bluuebunny/crossref_metadata_2025 huggingface dataset:
A longitudinal evaluation of varying widths of attached gingiva
Authors: Kennedy James E. , Bird William C. , Palcanis Kent G. , Dorfman Howard S.
Published: December 2005

Abstract 32 patients with bilateral areas of inadequate attached gingiva on the facial surface of homologous contralateral teeth have been followed for 6 years. Treatment consisted of scaling, root planing, oral hygiene and maintenance at 3‐ to 6‐month intervals or as needed to control inflammation. A free gingival graft was placed on one side (experimental), while the other side served as the unoperated control.

Areas of inadequate attached gingiva on control sides, to include those with recession and no attached gingiva, did not demonstrate additional recession or further loss of attachment. Gingival inflammation and plaque were significantly reduced. On experimental sides, the dimension of keratinized and attached gingiva increased and was stable over 6 years. Areas which began with recession and no attached gingiva exhibited a reduction in recession and gain in clinical attachment following the placement of a gingival graft.

Examination of patients who had discontinued participation in the study for a period of 5 years revealed a reestablishment of gingival inflammation on the control sides associated with additional recession. Similar changes were not observed in areas treated by a free graft.

The findings demonstrate that it is possible lo maintain periodontal health and attachment through control of gingival inflammation despite the absence of attached gingiva.
Regeneration of alveolar bone following surgical and non‐surgical periodontal treatment
Authors: Isidor F. , Attström R. , Karring T.
Published: December 2005

Abstract The purpose of this investigation was to examine the regeneration of alveolar bone following surgical and non‐surgical periodontal treatment. A total of 16 patients who had advanced periodontitis and demonstrated angular bony defects on radiographs participated in the study. After the initial examination, they received instruction in oral hygiene and had their teeth thoroughly scaled. When the individual patient at 2 succeeding appointments had plaque on less than 20% of the tooth surfaces, one maxillary and one mandibular quadrant was treated with the modified Widman flap procedure while one of the remaining quadrants was treated with the reverse bevel flap procedure. The last quadrant was treated with root planing under local anesthesia. None of these procedures included bone contouring. Following treatment, the patients were recalled every 2 weeks for professional tooth cleaning. Radiographs taken 12 months following treatment revealed that only minor changes in the hone level had occurred in areas with horizontal bone loss following the various treatment modalities. Following the modified Widman flap procedure, however, a statistically significant coronal regrowth of bone (0.5 mm) had occurred in angular bony defects. The majority of the angular bony defects persisted following all 3 treatment modalities.
Actinobacillus actinomycetemcomitans in human periodontal disease
Authors: Zambon Joseph J.
Published: December 2005

Abstract Recent evidence implicates Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis. This paper reviews the morphological, biochemical and serological characteristics of A. actinomycetemcomitans, evidence incriminating it as a periodontopathogen, its importance in human nonoral infections, and virulence factors which may be involved in the pathogenesis of A. actinomycetemcomitans infections.

A. actinomycetemcomitans is a non‐motile, gram‐negative, capnophilic, fermentative coccobacillus which closely resembles several Haemophilus species but which does not require X or V growth factors. The organism has been categorized into 10 biotypes based on the variable fermentation of dextrin, maltose, mannitol, and xylose and into 3 serotypes on the basis of heat stable, cell surface antigens.

A. actinomycetemcomitans primary human ecologic niche is the oral cavity. It is found in dental plaque, in periodontal pockets, and buccal mucosa in up to 36% of the normal population. The organism can apparently seed from these sites to cause severe infections throughout the human body such as brain abscesses and endocarditis.

There is a large body of evidence which implicates A. actinomycetemcomitans as an important microorganism in the etiology of localized juvenile periodontitis including: (1) an increased prevalence of the organism in almost all localized juvenile periodontitis patients and their families compared to other patient groups; (2) the observation that localized juvenile periodontitis patients exhibit elevated antibody levels to A actinomycetemcomitans in serum, saliva and gingival crevicular fluid; (3) the finding that localized juvenile periodontitis can be successfully treated by eliminating A. actinomycetemcomitans from periodontal pockets; (4) histopathologic investigations showing that A. actinomycetemcomitans invades the gingival connective tissue in localized juvenile periodontitis lesions; (5) the demonstration of several pathogenic products from A. actinomycetemcomitans including factors which may: (a) facilitate its adherence to mucosal surfaces such as capsular polysaccharides; (b) inhibit host defense mechanisms including leukotoxin, a polymorphonuclear leukocyte chemotaxis inhibiting factor, and a lymphocyte suppressing factor (c) cause tissue destruction such as lipopolysaccharide endotoxin, a bone resorption‐inducing toxin, acid and alkaline phosphatases, collagenase, a fibroblast inhibiting factor and an epitheliotoxin.

Although A. actinomycetemcomitans is an apparently important micro‐organism in the etiology of localized juvenile periodontitis, additional research is needed to pinpoint subjects at risk of contracting this disease, to develop means of preventing localized juvenile periodontitis, and to examine the role of this organism in other forms of periodontal disease.
Oral hygiene instruction in general dental practice by means of self‐teaching manuals
Authors: Glavind Leif , Christensen Hugo , Pedersen Egon , Rosendahl Hans , Attström Rolf
Published: December 2005

Abstract The present study evaluates the applicability of delivering oral hygiene instruction to patients in general dental practice by means of self‐educational programs. Patients (55) seeking dental treatment in 3 general dental practices in Denmark were divided at random into a conventional professional instruction group (C) in which each individual received personal instruction by the dentist and a self‐instruction group (S), in which the patients were given self‐educational programs. In order to evaluate the effect of the 2 types of instruction, the presence or absence of dento‐gingival plaque and gingival bleeding by probing was recorded prior to the instruction and after 3 and 6 months. The patients of the self‐instruction group (S) answered a questionnaire about the treatment 1 week after they had received the self‐instruction program. An identical improvement in oral hygiene and gingival health was recorded in both treatment groups after 3 and 6 months. This finding indicates, that the self‐educational programs were as effective in changing the oral hygiene habits of the patients as was personal oral hygiene instruction by dental personnel. The answers of the patients to the post‐treatment questionnaire reflected a favorable attitude towards the use of self‐educational programs.
Effects of cigarette smoking on the rate of plaque formation
Authors: Macgregor I. D. M. , Edgar W. M. , Greenwood A. R.
Published: December 2005

Abstract In 2 separate studies, plaque was harvested (i) from 15 smokers and 15 non‐smokers after a 48 h period without oral hygiene, and (ii) from 15 smokers and 12 non‐smokers after a 48 h hygiene‐free period following complete plaque removal by toothbrushing. No significant association emerged between wet weight of accumulated plaque and cigarette smoking, in either study. In the second study, the mean plaque calcium concentration was raised in smokers compared with non‐smokers, and significantly raised in 7 heavy smokers relative to non‐smokers. In both instances, calcium concentration was significantly raised relative to (total) phosphorus concentration, which may indicate that the additional calcium was not in mineral deposits. These results may reflect an association between calcium concentration of plaque and tobacco consumption.
Experimental gingivitis in relation to susceptibility to periodontal disease
Authors: Van Der Velden U. , Abbas F. , Hart A. A. M.
Published: December 2005

AbstractThe aim of the present study was to investigate the rate of development of experimentally‐induced gingival inflammation in relation to the susceptibility to periodontal disease. By selection according to age, a younger (25–39 years) and an older (45–54 years) age group, with a comparable reduced but healthy periodontium, was selected. This equal amount of periodontal breakdown may suggest that the younger age group represented individuals with a relatively higher degree of susceptibility to periodontal disease. At the start of the experiment, each patient was instructed to abstain from oral hygiene procedures in 1 quadrant of the mouth for a period of 18 days. Results showed that all subjects developed signs of gingival inflammation. Regarding the development of redness and swelling, no differences could be assessed between the 2 age groups. However, analysis of the bleeding scores revealed that bleeding on probing developed more rapidly in the younger age group. It was concluded that those patients who have suffered from a more rapid form of periodontal disease also develop inflammation, in terms of bleeding on probing, more rapidly.
Digitized image processing and pattern recognition in dental radiographs with emphasis on the interdental bone
Authors: van der Stelt P. F. , van der Linden L. W. J. , Geraets W. G. M. , Alons C. L.
Published: December 2005

Abstract Diagnosis of hone lesions on dental radiographs can be difficult due to the irregular trabecular pattern and subjectivity on the part of the observer. The purpose of this study is to improve the recognition of bone lesions by means of objective computer‐aided pattern recognition techniques. This article describes a method for the separation of teeth and bone regions in the image to facilitate further analysis, especially of the interdental bone.
Digitized pattern recognition in the diagnosis of periodontal bone defects
Authors: van der Stelt P. F. , van der Linden L. W. J. , Geraets W. G. M. , Alons C. L.
Published: December 2005

Abstract Radiography is an important tool in the diagnosis of periodontal bone lesions. Due to subjective factors in the interpretation by the observer, however, an error‐free diagnosis of bone lesions in an early stage is very difficult. The aim of this study was to reduce the influence of observer subjectivity by means of computer‐assisted image processing and pattern recognition in dental radiographs. The findings of the study show that periodontal lesions can be recognized and described in an objective way by means of digitized pattern recognition.
The influence of gingival stimulation on recovery from human experimental gingivitis
Authors: Bonfil J. J. , Fourel J. , Falabregues R.
Published: December 2005

Abstract The present study concerns an investigation carried out to determine the effects of gingival stimulation on the resolution of a human experimental gingivitis. 10 young male Dental students participated in the experiment. Following the baseline examination (day 0). the participants were instructed to abstain from all oral hygiene procedures during a 21‐day period. Heavy plaque accumulation and gingivitis developed during the 21‐day induction period. On the evening of the 21st day active oral hygiene measures were reinstitued, for an 8‐day period, using 2 different methods. For the left side of the maxillary arch, a hygiene procedure including gingival stimulation was prescribed. On the other hand, for the right side, a hygiene method without gingival stimulation was instituted. On both sides of the upper arch, the gingival condition was assessed by means of the gingival index and soft deposits were assessed by the plaque index (selected teeth: 13, 14, 15, 23, 24, 25). Measurements were performed on days 0, 21, 22, 23, 24, 25, 26, 27, 28, 29.

On day 29, ideal oral hygiene conditions and gingival health were re‐established on both sides. However, a statistical analysis of the data collected during the recovery period revealed that gingival index scores were temporarily, but significantly, higher on the side where mechanical stimulation was performed, although plaque deposits there decreased more rapidly. Thus the present work supports the idea that gingival stimulation does not in any way improve recovery from experimental gingivitis.
Healing of horizontal circumferential periodontal defects following regenerative surgery in beagle dogs
Authors: Bogle Gary , Claffey Noel , Egelberg Jan
Published: December 2005

Abstract Regenerative surgery of dog teeth with reduced periodontal support was undertaken to determine: (1) if new connective tissue attachment could be predictably attained back to the level of the cemento‐enamel junction; and (2) to what extent the new attachment would be accompanied by bone regeneration, root resorption, and ankylosis. The alveolar bone around mandibular premolars was surgically reduced up to 6 mm from the cementoenamel junction. The denuded root surfaces were exposed to the oral environment during a period of 3 months without plaque control. Regenerative surgery was then carried out employing citric acid root conditioning and coronally positioned flaps. 6 months later, histologic evaluation of the midbuccal and midlingual areas of mesial and distal roots revealed new attachment over extended portions of the root surfaces. In 9] of 120 available surfaces, there was no epithelial downgrowth apical to the cemento‐enamel junction. Bone regeneration varied from negligible amounts to complete reformation. However, root resorption and ankylosis were prevalent features. 2 different types of resorptions could be distinguished: those occurring near the cemento‐enamel junction (cervical resorption). and those occurring more apically in areas of newly formed bone (ankylosis‐associated resorption). Resorption of either or both types was noted for 92 of the 120 surfaces.
On the choice of computational unit in statistical analysis
Authors: Blomqvist N.
Published: December 2005

Abstract It is staled that in trials where experimental units on different levels (sites, patients, etc.) are employed, the highest level unit should be used as computational unit when computing standard errors and in statistical inference. Using a lower level unit will underestimate the standard error and the level of significance (P‐value). A numerical illustration is presented.
Gingival inflammatory reaction in children at different ages
Authors: Matron Lars , Goldberg Per
Published: December 2005

Abstract Earlier studies have demonstrated that, with similar levels of plaque accumulation, the tendency to develop gingivitis is lower in pre‐school children than in young adults. No studies are available in which the gingival reaction in older children and adults to a given amount of plaque has been compared. The aim of the present study was to compare the gingival reaction to dental plaque in children of different ages and in adults.

3 groups of children (4–6. 7–9 and 14–16 years of age) and 1 group of adults (20–22 years of age) were studied. The degree of gingivitis was determined using the gingival index and the amount of dental plaque was assessed in terms of the plaque index.

The results showed that with a given plaque score, the % of high gingivitis scores was less in the 4–6‐year‐old children than in the older children and adults. At all levels of plaque accumulation, the highest degree of gingival inflammation was noted in the 14–16‐year‐old children and in the adults. The results indicate that the gingival reactivity increases gradually front early childhood to adult age.
The removal of root surface deposits
Authors: Eaton K. A. , Kieser J. B. , Davies R. M.
Published: December 2005

Abstract The importance of adequate root surface instrumentation has received increasing emphasis. The purpose of this study was to determine the extent to which root planning could produce surfaces free of stainable deposits. Initial laboratory investigations on extracted, periodontally involved roots demonstrated that after meticulous root preparation, totally non‐stainable surfaces could be obtained. These surfaces were shown to consist of either thin cementum or dentine.

The efficacy of instrumenting periodontally involved buccal root surfaces on the anterior teeth of 33 instrumented either before or after the reflection of surgical flaps. Remaining bacterial deposits were disclosed with a gentian violet solution and their root surfaces then photographed. Further root planning, disclosure and photography were then carried out. These photographic slides were analysed for stainable deposits on the root surfaces using an image analysis system, based on densitometric principles, to measure the areas of stainable root surface deposits. The findings revealed that root planning under direct vision at the time of surgery was more effective than blind instrumentation. However, in no instance was any root surface found to be completely free of stainable deposits.
Cell processes in dentin tubules during early phases of attachment to demineralized periodontitis‐affected surfaces
Authors: Polson Alan M. , Fredfrick G. Thomas
Published: December 2005

Abstract This report details some preliminary observations regarding cell morphology and behavior during early phases of in vivo attachment to demineralized surfaces. Rectangular dentin specimens prepared from beneath calculus‐covered areas of root surfaces were treated with citric acid and implanted vertically into the skin of rats such that one end of the implant protruded above the skin. The implants were removed after 1 day and the dentin surface—connective tissue interface examined using scanning electron microscopy. A dynamic series of biological events seemed to be in progress. Numerous cells were attached lo the dentinal root surface. Cell processes extended a considerable distance along the root surface and into dentin tubules. Cell processes in dentin tubules are discussed.
The effects of phenytoin and sodium valproate on the periodontal health of adult epileptic patients
Authors: Seymour R. A. , Smith D. G. , Turnbull D. N.
Published: December 2005

Abstract The periodontal health of 30 adult epileptic patients treated with cither sodium valproate or phenytoin was compared with a control group (n= 15) of otherwise healthy patients. The 3 groups were matched for age and sex. Patients on phenytoin therapy showed significantly higher plaque scores (p < 0.05), gingival index (p < 0.05) and pocketing (P<0.05) than patients in the control group. The % of gingival hyperplusia was significantly higher (P < 0.05) in the phenytoin‐treated patients than those on sodium valproate or in the control group. However, patients on phenytoin therapy had significantly less bone loss than those on sodium valproale (p < 0.05) or in the control group (P < 0.01). No significant differences were observed between the sodium valproate group and the control group on any of the parameters assessed. The results from this study would suggest that sodium valproate has no unwanted effects on periodontal health and may be considered a safe alternative, regarding the periodontal aspects, to phenytoin for the treatment of adult onset epilepsy.
Ultrastructure of developing subgingival plaque in beagle dogs
Authors: ten Napel J. H. , Theilade J. , Matsson L. , Attström R.
Published: December 2005

Abstract The aim of this study was to describe the infrastructure of developing subgingival plaque. In 6 beagle dogs, healthy gingiva prevailed after a pre‐experimental period of intensive plaque control. At the start of the experiment, all oral hygiene measures were withdrawn. Biopsies comprising buccal gingiva and adjacent dental tissues were obtained from premolars and molars on days 0, 4, 7, 21, and 28 and processed for electron microscopy.

Sections of day 0 exhibited a junctional epithelium in close contact with the tooth and absence of subgingival aggregations of bacteria on the tooth surface. For each of the subsequent periods studied, some sections did not exhibit subgingival plaque. In the remaining sections with subgingival plaque, almost all bacteria appeared in aggregates attached to the tooth surface. The number of bacteria at the orifice of the gingival sulcus increased with time. Further apically, the micro‐organisms formed either a continuous layer of even thickness or more frequently, discrete microcolonies along the tooth surface. The bacteria comprised practically entirely Gram‐negative cocci, rods or spirochetes. The latter were present either mixed with the other types in the discrete microcolonies or constituted the bulk of the continuous layer of plaque. In the apical part of the sabgingival plaque, a shift from Gram‐negative cocci and rod during the early stages of gingival inflammation, to a predominance of spirochetes in later stages was noted.

The study shows that in dogs, starting from a plaque‐and gingivitis‐free baseline, a predominantly Gram‐negative subgingival flora may form within a few days after withdrawal of all oral hygiene measures and that a shift in the bacterial composition of the subgingival plaque rakes place during a 4‐week period of no oral hygiene.
The effect of citric acid and fibronectin application on healing following surgical treatment of naturally occurring periodontal disease in beagle dogs*
Authors: Caffesse Raul G. , Holden Michael J. , Kon Simao , Nasjlett Carlos E.
Published: December 2005

Abstract It has recently been suggested that following the exposure of root surface collagen with citric acid, the addition of topically applied fibronectin might promote healing with a fibrous re‐attachment. The purpose of this study was to determine the benefit of citric acid demineralization and fibronectin application in the surgical treatment of severe, naturally occurring periodontal disease in Beagle dogs.

The 4 treatment modalities employed were: (1) surgery alone (mucoperiosteal flaps); (2) surgery plus fibronectin; (3) surgery plus citric acid; (4) surgery plus citric acid followed by fibronectin application. Coronal and root surface notches were used as biometric and histometric reference points. Final clinical measurements were recorded 6 weeks post surgically, on the day of sacrifice.

Significantly increased amounts of connective tissue reattachment were observed in the areas treated with the citric acid/fibronectin combination. Fibrous re‐attachment was enhanced at the expense of epithelial downgrowth and occurred directly to both new and old cementum and exposed dentin, often in a functional manner, i.e., perpendicular to the root surface. Areas treated with the surgery and citric acid technique attained moderate amounts of fibrous re‐attachment while the other treatment modalities were associated with a long junctional epithelium. The enhanced fibrous re‐attachment may be the product of an accelerated coalescing of exposed soft tissue and root surface collagen fibrils, while under the mediating effect of fibronectin.
Morphology of polymorphonuclear neutrophils during periodontal disease in the cynomolgus monkey
Authors: Brecx M. , Patters M. R.
Published: December 2005

Abstract The polymorphonuclear neutrophil (PMN) appears to be an important cell in the protection of the host from pathogenic periodontal micro‐organisms. The purpose of the present histological studies was to observe the emigration of the PMN from the gingival vessels to the periodontal packet during gingivitis and ligature‐induced periodontitis in the cynomolgus monkey 2 adult female monkeys were treated by application of a silk ligature around selected posterior teeth. After 9 weeks, the monkeys were perfused and block sections of both ligated (early periodontitis) and non‐ligated (gingivitis) sites were obtained, cut into smaller blocks containing a single interdental area (N= 15 for periodontitis, N= 5 for gingivitis) and processed for light and electron microscopic observations. Morphologically, no differences in PMNs between gingivitis and periodontitis wrere observed and therefore the following description applies to both disease slates. In the vessels, the endothebal cells appeared to be actively involved in PMN emigration, maintaining long processes which surrounded the PMNs. Within the connective tissue, the PMNs maintained their typical morphology which included polylobated nuclei and numerous lysosomal granules. Many intact PMNs were observed intercellularly within the connective tissue and the epithelium. Within the periodontal pocket, a multilayer of PMNs surrounded the plaque mass. Cells with numerous bacteria‐containing phagolyso‐somes were observed with increasing frequency as they approached the plaque. Deeper within the bacterial deposit, PMNs were seen in varying stages of degeneration. These histologic studies, when interpreted in the light of reports of severe, rapidly‐progressive periodontitis in patients with PMN disorders, suggest that the interaction of PMNs with bacterial plaque may serve to maintain a defensive boundary which protects the host tissues from irreversible destruction.
Plaque growth‐inhibiting effects of an abrasive fluoride‐chlorhexidine toothpaste and a fluoride toothpaste containing oxidative enzymes
Authors: Etemadzadeh Hossein , Ainamo Jukka , Murtomaa Heikki
Published: December 2005

Abstract The aim of this 4 times cross‐over double‐blind clinical trial was to test the plaque‐inhibiting effect of 2 fluoride‐containing toothpastes. One toothpaste contained 0.8% chlorhexidine together with amine fluoride (0.1% F) and a suitable abrasive agent. The other contained 1.7 U/g glucose oxidase and 8.0 U/g amyloglucosidase, added to an amine fluoride (0.1 % F) toothpaste. 1% Hibitane dental gel was used as a positive and a conventional fluoride toothpaste (Vademecum MFP Fluor) as a negative control. 9 dental students, in a randomized sequence, applied the 4 dentifrices twice daily from Monday afternoon to Friday morning with cap splints, designed to cover the teeth and about 2 mm of gingiva. No other oral hygiene measures were allowed during the 4 test periods. On Fridays, the teeth were cleaned professionally and good oral hygiene was maintained during the week‐ends. At the beginning and at the end of each test period, per student plaque thickness was recorded using the plaque index, the visible plaque index, and plaque fresh weight as parameters, and the area of plaque as related to the area of the tooth surface was recorded planimetrically and according to the PLQ index. The best plaque growth‐inhibiting effect was recorded for the positive control (CHX) with the lest chlorhexidine toothpaste (TX) as next best. The enzyme‐containing toothpaste (TE) did not differ significantly from the negative control (C). All the significant differences in anti‐plaque effect between the 4 toothpastes were obtained by recordings of plaque thickness and none on the basis of area of plaque.
New attachment – reattachment following reconstructive periodontal surgery
Authors: Isidor Flemming , Karring Thorkld , Nyman Sture , Lindhe Jan
Published: December 2005

Abstract The present study was designed to evaluate if the conditions for reformation of a connective tissue attachment are less favorable on root surfaces which have lost their fibrous attachment because of periodontal disease than on root surfaces surgically deprived of their attachment apparatus.

In each of 4 Green monkeys. 2 maxillary and – mandibular teeth were selected for experimentation. Periodontal breakdown was produced and allowed to progress to the mid‐root level around one of the experimental teeth in both the maxilla and mandible by placing elastic ligatures around the neck of these teeth. 3 months after removal of the ligatures, the crown of the teeth was resected and the epithelium and the subjacent granulation tissue were removed. Using a diamond bur. circumferential defects similar to those obtained by the ligature induced destruction were then produced around the remaining 2 experimental teeth following resection of the crown. The root cementum on both groups of teeth was removed to the level of the reduced bone height. Finally, all roots were submerged to complete coverage by a mucosal flap. After 3 months of healing, the animals were sacrificed and the jaws removed and placed in fixative. After decalcification. histological sections of the experimental roots and their surrounding periodontal tissues were produced. No histological differences in the result of healing were discernible between the specimens of previously periodontitis‐affected roots and roots with surgically created defects. New cementum with inserting collagen fibers had formed in the apical part of the instrumented surface in both groups of teeth. The length of the new fibrous attachment on the root surfaces surgically deprived of their periodontal ligament tissue was 0.7 mm (mean) with a range from 0.1 to 1.9 mm. On the root surfaces exposed by ligature‐induced periodontal breakdown, the newly formed cementum had an average length of 1.0 mm with a range between 0.1 mm and 2.6 mm. This difference between the groups was not statistically significant. The results indicate that the potentials for reformation of fibrous attachment are similar on planed root surfaces previously exposed to periodontal disease and on surfaces surgically deprived of their attachment apparatus.
The microbial morphotypes associated with periodontitis health and adult periodontitis: composition and distribution
Authors: Offenbachbr S. , Odle B. , Van Dyke T.
Published: December 2005

Abstract Subgingival plaque samples were obtained from 162 sites in 27 adult periodontitis patients and 162 sites in 27 healthy patients using a standardized lavage technique. The distribution of 10 different microbial morphotypes was determined by darkfield microscopy. The lavage technique selectively samples the loosely adherent plaque at the base of the periodontal pocket and not the tooth‐associated, adherent plaque. This standardized technique permits quantitative comparisons of numerical density of morphotype composition at different sites, in addition to qualitative comparisons or relative proportions. There was a significant positive association between the numerical density of each morphotype within the non‐adherent plaque and the number of sites at which the organism was detected in both healthy and diseased subjects.

A previously undescribed darkfield morphotype, has been detected with this method. This morphotype. a small motile coccobacillus (S–MO‐CB) has been found to be the numerically dominant species in both health and disease. This morphotype has been recovered in pure culture following passage through a 0.4 μ filter and includes organisms of the Wollinella and Campylobacter genus, Non‐motile organisms comprised less than 1–2% of the sample from healthy and diseased sites. Motile forms, such as spirochetes, had a high frequency of detection in healthy individuals. Analysis of pooled plaque samples revealed that the prevalence of cocci and fusiforms was significantly elevated in patients with healthy periodontium, as compared to patients with adult periodontitis. In adult periodontitis patients, the frequency of occurrence of medium spirochetes, filaments and small non‐motile rods was significantly elevated in pooled plaque. Analysis of individual sites indicated that the proportion and numerical density of most morphotypes within the non‐adherent plaque were not significantly different in disease as compared to health. Disease is characterized by an increased % of small spirochetes and fusiforms at each site. At diseased sites which harbor small spirochetes, the numerical density is elevated four‐fold, as compared to healthy sites which have small spirochetes. The numerical density of other morphotypes is not significantly different comparing healthy sites to diseased sites. Thus, the increase in the % of small spirochetes in disease in due to a site‐localized four‐fold increase in numerical density within the non‐adherent plaque.
A clinical procedure for determining the proficiency of gingivitis examiners
Authors: Sturzenberger O. P. , Lehnhoff R. W. , Bollmer B. W.
Published: December 2005

Abstract The purpose of the present study was to evaluate a clinical procedure for determining the proficiency of gingivitis examiners. After 4 examiner trainees were instructed by and participated in practice examination sessions with a senior examiner, the 5 examiners participated in a 2‐group clinical study which employed appropriately timed‐staggered dental prophylaxes to create a gingivitis treatment effect between the 2 groups. The 1st group received dental prophylaxes 30 days before the 2nd group. 10 days after the 2nd group had received dental prophylaxes, both groups were examined independently by all 5 examiners. Baseline examinations had been made on all subjects by all 5 examiners independently to serve as a covariable in the statistical analyses. During this clinical exercise, the examiners did not know at what time prophylaxes had been given nor did they have access to the previous examination records. The expected presence of a treatment effect, as confirmed by the senior examiner, was found by all of the examiner trainees in this exercise. The treatment effect for all examiners was statistically significant.
Fluctuations in crevicular and salivary anti‐A viscosus antibody levels in response to treatment of gingivitis
Authors: Tyneuus‐Bratthall Gunilla , Ellen Richard P.
Published: December 2005

Abstract Experimental gingivitis studies support a pathogenic rôle for Actinomyces viscosus because of its numerical predominance in disease‐associated plaques. The aims of the present investigation were to quantify specific crevicular IgG against A. viscosus before and after conventional gingivitis treatment and to determine whether salivary IgA and IgG against A. viscosus and A. noeslundii would be affected concomitantly. 6 subjects with generalized gingivitis were selected. Examinations were made before and after treatment and included collection of unstimulated saliva, paraffin‐stimulated saliva and crevicular material as well as measurements of clinical parameters. The immunoglobulins were estimated by an ELISA assay using whole bacterial cells as antigen. Crevicular IgG against A. viscosus WVU 627 was demonstrated in pre‐ and post‐treatment samples with a tendency towards increased values in the post‐treatment samples. Salivary IgA and IgG against A. viscosus were also demonstrated in pre‐ and post‐treatment samples. There were tendencies towards increased IgA values for paraffin‐stimulated saliva and increased IgG values for unstimulated saliva in the post‐treatment samples. Salivary IgA and IgG values against A. naeslundii ATCC 12104 were either not detected or barely detectable in both pre‐ and post‐treatment samples. A. naeslundii B 74 IgG values were also rather low. As for A. viscosus WVU 627. anti‐B 74 IgA values demonstrated a post‐treatment increase for most subjects, especially for unstimulated saliva for which all post‐treatment values were elevated. It is interesting to note that saliva samples showed changes similar to crevicular material, considering that salivary IgA is most likely derived from a different source. Together, elevated crevicular and salivary antibody concentrations might account for some of the beneficial effects of periodontal therapy by scaling.
Improved periodontal conditions following therapy
Authors: Wlstfelt E. , Bragd L. , Socransky S. S. , Haffajee A. D. , Nyman S. , Lindhe J.
Published: December 2005

Abstract. The aim of the present clinical trial was to evaluate the effect of different modes of periodontal therapy on patients with moderately advanced periodontal disease and to express the findings in terms of probing pocket depth and attachment level alterations at periodontal sites with different initial probing depths.

The material consisted of 16 patients, 35–65 years of age. Following a Baseline examination including assessments of oral hygiene status, gingival conditions, probing pocket depths and probing attachment levels, the patients were subjected to periodontal treatment. A “split‐mouth” design approach of therapy was used and the jaw quadrants were randomly selected for the following different treatment procedures: (1) scaling and root planing, (2) scaling and root planing in con junction with a gingivectomy procedure, (3) scaling and root planing m conjunction with an apically repositioned flap procedure without bone recontouring. (4) scaling and root planing in conjunction with an apically repositioned flap procedure including bone recontouring, (5) scaling and root planing in conjunction with a modified Widman flap procedure without bone recontouring and (6) scaling and root planing in conjunction with a modified Widman flap procedure including bone recontouring. The patients were following active treatment enrolled in a supervised maintenance care program including “professional tooth cleaning” once every 2 weeks during a 6‐month period of healing, after which a final examination was performed.

The investigation demonstrated that active therapy including meticulous subgingival debridement resulted in a low frequency of gingival sites which bled on probing, a high frequency of sites with shallow pockets (<4 mm) and the disappearance of pockets with a probing depth of >6 mm. Between the Baseline examination and the 6‐month re‐examination, the probing attachment level for initially shallow‐pockets remained basically unaltered, but with a tendency of a minor apical shift. This occurred in all 6 treatment groups. For sites with initial probing depths of 4–6 mm and >6 mm, there was in all groups some gain of probing attachment. This gain was most pronounced in the initially deeper (>6 mm) pockets.

With the use of regression analysis, the “critical probing depth” (CPD) value (i.e. the initial probing depth value below which loss of attachment occurred as a result of treatment and above which gain of probing attachment level resulted) was calculated far each of the 6 methods of treatment used‐ A comparison of the CPD‐values between the 6 treatment groups did not reveal any major differences.
The occurrence of Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius in destructive periodontal disease in adults
Authors: Slots Jörgen , Bragd Lennart , Wikström Maude , Dahlén Gunnar
Published: December 2005

Abstract A total of 235 subgingival sites, including 104 progressive deep lesions from 61 untreated patients, 26 progressive deep lesions from 10 treated patients, 33 nonprogressive deep sites from 20 untreated patients, and 72 nonprogressive sites from 55 treated patients were examined for Actinobacillus actinomycetemcomitans, Bacteroides gingivalis and Bacteroides intermedius. The periodontal disease progression was mainly determined on the basis of radiographic changes in the crestal alveolar bone level. A. actinomycetemcomitans isolation was carried out using the selective TSBV medium and B. gingivalis and B. intermedius isolations were performed using a nonselective blood agar medium.

1 or more of the 3 bacteria studied appeared in 99.2% of progressive periodontal lesions but only in 40.0% of nonprogressive sites. Culture‐positive progressive periodontal sites in comparison with culture‐positive nonprogressive sites showed higher median recovery rates of A. actinomycetemcomitans(0.5% vs 0.3%), B. gingivalis(30.5% vs 0.3%) and B. intermedius(4.9% vs 0.5%). Of total progressive lesions, 12.3% yielded solely A. actinomycetemcomitans, 21.5% demonstrated solely B. gingivalis, and 20.8% revealed solely B. intermedius. The A. actinomycetemcomitans‐B. intermedius combination was found in 24.6% of progressive lesions. A. actinomycetemcomitans appeared in significantly higher prevalence in treated‐progressive lesions (80.8%) than in nontreated‐progressive lesions (42.3%). 32 of the 42 culture‐positive nonprogressive sites yielded B. intermedius as the sole test organism.

The main conclusion is that A. actinomycetemcomitans, B. gingivalis and B. intermedius are closely related to disease‐active periodontitis, and more closely than to periodontal pocket depth. This finding is important in understanding periodontal disease etiology and pathogenesis and may also aid in a clinical setting to differentiate progressing and nonprogressing periodontal sites.
Darkfield microscopy of subgingival plaque of an urban black population with poor oral hygiene
Authors: Reddy Jairam , Africa Charlene W. , Parker Joan R.
Published: December 2005

Abstract A low socio‐economic community residing in Crossroads, Cape Town, consists of people who originated from the Eastern Cape areas of the Ciskei and Transkei. These individuals have had virtually no dental care, with the exception of emergency treatment for pain. A darkfield microscopic study of a random sample of 52 individuals was undertaken to determine the predominant morphological forms in the subgingival plaque of this population. Spirochetes were found to constitute 42.1 % and motile rods, 7.7%, of the total darkfield microscopic count. Clinical assessment of the periodontal status of 100 individuals revealed the following mean values; plaque index (PI)= 1.44, gingival index (GI)= 1.31, probing depth (PD) = 2.35 mm and loss of attachment = 0.64 mm. Subgingival calculus deposits were present in 42% of the group and little or no mobility of the teeth was evident. Poor oral hygiene resulted in 90% of the tooth surfaces of the sampled population in Crossroads being covered with plaque, yet these individuals appear to be resistant to periodontitis. The high proportions of spirochetes and motile rods found in the subgingival plaque of this group were not indicative of periodontitis and therefore, fail to confirm the findings of other investigators.
Remaining teeth, periodontal condition, oral hygiene and tooth cleaning habits in dentate old‐age subjects
Authors: Ambjørnsen Eirik
Published: December 2005

Abstract The purpose of the present study was to describe the dental health status of a dentate elderly population in terms of remaining teeth, periodontal condition and oral hygiene. In a municipality near Oslo, 371 respondents from a random sample of elderly subjects were clinically examined in 1979/80. Of these, 169 were dentate, 39% had 1–9 teeth and 28% had 20 teeth or more. The mean number of teeth present was 13.8. Income, bone loss and oral hygiene explained most of the variance in the number of remaining teeth whereas age seemed to play a minor role. Gingivitis was recorded adjacent to 54% of the teeth, and plaque was visible on 63%. The variance in gingivitis was mainly explained by plaque, calculus and number of remaining teeth, while the amount of plaque was associated with differences in cleaning habits, the number of teeth and social class. 38% of the alveolar bone height was on average lost at teeth present at the time of examination. The variance was mainly explained by presence of plaque and gingivitis. However, the majority of remaining teeth displayed a fair periodontal condition.
A new method for assessing the % of spirochaetes in subgingival plaque
Authors: MacFarlane T. Wallace , McCourtie J. M. , Watkins T. R.
Published: December 2005

Abstract A new method for counting the numbers of spirochaetes in subgingival plaque is described. The technique involves the combined use of a negative stained preparation, dark field microscopy, and an image analysing system. Advantages of the method include: smears need not be made until 2 days after sampling, and can be examined microscopically for up to 1 year after preparation; reproducibility of counts are more than 90% and the data can be computerised. The new method should prove useful in the routine assessment of subgingival plaque from patients with various forms of periodontitis, and in epidemiological surveys.
A comparison of 4 techniques for clinical detection of early plaque formed during different dietary regimes
Authors: Lim L. P. , Tay F. B. K. , Waite I. M. , Cornick D. E. R.
Published: December 2005

Abstract The purpose of this study was to evaluate the sensitivity of 4 clinical techniques used in detecting early plaque during a period of dietary sucrose restriction and during a period of sucrose supplementation. The accumulation of plaque during experimental periods of 3 h, 6 h and 18 h was recorded in a group of 38 dental personnel for the 1st part of the study, and in a group of 32 for the 2nd part. Plaque levels were assessed using a caries probe, a plaque detection probe, erythrosin and a 2‐tone disclosing agent.

There was a progressive increase in plaque over the period of the study, with significant variation between the detection methods used and the sites being assessed. Plaque formed more rapidly interdentally and on the posterior teeth. 3 h after the teeth had been thoroughly cleaned, plaque was detectable on over 12% of sites for the sucrose‐restricted diet and on up to 23% of sites for the sucrose‐supplemented diet. After 18 h of plaque formation, the proportion of plaque‐covered surfaces had increased to between 52% and 73%.

For minimal amounts of plaque, the disclosing solutions were found to be the most sensitive assessment techniques. However, for moderate and abundant plaque deposits, the techniques using the probes resulted in a greater degree of differentiation in the proportional measurements of plaque. Overall, the plaque probe was found to be as sensitive or better than the other techniques under most conditions and was favourd on clinical grounds, as it aided access to the interdental areas and provided a contrasting colour at the tip to enable plaque to be detected with greater ease. The results of the study indicated that when assessing the compliance of an individual with plaque control procedures, the amounts of deposits should be assessed almost immediately after the subject has performed oral hygiene procedures. Alternatively, allowances must be made for the time that has lapsed since the teeth were last cleaned as well as for the other factors which would influence the amount of plaque recorded, e.g., the number of teeth in the mouth and their position, the sensitivity of the detection system for plaque, and the number of intakes of food or drink that contain sucrose.
Laboratory studies of a family manifesting premature exfoliation of deciduous teeth
Authors: Baab David A. , Page Roy C. , Ebersole Jeffrey L. , Williams Betsy L. , Scott C. Ronald
Published: December 2005

Abstract In a previous publication, we described the clinical and radiographic findings of a family in which the children manifested premature exfoliation of the deciduous teeth. We now report for the same family the results of extensive laboratory studies performed on blood and urine, analysis of periodontal microflora, and a family pedigree. We demonstrated the presence of putative periodontal pathogens in the subgingival microflora, elevated levels of serum antibodies reacting to Bacteroides gingivalis, Capnocytophaga gingivalis, and C. sputigena in 2 of the children, and significantly suppressed monocyte chemotaxis in all 3 children. Phosphoethanolamine was found in the urine of the father and all 3 children, but not in the mother. Likewise, serum alkaline phosphatase was abnormally low for all 3 children, and was at the extreme low end of normal range for the father, but was normal for the mother. On the basis of the alkaline phosphatase and phosphoethanolamine measurements, we assigned a diagnosis of hypophosphatasia to the 3 children. Phosphoethanolamine and alkaline phosphatase were also abnormal in the paternal grandmother and her brother. The son of this brother who was deceased had a daughter manifesting premature loss of the primary teeth. The data are consistent with an autosomal dominant mode of transmission. In the light of our findings, hypoplastic cementum must be considered in the etiology of some forms of early‐onset periodontitis.