bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluids and Microbial Penetration in the Internal Part of Cement‐Retained Versus Screw‐Retained Implant‐Abutment Connections
Authors: Piattelli Adriano , Scarano Antonio , Paolantonio Michele , Assenza Bartolomeo , Leghissa Giulio Cesare , Di Bonaventura Giovanni , Catamo Giovanni , Piccolomini Raffaele
Published: February 2005

Background: It has been recently observed that in implants with screwretained abutments, in in vitro as well as in vivo conditions, bacteria can penetrate inside the internal cavity of the implant as a consequence of leakage at the implant‐abutment interface. An alternative to screw‐retained abutments is represented by implants that can receive cemented abutments. In this case, the abutment goes through a transmucosal friction implant extension (collar) and is cemented inside the internal hexagonal portion of the implant. The aim of the present research was to compare fluids and bacterial penetration in 2 different implant systems, one with cement‐retained abutments (CRA) and the other with screw‐retained abutments (SRA).

Methods: Twelve CRA dental implants and 12 SRA implants were used in this study. The research was done in 3 steps: scanning electron microscopic (SEM) analysis, fluid penetration analysis, and bacterial penetration analysis.

Results: 1) Under SEM it was possible to observe in the SRA implants a mean 2 to 7 μ gap between implant and abutment, while in the CRA implants, the gap was 7 μ. In the latter group, however, the gap was always completely filled by the fixation cement. All the spaces between abutment and implant were filled by the cement. 2) With SRA implants, it was possible to observe the presence of toluidine blue at the level of the fixtureabutment interface and the internal threads; the absorbent paper was stained in all cases. With CRA implants, the absorbent paper inside the hollow portion of the implants was never stained by toluidine blue. No penetration of toluidine blue was observed at the implant‐abutment interface and inside the hollow portion of the implants. 3) In all the SRA implant assemblies, bacterial penetration was observed at the implant‐abutment interface. No bacteria were detected in the hollow portion of the CRA implants.

Conclusion: On the basis of the results obtained in the present study using 2 different implant systems, we conclude that CRA implants offer better results relating to fluid and bacterial permeability compared to SRA implants. J Periodontol 2001;72:1146‐1150.
Interaction Between Piroxicam and Azithromycin During Distribution to Human Periodontal Tissues
Authors: Malizia Tecla , Batoni Giovanna , Ghelardi Emilia , Baschiera Fabio , Graziani Filippo , Blandizzi Corrado , Gabriele Mario , Campa Mario , Tacca Mario Del , Senesi Sonia
Published: February 2005

Background: Non‐steroidal anti‐inflammatory drugs and antibiotics are important in the prevention of infections and pain associated with periodontal surgery as well as in the adjunctive therapy of periodontal disease. In this study, patients undergoing oral surgery were treated with piroxicam and azithromycin to examine the interactions of these drugs on periodontal tissues.

Methods: Sixty‐six patients were assigned to 3 groups and treated for 3 days as follows: 1) piroxicam 20 mg/day; 2) azithromycin 500 mg/day; or 3) piroxicam 20 mg/day plus azithromycin 500 mg/day. Samples of blood, saliva, gingiva, and alveolar bone were collected during surgery and at days 0.5, 2.5, 4.5, and 6.5 after last dose. Piroxicam concentrations were assayed by high‐performace liquid chromatography and azithromycin concentrations by microbiological assay.

Results: In patients treated with piroxicam alone, the highest drug concentrations were found in plasma at each time point, but consistent piroxicam levels were also detected in gingival samples up to 4.5 days. The combined treatment with piroxicam plus azithromycin was associated with a reduction of piroxicam concentrations in periodontal tissues. In patients receiving azithromycin alone, high drug levels were measured in periodontal tissues up to 6.5 days. This distribution pattern did not vary in patients treated with piroxicam plus azithromycin.

Conclusions: Treatment with piroxicam or azithromycin alone ensures a favorable distribution of these drugs into periodontal tissues. However, upon combined administration, azithromycin interferes negatively with the periodontal disposition of piroxicam. This interaction might depend on the displacement of piroxicam from acceptor sites at the level of periodontal tissues. J Periodontol 2001;72:1151‐1156.
The Use of Bovine Porous Bone Mineral in Combination With Enamel Matrix Proteins or With an Autologous Fibrinogen/ Fibronectin System in the Treatment of Intrabony Periodontal Defects in Humans
Authors: Lekovic Vojislav , Camargo Paulo M. , Weinlaender Michael , Vasilic Nikola , Djordjevic Maja , Kenney E. Barrie
Published: February 2005

Background: Enamel matrix derivative (EMD) and autologous fibrinogen/fibronectin system (AFFS) are agents that have been shown to be effective in periodontal regeneration. Their use in combination with graft materials, however, has not been extensively examined. The purpose of this study was to compare the clinical effectiveness of bovine porous bone mineral (BPBM) used in combination with an EMD or in combination with AFFS as regenerative treatments for periodontal intrabony defects in humans.

Methods: Twenty‐three paired intrabony defects were surgically treated using a split mouth design. Defects were treated with BPBM either combined with EMD (BPBM/EMD) or with AFFS (BPBM/AFFS). The clinical parameters evaluated included changes in attachment level, probing depth, and defect fill as revealed by re‐entry surgeries at 6 months.

Results: Preoperative probing depths, attachment levels, and transoperative bone measurements were similar for the 2 treatment groups. Postsurgical measurements taken at 6 months revealed that both treatment modalities resulted in clinically and statistically significant improvements in probing depth resolution, clinical attachment gain, and defect fill as compared to baseline. Both therapy modalities improved clinical parameters as compared to baseline, but the differences found between the groups were not statistically significant.

Conclusions: The results of this study indicate that EMD and AFFS used in combination with BPBM have similar effects in promoting probing depth reduction, clinical attachment gain, and defect fill when employed as regenerative therapy for intraosseous lesions in humans. A study involving a larger sample size is necessary to statistically confirm the equivalence between the 2 treatment modalities. J Periodontol 2001;72:1157‐1163.
An “S‐Shaped” Relationship Between Smoking Duration and Alveolar Bone Loss: Generating a Hypothesis
Authors: Schuller Annemarie A. , Holst Dorthe
Published: February 2005

Background: A number of epidemiological studies have shown that smoking is a risk factor for periodontal disease. Little is known about the relationship between smoking duration and alveolar bone loss. The purpose of this research was to describe the prevalence of alveolar bone loss according to smoking status in Norway. A dose‐response model for duration of tobacco smoking on alveolar bone loss was then developed and discussed.

Methods: The study population consisted of 812 individuals living in Norway aged 45 to 64 years old (248 current smokers, 245 former smokers and 319 non‐smokers). Alveolar bone loss was measured on bite‐wing radiographs. Simple descriptive statistics were used to describe the central tendency and variation in alveolar bone loss. Regression analyses were performed to study the relationship between smoking duration and alveolar bone loss.

Results: Mean alveolar bone loss varied between 1.51 mm and 2.64 mm depending on smoking status and age. Mean alveolar bone loss was lowest in non‐smokers and highest in current smokers. Given identical smoking status, the mean alveolar bone loss increased with increasing age except for the 2 oldest age groups of current smokers.

Conclusions: Our results generate the hypothesis that the relationship between smoking duration and alveolar bone loss was “S‐shaped.” Assuming that alveolar bone loss is irreversible after smoking cessation, it could be hypothesized that there is a threshold period for tobacco smoking after which the accumulated effect of smoking becomes clinically observable. After a certain number of years of smoking, the effect on alveolar bone loss seems to level out. To test this hypothesis, the relationship between smoking duration and alveolar bone loss should be studied in a prospective study design. J Periodontol 2001;72: 1164‐1171.
Performance of a Commercial Immunoassay for Detection and Differentiation of Periodontal Marker Bacteria: Analysis of Immunochemical Performance With Clinical Samples
Authors: Eggert F.‐Michael , McLeod M. Herbert , Flowerdew Gordon
Published: February 2005

Background: We employed a commercial immunoassay for simultaneous detection and differentiation of marker bacteria Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia and reassessed the immunochemical performance of the assay.

Methods: We compared the analytical performance of the immunoassay in our study of clinical samples from 249 periodontal patients in 2 private periodontal practices with the previously reported analytical performance of the same immunoassay. We also compared immunoassay measurements of the marker bacteria in clinical samples with values obtained in other studies by direct culture of the same organisms.

Results: The assay produced 3 times more high‐end readings than reported previously. We also reassessed and revised previously published calibration curves for the immunoassay. The immunoassay provided measurements of the marker bacteria in clinical samples from our patients that were comparable to and consistent with measurements of the same bacteria by direct culture in other studies.

Conclusions: We ascribe the increased sensitivity of the immunoassay in our study to: 1) a more standardized and vigorous sample dispersion that improves release of particulate and soluble antigens from dental plaque biofilm, and 2) better visualization of the reaction product of the enzyme‐linked immunoassay. High‐technology assays, such as diagnostic immunoassays, have a significant potential for future development in dental diagnosis, because they simplify detection and measurement of biologically important markers such as specific bacteria in clinical samples. Commercial assays also have an important potential for standardization of clinical measurements of biological markers. J Periodontol 2001;72:1201‐1209.
Periodontal Changes in Liver Cirrhosis and Post‐Transplantation Patients. I: Clinical Findings
Authors: Oettinger‐Barak Orit , Barak Shlomi , Machtei Eli E. , Ardekian Leon , Baruch Yaacov , Peled Micha
Published: February 2005

Background: Cyclosporin A (CsA) is widely used to prevent liver transplantation failure. CsA‐induced gingival overgrowth is a common side effect. However, the effect of cirrhotic liver disease, liver transplantation, and immunosuppressive therapy on the periodontium is yet unclear. The aim of the present cross‐sectional study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy on the periodontium.

Methods: The experimental group (LC) consisted of 13 liver cirrhosis patients. A second experimental group (PT) included 24 patients, post‐liver transplantation, receiving immunosuppressive therapy. Seventeen healthy subjects formed a control group. The Ramfjord index teeth were recorded for plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO).

Results: Mean PI and mean GI for the LC, PT, and C groups were not statistically different (P >0.05). Mean PD for the LC (3.32 ± 0.24 mm) and PT group (3.41 ± 0.13 mm) was significantly higher (P = 0.0001, ANOVA) compared to the C group (2.45 ± 0.16 mm). Likewise, CAL for the LC (4.89 ± 0.47 mm) and PT group (4.68 ± 0.47 mm) was significantly higher (P = 0.001, ANOVA) than the C group (2.78 ± 0.23 mm). Patients in the PT group exhibited the greatest mean GO scores (0.88 ± 0.09) compared to the LC group (0.37 ± 0.07) and the C group (0.09 ± 0.02). All 3 groups were significantly different from each other (P = 0.0001) despite great variability within the groups. GO in the CsA‐treated patients (1.1 ± 0.09) was significantly higher (P = 0.0001) than in those treated with tacrolimus (0.57 ± 0.1).

Conclusions: Liver cirrhosis patients demonstrated greater pocketing and attachment loss compared to healthy matched controls. These same differences were observed in patients post‐transplantation. Gingival overgrowth occurred as a result of the immunosuppressive therapy with CsA, while to a lesser degree with tacrolimus. Replacement of CsA by tacrolimus in patients manifesting gingival overgrowth might be recommended whenever possible to overcome this problem. J Periodontol 2001;72:1236‐1240.
Local Versus Systemic Adjunctive Antibiotic Therapy in 28 Patients With Generalized Aggressive Periodontitis
Authors: Purucker Peter , Mertes Helmut , Goodson J. Max , Bernimoulin Jean‐Pierre
Published: February 2005

Background: Although the use of systemic antibiotics has been studied in patients with generalized aggressive periodontitis (formerly rapidly progressive periodontitis), the use of adjunctive tetracycline fibers in these patients has not been reported. The purpose of the present study was to compare the clinical response of local versus systemic antibiotic treatment as adjuncts to scaling and root planing in patients with GAgP.

Methods: After initial therapy and full‐mouth scaling and root planing (SRP), 30 patients were randomly assigned to 1 of 2 antibiotic treatment groups. Probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP) were recorded with an automated probe prior to SRP at baseline (BL) and 15, 30, 41, and 54 weeks later. Three months after SRP, the patients were treated with amoxicillin/clavulanic acid (500 mg tid; SRP + AUG group) or with local tetracycline fiber in pockets with PD ≥5 mm (SRP + TCF group).

Results: In both treatment groups, PD decreased significantly from BL to week 54 (6.2 ± 1.5 mm to 4.7 ± 1.4 mm for SRP + TCF and 6.5 ± 1.4 mm to 4.2 ± 0.6 mm for SRP + AUG). However, there was no statistically significant difference between the 2 groups in pocket reduction. Similarly, in both treatment groups, there were small but significant gains in CAL from BL to week 54 (12.0 ± 1.8 mm to 11.3 ± 1.8 mm for SRP + TCF and 12.3 ± 1.5 mm to 11.2 ± 1.2 mm for SRP + AUG). The difference in CAL gain between the 2 groups was not statistically significant. At the final examination, both groups showed significant PD reduction and CAL gain (P <0.001) compared to BL. The frequency and percentage of bleeding sites decreased significantly in both groups. At week 54, this decrease was significantly greater in the SRP + AUG group (31.67% for SRP + TCF versus 3.85% for SRP + AUG).

Conclusions: These results indicate that the local delivery of tetracycline by a fiber or the systemic administration of amoxicillin/clavulanic acid given 3 months after scaling and root planing produced similar clinical outcomes over the 9‐month observation period. J Periodontol 2001;72:1241‐1245.
Health Behaviors and Their Relation to Metabolic Control and Periodontal Status in Type 2 Diabetic Patients: A Model Tested Using a Linear Structural Relations Program
Authors: Kawamura Makoto , Tsurumoto Akihisa , Fukuda Setsuko , Sasahara Hisako
Published: February 2005

Background: Although it has been reported that diabetic control is beneficial in managing periodontal disease, there are few studies in the literature where the relationship between singular behavioral factors and periodontal status has been examined. The aim of this study was to examine the simultaneous interrelationships among selected medical/dental variables and 5 behavior components with general health behavior (GHB), perceived fatigue (PF), diet control (DC), regular diet (RD), and dental behavioral inventory (HU‐DBI) scores, using data from a study of 102 type 2 diabetic patients.

Methods: A hypothesized model was tested by a linear structural relations program (LISREL).

Results: There was a significant correlation between oral health behavior and calculus accumulation (r = 0.399; P <0.001). Correlations were found between calculus and periodontal status measured by gingivitis index and probing depth (r = 0.232; P <0.05, r = 0.279; P <0.01, respectively). The final model was found to be consistent with the data (χ2 = 55.0, df = 47, P = 0.197; GFI = 0.922). Oral health behavior affected periodontal status through its effect on calculus but not plaque accumulation. General health behavior had significant effects on oral health behavior and diet behavior (P <0.05 and P <0.001, respectively). Diet behavior affected both plaque accumulation and metabolic control (P <0.05 and P <0.01, respectively). However, the result was the virtual absence of a significant pass coeffi‐cient between metabolic control and periodontal status.

Conclusions: The severity of the 2 diseases seemed to be connected indirectly through health behaviors such as diet behavior and oral health behavior. J Periodontol 2001;72:1246‐1253.
Comparative Clinical Study of Guided Tissue Regeneration With a Bioabsorbable Bilayer Collagen Membrane and Subepithelial Connective Tissue Graft
Authors: Romagna‐Genon Christine
Published: February 2005

Background: During the last decade, there have been great strides in the treatment of gingival recession defects, especially with subepithelial connective tissue graft and guided tissue regeneration (GTR) procedures. Gingival recession represents a significant concern for patients. It is necessary to choose the most appropriate procedure in order to obtain more root coverage while avoiding clinical disadvantages. The purpose of this randomized clinical trial was to evaluate the use of a bioabsorbable bilayer collagen membrane with GTR compared to a connective tissue graft in the treatment of gingival recession defects.

Methods: Twenty patients each contributing a pair of Miller Class I or II buccal gingival recessions were treated. In each pair, one recession was randomly assigned for treatment with GTR using a bioabsorbable bilayer collagen membrane and the other treated with subepithelial connective tissue graft (CTG). Clinical measurements taken at baseline (D0) and 3 and 6 months post‐treatment included recession depth (RD), recession width (RW), probing depth (PD), and clinical attachment level (CAL).

Results: Data were analyzed using the non‐parametric Wilcoxon matched pair test. All results were statistically significant. Both treatments resulted in a significant gain of root coverage (P <0.0001), amounting to an average of 2.80 mm at 3 months in the GTR group and 3.34 mm in the CTG group. At 6 months, the decrease of the mean RD remained statistically significant: 2.70 mm (74.59% root coverage) in the GTR group and 3.19 mm (84.84% root coverage) in the CTG group. The mean RW also decreased from 4.48 mm at D0 to 2.42 mm at 6 months in the GTR group, and from 4.38 mm at D0 to 1.35 mm at 6 months in the CTG group, representing a percentage of coverage of 45.98% and 69.18%, respectively. Mean CAL gain obtained between D0 and 6 months with the GTR procedure and CTG was 3.31 mm and 3.09 mm, respectively, and was significant within groups. At 3 and 6 months, the differences in the results for RD, CAL, and RW were not statistically significant between the 2 groups. However, the difference was significant for PD at 3 and 6 months.

Conclusions: The results suggest that a bioabsorbable bilayer collagen membrane can be used in the GTR treatment of human buccal recession defects, with no statistically significant differences between this procedure and connective tissue grafts. J Periodontol 2001;72:1258‐1264.
Localized Aggressive Periodontitis in a Patient With Type 1 Diabetes Mellitus: A Case Report
Authors: Emingil Gülnur , Darcan şükran , Keskinoğlu Ahmet , Kütükçüler Necil , Atilla Gül
Published: February 2005

Background: Poor metabolic control of diabetes mellitus (DM) has often been associated with the severity of periodontal disease. The aim of this report is to present a 9‐year‐old female with localized aggressive periodontitis who had a history of type 1 DM and the outcome of her treatment.

Methods: The patient had received medical, clinical, and radiographic periodontal examinations. Peripheral blood analysis was done as well. She had non‐surgical periodontal treatment, and medical management of her diabetes was performed at the same time. She was followed longitudinally for 5 years.

Results: Medical examination revealed no pathological findings except for growth retardation. Laboratory tests showed that she had poor metabolic control, with 497 mg/dl fasting blood glucose and 15.6% HbA1c. The random migration and neutrophil chemotaxis were significantly reduced. Periodontal treatment and metabolic control of her diabetes resulted in significant improvement in her periodontal condition. No incipient periodontal breakdown was observed around the teeth after 5 years from baseline.

Conclusions: This report proves the efficiency of periodontal therapy in the prevention of future periodontal breakdown in a systemically compromised patient. It seems that in certain individuals who are predisposed to the aggressive forms of periodontitis, clinical and medical examinations and intervention to the systemic condition, in combination with periodontal treatment, are important in the management of these individuals J Periodontol 2001;72:1265‐1270.
A Bioengineered Implant for a Predetermined Bone Cellular Response to Loading Forces. A Literature Review and Case Report
Authors: Misch Carl E. , Bidez Martha W. , Sharawy Mohamed
Published: February 2005

The presence of fibrous tissue has long been known to decrease the long‐term survival of a root‐form implant. Excessive loads on an osseointegrated implant may result in mobility of the supporting device, and excessive loads may also fracture an implant component or body. Although several conditions may cause crestal bone loss, one of these may be prosthetic overload. Excessive loads on the bone cause strain conditions to increase. These microstrains on the bone may affect the bone remodeling rate in a direct relationship.

When strain conditions to the interfacial bone are in the mild overload zone, an increased bone remodeling response occurs, which results in a reactive woven bone formation that is less mineralized and weaker. Greater stresses may cause the interfacial strain to reach the pathologic overload zone and may cause microfracture of the bone, fibrous tissue formation, and/or bone resorption. Recent reports suggest that the bone remodeling rate next to an implant may be used to evaluate biomechanical conditions and their influence on the implant‐to‐bone interface. These include a number of factors, such as loading conditions, implant body surface conditions, and implant design. For a given load condition, the implant design is one of the primary factors that determine the resultant strain at the interface.

A predetermined goal was established to bioengineer a dental implant to load the bone at the interface in a predetermined stress strain relationship, in order to maintain lamellar bone at the interface. A case report is presented of 2 bioengineered implants loaded for 1 year, which demonstrates that the bone was primarily lamellar in structure, the bone turnover rate was less than 5 microns/day, and was the same as the bone away from the interface. These findings corroborate those observed in a prior animal study reported with the same implant design. Although the number of implants evaluated in those 2 reports is few, they support a predetermined histological outcome. J Periodontol 2001;72:1276‐1286.
Gingival Plasma Cell Granuloma
Authors: Peacock Mark E. , Hokett Steven D. , Hellstein John W. , Herold Robert W. , Matzenbacher Scott A. , Scales Donald K. , Cuenin Michael F.
Published: February 2005

Plasma cell granulomas (pseudotumors) are rare benign, tumor‐like proliferations composed chiefly of plasma cells that manifest primarily in the lungs, but may occur in various anatomic locations. We report this case of a 54‐year‐old male who presented with an unusual maxillary anterior gingival overgrowth treated by excisional biopsy. Histological examination revealed a dense inflammatory cell infiltrate containing mainly plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. Intraoral plasma cell granuloma is exceedingly rare, although case reports documenting such lesions have been reported. This case highlights the need to biopsy unusual lesions to rule out potential neoplasms. J Periodontol 2001;72:1287‐1290.
Potential Associations Between Chronic Respiratory Disease and Periodontal Disease: Analysis of National Health and Nutrition Examination Survey III
Authors: Scannapieco Frank A. , Ho Alex W.
Published: February 2005

Background: Associations between poor oral health and chronic lung disease have recently been reported. The present study evaluated these potential associations by analyzing data from the National Health and Nutrition Examination Survey III (NHANES III), which documents the general health and nutritional status of randomly selected United States subjects from 1988 to 1994.

Methods: This cross‐sectional, retrospective study of the NHANES III database included a study population of 13,792 subjects ≥20 years of age with at least 6 natural teeth. A history of bronchitis and/or emphysema was recorded from the medical questionnaire, and a dichotomized variable combined those with either chronic bronchitis and/or emphysema, together considered as chronic obstructive pulmonary disease (COPD). Subject lung function was estimated by calculating the ratio of forced expiratory volume (FEV) after 1 second (FEV1)/forced vital capacity (FVC). Oral health status was assessed from the DMFS/T index (summary of cumulative caries experience), gingival bleeding, gingival recession, gingival probing depth, and periodontal attachment level. Unweighted analyses were used for initial examination of the data, and a weighted analysis was performed in a final logistic regression model adjusting for age, gender, race and ethnicity, education, income, frequency of dental visits, diabetes mellitus, smoking, and alcohol use.

Results: The mean age of all subjects was 44.4 ± 17.8 years (mean ± SD): COPD = 51.2 ± 17.9 years and subjects without COPD = 43.9 ± 17.7 years. Subjects with a history of COPD had more periodontal attachment loss than subjects without COPD (1.48 ± 1.35 mm versus 1.17 ± 1.09 mm, P = 0.0001). Subjects with mean attachment loss (MAL) ≥3.0 mm had a higher risk of COPD than those having MAL <3.0 mm (odds ratio, 1.45; 95% CI, 1.02 to 2.05). A trend was noted in that lung function appeared to diminish with increasing periodontal attachment loss.

Conclusions: The findings of the present analysis support recently published reports that suggest an association between periodontal disease and COPD. J Periodontol 2001;72:50‐56.
Fluid Dynamics of Gingival Tissues in Transition From Physiological Condition to Inflammation
Authors: Fabbro Massimo Del , Francetti Luca , Bulfamante Gaetano , Cribiù Milena , Miserocchi Giuseppe , Weinstein Roberto L.
Published: February 2005

Background: An increase in gingival sulcular fluid filtration is a common clinical sign of early gingivitis. The aim of this study was to describe the fluid dynamics of the gingival interstitial tissues at the level of the sulcus in the transition towards inflammation.

Methods: In 13 anesthetized rabbits, a silk ligature was placed around incisors close to the gingival margin, in order to prevent mechanical cleaning of plaque deposition. After 2 to 7 days, animals were anesthetized and interstitial fluid pressure measured using glass micropipettes connected to a servonull pressure system at the level of the free and attached gingiva.

Results: Interstitial pressure was 3.8 ± 2.9 cmH2O, significantly higher than the normal physiological value (about –1 cmH2O). Colloid osmotic pressure of interstitial fluid samples collected using the wick technique was measured using an osmometer whose membrane had a molecular cut‐off of 30 kD and averaged 12.8 ± 2.8 cmH2O (unchanged relative to control). Mean gingival sulcular fluid flow, measured by placing a PE tube (0.5 mm OD, 0.28 mm ID) in the sulcus, was 0.16 ± 0.12 µl/h; the mean colloid osmotic pressure was 13.6 ± 6.6 cmH2O, corresponding to a protein concentration of ∼2.8 g/dl. Proteins of gingival fluid may leak from inflamed gingival interstitium or derive from bacteria of dental plaque. Histological analysis of gingival biopsies showed neutrophilic polymorphonuclear leukocyte infiltrates in both the dermis and epidermis layer.

Conclusions: Based on hydraulic and colloid osmotic data, the Starling pressure gradient favored filtration from gingival interstitium to the sulcular space, a condition opposite to that observed in healthy gingiva where fluid filtration is absent. J Periodontol 2001;72:65‐73.
Immunohistochemical Study of Vestibular Gingival Blood Vessel Density and Internal Circumference in Smokers and Non‐Smokers
Authors: Mirbod Sayed M. , Ahing Stephen I. , Pruthi Vijay K.
Published: February 2005

Background: This study was undertaken to determine: 1) if sections stained with monoclonal antibody to CD34 can be used for measurement of gingival blood vessel density and circumference and 2) if long‐term smoking affects either of these 2 parameters.

Methods: Vestibular gingival biopsy samples were obtained from 17 adults (5 smokers and 12 non‐smokers) who were undergoing routine periodontal surgery independently of this study. Hematoxylin and eosin staining was used for histological assessment of inflammation, while immunohistochemical staining with CD34 mouse monoclonal antibody was used to mark the endothelial cells of the blood vessels within each sample. Stringent selection criteria were applied to the 17 biopsy samples, and 7 (from 3 smokers and 4 non‐smokers) were chosen to have their vascular density (number of vessels/unit area) and internal vessel circumference (IC) measured under a blinded protocol.

Results: Repeated measurements of vascular density and internal circumference showed small standard deviations, indicating the high reproducibility of the measurement technique. The smoker group showed a higher proportion of small (IC <50 µm) and a lower proportion of large blood vessels (IC >100 µm), which was statistically significant (P = 0.0403 and P <0.001, respectively). The difference between the vascular density of smokers and non‐smokers was not significant (P = 0.092).

Conclusions: The present study indicates that the CD34 immunohistochemical staining technique is a simple and reproducible method for the measurement of density and internal circumference of gingival blood vessels. Based on this technique, cigarette smokers show a higher percentage of smaller blood vessels and a lower percentage of larger vessels, but similar vascular density, to non‐smokers. J Periodontol 2001;72:1318‐1323.
The Fcγ Receptor Genotype as a Severity Factor for Chronic Periodontitis in Japanese Patients
Authors: Kobayashi Tetsuo , Yamamoto Kouji , Sugita Noriko , van der Pol W‐Ludo , Yasuda Keiko , Kaneko Susumu , van de Winkel Jan G. J. , Yoshie Hiromasa
Published: February 2005

Background: Functional polymorphisms of immunoglobulin G (IgG) Fc receptors (FcγR) have been shown to be associated with generalized aggressive periodontitis (GAgP) or recurrence of chronic periodontitis (CP) in Japanese patients. The purpose of this study was to evaluate whether FcγR polymorphisms are also associated with severity of CP.

Methods: Fifty Japanese non‐smoking patients with severe CP and 39 Japanese non‐smoking patients with moderate CP were identified according to established clinical criteria, including measurements of probing depth (PD), clinical attachment level (CAL), and alveolar bone loss (BL). FcγR genotypes for 3 bi‐allelic polymorphisms (FcγRIIa‐R/H131, FcγRIIIa‐158V/F, FcγRIIIb‐NA1/NA2) were determined in these CP patients and 64 race‐matched, non‐smoking healthy controls by means of allele‐specific polymerase chain reactions.

Results: There was a significant over‐representation of FcγRIIIa‐158V allele in severe CP patients compared to moderate CP patients (odds ratio 2.03, 95% confidence interval [CI] 1.03‐4.01, χ 2 = 4.86, P = 0.028). In addition, we found a strong association between CP severity and FcγR composite genotype comprising FcγRIIIa‐158V plus FcγRIIIb‐NA2 (severe CP versus moderate CP: odds ratio 4.69, 95% CI 1.52‐15.10, χ 2 = 9.35, P = 0.002; severe CP versus healthy controls: odds ratio 4.10, 95% CI 1.62‐10.59, χ 2 = 11.13, P = 0.0009). Moreover, CP patients positive for the composite genotype exhibited more severe signs of periodontitis than composite genotype‐negative individuals (positive versus negative; mean PD: 3.8 mm versus 3.2 mm, P = 0.005; mean CAL: 4.5 mm versus 3.7 mm, P = 0.005; mean % BL: 37.6% versus 29.9%, P = 0.008).

Conclusion: Our results document the FcγRIIIa‐158V allele and possibly FcγRIIIb‐NA2 to be associated with severity of CP in Japanese patients. J Periodontol 2001;72:1324‐1331.
Non‐Redundant Roles for Interleukin‐1α and Interleukin‐1β in Regulating Human IgG2
Authors: Ishihara Yuichi , Zhang Ji‐Bo , Fakher Mohamed , Best Al M. , Schenkein Harvey A. , Barbour Suzanne E. , Tew John G.
Published: February 2005

Background: Serum concentrations of immunoglobulin G2 (IgG2) are elevated in localized aggressive periodontitis (LAgP) patients, and secretory products of monocytes from LAgP patients enhance IgG2 responses of lymphocytes from healthy subjects. Furthermore, genes regulating production of interleukin (IL)‐1 influence the risk for both aggressive periodontitis (AgP) and chronic periodontitis. These observations, and the fact that IgG2 dominates responses to carbohydrates from Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, prompted the hypothesis that IL‐1α, IL‐1β, and IL‐RA may help regulate human IgG2 responses.

Methods: Human peripheral blood leukocytes (PBL) were stimulated in culture with pokeweed mitogen (PWM); the levels of available IL‐1 gene products were manipulated; and the effect on IgG2 production was monitored. Manipulations of IL‐1 were accomplished by adding specific neutralizing monoclonal antibodies or recombinant IL‐1RA, IL‐1α, or IL‐1β.

Results: Blocking the IL‐1 receptor with IL‐1RA or neutralizing IL‐1α or IL‐1β with specific antibody dramatically suppressed IgG2 production (50% to 70%). Additional IL‐1α did not compensate for neutralized IL‐1β, and additional IL‐1β did not compensate for neutralized IL‐1α, suggesting the 2 monokines have separate roles in promoting IgG2. Furthermore, combinations of anti‐IL‐1α and anti‐IL‐1β were more inhibitory than either antibody alone, and IL‐1α and IL‐1β in combination appeared to work additively in promoting IgG2. Moreover, PBL cultures from a group of LAgP patients with high IgG2 levels had elevated levels of IL‐1β.

Conclusion: IL‐1α and IL‐1β appear to have critical and nonredundant roles in the generation and regulation of potent IgG2 responses, which appear to be important in human responses to carbohydrate‐bearing bacteria. J Periodontol 2001;72:1332‐1339.
Clinical and Radiographic Evaluation of the Papilla Level Adjacent to Single‐Tooth Dental Implants. A Retrospective Study in the Maxillary Anterior Region
Authors: Choquet Vincent , Hermans Marc , Adriaenssens Philippe , Daelemans Philippe , Tarnow Dennis P. , Malevez Chantal
Published: February 2005

Background: The regeneration of gingival papillae after single‐implant treatment is an area of current investigation. This study was designed to determine: 1) whether the distance from the base of the contact point to the crest of the bone would correlate with the presence or absence of interproximal papillae adjacent to single‐tooth implants, and 2) whether the surgical technique at uncovering influences the outcome.

Methods: A clinical and radiographic retrospective evaluation of the papilla level around single dental implants and their adjacent teeth was performed in the anterior maxilla in 26 patients restored with 27 implants. Six months after insertion, 17 implants were uncovered with a standard technique, while 10 implants were uncovered with a technique designed to generate papilla‐like formation around dental implants. Fifty‐two papillae were available for clinical and radiographic evaluation. The presence or absence of papillae was determined, and the effects of the following variables were analyzed: the influence of the 2 surgical techniques; the vertical relation between the papilla height and the crest of bone between the implant and adjacent teeth; the vertical relation between the papilla level and the contact point between the crowns of the teeth and the implant; and the distance from the contact point to the crest of bone.

Results: When the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was ≥6 mm, the papilla was present 50% of the time or less. The mean distance between the crest of bone and the most coronal papilla level (interproximal soft tissue height) was 3.85 mm (SD = 1.04). When comparing the conventional and modified surgical technique, the relation shifted from 3.77 mm (SD = 1.01) to 4.01 mm (SD = 1.10), respectively.

Conclusions: These results clearly show the influence of the bone crest on the presence or absence of papillae between implants and adjacent teeth. The data also show a positive influence for the modified surgical technique, aimed at reconstructing papillae at the implant uncovering. J Periodontol 2001;72:1364‐1371.
Is Collagen Breakdown During Periodontitis Linked to Inflammatory Cells and Expression of Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases in Human Gingival Tissue?
Authors: Séguier Sylvie , Gogly Bruno , Bodineau Agnès , Godeau Gaston , Brousse Nicole
Published: February 2005

Background: Evidence of the role of matrix metalloproteinases (MMPs) produced by resident and inflammatory cells in periodontal destruction is now well established. The purpose of this study was to quantify, in healthy and diseased upper gingival connective tissue, the area fraction (AA%) occupied by collagen fibers, the cell number belonging to inflammatory cell subsets, and the amounts of MMPs and TIMPs (tissue inhibitors of MMPs) in order to investigate the possible correlations, if any, between such molecules, collagen loss, and inflammatory cell subsets.

Methods: Gingival tissue specimens from 6 healthy controls (C) and 6 patients with severe periodontitis (P) were divided into 2 groups. The first group of specimens was frozen and used for the staining of collagen fibers by sirius red F3Ba and for immunohistochemistry with antibodies against CD8, CD4, CD22, CD68, and TIA‐1 molecules. The second group was used for organ culture, zymography, Western blotting, and dot blotting. Morphometric and automated image analysis was performed for the evaluation of the area fraction occupied by collagen fibers, the number of inflammatory cell subsets and for enzymatic activities developed by MMPs, and the amounts of TIMPs expressed during periodontal disease.

Results: In group P, the area fraction of collagen fibers (33 ± 10%) was significantly decreased (P <0.0002) when compared to group C (60 ± 7%), and was correlated with the number of all inflammatory cells and amounts of MMPs and TIMPs. In group P, there were significant increases of CD8+, CD22+, CD68+, and TIA‐1+ cells, as well as increases in the amounts of MMP‐1, MMP‐2, MMP‐3, MMP‐9, and the active form of MMP‐9. The active form of MMP‐9 and the amount of TIMP‐1 were positively correlated with the number of CD22+, CD68+, and TIA‐1+ cells.

Conclusions: The present study showed an imbalance between MMPs and TIMPs associated with the pathologic breakdown of the extracellular matrix during periodontitis. The active form of MMP‐9 could be a marker for the clinical severity of periodontal disease. J Periodontol 2001;72:1398‐1406.
Thickness of Palatal Masticatory Mucosa Associated With Age
Authors: Wara‐aswapati Nawarat , Pitiphat Waranuch , Chandrapho Neerapa , Rattanayatikul Charunee , Karimbux Nadeem
Published: February 2005

Background: The palatal masticatory mucosa is widely used as a donor material in periodontal plastic surgery. However, there are relatively few studies investigating the volume or thickness of the palatal mucosa. The purpose of this study was to determine the thickness of palatal masticatory mucosa in Asian subjects aged 14 to 59 years by a direct clinical technique. The associations of age and gender with the thickness of palatal mucosa were also examined.

Methods: Sixty‐two systemically and periodontally healthy Asians (31 males; 31 females; age range 14 to 59 years) participated in this study. The younger age group (age 14 to 21 years) consisted of 32 subjects with a mean age of 16.8 years, whereas the older age group (age 30 to 59 years) consisted of 30 subjects with a mean age of 38.7 years. A bonesounding method using a periodontal probe with minimal anesthesia and a prepared clear acrylic stent were utilized to assess the thickness of palatal mucosa at 15 measurement sites defined according to the gingival margin and mid‐palatal line. Multiple linear regression analysis was performed to examine the associations of age and gender with the mean mucosal thickness at the subject level. The Wilcoxon test was used to determine the difference in mucosal thickness between the 2 age groups, and between gender at each measurement point.

Results: The mean thickness of palatal masticatory mucosa ranged from 2.0 to 3.7 mm. The younger age group had significantly thinner mucosa (mean 2.8 ± 0.3 mm) than the older age group (mean 3.1 ± 0.3 mm). Females had thinner mucosa than males in the same age group, but the difference was not statistically significant. Overall, the thickness of palatal mucosa increased from the canine to second molar areas and in the sites furthest from the gingival margin towards the mid‐palate (with the exception of the first molar area, where significantly decreased thickness was observed).

Conclusions: Within the limits of the present study, the canine and premolar areas appear to be the most appropriate donor site for grafting procedures in both young and adult individuals. The subepithelial connective tissue graft procedure can be considered as a treatment modality in young patients, since a sufficient volume of donor tissue can be obtained from the hard palate area. Other factors that may influence the thickness of palatal mucosa such as racial and genetic factors and body weight need to be further investigated. J Periodontol 2001;72:1407‐1412.
Clinical Comparison of Microporous Biocompatible Composite of PMMA, PHEMA and Calcium Hydroxide Grafts and Expanded Polytetrafluoroethylene Barrier Membranes in Human Mandibular Molar Class II Furcations. A Case Series
Authors: Calongne Kevin B. , Aichelmann‐Reidy Mary E. , Yukna Raymond A. , Mayer Elizabeth T.
Published: February 2005

Background: Class II furcations present difficult treatment problems. Several treatment approaches to obtain furcation fill have been used with varying success.

Methods: The response of mandibular Class II furcations to treatment with either a microporous biocompatible composite of PMMA (poly‐methyl‐methacrylate), PHEMA (poly‐hydroxyl‐ethyl methacrylate) and calcium hydroxide graft synthetic bone (HTR) replacement graft material; ePTFE barrier membrane; or a combination of the two was evaluated in trios of mandibular molars with Class II furcations in 8 patients with moderate to advanced periodontitis. Following initial preparation, full‐thickness flaps were raised in the areas being treated, the bone and furcation defects debrided of granulomatous tissue, and the involved root surfaces mechanically prepared and chemically conditioned. By random allocation, HTR, ePTFE, or a combination of both was placed into and/or fitted over the furcations, packed and/or secured in place, and the host flap replaced or coronally positioned with sutures. Postsurgical deplaquing was performed every 10 days leading up to ePTFE removal at approximately 6 weeks. Continuing periodontal maintenance therapy was provided until surgical reentry at 6 months for documentation and any further necessary treatment.

Results: Direct clinical measurements demonstrated essentially similar clinical results with all 3 treatments for bone and soft tissue changes. There were no statistically or clinically significant differences except for better horizontal amount and percent defect fill with HTR alone. Four of 8 furcations became Class I clinically with HTR alone, 5 of 8 became Class I with ePTFE alone, and 5 of 8 with combination treatment. The only complete furcation closure occurred with HTR.

Conclusion: The findings of this study suggest essentially equal clinical results with HTR bone replacement graft material alone, ePTFE barrier alone, and a combination of the two in mandibular molar Class II furcations. However, a real difference may not have been detected based on the small number of subjects in the study. J Periodontol 2001;72:1451‐1459.
Associations Between Serum Antibody Levels to Periodontal Pathogens and Early‐Onset Periodontitis
Authors: Albandar Jasim M. , DeNardin Ann M , Adesanya Margo R. , Diehl Scott R. , Winn Deborah M.
Published: February 2005

Background: The role of antibodies to periodontal microorganisms in the development of periodontal tissue destruction is still unclear. The aim of this study was to investigate the association between serum levels of IgG, IgA, and IgM antibodies to 6 periodontal microorganisms and clinical subtypes of varying severity of earlyonset periodontitis (EOP) in young African American adults.

Methods: The study group consisted of 159 African Americans aged 19 to 25 years (mean 22 years) and included 97 cases with EOP and 62 controls with no clinical signs of EOP. These subjects were selected from a nationally representative sample of adolescents who received an oral examination as part of the National Survey of Oral Health of United States Children in 1986‐1987. The group was examined clinically a second time 6 years later and blood samples were collected. Serum levels of IgG, IgA, and IgM reactive to Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Campylobacter rectus, Eikenella corrodens, and Fusobacterium nucleatum were assessed.

Results: Serum levels of IgG and IgA antibody reactive to P. gingivalis and A. actinomycetemcomitans and IgA antibody to P. intermedia were significantly higher in generalized EOP cases compared to healthy controls. IgM antibody levels did not show any significant associations with EOP for any of the 6 bacterial species tested. There were no significant differences in antibody levels between controls and the 13 subjects in our study who were classified with localized EOP.

Conclusions: The findings suggest that antibodies to P. gingivalis, P. intermedia, and A. actinomycetemcomitans may play a significant role in the pathogenesis of EOP. Substantial longitudinal studies that monitor antibody levels and avidity prior to disease onset, during progression, and following clinical intervention will be necessary to fully understand the role of this component of the immune response in protection versus tissue destruction and the potential use in EOP risk assessment and disease management. J Periodontol 2001;72:1463‐1469.