhibited the IFN‐γ‐induced HLA‐DR expression (P < 0.001). These observations suggest that the MCH class II expression on human gingival fibroblasts are influenced by the cytokine network and indirectly by the cytokine‐mediated fibroblast PGE2. J Periodontol 1994;65:336–341.
Clinical Evaluation of HTR Polymer Bone Replacement Grafts in Human Mandibular Class II Molar Furcations
Authors: Yukna Raymond A.
Published: March 2012

A biocompatible microporous composite of PMMA (poly‐methyl‐methacrylate), PHEMA (poly‐hydroxyl‐ethyl‐methacrylate), and calcium hydroxide (HTR) or autogenous osseous coagulum (AOC) bone replacement grafts were evaluated in 15 pairs of mandibular molar Class II furcations in 9 patients. Following initial preparation, full thickness flaps were raised to gain access to the furcations; mechanical hand and ultrasonic root and defect debridement and chemical (tetracycline) root preparation were performed; paired furcations in each patient were randomly grafted with either HTR or AOC; and the host flaps replaced or slightly coronally positioned. Weekly, then monthly, deplaquing was performed until surgical re‐entry at 6 to 12 months. Both treatments improved the clinical status of the treated furcations. Direct clinical measurements demonstrated essentially equivalent clinical results with both bone replacement graft materials related to most hard and soft tissue changes in the furcations. Differences in favor of HTR were found for horizontal residual furcation depth (2.4 mm vs. 3.9 mm), horizontal furcation fill (1.9 mm vs. 0.8 mm), and percent horizontal furcation fill (44.4% vs. 17.1%) (all P ≤ 0.05 paired t test). These favorable results with HTR polymer are similar to several reports with other graft materials and with GTR barriers, and suggest that HTR polymer may be a useful therapeutic adjunct in the clinical management of grade II mandibular molar furcations. J Periodontol 1994;65:342–349.
The Effect of Root Conditioning With Minocycline HCl in Removing Endotoxin From the Roots of Periodontally‐Involved Teeth
Authors: Minabe Masato , Takeuchi Kayo , Kumada Hidefumi , Umemoto Toshio
Published: March 2012

Noting the acid‐conditioning effect of minocycline on the root surface, we investigated the ability of minocycline to remove endotoxin on untreated, diseased cementum in vitro. Root surface specimens affected by periodontal disease were immersed in minocycline solution (10 mg/ml, 50 μg/ml, and 5 μg/ml) for 10 minutes, 1 day, 3 days, and 7 days, and endotoxin eluted was determined by the limulus amoebocyte lysate (LAL) assay. Specimens serving as controls were treated by immersion in pyrogen‐free water, agitation, polishing, or exposure to citric acid (pH 1.0) for 3 minutes. When the period of immersion was the same, the root treatment with minocycline (10 mg/ml) yielded a significantly higher rate of neutralization of endotoxin than that with a 5 μg/ml or 50 μg/ml solution. However, the detoxifying effect of this method was less adequate than that of polishing or treatment with citric acid solution. There was variability in the effects of polishing among the teeth tested. To obtain the expected effect of the root treatment with minocycline solution; i.e., removal of the endotoxin, the combining of minocycline with a mechanical root preparation, such as polishing or root planing, seems to be effective. J Periodontol 1994; 65:387–392.
Direct Detection of Porphyromonas gingivalis in Macaca fascicularis Dental Plaque Samples Using an Oligonucleotide Probe
Authors: Moncla Bernard J. , Braham Pamela H. , Persson G. Rutger , Page Roy C. , Weinberg Aaron
Published: March 2012

Oligonucleotide probes complementary to the hypervariable regions of the 16S rRNA of Porphyromonas gingivalis, and previously shown to specifically identify human P. gingivalis strains to the species level, were tested for their ability to recognize P. gingivalis from nonhuman primates (Macaca fascicularis), either as distinct isolates or in subgingival dental plaque. The 32P‐labeled probes hybridized with all 147 monkey isolates identified as P. gingivalis by morphology and biochemistry, but did not hybridize with any of the 331 isolates representing 17 genera of bacteria unrelated to P. gingivalis, or to the more closely related P. endodontalis and P. asaccharolytica. This corresponds to sensitivities and specificities of 100%. Of 76 M. fascicularis plaque samples, P. gingivalis was detected by probe and culture in 67. Of 26 human plaque samples taken from separate individuals free of periodontal disease, 23 failed to demonstrate P. gingivalis by probe or culture. The results of the combined 102 monkey and human plaque samples indicate that, when compared to culture as the “gold standard,” the P. gingivalis probe had a sensitivity of 96%, a specificity of 87%, and an overall agreement with culture of 93%. These results reveal that the oligonucleotide probes used to identify P. gingivalis are specific for this organism, and give results comparable to culture methods for detecting the presence of P. gingivalis in M. fascicularis dental plaque. J Periodontol 1994;65:398–403.
Osteoblast Activity at the Dental Implant‐Bone Interface: Transmission Electron Microscopic and High Voltage Electron Microscopic Observations
Authors: Steflik David E. , Parr Gregory R. , Sisk Allen L. , Lake Francis T. , Hanes Philip J. , Berkery Diana J. , Brewer Phyllis
Published: March 2012

The purpose of this report is to present transmission electron microscopic and high voltage transmission electron microscopic (HVEM) observations of a longitudinal investigation examining the activities of osteoblasts and associated tissues apposing titanium and alumina oxide ceramic endosteal dental implants. The HVEM permitted 3‐dimensional stereologic observations. All observations were obtained from undecalcified interfacial tissues from this in vivo experimental dog model using commercially available implants placed into the mandible. Two similar implants were placed in both sides of the mandible, with implants in 12 of the 18 dogs supporting fixed bridges for either 6 or 12 months. From the study, we observed that a mineralized matrix exists in direct apposition to the implant. Since bone does not interface the entire length of the implant, other interfacial zones were found to exist which consisted of unmineralized tissues. In such zones, we observed that osteoblasts were routinely found directly at the implant interface to the mandibular bone. These interfacial tissues included unmineralized collagen fibers, proteinaceous material, a finely fibrillar matrix, and the osteoblasts. This study has reinforced the concept that the oral tissue‐dental implant interface is a dynamic zone consisting of remodeling activities of the osseous cells and extracellular matrices. J Periodontol 1994; 65:404–413.
Periodontal Guided Tissue Regeneration With a New Resorbable Polylactic Acid Membrane
Authors: Robert Pierre M. , Frank Robert M.
Published: March 2012

The aim of the present study was to evaluate the use of 3 types of biodegradable, high molecular weight DL‐lactic acid (PLA) membranes containing respectively 0%, 10%, and 30% low molecular weight oligomers for obtaining guided tissue regeneration following treatment of experimental buccal periodontal defects created surgically in 6 young adult beagle dogs. On the buccal aspects of test and control teeth, a mucoperiostal flap was raised and the buccal alveolar bone removed. The exposed root surfaces were scaled and a notch was prepared in the root surface at the level of the reduced crest. PLA membranes containing respectively 0%, 10% and 30% oligomers, drawn at random, were placed over the experimental defects, while no membrane was placed over the control roots. The animals were sacrificed 2, 4, and 6 months after surgery. For comparison between control sites (without membrane) and experimental sites (with 3 types of membrane), serial bucco‐lingual sections were made of the experimental and control sites and studied histologically and histometrically. It appeared that a satisfactory regeneration of the periodontal tissues could be obtained with all 3 types of experimental PLA membranes and statistically significant differences could be observed for epithelial, attachment, alveolar bone regrowth, connective tissue attachment, and new cementum formation in the experimental group when compared with the controls. All 3 types of membranes were well tolerated. The resorption of the membranes started in the coronal portions and extended progressively in an apical direction and the resorption time seemed to be related to the content of oligomers. PLA membranes could be used as interesting alternatives for GTR in advanced human periodontal lesions. J Periodontal 1994; 65:414–422.
Association of Clinical Risk Factors With Treatment Outcomes
Authors: Newman Michael G. , Kornman Kenneth S. , Holtzman Samuel
Published: March 2012

A patient's decision to accept treatment recommended by his dental health care provider will be strongly influenced by the quality of the information he is given. Estimates of prognosis and treatment predictability must be based on the evidence available from the literature and the practitioners' own experience. Thorough, accurate, and relevant clinical and adjunctive diagnostic data will be a major influence in the development of the patient's individualized treatment strategy. Some clinical findings such as severity of disease for age, deepening pockets accompanied by loss of clinical attachment, frequent bleeding on probing, and bone loss can be considered as risk and prognosis factors. “Hard” data implicating specific clinical or diagnostic findings as risk factors or markers are difficult to find because there are few randomized longitudinal trials available. A new approach which attempts to focus on reducing the risk of undesirable outcomes while improving the probability of successful outcomes following treatment has been referred to as the Treatment Predictability Model. A key feature of this approach is the focus on individual patient circumstances and preferences through the use of decision analysis techniques. A large scale, long‐term project utilizing a practice‐based research network (PBRN) provided some descriptive information about factors that could distinguish between responders and nonresponder patients undergoing treatment for advanced periodontitis. Bacterial colonization, level of post‐treatment plaque control, and smoking were major predictive variables in this group of periodontitis patients. The predictive treatment approach may be one way to develop evidence that will improve the predictability of outcomes for individual patients. J Periodontol 1994; 65:489–497.
Development of a Risk Profile for Periodontal Disease: Microbial and Host Response Factors
Authors: Lamster Ira B. , Smith Quenton T. , Celenti Romanita S. , Singer Robert E. , Grbic John T.
Published: March 2012

Advances in our understanding of the relationship between the microbial challenge and the host response in periodontal disease have led to the search for pathogenesisbased risk indicators or risk factors for disease progression. This evaluation is based on analysis of non‐invasive or minimally invasive samples that allow measurement of the subgingival plaque microflora or the host response in gingival crevicular fluid (GCF), serum, or saliva. Studies conducted by us have indicated that in GCF, persistently elevated levels of β‐glucuronidase (βG, a marker for primary granule release from polymorphonuclear leukocytes) are associated with clinical attachment loss in patients with periodontitis. This finding has been confirmed in a multicenter trial. We have also observed that a statistically significant positive correlation exists between βG in GCF and measures of the subgingival microbial challenge, but the correlation was less than 0.5, suggesting variations in the host response to the challenge. Furthermore, βG levels in GCF were inversely correlated with the IgG serum antibody titer to a panel of periodontal pathogens, suggesting the essentially protective function of the systemic humoral response in periodontal disease. Data in the literature support this concept. In addition, recent studies of the relationship of antibody isotypes in GCF to progression of clinical attachment loss have suggested that IgA in GCF has a protective function. This may relate to the lack of complement activation by IgA. Alternately, the development of IgA antigen‐specific responses are T‐cell dependent, and reductions in local levels of IgA may indicate a decrease in T‐helper cell function. These data have allowed development of strategies for identifying individual risk profiles for patients with periodontal disease based on the host response to the microbial challenge. With identification of these risk indicators/risk factors for active periodontal disease, the next challenge is to provide clinicians with access to the tests and analyses that are required for this approach to periodontal diagnosis. Improved patient management should result from the incorporation of these tests into clinical practice. J Periodontol 1994;65:511–520.
Diabetes–A Risk Factor for Periodontitis in Adults?
Authors: Oliver Richard C. , Tervonen Tellervo
Published: March 2012

With the increasing number of diabetics in an aging population and controversial research reports on the relationship of diabetes to periodontitis, clarification of diabetes as a risk factor for periodontitis would be helpful. This review notes variations in type, metabolic control, and duration of diabetes and highlights the results of studies that have considered these variations. Diabetics who maintained reasonably good metabolic control had not lost more teeth or experienced more periodontal attachment loss than non‐diabetics, although they had more periodontal pockets. Poorly‐controlled diabetics with extensive calculus on their teeth had more periodontitis and tooth loss than well‐controlled diabetics or non‐diabetics. Long‐duration diabetics were also at greater risk for periodontitis. Mechanisms by which diabetes may contribute to periodontitis include vascular changes, neutrophil dysfunction, altered collagen synthesis, and genetic predisposition. Minimizing plaque and calculus in the oral cavity through careful self‐care and regular professional care is important to reduce the risk of periodontitis in diabetics. J Periodontol 1994; 65:530–538.
Oral Hygiene and Compliance as Risk Factors in Periodontitis
Authors: Bakdash Bashar
Published: March 2012

Periodontitis is an inflammatory disease caused by microbial infection in the subgingival region. Risk factors associated with the development and progression of this disease are numerous, multifactorial, complex, and often not well defined across individuals and population groups. The focus of this paper is to provide an overview of existing information relevant to oral hygiene and compliance as risk factors in periodontitis and to present a 26‐month prospective clinical study dealing with the same. The review of literature from epidemiological, clinical, and public health perspectives indicated that oral hygiene can be considered as risk indicator, risk factor, and/or risk predictor. The extent of oral hygiene contribution to the overall risk of individuals and population varies greatly across studies. Such variations may be attributed to population, personal and disease characteristics, research methodology used, and analytical strategies employed. The purpose of the study reported was to determine the role of self‐reported daily oral hygiene practices and clinical plaque scores as risk factors in a middle‐aged health‐conscious population with early periodontitis. The group consisted of 174 subjects selected on the basis of putative bacterial risk markers and clinical indices. Medical, dental, behavioral, and clinical periodontal measurements including plaque, calculus, gingival inflammation, probing depth, bleeding on probing, and relative attachment level were obtained by one of two calibrated examiners at baseline, 14, 20, and 26 months. Data analyses revealed that some trends were seen relevant to self‐reported oral hygiene and plaque scores favoring oral hygiene as a possible risk factor in periodontitis. Such trends, however, were neither clear nor consistent across various clinical parameters and observation intervals. These findings may be attributed to the characteristics of the population studied and to the impact of regular personal and professional preventive dental care. J Periodontol 1994; 65:539–544.
Guided Tissue Regeneration: Comparison of Bioabsorbable and Non‐Bioabsorbable Membranes. Histologic and Histometric Study in Dogs
Authors: Caffesse Raul G. , Nasjleti Carlos E. , Morrison Edith C. , Sanchez Raquel
Published: March 2012

This study examined histologic and histometric responses to 2 bioabsorbable membranes made from a synthetic copolymer of glycolide and lactide. They were tested for their biocompatibility, resorption characteristics, and ability to support periodontal regeneration. Expanded polytetrafluoroethylene (ePTFE) was used as control. Nine fox hound dogs with no periodontal disease were used. They were sedated and their teeth thoroughly scaled and root planed. Plaque control was maintained. Two weeks later, each dog was anesthetized using gas anesthesia. Buccal and lingual mucoperiosteal flaps were reflected in the mandibular premolar areas. Randomly selected, buccal alveolar bone was reduced on the 2nd and 4th premolare to a level 5 to 8 mm apical to the cemento‐enamel junction creating a Class II buccal furcation defect on one quadrant, while the other quadrant received a Class II buccal defect only on the 4th premolar. Root surfaces were denuded of periodontal ligament and cementum, and notches were placed at the bone level of each root. In one quadrant, one site received Type I membrane and the other site received Type II. The contralateral quadrant received ePTFE. Flaps were positioned slightly coronally and sutured. Sutures were removed 1 week later. One month after surgery, 3 dogs were sacrificed and ePTFE barriers were removed from the remaining 6 dogs. Of these, 3 were sacrificed 3 months after surgery and the other 3 at 6 months. Undemineralized experimental tissues were embedded in methylmethacrylate and 8 to 10 μm thick sections were cut in a bucco‐lingual direction throughout the mesiodistal extension of the tooth. These sections were evaluated by descriptive histology and linear measurements of the periodontal tissues made. A two‐factor analysis of variance was carried out on these measurements to test for differences between control and test membranes within an animal for connective tissue attachment, cementum, bone, and epithelium. Analyses were performed on data 1, 3, and 6 months post‐healing. Histologic and histometric evaluation demonstrated that, in spite of early resorption of resorbable membranes associated with the normal inflammatory reaction, the reformation of a connective tissue attachment was favored by the placement of the membranes. New cementum with inserting collagen fibers was observed on the previously denuded surfaces of test roots, similarly to that seen in the controls. Hence, these findings indicate that, from a clinical and histological stand point, similar results can be achieved in guided tissue regeneration procedures, whether bioabsorbable barriers or the non‐bioabsorbable ePTFE is applied. J Periodontal 1994;65:583–591.
Treatment of Mandibular Class III Periodontal Furcation Defects. Coronally Positioned Flaps With and Without Expanded Polytetrafluoroethylene Membranes
Authors: Garrett Steven , Gantes Bernard , Zimmerman Grenith , Egelberg Jan
Published: March 2012

Twenty‐six mandibular class III furcation defects were treated in 26 subjects using a regenerative therapy that included citric acid root conditioning, placement of freeze‐dried decalcified bone allograft and coronally positioned flaps secured by crownattached sutures. In addition to this therapy, expanded polytetrafluoroethylene (ePTFE) membranes were placed in 14 of the 26 defects. The effect of these therapies was evaluated after 52 to 60 weeks through a series of soft and hard tissue probing measurements including residual furcation classification. For both treatments, mean improvements were observed for furcal probing attachment levels, furcal bone levels, and defect volumes. However, only a few of these through‐and‐through defects had become closed as judged by a panel of 3 independent examiners. Four defects in each of the 2 treatment groups had changed from Class III to Class I/II or Class II/II evaluated with the soft tissue in place. One defect treated without membrane and 3 defects treated with membranes had changed from Class III to Class II as recorded after reflection of the soft tissues at re‐entry. Little difference was observed between defects treated with and without membranes. Further studies with larger sample sizes and longer observation times are needed to fully evaluate these regenerative procedures and their potential for healing Class III furcation defects. J Periodontology 1994;65:592–597.
Long‐Term Effect of Two Preventive Programs on the Incidence of Plaque and Gingivitis in Adolescents
Authors: Albandar Jasim M. , Buischi Yvonne A. P. , Mayer Marcia P.A. , Axelsson Per
Published: March 2012

The efficacy of two oral hygiene training programs on the control of plaque and the prevention of gingival inflammation in adolescents was evaluated during a 3‐year period. A population of 227 Brazilian schoolchildren were divided into 3 groups. The first group received a comprehensive program based on individual needs and included information sessions pertaining to the etiology and prevention of dental diseases together with extensive training in self‐diagnosis and oral hygiene. In addition, an information session was arranged for parents and teachers of these children. The second group received a less comprehensive program consisting of conventional oral hygiene training. The third group (control) received no preventive program. The programs were presented through frequent initial training sessions ensued by infrequent follow‐up visits. During the experimental period, the two oral hygiene training programs involved 3.5 and 1.5 hours per child, respectively. The children were examined clinically at baseline and annually over the next 3 years to assess plaque and gingival bleeding and the data were analyzed by a multi‐level variance component analysis. All children showed a perpetual improvement in their oral hygiene and gingival state during the course of the study. However, the improvements observed in the comprehensive group were significantly better than that of the control group. Results from the less comprehensive group were not significantly different from the control group. Longer exposure to the programs appeared to produce more improvement; children with higher plaque and gingivitis scores prior to the program showed less favorable results; girls exhibited better results than boys. In addition, anterior teeth and buccal sites showed more improvement. It was concluded that comprehensive training in self‐diagnosis and oral hygiene can be effective in maintaining satisfactory gingival health in adolescents. J Periodontol 1994; 65:605–610.
Sequential Manifestation of Different Forms of Early‐Onset Periodontitis. A Case Report
Authors: Shapira Lior , Smidt Ami , Van Dyke Thomas E. , Barak Vivian , Soskolne Aubrey W. , Brautbar Chaim , Sela Michael N. , Bimstein Enrique
Published: March 2012

Pathogenic bacteria constitute the primary extrinsic agent in the etiology of early onset periodontitis. However, the risk of developing periodontal disease is not equal for all individuals, suggesting host factors are involved in determining an individual's disease susceptibility. In this report, a case of an otherwise healthy female, who exhibited prepubertal periodontitis (PPP) at age 10, juvenile periodontitis (JP) at age 13, and rapidly progressive periodontitis (RPP) at age 29 years, is presented. Microbial, immunological, and genetic features of the case are presented. PPP, JP, and RPP are considered distinct disease entities, albeit with similar pathology and pathogenesis, yet all were manifest sequentially in the same individual. This report presents the idea that certain individuals are predisposed to early‐onset periodontal diseases and the early identification of risk factors is important in the management of these individuals. J Periodontol 1994;65:631–635.
A 6‐Month Multi‐Center Evaluation of Adjunctive Tetracycline Fiber Therapy Used in Conjunction With Scaling and Root Planing in Maintenance Patients: Clinical Results
Authors: Newman Michael G. , Kornman Kenneth S. , Doherty Frances M.
Published: March 2012

The purpose of this study was to compare the efficacy of scaling and root planing (S and RP) alone versus tetracycline fiber therapy used adjunctively with S and RP in the treatment of localized recurrent periodontitis sites in maintenance patients. A total of 113 patients receiving regular supportive periodontal therapy (SPT) were treated with whole mouth S and RP. Two non‐adjacent sites in separate quadrants were selected in each patient for monitoring based on criteria that the sites were 5 to 8 mm deep and had a history of bleeding on probing. The chosen sites were randomly assigned to one of the two treatment groups. Probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL) were measured at baseline and 1, 3, and 6 months. At 1, 3 and 6 months, adjunctive fiber therapy was significantly better in reducing PD (P < 0.05) and reducing BOP (P < 0.05) than S and RP alone. At 6 months, fiber therapy was significantly better in promoting clinical attachment gain (P < 0.05) than S and RP alone. Overall, these results indicate that fiber therapy significantly enhanced the effectiveness of S and RP in the management of localized recurrent periodontitis sites, in patients receiving regular supportive periodontal treatment. J Periodontol 1994;65:685–691.
Clinical Evaluation of the Efficacy and Safety of a New Sonic Toothbrush
Authors: Johnson Bradley D. , McLnnes Christopher
Published: March 2012

The efficacy and safety of a new sonic toothbrush were studied in this singleblind study. The sonic toothbrush combines acoustic vibrations and dynamic fluid activity surrounding the bristles with direct mechanical scrubbing of tooth surfaces. Fifty‐one subjects were randomly assigned to either the sonic or the manual toothbrush. Plaque scores were assessed before and after a 2‐minute brushing at baseline and 1, 2, and 4 weeks. Gingivitis and sulcular bleeding scores were also taken at each evaluation. To assess long‐term safety, 29 subjects returned after 6 months of product use. Repeated measures analysis of variance of the total mean plaque score indicated a significant difference between the devices over time (P < 0.01), with the sonic toothbrush demonstrating a greater level of plaque removal on all tooth surfaces. On average, the plaque reduction from the baseline score for the sonic toothbrush was 3 times greater than the manual brush. However, when broken down by dental region, the sonic toothbrush demonstrated an improved level of plaque removal ranging from 1.5 to 11.9 times better than the manual brush, with the greatest improvement in the interproximal and lingual areas. Both the gingivitis and sulcular bleeding scores exhibited a similar, significant reduction (P < 0.005) over time for both devices with an approximate 17% decrease in the gingivitis index and a 33% decrease in sulcular bleeding sites. Safety assessment after 6 months of use indicated no soft tissue abnormalities which could be attributed to the products. The results establish the safety of the sonic toothbrush and indicate that it achieves superior plaque removal compared to a manual brush while also attaining reductions in gingival inflammation similar to that achieved with the manual brush. J Periodontol 1994;65:692–697.
The Prevalence of Localized Juvenile Periodontitis in Saudi Subjects
Authors: Nassar Mohamed M. , Afifi Omeima , Deprez Ronald D.
Published: March 2012

The purpose of this study was to determine the prevalence and sex ratio of localized juvenile periodontitis (LJP) cases in a selected Saudi population, to compare these values with different societies, and to correlate the sex ratio with the presence of Actinobacillus actinomycetemcomitans in the afflicted sites. In a retrospective study over a 3‐year period 23 cases of LJP were diagnosed from a group of 5,480 subjects with different forms of periodontal disease. The overall prevalence was 0.42%. The female to male ratio was 1.88:1. The difference in the sex ratio was statistically significant (X = 5.490, P <.05). No statistically significant difference in the sex ratio association regarding the sites afflicted by Actinobacillus actinomycetemcomitans was found. J Periodontol 1994;65:698–701.
Cigarette Smoking and Periodontal Destruction in Young Adults
Authors: Linden Gerard J. , Mullally Brian H.
Published: March 2012

The relationship between cigarette smoking and periodontal destruction was assessed in young adults. Eighty‐two regular dental attenders (21 current cigarette smokers, 61 non‐smokers) aged between 20 and 33 years were examined. The smokers consumed on average 15.4 (±7.3) cigarettes per day and had smoked for an average of 11.8 (±7) years. Cigarette smokers had almost the same levels of plaque as non‐smokers but had more proximal surfaces with subgingival calculus (P <0.01) and which bled on probing (P <0.05). Smokers had significantly more pockets ≥ 4 mm (14.6±19.9) than nonsmokers (5.8±7.9), P <0.01. Only 2 (10%) of the smokers and 1 (2%) of the nonsmokers had deep pocketing (≥ 6 mm). Smokers had significantly more sites (21.8±24.9) with periodontal attachment loss of ≥ 2 mm than non‐smokers (9.3±12.2), P <0.01. Severe loss of periodontal attachment (≥ 6 mm) was present in 4 (19%) of smokers compared with 2 (3%) of non smokers. In total 4 (19%) of the smokers had „established periodontitis” compared with 1 (2%) of the non‐smokers. The odds ratio for the presence of „established periodontitis” and smoking was 14.1 (confidence interval 1.5 to 132.9). It is concluded that cigarette smoking was a major environmental factor associated with accelerated periodontal destruction in this selected group of young adult regular dental attenders. J Periodontol 1994; 65:718–723.
Gingival Overgrowth in Cyclosporine A Treated Multiple Sclerosis Patients
Authors: Hefti Arthur F. , Eshenaur Ann E. , Hassell Thomas M. , Stone Constance
Published: March 2012

Correlations have been reported between cyclosporine A (CsA)‐induced gingival overgrowth (OG) and plaque‐induced gingivitis, duration of CsA therapy, and blood and tissue drug levels. We evaluated the relative importance of such factors using data from a 2‐year, double‐blind study of CsA therapy in multiple sclerosis (MS) patients. Ninety subjects (40 taking CsA; 50 placebo) were evaluated for plaque, calculus, gingivitis, probing depths, attachment levels, and CsA levels in blood and saliva. OG was determined by a panel of 11 calibrated examiners from standardized clinical photographs taken at the end of the study. Logistic regression was used to determine which factors were associated with occurrence of OG. Four (17%) out of 23 CsA patients with CsA trough blood levels <400 ng/ml exhibited OG. In contrast, 10 (59%) out of 17 CsA patients with CsA trough blood levels a400 ng/ml were affected with OG. Logistic regression analysis resulted in odds ratios of 0.74 (P = 0.009), 17.3 (P = 0.024) and 10.1 (P = 0.030) for the associations between OG and age, CsA trough blood levels 2≥400 ng/ml, and the interaction “color × tone,” respectively. In conclusion, the incidence of CsA induced OG appears to be higher with CsA trough blood levels greater than 400 ng/ml. J Periodontol 1994;65:744–749.
Clinical and Microbiological Status of Osseointegrated Implants
Authors: George Kalykakis , Zafiropoulos Gregory‐George K. , Murat Yildirim , Hubertus Spiekermann , Nisengard Russell J.
Published: March 2012

Peri‐implantitis, an inflammatory response around implants, has a poorly defined etiology and pathogenesis. To better understand the role of specific microorganisms in this disease process, clinical and microbiological parameters were examined in 24 patients with 98 osseointegrated implants. Sites were evaluated for probing depth (PD), plaque/calculus index (PI), gingival bleeding index (GBI), mobility, and crevicular fluid flow rate (CFFR). Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in subgingival plaque were identified by latex agglutination assays. Clinically, a statistically significant correlation (P <0.001) was observed between probing depth and the length of time an implant was present. Mobility was also significantly greater (P <0.001) in the maxillary than in the mandibular implants. Subgingival sites harboring one of the three microorganisms had significantly greater PD, GBI, and CFFR than non‐colonized sites. Implants in partially edentulous patients more frequently were colonized with P. gingivalis/P. intermedia than edentulous patients. The incidence of these microorganisms also correlated with fixture longevity. Implants present for 3 to 4 years had a significantly greater frequency of test microorganisms than implants present for 1 to 2 years. These findings suggest that microbial pathogens associated with periodontitis occur more commonly around implants exhibiting gingival inflammation (GBI) and may contribute to peri‐implantitis. J Periodontol 1994; 65:766–770.
Alterations of Fibroblast Metabolism in Early Ligature‐Induced Periodontitis in the Cynomolgus Monkey
Authors: Hussain M. Zamirul , Ghani Q. Perveen , Zhang Jin‐Cai , Enriquez Belma , Hayashi Christine , Wirthlin M. Robert
Published: March 2012

Cellular and biochemical observations were made of fibroblasts harvested from ligature‐induced periodontitis and treated gingivitis areas in four adult female cynomolgus monkeys (Macaca fascicularis) to define the changes that occur in the early periodontitis lesion. Compared with fibroblasts from the treated sites, fibroblasts from the diseased areas had a significantly higher rate of proliferation, produced about two‐thirds the amount of total protein and collagen, and failed to respond to TGF‐β, which normally stimulates extracellular matrix formation in mesenchymal cells. The diseased cells were also deficient in the activity of poly(ADP‐ribose) synthetase, an enzyme involved in the repair of DNA breaks such as occur from the insults of Superoxide and other active radicals present in inflamed areas. Although the precise nature of these biochemical defects is not fully elucidated, they may have an important bearing on chronic periodontitis cases with a „downhill” course. J Periodontol 1994;65:771–775.
Combined Guided Tissue Regeneration, Root Conditioning, and Fibrin‐Fibronectin System Application in the Treatment of Gingival Recession. A 15‐Case Report
Authors: Trombetti Leonardo , Schincaglia Gianpietro , Checchi Luigi , Calura Giorgio
Published: March 2012

This paper describes a surgical technique to achieve root coverage in deep, wide gingival recessions using a root isolation procedure with ePTFE membrane, combined with tetracycline conditioning of the root surface and fibrin‐fibronectin sealing system application. The technique was used on 15 patients with isolated mucogingival defects 4 to 6 mm deep. A large trapezium‐shaped flap was raised 3 to 4 mm apical to the margin of the bone dehiscence. The root surface was thoroughly scaled by hand and rotating instruments. Tetracycline HCl solution (100 mg/ml) was topically applied for 4 minutes. Expanded polytetrafluoroethylene (ePTFE) membrane was adapted at least 1 mm coronal to the CEJ and retained in position by sling sutures. A film of fibrin‐fibronectin sealing system was injected between the membrane and the root surface. The flap was sutured coronally and the membrane removed 6 weeks later. The patients were reevaluated 6 months after the reentry procedure. The mean recession depth decreased from 4.7 mm initially to 1.1 mm at the final postoperative appointment. This represents a mean root coverage of 77.4%. Mean probing depth reduction was 0.9 mm and the mean width of keratinized tissue increased from 1.8 mm preoperatively to 2.9 mm 6 months after surgery. These findings show that the treatment of buccal gingival recession using guided tissue regeneration procedure plus tetracycline root demineralization and fibrin‐fibronectin glue application results in a consistent and predictable improvement of mucogingival defects. J Periodontol 1994;65:796–803.
Gingival Cell IL‐2 and IL‐4 in Early‐Onset Periodontitis
Authors: Manhart Scott S. , Reinhardt Richard A. , Payne Jeffrey B. , Seymour Gregory J. , Gemmell Erica , Dyer John K. , Petro Thomas M.
Published: March 2012

The purpose of this study was to compare, using cell blot analysis, the association of gingival tissue mononuclear cells (GTMC) isolated from lesions displaying histories of early‐onset periodontitis (EOP; typically B‐lymphocyte dominated) and gingivitis (typically T‐lymphocyte dominated) with the B‐cell stimulating cytokine, interleukin (IL)‐4, and the T‐cell stimulating cytokine, IL‐2. Eleven EOP patients and 11 age‐ and gender‐similar gingivitis control (GC). subjects participated. Gingival tissue adjacent to the alveolar crest normally removed during surgery was digested in collagenase‐containing media and GTMC were isolated by density gradient centrifugation. Cells were separated into four aliquots. One was left unstimulated; the remainder were stimulated for 2 hours with Porphyromonas gingivalis outer membrane protein, mitogen Concanavalin A, or common antigen tetanus toxoid. Cells then were centrifuged onto transfer membranes and incubated in RPMI 1640 media for 6 hours to allow adsorption of secreted cytokine. Membranes were treated with monoclonal anti‐IL‐2 or anti‐IL‐4, followed by a biotin‐conjugated second layer, streptavidin‐alkaline Phosphatase and nitro blue tetrazolium/5‐bromo‐4‐chloro‐indolyl‐phosphate (NBT/BCIP) color development. A higher percentage of GTMC from EOP patients were IL‐2+ when stimulated with P. gingivalis compared with GTMC from GC patients (20 ± 2% vs. 12 ± 2%, P < 0.003). A higher percentage of non‐stimulated GTMC from EOP patients produced IL‐4 than from GC (22 ± 4% vs. 6 ± 3%, P < 0.00007), as well as when stimulated with P. gingivalis (22 ± 3% vs. 13 ± 2%, P < 0.01). Analysis of IL‐2/IL‐4 positive GTMC ratios revealed significant differences between EOP and GC for non‐stimulated cultures (0.5 ± 0.2 vs. 2.9 ± 1.0, P < 0.02). Digital analysis indicated significantly greater areas of IL‐4 staining for EOP than GC GTMC in non‐stimulated cultures (P < 0.006). These data would support the hypothesis that altered IL‐2/IL‐4 activities are associated with the periodontitis lesion. J Periodontol 1994;65:807–813.