bluuebunny/crossref_metadata_2025 huggingface dataset:
Ridge Preservation Utilizing an Acellular Dermal Allograft and Demineralized Freeze‐Dried Bone Allograft: Part II. Immediate Endosseous Implant Placement
Authors: Fowler Edward B. , Breault Lawrence G. , Rebitski George
Published: February 2005

When maxillary anterior teeth are extracted, subsequent ridge collapse can significantly compromise esthetics. Preservation of an adequate volume of bone is vital to successful implant placement. Ridge preservation achieved utilizing an acellular dermal matrix as a barrier membrane with a demineralized freezedried bone allograft has been previously reported. In this case presentation, guided bone regeneration was achieved around an immediate endosseous implant when this same technique was used. As in the previous case reports, this technique demonstrated an acceptable esthetic result with virtually no loss of ridge height or width. Soft tissue dimensions were also preserved. Both the hard and soft tissue grafts were well accepted by the body and healing was rapid and without significant discomfort. This surgical technique provides the clinician with an option to provide immediate implant therapy when primary closure cannot be achieved. J Periodontol 2000;71:1360‐1364.
Treatment of Gingival Recession: Comparative Study Between Subepithelial Connective Tissue Graft and Guided Tissue Regeneration
Authors: Rosetti Elizabeth P. , Marcantonio Rosemary Adriana C. , Rossa Carlos , Chaves Eros S. , Goissis Gilberto , Marcantonio Elcio
Published: February 2005

Background: Various procedures have been proposed to treat gingival recession, but few studies compare these procedures to each other. The purpose of this study was to evaluate a clinical comparison of subepithelial connective tissue graft (SCTG) and guided tissue regeneration (GTR) with a collagen membrane in the treatment of gingival recessions in humans.

Methods: Twenty‐four defects were treated in 12 patients who presented canine or pre‐molar Miller Class I and/or II bilateral gingival recessions. Both treatments were performed in all patients, and clinical measurements were obtained at baseline and 18 months after surgery. These clinical measurements included gingival recession height (GR), root coverage (RC), probing depth (PD), keratinized tissue width (KT), and final esthetic result.

Results: Both SCTG and GTR with a bioabsorbable membrane and bone graft demonstrated significant clinical and esthetic improvement for gingival recession coverage. The SCTG group was statistically significantly better than GTR for height of GR (SCTG = 0.2 mm, GTR = 1.12 mm, P = 0.02) and KT (SCTG = 4.58 mm, GTR = 2.5 mm, P <0.0001). However, PD was statistically significantly better for GTR than SCTG treatment (GTR = 1.66 mm, SCTG = 1.00, P = 0.01). The 2 procedures were statistically similar in root coverage (SCTG = 95.6%, GTR = 84.2%, P = 0.073). The esthetic condition after both treatments was satisfactory (P = 0.024).

Conclusions: It was concluded that the gingival recessions treated with the SCTG group were superior for GR, RC, and KT clinical parameters, while GTR demonstrated better PD reduction. The final esthetic results were similar using both techniques. J Periodontol 2000;71:1441‐1447.
The Relationship Between Bone Mineral Density and Periodontitis in Postmenopausal Women
Authors: Tezal Mine , Wactawski‐Wende Jean , Grossi Sara G. , Ho Alex W. , Dunford Robert , Genco Robert J.
Published: February 2005

Background: Systemic bone loss has been proposed as a risk factor for periodontal disease; however, the relationship between these two diseases is still not clear. The objective of this study was to assess the relationship between systemic bone mineral density and periodontal disease, controlling for known confounders.

Methods: The study population included 70 postmenopausal Caucasian women aged 51 to 78 (mean ± SD: 62.10 ± 7.1 years). Skeletal bone mineral density (BMD) was assessed by dual energy x‐ray absorptiometry (DXA) at the neck, trochanter, intertrochanter, Ward's triangle, and total regions of the femur, and from the anterior‐posterior view of the lumbar spine. Periodontal disease severity was represented by clinical attachment loss (CAL) and interproximal alveolar bone loss (ABL). Other measures of periodontal status included probing depth (PD), supragingival plaque, gingival bleeding on probing, and calculus. DXA and oral examinations were performed by calibrated examiners. Partial correlation coefficients (r) were obtained from multiple linear regression analysis adjusting for age, age at menopause, estrogen supplementation, cigarette smoking, body mass index, and supragingival plaque.

Results: Mean ABL was significantly correlated with BMD of the trochanter (r = − 0.27), Ward's triangle (r = −0.26), and total regions of the femur (r = −0.25). Mean CAL appeared to be related to BMD consistently at all regions of the skeleton, although the association did not reach statistical significance.

Conclusions: We can conclude that skeletal BMD is related to interproximal alveolar bone loss and, to a lesser extent, to clinical attachment loss, implicating postmenopausal osteopenia as a risk indicator for periodontal disease in postmenopausal Caucasian women. J Periodontol 2000;71:1492‐1498.
A Longitudinal Clinical Comparison Plaque‐Induced Inflammation Between Gingival and Peri‐Implant Soft Tissues in the Maxilla
Authors: Toljanic Joseph A. , Ward Christopher B. , Gewerth Michael E. , Banakis Mark L.
Published: February 2005

Background: Little information exists concerning the periimplant soft tissue response to plaque compared to the gingiva of the dentition. The purpose of this study was to compare this relative tissue response to plaque in humans over time.

Methods: Two hundred seventy‐five (275) hydroxyapatitecoated implants were placed in the maxillae of 50 subjects followed by prosthetic rehabilitation. Baseline gingival (GI) and plaque (PI) index scores were obtained for all implants. Two to 4 teeth per subject were similarly measured, serving as controls. Measurements were repeated at 6‐month intervals over 30‐months. GI scores were evaluated relative to PI scores at 4 separate sites for each implant, to implant location within the oral cavity, and to length of time that each implant was in function.

Results: The peri‐implant mucosa demonstrated a significantly greater likelihood of having elevated GI scores relative to PI scores when compared to the gingiva (chi‐square for combined PI scores of 0 and 1 = 85.0, df = 1, P <0.001; for combined PI scores of 2 and 3 = 114.6, df = 1, P <0.001). A logistic generalized linear model confirmed the significance of these results (Student t for implant effect = 21.602). It further demonstrated significantly elevated GI scores for implant sites over time and for implants located in the posterior oral cavity.

Conclusions: The results indicate that maxillary peri‐implant soft tissues are at increased risk for plaque‐induced inflammation relative to the gingiva of the dentition. Hygiene recall standards and treatment regimens may require revisions to minimize peri‐implantitis and prevent bone loss. J Periodontol 2001;72:1139‐1145.
Effects of Whole Cell Sonicates of Treponema lecithinolyticum on Osteoclast Differentiation
Authors: Choi Bong‐Kyu , Ohk Seung‐Ho , Lee Hyun Jung , Kang Jung Hwa , Jeong Gook Jin , Yoo Yun‐Jung
Published: February 2005

Background: Alveolar bone destruction is a characteristic feature of periodontal diseases and multinucleated osteoclast cells derived from hemopoietic cells are responsible for bone resorption. Treponema lecithinolyticum is a novel oral spirochete isolated from the periodontal lesions.

Methods: The effect of whole cell sonicates on the osteoclast differentiation was examined in a co‐culture system of hemopoietic mouse bone marrow cells and calvaria derived‐osteoblastic cells to clarify the role of T. lecithinolyticum in the alveolar bone destruction associated with periodontal diseases. The differentiated osteoclasts were confirmed by tartrate‐resistant acid phosphatase (TRAP) staining.

Results: Sonicates of this bacterium stimulated the osteoclast formation in the co‐culture system in a dose‐dependent manner. The sonicates‐induced osteoclast formation was partially inhibited by the heat treatment of sonicates. Indomethacin, which is a prostaglandin inhibitor, decreased the osteoclast formation induced by the bacterial sonicates.

Conclusions: These findings suggest that T. lecithinolyticum induces osteoclast differentiation by a prostaglandin E2‐dependent mechanism and that heat‐labile components may be involved in this process. J Periodontol 2001;72:1172‐1177.
Effect of Different Mouthrinses on Morning Breath
Authors: Van Steenberghe Daniel , Avontroodt Pieter , Peeters Wouter , Pauwels Martine , Coucke Wim , Lijnen An , Quirynen Marc
Published: February 2005

Background: Morning breath odor is an often‐encountered complaint. This double‐blind, crossover, randomized study aimed to examine the bad breath‐inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12 days without mechanical plaque control.

Methods: Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days (with intervening washout periods of at least 3 weeks). A professional oral cleaning preceded each period. During each experimental period, as the only oral hygiene measure allowed, the students rinsed twice a day with one of the following formulations in a randomized order: CHX‐Alc (a 0.2% chlorhexidine [CHX] solution); CHX‐NaF (CHX 0.12% plus sodium fluoride 0.05%); or CHX‐CPC‐Zn (CHX 0.05% plus cetylpyridinium chloride 0.05% plus zinc lactate 0.14%). After 12 days, morning breath was scored via volatile sulfur compound (VSC) level measurements of the mouth air and organoleptic ratings of the mouth air, the expired air, and a scraping of the tongue coating. At the 12‐day visit, a questionnaire (subjective ratings) was completed and samples taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining. The de novo supragingival plaque formation was also recorded. All parameters were correlated with the baseline registrations.

Results: Although oral hygiene during the 3 experimental periods was limited to oral rinses, bad breath parameters systematically improved, with the exception of a slight increase in VSC levels while using CHXAlc, a finding which was associated with the direct influence of the CHX on the sulfide monitor. The oral microbial load after the use of CHX‐NaF remained unchanged, while for the CHX‐Alc and CHX‐CPC‐Zn, significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva samples. The composition of microflora, on the other hand, did not reveal significant changes. The supragingival plaque formation was inhibited, in descending order, by CHX‐Alc, CHX‐CPC‐Zn, and CHX‐NaF. The subjective scores for the rinses indicated a higher appreciation for CHX‐CPC‐Alc and CHX‐NaF because of a better taste and fewer side effects.

Conclusions: The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses. CHX‐Alc and CHX‐CPC‐Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva. J Periodontol 2001;72:1183‐1191.
Effects of Smoking and Treatment Status on Periodontal Bacteria: Evidence That Smoking Influences Control of Periodontal Bacteria at the Mucosal Surface of the Gingival Crevice
Authors: Eggert F.‐Michael , McLeod M. Herbert , Flowerdew Gordon
Published: February 2005

Background: We examined whether smoking status could influence growth of potentially pathogenic bacteria in the periodontal environment of treated and untreated periodontal patients.

Methods: We have previously reported effects of treatment status on marker bacteria in our patients. We established a history of any smoking during 6 months prior to microbiological sampling (F‐ME, 16 smokers out of 64; MHM, 70 smokers out of 185). We used a commercial immunoassay to quantitate Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in paper point samples from periodontal sites.

Results: Logistic regression showed that in smokers, neither P. gingivalis nor A. actinomycetemcomitans was quantitatively increased, while P. intermedia was somewhat increased. Multiple regression demonstrated that smoking disrupts the positive relationship between increasing probing depth and increasing bacterial growth that is found in non‐smokers. In smokers, growth of marker bacteria at shallow sites (≤5 mm) was significantly increased to the levels found at deeper sites (>5 mm) in both smokers and non‐smokers. Supragingival plaque biofilm was identified as a reservoir for marker bacteria; smokers and nonsmokers had equal ranges of oral cleanliness.

Conclusions: Smoking‐associated periodontitis is not simply a reflection of oral cleanliness. Smoking extends a favorable habitat for bacteria such as P. gingivalis, P. intermedia, and A. actinomycetemcomitans to shallow sites (≤5 mm). Molecular byproducts of smoking interfere with mechanisms that normally contain growth of damaging bacteria at the surface of the oral mucosa in gingival crevices. In this way, smoking can promote early development of periodontal lesions. J Periodontol 2001;72:1210‐1220.
Persistent Presence of Bacteroides forsythus as a Risk Factor for Attachment Loss in a Population With Low Prevalence and Severity of Adult Periodontitis
Authors: Tran Simon D. , Rudney Joel D. , Sparks Brandon S. , Hodges James S.
Published: February 2005

Background: Previous longitudinal studies investigating the role of microorganisms in periodontitis have focused on subjects with a high prevalence and severity of disease. The complex profile of microbial species in severe cases of periodontitis might not allow us to differentiate which bacterial species initiate disease or which species simply proliferate after disease progression. This prospective longitudinal study followed a group of 205 subjects who showed a low prevalence and severity of adult periodontitis, and thus allowed us to monitor early microbiological changes in the development of periodontitis.

Methods: Subgingival plaque was collected from proximal surfaces of a posterior sextant at 6‐month intervals for 2 years. During the monitoring period, 44 subjects had either attachment loss or attachment gain. Using multiplex polymerase chain reaction (PCR), all plaque samples from those 44 subjects were analyzed for the presence of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, and Porphyromonas gingivalis.

Results: Both subjects with attachment loss and those with attachment gain had a high prevalence of these 3 periodontal pathogens. The mere presence of any of the 3 species at a site could not predict future attachment loss at that specific site. However, subjects with a persistent presence of B. forsythus at any site across all visits had 5.3 times higher odds of having at least one site in their mouth losing attachment compared to subjects with occasional or no presence of B. forsythus.

Conclusions: The persistence of B. forsythus identified subjects at higher risk, but not which specific sites in those subjects would lose attachment. J Periodontol 2001;72:1‐10.
Detection of Platelet‐Activating Factor in Gingival Tissue Surrounding Failed Dental Implants
Authors: Bassi Francesco , Marchisella Cristiano , Schierano Gianmario , Gasser Egon , Montrucchio Giuseppe , Valente Guido , Camussi Giovanni , Preti Giulio
Published: February 2005

Background: Dental implant therapy has entered routine clinical practice. However, the failure rate of implants at 5 years, due to biological factors, is still around 7%. The pathogenesis of implant loss involves a complex network of cells and inflammatory mediators. This study evaluated platelet‐activating factor (PAF), a potent phospholipid mediator of inflammation, in soft tissue surrounding failed dental implants versus healthy implants.

Methods: PAF was estimated on extracted lipids by bioassay on washed rabbit platelets; inflammatory cell populations were assessed semiquantitatively after staining, and microvessel density was evaluated after immunohistochemical staining.

Results: Biologically active PAF was detected in the lipid extracts of samples excised from gingival tissue of patients with failed implants, but not in samples from patients with osseointegrated implants or from healthy edentulous subjects. The amount of PAF detected in failed implants was significantly higher than in healthy implants, suggesting a local production of this mediator.

Conclusions: The presence of PAF was associated with histopathological findings of local inflammation and increased blood vessel density. J Periodontol 2001;72:57‐64.
Comparison of 2 Clinical Techniques for Treatment of Gingival Recession
Authors: Wang Hom‐Lay , Bunyaratavej Pintippa , Labadie Margaret , Shyr Yu , MacNeil R. Lamont
Published: February 2005

Background: In early case studies, use of a collagen barrier as a guided tissue regeneration (GTR) material has shown particular promise in procedures aimed at root coverage. The similarities between collagen membrane and subepithelial connective tissue graft (SCTG) have made collagen membrane an attractive and a possible alternative material for root coverage. The purpose of this randomized clinical trial was to compare these 2 techniques, SCTG versus a GTR‐based procedure (GTRC), for root coverage/recession treatment.

Methods: Sixteen patients with bilateral Miller's Class I or II (gingival recession ≥3.0 mm) recession defects were treated either with SCTG or GTRC using a newly designed collagen membrane. Clinical parameters monitored included recession depth (RD), clinical attachment level (CAL), probing depth (PD), width of keratinized gingiva (KG), attached gingiva (AG), and recession width (RW), each measured at the mid‐buccal area to the nearest 0.5 mm. Measurements were taken at baseline and 6 months. A standard mucogingival surgical procedure was performed. Data were reported as means ± SD and were analyzed using the paired t test for univariate analysis and restricted/residual maximal likelihood (REML)‐based mixed effect model for multivariate analysis.

Results: No statistically significant differences were observed in RD, CAL, KG, and AG between test and control groups at either time period. However, SCTG showed significantly more residual PD and more RW gain when compared to GTRC at 6 months. Both treatments resulted in a statistically significant (P <0.05) reduction of recession defects (2.5 mm and 2.8 mm), gain of CAL (2.8 mm and 2.3 mm), reduction of RW (1.9 mm and 2.7 mm), and increase of KG (0.7 mm and 1.1 mm) and AG (0.7 mm and 0.5 mm) for GTRC and SCTG, respectively, when comparing 6‐month data to baseline. Mean root coverage of 73% (collagen membrane) and 84% (subepithelial connective tissue graft) was achieved.

Conclusions: The 2 techniques are clinically comparable. Use of a modified collagen membrane to attain root coverage may alleviate the need for donor site procurement of connective tissue. J Periodontol 2001;72:1301‐1311.
Treponema socranskii, Treponema denticola, and Porphyromonas gingivalis Are Associated With Severity of Periodontal Tissue Destruction
Authors: Takeuchi Yasuo , Umeda Makoto , Sakamoto Mitsuo , Benno Yoshimi , Huang Yi , Ishikawa Isao
Published: February 2005

Background: The aim of the present study was to identify Treponema socranskii in addition to Treponema denticola and Porphyromonas gingivalis by polymerase chain reaction (PCR), and to clarify the relationship between the presence of these microorganisms and the severity of clinical periodontal parameters.

Methods: Saliva and subgingival plaque collected from 123 subjects (38 aggressive periodontitis patients, 65 chronic periodontitis patients, 20 healthy patients) were subjected to PCR to detect the aforementioned 3 microorganisms.

Results: Detection frequencies of T. socranskii, T. denticola, and P. gingivalis in plaque samples from aggressive periodontitis patients (71.1%, 73.7%, 84.2%, respectively) and chronic periodontitis patients (89.2%, 93.8%, 95.3%) were much higher than those from healthy subjects (30%, 5.0%, 10.0%). In aggressive and chronic periodontitis patients, these 3 species of bacteria were detected frequently at sites that showed deep periodontal pockets and severe attachment loss. The percentage of these bacteria‐positive sites increased as the gingival index score of chronic periodontitis patients increased. T. socranskii was frequently detected together with T. denticola or P. gingivalis at the same sites, and coexistence of these microorganisms was frequently observed in deep periodontal pockets of aggressive periodontitis patients.

Conclusions: T. socranskii, T. denticola, and P. gingivalis were frequently detected in periodontitis patients by PCR. The prevalence of these 3 microorganisms was correlated with various clinical parameters. Taken together, our findings suggest that T. socranskii, T. denticola, and P. gingivalis are associated with the severity of periodontal tissue destruction. J Periodontol 2001;72:1354‐1363.
A Multi‐Center Study Comparing Dual Acid‐Etched and Machined‐Surfaced Implants in Various Bone Qualities
Authors: Khang Wahn , Feldman S. , Hawley C.E. , Gunsolley J.
Published: February 2005

Background: A major reason for the success of modern dental implant systems has been the development of implant designs. that enhance direct bone‐implant interface. Surface roughness has been a factor in this success and different systems have utilized very different implant surface roughness. The major purpose of this study was to evaluate 2 similar implants with different surface roughness characteristics.

Methods: Two similarly designed, screw‐type, commercially pure titanium implants, one dual acid‐etched (DAE) and the other machined‐surfaced (MS), were compared in this prospective, randomized‐controlled, multi‐center study, in which a total of 97 patients were enrolled at a private dental practice or a university dental clinic. Both implant types were placed in each patient using a 2‐stage approach with a conventional 4‐ to 6‐month healing period. Implants supported fixed prostheses, hybrid prostheses, and overdentures as dictated by the individual patient's need. All of the cases were followed using clinical and radiographic examinations. Criteria of success were the absence of peri‐implant radiolucency, mobility, and persistent signs or symptoms of pain or infection.

Results: Of the 432 implants (247 dual acid‐etched, 185 machined‐surfaced), 36 implants (12 dual acid‐etched and 24 machined‐surfaced) have failed. The pre‐loading integration success rate of the dual acid‐etched implants (95.0%) was statistically higher (P ∼0.01) than the success rate of the machined‐surfaced implants (86.7%). At 36 months, the cumulative SUC; cess rates (CSR) are 95.0% for the dual acid‐etched implants and 86.7% for the machined‐surfaced implants.

Conclusions: The difference in success rates is most likely attributed to the acid‐etched surface characteristics. The greatest performance difference is observed in the conditions of poor quality or soft bone where the 3‐year post‐loading CSR are 96.8% (dual acid‐etched) and 84.8% (machined‐surfaced). J Periodontol 2001;72:1384‐1390.
Histological and Clinical Evaluation of 3 Different Grafting Materials for Sinus Lifting Procedure Based on 8 Cases
Authors: Karabuda Cuneyt , Ozdemir Oguzhan , Tosun Tosun , Anil Ata , Olgaç Vakur
Published: February 2005

Background: The reconstruction of edentulous patients with adequate bone volume and density by using dental implants has become a viable treatment option with high predictability. However, initial stabilization is difficult to achieve in the posterior maxillary regions where cortical bone is thin or absent due to severly resorbed alveolar ridges. Maxillary sinus lift procedures applied with various grafting materials enable clinicians to place implant‐supported prostheses even in cases with increased pneumatization of the maxillary sinus.

Methods: The purpose of this study was to evaluate histologically and clinically different grafting materials used in maxillary sinus floor augmentation. Deproteinized bovine bone granules (DBBG), demineralized freeze‐dried bone powder (DFBP), and porous hydroxyapatite (PHA) were used as grafting materials. A total of 19 implants in 8 patients were placed into grafted sites. In 3 patients, a 2‐stage approach was used wherein implants were inserted after a 6‐month healing period following a sinus lift procedure. Specimens were taken with a trephine drill, and the site of the specimen was enlarged to accept an implant. For the remaining cases, a 1‐stage approach, which included sinus lifting and implant placement, was used and bone biopsies were taken during the uncovering stage. After 6 months of healing, fixed prosthetic restorations were fabricated.

Results: The healing period progressed without any complications, and all implants were loaded. The mean functioning time was 12 months, varying from 9 to 24 months.

Conclusion: The results indicate that DFBP resorbs earlier than PHA and DBBG in sinus lift procedures. J Periodontol 2001;72:1436‐1442.
A Clinical Evaluation of Hydroxyapatite Cement in the Treatment of Class III Furcation Defects
Authors: Rupprecht Robert D. , Horning Gregory M. , Towle Herbert J.
Published: February 2005

Background: Calcium hydroxyapatite cement (HAC) has been demonstrated in both animal models and human craniofacial defects to be safe, absorbable, osteoconductive, and possibly osteoinductive. This pilot study evaluated a novel technique using HAC to surgically obturate Class III mandibular molar furcation defects.

Methods: Following flap reflection, affected teeth in 6 patients were root planed and etched with citric acid. Experimental sites were grafted with HAC and coronally positioned flaps (CPF), while controls were treated by CPF only. A variety of clinical parameters were recorded initially, and at re‐entry surgery 9 months later.

Results: At re‐entry, all experimental sites exhibited granulation tissue interposed between the HAC and the alveolar bone, and clinical findings were unsatisfactory. Mean probing depth, clinical attachment loss, and recession increased by 0.8 mm, 1.9 mm, and 1.2 mm, respectively, in experimental sites. In controls, mean probing depth decreased by 0.8 mm, and clinical attachment loss and recession increased by 0.3 mm and 1.2 mm, respectively. There was a mean 1.6 mm loss in osseous crest height and a mean 2.2 mm worsening in osseous defect depth for experimental sites, but only a 0.5 mm loss in osseous crest and 0.5 mm increase in osseous defect depth in control sites.

Conclusions: Experimental sites lost 1.0 to 1.5 mm in bone and attachment compared to controls, without any significant clinical benefit. While the concept of surgically obturating Class III furcation defects with a safe, osteoconductive material remains attractive, HAC did not promote repair or regeneration in this technique. J Periodontol 2001;72:1443‐1450.
Comparison of 2 Techniques of Subepithelial Connective Tissue Graft in the Treatment of Gingival Recessions
Authors: Cordioli Giampiero , Mortarino Cinzia , Chierico Andrea , Grusovin Maria Gabriella , Majzoub Zeina
Published: February 2005

Background: The clinical outcome of connective tissue grafts in the treatment of gingival recessions has been documented in numerous studies. However, no attempt has been made to correlate the postoperative mucogingival changes with the surgical parameters. The present retrospective clinical study was undertaken to 1) evaluate root coverage and mucogingival changes 1 to 1.5 years following treatment of Miller's Class I and II recession defects using 2 variants of the subepithelial connective tissue graft (SCTG) procedure, and 2) assess the effect of the surgical parameters on the postoperative gingival width.

Methods: Thirty‐one recessions in 10 patients treated with the envelope technique (E) and 31 recessions in 11 patients treated with coronally positioned flap combined with connective tissue graft (CP) were retrospectively analyzed to evaluate: 1) percentage of root coverage obtained with the 2 procedures and variations in width of keratinized tissue (KT) 1 to 1.5 years postsurgery, and 2) the effect of the surgical parameters on the postoperative gingival width.

Results: Results showed a mean root coverage percentage of 89.6 ± 15% for the E group and 94.7 ± 11.4% for the CP group; the difference between groups was statistically insignificant (P = 0.1388). Mean KT increased signifi‐cantly from 1.4 ± 1.1 mm presurgery to 4.5 ± 1.1 mm postsurgery for the E group while a minor increase in KT was observed in the CP group (2 ± 1.5 mm presurgery versus 2.7 ± 1.6 mm postsurgery). For both treatment groups, the mean postsurgical width of keratinized tissue (POSTKT) was found to be mathematically correlated with the mean presurgical width of keratinized tissue (PREKT) and the corono‐apical height of the graft that remained exposed (GE) coronal to the flap margin in the recipient site.

Conclusions: Treatment of human gingival recession defects by the 2 variants of SCTG resulted in significant recession reduction. When SCTG is grafted beneath alveolar mucosa using the combined technique (CP), transformation of the mucosa into keratinized tissue does not seem to occur, at least within 1 to 1.5 years postsurgery. The treatment outcome in terms of keratinized tissue width seems to be correlated with the presurgical gingival dimensions and the height of the graft that remains exposed at the end of the surgical procedure. J Periodontol 2001;72:1470‐1476.
The Association Between Porphyromonas gingivalis‐Specific Maternal Serum IgG and Low Birth Weight
Authors: Dasanayake Ananda P. , Boyd Doryck , Madianos Phoebus N. , Offenbacher Steven , Hills Ed
Published: February 2005

Background: In Alabama, low birth weight (LBW) infants are about 20 times more likely to die before their first birthday compared to normal birth weight infants. While the rate of LBW has been consistently higher among African Americans compared to whites, there has been a gradual increase in LBW for both African Americans and whites over the last 15 years. In an attempt to identify modifiable risk factors for LBW, we have previously reported that a pregnant woman's poor periodontal health may be an independent risk factor for low birth weight.

Methods: A predominantly African American and socioeconomically homogeneous group of 448 women was followed from the second trimester of their first pregnancy. Thirty‐nine LBW cases were observed at the end of follow‐up. Using 17 preterm LBW cases and 63 randomly selected controls from the above cohort, the periodontal pathogen‐specific maternal serum IgG levels during the second trimester of pregnancy were evaluated in relation to birth weight of the infant, while controlling for known risk factors for LBW.

Results: Porphyromonas gingivalis (P.g.)‐specific maternal serum IgG levels were higher in the LBW group (mean 58.05, SE = 20.00 μg/ml) compared to the normal birth weight (NBW) group (mean 13.45, SE = 3.92 μg/ml; P = 0.004). Women with higher levels of P.g.‐specific IgG had higher odds of giving birth to LBW infants (odds ratio [OR] = 4.1; 95% confidence interval [CI] for odds ratio = 1.3 to 12.8). This association remained significant after controlling for smoking, age, IgG levels against other selected periodontal pathogens, and race.

Conclusions: Low birth weight deliveries were associated with a higher maternal serum antibody level against P. gingivalis at mid‐trimester. J Periodontol 2001;72:1491‐1497.
Attachment of Human Periodontal Ligament Cells to Enamel Matrix‐Derived Protein Is Mediated Via Interaction Between BSP‐Like Molecules and Integrin αvβ3
Authors: Suzuki Naoto , Ohyama Mariko , Maeno Masao , Ito Koichi , Otsuka Kichibee
Published: February 2005

Background: Although enamel matrix‐derived protein (EMD) can stimulate attachment of human periodontal ligament (HPDL) cells to the root surface, the biological mechanism of this phenomenon is unclear. The purpose of this study was to determine which molecules in EMD are involved in the attachment of HPDL cells, and which types of integrins on the cell surface mediate the interaction between the cells and EMD.

Methods: HPDL explants were obtained from tooth surfaces extracted from 4 individuals, and cells taken from the individual explants were separately harvested and subcultured through as many as 5 passages. Cells were incubated on EMD‐coated culture plates with and without neutral antibodies for integrins or RGD‐sequence blocking peptides and stained with toluidine blue. Proteins in EMD that were able to induce cell attachment were identified by incubating sodium dodecyl sulfate‐polyacrylamide gel electrophoresis (SDS‐PAGE) replicas with HPDL cells; the cell‐binding regions were detected by staining the cells with toluidine blue. Characteristics of the cell‐binding proteins in the EMD were identified by Western blot analysis.

Results: It was shown that anti‐αvβ3 antibody and GRGDSP peptide markedly reduced attachment of HPDL cells to EMD. When the cells were incubated with SDS‐PAGE replicas, distinct cell attachment was observed at a molecular mass of approximately 55 kDa. The cell‐binding ability of this protein was completely blocked by treatment with anti‐αvβ3 antibody or GRGDSP peptide. In the Western blot analysis, the 55 kDa protein was recognized by anti‐bone sialoprotein (BSP) antibody as a single band.

Conclusions: Our study provides the first evidence that the attachment of HPDL cells to EMD can be mediated by interaction between a BSP‐like molecule and integrin αvβ3 on the cell surface. J Periodontol 2001;72:1520‐1526.
Aggressive Periodontitis Associated With Fanconi's Anemia. A Case Report
Authors: Nowzari Hessam , Jorgensen Michael G. , Ta Thai T. , Contreras Adolfo , Slots J⊘rgen
Published: February 2005

Background: Fanconi's anemia is an autosomal recessive disease associated with chromosomal breakage as well as pancytopenia, skin pigmentation, renal hypoplasia, cardiac defects, microcephaly, congenital malformations of the skeleton, hypogonadism, and increased risk of leukemia. The present report describes the periodontal clinical and microbiological status of an 11‐year old male having Fanconi's anemia.

Methods: Polymerase chain reaction analysis to detect human cytomegalovirus (HCMV), Epstein‐Barr type 1 virus, and herpes simplex virus (HSV) was performed on paper‐point samples pooled from either 3 periodontal sites with advanced attachment loss or 3 gingivitis sites with no clinical attachment loss. Anaerobic bacterial culture examination was performed on the pooled periodontitis sample.

Results: The patient suffered from pancytopenia, allergy, asthma, hearing impairment, and mental retardation. Dentition consisted of 7 primary teeth, 11 erupted permanent teeth, and 14 unerrupted permanent teeth. Most erupted teeth showed severe gingival inflammation with some gingival overgrowth and various degrees of periodontal attachment loss. Genomes of HCMV and HSV were detected in the pooled periodontitis sample and HCMV in the pooled gingivitis sample. The periodontitis sample but not the gingivitis sample revealed HCMV mRNA of major capsid protein, suggestive of active viral infection. The periodontitis sample also yielded Actinobacillus actinomycetemcomitans (1.1% of total isolates), Fusobacterium species (7.9%), Campylobacter species (2.2%), Peptostreptococcus micros (3.4%), and Candida albicans (0.3%).

Conclusions: Oral features of Fanconi's anemia may include increased susceptibility to periodontitis. It is likely that underlying host defense impairment coupled with periodontal infection by HCMV and A. actinomycetemcomitans contribute to the severe type of periodontitis associated with Fanconi's anemia. J Periodontol 2001;72:1601‐1606.
Histology of Connective Tissue Graft. A Case Report
Authors: Majzoub Zeina , Landi Luca , Grusovin Maria Gabriella , Cordioli Giampiero
Published: February 2005

Background: Few investigations can be found the literature on the histological nature of the attachment of connective tissue grafts to root surfaces previously exposed by recession.

Methods: In this case report, a 24‐year‐old patient was treated with a connective tissue graft combined with a partial‐thickness coronally positioned flap for root coverage of Class I Miller recessions at the maxillary right and left canines and first premolars. The treated sites exhibited 83% and 100% root coverage on the right and left sides, respectively. Twelve months later, the case required extraction of all 4 first premolars for orthodontic reasons. Two conservative block sections including the maxillary first premolars with the buccal soft tissues were obtained and processed histologically in a bucco‐palatal plane.

Results: Histological analysis showed that healing occurred via a long juctional epithelium throughout the major portion of the previous recession site. Only minimal signs of new cementum‐like tissue formation could be seen in the apical portion of the recession area coronal to the base of the instrumented root surface. No root resorption or ankylosis could be detected in any of the serial sections.

Conclusions: The findings of this case report outline the possible variations in the histological outcome of connective tissue grafts. These variations can be attributed to differences in size and shape of the recession defects and flap positioning at the end of surgery. J Periodontol 2001;72:1607‐1615.
Observations on a New Collagen Barrier Membrane in 16 Consecutively Treated Patients. Clinical and Histological Findings
Authors: Friedmann Anton , Strietzel Frank Peter , Maretzki Burghard , Pitaru Sandu , Bernimoulin Jean‐Pierre
Published: February 2005

Background: Space‐maintaining capacity, cell disclusive potential, and stability over time are crucial factors to achieving sufficient bone augmentation with membrane barriers. The case series presented here assessed a new collagen barrier used in bone augmentation. Clinically, the healing pattern, especially in cases of secondary healing, was studied.

Methods: Soft tissue healing was documented by photographs, and the size of the dehiscences calculated by image analysis. The measurements were performed on digitized photographs. During reentry, barrier remnants were dissected and histologically evaluated.

Results: The mean value for dehiscences was 35.5 mm2; all dehiscences healed within 4 weeks after the exposure became evident. The difference was statistically significant between the week 2 and week 6 visits (P = 0.008) for each previously exposed site. The histologic observation of barrier remnants revealed direct apposition of fibrous and bone tissues on the membrane surface.

Conclusion: In cases of membrane exposure, gingival dehiscences always disappeared in the following weeks without affecting the healing process. Histologic results showed barrier stability over a 6‐month period, promoting bone regeneration. J Periodontol 2001;72:1616‐1623.
In Vitro Effect of Transforming Growth Factor‐β on Adhesion Molecule Expression by Human Gingival Fibroblasts Cultured in the Presence of a Titanium Abutment
Authors: Schierano Gianmario , Bellone Graziella , Manzella Carlo , Preti Giulio , Emanuelli Giorgio
Published: February 2005

Background: There is little information in the literature on the structural basis mediating gingival cell adhesion to the surface of titanium abutments. We cultured gingival fibroblasts on a titanium abutment creating as closely as possible the in vivo state. We analyzed the constitutive and transforming growth factor (TGF) β‐induced expression of the adhesion molecules CD44, CD49b, CD49c, CD51, CD54, and CD61 and extracellular matrix (ECM) components fibronectin, laminin and collagen IV.

Methods: Three totally edentulous patients underwent implant treatment to anchor the mandibular denture on 2 implants. Gingival mucosa cell specimens were collected from the mandible during the first surgical stage and the gingival fibroblast cultures were prepared. Cells were cultured for 48 hours with or without isoforms TGF‐β1, TGF‐β2, and TGF‐β3. The expression of adhesion molecules and ECM components was analyzed by immuno‐fluorescence staining and flow cytometry.

Results: The addition of TGF‐β isoforms to the cell culture over the incubation period had little effect on cell growth rate, but significantly influenced cell orientation, which changed from a sun‐burst pattern in control conditions to a more elongated organization and perpendicular to abutment surface. In all fibroblast preparations, a marked expression of CD44 and a moderate positivity for anti‐CD49b and CD49c were found. By contrast, CD51, CD54, and CD61 expressions were negligable. When fibroblasts were cultured for 48 hours in the presence of TGF‐β, the expression of most of the receptor molecules increased. The cells expressed constitutively moderate levels of laminin and fibronectin and low amounts of collagen IV. By contrast, treatment with any one of the 3 TGF‐β isoforms greatly enhanced the expression levels of fibronectin, laminin, and, especially, collagen IV.

Conclusions: TGF‐β not only seems to affect the orientation of the cultured gingival fibroblasts, but also to induce a clearcut modification of their adhesion molecule expression. J Periodontol 2001;72:1658‐1665.
The Simplified Papilla Preservation Flap in the Regenerative Treatment of Deep Intrabony Defects: Clinical Outcomes and Postoperative Morbidity
Authors: Cortellini Pierpaolo , Tonetti Maurizio S. , Lang Niklaus P. , Suvan Jean E. , Zucchelli Giovanni , Vangsted Tine , Silvestri Maurizio , Rossi Roberto , McClain Pamela , Fonzar Alberto , Dubravec Dominik , Adriaens Patrik
Published: February 2005

Background: The aims of the present multi‐center, randomized, controlled clinical trial were: 1) to compare the efficacy of the simplified papilla preservation flap with and without a barrier membrane in deep intrabony defects; 2) to evaluate the postoperative morbidity and surgical complications; and 3) to preliminarily test the impact of baseline tooth mobility on clinical outcomes.

Methods: This parallel group, randomized, multi‐center, controlled clinical trial involved 112 patients in 8 periodontal practices in 4 countries. A deep intrabony defect in each patient was accessed with the simplified papilla preservation flap. In the test defects, a bioabsorbable membrane was positioned. Patients' experiences with the surgical procedure and postoperative period were evaluated with a questionnaire. Clinical outcomes included clinical attachment level (CAL) and probing depth (PD) changes.

Results: Complete observations were available for 55 test and 54 control defects. CAL gains at 1 year were 3.5 ± 2.1 mm in the guided tissue regeneration (GTR) group and 2.6 ± 1.8 mm in the control group (P = 0.0117). CAL gains ≥4 mm were observed in 50.9% of GTR sites and 33.3% of control sites. A signifi‐cant center effect of 2.1 mm was observed (P = 0.01). Initial PD (P = 0.01) and baseline tooth mobility (P = 0.036) were significant covariates. During the procedure, 30.4% of test and 28.6% of controls reported feeling moderate pain, and subjects estimated the hardship of the procedure at 24 ± 25 visual analog scale (VAS) units in the test group, and at 22 ± 23 VAS in controls. In terms of the investigated outcomes, differences between test and control groups were not statistically significant. Among the postoperative complications, edema was most prevalent at week 1, and more frequently associated with the test treatment (P = 0.01). In the test group, 53.6% of membranes were exposed at week 3.

Conclusions: The present study further supports the added benefits of guided tissue regeneration with respect to access flap alone in the treatment of deep intrabony defects, as well as the general efficacy of GTR in different clinical settings. Furthermore, our study indicates a possible influence of baseline tooth mobility on clinical outcomes. J Periodontol 2001;72:1702‐1712.
Some Effects of Non‐Surgical Therapy on Gingival Inflammatory Cell Subsets in Patients With Early‐Onset Periodontitis Associated With Actinobacillus actinomycetemcomitans
Authors: Kleinfelder Jörg W. , Sculean Anton , Lange Dieter E.
Published: February 2005

Background: Limited information is available as to whether local cellular immunity in early‐onset periodontitis (EOP) subjects harboring Actinobacillus actinomycetemcomitans (Aa) differs from that in patients without Aa. In addition, the effect of scaling and root planing on various lymphocyte subsets is described rather sparsely.

Methods: In 10 subjects with early‐onset periodontitis harboring Aa (EOP‐Aa) and in 10 subjects without Aa (EOP‐nonAa), clinical measurements were recorded and gingival biopsies were performed before and after scaling and root planing. The specimens were cut into serial sections; using the alkaline phosphatase‐antialkaline phosphatase technique, monoclonal antibodies to CD20 (B cells), CD30 (plasma cells), and CD45RO (T‐memory cells) were applied as well as polyclonal antibodies to alpha, gamma, and mu chains (Ig A, G, and M). Cells were counted from an area of 0.25 mm2 in areas showing the largest infiltration.

Results: Before therapy, mean counts of all cell phenotypes were found to be markedly enhanced in the EOP‐Aa group compared to EOP‐nonAa subjects. Following scaling and root planing, the numbers of all phenotypes decreased in both groups. However, comparing the data before and after therapy in the EOP‐Aa group, the P value was <0.05 only for CD30‐positive cells. In the EOP‐nonAa group, the differences before and after therapy reached statistical significance (P <0.05) for all cell counts, except for IgMpositive cells. Furthermore, reduction of probing depth and gain of clinical attachment reached the 0.05 level of statistical significance only in EOP‐nonAa subjects.

Conclusions: In EOP subjects harboring Aa, inflammatory cell subsets were detected in 2‐ to 3‐fold higher numbers compared to patients without Aa. Scaling and root planing resulted in a decrease of all cell phenotypes studied in individuals without Aa, whereas in subjects with Aa, the only significant decrease that was seen occurred in plasma cells. J Periodontol 2001;72:1713‐1719.
Distribution of the Receptor for Advanced Glycation End Products Gene Polymorphisms in Patients With Chronic Periodontitis: A Preliminary Study
Authors: Hollá Lydie Izakovičová , Kaňková Kateřina , Fassmann Antonín , Bučková Dana , Halabala Tomáš , Znojil Vladimír , Vaněk Jiří
Published: February 2005

Background: Periodontal diseases are viewed today as multifactorial problems initiated and sustained by bacteria but significantly modified by the body's response to bacterial plaque. A recent study suggested that receptor for advanced glycation end products (RAGE) could be involved in the pathophysiology of periodontitis. The aim of this study was to investigate a possible association of 3 common polymorphisms in the RAGE gene with chronic periodontitis.

Methods: We studied 101 Caucasian patients with chronic periodontitis together with 162 orally healthy subjects. Three polymorphisms, one in intron 7 (1704G/T), second in intron 8 (2184A/G), and the third in exon 3 (G82S) of the RAGE gene, were investigated by polymerase chain reaction methods (PCR) with subsequent enzymatic restriction with BfaI, BsmFI, or AluI, respectively.

Results: A statistically significant difference in allele frequencies between patients and the reference group was found for intron variant 1704G/T (P = 0.02, Pcorr >0.05). There was no significant difference in genotype or allele frequency distributions between groups for intron variant 2184A/G or for the exon variant exchanging amino acid Gly for Ser at position 82 (G82S).

Conclusions: We can speculate that susceptibility to the development of chronic periodontitis could be influenced by the 1704G/T polymorphism of the RAGE gene, independently of diabetes. J Periodontol 2001;72:1742‐1746.