bluuebunny/crossref_metadata_2025 huggingface dataset:
Periodontal Status and Subgingival Microbiota of Insulin‐Dependent Juvenile Diabetics: A 3‐Year Longitudinal Study
Authors: Sbordone Ludovico , Ramaglia Luca , Barone Antonio , Ciaglia Renato Nicodemo , Iacono Vincent J.
Published: March 2012

This study examined for 3 years the changes in periodontal status and the possible correlations with selected subgingival microbiota and diabetic conditions in a group of 16 insulin‐dependent diabetes mellitus (IDDM, JD) patients as compared with their 16 healthy cohabiting siblings (HS). JD patients were monitored every 3 months for levels of glycosylated hemoglobin (HbA1c). Clinical and microbiological parameters were measured 6 weeks before drawing blood to determine levels of HbA1c. Periodontal parameters were measured at baseline (T0), year 2 (T2), year 3 (T3) and included: probing depth (PD), attachment level (AL), sulcus bleeding index (SBI), and plaque index (PI). Two sites in each patient were selected for microbial samples: a mesio‐facial aspect of the maxillary right first molar (defined as constant site, CS) and a site with the greatest probing depth (defined as deepest site, DS). Microbial samples were analyzed by culture techniques. No significant differences in clinical parameters were found between diabetics and healthy siblings at any examination. The SBI in the non‐diabetic group at T2 and at T3 was significantly lower than at baseline. PD and AL of constant sites in the diabetic group at T3 were significantly higher than baseline. There was a significant increase in Prevotella intermedia at T3 as compared with baseline for deepest sites in the diabetic group. Cluster analysis revealed, in a former study, two clusters (IV and V) at baseline which were significantly different from the overall mean regarding composition of Porphyromonas gingivalis and Capnocytophaga spp. They were not significantly different for periodontal parameters from T0 to T3. These data would suggest no significant differences in clinical parameters between the diabetics and non‐diabetic siblings throughout this 3‐year longitudinal study. J Periodontol 1998;69:120–128.
Recombinant Human Osteogenic Protein‐1 (OP‐1) Stimulates Periodontal Wound Healing in Class III Furcation Defects
Authors: Giannobile William V. , Ryan Susan , Shih Mei‐Shu , Su Dong Ling , Kaplan Paul L. , Chan Thomas C.K.
Published: March 2012

Osteogenic protein‐1 (OP‐1) is a member of the transforming growth factor beta superfamily and is a potent modulator of Osteogenesis and bone cell differentiation. This preclinical study in dogs sought to assess the effects of OP‐1 on periodontal wound healing in surgically created critical size Class III furcation defects. Eighteen male beagle dogs were subjected to the creation of bilateral mandibular 5 mm osseous defects. A split‐mouth design was utilized which randomly assigned opposing quadrants to control therapy (surgery alone or collagen vehicle) or 1 of 3 ascending concentrations of OP‐1 in a collagen vehicle (0.75 mg OP‐1/g collagen, 2.5 mg/g, or 7.5 mg/g). Thus, 9 quadrants per test group received OP‐1, 9 quadrants per control group received surgery alone, and 9 quadrants received collagen vehicle alone. Test articles were delivered by a surgeon masked to the treatment, and fluorogenic bone labels were injected at specified intervals post‐treatment. Eight weeks after defect creation and OP‐1 delivery, tissue blocks of the mandibulae were taken for masked histomorphometric analysis to assess parameters of periodontal regeneration (e.g., bone height, bone area, new attachment formation, and percent of defect filled with new bone). Histomorphometry revealed limited evidence of Osteogenesis, cementogenesis, and new attachment formation in either vehicle or surgery‐alone sites. In contrast, sites treated with all 3 concentrations of OP‐1 showed pronounced stimulation of Osteogenesis, regenerative cementum, and new attachment formation. Lesions treated with 7.5 mg/g of OP‐1 in collagen regenerated 3.9 ± 1.7 mm and 6.1 ± 3.4 mm2 (mean ± S.D.) of linear bone height and bone area, respectively. Furthermore, these differences were statistically different from both control therapies for all wound healing parameters (P < 0.0001). No significant increase in tooth root ankylosis was found among the treatment groups when compared to the surgery‐alone group. We conclude that OP‐1 offers promise as an attractive candidate for treating severe periodontal lesions. J Periodontol 1998;69:129–137.
Hollow Implants Retrieved for Fracture: A Light and Scanning Electron Microscope Analysis of 4 Cases
Authors: Piattelli A. , Scarano A. , Piattelli M. , Vaia E. , Matarasso S.
Published: March 2012

One of the possible complications of implant treatment is the occurrence of an implant fracture. Metal fatigue and biomechanical overload seem to be the most common causes of fractured implants. This study evaluated 4 implants (3 hollow cylinders and 1 hollow screw) which fractured after a mean loading period of 2.8 years. All implants had a 4 mm diameter and had been inserted in a posterior location. In 3 cases parafunctional habits were present. In all cases a vertical resorption of the peri‐implant bone was present. The endosseous portion of the implant presented always a very high bone‐implant contact percentage. Scanning electron microscopic examination showed that at least one of the implant holes was involved in the fracture line; no porosities or material defects were observed on the fractured surface of the implant. In hollow implants the holes could represent a site of less resistance. J Periodontol 1998;69:185–189.
Inflammatory Cervical Root Resorption Following Segmental Orthognathic Surgery. A Case Report
Authors: Hokett Steven D. , Hoen Michael M.
Published: March 2012

An unusual case of bilateral inflammatory external/internal root resorption developed in the maxillae of a 28 year‐old female approximately 4 years following routine segmental orthognathic surgery. The patient experienced dental pain in a tooth adjacent to a segmental osteotomy cut 8 months postsurgery, however, the tooth later became asymptomatic. A definitive diagnosis of inflammatory cervical root resorption was not established until nearly 4 years later on routine dental examination. The external/internal resorptive lesions were located 4 to 6 mm apical to the connective tissue attachment on 3 of the 4 tooth roots adjacent to osteotomy cuts. Two of the affected teeth required non‐surgical root canal therapy due to pulpal communication with the resorptive defects. The lesions were accessed by flap surgery, thoroughly debrided, and obturated with an intermediate restorative material until definitive restorative therapy could be completed. All sites healed uneventfully and the patient has been closely observed for approximately 2 years without symptoms or recurrence of the resorptive lesions. Dental health care providers should be alert to the possible occurrence of inflammatory root resorption in sites adjacent to osteotomy cuts over extended periods of time. Routine radiographic examination may be beneficial in the postoperative management of the segmental orthognathic surgery patient. J Periodontol 1998;69:219–226.
Concepts of Quality and the Provision of Periodontal Care: A Survey
Authors: Marcus Marvin , Spolsky Vladimir
Published: March 2012

This is a survey of various concepts of quality of care in the health care field and their application to periodontics. Definitions of quality care, measuring and improving quality, third party payment and quality of care, and the role of periodontists in managing quality are presented. The definitions of quality care include the following dimensions: access, appropriateness, technical quality, and the art of care. Examples of each of these dimensions are presented, and their implications for quality assessment are discussed. Emphasis is placed on appropriateness of care and the strengths and weaknesses of mechanisms for deriving evidence‐based decision making. The use of randomized clinical trials (RCT), employing expert opinion such as consensus panels, and meta‐analysis are discussed as they apply to appropriateness of periodontal treatment. Work in the area of technical quality of care (i.e., the third dimension of quality care) has resulted in the development of quality assurance guidelines. Examples of guidelines and practice parameters such as those developed by the U.S. Food and Drug Administration and by various dental specialties are presented. The fourth dimension of quality deals with the art of care. It focuses on the patient's participation in the process of care and the input of the provider in this interaction. The description of outcomes of care includes the concept of measuring clinical outcomes of treatment as well as efforts to measure the health and well‐being of a patient. It deals with quality of life measures. Patient satisfaction is another outcome that is presented. Examples of these aspects of quality measurement are discussed. These concepts and measures are presented within the context of a quality assurance program. The steps used to assess and assure quality are outlined. Examples of provider and patient profiles are presented, along with a discussion on how they are used in a quality assurance system. Lastly, the role of the periodontist in quality of care is presented, emphasizing the efforts that have already been made as well as the leadership role that the periodontist has in influencing the profession of dentistry. The advent of managed care and its implications for the quality of periodontal treatment and patient management are discussed using situations obtained from dental plans. J Periodontol 1998;69:228–240.
Legal Considerations for Periodontists in Dealing With Managed Care Organizations
Authors: Bierig Jack R.
Published: March 2012

For well over a decade, increasing numbers of medical patients have transferred from traditional indemnity insurance to managed care organizations (MCOs). Increasingly, MCOs are enrolling dental patients as well. Consequently, it is important for periodontists to understand issues in negotiating with MCOs. This article attempts to advise periodontists regarding what they can and cannot do collectively about managed care and what considerations they should take into account in individually negotiating and dealing with managed care plans. J Periodontol 1998;69:254–260.
Reproducibility and Validity of the Assessment of Clinical Furcation Parameters as Related to Different Probes
Authors: Eickholz Peter , Kim Ti‐Sun
Published: March 2012

The aim of this study was to investigate the reliability of the assessment of clinical furcation parameters (horizontal attachment levels [CAL‐H], class of furcation invasion). Replicate measurements of CAL‐H and furcation class were performed within 14 days in 420 molars of 105 patients with advanced periodontitis using a Nabers‐ (n = 50), a TPS‐ (n = 30) and a PCPUNC15‐probe (n = 25). Validity of clinical assessments was assessed by intrasurgical measurements. The standard deviation of single measurements (s) was calculated as a measure of the reproducibility of CAL‐H measurements and weighted kappa‐coefficients (kw) to estimate the agreement of furcation class assessments. The s ranged from 0.55 to 1.13 mm (Nabers), 0.55 to 1.02 mm (TPS), and 0.58 to 1.11 mm (PCPUNC 15). For all probes, a statistically significantly smaller measurement error was observed in buccal and lingual sites than in mesiolingual and distolingual furcations (P < 0.005). The kw ranged from 0.59 to 0.89 (Nabers), 0.50 to 0.80 (TPS), and 0.53 to 0.72 (PCPUNC15). Multiple linear regression analysis identified distolingual location, probing depth (PD) and CAL‐H as factors influencing the variability of CAL‐H measurements. Whereas there was no statistically significant difference between pre‐ and intrasurgical CAL‐H measurements using the Nabers probe, the TPS and PCPUNC 15 probe underestimated CAL‐H for distolingual furcations (P < 0.025). Using the Nabers probe, no asymmetries between pre‐ and intrasurgically obtained class of furcation involvement were revealed, while the TPS and PCPUNC15 probe underestimated furcation degrees (P < 0.1). Multiple linear regression analysis identified distolingual location and height of furcation, as well as PD, vertical attachment level (CAL‐V) and type of probe, as factors influencing the validity of CAL‐H measurements. Clinical diagnosis of furcation lesions using the 3 mm incrementally marked Nabers probe provides reproducible and valid information about furcation invasion. J Periodontol 1998;69:328–336.
Dynamics of Serum Immunoglobulin G Avidity for Porphyromonas gingivalis in Adult Periodontitis
Authors: Takahashi Junichi , Saito Atsushi , Nakagawa Taneaki , Yamada Satoru , Ishihara Kazuyuki , Okuda Katsuji
Published: March 2012

The purpose of this study was to examine avidity of Immunoglobulin G (IgG) antibody for surface antigens of Porphyromonas gingivalis in sera from patients with adult periodontitis. The antigens used were whole cell antigens, lipopolysaccharides (LPS), and fimbriae of non‐invasive P. gingivalis ATCC 33277 and invasive 16–1. Serum IgG titers for the P. gingivalis antigens were measured by enzyme‐linked immunosorbent assay (ELISA) before and after periodontal initial preparation. IgG avidity was measured by diethylamine dissociation ELISA. IgG titers for the whole cell antigens of 16–1, LPS, and the fimbria antigens from both P. gingivalis strains were significantly higher in the patient group than those in the control group, whereas values for avidities were significantly lower in patient sera. Although we found a statistically significant decrease in the IgG titers of patients following initial preparation, avidities against the fimbria antigen of invasive 16–1 strain increased. The present study showed that IgG antibodies elicited in patients were different in their ability to respond to invasive P. gingivalis 16–1 and to non‐invasive 33277. The patient sera with high IgG titers demonstrated low values for avidity, suggesting that IgG responses in patients play a limited role in colonization inhibition or elimination of P. gingivalis. The data indicate that periodontally healthy individuals may have highly functional antibodies which may protect against P. gingivalis colonization. Our findings suggest that the ability to produce functional antibodies in the patient group is lower than that in the periodontally healthy group, but the functional antibodies can be induced by the initial preparation. J Periodontol 1998;69:367–373.
Treatment of Gingival Recession With Titanium Reinforced Barrier Membranes Versus Connective Tissue Grafts
Authors: Jepsen Karin , Heinz Bernd , Halben Jan H. , Jepsen Søren
Published: March 2012

It was the aim of this study to compare barrier membrane therapy with connective tissue grafts in the treatment of recession defects. Fifteen patients with 2 paired vestibular recession defects participated in the study. After thorough scaling and root surface conditioning with tetracycline‐HC1, defects were randomly assigned to 1 of 2 treatment modalities. In one of the defects, a trapezoidal mucoperiosteal flap was prepared, and a titanium reinforced expanded polytetrafluoroethylene membrane was adapted to the defect and secured by a sling suture. The membrane was subsequently covered by a coronally positioned flap secured with crown attached sutures. The other defect was treated with a connective tissue graft employing the “envelope technique.” Twelve months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.6±0.7 mm to 0.5±0.5 mm for membrane treated defects and from 3.6±1.0 mm to 0.5±0.5 mm following use of grafts, corresponding to mean root coverages of 87.1% and 86.9%, respectively. Mean gains of keratinized tissue of 1.5 mm (membrane) and 2.5 mm (graft) could be observed. Thus, the results of this study demonstrate that both titanium reinforced barrier membranes and connective tissue grafts can be successfully used to treat periodontal recession defects. J Periodontol 1998;69:383–391.
Changing Number and Distribution of Periodontists: A Continuing Imbalance—1987–1995
Authors: Waldman H. Barry
Published: March 2012

A review of the 1995 and past American Dental Association (ADA) studies on the distribution of dentists provides information on the evolving numbers of periodontists. Despite an overall increase in the number of periodontists, major differences continue in practitioner‐to‐population ratios in different geographic areas. Suggestions include 1) efforts by the ADA and/or The Academy of Periodontology to draw attention to the limited numbers of periodontists in particular locales and states; 2) increased general efforts to educate the public on the need and value of periodontal services; and 3) increase in the profession's awareness of the growing diversity in the population of the nation and the need to modify and adjust its efforts to attract underserved populations with different familial, cultural, and educational backgrounds. J Periodontol 1998;69:439–444.
Clinical and Microbiological Evaluation of a Bioabsorbable and a Nonresorbable Barrier Membrane in the Treatment of Periodontal Intraosseous Lesions
Authors: MacDonald Erika Smith , Nowzari Hessam , Contreras Adolfo , Flynn Jane , Morrison John , Slots Jørgen
Published: March 2012

Clinical and microbiological features of periodontal healing in barrier membrane‐treated sites were determined in a randomized clinical trial. The study included 10 patients with advanced adult periodontitis and a minimum of one set of similar 2 to 3 wall intraosseous periodontal lesions with no furcation involvement. In each patient, one periodontal lesion was treated with a biodegradable membrane and a contralateral lesion with a nonresorbable barrier membrane. Within the preceding 3 months of regenerative therapy, all patients received full mouth osseous surgery except for the sites for regeneration, were instructed in oral hygiene, and were prescribed systemic ciprofloxacin and metronidazole (250 mg of each, TID, 8 days), starting 7 days before membrane placement. At baseline and at 6 months postsurgery, probing depth and clinical attachment level were assessed in each study site. The subgingival presence of suspected periodontal pathogens was determined by non‐selective and selective culture and by DNA probe analyses, and of human cytomegalovirus (HCMV) and Epstein‐Barr virus type 1 (EBV‐1) by a nested‐polymerase chain reaction detection method. At baseline, the barrier‐treated sites did not differ significantly in clinical and microbial parameters. Mean baseline probing depth was 7.8 ± 1.1 mm for bioabsorbable and 7.9 ± 1.3 mm for nonresorbable barrier‐treated sites. At 6 months, sites treated with bioabsorbable barrier revealed 4.6 ± 1.7 mm gain of clinical attachment (range: 1 to 7 mm) and sites treated with nonresorbable barrier 4.2 ± 2.0 mm (range: 1 to 8 mm). The 11 barrier‐treated sites that harbored 10% or less bacterial pathogens and were free of HCMV and EBV‐1 averaged significantly more clinical attachment gain than the 9 sites that yielded more than 10% bacterial pathogens and/or test viruses (5.6 mm versus 3.0 mm; P = 0.005). The present data suggest bioabsorbable and nonresorbable barriers provide similar clinical healing of 2 to 3 wall intraosseous periodontal lesions, emphasize the importance of controlling bacterial pathogens prior to and during periodontal healing, and point to the possible detrimental role of HCMV and EBV‐1 in periodontal repair. J Periodontol 1998;69:445–453.
Inflammatory Cell Population and Bacterial Contamination of Membranes Used for Guided Tissue Regenerative Procedures
Authors: Yoshinari Nobuo , Tohya Tosyo , Mori Atsushi , Koide Masanori , Kawase Hitoshi , Takada Tetsuo , Inagaki Koji , Noguchi Toshihide
Published: March 2012

The purpose of this study was to determine the types of inflammatory cells and bacterial contamination on expanded polytetrafluoroethylene (ePTFE) membranes which might affect new tissue formed by guided tissue regeneration (GTR). Forty periodontal bony defects were treated by the flap procedure, which included the use of an ePTFE membrane. Twelve months after the second surgery, the defect sites were re‐evaluated for changes in probing depth and clinical attachment level. The ePTFE membranes were retrieved after 4 to 6 weeks of healing and sectioned serially at 3 μm in a coronal‐apical plane. The ePTFE membrane was divided into 3 portions: cervical, middle, and apical, each of which was subdivided into outer, central, and inner segments, providing a total of 9 fields. Cells and bacteria were analyzed by light microscopy for their types: mononuclear cell, eryfhrocyte, fibroblast, neutrophil, plasma cell, T lymphocyte, B lymphocyte, macrophage, and oral bacteria. Both cells and bacteria decreased in number towards the apical portion and were present even in the central part. Most cells were mononuclear cells. Erythrocytes, fibroblasts, neutrophils, and plasma cells were rarely encountered. Bacteria, most of which were Gram‐positive, were observed in almost the same number in the outer and inner parts. The results indicate that numerous inflammatory cells adhered to and invaded the ePTFE membranes accompanied by bacterial contamination and that there was a tendency for a negative correlation between the increment number of bacteria and the gain of clinical attachment level. J Periodontol 1998;69:460–469.
Ability of Commercial Demineralized Freeze‐Dried Bone Allograft to Induce New Bone Formation Is Dependent on Donor Age But Not Gender
Authors: Schwartz Z. , Somers A. , Mellonig J.T. , Carnes D.L. , Dean D.D. , Cochran D.L. , Boyan B.D.
Published: March 2012

Demineralized freeze‐dried bone allografts (DFDBA) have been used extensively in periodontal therapy. DFDBA is used because it contains bone morphogenetic protein (BMP), which induces new bone formation during the healing process. Most commercial bone banks do not verify the presence or activity of BMP in DFDBA nor the ability of DFDBA to induce new bone. Recently, we showed that different bone bank preparations of DFDBA, even from the same bank, varied considerably in their ability to induce new bone, suggesting inherent differences in the quality of the material. Therefore, we examined whether donor age or gender contributed to the variability seen with these preparations. Twenty‐seven batches of DFDBA from different donors were donated by one bone bank which had been shown previously to supply DFDBA that was consistently able to induce new bone formation. Each batch was implanted bilaterally in the thigh muscle of nude mice. After 56 days, the implants were excised and examined by light microscopy and histomorphometry. Seventy percent of the preparations tested induced new bone formation. Most of these preparations produced ossicles containing cortical bone surrounding bone marrow‐like tissue. The ability to induce bone appears to be age‐dependent, with DFDBA from older donors being less likely to have strong bone‐inducing activity. By contrast, no difference in ability to induce new bone was noticed between male or female donors. The results of this study confirm that commercial preparations of DFDBA differ in their ability to induce new bone formation. In fact, some of the batches had no activity at all. The ability of DFDBA to induce new bone formation is suggested to be age‐dependent, but not gender‐dependent by our study. These results indicate that commercial bone banks need to verify the ability of DFDBA to induce new bone formation and should reconsider the advisability of using bone from older donors. J Periodontol 1998;69:470–478.
Equivalence and Superiority Testing in Regeneration Clinical Trials
Authors: Gunsolley J.C. , Elswick R.K. , Davenport J.M.
Published: March 2012

The purpose of this report is to investigate sample size requirements for both equivalence and superiority studies investigating products used in regeneration. The goal of a superiority clinical trial is to determine if a new therapy is superior to an established therapy or placebo. In contrast to superiority trials, equivalence trials are used to determine if a new product has similar therapeutic properties to an established product. The sample sizes for the two different types of clinical trials were based on the following assumptions: an alpha of 0.05, a power of 0.80, a 2 group parallel arm study, and equal variances and sample sizes for both groups. Separate sample size calculations were done for both intrabony defects and Class II furcation defects. Sample sizes for the equivalence and superiority trials using the same criteria were the same. However, criteria for estimating sample sizes for equivalence clinical trials require much smaller differences between groups, resulting in much larger sample sizes. A criterion of a 20% difference between groups of the total therapeutic effect resulted in sample sizes which ranged from 64 to 127 in equivalence clinical trials. These samples sizes are much larger than have been generally used in clinical trials investigating periodontal regeneration. J Periodontol 1998;69:521–527.
Periodontal Status and Serum Antibody Responses to Oral Microorganisms in Sjögren's Syndrome
Authors: Çelenligil Haviye , Eratalay Kenan , Kansu Emin , Ebersole Jeffrey L.
Published: March 2012

Sjögren's syndrome is an autoimmune disease characterized by keratoconjunctivitis sicca and xerostomia. Rapid bacterial plaque accumulation occurs in Sjögren's syndrome patients due to decreases in salivary flow rate. The purpose of this study was to evaluate the periodontal status of patients with Sjögren's syndrome and evaluate serum antibody responses to selected oral microorganisms, including major periodontopathogens, compared to healthy controls. Seventeen Sjögren's syndrome patients and 14 healthy subjects were included in the study. Plaque (PL), sulcular bleeding (SBI), periodontal index scores (PI), probing depths (PD), and total number of teeth were recorded. An ELISA was used to determine the serum IgG antibody level to a panel of 13 oral microorganisms. Significantly higher PL, SBI, PD, and PI scores, as well as an increased number of lost teeth were observed in patients with Sjögren's syndrome compared to healthy subjects (P <0.0001). Antibody levels to Streptococcus oralis zwere significantly lower in Sjögren's syndrome patients than controls (P <0.0002). These patients exhibited significantly elevated antibody levels to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis compared to controls (P <0.006 to 0.0004). Our findings indicate that Sjögren's syndrome patients have established periodontal disease and serum antibody responses to oral microorganisms previously identified as periodontopathogens in systemically healthy subjects. These results suggest that Sjögren's syndrome may affect bacterial colonization in plaque and contribute to increased periodontal disease in this compromised population. J Periodontol 1998;69:571–577.
Radiographic and Clinical Responses to Periodontal Therapy
Authors: Machtei Eli E. , Hausmann Ernest , Schmidt Millicent , Grossi Sara G. , Dunford Robert , Schifferle Robert , Munoz Kathryn , Davies Glenn , Chandler Julie , Genco Robert J.
Published: March 2012

Mechanical periodontal therapy is widely used for a variety of periodontal conditions. While the clinical efficacy of this treatment has been validated, the radiographic response has not been studied in depth. The purpose of the present study was to examine the clinical and radiographic response to mechanical periodontal therapy, and assess the factors associated with these changes. One hundred and eight patients, with established periodontitis, received oral hygiene instruction and mechanical periodontal therapy for a period of 4 to 5 weeks. Scheduled maintenance visits were performed at 3, 6, 9, and 15 months. Probing depth (PD) and attachment level (AL) measurements were performed at baseline, and at 3 and 15 months. Intraoral radiographs were taken at baseline and 12 to 15 months postsurgery using a Rinn alignment system. Alveolar eresiai height (ACH) measurements were performed on a pair of digitized images of the previously taken radiographs. An overall mean of patients' changes for PD, AL, and ACH was initially computed. Active sites (gainers and losers) were determined using a threshold method, and expressed as patient's percentage of active sites (number of active sites of the total sites measured in each patient). Mean overall probing reduction and AL gain was 0.5 mm and 0.44 mm, respectively. Of all sites measured, 16.6% exhibited AL gain, while only 6.2% of all sites exhibited AL loss. Mean overall change in ACH was −0.07 mm, of which 11.8% of all sites exhibited ACH gain, while 15.1% exhibited loss beyond the threshold. Non‐smokers presented no change in bone loss, while smokers continued to lose bone at an annual rate of 0.17 mm. despite treatment (P <0.005). Likewise, the average percent of sites per patients showing attachment gain beyond the threshold were much greater in non‐smokers (13.9%) compared to 9.0% in smokers (P <0.01). Mean probing reduction was 50% greater among non‐smokers (0.6 mm) when compared to smokers (0.4 mm), which was also statistically significant (P <0.05). A positive and significant correlation was established between the percentage of sites with AL gain and sites with ACH gain (Rho = 0.40; P = 0.0001). It is suggested that monitoring sites for AL and ACH gain expressed as changes beyond a selective threshold is an important outcome variable in treatment studies. J Periodontol 1998;69:590–595.
Repair of a Root Resorption Lesion. A Case Report
Authors: White Cecil
Published: March 2012

An extensive root surface lesion that presented both supra‐ and subgingival components was successfully treated with the use of glass ionomer cement to restore the lesion, and facilitate subsequent endodontic therapy and restoration. A coronally‐positioned flap covered the repaired/restored lesion, approximately 6 mm × 10 mm in dimension. At 6 months following placement of the restoration, all but 1 mm of the restoration appeared covered, with probing depths <3 mm and no clinical signs of inflammation. Glass ionomer cement appears to be a viable, biocompatible material to restore subgingival root surface lesions. J Periodontol 1998;69:596–600.
Autocrine Transforming Growth Factor β Stimulation of Extracellular Matrix Production by Fibroblasts From Fibrotic Human Gingiva
Authors: Tipton David A. , Dabbous Mustafa Kh.
Published: March 2012

Hereditary gingival fibromatosis (HGF) is a fibrotic enlargement of the gingiva. HGF gingiva contains large amounts of collagen and other extracellular matrix (ECM) molecules. In vitro, HGF fibroblasts produce greater amounts of the ECM components fibronectin (FN) and type 1 collagen than normal human gingival (GN) fibroblasts. Transforming growth factor β (TGF β) is a cytokine important in regulating tissue repair and regeneration after injury, and stimulating fibroblast proliferation and the production of FN and collagens. The objective of this study was to determine whether HGF fibroblasts produce TGF β and, with the use of neutralizing antibodies to TGF β isoforms, if their increased expression of FN and type 1 collagen is under autocrine TGF β control. The HGF strains produced greater amounts of TGF β1 and TGF β2 (P ≤ 0.003) as well as FN (P ≤ 0.04) and type I collagen (P ≤ 0.03) (measured by specific ELISA) than the GN strains. Treatment of HGF fibroblasts with anti‐TGF β1, β2, or β3, as well as a combination of all 3 antibodies, decreased their FN production by up to 60% (P ≤ 0.04), and was able to decrease FN production by HGF fibroblasts to the levels of the GN fibroblasts. When used alone, the neutralizing antibodies decreased type I collagen production by the HGF fibroblasts by up to 40% (P = 0.014), and treatment with all 3 antibodies caused decreases of up to 55% (P = 0.0005). The results suggest that autocrine stimulation by the increased amounts of TGF β isoforms made by HGF fibroblasts contributes to their increased production of FN and type 1 collagen. J Periodontol 1998;69:609–619.
Immediate Implant Placement: A Procedure Without Incisions
Authors: Schwartz‐Arad Devorah , Chaushu Gavriel
Published: March 2012

Primary socket closure in immediate implantation may be difficult, due to the opening left by the extracted tooth. The absolute need for bone augmentation and primary flap closure for implants placed into fresh extraction sites has never been proven. The hypothesis of the present study was that immediate implants can succeed without primary flap closure. A technique that does not require any incisions during immediate implant placement is described. No barrier membranes were used and the sole grafting material used were autogenous bone chips. Full soft tissue coverage was achieved 1 week to 2 months postimplantation. Clinical osseointegration was achieved with minimal gingival recession and papillae preservation. Immediate implant placement in the anterior maxilla can be successful for replacing a single tooth even without primary closure. J Periodontol 1998;69:743–750.
Comparison of Different Approaches of Interdental Oral Hygiene: Interdental Brushes Versus Dental Floss
Authors: Christou Vassiliki , Timmerman Mark F. , Van der Velden Ubele , Van der Weijden Fridus A.
Published: March 2012

The purpose of the present study was to compare in untreated patients suffering from moderate to severe periodontitis the efficacy of dental floss (DF) and interdental brushes (IDB) in the reduction of plaque, gingival inflammation, and probing depth in a 6‐week period prior to subgingival debridement. Twenty‐six patients (12 female, 14 male; mean age 37.4 years; range 27 to 72 years) were instructed to use DF for one side of the dentition and IDB for the other side as an adjunct to the daily toothbrushing for 6 weeks. Oral hygiene instructions for toothbrushing and the use of the two devices were given at baseline and at week 3. Measurements were carried out at baseline and at 6 weeks including plaque scores, probing depth, and 2 bleeding scores (periodontal pocket bleeding index and angulated bleeding index). With the IDB, the approximal plaque score at baseline of 3.09 reduced to 2.15 at 6 weeks and with DF, from 3.10 to 2.47, respectively. IDB proved to remove significantly more plaque than DF. Baseline probing depth of 5.84 mm for IDB sites and 5.59 mm for DF sites was reduced to 5.01 mm at 6 weeks for both regimens. Analysis showed that the use of IDB resulted in a greater pocket reduction. Both bleeding indices were slightly reduced with IDB and DF, but no differences between devices were found. In relation to patient acceptance, more problems were observed with DF, and IDB were felt to be more efficacious. In conclusion, the results of the present study indicate that in combination with a manual toothbrush, the use of interdental brushes is more effective in removal of plaque and results in a larger reduction of probing depth than the use of dental floss. Although the differences were small, they indicate, in combination with patient preferences, that interdental brushes are to be considered preferable to floss for interdental plaque removal in patients suffering from moderate to severe periodontitis. J Periodontol 1998;69:759–764.
The Utility of Whole Saliva to Detect the Oral Presence of Periodontopathic Bacteria
Authors: Umeda Makoto , Contreras Adolfo , Chen Casey , Bakker Ingalill , Slots Jørgen
Published: March 2012

This study compared the presence of 6 periodontopathic bacteria in whole saliva and subgingival plaque of 202 subjects. The test bacteria were identified using a 16S rRNA‐based PCR detection method. Each study subject contributed a whole saliva sample and a paper point sample pooled from the deepest periodontal pocket in each quadrant of the dentition. The kappa test revealed a fair agreement between the presence of Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola in whole saliva and periodontal pocket samples (kappa > 0.4). The McNemar test showed that the differences between sample types were due to a more frequent detection of the 3 organisms in whole saliva than in periodontal pocket samples (P < 0.01). Prevotella nigrescens also was detected more frequently in whole saliva than in periodontal pocket samples (P < 0.01; McNemar test). Although little agreement between samples was found for Actinobacillus actinomycetemcomitans and Bacteroides forsythus (kappa ≤ 0.4), neither whole saliva nor pocket samples showed better detection for these 2 species (P < 0.01, McNemar test). The results indicate that whole saliva is superior to pooled periodontal pocket samples to detect P. gingivalis, P. intermedia, P. nigrescens, and T. denticola in the oral cavity. The detection of oral A. actinomycetemcomitans and B. forsythus with reasonably good accuracy may require both whole saliva and periodontal pocket samples. J Periodontol 1998;69:828–833.
The Effect of Different Diagnostic Thresholds on Incidence of Disease Progression
Authors: Oringer Richard J. , Fiorellini Joseph P. , Reasner David S. , Howell T. Howard
Published: March 2012

Detection of periodontal disease progression occurs when a predetermined threshold of attachment loss is exceeded during longitudinal monitoring. The incidence of disease progression in a population may be dependent on the method and threshold utilized to identify significant changes in attachment level measurements. The aim of this study was to investigate the effect of utilizing different methods and thresholds on the incidence of disease progression in an untreated periodontitis population. The relationship between baseline clinical parameters and disease progression was also examined. A total of 411 interproximal sites in 46 individuals were monitored monthly over a 6‐month period. Disease progression was determined by the cumulative sum (CUSUM) method and by the absolute change in relative attachment level between months 0 and 6 utilizing 3 different thresholds for attachment level change (0.58 mm, 1.16 mm, and 1.74 mm) based upon examiner repeatability using an automated probe. Utilizing the CUSUM method, 49 of 411 sites (11.9%) demonstrated attachment loss over the 6‐month observation period. When attachment level changes ≥0.58 mm, ≤1.16 mm, and ≥1.74 mm were used to identify disease progression, the percentage of sites exhibiting deterioration were 19.5%, 8.8%, and 2.9%, respectively. These results demonstrate that the apparent incidence of disease progression was dependent on the method and threshold utilized to detect progressive sites. When utilizing the CUSUM and 0.58 mm thresholds a significant (P < 0.05), but weak relationship (r = −0.26) was observed between baseline relative attachment level measurements and sites exhibiting disease progression. This finding suggests that sites with significant but relatively less attachment loss may be more likely to experience further breakdown compared to sites with a history of greater periodontal destruction. J Periodontol 1998;69:872–878.
Heat Generation During Ultrasonic Instrumentation of Dentin as Affected by Different Irrigation Methods
Authors: Nicoll Brian K. , Peters Robert J.
Published: March 2012

Heat is produced by magnetostrictive ultrasonic sealers which may cause injury to pulpal and periodontal tissues. Water coolant flows around the instrument stack and is directed at the instrument tip to reduce the generation of heat. Sound surgical practice requires the use of a sterile coolant for ultrasonic scaling during surgery. Intermittent bulb irrigation is one way to deliver sterile coolant when using ultrasonic sealers not equipped with a dedicated sterile water reservoir. The purpose of this study was to compare the temperature rise in dentin during ultrasonic scaling using either ultrasonic handpiece irrigation or intermittent bulb irrigation. Twenty dentin/cementum root slabs were prepared for each thickness of 0.5, 1.5, and 2.5 mm. A 3.0 mm × 1.5 mm field was outlined on each slab to indicate the area of intended instrumentation. Each slab was mounted such that a thermocouple placed in contact with dentin opposite the area of instrumentation was shielded from irrigation. Twenty samples of each thickness were ultrasonically scaled during which dentin temperature was recorded every 5 seconds over a 30‐second period. All 60 slabs were first treated with dental unit ultrasonic handpiece water irrigation, followed by no irrigation, and finally by bulb irrigation with sterile saline. Repeated measures analysis of variance indicated that there were differences among the three treatment groups for temperature change over the course of the study (P < 0.001). Dentin temperature increased with both decreasing slab thickness and with increasing duration of instrumentation. However, only scaling without irrigation produced a rise in dentin temperature from baseline to a level reported as deleterious to pulpal and periodontal tissues. Bulb syringe irrigation delivered as a continuous drip and ultrasonic unit water spray minimized heat generation to physiologically tolerable levels. Intermittent bulb irrigation appears to be a satisfactory alternative to use of ultrasonic sealer water spray for cooling during ultrasonic scaling at surgery. J Periodontol 1998;69:884–888.
Nature and Attachment of Cementum Formed Under Guided Conditions in Human Teeth. An Electron Microscopic Study
Authors: Luder Hans U. , Zappa Urs
Published: March 2012

In an attempt at characterizing the nature and attachment of cementum formed under conditions of guided tissue regeneration (GTR) in humans, front teeth from 4 patients aged 42 to 72 years were examined at the elect ron microscopic level. All teeth were affected by complex periodontitis associated with advanced loss of periodontal support. Roots were surgically planed and notched, but not chemically conditioned. Either the mesial or distal surface of each tooth represented the experimental site and was covered with a biodegradable polyglactin 910 barrier, while the opposite approximal surface served as control. Following 3 months of healing, teeth were removed together with surrounding periodontal tissues including some alveolar bone. These blocks were fixed histologically, decalcified, embedded in epoxy, and sectioned for examination in the scanning (backscatter mode) and transmission electron microscope. Both experimental and control sites disclosed 2 types of regenerative cementum that seemed to be formed by cells resembling cementoblasts. The first type was characterized by a thin fringe of collagen fibrils which were arranged perpendicular to the root surface and appeared mineralized in a zone extending about 1 to 3 μm from the dentin. The second type occurred as thick patches which revealed scattered cementocytes and sheets of collagen fibrils oriented mainly parallel to the root surface, running both circularly and axially. In both situations, a continuous, thin, electrondense layer was interposed between newly formed cementum and preexisting radicular hard tissues. Interdigitation of collagen fibrils from cementum and dentin, such as observed along the natural cemento‐dentinal junction, did not occur. Thus, regenerative cementum laid down in humans under guided conditions on previously diseased and planed, but not otherwise treated root surfaces shares some morphologic features with cementum formed during spontaneous repair of root resorptions. However, unlike in the course of such repair, a fibrous attachment of new cementum resembling the natural cemento‐dentinal junction does not seem to be regenerated under guided conditions. J Periodontol 1998;69:889–898.
Gingival Crevicular pH in Experimental Gingivitis and Occlusal Trauma in Man
Authors: Kobayashi Kosei , Kobayashi Ken'ichi , Soeda Wataru , Watanabe Tatsutomi
Published: March 2012

The purpose of this study was to investigate the fluctuation of gingival crevicular pH during experimentally evoked gingivitis and occlusal trauma, and to examine the relationship between the pH and periodontal health status using a newly developed pH sensor. Maxillary first premolars with clinically healthy gingiva were selected as test teeth in 10 volunteers. In the first study phase, experimental gingivitis was evoked, and gingival index, plaque index, and crevicular pH were recorded during the study period. In the second study phase, experimental occlusal trauma was created with metal onlays having occlusal interferences in lateral movements, and tooth mobility and pH were recorded during the study period. In the gingivitis phase, Gl, P1I, and pH values fluctuated significantly during the study period (P < 0.01) and positive correlations were observed between both GI and pH values (P < 0.05), and P1I and pH values (P < 0.01). In the occlusal trauma phase, significant fluctuation was found among tooth mobilities (P < 0.05) during the study phase, but not in pH values. Statistically significant correlations were not observed between tooth mobilities and pH values. These data suggest that the crevicular pH level may not be influenced by experimental occlusal trauma, but shifts toward alkaline with experimental gingivitis. J Periodontol 1998;69:1036–1043.
Acceptance Program Guidelines: Chemotherapeutic Agents to Slow or Arrest Periodontitis
Authors:   Council on Scientific Affairs
Published: March 2012

Scope: These Guidelines apply to products used to slow or arrest periodontitis. The periodontal diseases represent a wide array of infections characterized by variable microbial clusters and host susceptibility factors that may require different therapeutic approaches. There are two basic ways to control periodontitis: 1) target the putative microbial components with anti‐infective strategies; or 2) strengthen or suppress the host response with host modulation agents. Products that are designed for the prevention and/or control of gingivitis are addressed elsewhere and are not considered in these guidelines.
The Relationship of Dental Calculus to Caries, Gingivitis, and Selected Salivary Factors in 11‐ to 13‐Year‐Old Children in Chiang Mai, Thailand
Authors: Pattanaporn Komkham , Navia Juan M.
Published: March 2012

Thai children have been shown to accumulate large amounts of dental calculus. The purpose of this study was to examine the relationship of calculus to caries and gingivitis, and salivary conditions which may contribute to calculus accumulation. Four‐hundred and thirty‐nine (439) children from 18 schools in Chiang Mai were selected for this study. The children were given oral examinations to determine calculus index (CI); decayed, missing, and filled surfaces (DMFS); decayed, missing, and filled teeth (DMFT); gingival index (GI); and plaque index (PI). Children with mean CI scores ≥1 (206) were assigned to the calculus group; the 233 children with mean CI scores of <1 to the noncalculus group. Saliva was collected from 60 randomlyselected children in each group. Unstimulated and stimulated whole saliva and stimulated parotid saliva were assessed for flow rate, pH, and buffer capacity using 2 methods. Results showed that calculus status was not significantly associated with caries, but that there was a high association between gingivitis and plaque status with calculus accumulation (P < 0.001). There were no significant differences in saliva flow rate, pH, or buffer capacity between calculus and noncalculus groups. The lack of association between calculus status and caries indicated these 2 conditions have different etiologies and suggests the importance of plaque and calculus prevention programs, in addition to caries control efforts, to maintain oral health of Thai children. J Periodontol 1998;69:955–961.