bluuebunny/crossref_metadata_2025 huggingface dataset:
Salt and Peroxide Compared with Conventional Oral Hygiene III. Patient Compliance and Acceptance
Authors: Bakdash M. Bashar , Wolff Larry F. , Pihlstrom Bruce L. , Aeppli Dorothee M. , Bandt Cari L.
Published: March 2012

This study was undertaken to evaluate patient compliance with, and acceptance of, a salt and peroxide oral hygiene regimen compared with conventional oral hygiene regimens without or with the use of phase‐contrast microscope viewing of subgingival plaque over a period of 2 years. A total of 231 subjects with early to moderate periodontitis were randomly divided into four groups. All groups were repeatedly instructed and motivated in their respective regimens. Subjects also received scaling and root planing using clinical and microbial criteria. Compliance with, and acceptance of, the two oral hygiene regimens were determined at the end of the study using a structured self‐administered questionnaire. Results indicated that 74% and 58% (P ≤ 0.01) of subjects in the conventional and salt/peroxide groups, respectively, used their assigned regimen 4 to 7 days a week during the entire study. More than half of the subjects (54%) using each of the oral hygiene regimens indicated that they flossed once daily. Inconvenience was cited by 23% of the conventional and 43% of the salt/peroxide groups (P ≤ 0.01) as the main reason for not using their regimens. Twentythree per cent of conventional group and 14% of salt/peroxide group indicated that they shared their oral hygiene supplies with others. Eighty per cent and 57% (P ≤ 0.01) of the conventional and salt/peroxide groups, respectively, stated that they liked their regimens. Ninety‐six per cent of all subjects felt that their regimen helped their periodontal status. Most subjects that microscopically viewed their subgingival plaque had a strong perception that such viewing significantly contributed to their understanding of their own periodontal conditions and motivated them to practice better oral hygiene. There is no evidence in terms of self‐reported behavior, however, to support their perceptions.
Hydrogen Peroxide Inhibits Glucose Metabolism and Collagen Synthesis in Bone
Authors: Ramp Warren K. , Arnold Roland R. , Russell James E. , Yancey John M.
Published: March 2012

Effects of H2O2 on bone were evaluated in an organ culture system. Tibiae from chick embryos were incubated for up to 3 days in culture medium containing 0.07 to 20 mM H2O2. Glucose metabolism was monitored by measuring lactate production and oxygen consumption, and collagen synthesis was determined by hydroxylation of proline. In addition to markedly inhibiting these parameters, H2O2 also decreased bone weight and alkaline Phosphatase activity. Multiple exposures to H2O2 were somewhat more effective than a single exposure. Since H2O2 inhibits bone at low concentrations in vitro, the results suggest that the potential for harmful effects of H2O2 in the oral cavity should be investigated.
Comparison of Dark‐Field Microscopy and a Flagella Stain for Monitoring the Effect of a Water Pik® on Bacterial Motility
Authors: Drisko Connie L. , White Connie L. , Killoy William J. , Mayberry William E.
Published: March 2012

The purpose of this examiner‐blind study was threefold: (1) to compare the microbial counts obtained by two different techniques for assessing bacterial motility, (2) to assess the inter‐rater reliability of these two techniques and (3) to evaluate the effect of a water irrigating device (Water Pik®) on bacterial motility at 3‐ and 6‐mm probing depths. Subgingival plaque samples were taken from 10 healthy patients having at least two sites that probed >6 mm, (one control, one experimental). Half of the patients were sampled at 3 mm, the other half at 6 mm, both at baseline (Day 0) and at Day 21. Two slides were prepared from each plaque sample, one for dark‐field evaluation and one stained with a simplified silver‐plating technique for flagella. All slides were read simultaneously by 3 observers, and the per cent motility calculated for spirochetes, motiles and all others. Strong positive inter‐rater reliability correlations ranging from r = 0.95 to r = 0.99 were found for both the dark‐field and flagella staining techniques. Spirochete counts obtained by both techniques were highly correlated (r = 0.91), whereas counts for motiles resulted in negative correlations between the techniques. Dark‐field counts were consistently higher than the flagella stain counts for motile rods. Spirochetes were reduced, but not significantly, after irrigation of both 3‐mm and 6mm sites. Bacterial motility can be evaluated by both dark‐field and flagella‐staining techniques with a high degree of inter‐rater reliability.
Effects of CO2 Laser Irradiation on Gingiva
Authors: Rossmann Jeffrey A. , Gottlieb Samuel , Koudelka Brent M. , McQuade Michael J.
Published: March 2012

A CO2 laser (Coherent Medical Model 400) was used to irradiate the gingival tissue of a cynomolgous monkey to determine laser effects on the epithelium and underlying connective tissue. A focal length of 400 mm and a 10‐watt power setting at 0.2‐ and 0.5second exposure was used. Biopsy results indicated that a 0.2‐second duration of CO2 laser irradiation was inadequate to completely de‐epithelialize the gingival tissue. A 0.5‐second exposure exhibited complete epithelial destruction with little or no disturbance of the underlying connective tissue layer and viable connective tissue 1.0 mm below the impact site.
Rapid Loss of Alveolar Bone Associated with Nonprecious Alloy Crowns in Two Patients with Nickel Hypersensitivity
Authors: Lamster Ira B. , Kalfus Donald I. , Steigerwald Paul J. , Chasens Abram I.
Published: March 2012

In recent years there has been a dramatic increase in the use of nonprecious alloy and porcelain crowns in clinical dentistry. The alloy in these restorations frequently contains a high percentage (>70%) of nickel. Most cases of metal hypersensitivity are related to nickel, and clinical manifestations of the hypersensitivity are the result of a cellular (Tlymphocyte) immune response. In this report, we review the cases of two women who demonstrated significant loss of alveolar bone about nickel‐rich nonprecious alloy and porcelain crowns. The loss of alveolar bone occurred within 18 months after placement of the restorations. Both individuals displayed a positive patch test to a nickel preparation. These findings suggest that a Type IV hypersensitivity reaction may have accounted for the rapid loss of alveolar bone. Though the majority of individuals treated with nonprecious alloy and porcelain crowns apparently tolerate these restorations quite well, greater care is urged in case selection.
Modulation of Immune Response
Authors: Dean Dwane H. , Hiramoto Raymond N. , Ghanta Vithal K.
Published: March 2012

Both epidermal growth factor (EGF) and nerve growth factor (NGF) were found to moderate the reactivity of mouse spleen cells in an in vitro model of immune response. Blastogenic response was suppressed by EGF and potentiated by NGF. Both proteins are present in mouse, but not human, saliva in quantities equal to or greater than those affecting blastogenic response in our assay. Immune response occurring in the mouse periodontium may be affected by the presence of these factors in the saliva.
Clinical Evaluation of Porous and Nonporous Hydroxyapatite in the Treatment of Human Periodontal Bony Defects
Authors: Krejci Charlene B. , Bissada Nabil F. , Farah Constantin , Greenwell Henry
Published: March 2012

The purpose of this study was to investigate the effectiveness of a synthetic nonporous hydroxyapatite graft material (OrthoMatrix® HA‐500), a porous replamineform hydroxyapatite graft material (Interpore® 200), and a debrided control with respect to defect fill. Twelve adult patients having periodontitis and three similar angular osseous defects as verified by radiographic analysis and clinical probe depths ≥5 mm were selected. Clinical parameters gathered prior to surgical intervention and at identified postoperative visits included plaque index, probing depth, and standardized radiographic examination. Customized acrylic stents were used as fixed reference guides for the insertion of endodontic silver points to the base of each defect during both initial and 6‐month reentry surgeries. A total of 36 defects were randomly assigned to one of three treatment modalities such that 12 defects received OrthoMatrix HA‐500, 12 received Interpore 200, and 12 served as debrided controls.

Comparison of nonporous hydroxyapatite, porous replamineform hydroxyapatite, and debrided control treatment modalities revealed a statistically significant improvement (P < 0.05) in the mean per cent of defect resolved in only those sites treated with nonporous hydroxyapatite. Similar positive trends were seen in the sites treated with nonporous hydroxyapatite for mean reentry defect depth and mean defect fill although these were not statistically significant (P > 0.05). No other significant differences were noted.
Tissue Localization of Actinobacillus actinomycetemcomitans in Human Periodontitis
Authors: Christersson Lars A. , Wikesjö Ulf M.E. , Albini Boris , Zambon Joseph J. , Genco Robert J.
Published: March 2012

Recent immunohistological studies have suggested that Actinobacillus actinomycetemcomitans is present in the gingival tissues in juvenile periodontitis lesions. The present study examined tissue bound A. actinomycetemcomitans by bacterial culture and immunohistological demonstration of antigen in tissue. A total of 14 periodontitis lesions were examined. Eleven biopsies were obtained from gingiva adjacent to A. actinomycetemcomitans infected pockets, while the remaining three control biopsies were obtained from gingiva adjacent to pockets where subgingival A. actinomycetemcomitans infection could not be detected. Each biopsy was hemisected, one half was used for immunofluorescence microscopic examination while the other half was processed for culture of A. actinomycetemcomitans. The latter section was surface‐disinfected, repeatedly washed and then minced to release bacteria from within the tissues. Aliquots from the serial washings and the minced tissue suspension were cultured on medium selective for A. actinomycetemcomitans.

Surface disinfection and serial washings gradually decreased cultivable A. actinomycetemcomitans in the washing aliquots. Following tissue disruption, an increase in colony‐forming units of A. actinomycetemcomitans was seen from eight of the 11 test biopsies. This bacterium could not be detected in washings or minced tissue suspensions from the control biopsies obtained from lesions in which subgingival A. actinomycetemcomitans was previously not detected. A positive correlation was seen between the presence of A. actinomycetemcomitans antigens in the gingival biopsies and; (1) A. actinomycetemcomitans colony‐forming units released from the minced tissues (r = 0.90, p = 0.000), as well as; (2) the colony‐forming units from the periodontal pocket (r = 0.62, P = 0.017).

The results indicate that viable A. actinomycetemcomitans is commonly present in the gingiva associated with periodontal pockets harboring this bacterium.
Periodontal Regeneration via Selective Cell Repopulation
Authors: Caton J. G. , DeFuria E. L. , Polson A. M. , Nyman S.
Published: March 2012

The purpose of this investigation was to determine the histogenesis of periodontal regeneration using the principle of selective and guided cell repopulation of the root surface. A fenestration model, developed in the squirrel monkey, made it possible to exclude gingival epithelium and connective tissue and promote cell repopulation of the denuded root surface from the periodontal ligament and alveolar bone. Experimental and sham‐operated control sites were compared histometrically after 3, 7, 14 and 35 days of healing. The results indicated that new cementum, bone and periodontal ligament formation occurred by the 14th day and that regeneration of the fenestration wound was almost complete by Day 35. Root resorption and ankylosis were observed in both experimental and sham‐operated controls. There was significantly more periodontal regeneration in the experimental sites, which favored cell repopulation of the root surface from the periodontal ligament and alveolar bone.
The Role of Adjunctive Rodogyl Therapy in the Treatment of Advanced Periodontal Disease
Authors: Quee Trevor Chin , Chan E.C.S. , Clark C. , Lautar‐Lemay C. , Bergeron M.‐J. , Bourgouin J. , Stamm J.
Published: March 2012

Several studies have indicated that the combination of metronidazole and spiramycin is synergistic against anaerobic bacteria and may be effective against oral infections. The present study sought to determine the efficacy and safety of a commercial preparation of these two antibiotics (Rodogyl) when used adjunctively in the treatment of advanced periodontal disease. In a double‐blind parallel randomized trial, 56 patients (mean age = 44 years) with advanced periodontitis (50 of whom completed the study) were assigned to either the Rodogyl or placebo group. Both groups were thoroughly scaled and root planed for approximately 6 hours, with one group receiving Rodogyl for 2 weeks and the other a placebo. No other therapy was received during the study period.

Two sites in each patient with probing depths of at least 7 mm were selected for study. Plaque level (PlI), gingival inflammation (GI), probing depth (PD), and attachment level (AL) were measured at baseline, 14 days, 1 month, and then at monthly intervals up to 6 months. Subgingival bacteria were monitored with dark‐field microscopy. The development of resistant bacteria, as well as side effects to the medications, was also monitored.

The Rodogyl group exhibited a greater gain in AL (0.67 mm) from the 2‐month interval until the end of the study. Although this difference was statistically significant (P < 0.05), it was not necessarily of biologic significance. There was a significantly greater decline in the proportion of spirochetes in the Rodogyl group at the 14‐day interval, and this difference remained significant (P < 0.05) at all study intervals. No difference in the proportion of motile organisms was observed. At the 6‐month interval, there were no significant differences in resistant bacteria. Diarrhea was recorded in 8% of the subjects in the Rodogyl Group.

The adjunctive use of Rodogyl in the therapy of advanced periodontitis resulted in a significant increase in attachment level as well as a significant decrease in the proportion of spirochetes, and both of these changes were sustained until the end of the study.
Periodontally Diseased Vs. Normal Roots as Evaluated by Scanning Electron Microscopy and Electron Probe Analysis
Authors: Barton Nancy S. , Van Swol Ronald L.
Published: March 2012

A scanning electron microscope and electron probe study was carried out to compare root structure from deep within periodontal pockets with roots exhibiting no periodontal disease. To eliminate the possibility of extraneous ion introduction or deletion, no attempt was made to subject the roots to fixation, embedding, or dehydration prior to sectioning and viewing in the electron microscope.

Mineral content and concentration were determined with an electron probe on two specimens per tooth. On one specimen, only the external cementai surface was analyzed. On an adjacent cross section, readings were taken from the surface and at incremental depths into the root. A nonparametric statistical analysis compared diseased with nondiseased roots.

The following conclusions can be drawn from the study: (1) Consistent and repeatable qualitative electron probe analyses can be performed on human teeth with minimal specimen preparation. This gives a more accurate assessment, since the integrity of the crystalline structure is not disrupted. (2) Minerals consistently found were P, Ca, Cu, Zn, Mg and Na. They were in similar concentrations throughout the area analyzed. (3) Mg and Cu showed higher values in the nondiseased teeth. (4) There were no differences in concentrations for Ca, P, Zn, and Na between roots exposed to a periodontal pocket and nondiseased roots.
The Effect of Supracrestal Tricalcium Phosphate Ceramic‐Microfibrillar Collagen Grafting on Postsurgical Soft Tissue Levels
Authors: Blumenthal Neil M.
Published: March 2012

In this clinical study, a combined tricalcium phosphate ceramic (TCP) microfibrillar collagen supracrestal graft was used in conjunction with pocket elimination surgery as a soft tissue space filler to maintain marginal and interproximal tissue heights. Fifteen volunteer adult patients (8 male, 7 female) aged 37 to 48 years were selected. Standardized clinical probing measurements were used to evaluate soft tissue recession, clinical attachment, and probing pocket depths. Intraoral photographs and radiographs supplemented documentation. Twenty‐five paired test and control sites were evaluated. Following flap surgery and minor osteoplasty, test defects received supracrestal grafts of TCP microfibrillar collagen prior to flap closure. Intrabony defects were excluded. Treatment modalities were compared by analyzing changes in clinical probing measurements over four months using the students t test for paired samples at the 0.01 level of significance.

Supracrestal grafting resulted in 16.74% less soft tissue recession than the control sites. In addition, there was a significant gain in clinical attachment levels compared with the controls. All implanted sites demonstrated an advantage in the use of supracrestal TCP‐collagen grafts compared with the controls. This treatment modality may have value in reducing esthetic deformities, food impaction areas, and root exposure that often occur following periodontal surgery.
An in Vitro Model to Study Bacterial Invasion of Periodontal Tissues
Authors: Winkler J. R. , Matarese V. , Hoover C. I. , Kramer R. H. , Murray P. A.
Published: March 2012

In periodontal disease, the abilities of bacteria to adhere to and degrade in vivo basement membranes should be considered as two of the rate‐limiting steps for the potential active or passive invasion of gingival connective tissues. To study these mechanisms in greater detail, we used the PF HR‐9 basement‐membrane‐like matrix to establish an in vitro model of bacterial invasion and degradation. Three gram‐negative anaerobic periodontopathic organisms, Bacteroides gingivalis, Fusobacterium nucleatum, and Actinobacillus actinomycetemcomitans, bound in considerably higher numbers to the HR‐9 matrix than did 6 strains of gram‐positive facultative organisms typically associated with periodontal health. In a further experiment with B. gingivalis, the organism rapidly degraded Type IV collagen, the major macromolecular component constituting the HR‐9 matrix. Streptococcus mitis, the nonperiodontopathic bacterium tested, did not degrade this model matrix. This study provides evidence that B. gingivalis, a periodontopathic bacterium, is able to adhere to and degrade basement membranes, whereas nonperiodontopathic organisms appear not to share in these abilities.
Intraoral Melanoacanthoma: A Reactive Melanocytic Hyperplasia
Authors: Wright John M.
Published: March 2012

Melanoacanthoma was originally described as a benign skin tumor of keratinocytes and dendritic melanocytes. There is now evidence that the intraoral lesions are unlike those occurring on skin. This article documents the reactive and reversible nature of the oral condition in a patient with these lesions.
Microvascularization of the Free Gingival Autograft
Authors: Nobuto Takahiro , Imai Hisao , Yamaoka Akira
Published: March 2012

Nobuto has previously reported on the initial anastomosis involved in establishing circulation between a free gingival autograft and the recipient bed. This study will present observations on the maturation of new sinusoidal vessels involved in maintaining circulation to the graft and the resulting histovascular organization. Using 56 mongrel dogs, the ongoing processes were observed periodically over 84 days after grafting. For this purpose, vascular corrosion casts were examined with the scanning electron microscope. At the same time, employing both light microscopy and transmission electron microscopy, histopathological and ultrastructural observation on the developing three‐dimensional vascular architecture were recorded with supporting photographs. Thus, the entire process from the development of a vascular plexus parallel to the bone surface on the seventh day to the transformation to a vertical dendritic vascular architecture firmly establishing the circulation to the graft by the 84th day, is provided in both descriptive and pictorial detail.
Fibrin and Fibronectin Sealing System in a Guided Tissue Regeneration Procedure
Authors: Pini Prato Giovan Paolo , Cortellini Pierpaolo , Clauser Carlo
Published: March 2012

A case is reported showing an iatrogenic, chronic abscess of six years' duration associated with a bony defect between the maxillary right central and lateral incisors. The osseous defect was treated by a guided tissue regeneration procedure with the use of a fibrin and fibronectin sealing system. The system was employed to fix the membranes and keep them apart from the root surface, thereby maintaining room for bone regeneration. This operation resulted in a 9‐mm clinical attachment gain and in an 11‐mm filling of the osseous defect. The second surgical stage after a three‐month reentry procedure was strictly for cosmetic improvement by means of a free gingival graft.
The Comparative Cytotoxicity of Periodontal Bacteria
Authors: Stevens R. H. , Hammond B. F.
Published: March 2012

The direct cytotoxicity of sonic extracts (SE) from nine periodontal bacteria for human gingival fibroblasts (HGF) was compared. Equivalent dosages (in terms of protein concentration) of SE were used to challenge HGF cultures. The cytotoxic potential of each SE was assessed by its ability to (1) inhibit HGF proliferation, as measured by direct cell counts; (2) inhibit 3H‐thymidine incorporation in HGF cultures; or (3) cause morphological alterations of the cells in challenged cultures. The highest concentration (500 μg SE protein/ ml) of any of the SEs used to challenge the cells was found to be markedly inhibitory to the HGFs by all three of the criteria of cytotoxicity. At the lowest dosage tested (50 μg SE protein/ml); only SE from Actinobacillus actinomycetemcomitans, Bacteroides gingivalis, and Fusobacterium nucleatum caused a significant effect (greater than 90% inhibition or overt morphological abnormalities) in the HGFs as determined by any of the criteria employed. SE from Capnocytophaga sputigena, Eikenella corrodens, or Wolinella recta also inhibited cell proliferation and thymidine incorporation at this dosage; however, the degree of inhibition (5–50%) was consistently, clearly less than that of the first group of three organisms named above. The SE of the three other organisms tested (Aclinomyces odontolyticus, Bacteroides intermedius, and Streptococcus sanguis) had little or no effect (0–10% inhibition) at this concentration. The data suggest that the outcome of the interaction between bacterial components and normal resident cells of the periodontium is, at least in part, a function of the bacterial species.
Collagen Linkage in Periodontal Connective Tissue Reattachment
Authors: Selvig Knut A. , Bogle Gary , Claffey Noel M.
Published: March 2012

Early stages of connective tissue reattachment to surgically denuded cementum and root dentin following citric acid application were studied in fenestration wounds. Block specimens were obtained after seven, 14, and 21 days. Continuity between newly deposited collagen fibrils in the granulation tissue and unmasked dental matrix collagen had been established within seven days by interdigitation of fibrils in an up to 0.5 μm‐wide zone at the cementum or dentin surface. Splicing of collagen at the fibrillar level by direct attachment to the severed end of matrix fibrils or by juxtapositioning of new and old fibrils was seen in rare instances only. At 14 and 21 days, distinct bundles of collagen fibrils inserted deeply into the orifice of dentinal tubules. Arrested and reversed surface resorption was encountered at all time points. At these sites as well, new collagen fibrils interdigitated with denuded matrix collagen, while some resorbed surfaces were characterized by absence of collagen continuity. The results lend continued support to the concept of reattachment based on interdigitation of collagen fibrils. However, since attachment is established even in the absence of this feature, a significant role for specific attachment substances not shown can also be postulated.
Severe Gingival Damage after Polysiloxane Impression Procedures
Authors: Shapiro Nathan
Published: March 2012

This is a report of a 38‐year‐old white female who developed severe gingival damage after impression for a full crown with vinyl polysiloxane material. Treatment of the lesion consisted of a gingival graft placed directly on bone. A one‐year follow‐up showed significant re‐establishment of a healthy gingival complex.
Evaluation of Four Modalities of Periodontal Therapy
Authors: Kaldahl Wayne B. , Kalkwarf Kenneth L. , Patil Kashinath D. , Dyer Jack K. , Bates Robert E.
Published: March 2012

Eighty‐two periodontally involved patients were treated in a split mouth design such that one quadrant received coronal scaling (CS), root planing (RP), modified Widman surgery (MW), and flap with osseous resection surgery (FO). The therapy was performed in three phases: Phase I: the teeth previously designated to receive RP, MW, and FO were thoroughly root planed and the teeth designated to receive CS were scaled with no subgingival instrumentation, plaque control was initiated and reinforced for the entire mouth; Phase II: the designated teeth received MW or FO surgery; and Phase III: maintenance therapy every three months. The CS teeth received coronal scaling and polishing during maintenance appointments, while RP, MW, and FO teeth received supragingival instrumentation, subgingival instrumentation and polishing. Clinical measurements were taken initially, four weeks post‐Phase I, 10 weeks post‐Phase II, and after each of two years of maintenance care. All therapy modalities resulted in a decrease of mean probing depth with the FO producing the greatest decrease followed by MW, RP, and CS. The deeper the initial probing depth, the greater was the mean reduction of probing depth. FO created a loss of mean probing attachment in the 1 to 4 mm category. RP and MW produced the greatest gain of mean probing attachment in the 5 to 6 mm category. RP, MW, and FO produced similar gains in the ≥7 mm category. FO created the most gingival recession followed by MW, RP, and CS.
CPITN Assessment of Periodontal Disease in Diabetic Patients
Authors: Bačić Miljenko , Plančak Darije , Granić Mate
Published: March 2012

The aim of this study was to investigate, using the CPITN system, the periodontal treatment needs in diabetic patients, and to shed additional light on the possible effects of the duration and control of diabetes on the periodontal status in these patients. A comparison was made between 222 diabetic patients (mean age, 46.9 years) and 189 control subjects (mean age, 43.9 years). Edentulous patients were not included in the study. The results indicated that diabetic patients demonstrated significantly more missing teeth (P < 0.001). The mean number of missing sextants was also significantly higher in diabetics. Pathologic pockets of 6 mm or more were found in 1.3 and 0.3 sextants in the diabetic and control group subjects, respectively (P < 0.001). Up to the age of 34, no differences were observed between the diabetic and control group subjects regarding pathologic pockets of 6 mm or more. Above this age, diabetics demonstrated significantly more sextants with deep pockets (P < 0.001). Concerning the type of diabetes, no differences related to CPITN score were found between insulin dependent and non‐insulin dependent diabetics. Neither were any differences found in the periodontal condition related to the duration and control of diabetes, whereas diabetics with advanced retinopathy demonstrated more sextants with deep pockets. Oral hygiene instructions and scaling were required in all patients from both study groups. On an average, 1.3 sextants in 50.9% of diabetics and 0.3 sextants in 17.9% of control subjects required complex treatment.
The Use of Collagen Membranes to Guide Regeneration of New Connective Tissue Attachment in Dogs
Authors: Blumenthal Neil M.
Published: March 2012

The aim of the present investigation was to evaluate the effectiveness of collagen membrane placement in excluding gingival epithelium and connective tissue cells and guiding new attachment in surgical treatment of created defects in dogs. Sixty defects were chosen at random and balanced in regard to receiving the following treatments: 1) untreated control, 2) debrided control, and 3) collagen membrane placement over the defect (along the root surface and under the replaced flap). Histologie and histometric evaluation at 2–12 weeks post‐operatively determined the healing responses of each treatment modality. Epithelium migration with no new attachment occurred in the untreated and debrided areas. Collagen membrane placement was effective in inhibiting epithelial migration and encouraging formation of new connective tissue attachment to root surface previously altered by plaque.
Pseudotumor Cerebri, A Rare Adverse Reaction to Tetracycline Therapy
Authors: Minutello J. S. , Dimayuga R. G. , Carter J.
Published: March 2012

With the more frequent use of antibiotics as adjuncts to periodontal therapy today, it is imperative that dental clinicians be aware of adverse reactions to these drugs, regardless of their reported incidence. It is the purpose of this case report to present and describe a rare adverse reaction to tetracycline hydrochloride called Pseudotumor cerebri or benign intracranial hypertension. It is manifested by an abnormal increase in intracranial pressure and papilledema in a patient with an otherwise normal neuroradiologic condition. Although severe headache appears to be the most bothersome acute symptom, the more important long‐term side effect is visual loss caused by the papilledema. Treatment should be directed towards discontinuation of the drug therapy, and immediate referral to a physician for a neuro‐ophthalmic evaluation.
Periodontal Surgery for a Patient with Paroxysmal Nocturnal Hemoglobinuria
Authors: Cohen Charles I. , Zimmerman Deena R.
Published: March 2012

Paroxysmal nocturnal hemoglobinuria (PNH) is an uncommon blood stem cell disorder. The acquired defect is in the cell membrane of the precursor of the affected clone, which renders erythrocytes, platelets and granulocytes unusually sensitive to the hemolytic effects of complement. It is characterized by chronic hemolysis, intermittent hemoglobinuria, thrombotic events and bone marrow hypoplasia. Hemolysis is precipitated by infection, strenuous exercise, surgery or menstruation. The dilemma of managing a PNH patient is that both the periodontal infection and the surgical treatment are precipitating factors. Management is further complicated by the fact that the patient is receiving corticosteroids. The treatment of the PNH patient is complex and potentially hazardous. It requires close cooperation between the periodontist and the hematologist. This paper describes the management of one such case.
Detection of Mycoplasma pneumoniae‐DNA within Diseased Gingiva by in Situ Hybridization Using a Biotin‐Labeled Probe
Authors: Saglie R. , Cheng L. , Sadighi R.
Published: March 2012

Isolation of Mycoplasma pneumoniae was accomplished in gingival biopsies of four patients exhibiting chronic inflammatory periodontal disease using in situ hybridization with biotin‐labeled DNA probes. The distribution of the M. pneumoniae organisms was mainly cytoplasmic and evenly spread around the nuclei of connective tissue cells. Controls of nondisease sites in the same patients showed no infection with M. pneumoniae. Since M. pneumoniae is the only Mycoplasma known to be pathogenic, their role in the pathogenesis of periodontal disease needs further study.
The Use of a Porous Hydroxylapatite Implant in Periodontal Defects
Authors: Kenney E. B. , Lekovic V. , Elbaz J. J. , Kovacvic K. , Carranza F. A. , Takei H. H.
Published: March 2012

Twenty‐three human subjects with two Class II furcation involvements in lower molars were treated with initial therapy following which presurgical measurements of pocket depth, gingival recession and attachment level were made. Periodontal flaps were used to expose the furcation defects, and one defect was implanted with porous hydroxylapatite while the other served as an unimplanted control. At the time of surgery, bone defects were measured obliquely and horizontally using a specially designed device to ensure reproducible probe angulation. Six months later the presurgical measurements were repeated, and reentry surgical procedures were carried out to measure the changes in the bone defects. Areas implanted with porous hydroxylapatite showed a statistically significant reduction in pocket depth and a statistically significant improvement in attachment level and fill of bone defects when compared with control defects. There was statistically less gingival recession in the implanted areas compared with the control sites. Control sites at six months showed no significant change in pocket depth, an increased loss of attachment and worsening of the bone defects.
The Relationship of Interradicular Width and Alveolar Bone Loss
Authors: Heins Paul J. , Thomas Ronald G. , Newton Janetta W.
Published: March 2012

Contrasting data exist on the relationship between interproximal width and loss of marginal bone in a Periodontitis susceptible population. Reports of clinical observations suggest that the prognosis of teeth with minimal interradicular width should be downgraded in periodontal patients. Others indicate a higher prevalence of intrabony lesions in wider interproximal spaces. Radiographs of 114 adult patients with evidence of bone loss consistent with Periodontitis were examined. Measurements of interradicular width and the location of the bone margin from the cementoenamel junction were made at 811 interproximal sites using an optical digitizer at 3x magnification. The relationship between bone loss and interradicular width was investigated.

The results indicate that as the interradicular width increases, the interproximal bone margin tends to be in a more apical location. No findings supported the contention that bone in a narrow interradicular space is at greater risk in patients who have had Periodontitis.
Automated Classification of Periodontal Disease Using Bitewing Radiographs
Authors: Hildebolt C. F. , Vannier M. W.
Published: March 2012

The feasibility of applying a prototype, computer‐based pattern recognition system to the objective classification of periodontal disease using dental radiographs was tested. Twenty‐nine observer‐classified bitewing radiographs, representing seven individuals with varying grades of periodontal disease, were selected. The radiographs were digitized using a computer‐controlled TV camera. Mathematical features of these radiographs were interactively extracted using a digital image processing system (International Imaging Systems Model 75 and System/575). The features extracted from these radiographs included the brightness levels of cortical and trabecular bone and ratios of bone‐loss to linear‐crown height. Twenty‐eight mathematically defined features (variables) were determined for each radiograph. Stepwise linear discriminant analysis used these features to classify subjects based on the presence and extent of periodontal disease. This pattern recognition system was able to grade periodontal disease in our test series with percentages of correct classifications ranging from 78.8% to 91%. This technology is particularly applicable to the development of morbidity and activity indices for periodontal diseases.
Initial Wound Healing Attachments to Demineralized Dentin
Authors: Hanes P. J. , Polson A. M. , Frederick G. T.
Published: March 2012

This report describes the initial in vivo wound healing response of connective tissue components and cells to demineralized and nondemineralized dentin surfaces. Rectangular dentin specimens were prepared from beneath root surfaces covered by periodontal ligament. One group of six specimens were treated with citric acid, while another six specimens served as untreated controls. Specimens were implanted vertically into the skin of rats such that one end of the implant protruded above the skin. After one day, the implants were removed, and the dentin surface‐connective tissue interface was examined using scanning electron microscopic methods. The surface of the nondemineralized dentin implants had the morphological characteristics of a surface smear layer. Cells that were present on these nondemineralized surfaces were rounded in shape with few processes or extensions to the dentin surface or to other cells. The surfaces of the demineralized dentin implants were fibrillar in appearance and were usually covered by a layer that had many globular and fibrillar structures attached. Cells that were present on these demineralized surfaces exhibited marked bipolarity with distinct attachments to the dentin surface. Cell processes often extended into the openings of demineralized dentin tubules. It was concluded that an established cellular and connective tissue response to demineralized dentin occurred within the first 24 hours of wound healing, and that this response differed markedly from that associated with nondemineralized dentin surfaces.
Quantitation of Phagocytic Cells in Phenytoin‐lnduced Connective Tissue Proliferation in the Rat
Authors: Dill R. E. , Davis W. L. , Zimmermann E. R.
Published: March 2012

This study demonstrates that, in rats, systemically administered Phenytoin produces a statistically significant increase in accumulation of phagocytic and esterase positive cells in areas of phenytoin‐induced connective tissue proliferation. Many of these cells are perceived to be macrophages. Since macrophages have been shown to produce chemoattractant and mitogens for fibroblasts, they may very well play a major role in the gingival hyperplasia seen in patients taking Phenytoin. The results of the study show that the effects of Phenytoin on fibroblasts may be more complex than previously thought.
Bacterial Invasion in Root Cementum and Radicular Dentin of Periodontally Diseased Teeth in Humans
Authors: Adriaens Patrick A. , De Boever Jan A. , Loesche Walter J.
Published: March 2012

In this study the viability and the distribution of bacteria within the radicular dentin and pulp of periodontally diseased caries‐free teeth were studied. Healthy teeth served as controls. Samples were obtained from the pulp tissue and from the radicular dentin. Dentin samples were taken from the interdental surfaces in the subgingival area. Starting from the pulpal side, three to five successive dentin layers of approximately 1 mm thickness were sampled. The samples were processed and cultured using an anaerobic technique. Bacterial growth was detected in 87% of the periodontally diseased teeth. In 83% of the teeth, bacteria were present in at least one of the dentin layers. Fifty‐nine percent of the diseased teeth, from which the pulp tissue was cultured, contained bacteria in the pulp samples. The mean bacterial concentrations in the pulp and dentin layers ranged from 1,399 to 16,537 colonyforming units (CFU) per mg of tissue. These concentrations were 259 to 7,190 times greater than concentrations found in healthy teeth. It is suggested that the roots of periodontally diseased teeth could act as bacterial reservoirs from which recolonization of mechanically treated root surfaces can occur, as well as infection of the dental pulp. These findings might change current concepts concerning root surface debridement in periodontal therapy.
Oral Manifestations of Agranulocytosis Associated with Methimazole Therapy
Authors: Hou Guey‐Lin , Tsai Chi‐Cheng
Published: March 2012

This paper reports a case of agranulocytosis that developed in a patient with hyperthyroidism two months after the administration of methimazole. The patient manifested symptoms of fever, sore throat, profound leukopenia, and oral complications such as generalized gingival necrosis and mucosa ulceration, which subsequently abated upon withdrawal of the drug. Dental practitioners should be aware of the potential of agranulocytosis associated with methimazole therapy. The oral manifestations should be kept in mind.
Nonspecific and Specific Immune Responses in a Child with Down's Syndrome and Her Sibling
Authors: Reuland‐Bosma Wimke , van den Barselaar Maria Th. , van de Gevel Joke S. , Leijh Peter C. J. , de Vries‐Huiges Harmke , The Hauw T.
Published: March 2012

In a child with Down's syndrome (DS) and her sibling, host immune responses were evaluated under experimental gingivitis conditions. The children live in the same environment under identical conditions. In the DS child an earlier and more extensive gingival inflammation than in her sibling had been observed. Investigation of nonspecific host defense mechanisms revealed identical results in both children for the phagocytosis and intracellular killing of Candida albicans by polymorphonuclear leukocytes in crevicular washings (CR–PMNs), in blood (PB–PMNs) and blood monocytes. Furthermore, CR‐ and PB–PMNs were able to secrete identical amounts of hydrogen peroxide upon stimulation. The chemotactic response of PB–PMNs in the DS child was impaired, however. The results of the studies performed on parameters of specific host defense mechanisms showed low blastogenic responses to phytohemagglutinin (PHA) and pokeweed (PWM) by lymphocytes of the DS child as compared with her sibling. Also a lack of immune regulation leading to prolonged helper/inducer cell activation on a local (gingival) and circulation level and a less pronounced T‐cell depression in PB were shown. Together, these differences observed in specific and nonspecific host response mechanisms may be responsible for the earlier and more extensive gingival inflammation found in the DS child.
Distributions of Periodontal Attachment Levels
Authors: Cohen Mark E. , Ralls Stephen A.
Published: March 2012

Distributions of periodontal attachment levels at probing sites within patients have traditionally been used in clinical diagnosis and treatment planning. Progression from mild to moderate to severe disease is generally associated with increasing magnitudes of attachment loss at greater percentages of sites.

Recent analyses of distributions of periodontal attachment levels have suggested three general patterns of loss defined by: (1) loss at less than about one third of all sites, (2) more widespread disease with multiple peaks and (3) normally distributed loss with virtually all sites being affected. In attempting to simulate these three patterns using a model based on the burst theory of periodontal attachment loss, divergent assumptions about burst magnitude, frequency, and possible local immunity were required. These findings were used to support the hypothesis that distinctly different disease processes are associated with the different patterns of attachment level.

In the present investigation an alternative model was developed which was theoretically consistent with the view that the three patterns reflect arbitrary stages in a continuous disease “aging” process. Simple assumptions concerning attachment loss probabilities and rates enabled the generation of attachment level distributions that matched all three patterns previously attributed to separate disease processes, depending only upon the duration of the process.
Intragingival Occurrence of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis in Active Destructive Periodontal Lesions
Authors: Saglie F. R. , Marfany A. , Camargo P.
Published: March 2012

A total of six active and six nonactive sites from six untreated Periodontitis patients were examined for intragingival presence of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis. The active destructive periodontal disease was determined by the “tolerance method.” The method of immunoperoxidase was used in the identification of intragingival microorganisms in active and nonactive periodontal sites. Light microscopic sections of gingival tissues consecutive to those with gram stain, revealing presence of bacteria (substantiated by electron microscopy), were stained with peroxidase‐labeled antibodies against A. actinomycetemcomitans and B. gingivalis. B. gingivalis was found to be significantly elevated in the connective tissue of active sites when compared to nonactive sites. A statistically significant border‐line difference was found between active and nonactive sites in the connective tissue invaded by A. actinomycetemcomitans. Our findings plus the 1 well established periodontopathic potential of A. actinomycetemcomitans and B. gingivalis support the concept that these bacteria are important invasive pathogenic agents in Periodontitis.
Clinical and Microbiologic Effects of Local Tetracycline Irrigation on Periodontitis
Authors: Silverstein Lee , Bissada Nabil , Manouchehr‐Pour M. , Greenwell Henry
Published: March 2012

This investigation was conducted on seven individuals referred for treatment of moderate adult periodontitis. Twenty‐eight sites with an average probing depth of 5.6 ± 0.9 mm were evaluated. One tooth per jaw quadrant was randomly assigned to receive one of the following treatments: (I) no treatment, i.e., control; (II) saline irrigation; (III) tetracycline irrigation and (IV) scaling and root planing (SC/RP).

A plaque control program was instituted one week prior to the experimental period and reinforced throughout the eight‐week study. Irrigation was performed every 48 hours during the first two weeks of the experiment for Groups II and III, and the single treatment of SC/RP was carried out immediately following the baseline examination for Group IV. Clinical and microbiologic changes were monitored every two weeks using plaque and gingival indices, gingival fluid flow, probing depths, bleeding on probing and dark‐field microscopic examination of the subgingival microbial flora.

The tetracycline and SC/RP treatment modalities resulted in statistically significant clinical and microbiological improvements when compared with the control. Tetracycline irrigation alone and SC/RP alone had a similar effect in changing the subgingival microflora from one associated with disease to one associated with health. Thus, these treatment modalities are effective methods of producing statistically significant alterations in the subgingival microflora. The property of substantivity may contribute to the sustained duration of the effect of locally delivered tetracycline.
Who Uses the Services of Periodontists?
Authors: Waldman H. Barry
Published: March 2012

A review is provided of data from the 1983 National Health Interview Survey on the use of the services of periodontists.
Specialized Postcapillary Venules in Human Gingival Tissue
Authors: Wynne Susan E. , Walsh Laurence J. , Seymour Gregory J.
Published: March 2012

High endothelial venules (HEV) are specialized postcapillary venules that play a central role in lymphocyte migration and recirculation. This study examined the occurrence and morphology of HEV‐like vessels in healthy gingiva and in lesions of chronic gingivitis in children, experimental gingivitis in adults, adult periodontitis, and in periapical granulomas. HEV‐like vessels were absent in gingival health, but present during the development of inflammation and in chronic inflammation. The morphology of these HEV‐like vessels in the oral cavity resembled that of lymphoid HEV. Thus gingival HEV may represent sites for the entry of lymphocytes into chronic inflammatory lesions.