bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative 6‐Month Clinical Study of a Subepithelial Connective Tissue Graft and Acellular Dermal Matrix Graft for the Treatment of Gingival Recession
Authors: Novaes Arthur B. , Grisi Daniela C. , Molina Gustavo O. , Souza Sérgio L.S. , Taba Mario , Grisi Márcio F.M.
Published: February 2005

Background: Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft.

Methods: Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery.

Results: There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference.

Conclusion: The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures. J Periodontol 2001;72:1477‐1484.
Periodontal Disease in Pregnancy Complicated by Type 1 Diabetes Mellitus
Authors: Guthmiller Janet M. , Hassebroek‐Johnson Jeanne R. , Weenig Duane R. , Johnson Georgia K. , Kirchner H. Lester , Kohout Frank J. , Hunter Stephen K.
Published: February 2005

Background: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non‐diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women.

Methods: Thirty‐three (13 diabetic and 20 non‐diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non‐diabetics was 28.5 ± 7.1(SD) and 27.0 ± 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL).

Results: Diabetic subjects had significantly (P <0.001) higher PI (1.48 ± 0.69) and GI (1.77 ± 0.44) scores than non‐diabetics (PI = 0.63 ± 0.38; GI = 0.93 ± 0.48). Mean PD for diabetics (2.95 ± 0.69 mm) was significantly different (P <0.024) from that of non‐diabetics (2.44 ± 0.32 mm). Although mean GM location was coronal to the cemento‐enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P <0.001) in the diabetics (−0.20 ± 1.24 mm) compared to non‐diabetics (−1.76 ± 0.53 mm). Mean CAL values also varied significantly (P <0.001) between diabetics (2.60 ± 1.54 mm) and non‐diabetics (0.68 ± 0.65 mm). Significant differences were seen for GI (P <0.001), PD (P = 0.005), GM location (P <0.001), and CAL (P <0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P = 0.001).

Conclusions: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non‐diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients. J Periodontol 2001;72:1485‐1490.
Surgical Therapy of Peri‐Implant Disease: A 3‐Year Follow‐Up Study of Cases Treated With 3 Different Techniques of Bone Regeneration
Authors: Khoury Fouad , Buchmann Rainer
Published: February 2005

Background: Advanced peri‐implant intrabony defects require comprehensive surgical treatment regimens different from periodontal therapy strategies. The purpose of this longitudinal trial was to evaluate the peri‐implant outcomes following guided bone regeneration with 3 treatment protocols.

Methods: In 25 patients, 41 peri‐implant defects with supporting bone loss >50% of the implant length were treated with flap surgery plus autogenous bone grafts alone (FG) (controls, n = 12) plus non‐resorbable (FGM) (test 1, n = 20) or bioabsorbable barriers (FGRM) (test 2, n = 9) and supportive antimicrobial therapy. Following submerged healing, the membranes were removed (FGM), and the peri‐implant probing depths (PD), probing bone levels (BL), mobility scores (PT), and intrabony defect height (DH) were radiographically evaluated at baseline, 6 months, and 1 and 3 years post‐therapy.

Results: Non‐surgical/anti‐infective therapy resulted in a limited improvement of PD scores after 6 months. At the 3‐year visit, surgical treatment revealed significant changes from baseline for the controls and both of the test groups for PD: 5.1 ± 2.7 mm (FG), 5.4 ± 3.0 mm (FGM), and 2.6 ± 1.6 mm (FGRM), and for BL: 3.2 ± 2.4 mm (FG), 3.4 ± 2.4 mm (FGM), and 2.3 ± 1.6 mm (FGRM), Mann‐Whitney test, P ≤0.05. The changes for DH and PT were significant only for FG‐ and FGM‐treated subjects. The overall improvement for FGRM‐treated patients during the 3‐year observation was less marked. However, the differences between the 3 surgical treatment protocols did not affect the treatment outcomes after 3 years.

Conclusions: Autogenous bone grafting is an appropriate treatment regimen to augment open crater‐formed peri‐implant defects. Although certain clinical situations require an additional fixation of barrier membranes, their routine application should be approached with caution. J Periodontol 2001;72:1498‐1508.
The Effects of Interleukin‐10 Depletion In Vivo on the Immune Response to Porphyromonas gingivalis in a Murine Model
Authors: Herminajeng Endang , Sosroseno Wihaskoro , Bird Philip S. , Seymour Gregory J.
Published: February 2005

Background: The immune response to Porphyromonas gingivalis in the mouse abscess model is known to be dependent upon CD4 T‐cell activation and the regulatory role of cytokines. The role of interleukin‐10 (IL‐10) in this mouse model was examined in vivo.

Methods: One‐week‐old, female BALB/c mice were divided into 4 groups. Groups 1 and 2 were given intraperitoneal (ip) injections of phosphate buffered saline (PBS) weekly for 5 weeks. Group 3 was given an ip injection of rat immunoglobulin. Group 4 was injected with rat anti‐IL‐10 antibodies. At week 6, group 1 was sham‐immunized with PBS, and groups 2, 3, and 4 were injected with P. gingivalis lipopolysaccharide (Pg‐LPS) weekly for 2 weeks. One week after the final immunization, delayed‐type hypersensitivity (DTH) was assessed by footpad swelling to Pg‐LPS. The level of serum antibodies to Pg‐LPS and IFNgamma (IFN‐γ) was determined by enzyme‐linked immunosorbent assay. Dorsal abscess formation induced by the injection of viable P. gingivalis was examined daily for 30 days.

Results: The footpad swelling of the anti‐IL‐10–treated group (group 4) was significantly higher than that of groups 1 to 3. Similarly, the serum IFN‐γ level in group 4 was much higher than that of the other experimental groups. There was no significant difference in serum IgG antibodies to Pg‐LPS in any of the experimental groups. However, the level of IgM antibodies in group 4 mice was significantly lower than that in groups 2 and 3. In addition, serum IgG1 was suppressed in group 4 mice, while IgG2a antibodies were raised. However, there was no difference observed between the levels of IgG2b and IgG3 antibodies in any group of mice. The lesions in sham‐immunized mice (group 1) persisted for 30 days, and those in group 2 and 3 were undetected by day 18 and 20, respectively. In sharp contrast, lesions in group 4 had healed completely by day 13.

Conclusions: This study has shown that IL‐10 depletion in vivo in P. gingivalis LPS‐induced immune response in mice led to an elevated DTH response, an increase in serum IFN‐γ levels, and raised levels of IgG and IgG2a antibodies. Treatment with anti‐IL‐10 antibodies resulted in suppressed IgG1 and IgM responses and a more rapid healing of abscesses than in non‐IL‐10–depleted mice. These results suggest that IL‐10 depletion in Pg‐LPS–induced immune response in mice may lead to a Th1‐like immune response and provide strong protection against a subsequent challenge with live P. gingivalis in an abscess model. J Periodontol 2001;72:1527‐1534.
Treatment of Periodontitis by Local Administration of Minocycline Microspheres: A Controlled Trial
Authors: Williams Ray C. , Paquette David W. , Offenbacher Steven , Adams Donald F. , Armitage Gary C. , Bray Kim , Caton Jack , Cochran David L. , Drisko Connie H. , Fiorellini Joseph P. , Giannobile William V. , Grossi Sara , Guerrero Denise M. , Johnson Georgia K , Lamster Ira B. , Magnusson Ingvar , Oringer Richard J. , Persson G. Rutger , Van Dyke Thomas E. , Wolff Larry F , Santucci Edward A. , Rodda Bruce E. , Lessem Jan
Published: February 2005

Background: Periodontitis is an inflammatory condition of toothsupporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline.

Methods: Seven hundred forty‐eight (748) patients with moderate to advanced periodontitis were enrolled in a multi‐center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months.

Results: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients’ smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups.

Conclusions: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients. J Periodontol 2001;72:1535‐1544.
Immediate Implantation in Fresh Extraction Sockets. A Controlled Clinical and Histological Study in Man
Authors: Paolantonio Michele , Dolci Marco , Scarano Antonio , D'Archivio Domenico , Di Placido Giacinto , Tumini Vincenzo , Piattelli Adriano
Published: February 2005

Background: Early implantation may preserve the alveolar anatomy, and the placement of a fixture in a fresh extraction socket helps to maintain the bony crest. Although a number of clinical studies exist, no histological reports show the outcome of implantation in fresh extraction sockets without the use of membranes in humans compared to implants placed in mature bone.

Methods: Forty‐eight healthy patients, receiving at least 4 fixtures in each of 2 symmetrical quadrants, underwent placement of 1 experimental fixture placed in a fresh extraction socket (TI) and 1 contralateral fixture in mature bone (CI). TI were placed after atraumatical tooth extraction, with a surgical site at the apex of the socket and a tight contact between the fixture and the socket's walls, but without the use of filling materials or membranes. The flap was coronally repositioned to obtain primary wound closure. Immediately after surgical intervention, a standardized periapical radiograph was taken. Second‐stage surgery was done after 6 months. Six months after the second surgery, a second standardized periapical radiograph was taken and clinical parameters (bleeding and plaque index) recorded. Marginal bone loss (MBL) from the time of implant placement to the time of fixture removal was calculated by comparing periapical radiographs. TI and CI were then removed by a hollow drill to obtain histological specimens. Non‐demineralized sections were stained by acid fuchsin and toluidine blue, and by von Kossa to evaluate the degree of bone mineralization. The percentage of direct implant‐bone contact (DBC) was calculated by a computerized microscopic digitizer.

Results: No significant differences in the clinical and radiographic parameters were observed between the 2 experimental categories. There was no statistically significant difference between TI and CI for DBC either in the maxilla or in the mandible. No connective or fibrous tissues were present around TI or CI. Bone resorption was not present in any of the histological sections.

Conclusions: The present study shows that when a screw‐type dental implant is placed without the use of barrier membranes or other regenerative materials into a fresh extraction socket with a bone‐to‐implant gap of 2 mm or less, the clinical outcome and degree of osteointegration does not differ from implants placed in healed, mature bone. J Periodontol 2001;72:1560‐1571.
A Comparison of Porous and Non‐Porous Teflon Membranes Plus Demineralized Freeze‐Dried Bone Allograft in the Treatment of Class II Buccal/Lingual Furcation Defects: A Clinical Reentry Study
Authors: Lamb James W. , Greenwell Henry , Drisko Connie , Henderson Robin D. , Scheetz James P. , Rebitski George
Published: February 2005

Background: The aim of this 9‐month reentry study was to compare the regenerative healing using porous (P) and nonporous (NP) teflon barrier membranes plus demineralized freeze dried bone allografts (DFDBA) in Class II buccal/lingual furcation defects.

Methods: Twenty‐four patients, 13 males and 11 females, ages 38 to 75 (mean 54 ± 10), were included in this study. Each patient had adult periodontitis and one Class II furcation defect measuring ≥3 mm open horizontal probing depth. Twelve patients were randomly selected to receive the NP treatment and 12 received the P membrane. All defects received a DFDBA graft. Measurements were performed by a masked examiner.

Results: No statistically significant differences (P >0.05) were found between NP and P groups at any time with respect to any open or closed measure. Improvement in mean open horizontal probing depth was significant for both the NP (2.33 ± 0.78 mm) and P (2.75 ± 0.75 mm) groups. Mean clinical attachment level gains at 9 months were significant for both NP (1.50 ± 1.62 mm) and P (2.50 ± 2.11 mm) groups. Seventeen of 24 defects had an intrabony component and ≥50% fill was obtained in 100% of these defects.

Conclusions: The results of this 9‐month reentry study comparing the use of porous and non‐porous barrier membranes with a DFDBA graft indicate that there were no statistically significant differences between groups. Both groups showed a statistically significant improvement following the treatment of Class II furcation defects in humans. J Periodontol 2001;72:1580‐1587.
Tetracycline Modulates Collagen Membrane Degradation In Vitro
Authors: Moses Ofer , Nemcovsky Carlos E , Tal Haim , Zohar Ron
Published: February 2005

Background: Structural integrity of implanted bioabsorbable barrier membranes should be preserved for a sufficient time to ensure expected results. Collagen membranes are degraded by metalloproteinases (MMP). Their degradation rate can be altered either by enhancing structural integrity or by delaying the degradation process using MMP inhibitors. Tetracyclines (TTC) present inhibitory effects on matrix MMP. Immersing membranes in TTC solution before implantation can delay their degradation. The purpose of the present study was to evaluate the effect of collagen membranes immersed in varying TTC concentration solutions on the rate of their degradation in vitro.

Methods: Collagen bioabsorbable membranes were prepared as 5 mm diameter membrane discs. Membranes were then incubated at 4°C for 24 hours, in either phosphate buffered saline (PBS, Ca2 + and Mg2 + free) or with TTC‐HCl dissolved in PBS concentrations of 5 mg/ml, 50 mg/ml or 100 mg/ml. After rinsing, membranes were incubated with either bacterial collagenase or cultures of human bone lineage cells. Membrane degradation was studied on days 2, 4, 7, and 14. Two‐ and 3‐way analysis of variance was used to analyze results.

Results: Samples supplemented with bacterial collagenase exhibited a statistically significant interaction between changes of free protein in the medium, antibiotic concentration used for the immersion, presence of collagenase in the medium, and incubation time (P <0.0001). Membranes incubated with bone cells exhibited similar degradation trends.

Conclusions: Collagen membranes immersed in 50 mg/ml TTC solution exhibited the longest degradation time, both in the clostridial collagenase and the human bone cell lineage assays. Immersion in a 50 mg/ml TTC solution before implantation will delay their degradation. J Periodontol 2001;72:1588‐1593.
Activation of Matrix Metalloproteinase‐2 by a Novel Oral Spirochetal Species Treponema lecithinolyticum
Authors: Choi Bong‐Kyu , Jung Jung‐Hag , Suh Hye‐Yuhn , Yoo Yun‐Jung , Cho Kyoo‐Sung , Chai Jung‐Kiu , Kim Chong‐Kwan
Published: February 2005

Background: Periodontal tissue destruction is a characteristic of periodontitis. This can be caused by either bacterial enzymes or host cell‐derived matrix metalloproteinases (MMPs). In order to elucidate the etiologic role of oral spirochetes, we investigated the effects of Treponema lecithinolyticum, a novel saccharolytic species, on MMP‐2 activation.

Methods: Gingival fibroblasts (GFs) and periodontal ligament (PDL) cells obtained from healthy human subjects were cultured to confluence in α‐minimal essential medium (α‐MEM) supplemented with 10% fetal bovine serum. After serum starvation for a day, the cultures were treated with whole cell sonicates, heat‐denatured whole cell sonicates, outer membrane fraction (OMF) or formaldehyde‐fixed cells of T. lecithinolyticum. Culture supernatants were collected after incubation for 24 to 48 hours and analyzed for MMP‐2 activation by gelatin zymography. Collagenolytic activity was quantitatively measured using human [3H] type IV collagen as a substrate.

Results: Treatment of GFs and PDL cells with whole cell sonicates, formaldehyde‐fixed whole cells, or the OMF of T. lecithinolyticum resulted in the production of MMP‐2 partly in the fully active form with a molecular mass of 62 kDa, whereas nontreated control cultures and cultures treated with a heat‐denatured fraction did not show the active form. Cultures exposed to T. lecithinolyticum had higher collagenolytic activity than non‐treated cultures.

Conclusions: Our results demonstrate that T. lecithinolyticum, possibly mediated by proteinaceous cell surface‐associated components, may participate in extracellular matrix degradation by activation of MMP‐2 during periodontal inflammation. J Periodontol 2001;72:1594‐1600.
Effect of Avocado and Soybean Unsaponifiables on Gelatinase A (MMP‐2), Stromelysin 1 (MMP‐3), and Tissue Inhibitors of Matrix Metalloproteinase (TIMP‐1 and TIMP‐2) Secretion by Human Fibroblasts in Culture
Authors: Kut‐Lasserre C. , Miller C. Chaussain , Ejeil A.L. , Gogly B. , Dridi M. , Piccardi N. , Guillou B. , Pellat B. , Godeau G.
Published: February 2005

Background: In inflamed periodontal tissues, gingival fibroblasts are able to express matrix metalloproteinases (MMPs) and their natural inhibitors, tissue inhibitors of matrix metalloproteinases (TIMPs). They can also respond to growth factors and cytokines. In this study, the in vitro effects of avocado and soybean unsaponifiable residues (ASU), their fractions (avocado unsaponifiable [ASF] or soy unsaponifiable [SSF]) on MMP‐2 and MMP‐3, and the activity and secretion of their inhibitors TIMP‐1 and TIMP‐2 were investigated using cultured human gingival fibroblasts.

Methods: Gingival fibroblasts were cultured for 72 hours with ASU, ASF, and SSF at concentrations of 0.1, 0.5, 2.5, 5, and 10 μg/ml of culture medium, after pretreatment or no pretreatment for 1 hour with interleukin‐1β (IL‐1β). MMP‐2 and MMP‐3 were detected and quantified in the culture media after zymography and image analysis. TIMP‐1, TIMP‐2, MMP‐2, and MMP‐3 were also evidenced by dot blotting and quantified by image analysis.

Results: In the absence of IL‐1β, a slight decrease in the secretion of MMP‐2 was observed with lower doses of ASU, ASF, and SSF. The decrease of MMP‐3 secretion was clearly marked with all fractions especially at low concentrations (0.1 and 2.5 μg/ml). A slight decrease in TIMP‐2 secretion was seen for low doses of ASU, ASF, and SSF, while a small increase was seen at higher concentrations. Concerning TIMP‐1, no significant variation was observed in culture medium for low concentrations, and a decrease was noted for 5 and 10 μg/ml of ASU, ASF, and SSF. As anticipated, IL‐1β induced a marked release of MMP‐2, MMP‐3, and TIMP‐1, but no variation for TIMP‐2 was seen. ASU, ASF, and SSF reversed the IL‐1β effect on gingival fibroblasts for MMP‐2 and MMP‐3, particularly with doses varying from 0.1 to 2.5 μg/ml and for TIMP‐1, particularly with doses varying from 2.5 to 10 μg/ml.

Conclusions: These findings suggest a potential role for avocado and soy unsaponifiable extracts to prevent the deleterious effects of IL‐1β that occur during periodontal diseases. J Periodontol 2001;72:1685‐1694.
Treatment of Intrabony Defects With Enamel Matrix Proteins or Bioabsorbable Membranes. A 4‐Year Follow‐Up Split‐Mouth Study
Authors: Sculean Anton , Donos Nikolaos , Miliauskaite Asta , Arweiler Nicole , Brecx Michel
Published: February 2005

Background: Treatment with enamel matrix proteins (EMD) and guided tissue regeneration (GTR) with bioabsorbable membranes has been shown to promote periodontal regeneration; however, until now, there were only limited data on the long‐term clinical results following these regenerative techniques. Therefore, the aim of the present study was to present the 4‐year results following treatment of intrabony defects with EMD or guided tissue regeneration (GTR).

Methods: Twelve patients, each displaying one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMD or with GTR by means of bioabsorbable membranes. The following clinical parameters were evaluated at baseline, at 1 year, and at 4 years after treatment: plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). The primary outcome variable was CAL. No statistically significant differences between the groups were found at baseline. Power analysis to determine superiority of EMD treatment showed that the available sample size would yield 70% power to detect a 1 mm difference.

Results: The sites treated with EMD demonstrated mean CAL change from 9.8 ± 2.0 mm to 6.4 ± 1.6 mm (P <0.001) and to 6.8 ± 1.8 mm (P <0.001) at 1 and 4 years, respectively. No statistically significant differences were found between the CAL mean at 1 and 4 years postoperatively. The sites treated with GTR showed a mean CAL change from 9.8 ± 2.3 mm to 6.6 ± 1.7 mm (P <0.001) at 1 year and to 6.9 ± 1.8 mm (P <0.001) at 4 years. The CAL change between 1 and 4 years did not present statistically significant differences. No statistically significant differences in any of the investigated parameters were observed at 1 and 4 years between the treatment groups.

Conclusions: It was concluded that the CAL gain obtained following treatment with EMD or GTR can be maintained over a 4‐year period. J Periodontol 2001;72:1695‐1701.
Histologic and Radiographic Evidence of Vertical Ridge Augmentation Utilizing Distraction Osteogenesis: 10 Consecutively Placed Distractors
Authors: McAllister Bradley S.
Published: February 2005

Background: Vertical ridge augmentation for dental implant placement is one of the greatest challenges facing the surgeon. Inadequate vertical bone compromises the implant positioning and resulting restoration. The cleansibility, esthetics, and mechanical properties of the restoration can all be compromised. While the technique of distraction osteogenesis has been successfully employed for long bone applications for over 40 years, it has only recently been introduced as a technique for vertical ridge augmentation prior to dental implant reconstruction.

Methods: In this study, the placement of 10 consecutive distractors in 7 patients was evaluated. The surgical technique, latency period, distraction rate, and consolidation period are reviewed.

Results: The technique of distraction osteogenesis resulted in an average vertical augmentation of 7 mm, with a range of 5 to 9 mm. There were no complications affecting the outcome of the distraction procedure. No failures have occurred to date in the 16 implants that were placed and loaded following distraction.

Conclusions: In summary, clinical, histologic, and radiographic evidence of consistent vertical bone augmentation was found with this technique of distraction osteogenesis for vertical ridge augmentation. J Periodontol 2001;72:1767‐1779.
Intra‐ and Inter‐Examiner Reproducibility in Keratinized Tissue Width Assessment With 3 Methods for Mucogingival Junction Determination
Authors: Guglielmoni Paola , Promsudthi Ananya , Tatakis Dimitris N. , Trombelli Leonardo
Published: February 2005

Background: Although the need for “adequate” amount of keratinized tissue (KT) for periodontal health is questionable, the mucogingival junction (MGJ) often serves as a measurement landmark in periodontal evaluations. Limited information is available on the reproducibility of KT width (KTW) assessment. The purpose of this study was to assess intra‐ and inter‐examiner reproducibility in measuring KTW by using 3 different methods to identify MGJ location.

Methods: Fifteen patients provided 17 teeth which had undergone a gingival augmentation procedure (connective tissue graft; surgery group) and an equal number of contralateral, non‐treated teeth (control group). At the midbuccal aspect of each tooth, KTW was assessed by 2 independent examiners after MGJ identification by the visual (VM), functional (FM), and visual with histochemical staining (HM) method. Data analysis was based on intra‐class correlation coefficients (ICC) and 3‐way analysis of variance (ANOVA) for differences between replicate measurements.

Results: KTW was significantly different between treated and control teeth. No significant differences in KTW were found in relation to method for MGJ determination and examiner. Intra‐ and inter‐examiner reproducibility was high, regardless of treatment status or method for MGJ determination (ICC = 0.92 – 0.99). Standard deviations of the difference between replicate measurements ranged from 0.46 mm for VM to 0.21 mm for HM.

Conclusions: Intra‐ and inter‐examiner reproducibility has been shown to be substantially consistent when different methods for MGJ determination are used to measure the apico‐coronal dimension of the gingiva. The level of reproducibility does not seem to be affected whether or not the mucogingival complex has been surgically altered by a gingival augmentation procedure. J Periodontol 2001;72:134‐139.
The Influence of Partial and Full‐Mouth Recordings on Estimates of Prevalence and Extent of Lifetime Cumulative Attachment Loss: A Study in a Population of Young Male Military Recruits
Authors: Eaton Kenneth A. , Duffy Sarah , Griffiths Gareth S. , Gilthorpe Mark S. , Johnson Newell W.
Published: February 2005

Background: Previous studies have shown that the use of index teeth may underestimate the prevalence of chronic periodontitis in adults. However, there is little information on the effect of using index teeth to estimate the prevalence of early periodontitis in younger adults and the effect this may have on planning treatment needs and health care resources. The aim of this study was to compare full mouth examination with partial examination using index teeth in a group of young British males.

Methods: One hundred subjects aged between 16 and 20 years (mean 17 years) on entry to the study were examined at baseline, 12 months later, and 30 months later. Lifetime cumulative attachment loss (LCAL) ≥1 mm was measured on the mesio‐buccal, disto‐buccal, mesio‐lingual, and disto‐lingual surfaces of all teeth, excluding third molars. All data were entered into a database. The indices used to express LCAL were prevalence, defined as the percentage of subjects with LCAL ≥1 mm, 2 mm, or 3 mm, and extent, defined as the percentage of sites with LCAL ≥1 mm, 2 mm, or 3 mm. Two sets of index teeth were chosen to compare with full mouth recordings, Ramfjord index teeth and the Periodontal Index for Treatment (PIT) teeth.

Results: The prevalence of LCAL ≥1 mm was similar (approaching 100%) for the full mouth and both partial mouth recordings. However, as LCAL increased from a minimum of 1 to 3 mm, partial mouth recording resulted in an underestimation of the prevalence of disease. LCAL ≥2 mm was underestimated by up to 22% and LCAL ≥3 mm by up to 36%. The extent of LCAL was less affected by partial mouth recording, in that the percentage of sites with no sign of early attachment loss was underestimated by up to 11%. However, the percentage of sites with LCAL ≥1 mm and 2 mm were overestimated by 11% and, 7% respectively.

Conclusions: These data indicate that the use of index teeth in epidemiological studies which include young adults may result in an underestimation of the prevalence of early periodontitis and an overestimation of the extent. J Periodontol 2001;72:140‐145.
Macrophages and Lymphocyte Subpopulations in Nifedipine‐ and Cyclosporin A‐Associated Human Gingival Overgrowth
Authors: Pernu Hilkka E. , Knuuttila Matti L. E.
Published: February 2005

Background: Nifedipine and cyclosporin A (CsA) induce gingival overgrowth. Both drugs have immunomodulating effects. It has been suggested that altered immune response is associated with drug‐induced gingival overgrowth. In this study, we evaluated whether there were differences in macrophages and lymphocyte subpopulations in human nifedipine‐ and CsA‐associated gingival overgrowth as compared with those in normal gingiva.

Methods: Biopsy samples of overgrown gingiva were obtained from 9 nifedipine‐treated cardiac outpatients, 13 CsA‐treated renal transplant recipients including 9 patients who were also receiving nifedipine, and 30 healthy control individuals undergoing dental treatment. Serial 5 µm thick cryostat sections were stained with mAbs for CD20 (B‐pan), CD68 (macrophages), CD4 (T‐helper/inducer), and CD8 (T‐cytotoxic/suppressor) using an avidin‐biotin‐horseradish peroxidase complex method. Numbers of mAb‐labeled and all nucleated cells were determined in 3 areas: the connective tissue beneath the sulcular epithelium, the middle connective tissue, and the connective tissue beneath the oral epithelium. Distributions of each type of cell were expressed as percentages of mAb‐labeled cells in relation to total number of nucleated cells in a counting zone. Significances of differences between groups were tested by means of the Kruskal‐Wallis test, and between pairs of results by means of the Mann‐Whitney U‐test.

Results: The proportion of CD8‐labeled cells was significantly higher in connective tissue beneath the sulcular epithelium in the nifedipine group than in the controls (P = 0.014). In both medicated groups, the proportions of CD68‐labeled cells were higher in all counting zones than in the controls, but statistically significantly only in the nifedipine group in the connective tissue beneath the oral epithelium (P = 0.008). No intergroup differences were found with respect to CD4‐ and CD20‐labeled cells. The CD4/CD8 ratio was significantly lower in connective tissue beneath the sulcular epithelium in the nifedipine group than in the controls (P = 0.013).

Conclusion: The results support the idea that immune response may be altered in drug‐induced gingival overgrowth. J Periodontol 2001;72: 160‐166.
Laser Irradiation of Bone: III. Long‐Term Healing Following Treatment by CO2 and Nd:YAG Lasers
Authors: McDavid Valerie G. , Cobb Charles M. , Rapley John W. , Glaros Alan G. , Spencer Paulette
Published: February 2005

Background: Relative few reports exist concerning healing of laser created osteotomies over an extended period of time. The purpose of this study was to evaluate long‐term healing, from 21 to 63 days, of osteotomy defects in the rat tibia created with the Nd:YAG and CO2 in the presence of a surface cooling spray of air/water.

Methods: The experimental model consisted of 15 large Sprague‐Dawley rats. Six treatment modalities were randomly distributed among 6 tibial recipient sites: 1) a negative control (no treatment); 2) a positive control (bur osteotomy); 3) CO2 laser at 5 W (860 J/cm2); 4) CO2 laser at 6 W (1032 J/cm2); 5) Nd:YAG laser at 5 W (714 J/cm2); and 6) Nd:YAG laser at 7 W (1000 J/cm2). All laser irradiation was delivered in the presence of a surface coolant consisting of air (15 psi) and sterile water. Five animals were sacrificed at each of 3 time intervals: 21, 35, and 63 days post‐treatment. Multiple histologic sections from each treatment site were examined by light microscopy using hematoxylin and eosin Goldner's trichrome stains, and polarized light and evaluated for presence of a char layer, heat induced cracking, heat related alterations in cells or tissue matrix, and osseous regeneration.

Results: Healing was severely delayed in all laser treated sites compared to positive control sites. Of the laser treated sites, those irradiated by CO2 laser at 5 W (780 J/cm2) exhibited the greater amount of bone regeneration. At best, however, only a small percentage of sections from any of the laser treated specimens showed evidence of bone regeneration within the ablation defect regardless of the post‐treatment time interval.

Conclusions: Under the conditions of this study, the osseous healing response was severely delayed by CO2 and Nd:YAG laser irradiation of bone, even in the presence of a surface cooling spray of air/water. J Periodontol 2001;72:174‐182.
Clinical and Radiological Improvement of Periodontal Disease in Patients With Type 2 Diabetes Mellitus Treated With Alendronate: A Randomized, Placebo‐Controlled Trial
Authors: Rocha Miriam , Nava Laura Eugenia , de la Torre Carlos Vázquez , Sánchez‐Marín Francisco , Garay‐Sevilla Ma. Eugenia , Malacara Juan Manuel
Published: February 2005

Background: Alendronate (ALN) is an aminobisphosphonate commonly used for osteoporosis in postmenopausal women. We studied the effect of ALN on bone loss prevention in type 2 diabetes mellitus patients with periodontal disease.

Methods: In a controlled double‐blind, randomized study we evaluated prospectively diabetic patients paired by gender and years since diagnosis for 6 months. The study included 40 patients (20 men and 20 women), 50 to 60 years old, with more than 5 years since diagnosis of diabetes and established periodontitis. They were randomly allocated to alendronate (10 mg/daily) or placebo treatment for 6 months. The endpoints of treatment were: the distance between the alveolar bone border and the cemento‐enamel‐junction (CEJ) evaluated by means of digital radiographic imaging, a biochemical marker of bone resorption (urine N‐telopeptide) (Ntx), and periodontal parameters. Metabolic control was assessed at baseline and after 6 months.

Results: Baseline and 6‐month glycated hemoglobin levels were similar in both groups. Alendronate induced a significant decrease in NTx at 6 months (P = 0.006). Periodontal parameters improved in both groups. However, they were significantly better for the ALN treated group. Alveolar bone border‐CEJ distance increased in the placebo, but decreased in the ALN group (P = 0.0003).

Conclusions: In type‐2 diabetic patients, alendronate induced more improvement in alveolar bone crest height than control therapy. No differences in urinary N‐telopeptide or glycated hemoglobin were observed in this short‐term randomized controlled pilot trial. J Periodontol 2001;72:204‐209.
Bacteremia Due to Periodontal Probing: A Clinical and Microbiological Investigation
Authors: Daly Christopher G. , Mitchell David H. , Highfield John E. , Grossberg David E. , Stewart Douglas
Published: February 2005

Background: Infective endocarditis can occur in susceptible individuals due to bacteremia of oral origin. The aim of this study was to investigate the occurrence of bacteremia caused by full mouth periodontal probing.

Methods: Forty patients, 20 with adult periodontitis (10 males, 10 females; mean age 43.0 years) and 20 with chronic gingivitis (11 males, 9 females; mean age 35.5 years) were investigated. Prior to and immediately following periodontal probing, 20 mL of venous blood were obtained from each patient and inoculated into aerobic and anaerobic blood culture bottles and incubated. Negative bottles were monitored continuously for 3 weeks before being discarded. Bottles which signalled positive were subcultured and isolates identified to genus level. Periodontal probing consisted of measuring pockets at 6 points around each tooth and recording the presence or absence of bleeding. A plaque index (PI) was assessed on the 6 Ramfjord teeth.

Results: Probing caused bacteremia of oral origin in 8 (40%) of the periodontitis patients and 2 (10%) of the gingivitis patients. Streptococcus spp. were the most common isolates in both groups. Compared with the gingivitis group the odds ratio (OR) for bacteremia in the periodontitis group was 5.993 (95% CI 1.081 to 33.215). Bleeding on probing (OR 1.025, 95% CI 1.004 to 1.047) and mean probing depth per tooth (OR 1.444, 95% CI 1.055 to 1.977) were significantly associated with bacteremia. No significant correlations were found between bacteremia and age, number of teeth probed, smoking status, PI, or total probing depth.

Conclusions: Patients with untreated adult periodontitis are at greater risk of bacteremia due to periodontal probing than patients with chronic gingivitis. For individuals at risk of infective endocarditis, radiographic assessment prior to periodontal probing would be advisable to identify those with periodontitis so that appropriate antibiotic prophylaxis can be provided. J Periodontol 2001;72:210‐214.
Collagen Membranes: A Review
Authors: Bunyaratavej Pintippa , Wang Hom‐Lay
Published: February 2005

Collagen materials have been utilized in medicine and dentistry because of their proven biocompatability and capability of promoting wound healing. For guided tissue regeneration (GTR) procedures, collagen membranes have been shown to be comparable to non‐absorbable membranes with regard to probing depth reduction, clinical attachment gain, and percent of bone fill. Although these membranes are absorbable, collagen membranes have been demonstrated to prevent epithelial downgrowth along the root surfaces during the early phase of wound healing. The use of grafting material in combination with collagen membranes seems to improve clinical outcomes for furcation, but not intrabony, defects when compared to the use of membranes alone. Recently, collagen materials have also been applied in guided bone regeneration (GBR) and root coverage procedures with comparable success rates to non‐absorbable expanded polytetrafluoroethylene (ePTFE) membranes and conventional subepithelial connective tissue grafts, respectively. Long‐term clinical trials are still needed to further evaluate the benefits of collagen membranes in periodontal and peri‐implant defects. This article will review the rationale for each indication and its related literature, both in vitro and in vivo studies. The properties that make collagen membranes attractive for use in regenerative therapy will be addressed. In addition, varieties of cross‐linking techniques utilized to retard the degradation rate of collagen membranes will be discussed. J Periodontol 2001;72:215‐229.
Periodontal Regeneration of a Class II Furcation Defect Utilizing a Bioabsorbable Barrier in a Human. A Case Study With Histology
Authors: Stoller Norman H. , Johnson Lonnie R. , Garrett Steve
Published: February 2005

This case report describes human histologic data of periodontal regeneration following guided tissue regeneration therapy (GTR) with a bioabsorbable barrier composed of polylactic acid. The tooth that was examined was part of a previously published study of the clinical effects of GTR therapy without the use of bone or bone substitutes on Class II furcation defects. Twenty‐five months following the surgical procedure, the tooth was extracted for non‐periodontal reasons. During this extraction, the bone within the furcation that was treated in the study was luxated with the tooth. At the completion of the study (month 12), the furcation's vertical probing depth had decreased by 2 mm with a 2 mm gain in clinical attachment. The horizontal furcation measurement decreased by 3 mm. Following extraction, the tooth was prepared for light microscopy and sectioned in the mesial‐distal plane. Reference notches were not placed in the tooth at the time of surgery as there were no plans to perform histologic analysis in the study. However, using the buccal root prominences and what we interpreted to be root planing marks on the cementum, we were able to demonstrate that complete periodontal regeneration occurred on the root surface that was exposed to the pocket environment prior to surgery. New alveolar bone, cementum, and periodontal ligament were consistently observed throughout the furcation in the areas that demonstrated clinical attachment gain and a decrease in horizontal probing depth. This case report adds to the accumulating evidence of histologic periodontal regeneration following guided tissue regeneration with bioabsorbable polylactic acid barriers. J Periodontol 2001; 72:238‐242.
Immunopathological Diagnosis of Cicatricial Pemphigoid With Desquamative Gingivitis. A Case Report
Authors: Kurihara Mikinao , Nishimura Fusanori , Hashimoto Takashi , Komai Ayako , Ueda Hiroyoshi , Kokeguchi Susumu , Takashiba Shogo , Murayama Yoji
Published: February 2005

Cicatricial pemphigoid (CP) is a chronic subepidermal bullous dermatosis which primarily involves the mucous membranes. The oral cavity and the eye are most frequently involved. Since extension of the lesion into the pharynx and esophagus causes sore throat and dysphagia and progressive ocular lesions may cause blindness, early and valid diagnosis is very important. Here we present a case of cicatricial pemphigoid with onset at age 45 in a patient who manifested severe periodontal disease and showed the lesion on the mucous membranes of the mouth (desquamative gingivitis), skin, and eyes. Since definite diagnosis is very important, we describe how we made a differential diagnosis from other diseases which also accompany desquamative gingivitis. We examined the clinical manifestations, blood test results, HLA‐genotype, histopathologic findings of the affected tissue, and immunological findings in relation to autoimmunity. Since many of the CP cases are first referred to periodontists or dentists, we believe that the diagnostic strategy described in the present study will be quite informative for making rapid and definite diagnoses of similar cases. J Periodontol 2001;72:243‐249.
Guided Bone Regeneration for Dehiscence and Fenestration Defects on Implants Using an Absorbable Polymer Barrier
Authors: Rosen Paul S. , Reynolds Mark A.
Published: February 2005

Background: Guided bone regeneration (GBR) using a non‐absorbable barrier has provided clinicians the ability to place implants in sites compromised by insufficient bone, including immediate extraction sites. Recent evidence suggests that successful GBR outcomes may be possible using bioabsorbable polymer barriers.

Methods: This report presents a case series of 9 patients with 8 fenestration and 3 dehiscence defects on implants consecutively treated with GBR. A bioabsorbable polymer barrier of poly(DL‐lactide) was used in conjunction with a composite graft of freeze‐dried bone allograft (FDBA)/demineralized freeze‐dried bone allograft (DFDBA) mixed in a ratio of 1:1. Secondstage surgeries were performed at 4 to 8.5 months (5.7 months average) post‐placement. Biopsy material from 2 sites was obtained while exposing the implant for healing abutment connection.

Results: Ten of the 11 defects (90.9%) achieved complete coverage of the osseous defects. Histologic evaluations revealed the formation of viable bone, frequently in close amalgamation with residual graft particles.

Conclusion: These case reports suggest that a poly(DL‐lactide) polymer can be used as a physical barrier with a composite bone replacement graft to achieve successful GBR results of dehiscence/fenestration defects when placing implants. J Periodontol 2001;72:250‐256.