bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal Effect of Non‐Surgical Treatment and Systemic Metronidazole for 1 Week in Smokers and Non‐Smokers With Refractory Periodontitis: A 5‐Year Study
Authors: Söder Birgitta , Nedlich Ulla , Jin Li Jian
Published: February 2005

Background: Periodontitis consists of a mixture of diseases, most of which respond favorably to traditional mechanical therapy. It is now recognized that advanced periodontitis does not always respond to conventional management with scaling, periodontal surgery, and oral hygiene measures. However, various types of antibiotics given systemically or locally improve the success rate of periodontal therapy. In short‐term studies, it has been shown that metronidazole, when systemically administered after debridement, resulted in treatment benefits including less need for surgical intervention.

Methods: In this double‐blind study, we evaluated periodontal treatment involving initial non‐surgical treatment, systemic administration of metronidazole for 1 week, and then follow‐ups for scaling and root planing every 6 months, for 5 years. The study population consisted of 64 subjects (37 smokers and 27 nonsmokers), mean age 36.3 (±3.0 SD) years, with severe periodontal disease. After initial scaling and root planing, patients were randomly assigned to the intervention or placebo groups: 400 mg metronidazole or a placebo administered at 8‐hour intervals for 1 week. The participants underwent an extensive clinical periodontal examination. Gingival crevicular fluid (GCF) was analyzed for spirochetes and granulocytes. Samples were cultured for Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Prevotella intermedia (P.i.).

Results: The number of patients infected with A.a., P.g., P.i., and spirochetes decreased during the study. Most patients who harbored spirochetes at the end of the study had these microorganisms at the beginning. Smokers responded less favorably to periodontal therapy than non‐smokers. Non‐smoking patients who required only non‐surgical therapy in the intervention group showed statistically significant improvement in the clinical parameters after 5 years. Patients with complete healing, defined as the absence of inflamed sites ≥5 mm, after 5 years were found only in the intervention group. The patients considered healthy after 5 years were the same patients found to be healthy after 6 months.

Conclusions: Decisive factors in the sustained long‐term improvement of patients who respond satisfactorily to treatment are probably initial scaling and root planing; a brief course of metronidazole; and regular follow‐up examinations at 6‐month intervals for oral hygiene and scaling and root planing. J Periodontol 1999;70:761‐771.
Involvement of Cyclooxygenase‐2 in Interleukin‐1α‐Induced Prostaglandin Production by Human Periodontal Ligament Cells
Authors: Noguchi Kazuyuki , Shitashige Miki , Ishikawa Isao
Published: February 2005

Background: Human periodontal ligament (PDL) cells produce prostaglandin (PG) E2 in response to proinflammatory cytokines. However, the mechanism of PGE2 production is not well understood. The purpose of the present study was to investigate the involvement of cyclooxygenase (COX)‐1 and COX‐2 in PGE, production by PDL cells to examine the regulation of PGE2 production by cell‐cell interaction of human gingival keratinocytes and PDL cells. stimulated with a proinflammatory cytokine, interleukin‐1 α (IL‐1 α ), and

Methods: The levels of PGE2 in the culture media of PDL cells stimulated with IL‐1 α or culture media of human gingival keratinocytes were determined by an enzyme‐linked immunosorbent assay. Expression of COX‐1 and ‐2 mRNA and protein was studied by Northern blot analysis and Western blot analysis, respectively.

Results: IL‐1 α ‐stimulated PDL cells produced PGE2 in a time‐dependent manner. Indomethacin, a non‐selective COX‐1/COX‐2 inhibitor, and NS‐398, a selective COX‐2 inhibitor, completely inhibited PGE2 production by the IL‐1 α ‐stimulated cells. COX‐2 mRNA was detected after IL‐1 α stimulation, although it was not detected in unstimulated cells. There was no difference in expression of COX‐1 mRNA between unstimulated cells and IL‐1 α ‐stimulated cells. Expression of COX‐2 protein in IL‐1 α ‐stimulated cells was increased, compared with that in unstimulated cells, whereas COX‐1 protein expression was almost the same in both the cells. Treatment of IL‐1 α ‐stimulated PDL cells with dexamethasone, known to inhibit COX‐2 expression, prevented PGE2 production and COX‐2 mRNA expression. Addition of the culture media of human gingival keratinocytes to PDL cells increased PGE2 production. The PGE2 production was depressed by treatment of the cells with IL‐1 receptor antagonist and anti‐ IL‐1 α antibody, not with anti‐IL‐1β antibody. The PGE2 production was also inhibited by treatment with NS‐398 and dexamethasone.

Conclusions: We suggest that PDL cells stimulated with IL‐1 α produce PGE2 through de novo synthesis of COX‐2 and that the cell interaction of gingival keratinocytes and PDL cells controls COX‐2 expression and PGE2 production via IL‐1 α or a IL‐1 α ‐like factor(s). Selective COX‐2 inhibitors, which have the advantage of reduced gastric toxicity, may provide a useful approach to treatment of periodontal disease. J Periodontol 1999; 70:902‐908.
Coronally Advanced Flap Procedure for Root Coverage. Treatment of Root Surface: Root Planing Versus Polishing
Authors: Pini‐Prato Giovanpaolo , Baldi Carlo , Pagliaro Umberto , Nieri Michele , Saletta Daniele , Rotundo Roberto , Cortellini Pierpaolo
Published: February 2005

This clinical study was designed to determine if mechanical instrumentation (root planing) of the exposed root is useful in treating gingival recession caused by traumatic toothbrushing following a coronally advanced flap (CAF). Ten patients with high levels of oral hygiene (full‐mouth plaque score <20%), from 25 to 57 years of age, were selected for the study. Each patient showed 2 bilateral Class I or II maxillary recessions. A total of 20 recessions were treated. The difference in the recessions was ≤1 mm. In each patient, one recession was randomly assigned to the test group and the contralateral one to the control group. In the test group, the exposed root surface was polished at slow speed with a rubber cup and prophylaxis paste for 60 seconds. In the control group, the exposed root surface was planed with a sharp curet. In both test and control groups, a trapezoidal full‐ and partial‐thickness flap was elevated, coronally displaced, and sutured to cover the treated root surface. Before treatment, the mean recession depth in the test group (polishing) was 3.1 ± 1.1 mm; and in the control group (root planing), 2.9 ± 1.0 mm. Three months after the described procedures, the test group (polishing) showed a mean recession reduction of 2.6 ± 0.6 mm; mean percent root coverage was 89 ± 14%. In the control group (root planing), the mean recession reduction was 2.3 ± 0.7 mm and mean percent root coverage was 83 ± 16%. The difference of recession reduction between the test and control group was not statistically significant (P = 0.1405), even though the test group showed slightly better clinical results in terms of root coverage. This prospective clinical, controlled, randomized study shows that mechanical instrumentation (root planing) of the exposed root surfaces is not necessary when shallow recessions caused by traumatic toothbrushing are treated using a coronally advanced flap (CAF) in patients with high levels of oral hygiene. J Periodontol 1999;70:1064‐1076.
Coronally Advanced Flap Procedure for Root Coverage. Is Flap Thickness a Relevant Predictor to Achieve Root Coverage? A 19‐Case Series
Authors: Baldi Carlo , Pini‐Prato Giovanpaolo , Pagliaro Umberto , Nieri Michele , Saletta Daniele , Muzzi Leonardo , Cortellini Pierpaolo
Published: February 2005

This clinical study was designed to determine whether the thickness of the flap can influence root coverage when gingival recessions associated with traumatic toothbrushing are treated using a coronally advanced flap (CAF). Nineteen patients, aged from 25 to 57 years, with high levels of oral hygiene (full‐mouth plaque scores <20%) were selected for the study. Each patient contributed with one Miller Class I or II maxillary or mandibular recession. A total of 19 recessions ≥2 mm were treated. After local anesthesia and before flap elevation, the exposed root surface was planed with a sharp curet. A trapezoidal fulland partial‐thickness flap was then elevated, displaced coronally, and sutured to cover the treated root surface. Before suturing, flap thickness was measured in the alveolar mucosa with a gauge. After surgery, all patients were recalled for control and professional prophylaxis once a week during the first month and monthly up to the third month. The mean initial recession depth was 3.0 ± 0.9 mm. Mean flap thickness (FT) was 0.7 ±0.2 mm. Three months later, mean recession depth was 0.6 ±0.6 (P <0.0001) and mean recession reduction was 2.4 ± 0.7 mm. Mean root coverage was 82 ±17%. Flap thickness >0.8 mm was associated with 100% of root coverage. The results of this study indicate that there is a direct relation between flap thickness and recession reduction (P <0.0001). J Periodontol 1999;70:1077‐1084.
Subgingival Acellular Dermal Matrix Allograft for the Treatment of Gingival Recession: A Case Report
Authors: Tal Haim
Published: February 2005

Root coverage procedures using subgingival soft tissue grafts or guided tissue regeneration have attracted much interest within the past 2 decades. Recently, acellular dermal matrix allograft (ADMA) has been introduced as a substitute for palatal donor tissue in gingival augmentation procedures. This study was undertaken to examine the potential of ADMA to be used as a substitute for autogenous connective tissue graft material in a root coverage procedure in a case with moderate gingival recession combined with reduced keratinized attached gingiva. After thorough root planing and conditioning of the root surface with a saturated solution of tetracycline‐HCl, a trapezoidal mucoperiosteal flap was raised and the papillae were de‐epithelialized. The exposed bone surrounding the exposed root surface was perforated with a No. 2 round drill, and the exposed root and surrounding bone were covered by ADMA. The allograft was stabilized by 5‐0 vicryl sutures. The flap was coronally positioned to completely cover the ADMA. Healing was uneventful. Eight‐month observations and measurements showed root coverage of more than 3.5 mm (>80%), a gingival margin that was harmonious with the neighboring teeth, and an increase of the zone of keratinized attached gingiva, from 1 to 3 mm. Within the limitations of these clinical observations, it is suggested that ADMA may be a possible substitute to free autogenous connective tissue grafts and/or bioabsorbable barrier membranes. Further clinical and histological studies are necessary to understand the healing process of this surgical wound. J Periodontol 1999;70:1118‐1124.
The Effect of Locally Delivered Controlled‐Release Doxycycline or Scaling and Root Planing on Periodontal Maintenance Patients Over 9 Months
Authors: Garrett Steven , Adams Donald F. , Bogle Gary , Donly Kevin , Hastings Drisko Connie , Hallmon William W. , Brady Hancock E. , Hanes Philip , Hawley Charles E. , Johnson Lonnie , Kiger Robert , Killoy William , Mellonig James T. , Raab Frank J. , Ryder Mark , Stoller Norman , Polson Alan , Wang Hom‐Lay , Wolinsky Lawrence E. , Yukna Raymond A. , Harrold Charles Q. , Hill Margaret , Johnson Valerie Blanco , Lee Southard G.
Published: February 2005

Background: This research report evaluates clinical changes resulting from local delivery of doxycycline hyclate (DH) or traditional scaling and root planing (SRP) in a group of patients undergoing supportive periodontal therapy (SPT).

Methods: In all, 141 patients received either DH (67) or SRP (74) treatment in sites ≥5 mm on one‐half of their dentition at baseline and month 4.

Results: Clinical results were determined at month 9. Baseline mean probing depth recordings were similar between the two groups (DH = 5.9 mm; SRP = 5.9 mm). Mean month 9 results showed similar clinical results for attachment level gain (DH 0.7 mm; SRP 0.8 mm) and probing depth reduction (DH 1.3 mm; SRP 1.1 mm). Percentage of sites showing ≥2 mm attachment level gain at month 9 was 24.7% in the DH group and 21.2% in the SRP group. Thirty‐nine percent (39%) of DH sites and 38% of SRP sites showed ≥2 mm probing depth reduction. When treated sides of the dentition were compared to untreated sides, DH showed a difference in disease activity (≥2 mm attachment loss) from 19.3% (untreated) to 7.2% (treated); and SRP from 14.3% (untreated) to 8.1% (treated).

Conclusions: Results show that both DH without concomitant mechanical instrumentation and SRP were equally effective as SPT in this patient group over the 9‐month study period. J Periodontol 2000;71:22‐30.
Combined Treatment of Periodontal Disease and Benign Mucous Membrane Pemphigoid. Case Report With 8 Years Maintenance
Authors: Damoulis Petros D. , Gagari Eleni
Published: February 2005

Background: Desquamative gingivitis may be the clinical manifestation of one of several systemic diseases. The clinical course of the disease can be complicated by plaque‐associated periodontitis. However, there is no information currently available for the concurrent management of both conditions.

Case report and results: This paper presents the treatment and 8‐year maintenance of a patient with periodontal disease and benign mucous membrane pemphigoid (BMMP). The first phase of treatment included oral hygiene instructions and local corticosteroid administration, followed by scaling and root planing. The patient's compliance and excellent response to therapy allowed for subsequent surgical pocket elimination and augmentation of the zone of keratinized tissue for prosthetic reasons. Over the following 8 years, the patient's periodontal condition remained stable even though periodontal maintenance was erratic. For the control of BMMP, intermittent administration of corticosteroids was necessary, without any significant local or systemic side effects.

Conclusions: We suggest that combined treatment and long‐term maintenance of BMMP and periodontitis are feasible under certain conditions and propose a clinical protocol for treatment which could serve as a guideline for similar conditions. J Periodontol 2000; 71:1620‐1629.
An Unusual Cause of Gingival Recession: Oral Piercing
Authors: Er Nuray , Özkavaf Arzu , Berberoğlu Atilla , Yamalik Nermin
Published: February 2005

Wearing so‐called jewelry in uncommon sites, termed as body piercing, is gaining increased popularity. There also seems to be a significant increase in oral piercing mainly in the lip and/or tongue. We report a case of multiple oral piercing sites and localized gingival recession as an adverse consequence. Furthermore, based on the medical characteristics of the case, we also emphasize the necessity and importance of professional dental/medical consultation before oral piercing. J Periodontol 2000;71:1767‐1769.
The Prevalence and Intraoral Distribution of Periodontal Attachment Loss in a Birth Cohort of 26‐Year‐Olds
Authors: Thomson W. Murray , Hashim Raghad , Pack Angela R.C.
Published: February 2005

Background: Most research efforts in periodontal epidemiology have focused on middle‐aged or older people, giving a picture of disease occurrence at a relatively late stage in the natural history of the condition. There is a paucity of comprehensive descriptive data from younger age groups. Understanding the epidemiology and clinical presentation of the condition earlier in the disease course may enable more appropriate interventions.

Methods: The aim of this study was to describe the occurrence of gingival recession, probing depth, periodontal attachment loss (AL), and gingivitis among participants at age 26 in the Dunedin Multidisciplinary Health and Development Study. Gingival recession and probing depth were measured at 3 sites per tooth in 2 randomly selected contralateral quadrants.

Results: At age 26, 980 (96.2%) of the surviving cohort participated and periodontal data were available for 914 individuals. Over 70% of the sample had one or more teeth with ≥1 mm of gingival recession and it was observed at over 20% of midbuccal sites. Over 15% had 1 or more sites with probing depths of ≥4 mm and nearly 20% had 1 or more sites with ≥4 mm of AL. The extent of gingival recession was greatest for midbuccal sites on mandibular premolars, followed by midbuccal sites on maxillary premolars and mandibular molars. In the mandible, more distolingual sites had probing depths of ≥4 mm, but a higher percentage of mesiobuccal sites was affected in the maxilla, and molars were the most affected, followed by premolars, incisors, and canines. Bleeding after probing was more extensive in the mandible than in the maxilla.

Conclusions: Periodontal disease appears to be well‐established among a small proportion of young adults. The prevalence of gingival recession was higher than expected, with clear differences by site. Pocketing and AL were more prevalent in mesiobuccal and distolingual sites than the buccal sites, with differences between the jaws. J Periodontol 2000;71:1840‐1845.
Association Between Periodontal Disease and Acute Myocardial Infarction
Authors: Emingil Gülnur , Buduneli Eralp , Aliyev Abbas , Akilli Azem , Atilla Gül
Published: February 2005

Background: Coronary heart disease is the leading cause of morbidity and mortality throughout the world. Well‐known risk factors independently or combined participate in both myocardial infarction and atherosclerosis. Recent data have shown that viral and bacterial infections may also contribute to the acute thromboembolic events. The aim of the present study was to investigate the possible association between periodontal health and coronary heart disease in patients with acute myocardial infarction and chronic coronary heart disease.

Methods: A total of 120 patients, 60 with acute myocardial infarction (AMI) and 60 with chronic coronary heart disease (CCHD) were included in this study. The patients in the AMI group (50 men and 10 women; mean age 53.8 ± 9.5 years) were admitted to the Department of Cardiology, University Hospital of Ege because of AMI. The CCHD patients group (42 men and 18 women; mean age 58.5 ± 11.6 years) had no documented history of recent acute coronary events. All patients were clinically examined and completed a medical questionnaire. Missing teeth, restorations, probing depth (PD) and bleeding on probing (BOP) were recorded. Blood samples were taken on admission for measurements of serum total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL‐cholesterol), low density lipoprotein cholesterol (LDL‐cholesterol), and fasting blood glucose level. Sample proportions were compared by chi square test, quantitative variables with Student t test. The relation of clinical parameters and conventional risk factors to AMI was assessed with logistic regression analysis.

Results: The number of sites with PD ≥4 mm, the percentage of sites exhibiting BOP, smoking status, total cholesterol, LDL‐cholesterol, and triglycerides were statistically different between AMI and CCHD groups (P <0.05). Logistic regression analysis showed that the percentage of sites exhibiting BOP, the number of sites with PD ≥4, the number of restorations, smoking status, and triglycerides levels were significantly associated with AMI (P <0.05).

Conclusions: The results of this study indicate that periodontal disease may be associated with acute myocardial infarction. To our knowledge, this is the first study that reports the importance of periodontal health in the occurrence of acute myocardial infarction in a Turkish population. We propose that prospective randomized studies are needed to determine whether periodontal disease is a risk factor in the occurrence of acute myocardial infarction. J Periodontol 2000;71:1882‐1886.
Low Prevalence of a Periodontitis‐Associated Interleukin‐1 Composite Genotype in Individuals of Chinese Heritage
Authors: Armitage Gary C. , Wu Yafei , Wang Hwa‐Ying , Sorrell Julian , di Giovine Francesco S. , Duff Gordon W.
Published: February 2005

Background: Polymorphisms in the interleukin‐1 (IL‐1) gene cluster have been associated with an increased risk of developing certain diseases. A specific composite genotype of IL‐1A and IL‐1B polymorphisms, consisting of allele 2 of both IL‐1A +4845 and IL‐1B +3954 (formerly +3953) has been associated with an increased risk of severe adult periodontitis. Approximately 30% of the European population carry this genotype. The prevalence of the above IL‐1A and IL‐1B composite genotype in populations of different ethnic origins is unknown. Therefore, the primary aim of this study was to determine the prevalence of the IL‐1 composite genotype in individuals of Chinese heritage, since epidemiologic studies indicate that periodontitis is widespread among ethnic Chinese. An additional aim was to evaluate if there was an association between the composite genotype and the severity of periodontal disease.

Methods: A convenience sample of 300 volunteers of Chinese heritage (ages 21 to 69 years) received a periodontal examination including full‐mouth clinical attachment loss measurements, probing depths, plaque index scores, and bleeding on probing. Blood was collected from a fingerstick and placed on a blotting paper card. The blood samples were analyzed for IL‐1A +4845 and IL‐1B +3954 polymorphisms using polymerase chain reaction (PCR)‐based methods.

Results: Only 7 of the 300 subjects (2.3%) carried the composite IL‐1 genotype consisting of allele 2 of both IL‐1A +4845 and IL‐1B +3954. Allele 2 of the IL‐1A +4845 polymorphism was carried by 17.0% (51/300) of the subjects; of these, only 2 were homozygous. Allele 2 of the IL‐1B +3954 polymorphism was much rarer with only 3.3% (10/300) of the study population carrying this marker. All of the people who carried the IL‐1B polymorphism were heterozygous. Too few of the subjects were positive for the IL‐1 composite genotype to establish any relationship with the susceptibility to periodontitis.

Conclusions: It was concluded that the prevalences of both IL‐1A and IL‐1B polymorphisms are dramatically lower in Chinese than those reported for Europeans. Findings from this study bring into question the usefulness of the composite genotype of allele 2 of both IL‐1A +4845 and IL‐1B +3954 as a method for determining the susceptibility of Chinese patients to adult periodontitis. J Periodontol 2000;71:164‐171.
Fluoroquinolones in the Treatment of Actinobacillus actinomycetemcomitans‐Associated Periodontitis
Authors: Kleinfelder Joerg W. , Mueller Ruediger F. , Lange Dieter E.
Published: February 2005

Background: Periodontitis patients harboring Actinobacillus actinmycetemcomitans (Aa) are prime candidates for systemic antibiotic therapy. Besides tetracycline and the combination of metronidazole and amoxicillin the fluoroquinolones are also believed to have antibacterial activity against Aa. The aim of the present study was to evaluate systemic ofloxacin therapy as adjunct to flap surgery.

Methods: Twenty‐five adult periodontitis patients with subgingival detection of Aa were treated with 2×200mg/d ofloxacin for 5 days as adjunct to open flap surgery (test). Another 10 patients received only flap surgery (control). Probing depth (PD) and clinical attachment level (CAL) was recorded and subgingival plaque samples were cultivated on TSBV agar for detection of Aa at baseline as well as 3 and 12 months following therapy.

Results: At 3 and 12 months following therapy mean PD at monitored sites in the test group changed from 6.8 mm (±1.3) to 3.6 mm (±1.0), 3.8 mm (±1.1) and CAL from 7.5 mm (±1.4) to 5.4 mm (±1.4), 5.5 mm (±1.3). In the control group PD changed from 6.5 mm (±0.7) to 4.0 mm (±1.7), 4.1 mm (±1.6) and CAL from 7.5 mm (±1.0) to 6.3 mm (±1.7), 6.4 mm (±1.8). P was <0.05 for CAL between groups. Three and 12 months following adjunctive systemic ofloxacin therapy, Aa was suppressed below detectable levels in 22 of 22, test patients, whereas Aa could not be recovered in only 2 of the 10 controls. (P <0.0001).

Conclusions: Systemic ofloxacin as adjunct to open flap surgery is able to suppress A. actinomycetemcomitans below detectable level in patients harboring this organism at baseline. J Periodontol 2000;71:202‐208.
Peptostreptococcus micros Smooth and Rough Genotypes in Periodontitis and Gingivitis
Authors: Kremer Bas H. A. , Loos Bruno G. , van der Velden Ubele , Jan van Winkelhoff Arie , Craandijk Jeroen , Bulthuis Hankie M. , Hutter Jaap , Varoufaki Anna S. , Martijn van Steenbergen T.J.
Published: February 2005

Background: Two genotypes can be distinguished within the species Peptostreptococcus micros: a smooth (Sm) and a rough (Rg) type. To date no systematic study has been performed on the prevalence and proportion of both types in untreated periodontitis patients and subjects without destructive periodontal disease. Therefore, the present study was performed to investigate: 1) the relative importance of the Sm and the Rg genotype of P. micros in periodontitis and gingivitis; 2) the correlation between smoking and the 2 genotypes of P. micros; and 3) the systemic antibody response against the 2 genotypes in relation to the periodontal condition and smoking.

Methods: A total of 104 untreated periodontitis patients and 41 individuals with gingivitis underwent clinical examination and microbiological sampling. Pocket samples were cultured anaerobically on blood agar plates to determine the prevalence and proportion of the Sm and Rg types of P. micros. Serum antibody titers against both types of P. micros were determined in all subjects by enzyme‐linked immunosorbent assay (ELISA) using whole bacterial cells as antigen. Additionally, in a representative group of subjects, the antigen specificity of the serum antibodies was assessed by immunoblotting experiments.

Results: The prevalence of the Sm genotype was higher in subjects with periodontitis (94%) compared to subjects with gingivitis (59%), whereas the prevalence of the Rg type was not significantly different (38% versus 29%). Similar analyses were performed for subgroups of smokers and non‐smokers; within the periodontitis group, the prevalence of the Sm type was not different between smokers and non‐smokers (96% and 92%, respectively), whereas the prevalence of the Rg type was higher in smokers (48%) compared to non‐smokers (19%). No difference in prevalence of both types was observed between smokers and non‐smokers within the gingivitis group. The titers and specificity of P. micros‐specific immunoglobulins in periodontitis patients were not different from those in gingivitis subjects, nor were they related to smoking status or culture‐positivity.

Conclusions: The results of this study suggest that both the Sm and the Rg genotypes of P. micros are part of the normal oral microbiota. However, the elevated prevalence of the Sm genotype in periodontitis and the elevated prevalence of the Rg type in periodontitis patients who smoke implies that both types can behave as opportunistic pathogens in destructive periodontal disease. J Periodontol 2000;71:209‐218.
Alveolar Bone Response to Submerged Bisphosphonate‐Complexed Hydroxyapatite Implants
Authors: Denissen Harry , Montanari Cristiana , Martinetti Roberta , van Lingen Arthur , van den Hooff Arnold
Published: February 2005

Background: In most studies using submerged hydroxyapatite implants, maintenance of alveolar bone after tooth extraction was attempted with plain hydroxyapatite materials. However, clinical results have shown that hydroxyapatite may require biological modification with a bone resorption‐inhibiting agent which may be beneficial for maintenance of alveolar bone. We conducted experimental and clinical studies to evaluate the effect of highly bisphosphonate‐complexed hydroxyapatite implants on osteoconduction and repair in alveolar bone.

Methods: Porous hydroxyapatite implants were pre‐incubated in 10−2M bisphosphonate solutions at pH 3.49. The implants had a diameter of 2.1 mm and a height of 2 mm and adsorbed 115 µg bisphosphonate. Five goats were implanted with 4 plain hydroxyapatite implants on each side of the mandible in root extraction sockets for the precision analysis of dual x‐ray absorptiometry (DEXA) measurements. Ten goats were implanted with 4 bisphosphonate/hydroxyapatite implants on one side of the mandible and 4 plain hydroxyapatite implants on the opposite mandible. In a clinical study, 23 bisphosphonate/hydroxyapatite implants were placed in periodontally destroyed tooth root sockets and followed up during one year.

Results: The range for the bone mineral density (BMD) measurement errors for goat histologic sections was 0.48% to 1.03%. There were large differences in peri‐implant BMDs in the left and right mandible of the same goat, irrespective as to whether hydroxyapatite or bisphosphonate/hydroxyapatite implants were present. This was due to local anatomical differences typical of alveolar bone. These differences were not significant. Histologically, all bisphosphonate/hydroxyapatite as well as hydroxyapatite controls appeared to be fully integrated and effective as bone replacement material in goat alveolar bone. They exhibited vascularization and osteoconduction of alveolar bone growth along and inside their porous structure. In patients peri‐implant healing was clinically and radiographically comparable to plain hydroxyapatite implants. All implants were retained and no dehiscences developed. Radiographically, peri‐implant radiolucencies disappeared and alveolar bone was deposited in close proximity to the implants.

Conclusions: This study contributes to the understanding of the biological properties of hydroxyapatite implants as carriers for the bone‐modulating agent bisphosphonate. Our study suggests that normal osteoconduction and repair occurred in alveolar bone around the highly bisphosphonate‐complexed hydroxyapatite implants. J Periodontol 2000;71:279‐286.
Effects of Combined Oral Treatments With Cyclosporine A and Nifedipine or Diltiazem on Drug‐Induced Gingival Overgrowth in Rats
Authors: Morisaki Ichijiro , Fukui Natsuko , Fujimori Yasushi , Murakami Jumpei , Daikoku Hiroshi , Amano Atsuo
Published: February 2005

Background: Cyclosporine A (CsA) and calcium channel blockers induce gingival overgrowth in humans and animals. Recently, nifedipine and diltiazem have often been used to control CsA‐related hypertension in organ transplant patients. The purpose of this study was to examine the effects of a combined oral treatment of CsA and nifedipine or diltiazem on the severity of gingival overgrowth in rats.

Methods: Fifteen‐day‐old Fischer rats were treated orally with single or combined applications of CsA, nifedipine, and/or diltiazem for 40 days; and induced gingival overgrowth, rat growth, and blood drug levels were compared among the different experimental groups. The experiment consisted of 6 groups: one control group (group A) and 5 test groups treated with CsA (group B), nifedipine (group C), and diltiazem (group D), as well as those concurrently treated with CsA and nifedipine (group E), and CsA and diltiazem (group F). Gingival overgrowth was determined by measuring the depth of the gingival sulcus.

Results: The mandibular buccal gingival sulcus depth of group A was 365 ± 41.2 μm. Among the test groups, the most remarkable gingival overgrowth was seen in group E (1,020 ± 63.3 μm), followed by group F (895 ± 43.8 μm), group B (870 ± 48.3 μm), group C (525 ± 116 μm), and then group D (505 ± 83.2 μm). Rat body weight gain was reduced significantly by oral CsA treatment. Neither nifedipine nor diltiazem suppressed rat growth when used independently; however, rat growth reduced by CsA was further suppressed by a combined use of diltiazem, but not nifedipine. CsA blood levels were reduced by concurrent oral treatment with nifedipine or diltiazem along with the blood levels of those calcium channel blockers when treatment was in combination with CsA.

Conclusions: These results suggest that gingival overgrowth is induced in rats as a side effect of CsA, nifedipine, or diltiazem, and the combined use of these drugs influences rat growth, blood drug levels, and the severity of gingival overgrowth. J Periodontol 2000;71:438‐443.
Ante‐Dependence Modeling in a Longitudinal Study of Periodontal Disease: The Effect of Age, Gender, and Smoking Status
Authors: Faddy Malcolm J. , Cullinan Mary P. , Palmer Jan E. , Westerman Bill , Seymour Gregory J.
Published: February 2005

Background: It is generally accepted that periodontal disease progresses by a series of bursts that are interspersed by periods of stability or even gain of attachment. In order to analyze longitudinal data on a patient's disease experience, it is necessary to use models which accommodate serial dependence. Ante‐dependence between the results of a series of periodontal examinations over time can be modeled using a Markov chain. This model describes temporal changes in patients’ levels of disease in terms of transition probabilities, which allow for both regression and progression of the disease. The aim of the present study was to demonstrate the use of a Markov chain model to analyze data from a longitudinal study investigating the progression of periodontal disease in an adult population.

Methods: The study population consisted of 504 volunteers; however, only 456 were included in the analysis because the remaining 48 subjects did not give consecutive data. Subjects were examined at baseline, 6 months, and 1, 2, and 3 years. Probing depths (PD) were recorded using an automated probe. Disease was defined as four or more sites with PD ≥ 4 mm. Markov chain modeling was used to determine the effect of age, gender, and smoking on the natural progression and regression (healing) of periodontal disease.

Results: Smoking and increasing age had no effect on the progression of disease in this population, but did have a significant effect (P values ≤ 0.05) in reducing the regression of disease; i.e., their effect on disease appears to be inhibition of the natural healing process. Gender had no significant effects.

Conclusions: These results demonstrate how ante‐dependence modeling of longitudinal data can reveal effects that may not be immediately apparent from the data, with smoking and increasing age being seen to inhibit the healing process rather than promote disease progression. J Periodontol 2000;71:454‐459.
Expression of Estrogen Receptors in Desquamative Gingivitis
Authors: Yih Wei‐Yung , Richardson Lisa , Kratochvil F. James , Avera Sean P. , Zieper Monica B.
Published: February 2005

Background: Most cases of chronic desquamative gingivitis (CDG) are shown by direct immunofluorescence (DIF) to be immune mediated diseases. Some patients present with similar clinical and microscopic findings as CDG but DIF staining is negative. It has been suggested that those cases of CDG may be hormone (estrogen) mediated and may be treated with estrogens with favorable results.

Methods: Gingival tissue from 24 cases of CDG and one case of ordinary gingivitis were studied for estrogen receptor (ER) expression using immunohistochemical techniques. Twenty‐four of the 25 cases were female. Using standard DIF analysis, 11 of the CDG cases were diagnosed as benign mucous membrane pemphigoid, 10 as lichen planus or lichenoid mucositis (LP), and one as pemphigus. The remaining 3 cases were not diagnostic for a specific disorder (idiopathic). Five of the females had a history of estrogen substitute therapy.

Results: Twenty‐two of 23 female CDG cases were positive for ER, although the degree of staining varied. A 32‐year‐old female with ordinary gingivitis, whose gingivitis varied with her menstrual cycle, did not stain for ER. A 50‐year‐old male and a 76‐year‐old female, both with gingival LP, also had negative staining for ER.

Conclusions: There appears to be no correlation between diagnosed diseases (immunological versus idiopathic) and expression of ER in CDG gingiva. ER expression in the gingiva is probably not related to the presence or absence of estrogen supplementation. The results of this study do not support the use of estrogen in the treatment of idiopathic CDG. J Periodontol 2000;71:482‐487.
Interleukin‐1 Gene Polymorphisms and Long‐Term Stability Following Guided Tissue Regeneration Therapy
Authors: De Sanctis Massimo , Zucchelli Giovanni
Published: February 2005

Background: Specific interleukin (IL)‐1 gene polymorphisms are associated with an increased susceptibility to severe periodontitis, increased inflammation, and increased likelihood of tooth loss during the maintenance phase after conventional periodontal therapy. The aim of the present study was to evaluate the impact of genotype on the maintenance of gained clinical attachment obtained after guided tissue regeneration (GTR) surgical therapy in deep intrabony defects.

Methods: Forty deep (≥4 mm) interproximal angular bony defects with presurgical clinical attachment loss of >8 mm were treated by GTR using a non‐absorbable expanded polytetrafluoroethylene (ePTFE) membrane. Membranes were surgically removed 4 to 6 weeks after surgery. Afterwards patients were placed on monthly recall for the first year and every 3 months for the following 3 years. At the 4‐year re‐evaluation, a IL‐1 genetic susceptibility test was performed on all patients.

Results: Fourteen (35% of the 40 patients) were genotype‐positive (+). At baseline no statistically significant differences were found between patients with different genotypes in full mouth plaque score (FMPS), full mouth bleeding score (FMBS), clinical attachment level (CAL), probing depth (PD), or gingival recession. At year 1 follow up visit, no statistically significant differences were noted between genotype + and genotype ‐ patients in FMPS, FMBS, amount of CAL gain, decrease in PD, or increase in gingival recession. Sixteen patients had membrane exposure after the GTR procedures. In these patients, the amount of CAL gain (P <0.001) and PD reduction (P <0.01) 1 year after surgery was significantly lower than those observed in patients without membrane exposure. At the year 4 follow‐up visit, no significant differences were found between genotype negative and positive patients in FMPS or FMBS and both groups showed a significant loss in CAL (P <0.001) and increase in PD (P <0.001) when compared to year 1 visit. No change in gingival recession was noted. Genotype + patients showed significantly more CAL loss (P <0.002) and increase in PD (P <0.001) between the years 1 and 4 when compared to genotype ‐ patients. A significant association between genotype and stability of the regenerated attachment was also demonstrated.

Conclusions: The results of this study demonstrate that genotype expression did not effect GTR treatment response at 1 year, but had a great impact on long‐term stability (year 4). In a 3‐year period, patients with positive IL‐1 genotype lost about 50% of the first year gained CAL and were about 10 times more likely of experiencing ≥2 mm CAL loss when compared to oral hygiene matched genotype‐negative patients. J Periodontol 2000;71:606‐613.
Proximal Caries in Juvenile Periodontitis Patients
Authors: Sioson Patricia B. , Furgang David , Steinberg Louis M. , Fine Daniel H.
Published: February 2005

Background: Caries is recognized as the prevalent proximal dental disease in adolescents, while proximal bone loss is minimal to non‐existent in this population. Adolescents demonstrating an inverse disease pattern, i.e., minimal caries and active periodontitis, could provide powerful clues with regard to both diseases. However, data are inconsistent. This study was designed to clarify this relationship by comparing proximal caries prevalence in a juvenile periodontitis (JP) group to a matched non‐periodontally diseased control group.

Methods: Two groups (cases [JPs] and control patients [CPs]) were matched for age, sex, and race and evaluated for decayed, missing, filled teeth and surfaces (DMFS) by radiographic analysis. Statistical analysis was performed by ANOVA and Student t test. The study consisted of four phases. Phase I was based on data from a previous study that failed to include race in the analysis. Thus, the original 23 JP patients (mostly African‐Americans from New York City) were rematched for race as well as sex and age with CPs from Newark, NJ. The effect of water fluoridation (found in NYC) was evaluated in Phase II by matching the 23 original CPs (mostly Caucasian from NYC) with 23 CPs from NJ. Since differences were seen, we rematched our original JPs from NYC with a new set of race‐matched CPs from NYC (Phase III). Finally, 13 JP patients from the University of Medicine and Dentistry of New Jersey (UMDNJ) were matched with CPs from NJ (Phase IV).

Results: Phase I and III indicated that JP patients had significantly less proximal caries than their matched CPs (P ≤0.05). Phase II confirmed the role of fluoride in caries reduction. Phase IV (NJ sample) supported our previous data and suggested that JP patients had less proximal caries than CPs (P ≥0.05).

Conclusions: JP patients had significantly less proximal caries than their matched CPs when groups were balanced and radiographic evaluations were performed. In‐depth studies of JP patients could provide important clues about both caries and periodontal disease etiology and pathogenesis. J Periodontol 2000;71:710‐716.
Non‐Surgical Periodontal Therapy and Tooth Loss. A Cohort Study
Authors: Hujoel P.P. , Leroux B.G. , Selipsky H. , White B.A.
Published: February 2005

Background: No reliable evidence is available regarding the effect of periodontal therapy on major disease endpoints such as tooth loss, edentulism, or quality of life. The primary objective of this study was to assess the association between tooth loss and the non‐surgical periodontal treatment history of 1,021 members of the Kaiser Permanente Dental Care Program.

Methods: Tooth loss rates were estimated using Poisson regression models, adjusting for some of the potentially confounding variables such as initial disease severity and extent.

Results: Continuous non‐surgical therapy (one or more nonsurgical procedures performed during 3 successive years), as opposed to no therapy during such a 3‐year period, reduced the subsequent tooth mortality rate by 58% (relative rate, 0.42; 95% confidence interval, 0.29‐0.61). Intermittent non‐surgical therapy reduced the tooth mortality rate by 48% (RR = 0.52; 95% confidence interval, 0.34‐0.80). As the number of non‐surgical procedures increased, tooth loss rates decreased.

Conclusions: These findings suggest that non‐surgical periodontal therapy may be associated with a substantial reduction in tooth mortality. Different study designs and populations are needed to confirm these findings. J Periodontol 2000;71:736‐742.
Case Report of Regional Alveolar Bone Actinomycosis: A Juvenile Periodontitis‐Like Lesion
Authors: Nagler Rafael M. , Ben‐Arieh Yehudith , Laufer Dov
Published: February 2005

Background: Cervicofacial actinomycosis infection most often involves the mandibular bone and rarely the alveolar crest.

Methods: We describe a 14‐year‐old patient who had actinomycosis involving the alveolar bone at the left lower dental quadrant region. Resembling juvenile periodontitis, it was difficult to diagnose properly and resulted in devastating dental and periodontal consequences: loss of one tooth with most of its adjacent regional alveolar bone, severely compromising the support of two other teeth.

Results: With the diagnosis came successful treatment, including surgical removal of the soft and hard tissues with concomitant prolonged penicillin administration.

Conclusions: We feel that this case should raise the interest and concern of both the periodontist and the general practitioner so that early diagnosis can be obtained, significantly improving the clinical outcome. J Periodontol 2000;71:825‐829.
Self‐Inflicted Gingival Injury Due to Habitual Fingernail Biting
Authors: Krejci Charlene B.
Published: February 2005

Self‐inflicted gingival injuries have been known to occur in children and adolescents secondary to a number of causes, including accidental trauma; fingernail biting; digit sucking; or sucking on objects such as pens, pencils, thread, or toothpicks. Of these causes, the one documented as the most common cause is habitual fingernail biting or onychophagia. This case report describes the gingival injury caused by habitual fingernail biting and the findings noted at the time of periodontal surgery. The potential ramifications of fingernail biting are discussed, and the steps necessary to ensure and preserve the dental health of the patient are identified. J Periodontol 2000;71:1029‐1031.
Evaluation of the Regenerative Effect of a 25% Doxycycline‐Loaded Biodegradable Membrane for Guided Tissue Regeneration
Authors: Chang Chao‐Yi , Yamada Satoru
Published: February 2005

Background: Biodegradable materials have been successfully utilized for guided tissue regeneration (GTR) and local delivery systems (LDS) because they are biocompatible, less cytotoxic, and do not require removal. Several studies have demonstrated that tetracyclines (TCs), when applied topically, stimulated osteogenesis in experimental bone defects. The purpose of this study was to evaluate the regenerative effect of a 25% doxycycline‐loaded biodegradable GTR membrane (Doxy‐M) in dogs.

Methods: Doxy‐M was made by coating the inner surface of a biodegradable membrane (BD‐M) with 25% doxycycline. Five male mongrel dogs with 20 created osseous defects were enrolled. The plain BD‐M was used as the control membrane. Either Doxy‐M or BD‐M was applied in 20 randomly selected defects (10 Doxy‐M, 10 BD‐M) for 12 weeks with the GTR technique. The histometric analysis was evaluated with the following parameters: defect height (DH), apical extension of junctional epithelium (AEJP), new cementum height (NCH), new bone height (NBH), and new bone area (NBA).

Results: The Doxy‐M–treated defects showed more pronounced new bone formation and less crestal bone resorption than the BD‐M–treated defects. There were no statistically significant differences between the two groups in DH, AEJP, and NCH. Statistically significantly larger NBH (P <0.05) and NBA (P <0.005) were seen in the Doxy‐M–treated defects.

Conclusions: The results strongly suggest that Doxy‐M may have a beneficial effect on osteogenesis to favor periodontal regeneration. J Periodontol 2000;71:1086‐1093.