bluuebunny/crossref_metadata_2025 huggingface dataset:
Intrapocket Anesthesia for Scaling and Root Planing in Pain‐Sensitive Patients
Authors: Magnusson Ingvar , Geurs Nico C. , Harris Pearl A. , Hefti Arthur F. , Mariotti Angelo J. , Mauriello Sally M. , Soler Lina , Offenbacher Steven
Published: February 2005

Background: In 2 previous multicenter studies evaluating the efficacy of a novel anesthetic gel (lidocaine 25 mg/g plus prilocaine 25 mg/g), there was a rather small, although statistically significant, overall difference between the active and placebo gels. There were, however, large center variations. At centers where the placebo‐treated patients reported high pain scores, the difference between treatments was large, suggesting that the anesthetic gel is most effective in patients who experience the procedure as painful. The present multicenter, double‐blind, randomized study evaluated the anesthetic effect of this gel in pain‐sensitive patients by using a visual analog scale (VAS) and a verbal rating scale (VRS).

Methods: One hundred thirteen (113) patients with moderate to severe periodontitis were screened for pain sensitivity upon probing. Eighty‐five reported VAS ≥30 mm on probing and were included in the treatment phase (43 anesthetic and 42 placebo gel). The periodontal pockets of one quadrant in each patient were treated with gel for 30 to 45 seconds, followed by scaling and/or root planing.

Results: The results were similar between centers. The median overall VAS pain score was 11 mm in the anesthetic group and 27 mm in the placebo group. The Hodges‐Lehmann point estimate of the treatment difference was 10 mm (P = 0.004). No pain or only mild pain was reported by 70% in the anesthetic group and by 48% in the placebo group (P = 0.003). Two patients in the anesthetic group and 7 patients in the placebo group required rescue anesthesia.

Conclusions: This study confirms the favorable anesthetic efficacy of active gel over placebo in selected pain‐sensitive patients. It suggests that the gel may be a valuable alternative to conventional injection anesthesia. J Periodontol 2003;74:597‐602.
Efficacy of Subgingival Irrigation Using Herbal Extracts on Gingival Inflammation
Authors: Pistorius Alexander , Willershausen Brita , Steinmeier Eva‐Maria , Kreisler Matthias
Published: February 2005

Background: The aim of the present study was to investigate the efficacy of an herbal‐based mouthrinse in combination with an oral irrigator in reducing gingival inflammation.

Methods: A total of 89 patients (45 females, 44 males; mean age 49.1 ± 1.31 years) were included in this prospective, randomized, double‐blind clinical study and allocated to 3 treatment groups: group 1 (n = 34), treated with an oral irrigator with subgingival tips and an herbal‐based mouthrinse; group 2 (n = 29), the oral irrigator was applied in combination with a conventional mouthwash; and group 3 (n = 26), treated with the conventional mouthwash without subgingival irrigation. Data collected at baseline and after 4, 8, and 12 weeks included gingival index (GI), sulcus bleeding index (SBI), plaque index (PI), and probing depth (PD).

Results: Over a period of 3 months, GI decreased from 1.80 ± 0.04 to 1.56 ± 0.04 in group 1; from 1.79 ± 0.05 to 1.68 ± 0.04 in group 2; and remained nearly constant in group 3 (from 1.79 ± 0.05 to 1.81 ± 0.04). Differences between the groups were significant (analysis of variance, P <0.05). SBI values in group 1 were reduced from 2.51 ± 0.06 to 2.13 ± 0.06 after 3 months and were significantly lower than in group 2 (P = 0.001) and 3 (P = 0.002), with SBIs of 2.44 ± 0.06 and 2.42 ± 0.07, respectively, after 12 weeks. A reduction in PI was noted for all 3 groups throughout the follow‐up period, with no statistically significant differences. Probing depths were not reduced significantly in any group.

Conclusion: Subgingival irrigation with an herbal‐based mouthrinse led to a significant reduction in both SBI and GI. This regimen can, therefore, be recommended as an adjunctive procedure to reduce gingival inflammation. J Periodontol 2003;74:616–622.
Periodontal Repair in Dogs: Evaluation of a Bioabsorbable Space‐Providing Macro‐Porous Membrane with Recombinant Human Bone Morphogenetic Protein‐2
Authors: Wikesjö Ulf M.E. , Lim Won Hee , Thomson Robert C. , Cook Alonzo D. , Wozney John M. , Hardwick W. Ross
Published: February 2005

Background: Recombinant human bone morphogenetic protein‐2 (rhBMP‐2) technologies have been shown to significantly support alveolar bone formation. Biomaterial limitations, however, have restricted the biologic potential for onlay indications. The objective of this study was to evaluate regeneration of alveolar bone and periodontal attachment, and biomaterials reaction following surgical implantation of a spaceproviding, bioabsorbable, macroporous, polyglycolic acid‐trimethylene carbonate (PGA‐TMC) membrane combined with a rhBMP‐2 construct in a discriminating onlay defect model.

Methods: Routine supraalveolar periodontal defects were created at the mandibular premolar teeth in 9 beagle dogs. Contralateral jaw quadrants in subsequent animals were randomly assigned to receive the domeshaped PGA‐TMC (100 to 120 μm pores) membrane with rhBMP‐2 (0.2 mg/mL) in a bioresorbable hyaluronan (Hy) carrier or the PGA‐TMC membrane with Hy alone (control). The gingival flaps were advanced to submerge the membranes and teeth and sutured. Animals were euthanized at 8 and 24 weeks postsurgery for histologic observations.

Results: Jaw quadrants receiving the PGA‐TMC membrane alone experienced exposures at various time points throughout the study. Jaw quadrants receiving the PGA‐TMC/rhBMP‐2 combination remained intact, although one site experienced a late minor exposure. Newly formed alveolar bone approached and became incorporated into the macroporous PGA‐TMC membrane in sites receiving rhBMP‐2. The PGA‐TMC biomaterial was occasionally associated with a limited inflammatory reaction. Residual PGA‐TMC could not be observed at 24 weeks postsurgery. Residual Hy could not be observed at any time interval. Regeneration of alveolar bone height (means ± SD) was significantly increased in sites receiving the PGA‐TMC/rhBMP 2 combination compared to control (3.8 ± 1.3 versus 0.7 ± 0.5 mm at 8 weeks and 4.6 ± 0.8 versus 2.1 ± 0.4 mm at 24 weeks; P <0.05). Limited cementum regeneration was observed for PGA‐TMC/rhBMP‐2 and PGA‐TMC control sites. Ankylosis compromised regeneration in sites receiving PGA‐TMC/rhBMP‐2.

Conclusions: The bioabsorbable, space‐providing, macroporous PGA‐TMC membrane appears to be compatible biomaterial for bone augmentation procedures. rhBMP‐2 significantly enhances alveolar bone augmentation and soft tissue healing when combined with the PGA‐TMC membrane. J Periodontol 2003; 74:635‐647.
Evaluation of Hard Tissue Replacement Composite Graft Material as a Ridge Preservation/Augmentation Material in Conjunction with Immediate Hydroxyapatite‐Coated Dental Implants
Authors: Yukna Raymond A. , Castellon Paulino , Saenz‐Nasr Ana M. , Owens Kris , Simmons Jason , Thunthy Kavas H. , Mayer Elizabeth T.
Published: February 2005

Background: Immediate placement of dental implants (DI) in fresh extraction sockets is associated with remaining voids around the DI and often a partial dehiscence or thin facial alveolar plate. Bone replacement grafts are often used to correct these problems. This study evaluated the use of a layered composite of PMMA (poly‐methyl‐methacrylate), PHEMA (poly‐hydroxyl‐ethyl‐methacrylate), and calcium hydroxide grafts (HTR) as a ridge preservation/ augmentation material used in conjunction with an immediate DI placement technique.

Methods: Twenty‐three patients requiring 1 or 2 extractions that were treatment planned for immediate DI placement received 4.0 or 3.25 mm diameter hydroxyapatite‐coated cylindrical implants in the extraction sockets. HTR was used to fill the remaining socket void and enhance the facial ridge width. A collagen hemostatic was placed to cover the DI sites, flaps released, and primary closure attempted with sutures. DI uncovering was performed at about 6 months. Measurements were taken to the nearest 0.5 mm of the internal socket width and total ridge width at DI placement and uncovering.

Results: Thirty DIs were placed in the 23 patients. Mean initial internal socket width was 6.9 mm. The total ridge width showed a mean change from 9.1 mm to 8.4 mm; 60% of the areas showed a net increase or no change, while 40% showed a decrease in overall ridge width. DI success rate was 97% out to 6 months of loading.

Conclusion: The results of this study suggest that HTR is a useful adjunct in the placement of immediate DIs for filling of socket voids and preservation of ridge width. J Periodontol 2003;74:679‐686.
Evidence‐Based Mucogingival Therapy. Part 1: A Critical Review of the Literature on Root Coverage Procedures
Authors: Pagliaro Umberto , Nieri Michele , Franceschi Debora , Clauser Carlo , Pini‐Prato Giovanpaolo
Published: February 2005

Background: Systematic reviews of the literature are an increasingly important tool for providing evidence‐ based guidance to the practitioner. This review article and a companion paper deal with the surgical coverage of exposed root surfaces, but their aim is to promote a more up‐to‐date way of writing and publishing scientific articles in this field. This article presents the published data about surgical root coverage in table form and its aim is to identify updated minimum standards for data presentation.

Methods: Manual and computer‐assisted searches were conducted to find the articles published on this topic during the 30‐year period from 1970 to 2000. Articles that described the surgical procedure and reported at least the number of treated recessions and the duration of the follow‐up, including case series, controlled studies, and randomized trials were selected and data were arranged in tables.

Results: Only 90 of the 290 articles that dealt with root coverage met the entry criteria; 25 of these were found only through manual searching. The overall clinical outcomes of different techniques appear to be satisfactory, but the published evidence is of little help in deciding which procedure is best suited for each clinical situation. Only a more homogeneous way of collecting and reporting clinical data and especially outcome measures will allow for an effective reanalysis which could help in everyday clinical decision making. Perhaps studies should be carried out and presented keeping in mind that the published results of sound clinical studies will, sooner or later, be reviewed and compared with other studies.

Conclusion: A standard format with minimum requirements for data collection and presentation should be established and imposed by international journals in order to provide readers and researchers with more useful information. J Periodontol 2003;74:709‐740.
The Segmental Ridge‐Split Procedure
Authors: Coatoam Gary W. , Mariotti Angelo
Published: February 2005

This report details surgical procedures for ridge expansion by means of splitting the crest of an edentulous ridge. Atrophic bony ridges present a unique challenge to the dental implant surgeon. In the past, onlay grafts of bone harvested from the hip, maxillary tuberosity, symphysis of the chin, or external oblique ridge have all been used with success in reconstruction of atrophic ridges. However, bone onlay grafting procedures require a secondary surgical site, which exhibits typical postoperative morbidity associated with bone harvesting performed with chisels and burs. Additionally, onlay grafts often require a healing period of 6 months to a year before dental implants can be placed, and the onlay graft sometimes fails to fuse to the augmented site. The segmental ridge‐split procedure provides a quicker method wherein an atrophic ridge can be predictably expanded and grafted with bone allograft, eliminating the need for a second surgical site. J Periodontol 2003;74:757‐770.
Prostaglandin E2‐Mediated Regulation of Immunoglobulin G2 via Interferon Gamma
Authors: Tanaka Shigehisa , Barbour Suzanne E. , Best Al M. , Schenkein Harvey A. , Tew John G.
Published: February 2005

Background: Patients with localized aggressive periodontitis (LAgP) produce elevated levels of IgG2 both in vivo and in vitro. Responses to the periodontitis‐associated pathogens Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis are dominated by IgG2, and these IgG2 responses are associated with reduced extent and severity of disease. Little is known about regulation of the IgG2 subclass, although prostaglandin E2 (PGE2) (a mediator known to polarize responses toward Th‐2) and interferon (IFN)‐γ (a Th‐1 mediator) both promote IgG2 production. This unusual relationship prompted the hypothesis that, in certain circumstances, PGE2 enhances rather than inhibits IFN‐γ production.

Methods: To test this hypothesis, indomethacin (IND)‐treated peripheral blood mononuclear cell (PBL) cultures from healthy volunteers were stimulated with pokeweed mitogen (PWM), and the cultures were manipulated by adding PGE2, rIFN‐γ, rIL‐1α, rIL‐1β, rIL‐6, or rIL‐12. Production of IgG1, IgG2, IFN‐γ, and PGE2 was monitored by enzyme‐linked immunosorbent assay.

Results: Indomethacin treatment inhibited IgG1 and IgG2 production, and PGE2 restored both immunoglobulins in PWMstimulated cultures. Remarkably, addition of IFN‐γ also restored IND‐suppressed IgG2 but not IgG1. In contrast, addition of rIL (interleukin)‐1α, rIL‐1β, rIL‐6, or rIL‐12 did not restore IgG2 responses. Furthermore, IND suppressed IFN‐γ production and PGE2 increased IFN‐γ levels. Kinetic studies indicate that PGE2 production occurred on the first day of culture, followed by IFN‐γ two days later.

Conclusions: These findings support the concept that in certain circumstances, PGE2 production can lead to increased IFN‐γ and that this IFN‐γ selectively promotes IgG2 responses. These data suggest that the elevated PGE2 observed in LAgP patients may contribute to increased IFN‐γ production and help explain elevated IgG2 responses. J Periodontol 2003;74:771‐779.
Subgingival Microflora in Turkish Patients with Periodontitis
Authors: Dog͠an Başak , Antinheimo Johanna , Çetiner Deniz , Bodur Ayşen , Emingil Gülnur , Buduneli Eralp , Uygur Cem , Firatli Erhan , Lakio Laura , Asikainen Sirkka
Published: February 2005

Background: No information exists on periodontitis‐associated subgingival microbiota from Turkey. We determined the occurrence, interspecies relationships, and clonal characteristics for a group of periodontal bacteria in a Turkish study population.

Methods: Subgingival microbial samples were obtained from patients with localized (LAgP, N = 18) or generalized (GAgP, N = 17) types of aggressive periodontitis, generalized chronic periodontitis (GCP, N = 14), and non‐periodontitis subjects (N = 20). Culture methods were used to recover 6 periodontal bacterial species and yeasts, and a polymerase chain reaction technique was used to detect Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Intraspecies characterization of A. actinomycetemcomitans was carried out by serotyping and genotyping.

Results: All species, except for Micromonas micros (formerly Peptostreptococcus micros) occurred more frequently (P <0.05) in periodontitis than non‐periodontitis subjects. Detection frequencies for Tannerella forsythensis (formerly Bacteroides forsythus) and Campylobacter rectus differed among the periodontitis subgroups; the lowest frequency occurred in LAgP. The mean proportions of A. actinomycetemcomitans, P. gingivalis, and C. rectus were higher (P <0.008) in GAgP than in non‐periodontitis subjects. Significant positive associations were seen between 7 of the 22 possible combinations (P <0.05). A. actinomycetemcomitans serotype c (34%) and non‐serotypeable isolates (34%) were the most common antigenic types among the 305 strains analyzed. Eleven arbitrarily primed (AP)‐PCR genotypes were distinguished among 273 isolates from 29 subjects. Yeasts were found in 23% of the 69 subjects.

Conclusions: The results on the Turkish study population were generally in line with earlier reports on the occurrence and interspecies relationships of certain bacteria in periodontitis. However, A. actinomycetemcomitans was not overrepresented in LAgP, and the serotype distribution resembled that reported from the East. The high frequency of non‐serotypeable isolates suggests local characteristics of the species. J Periodontol 2003; 74:803‐814.
Relationship of Destructive Periodontal Disease to the Acute‐Phase Response
Authors: Craig Ronald G. , Yip Julie K. , So Man Ki , Boylan Robert J. , Socransky Sigmund S. , Haffajee Anne D.
Published: February 2005

Background: Destructive periodontal diseases have been associated with an increased risk of atherosclerotic complications; however, the potential mechanisms are yet to be deﬁned. Inflammation plays a central role in atherosclerosis since C‐reactive protein (CRP), an acute‐phase protein monitored as a marker of inﬂammatory status, has been identiﬁed as a major risk factor for atherosclerotic complications. Recent reports that destructive periodontal diseases can increase CRP values present the possibility that the acute‐phase response may link these 2 disease processes. The objective of the present investigation was to determine the effect of destructive periodontal disease status, severity, and progression on components of the acutephase response in an urban minority population.

Methods: Clinical measurements recorded included probing depth, attachment level, gingival erythema, bleeding upon probing, suppuration, and plaque. Disease progression was deﬁned as a>2 mm loss of attachment 2 months post‐baseline. Serum antibody was measured by enzyme‐linked immunosorbent assay. CRP was measured using a high‐sensitivity CRP (hsCRP) assay. A commercial laboratory measured serum glucose (non‐fasting), albumin, cholesterol, high‐density lipoprotein (HDL), triglycerides, low‐density lipoprotein (LDL), and iron.

Results: Increased serum IgG antibody to Porphyromonas gingivalis, but not to 5 other species, was associated with periodontal disease status, increased severity, and progression as were age, male gender, and smoking. Cholesterol and LDL were increased in disease, and HDL and iron were increased in health. hsCRP, glucose, and cholesterol increased with disease progression. By regression analysis, IgG antibody to P. gingivalis correlated with age, probing depth, and hsCRP, and negatively correlated with albumin and iron. By logistic regression, subjects who experienced multiple sites of disease progression and elevated antibody to P. gingivalis increased the odds ratio of hsCRP >2.08 mg/l by 14.1 and 5.6, respectively.

Conclusion: These results suggest that destructive periodontal disease and disease progression are associated with changes in serum components consistent with an acute‐phase response. J Periodontol 2003;74:1007‐1016.
Evaluation of a Novell Alloplast for Osseous Regeneration in the Rat Calvarial Model
Authors: Francis Paul O. , McPherson James C. , Cuenin Michael F. , Hokett Steven D. , Peacock Mark E. , Billman Michael A. , Sharawy Mohamaed
Published: February 2005

Background: Alloplasts are inert foreign bodies acting as osteoconductive space maintainers during osseous wound healing. They may also function as carriers for growth factors that are known to enhance neovascularization and osteoinduction; human recombinant transforming growth factor beta (rhTGF‐β1) is one such factor. The purpose of this study was to evaluate di‐vinyl styrene beads (DVSb) and rhTGF‐β1 effects on osseous regeneration in the rat calvaria critical‐sized defect model.

Methods: Di‐vinyl styrene beads (DVSb) with and without rhTGF‐β1 were placed between membranes in a critical alsized defect in the rat (Rattus norvegicus) calvaria. Actual bone fill; percentage bone fill; bone formation rate (BFR); and mineralization at 3, 6, and 12 weeks postsurgery were measured using densitometry, histomorphometry, scanning electron microscopy (SEM), and vital staining with tetracycline‐HCI.

Results: Mean radiographic density and percentage fill were statistically greater for DVSb treatment groups as compared with controls (P≤0.05). BFR was consistently between 3 and 7 µmper day for all groups; alloplast group BFR was significantly greater than controls or rhTGF‐β1 the groups at 6 weeks (P≤0.05); however, at 3 and 12 weeks, the control BFR was greater than treatment groups (P≤0.05). Membranes often collapsed and little bone fill or mineralization occurred in defects without DVSb. Mineralization appeared to occur adjacent to the allo‐plast by 12 weeks in the histologic and SEM sections. While DVSb fibrous attachment occurred in some specimens, there was no evidence of an inflammatory response.

Conclusion: Di‐vinyl styrene beads, with or without rhTGF‐β1, significantly enhance bone regeneration in the rat calvaria defect model. J PeriodontoI 2003;74:1023‐1031.
Scanning Electron Microscope Evaluation of Two Methods of Resharpening Periodontal Curets: A Comparative Study
Authors: Moses Ofer , Tal Haim , Artzi Zvi , Sperling Alon , Zohar Ron , Nemcovsky Carlos E.
Published: February 2005

Background: Effective root planing demands sharp cutting edges on dental curets. However, after several strokes, they become dull and must be resharpened frequently. The purpose of this study was to evaluate by scanning electron microscopy (SEM) the quality of the cutting edge of periodontal curets resharpened by 2 different methods.

Methods: Forty new detachable Gracey curets were used in this study. After similar blunting, all instruments were resharpened either with 10 strokes using an Arkansas fine‐grit sharpening stone (AR), or with 7 strokes using a high‐grit and ‐density aluminum oxide stone (CH). The cutting edges of each instrument were examined using SEM at 1 mm and 2 mm from the tip before and after the resharpening procedure. Bevel measurement and the amount of functional and non‐functional wire edges (WE) on the cutting edge were evaluated. Data were statistically analyzed using analysis of variance (ANOVA) with repeated measures, 2‐way ANOVA, and Fisher's exact test.

Results: After blunting and resharpening, differences in bevel between groups were statistically non‐significant. Generally, after resharpening, there were significantly more functional and nonfunctional WE in the AR group than in the CH group. There were significantly more instruments with a complete absence of WE in the CH group.

Conclusions: The CH stone resulted in a smoother and better cutting edge than the AR stone. The procedure was easy to perform and required fewer strokes of the curet on the stone.J Periodontol 2003;74:1032‐1037.
A Salivary Incubation Test for Evaluation of Oral Malodor: A Pilot Study
Authors: Quirynen Marc , Zhao Hong , Avontroodt Pieter , Soers Catherine , Pauwels Martine , Coucke Wim , van Steenberghe Daniel
Published: February 2005

Background: Breath odor is scored by different techniques, each with its own shortcomings. Organoleptic ratings are uncomfortable for the patient, subjective, influenced by external parameters including food and cosmetics, and especially lack international calibration. Portable sulphide monitors are relatively expensive and neglect several major malodorous molecules (e.g., butyric and propionic acids, putrescine, and cadaverine). Gas chromatography necessitates expensive devices and experienced technicians. This pilot study explored the applicability of a new technique (saliva incubation) by comparing its discrimination power, in a morning bad breath inhibition study of antiseptics, to those of hydrogen sulphide (H2S) measurement devices and organoleptic ratings.

Methods: After a professional cleaning, 8 periodontally healthy students abstained from all means of mechanical plaque control for 5 experimental periods of 7 days, with intervening washout periods of at least 2 weeks. During each experimental period, the students rinsed only twice daily with different antiseptics. At day 7, morning breath was scored clinically (volatile sulphide compound [VSC] level and organoleptic ratings), and 1.5 ml of saliva was collected and divided between 3 glass tubes that were sealed and incubated (37°C, anaerobic chamber). Immediately after collection and after 3 and 6 hours of incubation, the headspace air in one of the tubes was examined for VSC production and organoleptic measurements.

Results: The investigations of the incubated saliva correlated well with the 7‐day intraoral VSC recordings and organoleptic ratings (P≤0.005). Moreover, evaluations showed a similar interproduct ranking for their efficacy in malodor control. The power analyses indicated a higher discrimination power for the saliva incubation test than for the intraoral registrations.

Conclusions: The strong correlation between odor production of incubated saliva and clinical assessments suggests that the saliva incubation test may be used as an indirect method to measure oral malodor and can be employed to investigate the antimalodor effectiveness of oral hygiene products. J Periodontol 2003;74:937‐944.
Ridge Preservation with Freeze‐Dried Bone Allograft and a Collagen Membrane Compared to Extraction Alone for Implant Site Development: A Clinical and Histologic Study in Humans
Authors: Iasella John M. , Greenwell Henry , Miller Richard L. , Hill Margaret , Drisko Connie , Bohra Aziz A. , Scheetz James P.
Published: February 2005

Background: Tooth extraction typically leads to loss of ridge width and height. The primary aim of this 6‐month randomized, controlled, blinded, clinical study was to determine whether ridge preservation would prevent post‐extraction resorptive changes as assessed by clinical and histologic parameters.

Methods: Twenty‐four patients, 10 males and 14 females, aged 28 to 76 (mean 51.5 ± 13.6), requiring a non‐molar extraction and delayed implant placement were randomly selected to receive either extraction alone (EXT) or ridge preservation (RP) using tetracycline hydrated freeze‐dried bone allograft (FDBA) and a collagen membrane. A replaced flap, which did not completely cover the sockets, was used. Following extraction, horizontal and vertical ridge dimensions were determined using a modified digital caliper and an acrylic stent, respectively. Prior to implant placement, a 2.7 × 6.0 mm trephine core was obtained and preserved in formalin for histologic analysis.

Results: The width of the RP group decreased from 9.2 ± 1.2 mm to 8.0 ± 1.4 mm (P <0.05), while the width of the EXT group decreased from 9.1 ± 1.0 mm to 6.4 ± 2.2 mm (P <0.05), a difference of 1.6 mm. Both the EXT and RP groups lost ridge width, although an improved result was obtained in the RP group. Most of the resorption occurred from the buccal; maxillary sites lost more width than mandibular sites. The vertical change for the RP group was a gain of 1.3 ± 2.0 mm versus a loss of 0.9 ± 1.6 mm for the EXT group (P <0.05), a height difference of 2.2 mm. Histologic analysis revealed more bone in the RP group: about 65 ± 10% versus 54 ± 12% in the EXT group. The RP group included both vital bone (28%) and nonvital (37%) FDBA fragments.

Conclusions: Ridge preservation using FDBA and a collagen membrane improved ridge height and width dimensions when compared to extraction alone. These dimensions may be more suitable for implant placement, especially in areas where loss of ridge height would compromise the esthetic result. The quantity of bone observed on histologic analysis was slightly greater in preservation sites, although these sites included both vital and non‐vital bone. The most predictable maintenance of ridge width, height, and position was achieved when a ridge preservation procedure was employed. J Periodontol 2003;74:990‐999.
Orthodontic Movement into Infrabony Defects in Patients with Advanced Periodontal Disease: A Clinical and Radiological Study
Authors: Corrente Giuseppe , Abundo Roberto , Re Stefania , Cardaropoli Daniele , Cardaropoli Giuseppe
Published: February 2005

Background: In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodonticorthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects.

Methods: Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD)≥6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed.

Results: At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P <0.001).

Conclusion: The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill. J Periodontol 2003;74:1104‐1109.
Evaluation of Human Recession Defects Treated with Coronally Advanced Flaps and Either Enamel Matrix Derivative or Connective Tissue. Part 1: Comparison of Clinical Parameters
Authors: McGuire Michael K. , Nunn Martha
Published: February 2005

Background: Recession defects around teeth have been treated with a variety of surgical techniques. Most of the literature suggests that the subepithelial connective tissue graft has the highest percentage of mean root coverage with the least variability. Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters. The purpose of this study was to compare the clinical efficacy of enamel matrix derivative placed under a coronally advanced flap to subepithelial connective tissue placed under a coronally advanced flap in patients with recession type defects.

Methods: Twenty patients with incisors or premolars presenting with a facial recession of ≥4 mm in contralateral quadrants of the same jaw were treated; 17 patients completed the study. One tooth in each patient was randomized to receive either a coronally advanced flap with a subepithelial connective tissue graft (control) or a coronally advanced flap with EMD (test). Clinical parameters measured at baseline and at 6, 9, and 12 months included amount of recession; width at the coronal extent of the gingival defect; width of keratinized tissue; probing depth; clinical attachment level; inflammation score; plaque score; plaque index; alveolar bone level; tissue texture and color; and patient perception of pain, bleeding, swelling, and sensitivity.

Results: Results for both the test and control groups were similar for all measured clinical parameters with the exception of early healing, self‐reported discomfort, and the amount of keratinized tissue obtained. The coronally advanced flap with EMD was superior to the subepithelial connective tissue graft with regard to early healing and patient‐reported discomfort, whereas the subepithelial connective tissue graft demonstrated greater amount of keratinized tissue during the 12‐month evaluation period. However, both the test and control showed a significant increase in the amount of keratinized tissue at 9 and 12 months compared to baseline. No significant difference in the amount of root coverage was found between the test and control groups (n = 19; P = 0.82). On average, a gain of 4.5 mm (range 4 to 8 mm) tissue covering the previously exposed root surfaces was achieved with both treatment groups. The average percentages of root coverage for control and test groups were 93.8% and 95.1%, respectively. One hundred percent root coverage was obtained 89.5% of the time with the coronally advanced flap with EMD and 79% of the time with the subepithelial connective tissue graft.

Conclusion: Based on the results of this investigation, the addition of EMD to the coronally advanced flap resulted in root coverage similar to the subepithelial connective tissue graft but without the morbidity and potential clinical difficulties associated with the donor site surgery. J Periodontol 2003;74:1110‐1125.
Partial‐Mouth Assessment of Periodontal Disease in an Adult Population of the United States
Authors: Owens Jason D. , Dowsett Sherie A. , Eckert George J. , Zero Domenick T. , Kowolik Michael J.
Published: February 2005

Background: It has been previously demonstrated, using periodontal data from an untreated population, that half‐mouth assessment of six sites/tooth provides an appropriate alternative to whole‐mouth assessment of periodontal disease status. Since periodontal destruction exhibits left‐right symmetry, it was hypothesized that this would be equally applicable to a population with access to routine dental care.

Methods: Adult subjects (N = 92) with a range of disease levels participated in the study. Probing depths (PDs) and recession (REC) were measured directly on six sites/tooth, on all teeth excluding third molars), and clinical attachment levels (CALs) were derived. Partial‐mouth assessments, i.e., assessment of limited sites and/or teeth, were compared with whole‐mouth assessment as follows. Intraclass correlation coefficients (ICCs) were calculated for mean PD, CAL, and REC, and for percentage of sites with disease above a specified threshold, to determine the agreement between the whole‐ and partial‐mouth assessment. The sensitivity of partial‐mouth assessment of disease prevalence also was determined.

Results: For assessment of six sites per tooth in one upper and one lower quadrant, ICCs were consistently >0.80. Assessment of two sites per tooth or only Ramfjord teeth generally underestimated disease extent and severity, and prevalence, compared to half‐mouth assessment.

Conclusions: These results support the use of a half‐mouth examination of six sites/tooth, to conserve time, limit cost, and reduce patient and examiner fatigue, while providing maximal clinical information. Assessment of only two sites per tooth or the Ramfjord teeth was not suitable for evaluation of either disease extent and severity or prevalence. JPeriodontol 2003; 74:1206‐1213.
Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study
Authors: Jeffcoat Marjorie K. , Hauth John C. , Geurs Nico C. , Reddy Michael S. , Cliver Suzanne P. , Hodgkins Pamela M. , Goldenberg Robert L.
Published: February 2005

Background: Previous case‐control and prospective studies have shown an association between the presence of periodontitis and the risk of preterm birth (PTB). The goal of this pilot trial was to determine the feasibility of conducting a trial to determine whether treatment of periodontitis reduces the risk of spontaneous preterm birth (SPTB).

Methods: Three hundred sixty‐six (366) women with periodontitis between 21 and 25 weeks' gestation were recruited and randomized to one of three treatment groups with stratifi‐ cation on the following two factors: 1) previous SPTB at <35 weeks and 2) body mass index <19.8 or bacterial vaginosis as assessed by gram stain. The treatment groups consisted of: 1) dental prophylaxis plus placebo capsule; 2) scaling and root planing (SRP) plus placebo capsule; and 3) SRP plus metronidazole capsule (250 mg t.i.d. for one week). An additional group of 723 pregnant women meeting the same criteria for periodontitis and enrolled in a prospective study served as an untreated reference group.

Results: The rate of PTB at <35 weeks was 4.9% in the prophylaxis group, compared to 3.3% in the SRP plus metronidazole group and 0.8% in the SRP plus placebo group (P = 0.75 and 0.12, respectively). The rate of PTB at <35 weeks was 6.3% in the reference group.

Conclusions: This trial indicates that performing SRP in pregnant women with periodontitis may reduce PTB in this population. Adjunctive metronidazole therapy did not improve pregnancy outcome. Larger trials will be needed to achieve statistical significance, especially at less than 35 weeks gestational age. J Periodontol 2003;74:1214‐1218.
Pain Experienced by Patients During Periodontal Maintenance
Authors: Chung Denine T. , Bogle Gary , Bernardini Melanie , Stephens Denise , Riggs Matt L. , Egelberg Jan H.
Published: February 2005

Background: The aims of this study were to determine: 1) the degree of pain experienced by patients during probing and debridement; 2) whether the treating hygienists could estimate the degree of pain experienced by the patients; and 3) whether the patients' pain responses could be predicted by factors such as the patients' age, gender, number of residual periodontal lesions, and answers to a questionnaire on dental anxiety.

Methods: Prior to periodontal maintenance procedures, two groups of 20 adult patients to be treated by two hygienists completed an anxiety questionnaire. Subsequently, measurements of probing depths were performed, followed by pain ratings by each patient using a visual analog scale (VAS). The hygienists also completed a VAS, estimating the pain level they perceived their patient to have experienced. The same protocol was repeated for instrumentation (debridement).

Results: Most patients showed low pain responses to both probing and instrumentation. However, using an arbitrary threshold of VAS ≥40 mm, 20% to 33% of the patients had a significant pain experience. The hygienists were quite accurate in their relative estimates of their patients' pain experiences. Regression analyses disclosed that significant portions of the pain responses could be predicted by the patients' answers to one of the dental anxiety questions.

Conclusions: Recognition of patients who are likely to experience significant pain during periodontal treatment may be facilitated by the use of one question on dental anxiety. During treatment, the ability to gauge and respond to patients' pain experiences would seem to be an important component of a therapist's clinical skills. J Periodontol 2003;74:1293‐1301.
Platelet‐Derived Growth Factor‐BB Stimulated Cell Migration Mediated Through p38 Signal Transduction Pathway in Periodontal Cells
Authors: Ray Angel K. , Jones Anne C. , Carnes David L. , Cochran David L. , Mellonig James T. , Oates Thomas W.
Published: February 2005

Background: Intracellular signaling pathways mediate specific responses to growth factors. The manipulation of these pathways ultimately may be used to control the clinical outcomes of periodontal regenerative therapy. The purpose of this study was to examine the role of the p38 signal transduction pathway in the responses of periodontal cells to platelet‐derived growth factor‐ BB (PDGF).

Methods: Primary cultures of human periodontal ligament cells (PDLs) and gingival fibroblasts (GFs) were used for all experiments. Cell numbers, 3H‐thymidine incorporation, and Boyden chamber assays were used to characterize the effects of SB 203580 (SB), a specific inhibitor of the p38 signaling pathway, on cell proliferation and migration. An in vitro wound model also was used to assess the effects of SB. For the in vitro wound assay, triplicate wells were incubated for 1, 3, 5, and 7 days using 0.1% fetal bovine serum (FBS), 10% FBS ± 10 μM SB, or 20 ng/ml PDGF ± 10 μM SB. Digital histomorphometric analysis assessed cellular fill within the wound area.

Results: SB specifically inhibited PDGF‐induced migration in the Boyden chamber assays without affecting cell proliferation. The wound model data showed similar levels of wound fill for PDLs and GFs in 10% FBS. Relative to 10% FBS, PDLs stimulated with PDGF showed significantly (P <0.01, analysis of variance) greater wound fill (74%) than GFs (12%). SB inhibited the PDGF‐induced wound fill of PDLs and GFs by 64% and 57%, respectively. This inhibition was significant (P <0.01, ANOVA) only for PDLs. The addition of SB to 10% FBS did not significantly affect the wound fill response of either cell type compared to 10% FBS alone.

Conclusions: These results demonstrate that periodontal cells possess distinct responses to PDGF that may be altered at the signal transduction level. The manipulation of these responses through the use of inhibitors to specific signaling pathways may enhance our control of periodontal regeneration in the future. J Periodontol 2003;74:1320‐1328.
A Gingival Cul‐de‐Sac Following a Root Coverage Procedure with a Subepithelial Connective Tissue Submerged Graft
Authors: Wei Pein‐Chi , Geivelis Milton
Published: February 2005

Background: The subepithelial connective tissue graft (SCTG) used as a submerged graft in combination with a partial thickness advanced flap or rotated flap is a predictable technique for achieving coverage of the denuded root surface and/or for increasing the width of attached gingiva in Miller's class I and II marginal tissue recessions. However, even with a successful result, complications may occasionally occur.

Methods: A 4‐mm marginal tissue recession with an insufficient zone of attached gingiva on the facial aspect of a mandibular left lateral incisor (#23) was covered with a submerged SCTG and an envelope partial thickness flap. The mucogingival defect was successfully corrected. Nevertheless, the facial gingiva, specifically between teeth #22 (mandibular left canine) and #23, remained bulky and was reshaped 6 months postoperatively. A 5‐mm long gingival cul‐de‐sac with an intermittent thick white discharge was detected 3 months following the gingivoplasty procedure.

Results: With a periodontal probe kept in the tract, the lining of the cul‐de‐sac was exposed to the oral cavity by making an incision on the facial gingiva, along the axis of the probe, through to the lumen. The gingival tissue was then removed with a rotary bur until only a thin layer of periosteum remained. The mucosal defect was subsequently repaired by grafting with a non‐submerged SCTG. The gingival contour was significantly improved and no sign of recurrence was noted up to 4 years later.

Conclusions: The existence of a cyst cannot be verified without a histological evaluation. However, the development of a gingival cyst should be suspected with persistent tissue bulkiness and/or emergence of a thick white discharge from a site where a submerged SCTG procedure was performed. In addition, the illcircumscribed border around the lesion makes complete elimination of the pathosis relatively hard to achieve by a “superficial” gingivoplasty procedure. J Periodontol 2003;74:1376‐1380.
The Effect of Adjunctive Low‐Dose Doxycycline Therapy on Clinical Parameters and Gingival Crevicular Fluid Matrix Metalloproteinase‐8 Levels in Chronic Periodontitis
Authors: Emingil Gülnur , Atilla Gül , Sorsa Timo , Luoto Hanne , Kirilmaz Levent , Baylas Haluk
Published: February 2005

Background: Low‐dose doxycycline (LDD) is recognized to have non‐antimicrobial properties that can therapeutically modulate the host response. The aim of the present randomized, double‐blind, placebo‐controlled, parallel‐arm study was to examine the effectiveness of LDD in combination with non‐surgical periodontal therapy, compared to non‐surgical periodontal therapy alone, on gingival crevicular fluid (GCF) matrix metalloproteinase‐8 (MMP‐8) levels and clinical parameters over a 12‐month period in patients with chronic periodontitis.

Methods: GCF samples were collected, and clinical parameters including probing depth (PD), clinical attachment level, gingival index (GI), and plaque index were recorded. Thirty chronic periodontitis patients were randomized either to a low‐dose doxycycline (LDD) or placebo group. The LDD group received lowdose doxycycline (20 mg) b.i.d. for 3 months plus scaling and root planing (SRP), while the placebo group was given placebo capsules b.i.d. for 3 months plus SRP. The patients were evaluated every 3 months during the 12‐month study period. At each visit, all clinical measurements and GCF sampling were repeated. GCF MMP‐8 levels were determined by a time‐resolved immunofluorescence assay. Intragroup comparisons were tested by the Friedman test followed by Wilcoxon signed‐rank test to analyze significance of changes over time. The Mann‐Whitney test was used to determine differences between the LDD and placebo groups.

Results: Significant improvements were observed in all clinical parameters in both groups over the 12‐month period (P <0.0125). The LDD group showed a significantly greater reduction in mean PD scores at 9 and 12 months and in mean GI scores at all time points than the placebo group (P <0.05). From baseline to 12 months, GCF MMP‐8 levels were significantly reduced in both groups (P <0.0125). The GCF MMP‐8 level in the LDD group was significantly lower than that of the placebo group at 6 months (P <0.05).

Conclusions: The present results indicate that low‐dose doxycycline therapy in combination with scaling and root planing can reduce GCF MMP‐8 levels and improve clinical periodontal parameters in patients with chronic periodontitis. These results provide additional information about the usefulness of low‐dose doxycycline therapy as an adjunct to non‐surgical periodontal therapy in the long‐term management of periodontal disease. The effectiveness and course of low‐dose doxycycline therapy can be monitored conveniently by assessing GCF MMP‐8 levels. J Periodontol 2004;75:106‐115.
The Oral Conditions and Pregnancy Study: Periodontal Status of a Cohort of Pregnant Women
Authors: Lieff Susan , Boggess Kim A. , Murtha Amy P. , Jared Heather , Madianos Phoebus N. , Moss Kevin , Beck James , Offenbacher Steven
Published: February 2005

Background: Our objective was to describe the oral health of pregnant women, to determine oral health changes during pregnancy, and to determine factors associated with maternal periodontal health or disease.

Materials and Methods: Between December 1997 and July 2001, 1,224 pregnant women at <26 weeks’ gestation were enrolled in the study and oral health examinations were performed at enrollment and within 48 hours of delivery. Demographic, medical, and health behavior data were determined by chart abstraction and questionnaire. Comparisons between oral health at enrollment and delivery were made by student t test or Fisher's exact test. Ordinal logistic regression analysis was used to identify risk factors for maternal periodontal disease.

Results: Among 903 women, there was a significant increase in those with health/periodontal disease absence between enrollment and delivery (P <0.001). However, we also observed a significant increase in women with four or more sites with attachment loss ≥2 mm or ≥3 mm (P <0.05, 0.001). Race, smoking, and insurance status were significantly associated with maternal periodontal disease. Black women were more likely than white women to have periodontal disease at enrollment (adj. odds ratio 2.9, 95% confidence interval 2.2 to 3.9) and delivery (adj. odds ratio 3.1, 95% confidence interval 2.2 to 4.2), and experience incident disease (adj. odds ratio 2.3, 95% confidence interval 1.6 to 3.4).

Conclusions: Oral health examinations were well accepted by pregnant women. An increase in attachment loss may represent active periodontal infection accelerated by pregnancy. Further study on racial disparity in oral health among pregnant women is needed. Continued efforts to evaluate and establish appropriate definitions of oral disease in pregnancy are warranted. J Periodontol 2004;75:116‐126.