bluuebunny/crossref_metadata_2025 huggingface dataset:
Adjunctive Benefits of Subantimicrobial Dose Doxycycline in the Management of Severe, Generalized, Chronic Periodontitis
Authors: Novak M. John , Johns Lee P. , Miller Renee C. , Bradshaw Mark H.
Published: February 2005

Background: Severe, generalized periodontitis is a form of chronic periodontitis that appears to be associated with an exaggerated host response. Little information is available on the benefits of using adjunctive host modulation in the management of this form of periodontal disease.

Methods: Thirty subjects ≤ 45 years of age with severe, generalized periodontitis received subgingival debridement and oral hygiene instructions each week for 4 weeks, plus 6 months of adjunctive subantimicrobial doxycycline (SDD) or placebo. Periodontal status was monitored at baseline, and at 1, 3, 5.25, and 8.25 months following completion of the hygiene sessions. Maintenance therapy was performed at 3, 5.25, and 8.25 months for both groups.

Results: Ten subjects in each group completed all phases of the study. Subgingival debridement plus adjunctive SDD reduced deep pockets (≥7 mm at baseline) by an average of 3.02 mm after 9 months versus 1.42 mm for the placebo group. A significant clinical response was seen in both groups as soon as 1 month, but the response was always clinically and statistically greater in the SDD group. In the SDD group, nearly 40% of 237 pockets 27 mm were reduced by ≥4 mm, and 55% were reduced by ≥3 mm. In addition, only 2 pockets deepened by ≥4 mm in the SDD group versus 10 in the placebo group.

Conclusions: The supplementation of hygienist‐delivered full mouth subgingival and supragingival debridement with a hostmodulating agent, SDD, provides clinically and statistically significant benefits in the reduction of deep pockets in patients with severe, generalized periodontitis. In addition, adjunctive SDD is more effective than a placebo in preventing further increases in probing depth. J Periodontol 2002;73:762‐769.
Six‐Month Comparison of Powered Versus Mannual Toothbrushing for Safety and Efficacy in the Absence of Professional Instruction in Mechanical Plaque Control
Authors: Dentino Andrew R. , Derderian Gay , Wolf MaryAnn , Cugini MaryAnn , Johnson Randy , Van Swol Ronald L. , King Dennis , Marks Pam , Warren Paul
Published: February 2005

Background: Reports suggest powered toothbrushing may provide some clinical benefit over manual toothbrushing, but most studies have been of short duration with subjects trained in toothbrush use. The aim was to determine if the oscillating‐rotating powered brush (PB) could safely provide clinical benefits over and above a manual brush (M) in subjects with no formal instruction or experience in powered brush use.

Methods: This 6‐month, single‐masked, parallel design, randomized clinical trial compared the PB with an American Dental Association (ADA)‐accepted soft‐bristle manual brush in a non‐flossing gingivitis population (n = 157). Subjects were given written instructions but no demonstration on toothbrush use at baseline. Efficacy was assessed by changes in gingival inflammation, plaque, calculus, and stain, while changes in clinical attachment levels and recession measurements provided safety data. A prophylaxis was provided after baseline assessment. The 6‐month plaque index (PI) was recorded immediately post‐brushing after covert timing of the subjects, and correlation analyses were run to assess the relationship of brushing time to PI. Paired t tests, analysis of variance (ANOVA), and analysis of covariance (ANCOVA) were used to assess within and between treatment group differences for PB (n = 76) versus M groups (n = 81).

Results: Measures of inflammation showed a statistically significant drop for both brushes at 3 and 6 months. Mean overnight full‐mouth PI scores were significantly lower at 3 months for the PB (1.57) compared to the M group (1.80), P = 0.0013. Immediate post‐brushing PI at 6 months was also significantly lower for the PB (1.10) versus M (1.39) (P = 0.0025). There was an overall negative correlation for PI and brushing time (r = ‐0.377, P = 0.0001). Mean calculus index (CI) scores were lower for the PB at 3 (P = 0.0304) and 6 months (P = 0.0078), while no significant differences in stain were observable. Clinical attachment level and recession measurements showed no significant between‐group changes from baseline for either brush on canine teeth or on teeth with recession at baseline.

Conclusion: The oscillating‐rotating toothbrush safely provides clinical benefits in plaque and calculus reduction over a manual brush even in subjects with no formal oral hygiene instruction. J Periodontol 2002;73:770‐778.
Enamel Matrix Derivative and Bone Healing After Guided Bone Regeneration in Dehiscence‐Type Defects Around Implants. A Histomorphometric Study in Dogs
Authors: Casati Marcio Z. , Sallum Enilson A. , Nociti Francisco H. , Caffesse Raul G. , Sallum Antonio Wilson
Published: February 2005

Background: The goal of this investigation was to histometrically evaluate the effect of enamel matrix derivative (EMD) on bone healing after guided bone regeneration (GBR) in dehiscence‐type osseous defects around dental implants; i.e., in the absence of periodontal ligament cells.

Methods: Six mongrel dogs were used. The second, third, and fourth mandibular premolars (p2, p3, and p4) and first molars (ml) were extracted. After 3 months, 2 implant osteotomies were prepared in each side of the mandible, dehiscence‐type defects were created on the buccal aspect of each implant osteotomy (3.5 mm × 5.0 mm), and titanium implants were placed (3.75 mm × 8.5 mm). The surgically‐created defects were randomly assigned to one of the treatments: EMD, GBR, EMD+GBR, or control. After 2 months, 4 additional defects were created and treated. The animals were sacrificed 3 months after the placement of the first implants, thus allowing the healing periods of 1 and 3 months. Undecalcified sections were obtained for the histometric evaluation including the percentage of bone‐to‐implant contact and new bone area on the implant threads related to the defect.

Results: No statistically significant differences were observed among the groups in the evaluated parameters after 1 month of healing. After 3 months, no statistically significant differences were observed among the groups for the percentage of bone‐to‐implant contact. The values for the new bone area were: 55.5 ± 11.8, 53.8 ± 16.3, 62.1 ± 18.4, and 36.9 ± 25.1 for EMD, GBR, EMD+GBR, and control, respectively. The difference between EMD+GBR and control was statistically significant (P < 0.05).

Conclusions: Within the limits of this study, it can be concluded that EMD may positively influence bone healing after GBR around titanium implants. EMD alone, however, had no statistically significant effect. J Periodontol 2002;73:789‐796.
Severe Periodontitis in Marfan's Syndrome: A Case Report
Authors: Straub Antje M. , Grahame Rodney , Scully Crispian , Tonetti Maurizio S.
Published: February 2005

Background: Connective tissue disorders, such as some forms of Ehlers‐Danlos syndrome, have been associated with severe periodontitis.

Methods: This report describes a case of Marfan's syndrome, an inherited disorder of connective tissue caused by mutations in the fibrillin‐1 gene, in which the patient presented with severe periodontitis.

Results: At examination, an average full‐mouth clinical attachment level loss of 5.6 ± 2.1 mm, furcation involvement, and severe alveolar bone loss were observed in a 41‐year‐old Caucasian male. Tooth hypermobility was also present.

Conclusions: This case appears to be the first documentation of severe periodontitis in a patient with Marfan's syndrome. It supports the hypothesis that a variety of connective tissue disorders may confer increased susceptibility to periodontal tissue breakdown. J Periodontol 2002;73:823‐826.
Frequency of Reactivity for Porphyromonas gingivalis and Prevotella spp. in Supraand Subgingival Plaques, and Periodontal Clinical Parameters According to Subject Age
Authors: Tanaka Shoji , Murakami Yukio , Ogiwara Takako , Shoji Masao , Seto Kazuhito , Nagasaki Masahumi , Fujisawa Seiichiro
Published: February 2005

Background: The present study was conducted to assess the association between selected clinical parameters and the distribution of Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Prevotella nigrescens (Pn), and Prevotella melaninogenica (Pm) in supra‐ and subgingival plaque samples measured by an immunoslot blot assay (IBA) using their monoclonal antibodies.

Methods: Plaque samples from 299 patients aged 6 to 69 randomly chosen from a group of dental outpatients were examined. Plaque index, gingival index, and probing depths were evaluated according to the criteria of positive (cell number ≥106) or negative (<106) reactivity to the 4 different monoclonal antibodies.

Results: An increase in probing depth in subjects exhibiting either a positive or negative reaction for the 4 test bacteria was associated with increasing age. Comparing bacteria‐positive subgingival plaque samples to their corresponding bacteria‐negative counterparts, we found an increased plaque index in children positive for any of the 4 bacteria; in addition, that for Pg and Pi was increased in subjects 40 to 49 years old. The gingival index increased with increasing amount of Pi and Pn, but not with Pg and Pm in those 20 to 29 years of age. The frequency of Pg reactivity in subgingival plaque was markedly enhanced in subjects older than 30 to 39 years of age, and was significantly higher than that in supragingival plaque. The frequency of Pi and Pn reactivity was significantly increased in adults aged 20 to 29 and plateaued at older ages. The frequency of Pm reactivity was relatively low and independent of subject age.

Conclusions: The increase in probing depth with increasing age was not affected by the occurrence of periodontopathic bacteria. The high rate of occurrence of Pg, together with Pi and Pn, in subgingival plaque of the adult age groups was suggested to be associated with the high frequency of periodontal disease in the older age groups (above 30 to 49 years of age). The IBA appears to be useful for the efficient and rapid detection of periodontopathic bacteria. J Periodontol 2002;73:877‐885.
Periodontal Therapy May Reduce the Risk of Preterm Low Birth Weight in Women With Peridotal Disease: A randomized Controlled Trial
Authors: López Néstor J. , Smith Patricio C. , Gutierrez Jorge
Published: February 2005

Background: Recent studies have suggested that periodontal disease is a risk factor for preterm low birth weight (PLBW). A randomized controlled trial was undertaken to help further evaluate the proposed association between periodontal disease and PLBW.

Methods: Four hundred pregnant women with periodontal disease, aged 18 to 35, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned to either an experimental group (n = 200), which received periodontal treatment before 28 weeks of gestation or to a control group (n = 200) which received periodontal treatment after delivery. Previous and current pregnancies and known risk factors were obtained from patient medical records and interviews. The primary outcome assessed was the delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g.

Results: Of the 400 women enrolled, 49 were excluded from the analyses for different reasons. The incidence of PLBW in the treatment group was 1.84% (3/163) and in the control group was 10.11% (19/188), (odds ratio [OR] 5.49, 95% confidence interval [CI] 1.65 to 18.22, P = 0.001). Multivariate logistic regression analysis showed that periodontal disease was the strongest factor related to PLBW (OR 4.70, 95% CI 1.29 to 17.13). Other factors significantly associated with such deliveries were: previous PLBW (OR 3.98, 95% CI 1.11 to 14.21), less than 6 prenatal visits (OR 3.70, 95% CI 1.46 to 9.38), and maternal low weight gain (OR 3.42, 95% CI 1.16 to 10.03).

Conclusions: Periodontal disease appears to be an independent risk factor for PLBW. Periodontal therapy significantly reduces the rates of PLBW in this population of women with periodontal disease. J Periodontol 2002;73:911‐924.
Characterization of Bone Defect Repair in Young and Aged Rat Femur Induced by Xenogenic Demineralized Bone Matrix
Authors: Torricelli Paola , Fini Milena , Giavaresi Gianluca , Rimondini Lia , Giardino Roberto
Published: February 2005

Background: The osteoinductive effect of some biomaterials could be affected by those systemic conditions typical of old age. The aim of the present paper was to assess the effects of age on the healing of bone defects treated with demineralized bone matrix (DBM).

Methods: The study was conducted in young (3 month old) and aged (18 month old) rats to assess the efficacy of DBM in the treatment of osseous defects in bone with limited repair capacities. A standard bone defect was created in the distal femoral condyles of male Wistar rats: the left condyle was filled with rabbit DBM granules, while the right condyle was left empty (control). Histological and microhardness analyses were performed at 30 and 45 days after implant surgery.

Results: After implantation of xenogenic DBM, bone healing areas of the aged and young groups showed a significant increase in the formation of newly mineralized bone relative to controls. Measurements of trabecular thickness on day 45 revealed no differences between newly formed and preexisting bone in the young group, while control values were lower. Microhardness measurements demonstrated that newly mineralized bone, either induced by DBM or not, and preexisting bone were comparable in terms of trabecular hardness after 45 days.

Conclusions: In conclusion, xenogenic DBM seems to be effective in bone defect healing, since it increases mineralized tissue volume. In both DBM‐filled and empty sites, age seems to have a detrimental effect on the volume of new bone formation but no influence on bone maturation. J Periodontol 2002;73:1003‐1009.
Evaluation of Non‐Surgical Periodontal Treatment Using 2 Time Intervals
Authors: Eren Kürşad S. , Gürgan Cem A. , Bostanci Hamit S.
Published: February 2005

Background: The aim of the present study was to evaluate the effectiveness of non‐surgical mechanical instrumentation at 2 different time intervals on short‐term healing and to assess patient reactions following non‐surgical periodontal therapy.

Methods: The study population consisted of 100 patients with moderate periodontal disease. Patients were equally distributed into 2 groups, treated daily or weekly. The daily group received full‐mouth daily scaling and root planing for 4 consecutive days. The weekly group was treated once a week for 4 weeks. All patients were asked for objective (lymphadenopathy, aphthous stomatitis, and edema) and subjective (fatigue, pain, pruritus, burning sensation, and dentinalgia) reactions. Clinical measurements of plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing (BOP), and gingival recession (GR) were taken at baseline and 3 months after treatment. All of the objective and subjective reactions were recorded after each treatment session.

Results: The results of our study revealed a significant decrease in PI, GI, BOP, and PD measurements at the end of the third month, but no significant changes in GR. The incidence of subjective and objective reactions was higher in the daily treated group compared to those in the weekly group. Most of these complaints were observed after the third treatment session.

Conclusions: Within the limits of this study, no differences were observed between the study groups when the clinical parameters were evaluated. However, taking the subjective and objective reactions into consideration, the smallest time interval for non‐surgical periodontal procedures might be 1 week. J Periodontol 2002;73:1015‐1019.
Histocompatible Healing of Periodontal Defects After Application of an Injectable Calcium Phosphate Bone Cement. A Preliminary Study in Dogs
Authors: Shirakata Yoshinori , Oda Shigeru , Kinoshita Atsuhiro , Kikuchi Shigenari , Tsuchioka Hiroaki , Ishikawa Isao
Published: February 2005

Background: A novel injectable, fast setting calcium phosphate cement (CPC) is currently used in orthopedic therapy for bone fractures. This study evaluated the possibility of applying this cement to healing periodontal defects.

Methods: Fenestrations and 3‐walled periodontal defects were surgically created on bilateral first molars and canines in 5 beagle dogs. CPC was applied to the defects on one side of the mandible. Untreated defects on the contralateral side served as controls. CPC was applied to all defects in the maxilla. Twelve weeks after surgery, the animals were sacrificed and decalcified and undecalcified specimens were prepared. Periodontal tissue healing was evaluated histologically and histometrically under a light microscope.

Results: Healing of periodontal tissues in terms of bone and cementum formation was consistently observed in the CPCapplied sites. CPC was partly replaced by new bone. The residual CPC appeared detached from the denuded root surface. New cementum and periodontal ligament‐like tissue were observed between the detached CPC and root surface. No unfavorable reaction was noted in the CPC‐applied sites. No statistically significant difference was noted in the experimental or control sites under histometric analysis.

Conclusions: Although there were no statistically significant differences between the 2 treatment groups, histological observation indicated that CPC seemed to act as a scaffold for bone formation and provided histocompatible healing of periodontal tissues in this study. This cement might be applicable to periodontal therapy; however, further investigations are required. J Periodontol 2002;73:1043‐1053.
Root Coverage With Connective Tissue Grafts: An Evaluation of Short‐ and Long‐Term Results
Authors: Harris Randall J.
Published: February 2005

Background: Subepithelial connective tissue grafts have been shown to be effective in obtaining root coverage. However, little is known about the long‐term results. The goal of this study was to evaluate and compare the short‐term (13.0 weeks) and long‐term (27.5 months) root coverage results obtained with subepithelial connective tissue grafts.

Methods: One‐hundred patients with 146 Miller Class I or Class II recession defects were treated with subepithelial connective tissue grafts to obtain root coverage. The changes in the clinical measurements were compared between the preoperative and short‐term results, between preoperative and longterm results, and between short‐term and long‐term results.

Results: The mean root coverage at 13.0 weeks was 97.1% and 98.4% at 27.5 months. This difference was statistically significant. There was a statistically significant decrease in recession and probing depth, reduction in attachment loss, and increase in quantity of keratinized tissue between the preoperative and short‐term results and between the preoperative and long‐term results. There was a statistically significant decrease in recession, increase in the quantity of keratinized tissue, increase in probing depth, and increase in attachment loss between short‐term and long‐term results.

Conclusions: The results of this study demonstrate that the subepithelial connective tissue graft is an effective method to cover exposed roots. The mean root coverage tended to improve with time. J Periodontol 2002;73:1054‐1059.
Comparison of 2 Retentive Systems for Implant‐Supported Overdentures: Soft Tissue Management and Evaluation of Patient Satisfaction
Authors: Karabuda Cuneyt , Tosun Tosun , Ermis Evren , Ozdemir Tayfun
Published: February 2005

Background: The aim of the present study was to compare the peri‐implant soft tissue health status of implants supporting overdentures with bar attachments or ball attachments in the mandible, as well as patient satisfaction with these attachment types.

Methods: The study included a Dolder bar group with 18 cases (43 implants) and a ball attachment group with 18 cases (51 implants). The mean function period in the Dolder bar group was 49 months (range: 12 to 72 months) and in the ball attachment group, the mean was 23 months (range: 12 to 40 months). Implants were clinically evaluated by using a modified plaque index (mPI), modified sulcus bleeding index (mSBI), and probing depths. Patient satisfaction with the treatment was recorded using a questionnaire.

Results: mPI, probing depth, and mSBI did not statistically differ between groups (Mann‐Whitney U test, P >0.05). Patient satisfaction was similar with both retentive systems.

Conclusion: Within the limits of this study, we concluded that there was no significant difference between the 2 attachment types used for implant‐supported overdentures with respect to the soft tissue health status or patient satisfaction. J Periodontol 2002;73:1067‐1070.
The Applicability of Half‐Mouth Examination to Periodontal Disease Assessment in Untreated Adult Populations
Authors: Dowsett Sherie A. , Eckert George J. , Kowolik Michael J.
Published: February 2005

Background: Data from whole‐mouth examinations are the gold standard for accurate assessment of periodontal disease. Since periodontal destruction exhibits left‐right symmetry, however, it is hypothesized that a half‐mouth exam provides an appropriate alternative to whole‐mouth assessment, with considerable advantage over a more limited partial‐mouth assessment of index teeth.

Methods: Data from 2 untreated populations were utilized in the analyses. Half‐mouth (random diagonal quadrants) and Ramfjord teeth assessment was compared with whole‐mouth assessment as follows. Intraclass correlation coefficients (ICCs) were calculated for mean plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) and for percentage of sites with PD ≥4, 5, or 6 mm; CAL ≥3, 4, 5, or 6 mm; and recession ≥3 mm to determine the agreement between the whole‐ and partial‐mouth assessment. Disease prevalence was also determined for both whole‐ and partialmouth assessments.

Results: For mean PI, GI, PD, and CAL, both half‐mouth and Ramfjord teeth assessment provided an acceptable alternative to whole‐mouth assessment (ICCs >0.92). For percentage of sites above a specified threshold, ICCs were generally greater than 0.90 in all age cohorts for half‐mouth assessment, but consistently lower for Ramfjord teeth assessment. Ramfjord teeth assessment also considerably underestimated disease prevalence compared with half‐mouth assessment.

Conclusions: These results support the use of a half‐mouth examination procedure, to conserve time, limit cost, and reduce patient and examiner fatigue while providing maximal clinical information. Ramfjord teeth assessment was not as suitable for evaluation of either disease extent or prevalence. J Periodontol 2002;73:975‐981.
The Role of Cigarette Smoking in the Association Between Periodontal Disease and Coronary Heart Disease
Authors: Hyman Jeffrey J. , Winn Deborah M. , Reid Britt C.
Published: February 2005

Background: Cigarette smoking is a significant risk factor for both coronary heart disease and periodontal disease. The goal of this study was to better understand the role of smoking in the relationship between periodontal disease and heart attack history.

Methods: The study population consisted of 5,285 participants in the Third National Health and Nutrition Examination Survey (NHANES) during 1988‐1994 and who were age 40 years or older when examined. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES.

Results: After adjustment for potential confounders, we only found significant associations between periodontal loss of attachment (LOA) and heart attack history for smokers, with odds ratios and 95% confidence interval (CI) of 2.64 (1.48 to 4.71), 3.84 (1.22 to 12.10) and 5.87 (1.91 to 18.00) for those with 2.0 to 2.99, 3.0 to 3.99, and 4 mm or more mean LOA, respectively. When the analysis was stratified by smoking status and tertile of age at heart attack, the statistically significant associations were limited to smokers who had a heart attack between the ages of 25 and 50 years, with odds ratios and 95% CI associated with increasing mean LOA for this group of 3.29 (1.35 to 8.04), 7.32 (1.60 to 33.51), and 8.04 (1.91 to 18.00), respectively.

Conclusions: These results suggest that cigarette smoking is a necessary cofactor in the relationship between periodontal disease and coronary heart disease, and the increase in risk appears to be age dependent. However, the key role played by smoking in the etiology of both periodontal and heart diseases makes it difficult to determine how much of the observed association resulted from periodontal disease. J Periodontol 2002;73:988‐994.
Defect‐Determined Regenerative Options for Treating Periodontal Intrabony Defects in Baboons
Authors: Blumenthal Neil M. , Alves Mario E.A.F. , Al‐Huwais Salah , Hofbauer Ann Marie , Koperski Rebecca D.
Published: February 2005

Background: In an effort to regenerate periodontal intrabony defects, the healing potential of the defect should determine what therapeutic modalities and materials are employed. The purpose of this study was to compare regenerative outcomes in baboon intrabony defects that were contained versus non‐contained, using various regenerative therapies.

Methods: Nine adult baboons (Papio anubis) in good health were treated. Eighty‐six interproximal, intrabony defects were surgically created: 43 contained by 3 walls of bone; 43 non‐contained with a missing buccal wall. Chronicity and plaque accumulation were encouraged with wire ligature placement for 8 weeks. After ligature removal, scaling, and a 2‐ to 4‐week healing period, the defects were treated with the following therapies: collagen membrane (GTR), human demineralized freeze‐dried bone (DFDB) grafting (BG), combined therapy (GTR + BG) and a DFDB‐glycoprotein sponge matrix (MAT). Clinical healing responses were evaluated in 58 sites by changes in soft tissue (recession, probing, clinical attachment) and hard tissue (resorption, defect fill) parameters 6 months post‐treatment. Histologic evaluation (defect regeneration, connective tissue attachment, epithelial migration) was done on 26 sites.

Results: For contained defects, no real significant clinical (ANOVA) or histologic differences existed among treatments. However, for noncontained defects, combined therapy (GTR + BG) demonstrated clinically significant (P ≤0.05, ANOVA) and histologically superior healing results over the other therapies tested.

Conclusion: These results confirm a defect morphology directed rationale for periodontal intrabony therapy. J Periodontol 2003;74:10‐24.
Perspective of Cytokine Regulation for Periodontal Treatment: Fibroblast Biology
Authors: Takashiba Shogo , Naruishi Koji , Murayama Yoji
Published: February 2005

Efforts to understand the pathogenesis of periodontal diseases have been underway for decades. Studies of immunological aspects in addition to the structural components of gingival fibroblasts showed that the fibroblasts actively participate in immune and inflammatory events in periodontal diseases. Future strategies for the prevention and treatment of periodontal diseases should biologically regulate fibroblast activities. These cells are surrounded by monocyte‐derived proinflammatory cytokines such as interleukin‐1 beta (IL‐1β), tumor necrosis factor‐alpha (TNF‐α), and lymphocyte‐derived interleukin‐6 (IL‐6) in inflamed gingival tissue. Recent anti‐cytokine therapy for inflammatory diseases including rheumatoid arthritis aimed to inhibit the binding of cytokines to targeted cells such as fibroblasts and condrocytes. IL‐1β and TNF‐α are thought to be therapeutic targets because these cytokines are essential for the initiation of inflammatory immune reactions and are produced for prolonged periods in inflammatory diseases. IL‐6 is also a target, because it is abundantly present in inflammatory lesions and activates fibroblasts in the presence of soluble IL‐6 receptor. In addition, these cytokines accelerate gingival fibroblasts to produce collagenolytic enzymes, resulting in tissue destruction. Soluble receptors for IL‐1β and TNF‐α are suggested to be candidates for therapeutic molecules, but soluble receptor for IL‐6 is suggested to be a factor‐stimulating fibroblast. This paper will review the utilization of soluble receptors specific to inflammatory cytokines which potentially stimulate fibroblasts to regulate biological events involved in the pathogenesis of periodontal diseases. J Periodontol 2003;74:103‐110.
Characterization of Biologically Active Cell Surface Components of a Periodontal Pathogen. The Roles of Major and Minor Fimbriae of Porphyromonas gingivalis
Authors: Umemoto Toshio , Hamada Nobushiro
Published: February 2005

Background: We previously reported that the presence of 2 different types of fimbriae expressed on the cell surface of Porphyromonas gingivalis ATCC 33277. The initial event in most infectious diseases involves adhesion of pathogens to host tissues and subsequent invasion by the pathogens. To define the role of fimbriae in Porphyromonas gingivalis adherence to and invasion of epithelial cells, we have constructed fimbrial mutants. The involvement of P. gingivalis fimbriae in the invasion process and alveolar bone resorption in rats was examined.

Methods: Inactivated mutants of 41‐K fimbrillin gene (fimA) and/or the 67‐K fimbrillin gene (mfa1) were constructed by a homologous recombination technique and compared among fimA mutant (MPG1), mfa1 mutant (MPG67), and double knockout mutant (MPG4167). Adherence and invasion of P. gingivalis was assessed in human oral epithelial KB cells. We used a rat model to examine the role of each type of fimbriae in alveolar bone loss by oral infection.

Results: The adherence and invasion levels of the mutants were lower than the wild‐type strain. The bone loss of rats infected with the MPG1 was higher than that of those infected with MPG67. Moreover, the bone loss of rats infected with the double knockout mutant was significantly decreased compared to that of rats infected with the wild‐type strain.

Conclusions: Data from this study suggest that not only the 41‐K fimbrial protein, but also the 67‐K fimbrial protein, play important roles in the pathogenesis of periodontal disease. J Periodontol 2003;74:119‐122.
Long‐Term Results of Guided Tissue Regeneration Therapy in the Treatment of Class II Furcation Defects: A Randomized Clinical Trial
Authors: Cury P.R. , Sallum E.A , Nociti F.H. , Sallum A.W. , Jeffcoat M.K.
Published: February 2005

Background: The purpose of this study was to evaluate the results after guided tissue regeneration (GTR) using a bioabsorbable membrane in Class II furcation defects in mandibular molars over a 24‐month period.

Methods: Nine patients with 2 comparable Class II furcation defects were included. The defects in each patient were randomly assigned to either test (GTR) or control (open flap debridement) group. Clinical measurements and standardized radiographs were taken at baseline, and at 6, 12, 18, and 24 months. The radiographs were analyzed by subtraction radiography.

Results: There were significant probing depth reductions for both test and control groups (P <0.007, P <0.0005, respectively); however the differences between groups were not significant at any examination. The intra‐group and inter‐group differences in the vertical clinical attachment level gain were not significant (P >0.05). Over 24 months, a significant horizontal clinical attachment level gain was observed in the test group compared to control (P <0.03). In the test group, 2 sites showed complete closure, one was converted to Class I, and one tooth was lost due to root resorption. In the control group, 2 defects progressed to Class III over 24 months. At 6 months, the test group showed 0.14 mm of bone loss while the control group showed 0.86 mm of bone gain (P = 0.035). The inter‐group differences were not significant at 12, 18, and 24 months. A significant bone height gain was observed in the test group at 24 months when compared to the values obtained after 6 months (P = 0.015).

Conclusion: GTR may provide a greater horizontal clinical attachment level gain with the possibility of complete closure of some defects and stability over time. J Periodontol 2003;74:3‐9.
Cyclosporin A‐Induced Gingival Overgrowth in Renal Transplant Patients
Authors: Afonso Mônica , Bello Vilber de Oliveira , Shibli Jamil Awad , Sposto Maria Regina
Published: February 2005

Background: The incidence of gingival overgrowth (GO) associated with the use of cyclosporin A (CsA) is controversial. In the present study, we determined the incidence of GO in Brazilian renal transplant patients treated with CsA and the possible associations between periodontal and pharmacological variables.

Methods: The test group consisted of 20 renal transplant patients, and the control group included 20 non‐transplant patients. Periodontal conditions were evaluated based on the plaque index (PI), gingival index (GI), probing depth (PD), and the rate of gingival overgrowth, together with pharmacological variables (daily CsA dose and duration of treatment).

Results: A significant difference in PI (P<0.0001) and PD P<0.0001) was observed between groups, while GI (P = 0.15) did not differ significantly. Using the Pearson correlation coefficient, a significant correlation was observed not only between GI (P<0.001; = 0.8141) and GO, but also for PD (P<0.001; r = 0.866) and GO. The other correlations were not statistically significant.

Conclusions: We conclude that GO induced by CsA may vary according to the individual sensitivity of each patient and may or may not be correlated with other local factors (periodontal variables). J Periodontol 2003;74:51‐56.
Effects of Selective Cyclooxygenase‐2 Inhibition on Gingival Tissue Levels of Prostaglandin E2 and Prostaglandin F2α and Clinical Parameters of Chronic Periodontitis
Authors: Vardar Saynur , Baylas Haluk , Huseyinov Afig
Published: February 2005

Background: The purpose of the present study was to evaluate the effect of a relatively selective cyclooxygenase (COX)‐2 inhibitor (nimesulide) and non‐selective COX‐1/COX‐2 inhibitor (naproxen) used as an adjunct to non‐surgical (scaling and root planing [SRP]) periodontal therapy in chronic periodontitis patients on the gingival tissue (GT) levels of prostaglandin (PG)E2 and PGF2α.

Methods: Thirty patients with chronic periodontitis were divided into 3 groups of 10 each. One group received 100 mg of nimesulide; one received 275 mg of naproxen sodium; and the third group received placebo tablets in a 2 × 1 regimen for 10 days as an adjunct to SRP. GT samples were obtained before drug intake and on day 10. Plaque index (PI) and papillary bleeding index (PBI) scores were recorded at baseline, day 10, and at 3 months; probing depth (PD) and clinical attachment level (CAL) were recorded at baseline and at 3 months. The levels of PGE2 were detected using an enzyme immunoassay (EIA), and the levels of PGF2α were analyzed by radioimmunoassay (RIA). Differences among and within the groups were assessed using non‐parametric statistical analysis. Ten periodontally healthy individuals served as controls.

Results: All 3 groups showed statistically significant reductions in PBI and PI on day 10 and at 3 months (P<0.02), and in PD and CAL at 3 months (P<0.02, P<0.05, respectively). In the naproxen group, GT PGE2 levels exhibited a significant decrease (P<0.05). However, the decrease of GT PGE2 levels in the nimesulide group was insignificant (P>0.05), while a significant increase was observed in the placebo group (P<0.05) on day 10. Both the nimesulide and naproxen groups showed a significant decrease (P<0.05) in PGF2α level, while the placebo group showed a significant increase (P<0.05).

Conclusions: Nimesulides, relatively selective COX‐2 inhibitors, may have additional inhibitory effects on GT PGF2α levels in the first week following non‐surgical periodontal treatment. However, nimesulide has an insignificant effect on reducing PGE2 levels in gingival tissue. The determination of GT levels of COX‐1 and COX‐2 enzymes as well as PGE2 and PGF2α in long‐term studies may provide further support for the adjunctive use of selective COX‐2 inhibitors in treatment of chronic periodontitis. J Periodontol 2003;74:57‐63.
Neutrophil‐Mediated Tissue Injury in Periodontal Disease Pathogenesis: Findings from Localized Aggressive Periodontitis
Authors: Kantarci Alpdogan , Oyaizu Kosuke , Van Dyke Thomas E.
Published: February 2005

Neutrophils play a major role in the host response against invading periodontopathogenic microorganisms. Localized aggressive periodontitis (LAgP) is associated with various functional abnormalities of neutrophils. Based on the recent findings, LAgP neutrophils are not “hypofunctional” or “deficient.” They are “hyperfunctional,” and their amplified activity is responsible for the tissue destruction in periodontal disease. Several signal transduction abnormalities are associated with elevated neutrophil function in LAgP. There is a strong correlation between defective chemotaxis and decreased intracellular Ca2+ levels; total calcium‐dependent protein Kinase C (PKC) activity of neutrophils is significantly lower than healthy subjects; and there is a marked increase in diacylglycerol (DAG) accompanied by a pronounced decrease in DAG kinase activity. In a separate set of experiments on the involvement of the inducible cyclooxygenase isoform (COX‐2) and the role of novel lipid mediators in the pathogenesis of periodontal disease, crevicular fluid samples from LAgP patients were found to contain prostaglandin E2 (PGE2) and 5‐LO‐derived products, leukotriene B4(LTB4), and the biosynthesis interaction product, lipoxin LXA4. Neutrophils from peripheral blood of LAgP patients, but not from healthy volunteers, also generated LXA4, suggesting that this immunomodulatory molecule may have a role in periodontal disease. Lipoxin generation and its relationship to PGE2 and LTB4can be visualized as an important marker for the pathogenesis of periodontal disease. Thus, major advances in our understanding of the role of the neutrophil in host defense against periodontal organisms have been made through studies of LAgP. LAgP is used as an example of a severe periodontal disease that is related to abnormal neutrophil function. In this model, it appears that a hyperresponsiveness of the neutrophil, due to cell priming/predisposition, results in enhanced tissue damage. J Periodontol 2003;74:66‐75.
Interactions of Porphyromonas gingivalis with Host Cells: Implications for Cardiovascular Diseases
Authors: Kuramitsu Howard K. , Kang In‐Chol , Qi Minshan
Published: February 2005

Background: Recent epidemiological studies have suggested a contribution of periodontitis in atherosclerotic diseases. Two mechanisms have been proposed to explain such a connection involving general inflammatory responses and/or specific effects of periodontal bacteria on host tissues.

Methods: The role of the periodontopathogen Porphyromonas gingivalis as a potential contributor to atherosclerosis has been investigated in model systems using human umbilical vein endothelial cells (HUVEC) and murine J774 macrophage cell cultures.

Results: P. gingivalis 381 was demonstrated to induce foam cell formation in J774 macrophage cell cultures in the presence of low‐density lipoproteins. The active bacterial component involved in this process appears to be lipopolysaccharide. This effect was not limited to these organisms as several other Gram‐positive and Gram‐negative oral bacteria exhibited the same property. In addition, in a more specific manner, P. gingivalis induced monocyte chemoattractant protein‐1 secretion in HUVEC cultures.

Conclusions: The fimbriae of strain 381 are important, but are not required, for this inductive effect. Taken together, these results suggest a potential role for P. gingivalis in several steps involved in atherosclerotic lesion formation. J Periodontol 2003; 74:85‐89.
Nicotine Stimulates Osteoclast Resorption in a Porcine Marrow Cell Model
Authors: Henemyre Claudia L. , K. Scales Donald , Hokett Steven D. , Cuenin Michael F. , Peacock Mark E. , Parker M. Harry , Brewer Phyllis D. , Chuang Augustine H.
Published: February 2005

Background: Combustible tobacco use is generally linked with accelerated periodontal bone loss and diminished post‐surgical wound healing; however, the pathogenesis of this process at the cellular level remains unclear. Nicotine is known to affect human gingival fibroblast orientation, attachment, and β1 integrin expression, yet little is known about its effects on osteoclasts, the cells most responsible for bone resorption. The purpose of this study was to determine the effects of physiologically relevant nicotine levels on porcine osteoclast function as measured by resorption of calcium phosphate.

Methods: Pure nicotine was diluted in medium to the following concentrations: 0.03 µM, 0.15 µM, 0.30 µM, 0.60 µM, and 1.50 µM. Porcine osteoclasts were seeded onto calcium phosphate multi‐test slides and incubated at 37°C with half media changes every 24 hours. Cells received 0, 0.15, 0.30, 0.60, and 1.50 µM nicotine, or 25 nM parathyroid hormone (PTH). Osteoclast resorption was quantified by measuring the resorbed surface area of the calcium phosphate substrate.

Results: Osteoclast cultures resorbed bone slices and calcium phosphate substrate. All nicotine concentrations and PTH resulted in statistically significantly greater mean percent resorptions than the control group (P <0.05). However, no statistical difference was found between the various nicotine doses or PTH. The number of osteoclasts increased in a linear relationship to the increasing nicotine concentrations; however, no correlation was found between osteoclast number and the amount of resorption.

Conclusions: Nicotine is non‐toxic to osteoclasts at the clinically relevant levels tested. Nicotine appears to stimulate osteoclast differentiation and resorption of calcium phosphate, the major component of bone. Nicotine‐modulated osteoclast stimulation may, in part, explain the increased rapidity of periodontal bone loss and refractory disease incidence in smokers. J Periodontol 2003;74:1440‐1446.
Cross‐Talk Between Interleukin‐6 and Transforming Growth Factor‐β3 Regulates Extracellular Matrix Production by Human Fibroblasts from Subjects with Non‐Syndromic Cleft Lip and Palate
Authors: Baroni Tiziano , Carinci Paolo , Bellucci Catia , Lilli Cinzia , Becchetti Ennio , Carinci Francesco , Stabellini Giordano , Pezzetti Furio , Caramelli Elisabetta , Tognon Mauro , Bodo Maria
Published: February 2005

Background: Transforming growth factor‐beta (TGF‐β) interference with interleukin 6 (IL‐6) activity and the role of the latter in early human embryonic development prompted us to examine the effects IL‐6 on matrix synthesis and the effects of TGF‐β3 on IL‐6 expression human cleft lip and palate (CLP) fibroblasts.

Methods: Collagen and glycosaminoglycan (GAG) synthesis were determined by radiolabeled precursors and biglycan expression by Northern blotting before and after adding IL‐6. The effects of TGF‐β3 on IL‐6 production were assayed by evaluating IL‐6 transcript by Northern blotting and IL‐6 protein secretion by enzyme‐linked immunosorbent assay.

Results: The results showed that IL‐6 elicited an inhibitory effect on collagen and GAG levels in CLP fibroblasts by lowering hyaluronan and dermatan sulfate secretion. IL‐6 up‐regulated biglycan expression, but less strongly than TGF‐β3. TGF‐β3 significantly down‐regulated IL‐6 transcript and secretion in CLP fibroblasts.

Conclusions: These data suggest the increase in matrix components that characterize the CLP fibroblast phenotype might be due to a concerted TGF‐β3‐IL‐6 action. We hypothesize changes in cross‐talk between TGF‐β3 and IL‐6 signal transduction pathways are involved in the induction of cleft palate. J Periodontol 2003;74:1447‐1453.
Prevalence of Periodontopathic Bacteria in Aggressive Periodontitis Patients in a Japanese Population
Authors: Takeuchi Yasuo , Umeda Makoto , Ishizuka Motoko , Huang Yi , Ishikawa Isao
Published: February 2005

Background:Actinobacillus actinomycetemcomitans is considered a major etiologic agent of aggressive periodontitis. Other periodontopathic bacteria such as Porphyromonas gingivalis are also suspected of participating in aggressive periodontitis, although the evidence is controversial. The aim of the present study was to investigate the prevalence of periodontopathic bacteria and to clarify the microbiological features of aggressive periodontitis in Japanese patients.

Methods: Subgingival plaque was collected from 50 aggressive periodontitis (AgP) patients (localized 10, generalized 40). Samples from 35 generalized chronic periodontitis (CP) patients and 18 healthy subjects were examined as controls. Plaque samples were examined using culture and polymerase chain reaction (PCR) method.

Results: The prevalence of A. actinomycetemcomitans was relatively low in the localized (20%) and generalized (17.5%) AgP patients, with no significant difference observed in detection frequencies between AgP and the control groups (CP 8.6%, healthy 0%). On the other hand, Tannerella forsythensis (formerly Bacteroides forsythus),Campylobacter rectus, P. gingivalis, and Treponema denticola were frequently detected in localized as well as generalized aggressive periodontitis patients. The prevalence and proportion of P. gingivalis correlated with severity of clinical attachment loss in both localized and generalized aggressive periodontitis.

Conclusions:T. forsythensis, C. rectus, P. gingivalis, and T. denticola were the predominant periodontopathic bacteria of aggressive periodontitis patients in Japan. Although A. actinomycetem‐ comitans was also detected in AgP patients, the prevalence of this bacterium was much lower than that of P. gingivalis. J Periodontol 2003;74:1460‐1469.
Effect of Tobacco Smoking on Neutrophil Activity Following Periodontal Surgery
Authors: Persson Lena , Bergström Jan , Gustafsson Anders
Published: February 2005

Background: Tobacco smoking has considerable negative effects on the outcome of periodontal treatment. The reason for the inferior therapeutical effect might be related to an altered neutrophil activity in terms of elastase and/or matrix metalloproteinase‐8 (MMP‐8), as well as in the protease inhibitor alpha‐1‐antitrypsin (α‐1‐AT) and alpha‐2‐macroglobulin (α‐2‐MG) activities. The aim of the present study, therefore, was to elucidate the effect of tobacco smoking on gingival crevicular fluid GCF) levels of these substances following surgical treatment.

Methods: The study population included 15 smoking and 15 non‐smoking patients with moderate to severe periodontitis receiving surgical treatment. Clinical examinations and collection of GCF were done prior to surgery and 1 and 5 weeks following treatment. The elastase activity was measured with a chromogenic low‐molecular substrate and the levels of α‐1‐AT, α‐2‐MG, and MMP‐8 with enzyme‐linked immunosorbent assay.

Results: The results showed unaltered levels of α‐1‐AT, α‐2‐MG, and MMP‐8 in smokers following surgery. In non‐smokers, the levels of α‐1‐AT and α‐2‐MG increased, whereas MMP‐8 levels decreased. The levels of elastase remained unaltered in both smokers and non‐smokers.

Conclusions: These results indicate that in the presence of smoking, the levels of α‐1‐AT, α‐2‐MG, and MMP‐8 remained unaltered during the recovery period following surgical treatment. This is interpreted as a possible interference of smoking with the treatment response and may, in part, explain the clinical evidence of an inferior treatment outcome in smokers. J Periodontol 2003;74:1475‐1482.