bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Look at the Etiology and Pathogenesis of Early‐Onset Periodontitis: Cementopathia Revisited
Authors: Page Roy C. , Baab David A.
Published: March 2012

For more than 20 years, investigators have unanimously agreed that human periodontitis is caused by bacterial colonization of the surfaces of the teeth and their extension apically. Recently, several investigators have demonstrated that most, if not all, individuals manifesting the early‐onset, aggressive forms of periodontitis have abnormalities in their peripheral blood phagocytes which can be detected as abnormal cell motility or adherence. Because of the major role of these cells, especially the neutrophilic granulocytes, in host defense against the microbial onslaught at the gingival sulcus, these leukocyte abnormalities have been considered to be the major determinant of susceptibility to microbial infection and invasion of the periodontal tissues. In recent years the possibility that other etiologies may be involved has not been seriously considered. The purpose of the present communication is to focus attention on the idea that factors other than bacteria and host defense mechanisms may be of significance. We specifically want to call attention to a potentially important role for root cementum.
Cell and Fiber Attachment to Demineralized Dentin from Normal Root Surfaces
Authors: Hanes Philip J. , Polson Alan M. , Ladenheim Stephen
Published: March 2012

This study assessed connective tissue and epithelial responses to dentin specimens (obtained from normal roots of human teeth) after surface demineralization. Rectangular dental specimens with opposite faces of root and pulpal dentin were prepared from beneath root surfaces covered by periodontal ligament. One‐half of the specimens were treated with citric acid, pH 1, for 3 minutes, while the remainder served as untreated control specimens. Specimens were implanted vertically into incisional wounds on the dorsal surface of rats with one end of the implant protruding through the skin. Four specimens in each group were available 1, 3, 5 and 10 days after implantation. Histologic and histometric analyses included counts of adhering cells, evaluation of connective tissue fiber relationships and assessment of epithelial migration. Analyses within each group comparing root and pulpal surfaces showed no differences between any of the parameters. Comparisons between experimental and control groups showed that demineralized surfaces had a greater number of cells attached, fiber attachment occurred and epithelial downgrowth was inhibited. The fiber attachment to experimental specimens differed morphologically from fiber attachment to normal root surfaces: the number of fibers attached per unit length and the diameter of attached fibers were significantly less on experimental specimens. Demineralized specimens at 10 days had a distinct eosinophilic surface zone. Surface demineralization of dentin predisposed toward a cell and fiber attachment system which inhibited migration of epithelium.
Gingival Wound Healing in the Presence of Plaque Induced Inflammation
Authors: Yumet Jose A. , Polson Alan M.
Published: March 2012

An accelerated loss of connective tissue attachment has been reported following surgery in plaque‐infected dentitions. It was the purpose of the present study to evaluate histologically the healing of incisional wounds in the gingival supracrestal region in the presence and absence of bacterially induced inflammation.

In the experimental group, marginal periodontitis was induced around the teeth by tying plaque‐retentive ligatures at the gingival margins and 10 weeks later an incisional wound was made from within the gingival sulcus to the crest of the bone. In the control group, similar incisional wounds were made in normal gingiva. In each group, three specimens were available for histologic and histometric analysis 1, 3, 7 and 21 days after wounding. In the control group, the wound healing sequence in the supracrestal region was similar to that reported following incisional cutaneous wounds. In the experimental group, epithelial continuity across the wound was re‐established earlier, and marked invagination of epithelium occurred into the incision. This invagination was significantly greater than in control specimens at all time points. In addition, within the experimental group a second significant epithelial migration into the wound occurred between 7 and 21 days. The epithelial invagination extended through the major portion of the supracrestal area and terminated near the cementum surface. It is conceivable that marked epithelial invagination into a supracrestal wound may predispose to an accelerated loss of connective tissue attachment.
Hydroxylapatite as an Alloplastic Graft in the Treatment of Human Periodontal Osseous Defects
Authors: Meffert Roland M. , Thomas Jeffery R. , Hamilton Kent M. , Brownstein Carol N.
Published: March 2012

Twelve patients, 32 to 60 years of age, received a polycrystalline ceramic form of pure dense hydroxylapatite as an alloplastic bone implant material in intrabony defects following reflection of full mucoperiosteal flaps, root planing and defect‐curettment. The defects were measured from an acrylic stent, using an endodontic silver point which was placed to the base of the defect. Similarly, debrided and curetted defects in the same patients were not implanted and served as controls. Recalls for documentation and plaque control were at 1, 2, and 4 weeks, and at 3, 6 and 9 months. Measurements relating to changes in defect‐depth were made upon reentry at 9 months.

The twelve defects, serving as controls, showed very little difference between the pretherapy and 9‐month measurements. The initial mean measurement from the base of the defect to the highest alveolar crest was 4.27 mm and the 9‐month mean measurement after curettage only was 3.36 mm. In terms of resolution of the original defect this amounted to 19.49% reduction, but a 0.46‐mm mean loss in height of the alveolar crest provided an actual percentage fill of the original defect of 9.91%.

Of sixteen experimental defects, the same initial mean measurement from the base of the defect to the highest alveolar crest was 5.18 mm and the 9‐month mean measurement after grafting was 2.43 mm. In terms of resolution of the original defect, this amounted to a 53.57% reduction, but in contradistinction to the curettage sites, a mean increase in height of the highest alveolar crest of 0.61 mm gave a true percentage fill of the original defect of 66.89%.

At the 9‐month reentry, the implanted mass seemed to be partially “calcified” and was resistant to penetration with a probe or removal with a curette. The data and clinical impression strongly suggest that hydroxylapatite has a potential as an alloplastic implant with clinically apparent acceptance by the soft and hard tissues.
Focus of Epithelial Dysplasia Arising in Hereditary Gingival Fibromatosis
Authors: Redman Robert S. , Ward Cullen C. , Patterson Robert H.
Published: March 2012

The gingiva of a 32‐year‐old black male was biopsied for evidence of vasculitis, but instead an area of epithelial dysplasia was found. Further investigation revealed that the patient and several members of his family had hereditary gingival fibromatosis. Treatment included four quadrants of gingivectomy plus inverse bevel incisions for trimming those areas which were too thick for simple gingivectomy. Histopathologic examination of the excised tissues supported the diagnosis of gingival fibromatosis, but no other areas of epithelial dysplasia were seen. To our knowledge, this is the only reported instance of a premalignancy or malignancy arising in gingival fibromatosis, and thus there is no reason to regard the gingival disorder as predisposing to carcinoma. However, the pedigree reported here supports a previous suggestion that hereditary gingival fibromatosis is not as rare among blacks as the literature has indicated.
The Botryoid Odontogenic Cyst: Report of a Case and Review of the Literature
Authors: Lynch Denis P. , Madden Clark R.
Published: March 2012

The botryoid odontogenic cyst is a morphologic variant of developmental cysts of odontogenic epithelial residue, i.e., lateral periodontal cysts and gingival cysts. Such variants have distinctive clinical and histologic characteristics, including a lobular appearance in situ, multiple cystic spaces lined by thin, nonkeratinized epithelium with focal plaque‐like thickenings and occasional glycogen‐rich clear cells. Lateral periodontal cysts most likely arise from rests of Malassez, while gingival cysts certainly arise from rests of Serres. When cortical perforation occurs, the origin of the cyst may be determined on the basis of the pattern of bone resorption. The term botryoid odontogenic cyst should be reserved for those developmental cysts of odontogenic epithelial residue that have a grossly lobulated appearance in addition to characteristic histomorphologic features. Its use should be restricted to the gross and histopathologic description rather than as a modifier of the definitive diagnosis. a botryoid variant of a gingival cyst with cortical perforation is presented.
Repair of Anterior Gingival Deformity with Durapatite
Authors: Greenstein G. , Jaffin R. A. , Hilsen K. L. , Berman C. L.
Published: March 2012

After the extraction of a maxillary anterior tooth, a gingival deformity may occur due to the loss of the labial plate of bone. This often creates an esthetic problem in the construction of a fixed partial denture. In the past, various surgical techniques have been devised to eliminate this gingival defect. A technique using durapatite is discussed.
Nifedipine‐Induced Gingival Hyperplasia: A Histochemical and Ultrastructural Study
Authors: Lucas Robert M. , Howell Lydia P. , Wall Brian A.
Published: March 2012

Gingival hyperplasia induced by nifedipine (Procardia), a calcium channel‐blocking agent used as an anti‐anginal drug, was studied. In recent months, the role of nifedipine in the etiology of gingival hyperplasia has attracted interest. The purpose of this study was to determine the causal relationship and compare nifedipine to other drug‐induced (phenytoin) and nondrug‐induced gingival hyperplasias. Histochemical studies revealed increased numbers of fibroblasts containing strongly sulfated mucopolysaccharides in the nifedipine‐ and phenytoin‐ (Dilantin) induced gingival hyperplasias as compared to the nondrug‐induced cases. Numerous secretory granules were also noted in the fibroblast cytoplasm in the nifedipine‐treated case studied by electron microscopy. These results imply that there is an increase in acid mucopolysaccharide production in the nifedipine‐ and phenytoin‐induced gingival hyperplasias. The potential significance and comparisons of the drugs' effects at the cellular level are discussed.
Periodontal Disease Treatment by Local Drug Delivery
Authors: Goodson J. M. , Offenbacher S. , Farr D. H. , Hogan P. E.
Published: March 2012

The subgingival microbiologic composition of diseased periodontal sites was evaluated by darkfield microscopy before and after scaling or local delivery of tetracycline. A standardized sampling and counting method using a crevicular washing technique was developed to determine both numbers and proportions of morphotypes using darkfield microscopy. Tetracycline‐loaded hollow fibers established an initial intrasulcular concentration of 200,000 μg/ml, which decreased exponentially to 15 μg/ml in 24 hours. Repetitive intrasulcular placement of these fibers at periodontitis sites produced an incremental reduction in bacterial counts over a 10‐day period. Monolithic fibers made of ethylene vinyl acetate loaded with 25% tetracycline hydrochloride provided sustained release for 10 days under in vitro test conditions. Ten patients were treated in a study comparing the effects of these fibers with scaling. Fibers were placed subgingivally to fill pockets to their probable depth and covered with a periodontal dressing which was maintained for 10 days. The average intrasulcular tetracycline concentration measured at the end of the 10‐day period was 643 μg/ml. At these sites, total counts, spirochetes, motile rods and nonmotile rods were significantly reduced immediately following treatment. Total counts were depressed to levels near the detection limit of darkfield microscopy. In comparison, scaling produced much smaller alterations of darkfield counts which were not statistically significant.
A Variation from Classic Oral Manifestations Associated with Acute Myeloblastic Leukemia
Authors: Gordon Mark R. , O'Neal Robert B. , Woodyard Stephen G.
Published: March 2012

A case representing previously misdiagnosed acute myeloblastic leukemia associated with an absence of classical intraoral manifestations is presented. Platelet count was < 15,000, and hematocrit was 20.3, yet clinical signs were limited to malaise and extreme gingival and mucosal pallor. The typical initial signs of gingival enlargement or hemorrhage never appeared, probably due to excellent plaque control by this patient. Mucosal color changes dictated the need for laboratory studies leading to a rapid and relatively early diagnosis.
Effectiveness of a Dentifrice Containing Formalin and Sodium Monofluorophosphate on Dental Hypersensitivity
Authors: McFall Walter T. , Morgan William C.
Published: March 2012

A double‐blind investigation comparing a control dentifrice with one containing active ingredients was conducted to determine their effect on dentinal hypersensitivity in 67 human subjects. Baseline data was obtained by patient questionnaire, dental examination and by soliciting subjective responses to controlled mechanical and thermal stimuli. A calcium carbonate‐based toothpaste constituted the base for both the control and active dentifrice. The active dentifrice contained 0.8% sodium monofluorophosphate and 1.3% formalin while the control lacked these ingredients. Dentifrices were supplied to patients on a random basis, and patients were instructed to brush twice each day for 28 days. Mechanical and thermal response as accomplished at baseline were obtained at 14 and 28 days after baseline on 60 subjects. A statistically significant reduction was not obtained in response to mechanical stimulus. The active dentifrice demonstrated a statistically significant reduction (P < 0.05) to thermal stimulus at both 14 and 28 days.
A Clinical and Histometric Study of Gingivitis Associated with the Human Deciduous Dentition
Authors: Bimstein E. , Lustmann J. , Soskolne W. A.
Published: March 2012

This study examined the relationship between clinical indices and the histologic parameters associated with the gingiva of the human deciduous dentition. The plaque index, gingival swelling and color, probing depth, bleeding on probing, contact with adjacent teeth and the degree of root resorption of 58 deciduous teeth were recorded. The teeth were extracted with their surrounding gingiva and prepared for histologic examination. The area of epithelium and connective tissue with and without inflammatory cells was measured as well as the epithelial length from the gingival margin including the junctional epithelium. When these measurements were grouped according to the values of the clinical indices, nonmobile teeth were found to have less epithelium than those with mobility and gingiva with a healthy color had a significantly smaller inflammatory cell infiltrate than red gingiva. Bleeding and increased probing depth were not associated with the other clinical signs of inflammation. The amount of plaque did not correlate with the measures of clinical inflammation. The inflammatory cell infiltrate was present irrespective of whether the gingiva was clinically normal or not and the inflammation did not correlate with the amount of plaque.
The Similarity of Periodontal Microorganisms between Husband and Wife Cohabitants: Association or Transmission?
Authors: Offenbacher Steven , Olsvik Bente , Tonder Aud
Published: March 2012

Fourteen married couples were studied to determine the degree of similarity of the periodontal subgingival flora between paired contralateral sites and between couples. Six sites per person were sampled by a subgingival lavage technique and 10 darkfield morphotypes enumerated at each site. Cross‐arch matching revealed a positive association for the presence of medium spirochetes, filaments, large motile rods and cocci (P < 0.05). The odds that medium spirochetes will be detected at a subgingival site are elevated 7‐fold, if present at the contralateral site. Similarly, the odds ratio for filaments was 4.0, 1.3 for large motile rods and 1.6 for cocci. Analysis of data, pairing between couples, revealed a positive association for medium spirochetes and filaments (P < 0.05). No significant associations were found for randomized pairs of couples using matched sites as controls. The odds of medium spirochetes being present in a patient are 3 times greater if the morphotype is present in the spouse and 30% greater for filaments. Although an individual is “at risk“ if these morphotypes are present in the spouse, analyses failed to demonstrate that the presence of any morphotype depends upon, or requires the presence of, that morphotype in the spouse.
Biologic Activity of Type I and Type II Fusobacterium nucleatum Isolates from Clinically Characterized Sites
Authors: Vincent Jack W. , Cornett Willy C. , Falkler William A. , Montoya Ralph G.
Published: March 2012

Fusobacterium nucleatum is a microorganism commonly cultured from periodontal disease sites. F. nucleatum isolates (120) were obtained from subgingival plaque samples taken from 27 clinically characterized sites using a selective culture medium. All isolates were verified by morphology, Gram‐stain reactions, oxygen tolerance and biochemical reactions. A total of eight clinical isolates and two typed strains were used for further evaluation. In this study, there was no relationship found between GI and probing depth or between probing depth and frequency of isolation of Type I or Type II F. nucleatum colonies. There was a significant increase in isolation of Type II colonies with a GI of 2 (P < 0.0001). All isolates tested shared lines of identity by double diffusion in agar and displayed similar ability to hemagglutinate sheep erythrocytes and a reduction in this hemagglutination activity by previous exposure to 50 dim d‐galactose. All isolates tested showed similar protein patterns as determined by Polyacrylamide gel electrophoresis. By the methods used, no differences were detected between Type I and Type II F. nucleatum; however, there was a statistically significant increase in Type II isolates with increasing levels of gingivitis.
The Stimulation of Human Peripheral Blood Lymphocytes by Solubilized Dental Plaque: Macrophage and T‐Cell Dependence
Authors: Baker John J. , Tondreau S. P.
Published: March 2012

This study compared the ability of human peripheral blood lymphocyte subpopulations from individuals with moderate periodontitis to proliferate in response to stimulation with solubilized dental plaque, phytohemagglutinin (PHA), pokeweed mitogen (PWM) and purified protein derivative (PPD). Unseparated mononuclear lymphocytes and recombined purified T and B lymphocytes (4/1) responded significantly to all of the stimulants. DNA synthesis in response to solubilized dental plaque was maximal after 6 to 7 days of culture; the optimum dose was usually 10 to 20 μg/ml. T lymphocyte subpopulations purified by rosetting with sheep red blood cells and density gradient centrifugation responded well to PHA and PWM, but were unresponsive to solubilized dental plaque and PPD unless supplemented with 2% autologous macrophages, demonstrating that T cell responses to solubilized dental plaque and to PPD are macrophage‐dependent. T cell‐depleted enriched B lymphocyte subpopulations were poorly responsive to all of the tested stimulants; however, the responses of these cells to solubilized dental plaque and to the known T cell‐dependent B cell mitogens PWM and PPD were increased significantly by the presence of 10% mitomycin C‐treated T cells, demonstrating that B cell proliferation to solubilized dental plaque is T cell‐dependent. Thus, cellular interactions between macrophages, T lymphocytes and B lymphocytes are required to obtain optimal proliferative lymphocyte responses to solubilized dental plaque. Since both T and B lymphocytes respond to dental plaque stimulants, they both have the potential to mediate periodontal inflammation and tissue destruction whenever dental plaque stimulants gain entrance into the periodontal tissues.
The Regeneration of Gingival Basement Membrane Antigens During Secondary Wound Healing
Authors: Peng T. K. , Nisengard R. J. , Levine M. J.
Published: March 2012

The reformation of basement membrane antigens was examined during healing following gingivectomy procedures. Three antigens, Type IV collagen, bullous pemphigoid antigen and epidermolysis bullosa acquisita (EBA) antigen, were identified by indirect immunofluorescent tests. While all three antigens could be identified in the healing wound within 2 days, the antigens regenerated at different rates. The bullous pemphigoid antigen reformed the earliest and extended furthest along the healing front of epithelium. The Type IV collagen reformed at an intermediate rate and the EBA antigen formed the slowest. These results confirm that these three antigens are different and suggest that the gingival basement membrane is a heterogeneous structure which contains elements that form at different rates during secondary wound healing.
Generalized Juvenile Periodontitis, Defective Neutrophil Chemotaxis and Bacteroides gingivalis in a 13‐Year‐Old Female
Authors: Wilson Mark E. , Zambon Joseph J. , Suzuki Jon B. , Genco Robert J.
Published: March 2012

Host immune responses and the predominant subgingival microflora were evaluated in a 13‐year‐old female exhibiting a severe form of generalized juvenile periodontitis. The patient's neutrophils were chemotactically depressed but exhibited a normal oxidative capacity. Serum IgG antibody to Bacteroides gingivalis and to Actinobacillus actinomycetemcomitans serotype c were elevated. Significantly, B. gingivalis constituted 8 to 16% of the cultivable microflora and 13 to 20% of the total cell count in subgingival plaque samples obtained from five out of five periodontally diseased sites examined. It was not detectable in a healthy site. A. actinomycetemcomitans was recovered in small numbers from all subgingival plaque samples taken. The present study provides additional evidence for an etiologic association between B. gingivalis and generalized juvenile periodontitis.
Healing of Spontaneous Periodontal Defects in Dogs Treated with Xenogeneic Demineralized Bone
Authors: Sonis Stephen T. , Williams Ray C. , Jeffcoat Marjorie K. , Black Richard , Shklar Gerald
Published: March 2012

This study was undertaken to histologically, clinically and radiographically evaluate the sequence of healing following implantation of bovine demineralized bone powder (DBP) into severe, spontaneous periodontal defects in beagle dogs. Eight dogs with documented severe periodontitis were treated surgically following initial debridement. One quadrant in each arch was treated with conventional flap surgery and the others were treated with surgery followed by DBP implantation. Animals received postoperative debridement and clinical and radiographic evaluation. Two dogs were sacrificed at 1, 3,6 or 12 months postoperatively, and the jaws were evaluated histologically. Clinically, DBP was well tolerated by recipients. No evidence of localized inflammatory response or delayed hypersensitivity reaction was noted. Significant reductions in gingival inflammation were noted in both experimental and control sites at 1 month postoperatively compared to preoperative scores. Equivalent periodontal pocket reduction was noted between test and experimental sites and remained significant at 12 months. Radiographically, no differences were noted in the rate of bone loss between control and test sites. Histologic evaluation demonstrated the presence of DBP at 1 month following implantation, but the material was replaced with new bone by the next sacrifice period. Periodontal ligament fibers of standard orientation were seen extending from DBP‐induced bone to the root surface by 1 month after implantation. An intact epithelial attachment appeared to be present 1 month after the implantation of DBP. No differences in root surfaces were detected between test and control groups. Ankylosis was a rare finding, noted equally between test and control sites. DBP did not appear to predispose to external root resorption. In later stages, histologic evidence of advancing periodontitis was noted equally in both control and experimental groups. While DBP successfully induced new bone formation, the inability to adequately maintain the periodontal tissues due to bacterial accumulation in this model combined with recurrent pocket formation, precluded any conclusion regarding long‐term advantage. Based on these findings, clinical trials of this or similar materials are recommended.
Phenothiazine—Another Possible Etiologic Agent in Erythema Multiforme
Authors: Rees Terry D.
Published: March 2012

A case report is presented which offers evidence that administration of a phenothiazine drug resulted in erythema multiforme of the oral cavity in a psychotic patient. The condition remissed after discontinuation of the medication.
Elimination of Epithelium from Healing Postsurgical Periodontal Wounds by Ultralow Temperature: Initial Observations
Authors: Tal Haim , Stahl S. Sigmund
Published: March 2012

Prevention of epithelial migration into healing postsurgical periodontal wounds may enhance connective tissue attachment. This study attempted to destroy selectively epithelium on gingival flap surfaces by ultra‐low temperature. Sixteen sites in four young adult cats received subcrestal reverse bevel incisions followed by sulcular incisions. Full thickness periodontal flaps were reflected, the remaining supracrestal soft tissue surrounding the teeth was removed, and exposed root surfaces were curetted. Narrow zones measuring about 4 mm along the coronal margins of the flaps were exposed to ultra‐low temperature for 5 seconds using a gas expansion cryoprobe cooled to ‐81°C and placed at the oral gingival aspects of the flaps. Flaps were then repositioned and sutured. Control sites were shamoperated with the cryoprobe kept at room temperature (25°C). Gingival biopsies were taken at 1 hour and at 2, 4, 8 and 12 days following surgery. Microscopically, 1‐hour postfreezing and control specimens appeared similar. At 2 and 4 days, large surface areas of corium were denuded of epithelium or were covered by necrotic debris. Mild inflammatory responses were noted within the corium. At 8 days, the epithelium almost completely covered the corium with some initial formation of crevicular epithelium. After 12 days, crevicular epithelium was observed in all tissue sections. No significant morphologic damage to the connective tissue was noted at any time. We, therefore, concluded that low cryodoses can effectively destroy oral gingival epithelium without causing significant morphologic damage to the underlying lamina propria at this level of observation.
Scanning Electron Microscope Evaluation of Wear of Dental Curettes during Standardized Root Planing
Authors: Tal Haim , Panno Joan M. , Vaidyanathan T. K.
Published: March 2012

Root planing relies upon the quality of instrument cutting edges. This study evaluated the sharpness and wear of some dental curettes available in the market following standardized root planing procedures. Nine working edges of nine Gracey No. 1/2 DE curettes, three each from three different manufacturers, were used as controls. These unused factory‐sharpened edges were examined by scanning electron microscope (SEM). Eighteen edges of nine curettes of the same brands were likewise examined after root planing procedures. Root planing was carried out on extracted one‐rooted teeth mounted in natural positions in manikin jaws. Working areas measuring 3 × 5 mm were marked on root surfaces previously exposed by periodontitis. Root planing procedures included (1) 15 vertical strokes done by either Side 1 or Side 2 of each instrument in relation to a single working area of a tooth, and (2) the same procedure repeated 3 times using the opposite side of the curette. All working edges were examined at points 1 and 2 mm from the tip under 500 times magnification. Edge deformation increased significantly from the control group to the “15stroke” group and from the “15‐stroke” group to the “45‐stroke” group. Factory‐sharpened curettes (control) were sharp, with functional wire edges present on 55% of the specimens. After 15 strokes, nonfunctional wire edges and narrow edge deformations with bevels measuring less than 15 μ were present. After 45 strokes eight cutting edges (88.9%) showed bevels wider than 15 μ. The difference between the three brands was not significant in any group (i.e., controls, 15 strokes, 45 strokes). Further study is indicated to evaluate the relationships between bevel dimensions and root planing effectiveness.
The Keyes Technique and Self‐inflicted Injuries
Authors: Austin Grace , Mesa Mayra , Lambert Clark
Published: March 2012

Three cases of self‐inflicted gingival injuries resulting fron the improper use of the Keyes technique are presented. The profession must assume responsibility for studies to determine the safety of the methods of application of the hydrogen peroxide, salt and baking soda mixtures and disseminate this information for the public interest.
Evaluation of Durapatite Ceramic as an Alloplastic Implant in Periodontal Osseous Defects: II. Twelve Month Reentry Results
Authors: Yukna Raymond A. , Harrison B. Geoffrey , Caudill Richard F. , Evans Gerald H. , Mayer Elizabeth T. , Miller Suzanne
Published: March 2012

Thirteen patients received Durapatite, a hydroxylapatite ceramic (Periograf®), as a bone implant material in various types of intrabony defects following internally beveled full thickness flaps, root planing, and defect debridement. All osseous margins and defects were measured from the cemento‐enamel junction (CEJ) at specific locations using a standardized periodontal probe. Similarly debrided, nonimplanted defects served as controls. Defect selection as either experimental or control site was based on an alternating defects design after local therapy was completed. Periodontal dressing and systemic tetracycline were used for 10 days. Postsurgical visits for documentation and plaque control were at 10, 20 and 30 days, and 3, 6, 9 and 12 months. Measurements relating to defect changes were made at the 12‐month surgical reentry. For evaluation purposes original defect depths were divided into three groups. In Group I (<3 mm) defect fill was 1.0 mm (47%) for the implanted defects and 0.3 mm (33%) for the control sites (significantly different at P < 0.05). In Group II (3– 6 mm) defect fill of 1.7 mm (44%) for implanted sites was significantly better (P < 0.05) than the 0.8 mm (29%) found in control sites. In the deepest group (Group III, >6 mm) Durapatite placement yielded 2.1 mm (32%) of defect fill while debridement alone resulted in 1.8 mm (26%) of fill (P > 0.05). Hard tissue responses demonstrated a substantial advantage for use of Durapatite over controls, while soft tissue changes were similar for both. The findings of this study indicate that Durapatite use resulted in greater fill of periodontal osseous defects than debridement alone at 1 year postsurgically. However, one must be cautious in comparing clinical studies of this type, and put small numerical differences even if statistically significant into proper biologic perspective. Furthermore, whereas the findings suggest that the use of Durapatite will generally be the better treatment in a given patient, it is not universally more beneficial. Occasionally, the debridement‐only defects outperformed or had similar results as the grafted areas.
Lactic Acid Production by Oral Streptococcus mitis Inhibits the Growth of Oral Capnocytophaga
Authors: Mashimo P. A. , Yamamoto Y. , Nakamura M. , Reynolds H. S. , Genco R. J.
Published: March 2012

Various relationships including inhibition or stimulation of growth have been demonstrated among the bacteria present in dental plaque, both in vitro and in vivo. A large number of these relationships involved oral Streptococci. An earlier study found that strains of Streptococcus mitis inhibited the growth of potential periodontopathic microorganisms, such as Actinobacillus actinomycetemcomitans, Capnocytophaga and species of Bacteroides and Fusobaclerium. The present investigation showed that this inhibitory effect resulted primarily from lactic acid production.
Intracellular Localization of Bacterial Lipopolysaccharide Using the Avidin Biotin Complex Method at the Electron Microscopic Level
Authors: Lucas Robert M. , Subramoniam Appian , Aleo Joseph J.
Published: March 2012

The intracellular localization in 3T6 fibroblasts of Escherichia coli lipopolysaccharide (LPS) using the rapid avidin‐biotin‐immunoperoxidase technique at the electron microscopic level was studied. The role of bacterial endotoxin in the etiology of periodontal disease has been well documented previously. The purpose of the present study was to localize LPS within the cell, thereby determining which organelles concentrate the material and relate this to the cytologic pathophysiology. An increased concentration of LPS was found in the cell nuclei and, specifically, in association with nuclear chromatin and nucleoli. The concentration of LPS in the nucleus was directly related to the time of incubation, with some product appearing in that site within 2 minutes. There was no specific localization of endotoxin in mitochondria, lysosomes, Golgi, endoplasmic reticulum or ribosomes. These results imply that bacterial endotoxin may have a direct effect on nuclear components of fibroblasts. The relationship of these results to the etiologic mechanisms of periodontal disease is discussed.
An Overview of a Conference on “Implications of Periodontal Research on Predoctoral Education”
Authors: Hutchens Luther H.
Published: March 2012

A conference on “The Implications of Periodontal Research on Predoctoral Education” was held in New Orleans on September 18, 1984, preceding the meeting of the American Academy of Periodontology. The conference was sponsored by the Academy and made possible by a grant from the Warner‐Lambert Company. Organizing the conference were Drs. Sebastian G. Ciancio, Chairman, Erwin Barrington, Peter Fedi, Leslie M. Salkin and Luther H. Hutchens, Jr. Presenting were Drs. Michael G. Newman, Sebastian G. Ciancio, Timothy J. O'Leary and Raul G Caffesse. Dr. Salkin served as moderator and Dr. Hutchens summarized the conference presentations. This synopsis is based upon that summary.
A 7‐Month Study of Sulcular Fluid Flow in the Assessment of Healing after Debridement of Deep Pockets
Authors: Hakkarainen Kristiina , Asikainen Sirkka , Ainamo Jukka
Published: March 2012

The purpose of this investigation was to assess the value of sulcular fluid flow (SFF) measurements in evaluation of the healing of deep periodontal pockets after scaling and root planing. Fourteen adult patients with advanced periodontal disease received supragingival prophylaxis and instructions in oral hygiene. Immediately after baseline examination, meticulous scaling and root planing were performed. One to five selected pockets per patient were monitored on Days 0, 30, 120 and 210. Subgingival microbial proportions, sulcular fluid flow, probing depth, Gingival Index and bleeding after probing were assessed and recorded. The subgingival microbial proportions were determined with darkfield microscopy.

The periodontal conditions were markedly improved by Day 210 as depicted by the microbial proportions. The proportion of motile micro‐organisms was reduced from 51 % at baseline to 9% on Day 30. This result was sustained until Day 210. Healing was also evident from the changes in Gingival Index scores and bleeding after probing. Probing depth was reduced from a mean of 8.3 to 4.5 mm.

Correlations between the individual means recorded for the clinical parameters and bacterial proportions were calculated for the pooled data of all four examinations. Sulcular fluid flow did not correlate with the clinical parameters: Gingival Index, bleeding after probing or probing depth. The latter three parameters correlated significantly with the microbial proportions and each other. When the pooled tooth surface recordings of Days 30, 120 and 210 were divided into two groups according to the proportion of motile bacteria (the group with < 18% of spirochetes and motile rods and the group with > 18% of spirochetes and motile rods), a significant difference in the mean amount of sulcular fluid flow (P < 0.01) and mean probing depth (P < 0.001) could be demonstrated between the two groups.
The Alteration in Gingival Basement Membrane Antigens in Chronic Periodontitis
Authors: Peng T. K. , Nisengard R. J. , Levine M. J.
Published: March 2012

The gingival basement membrane antigens, Type IV collagen, bullous pemphigoid antigen and epidermolysis bullosa acquisita antigen were studied by indirect immunofluorescence in 11 gingival specimens from patients with periodontitis and 2 normal gingival specimens. In the normal control gingival specimens, the antigens were all present and stained with a continuous linear pattern. In periodontitis, alterations occurred in the gingival basement membrane antigens in the apical portion of the pockets. These included thinning, interruptions, partial or complete absence involving one or more rete pegs and fragmentation. These alterations may result from the disease process or play a role in the pathogenesis.
Repair of an Extensive Periodontal Defect after Tetracycline Administration
Authors: Moskow Bemard S.
Published: March 2012

A pathologically migrated maxillary central incisor tooth with a poor periodontal prognosis was treated successfully with conventional periodontal therapy. After almost 4 years, an extensive periodontal lesion developed on the same tooth and extraction was recommended. The patient did not comply and the acute symptoms disappeared after the administration of 1 gm of Tetracycline a day for 2 weeks. Although no definitive periodontal therapy was done, complete resolution of the lesion occurred with healing of the structures of the periodontium and a dramatic reduction in mobility of the tooth. Antibacterial therapy could be an effective means of treating some periodontal lesions once a more exact and direct association is established between the various clinical forms of periodontitis and specific periodontal pathogens or groups of pathogens.
Coronal Positioning of Tissue Previously Treated with Freeze‐Dried Dura Mater Grafts
Authors: Cho Jun Young , Charbeneau Thomas D.
Published: March 2012

Root surfaces exposed to the oral environment may present a variety of problems to dental patients. Mucogingival surgical procedures represent one approach to the management of these concerns. Procedures currently in use often require two or three wounds, and sometimes two surgical sessions. Recent observations suggest that an allograft, freeze‐dried dura mater, may serve well as a donor material in mucogingival surgery. This report describes the use of coronally positioned flap procedures to treat residual areas of recession 4 years after placement of freeze‐dried dura mater allografts.
Faint in the Supine Position: Selective Review of the Literature and a Case Report
Authors: Milam Stephen B. , Giovannitti Joseph A. , Israelson Hilton
Published: March 2012

A case of faint occurred in a patient undergoing periodontal surgery with intravenous conscious‐sedation in the horizontal position. The faint occurred 3 hours and 40 minutes into the procedure, immediately following the extraction of a maxillary molar that could not be salvaged due to excessive bone loss. Since the patient was judged to be adequately sedated by both the operator and the anesthetist, the faint could not be attributed to anxiety. Recent evidence suggests that somatosensory stimulation of the trigeminal nerve may produce a reflex parasympathetic discharge that could account for some syncopal episodes observed during dental procedures.
An SEM Study of Overhang Removal Methods
Authors: Spinks Gary C. , Carson Robert E. , Hancock Everett B. , Pelleu George B.
Published: March 2012

The sonic scaler, the curet, and the reciprocating motor‐driven diamond tip were evaluated by comparing the number of rough root surfaces produced by each device in recontouring overhanging root‐surface margins of amalgam and composite resin restorations. Ninety extracted human teeth were restored with amalgam or composite resin so that overhangs were created. Each instrument was used to remove 30 overhangs. The root surfaces apical to the overhangs were photographed under the scanning electron microscope at a magnification of × 140 and compared by five dentists, in a single‐blind manner, with two control photomicrographs of surfaces classified as rough (treated with a coarse diamond bur) or not rough (treated with a greenstone). The number of rough responses for each instrument were compared statistically. For both restorative materials, the sonic sealer produced a significantly greater number of rough responses than did the other two instruments. Similar comparisons between the curets and the diamond‐tip system showed no significant differences. No differences in the number of gaps produced between restoration and tooth were noted among the instruments. Clinical ease of overhang removal was greatest for the reciprocating motor‐driven diamond tip and least for the curet. The approximate time to remove an overhang from a tooth was 3 minutes for the motor‐driven diamond tip, 7 minutes for the sonic sealer and 15 minutes for the curet.
A Comparison of Postoperative Pain Experience Following Periodontal Surgery Using Two Local Anesthetic Agents
Authors: Linden Eric Thomas , Abrains Herbert , Matheny James , Kaplan Alan L. , Kopczyk Raymond A. , Jasper Samuel J.
Published: March 2012

This controlled, double‐blind, split‐mouth study was designed to evaluate postoperative pain experience following periodontal surgery on 20 patients. Two commercially available local anesthetic agents, bupivacaine HCl and lidocaine HCl, were used. Periodontal surgeries were standardized to minimize differences in difficulty, extent and time. A patient questionnaire was used to collect data for the 24‐hour observation period following periodontal surgery. During this period, pain perception was assessed by visual analogue scales. The results indicated that when bupivacaine was used, there was less postoperative pain, fewer postoperative analgesics taken and a longer period of “numbness” (anesthesia) as compared to lidocaine. The patients expressed a strong preference for bupivacaine over lidocaine.
Healing Following Devitalization of Sites within the Periodontal Ligament by Ultralow Temperatures
Authors: Tal Haim , Stahl S. Sigmund
Published: March 2012

Healing of specific rat periodontal ligament (PDL) sites following freezing injury was monitored histologically to evaluate repair potentials of this tissue. Buccal alveolar plates supporting the first mandibular molar in 15 adult rats were surgically exposed. The coronal 3 mm of plate covering the buccal surface of the mesiobuccal root and underlying periodontal ligament and cementum were subjected to ultralow temperature using a gas expansion micro/cryoprobe, diameter 2 mm, cooled to ‐81°C for 5 seconds. Tissues were repositioned and sutured in layers. Animals were sacrificed at 1, 24 and 72 hours and at 2, 5 and 7 weeks following surgery and mandibles removed for histologic analysis. Microscopic evaluation of 24‐hour specimens showed loss of cellular vitality in the PDL, adjacent bone and cementum at experimental sites. Cellularity of the gingiva coronal to the crest, and of the PDL apical to the experimental zone, appeared to be within normal limits. Transition between experimental and nonexperimental sites was abrupt. After 72 hours cells from the PDL and gingiva appeared to migrate into and repopulate the noncellular PDL. Few capillaries surrounded by mesenchymal cells and limited polymorphonuclear neutrophil infiltration were observed within the injured PDL site. Marginal gingival inflammation was minimal. At 14 days, collagen lysis, resorption of alveolar bone and root resorption were evident. In the PDL space, nonfunctionally oriented, cellular connective tissue elements were abundant. At 5 and 7 weeks, root resorption was marked. At this time interval, Osteogenesis at seams of nonvital bone, repair cementum at sites of root resorption, and at times, ankylosis, were noted.

Thus, cryosurgery devitalizes cells in predetermined areas in the PDL without causing significant morphologic changes in the periodontium. However, since healing following freezing injury may not be identical to that observed after standard surgery, the histologic sequences described in this study must be considered preliminary. On the other hand, freezing injury may be of value to further study PDL repair potential since this insult does not alter the gross morphology at the injured site.
Ridge Augmentation under Existing Fixed Prosthesis: Simplified Technique
Authors: Miller Preston D.
Published: March 2012

A simplified surgical technique for ridge augmentation using a subepithelial connective tissue graft is presented. Ten patients demonstrating moderate Type B and mild Type C ridge deficiencies were treated. Six had existing fixed restorations, while four patients were later restored. The simplified surgical technique uses only one vertical incision with the creation of a “tunnel” between the soft tissue and bone. The subepithelial connective tissue graft, taken from the palate, is inserted into this “tunnel” for ridge augmentation. The technique lends itself to management of ridge defects under existing restorations.
Interproximal Gingival Inflammation Related to the Conversion of a Bleeding to a Nonbleeding State
Authors: Amato Richard , Caton Jack , Poison Alan , Espeland Mark
Published: March 2012

Elimination of gingival bleeding has been related to a reduction in inflammation; however, histologic data are not available to support this association. The purpose of this study was to characterize the histology of interproximal gingiva that was converted from a bleeding to a nonbleeding state. An interproximal gingival biopsy was obtained from each of 32 patients, 15 of whom bled upon stimulation with a soft wooden interdental cleaner. The remaining 17 biopsies were obtained from sites which initially bled, but were converted to nonbleeding by scaling and interproximal plaque control. Specimens were processed for light microscopic evaluation and subjected to a morphometric analysis for various tissue components. Data from bleeding and “stopped bleeding” specimens were compared using analysis of covariance. The results indicated that “stopped bleeding” specimens had significantly less inflamed connective tissue. It was concluded that the conversion of a bleeding to a nonbleeding state corresponds with a histological reduction in the magnitude of the interproximal inflammatory lesion and provides a rationale, therefore, for the use of bleeding to monitor the effects of therapeutic methods.
The Impact of Research on Scaling and Root Planing
Authors: O'Leary Timothy J.
Published: March 2012

The research expanding our knowledge of the periodontally involved root surface and its treatment is reviewed. To improve communication in the clinic and classroom, definitions are suggested for the terms “scaling” and “root planing.” The objectives and limitations of root planing procedures are discussed.