bluuebunny/crossref_metadata_2025 huggingface dataset:
Position Paper: Diagnosis of Periodontal Diseases
Authors:   Research, Science and Therapy Committee
Published: February 2005

This position paper on the diagnosis of periodontal diseases was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology. It is intended for the information of the dental profession and other interested parties. The purpose of the paper is to provide the reader with a general overview of the important issues related to the diagnosis of periodontal diseases. It is not intended as a comprehensive review of the subject. J Periodontol 2003;74:1237‐1247.
Impact of Increased Occlusal Contact, Interleukin‐1 Genotype, and Periodontitis Severity on Gingival Crevicular Fluid IL‐1β Levels
Authors: McDevitt Michael J. , Russell Carl M. , Schmid Marian J. , Reinhardt Richard A.
Published: February 2005

Background: The study of occlusal therapy in humans with periodontitis is problematic due to potential irreversible bone loss in control subjects. The hypothesis of this pilot investigation was that increased interocclusal contact initiated by shortterm occlusal splint disuse would increase tooth mobility and the bone‐resorptive cytokine interleukin (IL)‐1β in gingival crevicular fluid (GCF), comparable to IL‐1–positive genotype and increased periodontitis severity.

Methods: Nineteen non‐smoking chronic periodontitis patients using nocturnal occlusal splints and undergoing periodontal maintenance in a private practice were evaluated at five time points: 24 hours after continuous splint use; 1, 2, and 3 days after no occlusal splint use; and 14 days after resumption of customary nighttime splint use. Subjects were evaluated to confirm that the plaque index and gingival index were ≤1.0, and to categorize past periodontitis (moderate or severe) and IL‐1 genotype (1A +4845 plus IL‐1B +3954). Test sites on two anterior teeth vulnerable to occlusal trauma were sampled for mobility, GCF IL‐1β, and IL‐1 receptor antagonist (ra).

Results: Tooth mobility remained low during the 3‐day period when patients were not wearing their occlusal appliance. GCF IL‐ 1β decreased after not wearing the appliances (P = 0.016), especially at 48 hours. At this time, genotype‐positive subjects had higher levels of GCF IL‐1β/IL‐1ra than genotype‐negative subjects (P = 0.045), and patients who had experienced severe periodontitis had higher IL‐1β levels than moderate periodontitis subjects (P = 0.004).

Conclusions: These findings suggest that short‐term discontinuation of occlusal splint therapy in non‐smoking periodontitis patients undergoing periodontal maintenance does not result in potential signs of early occlusal trauma (increasing mobility or GCF IL‐1β). Longer‐term studies may be needed to determine appropriate therapy applications for periodontitis‐susceptible patients with definable occlusal discrepancies and/or parafunction. J Periodontol 2003;74:1302‐1307.
Effect of Loading on the Vibration Characteristics of Thin Magnetostrictive Ultrasonic Scaler Inserts
Authors: Trenter Suzanne C. , Landini Gabriel , Walmsley A. Damien
Published: February 2005

Background: The ultrasonic scaler market has seen an increase in availability of thin inserts for periodontal pocket access. While such thin inserts may have advantages in negotiating the periodontal pocket, the relatively narrow structure may be prone to damping under load. The purpose of this study was to assess the vibration characteristics under load of thin, straight, ultrasonic scaler inserts.

Methods: Five types of thin inserts were each obtained from three manufacturers and were operated using an ultrasonic generator at medium power and low water. The displacement amplitude of the scaling tip was measured via a scanning laser vibrometer (SLV). Increasing forces up to 1.0 N were applied either to the base of the tip (up through its center) or while it was loaded from the side. Displacement measurements were obtained using the SLV under these loading conditions.

Results: Under loading, there was a drop in displacement amplitude of all tips. Furthermore, loading of the tips resulted in large variations of displacement amplitudes recorded. The mean tip displacements recorded ranged from 10 to 30 μm when unloaded and 7 to 25 μm when loaded. The fundamental frequency of the ultrasonic tips' oscillation was at 30 kHz. However, loading resulted in the production of additional subharmonic frequencies in the region of 6 to 10 kHz.

Conclusions: Thin ultrasonic scaler tips are susceptible to loading. This results in a reduction in the displacement amplitude that shows variation not only between tips of different design but also between those of the same design made by the same manufacturer. Clinicians and researchers should be aware of this variability, which may influence both clinical procedures and future research with thin ultrasonic scaling tips. J Periodontol 2003;74:1308‐1315.
Distribution of Periodontal Pathogens in Korean Aggressive Periodontitis
Authors: Lee Jung‐Wook , Choi Bong‐Kyu , Yoo Yun‐Jung , Choi Seong‐Ho , Cho Kyoo‐Sung , Chai Jung‐Kiu , Kim Chong‐Kwan
Published: February 2005

Background: Microbial associations in aggressive periodontitis versus different ethnic origins are substantially unknown. We undertook this study to determine the prevalence of seven putative periodontopathogens in Korean patients and to evaluate microbial differences in localized and generalized aggressive periodontitis patients.

Methods: Thirty‐nine aggressive periodontitis patients between 20 and 35 years old (24 males and 15 females; mean age 29.6 years) were selected according to clinical criteria. The patients were subclassified into 17 localized and 22 generalized aggressive periodontitis patients. In each of the 39 individuals, subgingival plaque samples were collected from four diseased teeth (≥6 mm probing depth, 156 sites) and one healthy site (≤3 mm probing depth, 39 sites). Polymerase chain reaction (PCR) of the 16S ribosomal RNA gene fragments (about 530 bp) of plaque bacteria and their subsequent detection by dot‐blot hybridization using specific oligonucleotide probes were performed to determine the presence of seven periodontopathogens.

Results: The prevalences were 75% for Actinobacillus actinomycetemcomitans, 94.2% for Tannerella forsythensis (formerly Bacteroides forsythus), 99.4% for Fusobacterium sp., 85.9% for Micromonas micros (formerly Peptostreptococcus micros), 96.8% for Porphyromonas gingivalis, 78.8% for Prevotella intermedia, and 96.8% for Treponema sp. The prevalences of these bacteria were significantly higher in diseased sites than in healthy sites. Logistic regression analysis showed that P. intermedia was more significantly associated with generalized aggressive periodontitis than the localized form, with an odds ratio of 3.28 (95% con‐ fidence interval 1.26‐8.56, P = 0.015).

Conclusions: Our results demonstrate that the seven periodontal pathogens analyzed are strongly associated with Korean aggressive periodontitis. In particular, P. intermedia are more significantly associated with generalized aggressive periodontitis, a more severe and progressive form, than with localized aggressive periodontitis. J Periodontol 2003;74:1329‐1335.
Periodontal Disease in HIV‐Positive Individuals: Association of Periodontal Indices with Stages of HIV Disease
Authors: Vastardis Sotirios A. , Yukna Raymond A. , Fidel Paul L. , Leigh Janet E. , Mercante Donald E.
Published: February 2005

Background: Periodontal disease has been previously associated with human immunodeficiency virus (HIV) infection, and HIV infection has been considered a modifier of periodontal disease. The aim of this study was to report the prevalence and severity of periodontal disease in a population of HIV‐positive individuals and to investigate the association between clinical periodontal indices and the stage of HIV disease, as expressed by CD4 cell counts.

Methods: Thirty‐nine male HIV‐positive patients were recruited and a medical history was taken. To evaluate periodontal disease, probing depth (PD), attachment level loss (AL), bleeding index (BI), and modified gingival index (MGI) were recorded. Associations between the above indices and CD4 counts were examined.

Results: Immunocompromised patients (with CD4 cell counts <200 cells/μl) showed significantly lower BI and fewer sites with PD and AL >4 mm compared to patients with CD4 cell counts >200 cells/μl. When patients with CD4 counts <500 cells/μl were considered alone, a correlation was observed between CD4 cell counts and BI (r2 = 0.1617, P = 0.0463), MGI (r2 = 0.2123, P = 0.0204), and number of sites with AL >4 mm (r2 = 0.1469, P = 0.056).

Conclusions: Severely immunocompromised HIV‐positive patients showed less severe gingival inflammation than expected. Patients with CD4 cell counts >500 cells/μl showed no association between CD4 cell count and periodontal indices. J Periodontol 2003;74:1336‐1341.
Digital Image Analysis of Cadaver Mandibular Trabecular Bone Patterns
Authors: Shrout Michael K. , Jett Scott , Mailhot Jason M. , Potter Brad J. , Borke James L. , Hildebolt Charles F.
Published: February 2005

Background: The purpose of this study was to investigate the source of radiographic trabecular patterns by removing trabecular bone in four sequential steps from six cadaver mandible sections, radiographing the sections after each removal, and using four digital‐image analysis methods to quantify any resulting changes to the radiographs.

Methods: Mandible sections were cut sagittally into halves. Trabecular bone was removed from each section in four stages. Following each stage, standardized radiographs were taken, using direct digital equipment. Trabecular bone in the resulting digital images was measured with four methods. Mean gray level values (method 1) and cumulative percent histograms (method 2) were calculated from the raw data. Morphological image processing was used to skeletonize the trabecular structure, which was quantified by counting the number of trabecular ends and segments in the skeletonized images (method 3) and performing fractal analyses of the skeletonized images (method 4). Repeated measures analysis of variance (ANOVA) was used to test for changes in measurements attributable to bone removal.

Results: Repeated measures ANOVA indicated that the use of gray levels, cumulative percent histograms, and morphologic operators resulted in highly significant changes in measurements following bone removal (P <0.01). Ends and segments demonstrated similar performance, with changes highly significant over time (P <0.01). Fractal analysis also resulted in highly signifi‐ cant changes over time (P <0.01).

Conclusions: The analyses performed in this study demonstrated consistent image differences following the four steps of bone removal. These differences appeared whether light, cancellous bone or heavier endosteal bone was removed. These findings indicate that trabecular and endosteal bone combine to form the structure that most dentists identify as trabeculae on intraoral radiographs. J Periodontol 2003;74:1342‐1347.
A Histopathological Investigation on the Effect of Systemic Administration of the Bisphosphonate Alendronate on Resorptive Phase Following Mucoperiosteal Flap Surgery in the Rat Mandible
Authors: Kaynak Deniz , Meffert Roland , Bostancı Hamit , Günhan Ömer , Özkaya Özay Gököz
Published: February 2005

Background: The present study was designed to assess histopathologically whether the systemic administration of aminobisphosphonate (alendronate), 0.5 mg/kg body weight, is effective in preventing alveolar bone resorption following mucoperiosteal flap surgery, and whether alendronate modulates tissue factors.

Methods: The effect of alendronate on bone resorption was evaluated in mucoperiosteal flaps used as a resorptive model. The animals were given subcutaneous injections of either saline (control group) or 0.5 mg/kg of alendronate (experimental group). The alendronate or saline was administered subcutaneously 1 week prior to surgery, immediately prior to surgery, and 1 week after surgery. The parameters determined with a semiquantitative subjective method for histopathological evaluation were as follows: inflammatory cell infiltration (ICI) of adjacent periodontal tissue, degree of fibrosis and collagen bundle formation, number and morphology of osteoclasts of the alveolar bone and interdental septum, resorption lacunae (osteoclast surfaces), and osteoblastic activity (forming surfaces).

Results: There were no statistically significant differences between the saline and alendronate groups with regard to inflammatory cell infiltration, number of osteoclasts, and osteoblastic activity. Fibrosis and collagen bundle formation, osteoclast morphologies, and resorption lacunae formation were significantly different between the two groups, in favor of the alendronate group.

Conclusions: The systemic administration of 0.5 mg/kg alendronate was effective in preventing alveolar bone loss and in modulating tissue factors. These findings indicate that alendronate would be a valuable addition to the therapeutic armamentarium available for the treatment of periodontal diseases, either alone or in combination with regenerative components such as anti‐inflammatory drugs, bone graft materials, and guided tissue regeneration techniques, and even with dental implants. J Periodontol 2003;74:1348‐1354.
Effect of Non‐Surgical Periodontal Therapy on Glycemic Control in Patients with Type 2 Diabetes Mellitus
Authors: Rodrigues Débora C. , Taba Mário , Novaes Arthur B. , Souza Sérgio L.S. , Grisi Márcio F.M.
Published: February 2005

Background: The literature suggests that an alteration in glucose metabolism occurs as a result of antibacterial periodontal therapy. The objective of this study was to monitor the effect of non‐surgical periodontal therapy on glycemic control in patients with type 2 diabetes mellitus (DM).

Methods: Thirty type 2 DM subjects with periodontitis were randomly divided into two groups. Group 1 (G1), 15 subjects, received one‐stage full‐mouth scaling and root planing (FMSRP) plus amoxicillin/clavulanic acid 875 mg; group 2 (G2), 15 patients, received only FMSRP. At baseline and after 3 months, the glycated hemoglobin (HbA1c) values, fasting glucose, and clinical parameters (with computerized probing and individualized acrylic stents) were recorded. Following therapy, the subjects were enrolled in a 2‐week interval maintenance program for 3 months.

Results: After treatment, both groups showed clinical improvements. A probing depth (PD) reduction of 0.8 ± 0.6 mm (P <0.05) occurred in G1 and 0.9 ± 0.4 mm in G2 (P <0.05), but there were no significant changes in attachment level. Treatment reduced the HbA1c values after the 3‐month observation period in both groups; however, the reduction in HbA1c values for the G2 group was statistically significant, but not for the G1 group. The changes in fasting glucose levels were not significant for either group.

Conclusions: Periodontal therapy improved glycemic control in patients with type 2 DM in both groups; however, the reduction in HbA1c values reached statistical significance only in the group receiving scaling and root planing alone. J Periodontol 2003;74:1361‐1367.
Peripheral Giant Cell Granuloma Associated with Dental Implants
Authors: Hirshberg Abraham , Kozlovsky Avital , Schwartz‐Arad Devorah , Mardinger Ofer , Kaplan Ilana
Published: February 2005

Background: Peripheral giant cell granuloma (PGCG) is a well‐circumscribed lesion confined to the alveolar and gingival mucosa. PGCG is considered a reactive lesion caused by local irritation or trauma. The objectives of the present study were to evaluate the incidence of PGCG in peri‐implant lesions submitted for histologic examination, to establish its correlation with implant failure, and to discuss its pathogenesis.

Methods: The study was conducted on 25 periimplant biopsy specimens submitted for histological examination between 1999 and 2001. Sections (5 μm) of paraffin embedded tissues were cut and stained with hematoxylin and eosin.

Results: From the 25 specimens, three (two males and one female, ranging in age from 31 to 69 years) were identified as peripheral giant cell granuloma. The posterior mandible was affected in two cases and the anterior maxilla in one. The clinical appearance was an exophytic mass with a bleeding surface. The time interval between implantation and lesion development was from several months to 6 years. Recurrence following curettage was found in all cases. The implants were stable; however, two were removed either because of bone loss around the implant or because of several recurrences. In all cases healing was uneventful.

Conclusions: Peripheral giant cell granuloma can develop in association with dental implants. Clinically, the lesions are similar to the classical PGCG. In the present study, the precise incidence could not be concluded because of the small number of selected cases. Due to the aggressive nature of the lesion and the high recurrence rate, implants can fail unless the lesion is detected early and proper surgical removal is performed. Tissue removed from the peri‐implant area should always be submitted for histologic examination for accurate diagnosis. J Periodontol 2003;74:1381‐1384.
Lichen Planus and the Vulvovaginal‐Gingival Syndrome
Authors: Ramer M.A. , Altchek A. , Deligdisch L. , Phelps R. , Montazem A. , Buonocore P.M.
Published: February 2005

Lichen planus is a dermatologic disease that affects both skin and mucosa. Here we report five cases of lichen planus that presented as the oral component of the vulvovaginal‐gingival syndrome. Four of the cases were associated with biopsy‐proven oral lichen planus, and all five patients had oral lesions that clinically resembled lichen planus. Three patients were taking medications that are associated with lichenoid drug reactions; four patients were postmenopausal; and all five patients had desquamative vulvovaginitis. Clinicians may see these patients when they show persistent signs and symptoms of oral lichen planus. We report five case histories and review the 127 cases found in the literature to make the practicing clinician aware of this unusual clinical entity. The hepatitis C virus association and drug‐induced lichenoid mucositis are topics that are addressed. In addition, clarification of the issues surrounding the premalignant potential of oral lichen planus is provided with evidence, rationale, and data from the literature to support the position that true oral lichen planus has no inherent predisposition to become malignant. J Periodontol 2003;74:1385‐1393.
The Application of Multilevel Modeling in the Analysis of Longitudinal Periodontal Data –Part II: Changes in Disease Levels over Time
Authors: Tu Yu‐Kang , Gilthorpe Mark S. , Griffiths Gareth S. , Maddick Ian H. , Eaton Kenneth A. , Johnson Newell W.
Published: February 2005

Background: The aim of this study was to investigate the longitudinal relationships between the outcome measurements of changes in lifetime cumulative attachment loss (cLCAL) and changes in probing depth (cPD) in relation to potential risk factors or other risk markers for periodontal disease progression from a cohort of 100 young males. In order to account for the hierarchical data structure, and to explore explicitly the site, tooth, and subject levels simultaneously, multilevel modeling was undertaken.

Methods: The analyses were undertaken in two parts. Within a previous article, the absolute levels of disease were analyzed in relation to potential risk factors; within this article, changes in disease are analyzed in relation to these factors. Each analytical approach yielded substantively different insights.

Results: Subject‐level risk factors had limited predictive value for cLCAL/cPD throughout the 30‐month observation period. Tooth position demonstrated a near linear relationship for both outcomes, with disease increasing from anterior to posterior teeth. Supragingival plaque had no significant effect on cLCAL/ cPD, while subgingival calculus and bleeding on probing were negatively associated with cLCAL/cPD. In contrast to the outcomes LCAL/PD, supragingival calculus had no significant protective effect on cLCAL/cPD. There was no significant influence of smoking in this cohort.

Conclusions: This study provides, for a relatively young cohort, considerable insights into the factors associated with longitudinal patterns of early‐life periodontal disease at all levels of the natural hierarchy of sites within teeth within subjects. Furthermore, it is demonstrated how multilevel modeling can provide considerable insight into some of the inconsistencies and controversies found in the previous periodontal literature. J Periodontol 2004;75:137‐145.
The Effect of Cigareté Smoking on Gingival Bleeding
Authors: Dietrich Thomas , Bernimoulin Jean‐Pierre , Glynn Robert J.
Published: February 2005

Background: The purpose of this study was to investigate the dose‐dependent effect of cigarette smoking upon gingival bleeding on probing (BOP) in a large representative sample of the United States population (National Health and Nutrition Examination Survey III).

Methods: Weighted multiple logistic regression was used to model bleeding on probing of 141,967 mesio‐buccal sites in 12,385 individuals with complete case records on all covariates. Adjustments were made for age, gender, race/ethnicity, number of missing teeth, tooth type/jaw, root caries, full crown coverage, socioeconomic status (poverty/income ratio), and survey characteristics. The model stratified by presence of calculus (CALC) and increased probing depth (PD≥4 mm). Generalized estimating equations were used to account for dependence of sites within subjects.

Results: Smoking had a strong suppressive effect on gingival bleeding. The effect was strongest in heavier smokers (>10 cigarettes/day) and smallest in former smokers. In healthy sites (no CALC, PD ≤3 mm), the odds ratio (OR) of bleeding for sites in heavier smokers compared to never‐smokers was 0.56 (95% CI: 0.45‐0.70). Sites with CALC and/or PD≥4 mm were more likely to bleed in never‐smokers (OR: 5.7; 95% CI: 4.3‐7.6). This relationship was less evident among heavier smokers (OR: 1.3; 95% CI: 0.8‐1.9). The effect of smoking did not differ between maxillary and mandibular molars, premolars, or incisors.

Conclusion: Smoking exerts a strong, chronic, and dosedependent suppressive effect on gingival bleeding on probing. J Periodontol 2004;75:16‐22.
Effects of Tumor Necrosis Factor‐α Inhibitors Pentoxifylline and Thalidomide on Alveolar Bone Loss in Short‐Term Experimental Periodontal Disease in Rats
Authors: Lima Vilma , Vidal Francisco D.P. , Rocha Francisco Airton C. , Brito Gerly Anne C. , Ribeiro Ronaldo A.
Published: February 2005

Background: Pentoxifylline (PTX) and thalidomide (TLD) have been shown to inhibit cytokine synthesis, mainly tumor necrosis factor (TNF)‐α, in different inflammatory conditions. We studied the effects of these cytokine inhibitors in an experimental model of periodontitis.

Methods: Wistar rats were subjected to a ligature placement around the second upper right molars. Alveolar bone loss was evaluated by the sum of the distances between the cusp tip and the alveolar bone along the axis of each molar root, subtracting from the contralateral side. Histopathological analysis was based on cell influx, amount of alveolar bone, and cementum integrity. Animals were weighed daily, and total and differential peripheral white blood cell counts were performed at 6 hours and 1, 7, and 11 days after induction of periodontitis. Groups were treated with saline (positive control), PTX, or TLD 1 hour before and daily up to 11 days after induction of periodontitis.

Results: Alveolar bone loss was inhibited 42%, 54%, and 69% by PTX at 5, 15, and 45 mg/kg, and 25%, 25%, 42%, and 54% by TLD at 5, 15, 45, and 90 mg/kg, respectively, as compared to the control (P <0.05; analysis of variance). Histological analysis showed that PTX and TLD reduced cell influx and alveolar bone and cementum destruction. PTX and TLD also reversed peripheral lymphomonocytosis but not weight loss, as compared to controls. These data showed that both PTX and TLD reduced alveolar bone loss in periodontitis.

Conclusion: The data showed a protective effect of PTX and TLD on experimental periodontitis, suggesting a role for TNF‐α in the pathophysiology of periodontitis. J Periodontol 2004;75:162‐168.
Specific Antibiotics in the Treatment of Periodontitis – A Proposed Strategy
Authors: Beikler Thomas , Prior Karola , Ehmke Benjamin , Flemmig Thomas F.
Published: February 2005

Background: The purpose of the present study was to propose a strategy for the selection of antibiotics that specifically target complexes of periodontal pathogens present in patients with periodontitis.

Methods: Seven hundred seventy‐four (774) patients with various forms of periodontitis were included in the study. Subgingival plaque samples were taken from the deepest periodontal pockets in each quadrant using a sterile curet, and pooled. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Eikenella corrodens, Tannerella forsythensis, Prevotella intermedia, and Prevotella nigrescenswere identified by polymerase chain reaction, and the prevalence of combinations of these pathogens was determined. To each pathogen complex (PC), i.e., combination of pathogens, those antibiotics were assigned that were most specific according to the published minimum inhibitory concentration (MIC90) values and the gingival crevicular fluid (GCF) concentrations achievable in vivo. Antibiotic GCF concentrations had to be at least 10 times the MIC90 values, and the narrowest spectrum was selected with respect to the assessed periodontal pathogens.

Results: Nine major PCs (each ≥3% of all patients) were found in 73.4% of all patients, whereas 38 minor PCs (each <3% of all patients) were distributed in 26.6% of all patients. Ten different antibiotic regimens were found to be specific for the total of 46 PCs; i.e., metronidazole and amoxicillin in 11 PCs (55.0% of all patients), metronidazole and amoxicillin/clavulanic acid or metronidazole and ciprofloxacin in 13 PCs (18.9%), amoxicillin in 4 PCs (8.3%), doxycycline in 2 PCs (6.1%), metronidazole in 8 PCs (4.1%), amoxicillin/ clavulanic acid in 3 PCs (2.9%), clindamycin in 2 PCs (1.5%), ciprofloxacin in 2 PCs (0.4%), and tetracycline in 1 PC (0.3%).

Conclusion: The results of the study indicate that there are at least 46 different combinations of the assessed periodontal pathogens in subjects with periodontitis, and at least 10 different antibiotic regimens might be required to specifically target the various pathogen complexes. J Periodontol 2004;75:169‐175.
Periodontal Parameters Around Implants Anchoring Orthodontic Appliances: A Series of Case Reports
Authors: Molly Liene , Willems Guy , van Steenberghe Daniel , Quirynen Marc
Published: February 2005

Background: Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved.

Methods: A total of 38 two‐stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra‐oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment.

Results: In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment.

Conclusion: No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment. J Periodontol 2004;75:176‐181.
P‐15 Cell‐Binding Domain Derived from Collagen: Analysis of MG63 Osteoblastic‐Cell Response by Means of a Microarray Technology
Authors: Carinci Francesco , Pezzetti Furio , Volinia Stefano , Laino Gregorio , Arcelli Diego , Caramelli Elisabetta , Degidi Marco , Piattelli Adriano
Published: February 2005

Background: P‐15 is an analog of the cell‐binding domain of collagen. P‐15 has been shown to facilitate physiological processes in a way similar to collagen; to serve as an anchorage for cells; and to promote the binding, migration, and differentiation of cells.

Methods: Expression profiling by DNA microarray is a molecular technology that allows the analysis of gene expression in a cell system. By using DNA microarrays containing 19,200 genes, we identified in osteoblast‐like cell line (MG‐63) cultured with P‐15 several genes whose expression was significantly up‐ or downregulated.

Results: The differentially expressed genes cover a broad range of functional activities: 1) signaling transduction, 2) differentiation, 3) apoptosis, and 4) cell‐cycle regulation. It was also possible to detect some genes whose function is unknown.

Conclusions: The data reported are, to our knowledge, the first genetic portrait of P‐15 effects. They can help us to better understand the molecular mechanism of osteogenesis and can serve as a model for comparing different cell cultures and/or other materials with similar effect. J Periodontol 2004;75:66‐83.
Telomere Length in Leukocytes and Cultured Gingival Fibroblasts from Patients with Aggressive Periodontitis
Authors: Takahashi Keiso , Nishida Hideaki , Takeda Hiroyuki , Shin Kitetsu
Published: February 2005

Background: The association of genetic risk factors with the pathogenesis of aggressive periodontitis (AgP) has been a focus of attention. Telomeres, which are nucleoprotein complexes at the ends of chromosomes, could be a genetic marker for Down's syndrome and Hutchinson‐Gilford progeria, in which patients' premature aging is involved in the pathogenesis. It has been reported that these patients tend to experience severe periodontitis. Therefore, we investigated the telomere length of peripheral blood leukocytes (PBL) obtained from patients with AgP and that in the patients' gingival fibroblasts undergoing cellular aging in vitro.

Methods: Twenty‐one patients with AgP and 50 age‐matched, periodontally healthy subjects (HS) participated in this study. Genomic DNA from PBL and from human gingival fibroblasts (HGF) was analyzed by Southern blotting for telomere length. The percentage of HGF positive for β‐galactosidase (β‐gal), a marker for cellular senescence, was also investigated.

Results: There was no significant difference in the telomere length (P = 0.20, Student's t test) between the two groups, and wide interindividual variation was found (5.93 to 11.4 kbp, average 8.35 ± 1.19 kbp). The telomere length from PBL negatively correlated with donor age, but no significant difference in telomere loss between the two groups was observed. With HGF undergoing aging in culture, the mean telomere length of these cells from six patients with AgP and seven HS decreased an average of –67.5 bp and –81.0 bp, respectively. No association was found in the telomere length between PBL and HGF from the same donors (r = 0.56, P = 0.20). A significant association was found between the telomere length and the percentages of β‐ gal–positive HGF during cell passages (r = 0.70, P <0.001).

Conclusions: These results indicate that patients with AgP do not have excessive telomere loss and thus do not support the notion of the occurrence of a generalized premature cellular aging in patients with AgP. Further studies are required to investigate the association between telomere length and β‐gal in HGF. J Periodontol 2004;75:84‐90.
Cigarette Smoking and the Periodontal Patient
Authors: Johnson Georgia K. , Hill Margaret
Published: February 2005

Evidence from cross‐sectional and case‐control studies in various populations demonstrates that adult smokers are approximately three times as likely as non‐smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non‐surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of nonsmokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco‐induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a nonsmoker following tobacco cessation. Likewise, recent non‐smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask – identify tobacco users; advise – advise them to quit; assess – evaluate the patient's readiness to quit; assist – offer assistance in cessation; and arrange – follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. The American Academy of Periodontology Parameters of Care include tobacco cessation as a part of periodontal therapy, and the 2000 Surgeon General's Report on Oral Health in America encourages dental professionals to become more active in tobacco cessation counseling. Doing so will have far‐reaching positive effects on our patients' oral and general health. J Periodontol 2004;75:196‐209.
Treatment of Gingival Recession Using a Collagen Membrane with or without the Use of Demineralized Freeze‐Dried Bone Allograft for Space Maintenance
Authors: Kimble Kenneth M. , Eber Robert M. , Soehren Stephen , Shyr Yu , Wang Hom‐Lay
Published: February 2005

Background: Studies utilizing collagen membranes for guided tissue regeneration (GTR)‐based root coverage procedures have reported promising results. However, creating and maintaining space underneath the membrane remains a challenge. Therefore, the purpose of this clinical trial was to determine whether the addition of bone graft (i.e., demineralized freeze‐dried bone allograft [DFDBA]) significantly affects the outcome of collagen membrane GTR‐based root coverage procedures.

Methods: Twenty patients participated. One Miller's Class I or II recession defect per patient was treated with a collagen membrane covered by a coronally positioned flap. Half of the patients also had DFDBA placed under the membrane. Clinical parameters recorded included: recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth, measured to the nearest 0.5 mm. Presurgery and postsurgery (6‐month) data were compared using Student's paired t test for parametric data and the Wilcoxon matched pairs test for non‐parametric data.

Results: Guided tissue regeneration with collagen (COLL) and collagen + DFDBA (COBA) both resulted in statistically signifi‐ cant (P <0.05) reductions in recession depth (2.1 ± 0.9 mm and 2.5 ± 0.5 mm), recession width (1.5 ± 1.7 mm and 2.2 ± 1.6 mm), increase in keratinized tissue (0.7 ± 0.8 mm and 1.2 ± 1.0 mm), and gain of clinical attachment level (2.1 ± 1.0 mm and 3.0 ± 1.0 mm), when comparing 6‐month data to baseline. Mean root coverage was 68.4 ± 15.2% with COLL and 74.3 ± 11.7% with COBA. However, there were no statistically significant differences between groups for recession depth, recession width, width of keratinized tissue, clinical attachment level, and probing depth.

Conclusions: Both techniques are effective in attaining root coverage. Although root coverage tended to be better with the addition of DFDBA, the difference was not statistically significant. Further studies with a larger sample size are needed to determine whether adding DFDBA to GTR‐based procedures using collagen membranes is of any benefit. J Periodontol 2004;75:210‐220.
IgG Antibody Levels to Porphyromonas gingivalis and Clinical Measures in Children
Authors: Donley Cara L. , Badovinac Rachel , Sapir Shabtai , Shapira Lior , Houri Yael , Kantarci Alpdogan , Warbington Martha L. , Dibart Serge , Van Dyke Thomas E. , Needleman Howard L. , Karimbux Nadeem , Bimstein Enrique
Published: February 2005

Background: Periodontopathic clinical markers are poorly understood in the pediatric population. Several studies have proposed Porphyromonas gingivalis (P. gingivalis) and an antibody response to the microorganism as factors in periodontal tissue destruction in children. The objective of this study was to examine the prevalence of P. gingivalis in dental plaque and of serum immunoglobulin G (IgG) antibody levels to P. gingivalis, and their relationship to periodontal clinical measures in children.

Methods: Thirty‐one subjects, aged 20 to 163 months, participated in this study. Clinical measures examined included gingivitis, plaque, alveolar bone height, age, gender, ethnicity, medical status, caries, and IgG antibody levels to P. gingivalis. Five ml of blood was collected for serum analysis, and IgG antibody levels to P. gingivalis were determined by using enzyme‐linked immunosorbent assay. Plaque samples were examined for the presence of P. gingivalis by DNA‐DNA checkerboard. Data were analyzed on a person‐level basis for relationships to serum IgG antibody levels to P. gingivalis and on a site‐specific level for relationships to the presence of P. gingivalis in plaque.

Results: A majority (77%) of the subjects were systemically healthy, non‐white (74%), and did not have detectable P. gingivalis in their plaque. Fifty‐two percent of the subjects had positive serum IgG antibody levels to P. gingivalis. Based on univariate linear regression, factors related to IgG antibody levels to P. gingivalis (P <0.05) included age, average gingival index (GI), average probing depth, and number of teeth with alveolar bone crest to cemento‐enamel junction (ABC‐CEJ) distances >2 mm. When all clinical measures were considered together, only age remained statistically significantly related to serum IgG antibody levels to P. gingivalis.

Conclusions: Age is one of the most important factors in the development of the immune response to putative microorganisms such as P. gingivalis in children. The role of IgG as a timesensitive measure of periodontal health in children needs to be investigated further. J Periodontol 2004;75:221‐228.
Enhanced Cementum Formation in Experimentally Induced Cementum Defects of the Root Surface with the Application of Recombinant Basic Fibroblast Growth Factor in Collagen Gel In Vivo
Authors: Sato Yasuko , Kikuchi Masahiro , Ohata Noboru , Tamura Masato , Kuboki Yoshinori
Published: February 2005

Background: Therapies using biologically active, soluble factors such as growth factors or cytokines have been investigated for potential clinical use in regenerating lost periodontal tissue due to periodontitis. Basic fibroblast growth factor (bFGF, FGF‐2) is a multifunctional growth factor that has a variety of effects including induction of proliferation and morphogenesis in a wide range of cells and tissues including periodontal ligament tissue.

Methods: In this study, we examined the effects of bFGF on the regeneration of cementum and periodontal ligament in experimentally induced partial defects in a beagle dog model. bFGF in a collagen gel was applied to the defects and root surfaces, and the teeth were replanted.

Results: Eight weeks post‐surgery, formation of cementum on denuded dentin was enhanced by application of 0.1, 1, or 5 μg of bFGF in a collagen gel compared to collagen gel containing vehicle. Histological analyses revealed that at 4 weeks post‐surgery, random periodontal ligament fibers had bound to dentin, but were attached only to denuded dentin to which 0.1, 1, or 5 μg of bFGF in collagen gel had been applied. At 8 weeks post‐surgery, we observed the formation of dense fibers bound to alveolar bone and newly synthesized cementum in teeth treated with 1 μg of bFGF.

Conclusion: These results suggest that basic fibroblast growth factor in a collagen gel is a suitable therapy for damaged periodontal ligament and could lead to readily achievable methods of treatment for periodontal disease. J Periodontol 2004;75:243‐248.
Bacterial Adhesion on Commercially Pure Titanium and Zirconium Oxide Disks: An In Vivo Human Study
Authors: Scarano Antonio , Piattelli Maurizio , Caputi Sergio , Favero Gian Antonio , Piattelli Adriano
Published: February 2005

Background: Little is known about the mechanisms of bacterial interaction with implant materials in the oral cavity. A correlation between plaque accumulation and progressive bone loss around implants has been reported. Bacterial adhesion shows a direct positive correlation with surface roughness. Other surface characteristics also seem to be extremely important with regard to plaque formation. Different adhesion affinities of bacteria have been reported for different materials. The aim of this study was to characterize the percentage of surface covered by bacteria on commercially pure titanium and zirconium oxide disks.

Methods: Ten patients participated in this study. A removable acrylic device was adapted to the molar‐premolar region, and commercially pure titanium (control) and zirconium oxide (test) disks were glued to the buccal aspect of each device. The surface roughness of titanium and test specimens was similar. After 24 hours, all disks were removed and processed for scanning electron microscopy, for the evaluation of the portion of surface covered by bacteria.

Results: In control specimens, the area covered by bacteria was 19.3% ± 2.9; in test specimens, the area was 12.1% ± 1.96. The disk surface covered by bacteria on test specimens was significantly lower than that of control specimens (P = 0.0001).

Conclusion: Our results demonstrate that zirconium oxide may be a suitable material for manufacturing implant abutments with a low colonization potential. J Periodontol 2004;75:292‐296.
Lysophosphatidic Acid Modulates the Regenerative Responses of Human Gingival Fibroblasts and Enhances the Actions of Platelet‐Derived Growth Factor
Authors: Cerutis D. Roselyn , Dreyer Andrew , Cordini Franco , McVaney Timothy P. , Mattson John S. , Parrish Lawrence C. , Romito Laura , Huebner Gene R. , Jabro Mansoor
Published: February 2005

Background: Platelet‐derived growth factor (PDGF) has been used to promote healing in many in vitro and in vivo models of periodontal regeneration. PDGF is known to interact extensively with another platelet mediator, lysophosphatidic acid (LPA), to enhance regenerative responses in non‐oral systems. PDGF and LPA are both liberated by platelets in the blood clot, which is known to be critical in stabilizing early periodontal wound healing. The purpose of this study was to evaluate the basic interactions of LPA with primary human gingival fibroblasts (GF) alone and with PDGFBB for promoting GF growth and migration, as well as their effects in an in vitro oral wound‐healing model.

Methods: GF regenerative responses were measured using 1 and 10 μM LPA in the absence or presence of 1 or 10 ng/ml PDGF‐BB. Cell growth was determined using [3H]thymidine incorporation and cell counting. Migration responses were measured using a microchemotaxis chamber. For the in vitro wound‐healing experiments, GF were grown to confluence on glass slides, and a 3 mm wide wound was mechanically inflicted. Percent wound fill on days 4, 6, and 9 was analyzed using computer‐assisted histomorphometry.

Results: GF exhibited proliferative and chemotactic responses to LPA. These responses were synergistic when LPA and PDGF‐BB were present together. LPA on its own did not stimulate statistically significant wound fill, but when combined with PDGF‐BB, wound fill was equivalent to the 10% serum positive control group by day 6 (5.5‐fold of negative control, [P <0.001]) and again on day 9 (6‐ fold of negative control, [P <0.001]).

Conclusions: These studies provide the first evidence that LPA stimulates human GF regenerative responses and that it interacts positively with PDGF‐BB to regulate these actions. The results suggest that LPA needs to be further investigated in the oral system as a factor that should be considered for incorporation when designing new periodontal wound‐healing therapies using PDGF. J Periodontol 2004;75:297‐305.
Combined Bone Grafting and Orthodontic Treatment of an Iatrogenic Periodontal Defect: A Case Report with Clinical Reentry
Authors: Naaman Nada Bou‐Abboud , Chaptini Edmond , Taha Hala , Mokbel Nadim
Published: February 2005

Background: This case report discusses the treatment of an iatrogenic periodontal defect caused by an inadequate orthodontic appliance in a 9‐year‐old girl.

Methods: The multidisciplinary approach to this case consisted of periodontal treatment using a bone grafting technique to restore the 10 mm bone dehiscence. Three months later orthodontic treatment was initiated to straighten and level the central incisors. Six months later mucogingival surgery was performed to cover 2 to 3 mm gingival recession.

Results: The bony defects were completely filled and the 10 mm dehiscence was reduced to 4 mm. The connective tissue graft resulted in a complete coverage of the recessions and a thickening of the keratinized gingiva. The patient is still undergoing orthodontic treatment. So far, straightening of the upper central incisors and closure of the diastema are satisfactory.

Conclusions: Inadequate orthodontic appliances can cause iatrogenic periodontal defects. A multidisciplinary approach in a well‐defined sequence can restore lost periodontal tissue, thus achieving comfort, function, and esthetics. J Periodontol 2004;75:316‐321.
Success and Failure Rates of 9 mm or Shorter Implants in the Replacement of Missing Maxillary Molars When Restored with Individual Crowns: Preliminary Results 0 to 84 Months in Function. A Retrospective Study
Authors: Fugazzotto Paul A. , Beagle Jay R. , Ganeles Jeffrey , Jaffin Robert , Vlassis James , Kumar Akshay
Published: February 2005

Background: The ability to utilize shorter implants in the reconstruction of the posterior maxilla would, theoretically, simplify therapy by lessening the need for augmentation surgery. The purpose of this retrospective study was to assess the success and failure rates of ≤9 mm or shorter implants in the maxillary posterior regions restored with individual crowns.

Methods: A total of 979 implants were placed in maxillary molar positions and restored with individual crowns. The implants were followed in function for up to 84 months. The results are discussed in terms of clinical applicability and indications for use.

Results: The cumulative success rates in function were 94.5% for implants in the maxillary first molar positions and 98.7% for implants in the maxillary second molar positions, yielding an overall cumulative success rate of 95.1%, in function for up to 84 months.

Conclusion: These findings suggest that non‐countersunk implants of 7 to 9 mm in length may be successfully restored with single crowns in the maxillary molar region. J Periodontol 2004;75:327‐332.