bluuebunny/crossref_metadata_2025 huggingface dataset:
Occurrence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia in Progressive Adult Periodontitis
Authors: López Néstor J.
Published: February 2005

Background: Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia are the major periodontal bacteria species in most forms of progressive periodontitis in Scandinavia and the United States. The occurrence of periodontal pathogens appears to be different in subjects of different ethnic origin, and geographical factors may influence the distribution of these species.

Methods: The occurrence of A. actinomycetemcomitans, P. gingivalis, and P. intermedia was determined using a DNA probe in progressive adult periodontitis in Chileans. Sixty patients (mean age 43.6 ± 8 years) who had not previously received any type of periodontal therapy were selected. Bleeding on probing, probing depth, and clinical attachment level measurements were made with an automated probe. Patients were monitored at 2‐month intervals until at least 2 sites exhibited ≥2 mm attachment loss. Two subgingival plaque samples from active sites were taken in 56 subjects and matched with 2 plaque samples from inactive sites in the same individuals.

Results: P. gingivalis was found in 75% of active sites and in 59.7% of inactive sites in 96% of the patients (P = 0.022). P. gingivalis at high levels of detection was significantly more frequent in active sites (48.2%) than in inactive sites (31.2%) (P = 0.014). A. actinomycetemcomitans was detected in 6.25% of active sites and in 12.5% of inactive sites in 11.6% of patients. P. intermedia was found in 33% of patients and at a significantly higher proportion in active sites (49.1%) than in inactive sites (30.3%) (P = 0.006). There was a significantly higher proportion of inactive sites (34.8%) than active sites (19.6%) without any of the 3 pathogens (P = 0.016). Bleeding on probing was significantly more associated with active sites with high levels of P. gingivalis and with active sites with P. intermedia than with inactive sites.

Conclusions: A high prevalence of P. gingivalis and P. intermedia was found in adult periodontitis, and the occurrence of these bacteria appears to be higher in Chileans than in other populations. No apparent association exists between A. actinomycetemcomitans and progressive adult periodontitis in Chileans. J Periodontol 2000;71:948‐954.
Phenytoin and Cyclosporin A Suppress the Expression of MMP‐1, TIMP‐1, and Cathepsin L, But Not Cathepsin B in Cultured Gingival Fibroblasts
Authors: Yamada Hisa , Nishimura Fusanori , Naruishi Koji , Chou Hsin‐Hua , Takashiba Shogo , Albright George M. , Nares Salvador , Iacopino Anthony M. , Murayama Yoji
Published: February 2005

Background: Fibroblasts are known not only to synthesize and secrete extracellular matrix proteins, but also to degrade them for connective tissue remodeling. Drug‐induced gingival overgrowth is characterized by a massive accumulation of extracellular matrix components in gingival connective tissues. Although some previous reports suggested that causative drugs stimulated the fibroblast proliferation, the results are not conclusive yet. In this study, we hypothesized that drug‐induced gingival overgrowth could be a consequence of impaired ability of matrix degradation rather than an enhanced proliferation of gingival fibroblasts induced by these drugs.

Methods: Normal human gingival fibroblasts were cultured with or without either 20 µg/ml of phenytoin or 200 ng/ml of cyclosporin A. Total RNA and cellular proteins were collected every day for RTPCR analyses and for measuring lysosomal enzyme activity. In addition, an immunohistochemical study was performed to detect lysosomal enzymes in cells from enlarged gingiva of the patients with phenytoin‐induced gingival overgrowth.

Results: RT‐PCR analyses revealed that these drugs suppressed the expression of MMP‐1, TIMP‐1, and cathepsin L, but not that of cathepsin B in a time‐dependent manner. Then, we measured the activity of lysosomal enzymes and cathepsin B and L. The results indicated that although cathepsin B activity was not observed to be impaired, regardless of the drugs used in these cells, both total and active forms of combined activity of cathepsins B and L were suppressed in a time‐dependent manner.

Conclusions: The results indicate that, besides suggested effects of these drugs on gingival fibroblasts and/or on accumulated cells in the gingival tissues, extracellular matrix‐degrading ability, particularly that by cathepsin L, is also suppressed by cyclosporin A and phenytoin in gingival fibroblasts, and that lysosomal enzyme plays an important role in the pathogenesis of drug‐induced gingival hyperplasia. J Periodontol 2000;71:955‐960.
Ultrastructural and Immunoelectron Microscopic Studies of the Peri‐Implant Epithelium‐Implant (Ti‐6Al‐4V) Interface of Rat Maxilla
Authors: Ikeda Hidehiro , Yamaza Takayoshi , Yoshinari Masao , Ohsaki Yasuyoshi , Ayukawa Yasunori , Kido Mizuho A. , Inoue Takashi , Shimono Masaki , Koyano Kiyoshi , Tanaka Teruo
Published: February 2005

Background: The role played by the internal basal lamina (IBL) and hemidesmosomes between an implant and the periimplant epithelium (PIE) in the adherence of the epithelium to the implant is controversial. This study used rat maxilla implantation models to clarify the ultrastructure of the PIE‐implant interface.

Methods: Ti‐6Al‐4V implants were inserted either immediately or 2 weeks after the extraction of the upper left first molar of 6‐ or 4‐week‐old rats, respectively. The junctional epithelium (JE) of the upper right molars in the same animals was used as a control. Four weeks after implantation, the animals were sacrificed to prepare specimens for light and immunoelectron microscopy.

Results: Under light microscopy, the PIE appeared to attach to the implant surface. Ultrastructurally, IBL, consisting of the lamina densa and lamina lucida, and hemidesmosomes were formed only in the lower region, and rarely in the middle region, of the PIE‐implant interface. In control teeth, the IBL and hemidesmosomes formed throughout the dento‐JE interface. Laminin‐1 was found in the IBL and also in the vesicles and vacuoles of the PIE and JE cells. Statistical analysis showed that there was also a significant difference in the amount of IBL between the PIE‐implant and dento‐JE interfaces.

Conclusions: PIE attached to the implant via hemidesmosomes and IBL in the lower region of the PIE‐implant interface. Although PIE cells may secrete laminin‐1, which contributes to epidermal cell adhesion, the PIE which attaches to implants only in the lower region of the interface is considered to be the poorly adhered epithelium. J Periodontol 2000;71:961‐973.
Inverse Dose‐ and Time‐Dependent Effect of Basic Fibroblast Growth Factor on the Gene Expression of Collagen Type I and Matrix Metalloproteinase‐1 by Periodontal Ligament Cells in Culture
Authors: Palmon A. , Roos H. , Edel J. , Zax B. , Savion N. , Grosskop A. , Pitaru S.
Published: February 2005

Background: Growth factors are known to play a major role in the regeneration of the periodontium. Basic fibroblast growth factor (bFGF) is a polypeptide growth factor considered to have a role in chemotaxis and mitogenesis of periodontal ligament cells (PLC). The aim of this study was to assess the dose‐dependent effect of bFGF administration on the levels of gene expression of collagen type I (a1) (col I), collagen type III (col III), and collagenase‐1 (MMP‐1) in PLC.

Methods: PLC were cultured in different concentrations of bFGF (0.1 to 10 ng of bFGF) for 14 and 21 days. At each time point, the gene expression of the examined molecules was assessed semi‐quantitatively by reverse transcription‐polymerase chain reaction (RT‐PCR) assay.

Results: The results indicated that bFGF exhibits an inverse time‐ and dose‐dependent effect on the gene expression of col I and MMP‐1: it simultaneously downregulates the gene expression of col I and upregulates the gene expression of MMP‐1. On the other hand, bFGF had no dose‐dependent effect on col III gene expression. The effect of bFGF on the expression of the three genes was modulated by the time of incubation with bFGF.

Conclusions: These results suggest that bFGF is one of the important regulators involved in the active remodeling of col I in the periodontal ligament and possibly in other connective tissues. J Periodontol 2000;71:974‐980.
Human Herpesviruses and Porphyromonas gingivalis Are Associated With Juvenile Periodontitis
Authors: Michalowicz Bryan S. , Ronderos Mauricio , Camara‐Silva Reneé , Contreras Aldofo , Slots J⊘rgen
Published: February 2005

Background: Although herpesviruses have been associated with adult periodontitis, their relationship with juvenile periodontitis (JP) has not been established. This case‐control study examined possible associations between JP and pathogenic bacteria, the human cytomegalovirus (HCMV), and the Epstein‐Barr type 1 virus (EBV‐1).

Methods: Subjects were participants in a larger survey of schoolchildren in North‐Central Jamaica. Subgingival plaque samples from 15 subjects with JP, 20 with incipient periodontitis (IP), and 65 randomly‐selected healthy controls were assayed for Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans using a 16S rRNA polymerase chain reaction (PCR) identification method, and for HCMV and EBV‐1 using nested PCR identification.

Results: Strong bivariate associations were found between JP and P. gingivalis (odds ratio [OR] = 12.7; 95% CI = 2.6, 61.4), HCMV (OR = 10.0; 95% CI = 2.7, 36.3), and A. actinomycetemcomitans (OR = 8.0; 95% CI = 2.3, 27.5), but not EBV‐1. In multivariate analyses, P. gingivalis remained a significant explanatory variable (OR = 7.8; 95% CI = 1.5, 40.9); however, the associations were marginal for HCMV (OR = 4.6; 95% CI = 0.9, 22.7), and non‐significant for A. actinomycetemcomitans (OR = 2.0; 95% CI = 0.4, 9.7). The associations with JP and the extent of attachment loss were even stronger when both P. gingivalis and HCMV were detected together. P. gingivalis (OR = 3.9; 95% CI = 1.3, 12.0) and EBV‐1 (OR = 3.3; 95% CI = 1.0, 10.3) were the only significant explanatory variables in the multivariate analysis of IP.

Conclusions: P. gingivalis is the strongest and most stable indicator of periodontitis in Jamaican adolescents. Co‐infection with P. gingivalis and HCMV appears to be particularly deleterious to periodontal health. J Periodontol 2000;71:981‐988.
Coronally Positioned Flap Procedures With or Without a Bioabsorbable Membrane in the Treatment of Human Gingival Recession
Authors: Amarante Evandro S. , Leknes Knut N. , Skavland Johanne , Lie Tryggve
Published: February 2005

Background: A variety of surgical techniques have been used to cover recession type defects. New data have indicated that the outcome of coronally positioned flap procedures may be augmented by supporting the flap with a membrane.

Methods: The present study aimed at comparing the clinical outcome following treatment of localized gingival recessions by a coronally positioned flap procedure alone, or combined with a bioabsorbable membrane. Twenty patients with buccal bilateral Miller Class I or Class II gingival recessions in cuspids or premolars participated in the study. The split‐mouth design, randomized selection of site treatment, and blind evaluation provided 20 sites in a membrane group and 20 sites in a non‐membrane group for examination at baseline, and at 3 months and 6 months postoperatively. Clinical variables included the apical extent of the gingival recession, the width of the recession defect measured at the cemento‐enamel junction (CEJ), and the width of keratinized tissue at the recession site as well as probing depth and attachment level.

Results: Both treatments resulted in a significant gain (P <0.0001) of root coverage, amounting to an average of 2.3 mm in the membrane group and 2.5 mm in the non‐membrane group at the 6‐month evaluation. There was no significant difference between the treatments. Similarly, a significant gain of clinical attachment level was seen in the membrane (1.3 mm; P <0.001) as well as in the non‐membrane (1.5 mm; P <0.0001) group, but without a significant difference between the groups. The reduction of the recession width from baseline to 6 months was significantly greater (P <0.01) for the non‐membrane (2.3 mm) than for the membrane (1.4 mm) group. Probing depth changes were small and not significant for either of the treatments. When patients were grouped as smokers (8) and non‐smokers (12), no significant differences were revealed for any of the response variables. Overall, among the 20 membrane sites, one showed no change while the remaining 19 gained root coverage at the 6‐month examination. Five sites obtained coverage to the CEJ. Among the non‐membrane sites, all gained root coverage at 6 months and 10 sites showed complete coverage to the CEJ.

Conclusions: The coronally positioned flap operation offers a predictable, simple, and convenient approach as a root coverage procedure in Miller Class I and Class II recession defects. Combining this technique with the placement of a bioabsorbable membrane does not seem to improve the results following surgical treatment of such defects. J Periodontol 2000;71:989‐998.
Calcium and the Risk For Periodontal Disease
Authors: Nishida Mieko , Grossi Sara G. , Dunford Robert G. , Ho Alex W. , Trevisan Maurizio , Genco Robert J.
Published: February 2005

Background: Dietary calcium has long been a candidate to modulate periodontal disease. Animal as weii as numan stuaies of calcium intaKe, Done mineral density, and tooth loss provide a rationale for hypothesizing that low dietary intake of calcium is a risk factor for periodontal disease.

Methods: We evaluated the role of dietary calcium intake as a contributing risk factor for periodontal disease utilizing the Third National Health and Nutrition Examination Survey (NHANES Ill), which is representative of the US. civilian non‐institutionalized population. Dietary calcium intake was determined from a 24‐hour dietary recall. The U.S. Department of Agriculture Nutrient Database was used as a source of nutrient composition data. Periodontal disease was measured by attachment loss. In addition, serum calcium was assessed using venous blood samples. Logistic regression analysis was used to examine the association between periodontal disease and dietary calcium intake or serum calcium levels after adjusting for covariants including age, gender, tobacco consumption, and gingival bleeding.

Results: The association of lower dietary calcium intake with periodontal disease was found for young males and females (20 to 39 years of age), and for older males (40 to 59 years of age). The relationship between low dietary calcium intake and increased levels of periodontal disease showed an estimated odds ratio (OR) of 1.84 (95% CI: 1.36 to 2.48) for young males, 1.99 (95% CI: 1.34 to 2.97) for young females, and 1.90 (95% CI: 1.41 to 2.55) for the older group of males. These odds ratios were adjusted for gingival bleeding and tobacco consumption. The dose response was also seen in females, where there was 54% greater risk of periodontal disease for the lowest level of dietary calcium intake (2 to 499 mg) and 27% greater risk in females who took moderate levels of dietary calcium (500 to 799 mg) as compared to those who took 800 mg or more dietary calcium per day. A statistically significant association between low total serum calcium and periodontal disease was found in younger females aged 20 to 39 with OR = 6. l l (95% CI: 2.36 to 15.84) but not for males or older females, after adjusting for tobacco use, gingival bleeding, and dietary calcium intake.

Conclusions: These results suggest that low dietary intake of calcium results in more severe periodontal disease. Further studies will be needed to better define the role of calcium in periodontal disease and to determine the extent to which calcium supplementation will modulate periodontal disease and tooth loss. J Periodontol 2000;71:1057‐1066.
Bone Mineral Density of Alveolar Bone in Rats During Pregnancy and Lactation
Authors: Shoji K. , Ohtsuka‐Isoya M. , Horiuchi H. , Shinoda H.
Published: February 2005

Background: The present study was designed to investigate the effect of pregnancy and lactation on the bone mineral density (BMD) of alveolar bone in rats fed diets containing different amounts of calcium (Ca). The effects of different levels of Ca intake by the mothers on the BMD of alveolar bone in their pups were also examined.

Methods: Ten‐week‐old female Wistar rats were housed with male rats for breeding and were divided into 3 groups fed diets containing 0.9, 0.3, and 0.02% Ca, respectively. They were further divided into 2 groups according to pregnancy or non‐pregnancy. Animals in the pregnant group were raised with their own pups for lactation. After the experiment, all animals were sacrificed, their mandibles were dissected, and soft x‐ray microradiographs were taken to determine BMD in the interdental area with an image analyzer.

Results: In both groups, BMD in alveolar bone decreased based on the amount of Ca in the diet, but the magnitude of this decrease was much greater in the pregnant group than in the non‐pregnant group. There was no significant difference in BMD between 2 groups fed a 0.9% Ca diet. The BMD of alveolar bone in the pups also decreased depending on the amount of Ca in the diet.

Conclusions: The above results suggest that pregnancy and subsequent lactation could be risk factors for alveolar bone loss, especially under conditions of Ca insufficiency or deficiency and that Ca insufficiency or deficiency in the mother caused decreases in the BMD of alveolar bone in the pups. J Periodontol 2000;71: 1073‐1078.
Collagen Fibers and Inflammatory Cells in Healthy and Diseased Human Gingival Tissues: A Comparative and Quantitative Study by Immunohistochemistry and Automated Image Analysis
Authors: Séguier Sylvie , Godeau Gaston , Brousse Nicole
Published: February 2005

Background: Periodontal disease is histologically characterized by the degradation of extracellular matrix components associated with a gingival infiltration of inflammatory cell populations. The purpose of this in situ study was to quantify inflammatory cell subsets and the area fraction (AA%) occupied by collagen fibers in healthy and diseased upper gingival connective tissue in order to investigate the association, if any, between collagen loss and inflammatory cell infiltrate.

Methods: Paraffin gingival tissue sections from 10 healthy controls (C), 9 patients with gingivitis (G), and 10 patients with severe chronic periodontitis (P) were immunohistochemically stained by antibodies against CD45, CD3, CD8, CD20, CD68, TIA‐1, and GrB molecules, and the collagen fibers were stained using sirius red F3Ba. The quantitative evaluations of inflammatory cell numbers and the AA% occupied by collagen fibers were performed by morphometric and automated image analysis.

Results: In group P, CD45+, CD20+, CD68+, TIA‐1+, and GrB+ cell numbers were significantly increased (P <0.05) when compared to both C and G groups. The present study revealed significant differences (P <0.01) between means of AA% observed in group C (63%), group G (46%), and group P (26%), and AA% of group G and group P was inversely correlated with the numbers of TIA‐1+ cells (P <0.01) and GrB+ cells (P <0.01 and P <0.05, respectively).

Conclusions: This study showed great differences in the number of the distinct inflammatory cell subsets according to the severity of the periodontal disease and suggested that activated cytotoxic cells could play a pivotal role in the loss of collagen fibers observed during these pathological states. During periodontitis, collagen loss was significantly correlated with all inflammatory cell subset numbers. Finally, the quantitative evaluation of the area fraction occupied by gingival collagen fibers may reflect the clinical severity of the periodontal disease. J Periodontol 2000;71:1079‐1085.
A Study of Attached and Oriented Human Periodontal Ligament Cells to Periodontally Diseased Cementum and Dentin After Demineralizing With Neutral and Low pH Etching Solution
Authors: Zaman Khurshid U. , Sugaya Tsutomu , Hongo Okito , Kato Hiroshi
Published: February 2005

Background: This study aimed to evaluate quantitatively the migrated, attached, and oriented human periodontal ligament cells (HPLC) to periodontally diseased cementum and dentin after demineralization with low and neutral pH etching solution.

Methods: Human teeth, extracted due to periodontal diseases, were scaled and root planed so that cementum remained on one longitudinal half of the root and dentin was exposed on the other half. Forty root slices of 200 µm thickness, obtained from the mid‐third of these roots, were divided into four groups: group 1, demineralized with a saturated solution of citric acid (pH 1.20); group 2, with 24% EDTA (pH 7.04); group 3, with tetracycline HCl 100 mg/ml (pH 2.00); and group 4, only scaled and root planed (control). Root slices were placed over the confluent HPLC in 35 mm culture dishes and incubated. Phase contrast microscopic photographs of attached and oriented refractile HPLC to root surfaces were taken at days 1, 3, and 7. Quantitative analysis of attached and oriented HPLC from these photographs was done using special software.

Results: The results showed no significant difference in the attachment and orientation index of HPLC to cementum compared to dentin in any method of demineralization at each time point (P >0.05), although there was a significantly higher cell attachment and orientation index to demineralized dentin with EDTA and citric acid than to non‐etched dentin and to all 3 demineralized cementum surfaces compared to non‐etched cementum (P <0.05).

Conclusions: EDTA and citric acid demineralization may enhance HPLC attachment and orientation to the root surface, and it is not always necessary to remove excessive cementum when the demineralizing procedure is used. J Periodontol 2000; 71:1094‐1099.
A Comparison Between Enamel Matrix Proteins Used Alone or in Combination With Bovine Porous Bone Mineral in the Treatment of Intrabony Periodontal Defects in Humans
Authors: Lekovic Vojislav , Camargo Paulo M. , Weinlaender Michael , Aleksic Zoran , Barrie Kenney E. , Nedic Melica
Published: February 2005

Background: It has been shown that clinical improvement of intrabony periodontal defects can be achieved with the use of enamel matrix proteins (EMPs) or by grafting with bovine porous bone mineral (BPBM). There is no report on the potential synergistic effect of EMPs and BPBM in periodontal regenerative therapy. The purpose of this study was to compare the clinical effectiveness of EMPs used alone or in combination with BPBM in the treatment of periodontal intrabony defects in humans.

Methods: Twenty‐one paired intrabony defects were surgically treated using a split‐mouth design. Intrabony defects were treated either with enamel matrix proteins (EMP group) or with enamel matrix proteins combined with bovine porous bone mineral (EMP/BPBM group). Re‐entry surgeries were performed at 6 months.

Results: Preoperative probing depths, attachment levels, and transoperative bone measurements were similar for the EMP and EMP/BPBM groups. Postsurgical measurements taken at 6 months revealed a significantly greater reduction in probing depth in the EMP/BPBM group (3.43 ± 1.32 mm on buccal sites and 3.36 ± 1.35 mm on lingual sites) when compared to the EMP group (1.91 ± 1.42 mm on buccal sites and 1.85 ± 1.38 mm on lingual sites). The EMP/BPBM group also presented with significantly more attachment gain (3.13 ± 1.41 mm on buccal sites and 3.11 ± 1.39 mm on lingual sites) than the EMP group (1.72 ± 1.33 mm on buccal sites and 1.75 ± 1.37 mm on lingual sites). Surgical re‐entry of the treated defects revealed a significantly greater amount of defect fill in favor of the EMP/BPBM group (3.82 ± 1.43 mm on buccal sites and 3.74 ± 1.38 mm on lingual sites) as compared to the EMP group (1.33 ± 1.17 mm on buccal sites and 1.41 ± 1.19 mm on lingual sites).

Conclusions: The results of this study indicate that BPBM has the ability to augment the effects of EMPs in reducing probing depth, improving clinical attachment levels, and promoting defect fill when compared to presurgical levels. J Periodontol 2000;71:1110‐1116.
Fusobacterium nucleatum Involvement in Adult Periodontitis and Possible Modification of Strain Classification
Authors: Roques Christine G. , Kaddouri Said El , Barthet Pierre , Duffort Jean‐François , Arellano Michel
Published: February 2005

Background: This investigation was designed to evaluate the involvement of Fusobacterium nucleatum clinical strains in adult periodontitis by subspecies and expression of hemagglutination activity.

Methods: Forty‐nine Fusobacterium strains were isolated from 40 sites in 40 subjects presenting with adult periodontitis. F. nucleatum subspecies identification was based on the electrophoretic migration of glutamate dehydrogenase and 2‐oxoglutarate reductase. Hemagglutination activity and inhibition by galactose were tested on sheep erythrocytes.

Results: The 49 isolates belonged to the F. nucleatum species with a predominance of the nucleatum (34.7%) followed by the vincentii (26.5%) subspecies. In parallel, 71% of the strains belonging to the nucleatum subspecies were preferentially associated with Porphyromonas gingivalis. Prevotella intermedia/nigrescens detection was essentially correlated with identification of Fusobacterium nucleatum subspecies vincentii. No correlation was established between any particular subspecies and the pathogenicity factors tested (hemagglutination and production of short‐chain fatty acids). On the other hand, significant predominance (65%, P = 0.017) of strongly hemagglutinating strains (titre ≥8 U) was observed in the sites where Porphyromonas gingivalis, Prevotella intermedia/nigrescens and/or Campylobacter rectus were not detected. These strains also showed higher butyric acid production.

Conclusion: The importance of the adherence factors for Fusobacterium nucleatum strains and their multimodal aspect may indicate a higher pathogenicity or a higher involvement of certain strains and could lead to a classification of these strains, which is more closely related to their implication in the development of periodontal disease. J Periodontol 2000;71:1144‐1150.
The Use of Hydroxyapatite Bone Cement for Sinus Floor Augmentation With Simultaneous Implant Placement in the Atrophic Maxilla. A Report of 10 Cases
Authors: Mazor Ziv , Peleg Michael , Garg Arun K. , Chaushu Gavriel
Published: February 2005

Background: Dental implant placement associated with sinus floor augmentation in a severely atrophic maxilla can be performed in a 1‐ or 2‐stage surgical procedure, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm is recommended for a 1‐stage procedure.

Methods: This clinical study describes the use of hydroxyapatite (HA) bone cement to stabilize HAcoated cylindrical implants placed simultaneously during sinus augmentation in 10 patients where insuf‐ficient bone volume did not allow primary implant stability. A total of 26 HA‐coated dental implants were inserted in 10 grafted sinuses of 10 patients.

Results: None of the cases presented any difficulty in achieving initial stabilization and parallelism. No clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed the implants embedded in a densely homogeneous radiopaque mass. At second‐stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant‐supported prostheses. Mean follow‐up was 18 months (range 12 to 24 months).

Conclusions: According to this preliminary study, the hydroxyapatite bone cement appears to hold great promise as a grafting alloplastic material for sinus floor augmentations. Its main advantage is its ability to provide initial stability required for osseointegration and proper implant location and parallelism. Further clinical and histological studies are required before it can be recommended for routine use in sinus lift procedures. J Periodontol 2000;71:1187‐1194.
Spontaneous Early Exposure of Submerged Implants: III. Histopathology of Perforated Mucosa Covering Submerged Implants
Authors: Tal Haim , Dayan Dan
Published: February 2005

Background: Spontaneous early exposure of dental implants could interfere with the early healing phase of dental implants. These exposures have been clinically classified according to degree of implant exposure from 0 (intact mucosa) to IV (complete exposure). The characteristics of perforated mucosa (Class I and II) covering submerged dental implants were examined histologically in this study.

Methods: Biopsy specimens of 34 Class I and II perforated mucosa covering submerged dental implants were examined histologically. Serial sections were evaluated from the periphery of the specimen to the center of each perforation lesion.

Results: Class I specimens presented hyperplastic epithelium characterized by hyperparakeratosis and acanthosis. Chronic inflammatory cells diffusely infiltrated the connective tissue. Sections closer to the perforation revealed gradual epithelial invagination; in the deepest aspect, there was a cyst‐like structure in all Class I specimens examined. A thin layer of connective tissue containing necrotic material and debris formed the “cystic” wall proximal to the implant cover screw. Class II specimens presented the same epithelial patterns; however, the cystic structures were replaced by direct contact between the cover screw and the oral cavity via the perforation.

Conclusions: Spontaneous early perforations are the sequela of either traumatic irritation or failure of the tissue flaps to produce primary healing. Most Class I perforations include epithelial invagination and the formation of a cyst‐like structure. Necrosis of the base of the “cyst” or enlargement of the perforation results in direct communication between the oral cavity and the covering screw surface (Class II). J Periodontol 2000;71:1231‐1235.
Effectiveness of Local Delivery of Alendronate in Reducing Alveolar Bone Loss Following Periodontal Surgery in Rats
Authors: Binderman I. , Adut M. , Yaffe A.
Published: February 2005

Background: Mucoperiosteal flaps are used to access bone and root surfaces for debridement, pocket elimination, management of periodontal defects, and in regenerative procedures, as well as in implant surgery. Many reports show that periodontal surgery stimulates osteoclast activity with varying amounts of alveolar bone loss. Alendronate given intravenously significantly reduced alveolar bone loss in mucoperiosteal flap procedures. In the present study, we explored the effectiveness of different concentrations of alendronate, delivered at the surgical site at the time of surgery, in distant delivery in reducing alveolar bone loss.

Methods: Following elevation of a mucoperiosteal flap next to molars of the rat mandible, a gelatin sponge soaked with different concentrations of alendronate (0, 1, 5, 20, or 40 mg/ml; experiment A) was applied to exposed bone on the experimental side. In the second group (experiment B), alendronate (0, 50, 200, or 400 µg) was topically delivered in the cheek submucosa on the left side (distant to the surgical site) in a small cut into which the gelatin sponge soaked with the drug was placed.

Results: Topical application of 200 µg and 400 µg doses of alendronate at the time of surgery was significantly effective (P <0.001) in reducing bone loss. Generally, the percentage of sections with mild bone loss (V1, V2) increased with an increase in the dose of alendronate, while the percentage of sections with severe bone loss (H1, H2) decreased with an increase in alendronate dose. Topical application of 400 µg of alendronate had a systemic effect.

Conclusions: This study implies that topical delivery of alendronate at the time of surgery reduces bone loss in periodontal procedures involving mucoperiosteal flap surgery. The most effective dose is 200 µg for topical delivery at the surgical site and 400 µg for distant sites. J Periodontol 2000;71:1236‐1240.
The Mouthwash: A Non‐Invasive Sampling Method to Study Cytokine Gene Polymorphisms
Authors: Laine Marja L. , Farré Maria A. , Crusius J. Bart A. , van Winkelhoff Arie‐Jan , Peña A. Salvador
Published: February 2005

Background: We describe a simple, non‐invasive mouthwash sampling method for rapid DNA isolation to detect cytokine gene polymorphisms. In the present paper, interleukin‐1β (IL‐1B) and interleukin‐1 receptor antagonist (IL‐1RN) gene polymorphisms were studied.

Methods: Two mouthwash samples and blood samples were collected from 11 healthy individuals. The second mouthwash sample was stored for 7 days at room temperature. Polymerase chain reaction amplification was used to identify a bi‐allelic polymorphism at position +3953 in the IL‐1B gene and a variable number of tandem repeats (VNTR) polymorphism in the IL‐1RN gene.

Results: Our results show that the typing of these cytokine gene polymorphisms using DNA isolated from mouthwash samples did not differ from those obtained by a phenol/chloroform isolation method from EDTA anti‐coagulated blood. Moreover, reliable results from mouthwash samples were obtained after storage for at least 7 days at room temperature.

Conclusions: Mouthwash can be the method of choice to study gene polymorphisms in periodontitis and other chronic inflammatory diseases. J Periodontol 2000;71:1315‐1318.
Odontogenic Carcinoma Occurring in a Dentigerous Cyst: Case Report and Clinical Management
Authors: Olson John W. , Miller Richard L. , Kushner George M. , Vest Tracy M.
Published: February 2005

This case report describes an unusual odontogenic carcinoma, which was detected during routine periodontal examination. The lesion occurred in a dentigerous cyst associated with an impacted third molar in an otherwise asymptomatic 66‐year‐old male patient. The impacted tooth and lesion were excised based on evidence of radiographic change and clinical findings. An unusual histopathologic presentation is reported. The treatment provided for this tumor and the management of impacted teeth is reviewed. J Periodontol 2000;71:1365‐1370.
Morphology and Elemental Composition of Subgingival Calculus in Two Ethnic Groups
Authors: Roberts‐Harry Elizabeth A. , Clerehugh Valerie , Shore Roger C. , Kirkham Jennifer , Robinson Colin
Published: February 2005

Background: The aim of the present study was to compare the morphology and elemental composition of subgingival calculus between Indo‐Pakistani and Caucasian patient groups.

Methods: Extracted teeth from 14 Indo‐Pakistani and 19 Caucasian subjects were collected. Of these, 12 Indo‐Pakistani and 10 Caucasian teeth had sufficient subgingival calculus for analysis. Subgingival calculus present on the 22 teeth was classified into six morphological types: 1) crusty/spiny/nodular; 2) ledge/ring; 3) thin, smooth veneers; 4) finger/fern‐like; 5) individual islands/spots; or 6) supramarginal on submarginal. Subgingival calculus was zoned: coronal, mid, and apical. A sample obtained from each zone was subdivided to allow 3 separate analyses: transmission electron microscopic (TEM) x‐ray microanalysis for elemental composition, fluoride analysis, and carbonate analysis.

Results: Crusty/spiny/nodular, ledge/ring, and thin, smooth veneers were more commonly found in the Indo‐Pakistani group; individual islands were more prevalent in the Caucasian subjects. Supramarginal on submarginal calculus was found only in the Indo‐Pakistani group. No finger/fern‐like deposits were found. No differences within or between the two ethnic groups were found with regard to calcium:phosphate ratios, fluoride, or carbonate content. However, the Indo‐Pakistani group showed significantly lower levels of sodium in apical samples than in coronal samples (ANOVA, F1,16 = 5.98, P = 0.03), and significantly lower levels of sodium (ANOVA, F1,12 = 4.75, P = 0.05) and magnesium (ANOVA, F1,12 = 5.16, P = 0.04) in apical samples than in those from Caucasians. After adjusting for smoking, the magnesium results remained significant (ANOVA, F2,11 = 4.64, P = 0.05).

Conclusions: Subgingival calculus demonstrated differences in morphology between these two ethnic groups and differences in elemental composition, which may influence its overall solubility and contribute to its greater accretion in the Indo‐Pakistani subjects. J Periodontol 2000;71:1401‐1411.
Evaluation of a New Bioabsorbable Barrier for Recession Therapy: A Feasibility Study
Authors: Jepsen S⊘ren , Heinz Bernd , Kermanie Mehrdad Arjomand , Jepsen Karin
Published: February 2005

Background: The objective of this study was to evaluate the feasibility of a new polylactic acid bioabsorbable barrier in the treatment of gingival recession.

Methods: Twenty patients with buccal recession defects (Miller class I, II, and III; mean recession: 4.0 ± 1.2 mm; range: 2.0 to 6.8 mm) participated. After thorough scaling and root surface conditioning with 10% tetracycline‐HCl, a trapezoidal mucoperiosteal flap was prepared. A customized barrier was applied to cover the defect. Barriers adhered directly to tooth and bone and no sutures were used. The barrier was subsequently covered by a coronally positioned flap. Assessments of probing depths were performed by means of a controlled‐force electronic probe, and recession was determined on stone models with a digital caliper at baseline and 12 months following therapy.

Results: Eight barriers showed limited exposure (1 to 2 mm) with minimal signs of gingival inflammation between 2 and 6 weeks following surgery. Comparing baseline measurements with outcomes at 12 months, significant root coverage and probing attachment gain were observed (P <0.0001, paired t test). Mean gingival recession was reduced to 0.4 ± 0.5 mm, corresponding to a mean root coverage of 91.9%, and overall attachment gains amounted to 4.2 mm. A significant gain of keratinized tissue was found (2.9 ± 0.7 mm), and mean probing depths were slightly reduced from 2.2 to 1.7 mm.

Conclusions: The results of this study indicate favorable outcomes after using a new bioabsorbable barrier material for root coverage in recession‐type defects. J Periodontol 2000;71:1433‐1440.
Gingival Fluid Ciprofloxacin Levels at Healthy and Inflamed Human Periodontal Sites
Authors: Conway Theresa B. , Beck Frank M. , Walters John D.
Published: February 2005

Background: Polymorphonuclear leukocytes (PMNs) take up and accumulate ciprofloxacin. This may allow them to enhance the delivery of this agent to the inflamed periodontium.

Methods: Cross‐sectional and longitudinal approaches were used to test the hypothesis. In the cross‐sectional study, 7 periodontally healthy adults and 8 adults with untreated periodontitis were administered three doses of ciprofloxacin (500 mg bid). Gingival fluid (GF) and serum samples were obtained after 28 hours and analyzed by high‐performance liquid chromatography (HPLC). In the longitudinal study, 8 adult periodontitis subjects were administered 500 mg ciprofloxacin bid for 8 days. After 28 hours, GF from 4 sites with 5 to 8 mm probing depths was sampled in each subject, serum samples were obtained, and 2 of the 4 sites were root planed. GF and serum were sampled again 7 days later (196 hours after the initial dose).

Results: The mean ciprofloxacin levels in the GF and serum of periodontally healthy subjects were 2.52 ± 0.22 μg/ml and 0.47 ± 0.05 μg/ml, respectively. In subjects with periodontitis, these levels were 2.69 ± 0.44 μg/ml and 0.61 ± 0.13 μg/ml, respectively. GF ciprofloxacin levels were significantly higher than corresponding serum levels in healthy and diseased subjects (P <0.01), but there were no significant differences in GF or serum levels between the 2 subject groups. Since GF flow was significantly higher at diseased sites, however, more ciprofloxacin was distributed to these sites than to healthy sites. In the longitudinal study, GF flow at 196 hours was 16% lower at root planed sites than at untreated control sites (P = 0.412). The minor decrease in this index of inflammation was accompanied by a small (9%), but statistically significant (P = 0.007), decrease in GF ciprofloxacin levels.

Conclusions: GF ciprofloxacin levels decreased slightly at inflamed periodontal sites after root planing, but were significantly higher than serum levels even at healthy periodontal sites. Inflammation may enhance the distribution of ciprofloxacin to diseased sites, but it is not a major determinant of GF ciprofloxacin levels. J Periodontol 2000;71:1448‐1452.
Histologic Response to Intraligament Injections Using a Computerized Local Anesthetic Delivery System. A Pilot Study in Mini‐Swine
Authors: Froum Stuart J. , Tarnow Dennis , Caiazzo Alfonso , Hochman Mark N.
Published: February 2005

Background: Intraligamentary (periodontal ligament) injection has been used to locally control pain with minimal anesthetic dose. The purpose of the present study was to determine the histologic effect of using a computer‐controlled local anesthesia delivery system (CCLADS) for the administration of a periodontal ligament injection in the mini‐swine model system.

Methods: Thirty‐two sites in 3 mini‐swine pigs with healthy periodontium were selected. Each site was notched on the mesial‐lingual line angle of the tooth to allow a reference for needle placement and provide a histologic marker. An anesthetic cartridge was used with a 30‐gauge needle attached to the handpiece of the CCLADS. This provided a controlled flow rate for 2 minutes. The control sites were treated with the same needle in place for 20 seconds. The animals were sacrificed and provided observation periods of 1 hour, 1, 4, 7, 21, and 49 days. Specimens were stained with hematoxylin and eosin and trichrome.

Results: Twenty‐four hours after injection, limited localized inflammation was present. By 7 days, the ligament appeared within normal limits. Apical migration of the junctional epithelium extended to the apical limit of the notch and was similar in test and control specimens.

Conclusions: Within the limits of this study, the histologic results showed that tissue responses following intraligament injections using a CCLADS demonstrated limited inflammatory responses within the first 24 hours, which abated by 7 days postinjection. Similar migration of the junctional epithelium was seen in test and control specimens and was probably related to tooth injury rather than anesthetic injections. Further investigations are warranted using CCLADS to determine whether clinical benefits will translate in the human model system. J Periodontol 2000;71:1453‐1459.
The Influence of Nicotine on the Bone Loss Rate in Ligature‐Induced Periodontitis. A Histometric Study in Rats
Authors: Nociti Francisco H. , Nogueira‐Filho Getúlio R. , Primo Mariana T. , Machado Maria A.N. , Tramontina Vinícius A. , Barros Silvana P. , Sallum Enilson A.
Published: February 2005

Background: The present study investigated the possible influence of nicotine on the bone loss rate in the furcation region due to ligature‐induced periodontitis in rats.

Methods: Twenty adult male Wistar rats were included. After anesthesia, the tooth was randomly assigned to receive the cotton ligature in the sulcular area, while the contralateral tooth was left unligated. The animals were randomly assigned to one of the following treatments, including daily intraperitoneal injections: group A, 2 μl/g body weight of saline solution; group B, 2 μl/g body weight of a nicotine solution with 0.13 μl of nicotine/ml of saline solution; group C, 2 μl/g body weight of a nicotine solution with 0.19 μl of nicotine/ml of saline solution; and group D, 2 μl/g body weight of a nicotine solution with 0.26 μl of nicotine/ml of saline solution. Thirty days later, the animals were sacrificed and the specimens routinely processed for serial decalcified sections.

Results: Intergroup analysis revealed greater bone loss in the ligated teeth of group B (1.01 ± 0.61 mm2), group C (1.14 ± 0.72 mm2), and group D (1.36 ± 0.60 mm2) when compared with group A (0.64 ± 0.62 mm2) (P <0.01). However, no statistically significant differences in bone loss were found among groups B, C, and D. In addition, no bone loss was observed for unligated teeth (P >0.01).

Conclusions: Within the limits of the present study, nicotine enhanced the effects of the local components of periodontal disease in a non‐dose‐dependent way; nevertheless, the administration of nicotine did not produce periodontal bone loss by itself. J Periodontol 2000;71:1460‐1464.
Treatment of Multiple Recession‐Type Defects in Patients With Esthetic Demands
Authors: Zucchelli G. , De Sanctis M.
Published: February 2005

Background: When multiple recession defects affecting adjacent teeth in esthetic areas of the mouth are present, patient‐related considerations suggest the selection of surgical techniques that allow all gingival defects to be simultaneously corrected with the soft tissue close to the defects themselves. The aim of the present study was to evaluate, with respect to root coverage, the effectiveness of a new surgical approach to the coronally advanced flap procedure for the treatment of multiple recession defects in patients with esthetic demands.

Methods: Twenty‐two young systemically and periodontally healthy subjects with at least 2 recession‐type defects affecting adjacent teeth in esthetic areas of the mouth were enrolled in the study. All recessions were Miller Class I or II. In each patient, all present recessions were treated at the same time with a modification of the coronally advanced flap technique. The clinical re‐evaluation was made 1 year after the surgery.

Results: A total of 73 recessions (mean recession depth 2.8 mm) were treated; mean number of gingival recessions in each subject was 3.4. At the 1‐year examination, on average, 97% of the root surface was covered with soft tissue and 64 defects (88%) showed complete root coverage. Complete root coverage in all recessions was achieved in 16 out of 22 patients (73%), and no statistically significant relationship was found between the root coverage results and the number of recession defects treated in each patient. A statistically significant increase of keratinized tissue (0.6 mm) was observed after 1 year; this increase was inversely correlated (P <0.001) with the amount of presurgical keratinized tissue. The multiple regression model showed that the final result, in terms of root coverage, was significantly affected by the initial recession depth and by the amount of presurgical keratinized tissue. Greater reductions in recession depth were observed in the cases with worse initial conditions and with lesser amount of keratinized tissue apical to the recession defect.

Conclusions: The results of the present study demonstrated that the proposed surgical technique was very effective for the treatment of multiple gingival recessions affecting teeth in esthetic areas of the mouth and that these successful root coverage results could be achieved irrespective to both the number of recessions simultaneously treated during the surgical intervention and the presence, before surgery, of a minimal amount of keratinized tissue apical to the defects. J Periodontol 2000;71:1506‐1514.