bluuebunny/crossref_metadata_2025 huggingface dataset:
Locally Produced Anti‐Phosphorylcholine and Anti‐Oxidized Low‐Density Lipoprotein Antibodies in Gingival Crevicular Fluid from Aggressive Periodontitis Patients
Authors: Schenkein Harvey A. , Berry C. Rennie , Burmeister John A. , Brooks Carol N. , Best Al M. , Tew John G.
Published: February 2005

Background: Sera from patients with periodontal attachment loss contain higher concentrations of IgG anti‐phosphorylcholine (anti‐PC) than sera from healthy subjects. Furthermore, a large proportion of plaque bacteria bear PC‐containing surface antigens, implicating the oral flora as a source of immunogen for anti‐PC. Additionally, anti‐PC is cross‐reactive with a variety of oral bacterial antigens and human antigens such as oxidized low‐density lipoprotein (oxLDL). We hypothesized that, if the oral flora is a source of PC antigens, then we should be able to detect local anti‐ PC and anti‐oxLDL production in gingival crevicular fluid (GCF).

Methods: To test this, we collected 66 GCF samples from 15 patients with aggressive periodontitis and examined both the GCF samples and serum samples for their content of IgG anti‐PC, IgG anti‐LDL, and IgG anti‐oxLDL by enzyme‐linked immunosorbent assay. We also determined levels of anti‐tetanus toxoid (anti‐TT) as a non‐oral antigen control. Serum and GCF concentrations of serum albumin (HSA) were also determined for use as a dilution marker. A conservative GCF:serum antibody ratio of greater than 1.5 was considered to be evidence of local antibody production.

Results: For the non‐oral antigen TT, only one out of 62 samples contained locally produced antibody. Eight out of 64 samples (7 from a single subject) demonstrated local production of anti‐LDL. In contrast, 28 out of 66 samples demonstrated local production of anti‐PC, and 47 out of 66 samples contained locally produced anti‐oxLDL. It was observed thatA. actinomycetemcomitans strains containing or devoid of PC could absorb antioxLDL from human sera. Although there was a correlation between the ratios of anti‐PC and anti‐oxLDL (Spearman's rho = 0.35, P = 0.0037), local production of both antibodies was found in only 17 out of 65 samples, indicating that these antibodies are not always reflective of reactivity to the same antigens.

Conclusion: The local production of anti‐PC and anti‐oxLDL further implicates the oral flora as a source of antigen that may mediate immune reactions of relevance to cardiovascular and other systemic diseases. J Periodontol 2004;75:146‐153.
Analysis of the Interleukin‐6 Gene Promoter Polymorphisms in Czech Patients with Chronic Periodontitis
Authors: Holla Lydie Izakovicova , Fassmann Antonin , Stejskalová Andrea , Znojil Vladimír , Vaněk Jiri , Vacha Jiri
Published: February 2005

Background: Chronic periodontitis is an inflammatory disease, which is a major cause of tooth loss. The proinflammatory cytokines interleukin‐1 (IL‐1) and interleukin‐6 (IL‐6) are key regulators of the host response to microbial infection and major modulators of extracellular matrix catabolism and bone resorption. The purpose of this study was to investigate the associations of chronic periodontitis with IL‐6 gene polymorphisms (at positions –597 [G/A], –572 [G/C], and –174 [G/C]).

Methods: We analyzed allele, genotype, and haplotype distributions of the IL‐6 promoter variants in a case‐control study involving 148 patients with chronic periodontitis and 107 unrelated controls.

Results: Our results showed significant differences in the distributions of alleles and genotypes of the IL‐6 (–572 G/C) polymorphism between patients and the control population (X2 = 10.393, P = 0.001, Pcorr <0.01). The difference was due to the underrepresentation of the –572 G/C heterozygotes in patients (6.1%) compared to controls (19.6%). Although no variant “CC” homozygotes were detected in our cases and controls, heterozygosity protected against chronic periodontitis, representing a 73% reduction of risk (odds ratio [OR] = 0.27, 95% con‐ fidence interval: 0.12‐0.61) compared to wild‐type homozygotes. However, there were no significant differences in genotype or allele frequencies between both groups for IL‐6 –597 G/A and –174 G/C polymorphisms.

Conclusion: This study is the first, to our knowledge, suggesting that the –572 G/C polymorphism of the IL‐6 gene may be one of the protective factors associated with lower susceptibility to chronic periodontitis. J Periodontol 2004;75:30‐36.
The Clinical Effect of Acellular Dermal Matrix on Gingival Thickness and Root Coverage Compared to Coronally Positioned Flap Alone
Authors: Woodyard James G. , Greenwell Henry , Hill Margaret , Drisko Connie , Iasella John M. , Scheetz James
Published: February 2005

Background: The primary aim of this randomized, controlled, blinded, clinical investigation was to compare the coronally positioned flap (CPF) plus an acellular dermal matrix (ADM) allograft to CPF alone to determine their effect on gingival thickness and percent root coverage.

Methods: Twenty‐four subjects with one Miller Class I or II buccal recession defect of ≥3 mm were treated with a CPF plus ADM or a CPF alone. Multiple additional recession sites were treated with the same flap procedure, and all sites were studied for 6 months. Tissue thickness was measured at the sulcus base and at the mucogingival junction of all teeth, with an SDM ultrasonic gingival thickness meter.

Results: For the ADM sites, mean initial recession of 3.46 mm was reduced to 0.04 mm for defect coverage of 3.42 mm or 99% ( P <0.05). For the CPF group, mean initial recession of 3.27 mm was reduced to 1.08 mm for defect coverage of 2.19 mm or 67% (P <0.05). The difference between ADM and CPF groups was statistically significant (P <0.05). Marginal soft‐tissue thickness was increased by 0.40 mm (P <0.05) for the ADM group, whereas the CPF group remained essentially unchanged. Keratinized tissue was increased for the ADM group by 0.81 mm (P <0.05), whereas the CPF group increased by 0.33 mm (P >0.05). No additional root coverage was gained due to creeping attachment between 2 and 6 months for either group.

Conclusions: Treatment with a CPF plus an ADM allograft significantly increased gingival thickness when compared with a CPF alone. Recession defect coverage was significantly improved with the use of ADM. J Periodontol 2004;75:44‐56.
Efficacy of a Fluoridated Hydrogen Peroxide‐Based Mouthrinse for the Treatment of Gingivitis: A Randomized Clinical Trial
Authors: Hasturk Hatice , Nunn Martha , Warbington Martha , Van Dyke Thomas E.
Published: February 2005

Background: A randomized clinical trial was performed to test the efficacy of a fluoridated hydrogen peroxide–based mouthrinse on gingivitis and tooth whitening in a two‐phase study. The first phase (28 days) included the experimental gingivitis phase; the second phase (5 months) was the oral hygiene phase, which included rinsing.

Methods: A total of 99 subjects were included in the study and were randomly assigned to receive either placebo or test mouthrinse. Clinical measures were chosen to reflect the gingival health and tooth whiteness in an intent‐to‐treat study design. Statistical analyses of clinical parameters related to gingival health and tooth color were conducted, using the method of generalized estimating equations (GEE), with an exchangeable working correlation to accommodate tooth‐level data. Baseline differences between the groups were adjusted. Microbial samples taken at the beginning and at the end of the study were analyzed by DNA‐DNA hybridization technique, to determine whether there was any adverse shift in supragingival flora.

Results: Eastman bleeding index, modified gingival index, intensity of stain, and extent of stain were significantly reduced in the test group at 6 months compared to baseline (P <0.05). In contrast, only the Eastman bleeding index was significantly reduced in the control group (P <0.05). The reduction in the index of gingival inflammation for the test group was significantly greater than for the control group (P = 0.004). Subjects using the test rinse were also six times more likely to exhibit an improvement in tooth color after 6 months than were subjects using placebo (P = 0.002). As a result of the clinical evaluations and microbial analysis, test mouthrinse was found to be safe during a 6‐month period.

Conclusion: The results of this study indicate that the fluoridated hydrogen peroxide–based mouthrinse effectively whitens teeth and significantly reduces gingivitis. J Periodontol 2004;75:57‐65.
Periodontal Repair in Surgically Created Intrabony Defects in Dogs: Influence of the Number of Bone Walls on Healing Response
Authors: Kim Chang‐Sung , Choi Seong‐Ho , Chai Jung‐Kiu , Cho Kyoo‐Sung , Moon Ik‐Sang , Wikesjö Ulf M.E. , Kim Chong‐Kwan
Published: February 2005

Background: The objective of this study was to histologically evaluate periodontal healing following flap surgery in intrabony periodontal defects to determine the influence of the number of bone walls on periodontal regeneration.

Methods: One‐, 2‐, and 3‐wall intrabony periodontal defects were surgically produced at the proximal aspect of mandibular premolars in either right or left jaw quadrants in six beagle dogs. Mucoperiosteal flaps were positioned and sutured to their presurgery position following defect preparation. The animals were euthanized at 8 weeks post‐surgery, and block sections of the defect sites were collected for histologic and histometric analysis.

Results: Bone and cementum regeneration was positively correlated to the number of bone walls limiting the intrabony periodontal defects. The junctional epithelium averaged (± SD) 1.5 ± 0.2, 1.2 ± 0.3, and 0.9 ± 0.2 mm for the 1‐, 2‐, and 3‐wall defects, respectively, with the 3‐wall defects being significantly different from the 1‐wall defects (P <0.05). Cementum regeneration averaged 1.2 ± 0.6, 2.0 ± 0.6, and 2.8 ± 0.5 mm for the 1‐, 2‐, and 3‐wall defects, respectively; all groups were significantly different from each other (P <0.05). Bone regeneration averaged 1.5 ± 0.5, 1.7 ± 0.6, and 2.3 ± 0.5 mm for the 1‐, 2‐, and 3‐wall defects, respectively, with the 3‐wall defects being significantly different from the 1‐wall defects (P <0.05).

Conclusions: The results suggest that the number of bone walls is a critical factor determining treatment outcomes in intrabony periodontal defects. One‐ and 3‐wall intrabony defects appear to be reproducible models to evaluate candidate technologies for periodontal regeneration. J Periodontol 2004:75:229‐235.
Regulation of Rat Bone Sialoprotein Gene Transcription by Enamel Matrix Derivative
Authors: Shimizu Emi , Nakajima Yu , Kato Naoko , Nakayama Youhei , Saito Ryoichiro , Samoto Hiroshi , Ogata Yorimasa
Published: February 2005

Background: Enamel matrix derivative (EMD) has recently been developed for use as a periodontal regenerative treatment. While EMD is believed to induce regeneration of periodontal tissue, the precise mechanism is not known. Bone sialoprotein (BSP), an early phenotypic marker of osteoblast differentiation, has been implicated in the nucleation of hydroxyapatite during bone formation. In this study, we examined the ability of EMD to regulate BSP gene transcription in osteoblast‐like cells.

Methods: To determine the molecular basis of the transcriptional regulation of BSP gene transcription by EMD, we conducted Northern hybridization, transient transfection analyses with chimeric constructs of the rat BSP gene promoter linked to a luciferase reporter gene, and gel mobility shift assays.

Results: Using the osteoblastic cell line ROS 17/2.8, we determined that BSP mRNA levels increased ~2.8‐fold by EMD. In transient transfection analyses, EMD (50 μg/ml, 12 hours) increased luciferase activities of pLUC4 (nt −425 to +60) and pLUC5 (nt −801 to +60), transfected into ROS 17/2.8 cells. Within the pLUC4 and 5, a homeodomain binding element (HOX) and a transforming growth factor (TGF)‐β activation element (TAE) are present. Gel mobility shift assays with radiolabeled HOX and TAE ds‐oligonucleotides revealed increased binding of nuclear proteins from EMD stimulated ROS 17/2.8 cells.

Conclusion: These studies have, therefore, identified EMD response elements in the rat BSP gene promoter that may mediates the effects of EMD on BSP gene transcription. J Periodontol 2004;75:260‐267.
Different Titanium Surface Treatment Influences Human Mandibular Osteoblast Response
Authors: Guizzardi Stefano , Galli Carlo , Martini Desiree , Belletti Silvana , Tinti Anna , Raspanti Mario , Taddei Paola , Ruggeri Alessandro , Scandroglio Renato
Published: February 2005

Background: Six titanium disks with six different surface treatments were examined: SS: smooth (polished) surface; TPS: plasma spray; C100: sand blasting by aluminum oxide (Al2O3) Ø 100 µm and acid etching; C150: sand blasting by Al2O3 Ø 150 µm and acid etching; B60: sand blasting by zirconium oxide (ZrO2) Ø 60 µm and acid etching; and B120: sand blasting by ZrO2 Ø 120 µm and acid etching.

Methods: The surface characteristics were determined by scanning electron microscopy (SEM) observation and a roughness tester. Raman spectroscopy was used to determine the presence of residual substances on the samples. Cells were seeded onto the disk and after 24 hours, 6 days, and 12 days were observed under SEM and growth curves generated with a cell counter. Some samples were used to determine alkaline phosphatase activity (ALP), using a colorimetric assay.

Results: SEM observation revealed drastic differences in surface microtopography, with a higher cell density on sand‐blasted and acid‐etched (SLA) samples than SS and TPS, and more regularly aligned cells on B60 and B120 surfaces than on the others. The growth curves showed a greater adhesion of cells on the etched/blasted surfaces compared to the SS and TPS surfaces. The number of cells increased on all the SLA samples, especially B60, throughout the experiment. At the same time, there was considerable ALP activity on the B60 sample, while it remained at extremely low levels on SS and TPS surfaces. Raman analyses revealed Al2O3 debris on C100 and C150, partly explaining the poorer performances of these two surface treatments, since this substance was shown to be toxic for cultured osteoblasts.

Conclusions: Surface treatments influence the growth and the metabolic activity of cultured osteoblasts, and B60 seems to be the most favorable surface inducing a more pronounced proliferation of cells together with a high differentiation degree. J Periodontol 2004;75:273‐282.
Interleukin‐4 Suppresses IL‐17–Induced Expression of Matrix Metalloproteinase‐3 in Human Gingival Fibroblasts
Authors: Jenkins Kosunique , Javadi Masoud , Borghaei Ruth Carter
Published: February 2005

Background: In periodontitis, matrix metalloproteinase‐3 (MMP‐3, stromelysin 1) is present at increased levels in active disease sites compared to inactive or healthy sites, and the levels are correlated with clinical parameters and associated with progression of the disease. Interleukin (IL)‐4 has been shown in human skin and synovial fibroblasts and articular chondrocytes to suppress IL‐1–induced expression of MMP‐3, but this has not been shown in human gingival fibroblasts. The objective of this study is to determine the effects of IL‐4 on the IL‐1–induced expression of MMP‐3 in human gingival fibroblasts isolated from patients with periodontitis.

Methods: Northern blot analysis was performed to determine the effects of IL‐4 on the IL‐1 induction of MMP‐3 mRNA. MMP‐3 protein levels were determined by enzyme‐linked immunosorbent assay (ELISA), and prostaglandin E2 (PGE2) levels were measured by enzyme immunoassay (EIA). DNA binding of activator protein (AP)‐1 and nuclear factor (NF)‐κB was assessed by electrophoretic mobility shift assay (EMSA).

Results: Northern blot analysis revealed that co‐incubation of gingival fibroblasts with IL‐1 and IL‐4 resulted in a significant decrease in MMP‐3 mRNA levels compared to IL‐1 alone, with a concomitant decrease in protein levels. This inhibition is dosedependent, and is apparent as early as 3 hours after stimulation. IL‐1‐induced production of PGE2 was not affected in four of six cultures isolated from different individuals. Addition of exogenous PGE2 had no effect on the suppressive effects of IL‐ 4. DNA binding of transcription factors AP‐1 and NF‐κB was not affected by IL‐4.

Conclusions: IL‐4 inhibits the IL‐1 induction of MMP‐3 in human gingival fibroblasts isolated from patients with periodontitis. This effect is independent of PGE2 and is not due to inhibition of the DNA binding activity of known transcription factors binding to the MMP‐3 promoter. J Periodontol 2004;75:283‐291.
Effect of Restraint Stress on the Progression of Experimental Periodontitis in Rats
Authors: Takada Tetsuo , Yoshinari Nobuo , Sugiishi Shin , Kawase Hitoshi , Yamane Takashi , Noguchi Toshihide
Published: February 2005

Background: A hypothesis of an increased risk for destructive periodontal diseases due to psychological stress has long been promoted. However, the research on stress and periodontal disease is still in its infancy. One of the reasons is thought to be that there is no suitable animal model for investigating the relationship.

Methods: One hundred male Wistar rats were included. A nylon ligature was placed around the second right maxillary molars. The animals were then divided into group S, exposed to a restraint stress for 12 hours/day for up to 10 days, and group N, controls. Ten animals were sacrificed on days 2, 4, 6, 8, and 10. Blood samples were taken, and the blood glucose level and the concentrations of adrenocorticotropic hormone, corticosterone, and adrenaline were measured as the markers of stress. The atrophies of the thymus and the spleen were measured. The furcation area of the second maxillary molars was examined histologically and histometrically.

Results: In group S, all values of stress markers were increased, and the thymus and the spleen were atrophied. Whereas group N showed only slight alveolar bone resorption, a marked alveolar bone resorption occurred in group S between days 8 and 10. An increase in beaded nerve terminals occurred around the vessels in the furcation area of group S.

Conclusion: The results of the present study suggest that the restraint stress modulates the progression of periodontal inflammation and that this rat model is suitable for investigating the association between stress and periodontal disease. J Periodontol 2004;75:306‐315.
Clinical Significance of the Structural Integrity of the Superior Aspect of the Mandibular Canal
Authors: Reiser Gary M. , Manwaring Jeremy D. , Damoulis Petros D.
Published: February 2005

Background: Sparse data can be found regarding the structural integrity of the superior aspect of the mandibular canal. In many cases, the mandibular canal must be carefully evaluated prior to defining patient treatment.

Methods: In this case report, a 54‐year‐old patient presented with a periapical infection involving the mesial root of the mandibular right second molar (#31). Radiographic evaluation revealed that the periapical lesion extended from the apex of the tooth to the superior aspect of the mandibular canal. Upon surgical removal of the tooth, an apical communication between the extraction socket and mandibular nerve was located. A guided bone regeneration procedure was performed to protect the nerve from subsequent damage and to prepare the site for future implant placement. Implants were placed in the area approximately 5 months following the regenerative procedure.

Results: After implant placement, the patient experienced normal function and no mandibular symptomatology. Implants have been in function for the past 4 years.

Conclusions: Many factors, both pathologic and developmental, can lead to a discontinuity of the superior aspect of the mandibular canal. Normally, a thin cortical plate of bone protects the nerve. When a lack of structural integrity of the canal roof is discovered, enucleation of a periapical infection or subsequent implant placement can lead to potential disruption of the nerve. Limited information is available regarding the integrity of this protective cover. This case report underscores the importance of proper clinical diagnosis before implant placement in the posterior mandible. J Periodontol 2004;75:322‐326.
Human Gingival Epithelial Cells Produce Chemotactic Factors Interleukin‐8 and Monocyte Chemoattractant Protein‐1 After Stimulation With Porphyromonas gingivalis via Toll‐Like Receptor 2
Authors: Kusumoto Yutaka , Hirano Hiroyuki , Saitoh Keiko , Yamada Satoru , Takedachi Masahide , Nozaki Takenori , Ozawa Yasuhiro , Nakahira You , Saho Teruyuki , Ogo Hideji , Shimabukuro Yoshio , Okada Hiroshi , Murakami Shinya
Published: February 2005

Background: The mechanism of stimulation of human gingival epithelial cells (HGEC) by Porphyromonas gingivalis (Pg) has not been fully clarified yet. In order to investigate the possible activation of HGEC by Pg through Toll‐like receptors (TLRs), we analyzed the production of chemotactic factors and the activated nuclear factor‐kappa B (NF‐κB).

Methods: The mRNA expression of TLRs and the protein expression of TLR2 and TLR4 in HGEC and gingival tissue were assessed using reverse transcription‐polymerase chain reaction (RT‐PCR) assay and immunohistochemical staining. Primary cultured HGEC (nHGEC) and HGEC transformed by simian virus 40 T antigen (OBA‐9) were activated by a sonic extract (SE) of Pg to examine cytokine production and NF‐κB activation using enzyme‐linked immunosorbant assay (ELISA). In addition, Pg mediated activation of NF‐κB in a TLR2‐transfectant was also investigated.

Results: RT‐PCR results revealed that HGEC expressed mRNA of TLR2, TLR4, TLR5, and TLR9, although the expression pro‐ files of each cell line were slightly different. In addition, immunostaining revealed the prominent expression of TLR2 not only in nHGEC, but also in the gingival epithelium of the tissue specimen. Interestingly, nHGEC and OBA‐9 secreted IL‐8 and monocyte chemoattractant protein (MCP)‐1 upon stimulation with Pg SE more efficiently than LPS and fimbriae of Pg. Furthermore, Pg SE increased the activated NF‐κB not only in OBA‐9, but also in 293T cells transfected with the human TLR2 gene.

Conclusion: TLR2 participates, at least partly, in the signaling pathway to induce chemokine production in gingival epithelium as a reaction against Pg component(s), probably other than lipopolysaccharide and fimbriae. J Periodontol 2004;75:370‐379.
The Effect of Menstrual Cycle on Periodontal Health
Authors: Machtei Eli E. , Mahler Dan , Sanduri Hana , Peled Micha
Published: February 2005

Background: Fluctuation in estrogen/progesterone levels has been shown to affect the periodontium. The effects of pregnancy, prepuberty, and oral contraceptives on gingival health has been studied extensively, with gingival scores reported to be higher, in most instances, than in controls. Fluctuation in steroid sex hormone is also noticeable through women's menstrual cycle. Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, most commonly around the menses period. However, this well‐known phenomenon has never been studied. The purpose of this longitudinal, prospective study was to compare the periodontal status of premenopausal women at different times during their menstrual cycle.

Methods: Eighteen premenopausal women, enrolled in our maintenance program, were recruited. Clinical examination was performed before the recall visit at three different time points in their menstrual cycle: ovulation (OV), premenstruation (PM), and menstruation (M). Plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) were examined around the Ramfjord index teeth. Analysis of variance, with Scheffe modification, was used to determine differences between the menstrual time points.

Results: Several women in this study reported appreciable oral symptoms just before or during menses. Mean PI (0.85 ± 0.06) was almost identical at all time points. Despite this, GI was significantly higher (P = 0.0245) in OV (0.54 ± 0.07) and in PM (0.5 ± 0.08) than in M (0.38 ± 0.07). Mean patient's PD (2.22 ± 0.08 mm) and CAL (2.92 ± 0.15 mm) was not significantly different between examinations.

Conclusions: We observed changes in gingival scores during the menstrual cycles of periodontally healthy women. These changes need to be addressed when analyzing data from epidemiological and treatment studies in premenopausal women. J Periodontol 2004;75:408‐412.
The Short‐Term Effects of Treatment of Chronic Periodontitis on Circulating Levels of Endotoxin, C‐Reactive Protein, Tumor Necrosis Factor‐α, and Interleukin‐6
Authors: Ide Mark , Jagdev Daljit , Coward Paula Y. , Crook Martin , Barclay G. Robin , Wilson Ron F.
Published: February 2005

Background: The acute‐phase response involves molecules including tumor necrosis factor‐alpha (TNF‐α), interleukin‐6 (IL‐6), and C‐reactive protein (CRP). This study aimed to determine whether subgingival scaling resulted in rapid changes in plasma concentrations of these molecules.

Methods: Twenty‐three non‐smoking adults with chronic periodontitis received subgingival scaling for 60 minutes. Venous blood samples were taken at 0, 15, 30, 60, and 120 minutes. TNF‐ α and IL‐6 were assayed from all samples and CRP from the baseline and final samples. Lipopolysaccharide (LPS) was assayed at 0, 15, and 30 minutes using limulus lysate assay (LAL) and EndoCAb Ig assays.

Results: LPS assays were suggestive of a transient low‐grade bacteremia, but changes in LPS approaching significance (P = 0.061) were seen with LAL only. There was a significant increase in circulating TNF‐α (P = 0.0387) and IL‐6 (P <0.0001), and the degree of change in TNF‐α was correlated with the severity of periodontal breakdown (P = 0.001). There was also a significant correlation between levels of IL‐6 and TNF‐α (P <0.001).

Conclusions: Chronic periodontitis patients undergoing an episode of subgingival scaling show a significant elevation in circulating TNF‐α and IL‐6. This may account for anecdotal reports of pyrexia following treatment and may be significant in terms of the relationship between periodontal disease, bacteremia, and cardiovascular disease. J Periodontol 2004;75:420‐428.
Locally Delivered Doxycycline as an Adjunctive Therapy to Scaling and Root Planing in the Treatment of Smokers: A Clinical Study
Authors: Machion Luciana , Andia Denise Carleto , Benatti Bruno Braga , Carvalho Marcelo Diniz , Nogueira‐Filho Getúlio R. , Casati Márcio Zafallon , Nociti Francisco H. , Sallum Enilson Antonio
Published: February 2005

Background: The aim of this clinical study was to evaluate the association of locally delivered doxycycline (10%) with scaling and root planing in the periodontal treatment of smokers.

Methods: Forty‐three patients with chronic periodontitis and a minimum of four pockets (≥5 mm) on anterior teeth that bled on probing were selected. Patients were randomly assigned to scaling and root planing (SRP) or scaling and root planing followed by local application of doxycycline (SRP‐D). Plaque, bleeding on probing, gingival recession, relative attachment level RAL), and probing depth (PD) were recorded at baseline, 45 days, and 3 and 6 months. Differences between baseline and each period were considered for analysis.

Results: At 6 months, no difference was found between groups regarding plaque, bleeding reduction, gingival recession or PD (P >0.05). However, RAL gain was greater for SRP‐D (1.63 ± 0.93 mm) than for SRP (1.04 ± 0.71 mm) (P = 0.025). In addition, deep pockets (≥7 mm) showed a significant reduction (3.78 ± 1.41 versus 2.60 ± 1.28 mm, P = 0.039) and RAL gain (2.54 ± 1.27 mm versus 1.29 ± 0.95 mm, P = 0.01) when doxycycline was applied. The proportion of sites showing RAL gain of 1 to 2 mm was 36.8% versus 21.7% for SRP‐D and SRP, respectively (P = 0.01).

Conclusion: The use of locally delivered doxycycline may constitute an important adjunct for the treatment of severe periodontal disease in smokers. J Periodontol 2004;75:464‐469.
The Influence of Enamel Matrix Derivative Associated With Insulin‐Like Growth Factor‐I on Periodontal Ligament Fibroblasts
Authors: Palioto Daniela B. , Coletta Ricardo D. , Graner Edgard , Joly Julio Cesar , de Lima Antonio Fernando Martorelli
Published: February 2005

Background: Enamel matrix derivative (EMD) has recently been shown to promote periodontal regeneration in vivo. Insulin‐like growth factor‐I (IGF‐I) is a potent modulator of periodontal regeneration stimulating cell proliferation, differentiation, synthesis of type I collagen, and non‐collagenous proteins. However, the biochemical effects of these factors on periodontal ligament (PDL) fibroblasts are not completely understood. The objective of the present study was to evaluate the effect of EMD, IGF‐I, and the combination of these two factors on the proliferation, adhesion, migration, and expression of type I collagen in PDL fibroblasts.

Methods: The proliferation rate was measured by automated cell counting and immunohistochemical expression of proliferating cell nuclear antigen (PCNA). The cell adhesion was analyzed by a colorimetric assay and cell migration was measured in Boyden chambers. Type I collagen expression and production was determined by semi‐quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR) and enzyme‐linked immunosorbent assay (ELISA), respectively.

Results: The results indicated that the proliferation of PDL fibroblasts was significantly stimulated by EMD and EMD plus IGF‐I in a dose‐ and time‐dependent manner. EMD, IGF‐I, and the combination of both factors had no effects on cellular migration and adhesion or expression and production of type I collagen.

Conclusion: Our results showed that EMD, IGF‐I, and the combination of both factors stimulated PDL fibroblast proliferation, whereas these factors did not affect adhesion, migration, or expression of type I collagen of these cells. J Periodontol 2004;75:498‐504.
The Prevalence of Surgical Complications of the Sinus Graft Procedure and Their Impact on Implant Survival
Authors: Schwartz‐Arad Devorah , Herzberg Ran , Dolev Eran
Published: February 2005

Background: Grafting of the maxillary sinus floor has been performed successfully over the last decade. The ultimate goal of this procedure is to allow surviving implants to support a functional prosthesis. Surgical complications of the procedure are rarely reported and their impact on implant survival has been investigated even to a lesser extent. The purpose of this study was to evaluate the prevalence of surgical complications of the sinus graft procedure and their impact on implant survival.

Methods: The study consisted of 70 patients who underwent 81 sinus graft procedures using the lateral wall approach from 1995 to 2000. A total of 212 screw‐shaped implants were placed in the grafted sinuses and were restored by fixed prosthesis. Mean follow‐up period for the implants was 43.6 months. Intra‐ and postoperative complications were thoroughly documented regarding clinical signs, times of occurrence, and treatment regimens.

Results: Perforation of the Schneiderian membrane was the major intraoperative complication, observed in 36 of the 81 sinuses 44%). Of the 70 patients, seven (10%) suffered from postoperative complications, specifically related to the sinus graft procedure, which included an uncommon cyst formation and an infection. Membrane perforations were strongly associated with the appearance of postoperative complications (specific and nonspecific to the procedure) (P <0.001). However, no association was found between membrane perforations or postoperative complications and implant survival.

Conclusions: Intraoperative complications may lead to postoperative complications. Surgical complications did not signifi‐ cantly influence implant survival. J Periodontol 2004;75:511‐516.
Specific Pro‐Apoptotic Fibronectin Fragments Modulate Proteinase Expression in Periodontal Ligament Cells
Authors: Jee Sang‐Wook , Wang Shaohui , Kapila Yvonne L.
Published: February 2005

Background: During inflammation and periodontal disease, the extracellular matrix protein fibronectin (FN) is degraded into fragments whose activities differ from those of the intact molecule. In periodontal ligament cells in vitro, some fragments elevate the expression of matrix metalloproteinases and serine proteinases, while others induce apoptosis through a mechanism regulated by caspase proteases and specific signaling pathways. In this study, we investigated whether the pro‐apoptotic V+H– fibronectin fragment modulates proteinase expression as part of the apoptotic mechanism in periodontal ligament cells. The importance of this study is that a structurally similar fibronectin fragment found in vivo (40‐kDa) is associated with periodontal disease status. However, the recombinant V+H– FN protein which is structurally and functionally similar to the in vivo 40‐kDa fragment was chosen as the focus of these studies over the in vivo fragment because of the ability to readily produce and purify large quantities of recombinant fragments for detailed studies. Thus, findings from this study relate to our understanding of how the extracellular matrix of the periodontal ligament in an inflamed environment may contribute to periodontal disease and its progression.

Methods: We used substrate zymography, reverse zymography, proteinase inhibitors, and partial sequencing to investigate whether the pro‐apoptotic V+H– fibronectin fragment modulates proteinase expression as part of this apoptotic mechanism.

Results: Incubation with the V+H– fragment reduced the expression of all gelatinolytic proteinases and inhibitors commonly expressed by periodontal ligament cells. In the presence of caspase inhibitors, inhibitors known to suppress apoptosis, however, the reduced proteinase profile was rescued, showing that caspase inhibitors were able to reverse the reduced proteinase profile and indicating that caspase‐mediated pathways are pertinent to fibronectin‐fragment‐mediated matrix metalloproteinase expression. In addition, the V+H– fragment also triggered the expression of a unique high molecular weight gelatinolytic proteinase of approximately 200 kDa. This proteinase was a serine proteinase, whose identity is not known.

Conclusion: These findings suggest that matrix‐degrading proteinases may be involved in apoptosis as part of a unique mechanism of periodontal tissue breakdown, in which novel proteinases may help execute the dissolution of the extracellular matrix. J Periodontol 2004;75:523‐530.
Guided Bone Regeneration May Be Negatively Influenced by Nicotine Administration: A Histologic Study in Dogs
Authors: Saldanha Juliana B. , Pimentel Suzana P. , Casati Marcio Z. , Sallum Enilson A. , Barbieri Deise , Moreno Heitor , Nociti Francisco H.
Published: February 2005

Background: A series of animal and in vitro data confirms that nicotine impairs bone healing, diminishes osteoblast function, and causes autogenous bone graft morbidity. Therefore, this study aimed to investigate the impact of nicotine on the healing of bone defects treated by the guided bone regeneration (GBR) principle.

Methods: Sixteen mongrel dogs were used. One defect was surgically created bilaterally and randomly assigned as an expanded polytetrafluoroethylene (ePTFE) membrane site or a non‐membrane control site. The animals were randomly assigned to one of the following groups: group 1, placebo (n = 8) and group 2, subcutaneous administration of nicotine (2 mg/kg) twice daily (n = 8). After 4 months, the animals were sacrificed and the specimens routinely processed for semi‐serial decalcified sections. The evaluated parameters were bone height, bone width, bone density, and bone area of newly formed bone.

Results: Intergroup analysis (Kruskal‐Wallis) showed that membrane‐protected defects in the placebo group demonstrated an increased bone area when compared to membrane‐protected defects in the nicotine group and non‐membrane sites, regardless of nicotine administration (P <0.05). In addition, nicotine administration significantly affected bone density in membrane‐ and non–membrane‐protected sites (P <0.05).

Conclusions: Within the limits of the present study, nicotine might affect, but not prevent, bone healing in defects treated by guided bone regeneration. The mechanisms of this effect should be investigated further. J Periodontol 2004;75:565‐571.
Initial Implant Position Determines the Magnitude of Crestal Bone Remodeling
Authors: Hartman Gary A. , Cochran David L.
Published: February 2005

Background: The ability to predict the amount of bone remodeling around implants is important for a stable and predictable esthetic result. The purpose of this study was to investigate the amount of radiographic bone remodeling that occurs over time using a one‐piece implant system.

Methods: Twenty‐seven patients receiving implants in the maxilla and 15 receiving implants in the mandible were included in the study. All implants were placed with a non‐submerged surgical technique with varying locations of the rough‐smooth border with respect to the alveolar crest. Clinical exams and radiographs were taken on the day of implant placement, at 6 months, and annually up to 5 years. Linear measurements from digitized radiographs were made from the implant shoulder to the first boneto‐ implant contact at all time points.

Results: A significant amount of bone remodeling compared to baseline occurred for all implants at the 6‐month follow‐up visit (1.10 mm), with the remaining time points showing virtually no change (0.1 mm). A relationship was found between the amount of bone remodeling and the location of the rough‐smooth border with respect to the alveolar crest. Those implants with the rough‐smooth border surgically placed below the crest had, on average, a greater amount of remodeling at 6 months (average 1.72 mm) than implants with the rough‐smooth border placed at or near the crest (average 0.68 mm). In both situations, this remodeling: 1) occurred early (within 6 months), 2) reached a similar level, and 3) remained virtually unchanged up through 60 months (0.05 mm).

Conclusions: A physiologic dimension appears to exist between the bone and the implant‐crown interface around onepiece implants that is established early and maintained over time. These results are significant because they demonstrate in patients that the magnitude of initial bone remodeling around these onepiece dental implants is dependent on the positioning of the rough‐smooth border of the implant in an apico‐coronal dimension. Furthermore, the dimension, from the crown‐implant interface to the first bone‐to‐implant contact, is consistent with the formation of a biologic width similar to that found around the natural dentition. J Periodontol 2004;75:572‐577.
Smoking May Affect Root Coverage Outcome: A Prospective Clinical Study in Humans
Authors: Martins Angela Guimarães , Andia Denise Carleto , Sallum Antonio Wilson , Sallum Enilson A. , Casati Márcio Z. , Nociti Francisco H.
Published: February 2005

Background: Cigarette smoking has been shown to negatively influence healing following periodontal therapeutic procedures. Therefore, the aim of this study was to evaluate the impact of smoking on clinical outcome of root coverage following subepithelial connective tissue graft (CTG) surgery.

Methods: Eighteen defects were treated in 15 patients (seven smokers and eight non‐smokers) who presented canine and premolar Miller Class I and II recessions. CTG was performed and clinical measurements were obtained at baseline, and 30, 60, 90, and 120 days after surgery. Clinical measurements included plaque and gingival indexes, gingival recession, probing depth, clinical attachment level, gingival thickness, and keratinized tissue width.

Results: Intragroup analysis showed that CTG was able to promote root coverage, increase gingival thickness, and improve clinical attachment level in both groups (P <0.05). On the other hand, intergroup analysis demonstrated that smokers presented with a lower percentage of root coverage (58.84% ± 13.68% versus 74.73% ± 14.72%), less clinical attachment level gain (2.54 ± 0.79 mm versus 2.00 ± 1.04 mm), and deeper probing depths (1.56 ± 0.53 mm versus 2.35 ± 0.67 mm) than non‐smokers (P <0.05). Moreover, 4 months after CTG, smokers presented more keratinized tissue compared to non‐smokers (3.30 < 0.86 mm versus 4.50 ± 1.16 mm) (P <0.05).

Conclusion: Within the limits of the present study, it can be concluded that cigarette consumption may present a negative impact on root coverage outcome by CTG and, therefore, may represent one more challenge for periodontal plastic therapy. J Periodontol 2004;75:586‐591.
A Radiographic Evaluation of Cervical Bone Loss Associated With Immediate and Delayed Implants Placed for Fixed Restorations in Edentulous Jaws
Authors: Schwartz‐Arad Devorah , Yaniv Yael , Levin Liran , Kaffe Israel
Published: February 2005

Background: Placement of dental implants is considered a successful and predictable procedure. An important biological benefit is the preservation of bone height following implantation. The purpose of this study was to examine the cervical bone loss (CBL) and its correlation with implant characteristics and anatomic factors, 1 to 8 years post‐implantation of immediate and delayed implants.

Methods: A total of 381 implants (144 immediate and 237 delayed) were placed in 44 edentulous patients (53 jaws) for fixed ceramometal restoration from 1989 to 1996. The mean mesial and distal cervical bone resorption of each implant was measured using panoramic radiographs, by an objective examiner using a computerized scanner before second stage surgery and 1 to 8 years (mean 3.5 years) follow‐up. The length of the implant served as an internal standard. The examiner had no prior information on the examined implants.

Results: Total CBL was 0.78 ±1.22 mm. There was a significant difference (P = 0.049) between CBL of immediate implants compared to delayed ones. Implants >13 mm showed a significantly (P <0.001) lower CBL than shorter implants. Hydroxyapatite‐coated implants had a higher CBL (P <0.001) compared to commercially pure titanium implants (P <0.001). The CBL of maxillary implants was higher than mandibular implants (P <0.001). Step‐wise multiple regression probability tests demonstrated that implant location followed by coating, length, and timing of placement were the most important parameters for implant success (R2 = 0.102).

Conclusion: Cervical bone loss around dental implants is influenced by location, coating, length, and implant timing. J Periodontol 2004;75:652‐657.
Estrogen Suppression Induces Papillary Gingival Overgrowth in Pregnant Baboons
Authors: Reynolds Mark A. , Aberdeen Graham W. , Pepe Gerald J. , Sauk John J. , Albrecht Eugene D.
Published: February 2005

Background: Alterations in sex steroids during pregnancy are associated with the development and exacerbation of reactive lesions involving the gingiva. Currently, few experimental animal models similar to humans are available to examine regulatory pathways involving sex steroids and the periodontium.

Methods: In the present study, we used the baboon as a novel experimental model for the study of the regulatory actions of estrogen on the periodontium during pregnancy. Pregnant baboons (N = 5) were administered the potent, highly specific aromatase inhibitor CGS 20267 (2 mg/day subcutaneously) daily on days 60 through 165 of gestation (term = 184). Untreated females (N = 10) and females (5) concomitantly administered aromatase inhibitor and estradiol benzoate (2.0 mg/day each subcutaneously) served as controls. Gingival biopsies were taken between days 145 and 165 of gestation.

Results: Administration of CGS 20267 in all females suppressed maternal serum concentrations of estradiol by 95% and induced the development of an exuberant papillomatous enlargement of the gingiva by gestational day 110, with the most prominent development involving the labial aspects of the anterior sextants. None of the untreated pregnant controls or females concomitantly administered aromatase inhibitor and estradiol benzoate developed gingival overgrowth. Thus, estradiol alone prevented the onset of gingival overgrowth induced by estrogen suppression. In all baboons, discontinuation of the aromatase inhibitor at time of cesarean section resulted in spontaneous regression and resolution of the papillomatous hyperplasia within 4 to 6 weeks. Clinically, the gingival papillary overgrowth was erythematous and edematous, with a propensity toward spontaneous subgingival hemorrhage. Histologically, the biopsy specimens demonstrated hyperplasia of the epithelium typified by mild hyperkeratosis, acanthosis, and elongation and isolated anastamoses of rete ridges. Subjacent to the intact epithelium was a loose connective tissue stroma with isolated areas of inflammatory cell infiltrate. Special stains verified the presence of isolated bacterial biofilms; however, no evidence of fungal filaments was present. Histological features suggestive of viral infection were notably absent in the epithelium. No evidence of viral particles or capsids was identified using transmission electron microscopy. Reverse transcription polymerase chain reaction analysis, using a panel of degenerate primers, was negative for papilloma family viruses.

Conclusions: These results are consistent with a significant role for estrogen during primate pregnancy in the regulation of cellular proliferation and differentiation within the gingiva. The baboon represents an important experimental model for studying the regulatory actions of estrogen on the periodontium during pregnancy. J Periodontol 2004;75:693‐701.
A Short‐Term and Long‐Term Comparison of Root Coverage With an Acellular Dermal Matrix and a Subepithelial Graft
Authors: Harris Randall J.
Published: February 2005

Background: Obtaining predictable and esthetic root coverage has become important. Unfortunately, there is only a limited amount of information available on the long‐term results of root coverage procedures. The goal of this study was to evaluate the short‐term and long‐term root coverage results obtained with an acellular dermal matrix and a subepithelial graft.

Methods: An a priori power analysis was done to determine that 25 was an adequate sample size for each group in this study. Twenty‐five patients treated with either an acellular dermal matrix or a subepithelial graft for root coverage were included in this study. The short‐term (mean 12.3 to 13.2 weeks) and long‐term (mean 48.1 to 49.2 months) results were compared. Additionally, various factors were evaluated to determine whether they could affect the results. This study was a retrospective study of patients in a fee‐for‐service private periodontal practice. The patients were not randomly assigned to treatment groups.

Results: The mean root coverages for the short‐term acellular dermal matrix (93.4%), short‐term subepithelial graft (96.6%), and long‐term subepithelial graft (97.0%) were statistically similar. All three were statistically greater than the long‐term acellular dermal matrix mean root coverage (65.8%). Similar results were noted in the change in recession. There were smaller probing reductions and less of an increase in keratinized tissue with the acellular dermal matrix than the subepithelial graft. None of the factors evaluated resulted in the acellular dermal graft having a statistically significant better result than the subepithelial graft. However, in long‐term cases where multiple defects were treated with an acellular dermal matrix, the mean root coverage (70.8%) was greater than the mean root coverage in long‐term cases where a single defect was treated with an acellular dermal matrix (50.0%).

Conclusions: The mean results with the subepithelial graft held up with time better than the mean results with an acellular dermal matrix. However, the results were not universal. In 32.0% of the cases treated with an acellular dermal matrix, the results improved or remained stable with time. J Periodontol 2004;75:734‐743.