bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Scaling and Root Planing on Subgingival Microbial Proportions Standardized in Terms of Their Naturally Occurring Distribution
Authors: Hinrichs James E. , Wolff Larry F. , Pihlstrom Bruce L. , Schaffer Erwin M. , Liljemark William F. , Bandt Carl L.
Published: March 2012

This investigation included A cross‐sectional component (284, 20–40‐year‐old subjects/568 sites) and a longitudinal component (19 subjects with moderate to advanced periodontitis/76 sites). Subgingival plaque samples and clinical data were obtained from all upper second bicuspids and first molars in the longitudinal subjects and from both upper first molars in the cross‐sectional subjects. The purpose was to: (1) determine/confirm changes in proportions of selected subgingival microorganisms following root planing combined with conventional oral hygiene procedures in the longitudinal subjects, (2) evaluate those changes in terms of an estimate of the naturally occurring distribution of subgingival microorganisms based on data obtained from the cross‐sectional subjects and (3) relate shifts in the subgingival microorganisms to changes in clinical measurements.

Changes following treatment at sites with pre‐instrumentation probing depths ≥4.5 mm included cocci, 18.3 to 46.9%; spirochetes, 20.9 to 3.1%; total motile organisms, 28.5 to 5.9%; Fusobacterium spp., 10.2 to 2.2%; and dark‐pigmented Bacteroides spp., 14.0 to 9.7%. Translating proportions of microorganisms in samples from subjects in the longitudinal treatment study to equivalent percentile ranks within the large cross‐sectional data base demonstrated that at probing depths ≥4.5 mm cocci moved from below the 50th percentile in our estimate of the naturally occurring distribution of subgingival microorganisms to above, and spirochetes, total motile organisms and Fusobacterium spp. moved from above the 50th percentile to below. The microbiological findings were consistent with statistically significant improvements in clinical measurements. Statistically significant changes also occurred in microorganisms at sites with initial probing depths <4.5 mm.
Measuring and Interpreting Increases in Probing Depth and Attachment Loss
Authors: Aeppli Dorothee M. , Boen James R. , Bandt Carl L.
Published: March 2012

Increases in probing depth and attachment level measurements are used by clinicians and clinical scientists for assessing the periodontal status and/or change in status of patients. Interpretation of these measurements has implications with respect to our understanding of periodontal disease, treatment of patients and the implementation of clinical investigations. Measurements of probing depths and attachment loss were made on 204 teeth in 34 patients. The measurements were repeated after short periods of time by different examiners as well as the same examiners. Using these data, sensitivities and specificities of several potential diagnostic thresholds were calculated. It is concluded that observing an increase of probing depth greater than 1 mm serves as a diagnostic test with high sensitivity and specificity.
Microbial Interpretation of Plaque Relative to the Diagnosis and Treatment of Periodontal Disease
Authors: Wolff Larry F. , Bakdash M. Bashar , Bandt Carl L.
Published: March 2012

It has been suggested that monitoring microbial forms in plaque with the microscope may prove useful to the clinician in assessing periodontal status. In this regard, the microbial interpretation of plaque relative to the diagnosis and treatment of periodontal disease has recently received considerable attention. However, questions remain to be answered before the microscope is accepted for routine use in the diagnosis and treatment of periodontal disease. This report addresses a number of these questions surrounding the use of the microscope in evaluating plaque and its role in the diagnosis and treatment of periodontal disease.
The Cellular Host Response in Juvenile Periodontitis
Authors: Sandholm Leena
Published: March 2012

The current knowledge on the cellular, host‐response features in juvenile periodontitis (JP) has been reviewed. The Chemotaxis of the polymorphonuclear leukocytes (PMNs), known to be defective in JP, is modulated by serum factors and bacteria. The interactions of the putative etiologic pathogen Actinobacillus actinomycetemcomitans (A.a.) and the enzyme lysozyme with PMNs modify the host defense. Data on the phagocytic capacity of the peripheral blood and gingival crevice PMNs in JP are still controversial. The monocytes exhibit similar alterations as PMNs in interaction with A.a., but the reports on defective monocyte Chemotaxis are conflicting. Both bacterial challenge and genetic factors may regulate the lymphocyte response in JP.
The Laser Gingivectomy: The Use of the CO2 Laser for the Removal of Phenytoin Hyperplasia
Authors: Pick Robert M. , Pecaro Bernard C. , Silberman Charles J.
Published: March 2012

A new technique for the removal of phenytoin hyperplasia using the carbon dioxide (CO2) surgical laser is presented as well as a review of laser physics and the current uses of the CO2 laser in dentistry. Twelve cases of phenytoin hyperplasia removed surgically by the CO2 laser are presented; hence a laser gingivectomy. Advantages of the procedure include lack of hemorrhage yielding a dry field, noncontact surgery, sterilization of the surgical area, prompt healing, minimal post operative discomfort, and minimal time spent to perform the procedure. At the present time the use of the laser in dentistry is new and limited. In the future the laser may offer an alternative or an advancement to current procedures now used in dentistry.
Relationship of Maxillary Molar Root Angulation and Palatal Vault Height
Authors: Howell Monroe M. , Cassingham R. Jack , Yukna Raymond A.
Published: March 2012

If the vertical angulation of maxillary molar roots could be reliably predicted, this might affect the choice of root(s) to retain in root resection procedures. In an attempt to develop this prediction, angulation of palatal roots was compared to palatal vault height. Human cadaveric maxillae with molars were sectioned faciopalatally through each tooth root to the palatal midline and photographed. Root angles and palatal height were measured on the photographs in relation to a reference line connecting buccal and palatal cementoenamel junctions (CEJ). Palatal vault heights were classified as low, medium, or high according to the perpendicular distance from the midpalatal suture to the reference line. Root angles were subtended by a line following the length of pulp canals and perpendicular to the CEJ reference.

Analysis by Spearman's Rank Correlation Coefficient demonstrated a weak and nonsignificant relationship between palatal vault height and the angulation of the various maxillary molar roots. Thus, palatal vault height would not be a reliable predictor of root angulation if this were to be used as a basis for root retention.
Periodontal Destruction in Down's Syndrome and in Juvenile Periodontitis: How Close a Similarity?
Authors: Shaw Linda , Saxby M. S.
Published: March 2012

Advanced destruction of the periodontium, with similarities in alveolar distribution, age range, and diminished host responses of varying severity, may be seen in Down's syndrome and in juvenile periodontitis. This review compares and contrasts periodontal destruction and immunologic mechanisms in the two conditions. Both are characterized by raised serum Immunoglobulins, selective cell‐mediated immunodeficiencies, and defective neutrophil polymorphonuclear leukocyte Chemotaxis. There is a possibility of defective monocyte Chemotaxis in both conditions, although this is less clear in juvenile periodontitis. By contrast, antigen‐induced DNA synthesis is enhanced in Down's syndrome, but reduced in juvenile periodontitis.
Bioceramic Implants in Surgical Periodontal Defects: A Comparison Study
Authors: Barney Vermon C. , Levin Marvin P. , Adams Donald F.
Published: March 2012

The healing response of two commercially available bioceramics, beta tricalcium phosphate (TCP) and hydroxylapatite (HA), was compared after implantation in surgically created defects in dogs.

Three 18 to 24 month old female Labrador dogs were used. Under general anesthesia 3wall defects were created on the canines and premolars. The roots were planed, and reference notches were placed to identify the alveolar crest and the apical extent of the defects. TCP or HA was placed in alternating canine defects. The premolars received no implants and served as controls. Plaque management was accomplished by biweekly brushing with 0.2% Chlorhexidine. Following healing periods of 5, 12 and 16 weeks, the dogs were sacrificed and perfused with 10% formalin. Six‐μ step serial sections were evaluated by light microscopy.

Healing against the root planed surface varied from a long junctional epithelium to a connective tissue reattachment in new cementum. TCP particles were actively resorbed by giant cells and macrophages and were incorporated into new bone matrix. The HA particles were encapsulated by fibrous connective tissue and rarely seen in contact with repairing bone. Bone formation was slower around HA particles at all time periods. Some evidence of HA particle resorption was seen at each time period.
Serum and Crevicular Fluid Concentrations after a Single Oral Dose of Metronidazole
Authors: Britt Michael R. , Pohlod Donald J.
Published: March 2012

Previous studies have shown that metronidazole is an effective chemotherapeutic agent in the treatment of certain types of periodontal disease. The purpose of this study was to assess, over 18 hours, the concentration of the drug in serum and gingival crevicular fluid after a single oral dose. Six female volunteers with gingivitis created by cessation of brushing for 2 weeks, took 250 mg of metronidazole orally. Micropipettes were used to collect 20 μl of serum and 4 to 5 μl of gingival fluid hourly for 8 hours, and at the 12th and 18th hours. Samples were assayed with a high pressure liquid Chromatograph. Mean drug levels in serum closely matched those reported by Stephen et al. (Br Dent Jl: 313, 1966) with polography. Mean serum drug levels peaked at 6.09 μg/ml at the 2nd hour, and mean gingival crevicular fluid drug levels peaked at 3.62 μg/ml at the 2nd and 7th hours. The drug was detectable in both fluids for up to 18 hours. Mean serum concentrations remained greater than mean gingival fluid concentrations at all time intervals, though the differences were not significant (P < 0.05) as determined by a Hotelings' T2 test. Using reported minimal inhibitory concentration values of metronidazole for various periodontopathogens, it was concluded that a single oral dose of metronidazole will deliver potentially inhibitory levels of the drug to the periodontium in serum and in gingival crevicular fluid.
Human Allografts of Iliac Bone and Marrow in Periodontal Osseous Defects
Authors: Schrad Steven C. , Tussing Gerald J.
Published: March 2012

The purpose of this study was to statistically compare the bone regeneration and/or remodeling that occurred in human periodontal osseous defects treated with frozen allogenic, cancellous, iliac bone and marrow grafts, to defects treated by nongrafted flap curettage using a split‐mouth protocol. Six patients were selected to participate in the study. These patients exhibited bilateral intrabony periodontal defects that had been refractory to nonsurgical periodontal therapy. Twenty‐three intrabony defects were treated by osseous grafting using allogenic iliac bone and marrow and 32 intrabony defects were treated by open debridement procedures. The bony regeneration in each defect treated was evaluated by probing measurements taken from a fixed reference made at the initial surgery and at reentry 1 year after transplantation. The overall results of this study demonstrated that the percentage of osseous regeneration that occurred in intrabony defects treated by allogenic bone and marrow grafting was statistically greater than that which occurred in defects treated by nongrafted flap curettage procedures.
Effect of Metronidazole on Development of Subgingival Plaque and Experimental Periodontitis
Authors: Polson Alan M. , Zappa Urs E. , Espeland Mark A. , Eisenberg Arthur D.
Published: March 2012

Active tissue destruction in experimental periodontitis has been positively correlated with subgingival spirochetes and total number of organisms. The present study was designed to inhibit spirochete populations and evaluate the effect upon periodontal destruction. Metronidazole was administered orally to four squirrel monkeys (100 mg/kg/bwt) for 17 days, After 3 days, marginal periodontitis was induced around bicuspids and molars by tying silk ligatures at the gingival margins. Subgingival plaque samples were taken baseline and 14 days after ligature placement. Dark‐field microscopy quantitated motile forms, spirochetes, straight and curved rods, filaments, cocci and fusiforms. Periodontal destruction was evaluated at 2 weeks by histometric analysis of connective tissue attachment, crestal alveolar bone and infiltrated connective tissue. Bacterial and histometric comparisons were made with experimental periodontitis data from four animals (control) which had not received metronidazole.

Subgingival plaque prior to periodontitis induction was dominated by cocci, but fusiforms and straight rods were also present. Straight rods formed a greater proportion of the plaque which developed in metronidazole‐receiving animals. The absence of spirochetes and motile rods contrasted with the control group where spirochetes were the predominant type. The total number of bacteria was also larger in the control animals. Histometric analysis showed that areas of infiltrated supracrestal connective tissue were similar in both groups. Loss of connective tissue attachment and alveolar bone was significantly less in experimental animals, and the latter values did not differ significantly from baseline dimensions. The results indicated that the subgingival bacterial populations which developed during metronidazole administration did not result in an experimental periodontitis.
Bacterial Adherence to Gingival Epithelial Cells of Rats with Naturally Occurring Gingivitis
Authors: Isogai Emiko , Isogai Hiroshi , Sawada Hiroko , Ito Nobuyoshi
Published: March 2012

Bacterial adherence to gingival cells was compared in rats with spontaneous gingivitis (SUS rat) and in control rats (RES rat). In the SUS rat, the number of adherent bacteria in gingival cells changed according to the progression of gingival inflammation. There was a correlation between the change of the number of adherent bacteria, progress of inflammation and pH in the pocket. In the RES rat, the number of adherent bacteria was constant and very small. In the adherence assay, adherence of Bacteroides intermedius to epithelial cells was dependent on the pH. Adherence of B. intermedius was better than that of other species. B. gingivalis and B. macacae showed good adherence but B. levii showed poor adherence. Adherence to the epithelial cells of the SUS rat was always better than that of the RES rat. These results were supported by scanning electron microscopic studies.
The Prevalence of Periodontitis and Dental Caries in a Down's Syndrome Population
Authors: Barnett Michael L. , Press Kenneth P. , Friedman Deborah , Sonnenberg Edward M.
Published: March 2012

The prevalence rates of periodontitis and dental caries in 30 Down's syndrome patients and 30 matched, otherwise retarded, controls were compared. The populations were older than those usually studied, with mean (±SE) ages of 27.4 (±2.1) and 28.9 (±2.3) for the Down's syndrome and control groups, respectively. Bone loss was found in 60.0% of sites in the Down's syndrome patients, compared with 9.3% sites in controls. In Down's syndrome, bone loss was first seen at about age 16, with 92% of patients 16 or older having loss; in contrast, only 42% of control patients 16 or older had bone loss, which first appeared at about age 28. There was a considerable difference in caries prevalence in the two groups, with the Down's syndrome patients having a lower overall prevalence which was most noticeable with respect to interproximal lesions. Seven Down's syndrome patients over age 15 were caries‐free, as opposed to only one control patient.
Rapidly Progressive Periodontitis: Report of a Case
Authors: Palcanis Kent G. , Wolfe Barry , McClung James F. , Elzay Richard P.
Published: March 2012

A nineteen year old white female was referred for an evaluation of severe, rapidly progressive periodontitis. Although the patient was physically healthy and did not demonstrate any remarkable abnormalities in routine laboratory tests or upon physical examination, a detailed immune profile elucidated abnormal findings. Additionally, the patient demonstrated a poor healing response after tooth removal and a continued loss of bone following insertion of dentures.
The Effect of Root Detoxification on Human Gingival Fibroblasts
Authors: Gilman Richard S. , Maxey Brian R.
Published: March 2012

Comparative growth or inhibition of growth of human gingival fibroblasts on experimental root surfaces was used to assess the efficacy in vitro of the Cavitron and Prophy‐Jet. Six teeth with a hopeless periodontal prognosis, slated for prosthetic replacement, were extracted and sectioned into 12 specimens. Experimental specimens were instrumented with the Cavitron or Cavitron and Prophy‐Jet. Four calculus‐covered control specimens were not treated. Eight root specimens in fibroblast tissue culture were stained with 1.0% toluidine blue for determination of fibroblast viability after 48 hours. No fibroblast growth took place on calculus control specimens. Cavitron specimens showed light fibroblast growth and viability. Cavitron/Prophy‐Jet specimens showed superior growth and vitality of fibroblasts.
Biologic Preparation of Diseased Root Surfaces
Authors: Assad Daniel A. , Dunlap Robert M. , Weinberg Sheila R. , Ahl Dennis R.
Published: March 2012

This study evaluated the effect of 2% sodium desoxycholate combined with whole plasma from a single donor on gingival fibroblast attachment to diseased root surfaces. Twenty extracted periodontally involved teeth were cut into halves buccolingually and sterilized by moist heat under high pressure. The diseased root surface of each control half was rubbed with a sterile cotton pellet saturated with Dulbecco's phosphate‐buffered saline (PBS). The diseased root surface of each experimental half was rubbed with a sterile cotton pellet saturated with 2% sodium desoxycholate and then rubbed with a pellet soaked in human plasma. The control and experimental halves were placed in separate petri dishes, and a fibroblast cell suspension was added to each dish. The mean number of attached cells per half tooth was calculated for each group. Tooth surfaces treated with PBS (controls) showed a mean of 307 ±63 attached cells for 17 tooth halves; the experimental treated surfaces exhibited a mean of 650 ± 130 attached cells for 16 halves. The difference between these numbers was statistically significant (P < 0.01). These findings suggest that the desoxycholate/plasma combination enhanced in vitro fibroblast attachment to diseased root surfaces.
Microfilaments in Human Cementoblasts and Periodontal Fibroblasts
Authors: Yamasaki A. , Rose G. G. , Pinero G. J. , Mahan C. J.
Published: March 2012

An electron microscopic survey was carried out on the human periodontal ligament (PDL), including a part of the gingival connective tissue attached to extracted tooth roots (11 functioning premolars and 6 nonfunctioning third molars) in order to examine the characteristics of microfilaments (6 nm) in cementoblasts and PDL fibroblasts. Microfilaments which were grouped in bundles with semiperiodic dense nodes or in meshworks just beneath the cell membrane were seen predominantly in the cells characterized by their ultrastructurally immature appearance. These microfilaments were more commonly observed in third molar PDL than in premolar PDL and, in general, more conspicuous in cementoblasts than in fibroblasts. The significance of microfilaments in human PDL is discussed, particularly in relation to cell differentiation and morphogenesis.
A Study of the Association of Fraenal Attachment, Lip Coverage, and Vestibular Depth with Plaque and Gingivitis
Authors: Addy M. , Dummer P. M. H. , Hunter M. L. , Kingdon A. , Shaw W. C.
Published: March 2012

The effects of fraenal attachment, upper lip coverage, and mandibular vestibular depth on plaque and bleeding indices in the maxillary and mandibular anterior segments were studied in a group of 1015 school children aged 11.5 to 12.5 years. The position of the mandibular labial fraenum was relatively unimportant to plaque and mandibular gingivitis, but anterior fraenal attachment in the maxilla appeared to affect the retention of plaque and the degree of gingivitis. Maxillary and mandibular plaque and bleeding scores increased with decreasing upper lip coverage at rest. In the mandibular anterior segment, plaque and bleeding indices decreased with increasing vestibular depth. Further analysis demonstrated that fraenal attachment and vestibular depth and fraenal attachment and lip coverage were significantly associated. However, two‐way analysis of variance indicated that the influence of fraenal attachment, vestibular depth, and lip coverage on plaque and gingivitis was independent. The influences of these soft tissue variables on plaque accumulation and gingivitis were of small clinical significance and not in themselves a justification for mucogingival surgery.
Orientation of Gingival Fibroblasts in Simulated Periodontal Spaces in Vitro Containing Collagen Gels
Authors: Fernyhough W. , Aukhil I. , Link T.
Published: March 2012

The present study examined the orientation of cultured human gingival fibroblasts in simulated periodontal spaces in vitro containing three dimensional hydrated collagen gels. Extracted human teeth were root planed followed by root resection and root canal instrumentation. The middle and cervical thirds of each root were cut transversely to create 600μm thick sections. Cortical bovine bone was cut, sectioned, and contoured to create bone rings 600 μm thick with an internal diameter large enough to accommodate a root slice leaving a circumferential space varying from approximately 0.1 to 1.0 mm. Root slices and bone rings were incubated in an enzyme solution to remove all remaining soft tissues and then completely demineralized in EDTA (18%) for 72 hours. Human gingival fibroblasts (HGF) were plated to confluency in tissue culture dishes. The dentin slices were then gently placed over the HGF monolayer along with bone rings around them to create simulated periodontal spaces. Five days later, when initial cell attachment to the dentin and root slices had occurred, a collagen gel was poured in the space. The cultures were maintained for six weeks and were then processed for transmission electron microscopy.

The HGF appeared to have formed multilayered cell sheets extending from the periphery of the root slices to the inner surface of bone rings. The HGF had apparently attached to both the bone and root surfaces. There was a close interaction of cells with the matrix fibrils of the gel. The cells and matrix fibrils were oriented parallel to each other. The present findings suggest that HGF grown in simulated periodontal spaces containing a collagen gel in vitro can form oriented, multilayered cell sheets and some degree of physical rearrangement of matrix fibrils occurs during this process.
Bacterial Penetration of the Pocket Tissues in Juvenile/ Postjuvenile Periodontitis after the Presurgical Oral Hygiene Phase
Authors: Liakoni H. , Barber P. M. , Newman H. N.
Published: March 2012

Previous ultrastructural investigations of untreated sites of both adult and juvenile periodontitis have shown bacteria within the periodontal soft tissues. In the present study biopsies of the soft tissue walls of deep pockets from seven patients with juvenile (JP) or postjuvenile periodontitis (PJP) were removed at the end of the presurgical oral hygiene phase of treatment and examined in the transmission electron microscope. Bacteria were sparse, regardless of the level of tissue breakdown, both on the surface and within the superficial layers of the epithelium, deep to the basement membrane and throughout the underlying connective tissue. Of the 140 blocks from 20 biopsies, only two revealed intratissue accumulations of microorganisms. The organisms observed were gram‐positive or gram‐negative and appeared to be exclusively coccoid or rod‐shaped. It is suggested that the reduced tissue content of bacteria reflects the establishment of adequate oral hygiene. Evidently either the tissue content of bacteria is less than has been reported previously or the host response is able to cope with residual bacteria that have penetrated the soft tissue.
Rapidly Progressive Periodontitis
Authors: Murro Carlo Di , Nisini Roberto , Cattabriga Marcello , Simonetti‐D'Arca Adele , Moli Soccorsa Le , Paolantonio Michele , Sebastiani Laetitia , D'Amelio Raffaele
Published: March 2012

In the last few years several bacteriological and immunological studies have investigated the role of bacteria and immune defects in order to establish the etiopathogenesis of periodontal disease. With regard to the immune system, a defect in polymorphonuclear neutrophil (PMN) Chemotaxis has been frequently reported in patients with rapidly progressive or juvenile periodontitis.

The purpose of this study was to investigate in five patients with rapidly progressive periodontitis and normal Chemotaxis of peripheral blood PMNs the presence of Chemotaxis inhibitory activity in gingival fluid and to relate such activity to three types of bacteria, often involved in rapidly evolving periodontal lesions, that are able to inhibit in vitro PMN Chemotaxis: Bacteroides gingivalis, Capnocytophaga sp., and Actinobacillus actinomycetemcomitans. We found strong inhibitory activity in three of these patients. This activity was consistently associated with the finding of B. gingivalis in gingival pockets. We cannot rule out, however, that other substances not of bacterial origin could be responsible for such inhibitory activity. The strict association with B. gingivalis, known to secrete blocking factors, is highly suggestive, although this data must be considered preliminary.
Periodontal Wound Healing in the Absence of Periodontal Ligament Cells
Authors: Aukhil I. , Pettersson E. , Suggs C.
Published: March 2012

This experiment was designed to study the ability of mucoperiosteal flap connective tissue to form new attachment on partially demineralized roots as well as nondemineralized roots in a wound‐model where periodontal ligament (PDL) cells are absent, and ingrowth of bone granulation tissue is controlled.

After reflecting mucoperiosteal flaps, bone was removed circumferentially around the distal root of mandibular second premolars and the mesial root of mandibular third premolare in five beagle dogs. The roots were completely denuded from the cementoenamel junction to the apex and curetted to remove PDL and cementum. Following root canal filling, the denuded roots on one side were conditioned with citric acid while the contralateral roots served as controls. To prevent bone‐derived granulation tissue from contacting denuded roots, sheets of Nuclepore® membrane were placed over the exposed bone margins and secured in place with steel ligatures. The flaps were coronally positioned and sutured. Histologic examination was made after three months of healing accompanied by regular plaque control. Both the experimental (acid conditioned) and control roots showed epithelium extending into the apical third of denuded roots and root resorption confined to the root apices. Some experimental specimens showed connective tissue adhesion in the apical third of roots without any new cementum or oriented fibers. Inflammatory cell infiltrate was seen extending to the apical third of denuded roots in both groups. In this model, the flap connective tissue cells failed to form new cementum and inserting fibers. Whether this was the result of inflammation and epithelial downgrowth or the inability of flap connective tissues to form new attachment could not be concluded from the study.
Bacterial Invasion in Periodontal Disease
Authors: Nisengard Russell
Published: March 2012

A workshop sponsored by the U.S. Spain Joint Committee for Scientific and Technologic Cooperation was held from May 16 to 18, 1986 in Niagara Falls, New York, to consider bacterial invasion in periodontal disease. Participants included representatives from the State University of New York at Buffalo, University of California at Los Angeles, University of Madrid, and the National Institute of Dental Research. This limited workshop provided an opportunity for those active in this area of research to exchange current research data, pool their expertise, and plan collaborative efforts to elucidate the role of bacterial penetration in the pathogenesis of periodontal disease. Included below are abstracts of the presentations by the U.S. and Spanish scientists.
Periodontal Manifestations of the Heritable Mac‐1, LFA‐1, Deficiency Syndrome
Authors: Waldrop Thomas C. , Anderson Donald C. , Hallmon William W. , Schmalstieg Frank C. , Jacobs Robert L.
Published: March 2012

The clinical, histopathologic and functional consequences of the genetic deficiency of leukocyte Mac‐1, LFA‐1 and p150,95 were assessed among (1) three affected patients, (2) heterozygotes and (3) unaffected individuals among two generations of a single kindred. Longitudinal assessments of this family afforded the unique opportunity to characterize the natural history of severe periodontal manifestations associated with this disorder. Features uniformly observed among each patient included recurrent, necrotic soft tissue infections, impaired pus formation, delayed wound healing, constant granulocytosis, severe abnormalities of adhesion‐dependent granulocyte functions and a profound deficiency (3%–6% of normal) of Mac‐1 glycoproteins on granulocyte surfaces. Characteristic features of generalized prepubertal periodontitis including rapidly progressive alveolar bone loss affecting the primary and permanent dentitions (leading to premature tooth loss), recession, clefting and migration in association with intense gingival inflammation were uniformly observed. Biopsies of inflamed periodontal tissues in these individuals demonstrated dense infiltrates of mononuclear leukocytes but a striking absence of extravascular neutrophil granulocytes. Heterozygous family members demonstrated approximately half normal Mac‐1 protein expression but no susceptibility to systemic infections and normal, adhesion‐dependent leukocyte functions. Prepubescent heterozygotes demonstrated no periodontal manifestations but a 31‐year‐old heterozygous female exhibited clinical and radiographic features typical of postjuvenile periodontitis. The profound periodontal manifestations recognized in this clinical‐pathologic model emphasize the physiologic importance of leukocyte adhesion reactions in defense of the periodontium and further suggest a possible pathologic role for Mac‐1 proteins in other forms of early‐onset periodontitis.
The Presence of Bacteria in the Oral Epithelium in Periodontal Disease
Authors: Saglie F. R. , Pertuiset J. H. , Smith C. T. , Nestor M. G. , Carranza F. A. , Newman M. G. , Rezende M. T. , Nisengard R.
Published: March 2012

Langerhans cells (LC) are cell types found in the skin and gingiva. LC have immunological functions as phagocytic cells and as antigen‐presenting cells for T and B lymphocytes. Sections from biopsies of the gingiva in cases of periodontal disease were found to have increased numbers of LC. These biopsies also contained intragingival bacteria. Serial sections of frozen specimens of human gingiva were prepared for staining. Hematoxylin and eosin were used for tissue survey, the Gram stain for assessment of bacterial invasion, anti‐Leu‐6 monoclonal antibody associated with peroxidase technique (PAP) to identify LC, antibacterial sera to Bacteroides gingivalis and ActinobacUlus actinomycetemcomitans associated with peroxidase to specifically identify these two common periodontopathogenic bacteria. Additional positive identification of bacteria was performed by preparing the same histological section containing gram‐stained particles for scanning electron microscope and transmission electron microscope LC confirmation. The results suggest that the increased number of LC seen in diseased sites of oral epithelium containing intragingival microorganisms may be one of the host immune mechanisms to penetration by bacteria.
Cyclosporin‐A‐Induced Gingival Enlargement
Authors: Savage N. W. , Seymour G. J. , Robinson M. F.
Published: March 2012

Cyclosporin‐A (CsA)‐induced gingival enlargement has been reported in a small number of cases but may involve up to one third of all patients taking CsA. The present study reports a case of CsA‐induced gingival enlargement during suppressive therapy for myasthenia gravis. Gingival tissues were examined histologically, histochemically, and immunohistologically. The basic tissue response seemed to be a dental plaque‐ and traumainduced fibroblastic response characterized by large aggregations of plasma cells, macrophages and helper T lymphocytes. The reactive areas rapidly matured into noninflamed fibrocytic tissue. The suppressive effect of CsA appears responsible for removal of sectors of the normal immune response and, in combination with an elevated number of macrophages, may be instrumental in initiating a fibrous hyperplastic response.
Ultrastructural and Immunocytochemical Characterization of Polymorphonuclear Leukocytes from Gingival Crevice in Man
Authors: Saito Ichiro , Komiyama Kazuo , Moro Itaru , Akachi Kazufumi , Shiomi Noboru , Lto Koichi , Murai Seidai , Umemura Shinichiro
Published: March 2012

Polymorphonuclear leukocytes from the gingival crevicular fluid (CF‐PMNs) of patients with generalized severe periodontitis were examined using electron microscopy and immunocytochemical techniques. CF‐PMNs were found to contain numerous phagocytic vacuoles. This suggests that CF‐PMNs actively phagocytized various substances from the environment. Immunocytochemical staining with FITC‐conjugated IgG, IgM, and IgA reagents and TRITC‐conjugated C3 reagent was applied to CF‐PMNs as well as peripheral blood PMNs incubated with cell‐free crevicular fluid. The cytoplasm of PMNs exhibited numerous granular foci of immunofluorescence. This finding suggests that these proteins were acquired from the environment by PMNs. The coincidental appearances of Immunoglobulins and C3 in a single cell were considered to be immune complexes phagocytized by CF‐PMNs in generalized severe periodontitis.
Recurrent Periodontal Disease and Bacterial Presence in the Gingiva
Authors: Pertuiset J. H. , Saglie F. R. , Lofthus J. , Rezende M. , Sanz M.
Published: March 2012

Previous investigations have shown that, in biopsies taken from untreated sites of periodontitis, bacteria were present between the epithelial cells and within the connective tissue. In the present study we have examined Gram‐stained sections of diseased gingival sites where the disease had recurred after surgical periodontal treatment. The six subjects chosen for the study were patients who had undergone surgical therapy for the treatment of periodontitis and who, upon subsequent recall visits, showed evidence of at least one site recurrent after treatment as detected by bleeding on probing and increased pocket depth of 5 mm or more. A normal control site from the same patient was chosen, preferably contralaterally, showing positive response to treatment with no signs of disease. Sections were stained with either hematoxylin and eosin for tissue survey or Gram for assessment of bacteria and examined by light microscopy. In many specimens, the bacterial nature of Gram‐stained material was substantiated. Preliminary results showed a significantly increased number of bacteria in the refractory sites when compared with control sites which responded positively to treatment.

The results of this investigation provided further evidence that bacterial presence inside the periodontal tissue may be an important pathogenic factor in periodontal disease.
The Use of Blade Implants in a Selected Population of Partially Edentulous Adults
Authors: Smithloff Milton , Fritz Michael E.
Published: March 2012

In order to provide longitudinal data for endosteal bladevent implants, a continuing study is being conducted from an original group of 49 implants in 32 patients placed 15 years ago. The present work evaluated 26 of these bladevent implants in 18 patients. Three basic patterns were observed 15 years postoperatively: (1) In 13 of 26 implants, there was clinical and radiographic evidence of health; (2) in 13 of 26 implants, there was a radiolucency 2‐ to 3‐mm square around the neck and shoulder of the implants, along with sulcular depths capable of being probed and evidence of bleeding on probing; and (3) two implants showed evidence of settling deeper into the bone. These results indicate that bladevent endosteal implants can be maintained in the mouth for up to 15 years, and 50% can be free from periodontal disease.
Depressed Leukotriene B4 Chemotactic Response of Neutrophils from Localized Juvenile Periodontitis Patients
Authors: Offenbacher Steven , Scott Steven S. , Odle Bonnie M. , Wilson‐Burrows Carolyn , Van Dyke Thomas E.
Published: March 2012

Previous studies have demonstrated that certain local juvenile periodontitis (LJP) patients possess neutrophils with an intrinsic chemotactic defect to the peptide chemoattractants f‐met‐leu‐phe (FMLP) and C5a. In this investigation, the in vitro response of neutrophils to the chemotactic agent leukotriene B4 (LTB4) was examined. Those LJP patients who possessed defective chemotactic responses to FMLP and endotoxin activated serum (EAS) also had impaired Chemotaxis to LTB4. Exogenous LTB4 failed to augment the impaired response to FMLP. Evidence for a global membrane defect in LJP neutrophils resulting in hyporesponsiveness to chemically diverse chemotactic agents is presented.
A Comparison of the Reactivity of Eubacterium Species with Localized and Serum Immunoglobulins from Rapidly Progressive and Adult Periodontitis Patients
Authors: Martin Stephen A. , Falkler William A. , Vincent Jack W. , Mackler Bruce F. , Suzuki Jon B.
Published: March 2012

Immunoglobulins in sera and in supernatant fluids of explant cultures of diseased gingival tissues from 20 rapidly progressive and 20 adult Periodontitis sites were tested by an ELISA assay for reactivity with typed strains of Eubacterium alactolyticum, E. brachy, E. limosum and E. nodatum. Immunoglobulins present in tissue culture fluids from both rapidly progressive and adult Periodontitis samples reactive with E. brachy and E. nodatum were significantly greater (P < 0.05) than those reactive with E. alactolyticum or E. limosum. The titers to E. brachy in tissue culture fluids from adult Periodontitis were significantly greater (P < 0.05) than those from rapidly progressive Periodontitis; there was no difference in titers to the other three species. The only significant difference in serum titers was that sera from patients with rapidly progressive Periodontitis had significantly greater reactivity to E. alactolyticum than did sera from adult Periodontitis patients. These data indicate that Immunoglobulins in the sera of rapidly progressive and adult Periodontitis patients do not necessarily reflect the reactivity of localized immunoglobulins present in the diseased gingival tissue expiant culture fluids from these patients.
Clinical Effects of Electromagnetic Stimulation as an Adjunct to Periodontal Therapy
Authors: Steffensen B. , Caffesse R. G. , Hanks C. T. , Avery J. K. , Wright N.
Published: March 2012

The clinical effects of electromagnetic stimulation (EMS) on periodontal soft tissues and alveolar bone level were studied among 23 patients. The sides of the arch to receive EMS were randomly selected and exposed for a period of eight weeks following periodontal surgery. The contralateral control sides received surgery only. The electromagnetic signal was a multiple pulse signal with 21 asymmetrical quasirectangular pulses per burst and a burst frequency of 16.9 Hz. The peak magnetic field strength reached 0.46 Gauss. Changes from baseline in clinical attachment level, probing depth, and radiographic alveolar bone level were assessed at six, 12, and 18 months postsurgically.

A greater gain of clinical attachment level following EMS was observed only for pockets with initial depth of 1 to 3 mm. There were no consistent differences between test (EMS) and control sides in the change of clinical attachment level or probing depth for pockets deeper than 4 mm. Radiographically, the test sides demonstrated statistically significant gain of alveolar bone level compared with the control sides at six months following surgery. Hereafter, the rates of change were similar in the stimulated and unstimulated sides, and the total gain of alveolar bone level remained greater in the test side throughout the observation period.

Within the limitations of this study, it was concluded that electromagnetic stimulation does not promote gains in clinical attachment or alveolar bone level to the extent that it can be recommended as an adjunct to conventional periodontal therapy.
Lipopolysaccharide‐Stimulated PGE2 Release from Human Monocytes
Authors: Garrison Scott W. , Holt S. C. , Nichols Frank C.
Published: March 2012

Lipopolysaccharides (LPS) prepared from the suspected periodontal pathogens Actinobacillus actinomycetemcomitans(A. a.), Bacteroides gingivalis, B. intermedius and Wolinella recta were compared to Salmonella typhimurium LPS for their capacity to stimulate prostaglandin E2 (PGE2) release from human monocytes. Counterflow isolated monocytes were cultured with control medium or media containing 10 μg/ml LPS. Media were then exchanged every 24 hours for a total of 72 hours. Salmonella and Wolinella LPS preparations demonstrated seven‐fold greater PGE2 release than B. gingivalis and two‐fold greater than A. a. and B. intermedius. PGE2 release was found to decrease over time with all LPS preparations except Wolinella. The potency of the LPS preparations is tentatively ranked as follows: Wolinella ≥ Salmonella > A. a. > B. intermedius ≥ B. gingivalis. These findings demonstrate that LPS preparations from suspected periodontal pathogens are capable of stimulating PGE2 release from human monocytes. The high potency and prolonged stimulation of PGE2 release with Wolinella LPS suggests unusual toxic properties that may exert a greater influence in the pathogenesis of destructive periodontal diseases.
Associations between Bleeding and Visual Signs of Interdental Gingival Inflammation
Authors: Caton Jack , Poison Alan , Bouwsma Otis , Blieden Timothy , Frantz Bryan , Espeland Mark
Published: March 2012

Interdental gingival tissues are designated inflamed on the basis of their color and bleeding after stimulation. Gingival bleeding was previously shown in histological studies to indicate the presence of inflammatory lesions. The present study was undertaken to determine associations between bleeding and visual signs of interdental gingival inflammation. Each interdental site in 82 males, aged 18 to 30, was evaluated for the presence or absence of visual signs of inflammation. The interdental sites on one side of the mouth were evaluated for bleeding tendency using the Papilla Bleeding Index (PBI), while the other half was evaluated using the Eastman Interdental Bleeding Index (EIBI). The percentage of inflamed areas detected with the EIBI and visual method was similar and significantly higher than with the PBI. When the visually noninflamed sites were examined, 38.5% of these areas bled, indicating that interdental inflammatory lesions existed in the absence of visual signs of inflammation. Of the sites that bled but were visually noninflamed, 33.1% were detected using the PBI, while 66.9% were detected using the EIBI. The Eastman Interdental Bleeding Index was a more reliable clinical indicator for detecting interdental inflammatory lesions than the Papilla Bleeding Index.
Actinobacillus actinomycetemcomitans and Bacteroides gingivalis Activate Human Peripheral Monocytes to Produce lnterleukin‐1 and Tumor Necrosis Factor
Authors: Lindemann R. A. , Economou J. S.
Published: March 2012

The effects of gram‐negative bacteria clearly associated with juvenile and adult Periodontitis on monokine production were assessed using standard in vitro assay techniques. Actinobacillus actinomycetemcomitans and Bacteroides gingivalis were able to activate human peripheral blood monocytes to produce significant amounts of interleukin‐1 (IL‐1) and tumor necrosis factor (TNF). These monokines are known to induce osteoclastic bone resorption. An oral gram‐positive organism, Staphylococcus epidermidis, was able to induce only modest amounts of IL‐1 and TNF, slightly above unstimulated monocyte levels.
Histological Characteristics Associated with Suppurating Periodontal Pockets
Authors: Passo Samuel A. , Reinhardt Richard A. , DuBois Linda M. , Cohen Donald M.
Published: March 2012

The purpose of this study was to characterize histologically the gingival lesion associated with suppuration in advanced Periodontitis. Thirty‐three bleeding, suppurating (S) and 23 bleeding, nonsuppurating (NS) interproximal biopsies were obtained from nine patients and processed for light microscopy. Pocket depths (mean ± SD) were 6.7 ± 1.6 mm (S) and 5.4 ± 2.2 mm (NS). Six‐micron serial sections were stained with (1) hematoxylin/eosin and (2) van Gieson. Quantitative cell types were determined by a grid intersection counting technique at × 1000. Volumetric analysis of collagen‐poor (inflammation) areas was conducted using a computer biometrie system that revealed three histologie patterns: Type I sites showed mild to moderate inflammation (<50% infiltrate, S = 15, NS = 20); Type II sites showed intense inflammation (>50% infiltrate, S = 17, NS = 3); and only one (S) site had a large connective tissue abscess (Type III). The mean percentage of collagen‐poor area was significantly larger in suppurating (42.1 ± 25.5%) versus nonsuppurating (27.7 ± 20.4%) sites (P = 0.02). In both S and NS sites, plasma cells (x = 66%) and lymphocytes (x = 27%) predominated in the inflammatory infiltrates. Histologically, suppuration appeared to be associated with increased gingival inflammation and a slight increase in connective tissue neutrophils.
Effect of Citric Acid Treatment on the Migration of Epithelium on Root Surfaces in Vitro
Authors: Larjava Hannu , Salonen Jukka , Häkkinen Lari , Närhi Timo
Published: March 2012

Explants of bovine gingival mucosa were cultured for four days on scaled and citric acid‐conditioned root surfaces. Demineralization of the hard tissue with citric acid exposed the collagenous matrix of the root. Undemineralized islands were frequently seen among the collagen fibers of the treated roots. When cultured on scaled, control root surfaces, the epithelium migrated inwards between the connective tissue of the expiant and the root surface. On citric acid‐treated roots, epithelial migration in this direction was rare although it was possible. Citric acid treatment of the substratum directed the epithelium to migrate outwards from the expiant. Only a few of the controls showed epithelial migration to the outward direction. The findings indicate that demineralization of the root surface has an influence on the direction in which the epithelium initially starts to migrate. An induced delay of epithelial migration between the gingival connective tissue and the hard tissue may be favorable for connective tissue attachment to the root surface.