bluuebunny/crossref_metadata_2025 huggingface dataset:
Periodontal status by CPITN, and associated variables in an Israeli permanent force military population
Authors: Katz J. , Peretz B. , Sgan‐Cohen H. D. , Horev T. , Eldad A.
Published: March 2003

Aims: The objectives were to determine periodontal treatment needs using the CPITN index, of Israeli permanent force military personnel.

Methods: The study population consisted of 1300 military personnel aged 25–44 years (mean age 33.8±5.4), who attended obligatory routine medical and dental examinations. Clinical examinations were conducted by 3 calibrated examiners, employing flat dental mirrors, the specially designed WHO periodontal probes (FDI probes) and following CPITN criteria. The frequency distributions were studied with regard to age groups, gender and education, as well as differences in the severity of the disease. Also, the mean number of sextants affected per person by age was assessed.

Results: Only 1.19% of the subjects demonstrated healthy periodontal tissue. Shallow pockets were similarly found among all age groups, and the number of persons with deep pockets increased with age. Deep pockets were found almost 3 × more among males (18.66%) in comparison with females (6.19%). Persons with higher education (>12 years), had less deep pockets and bleeding than individuals with less than 12 years of education (p<0.05).

Conclusions: Compared with data from other countries reported by the WHO, this periodontal status indicates a relatively high level of treatment needs. This survey provides a substantial contribution to the national oral health data bank concerning the adult working population in Israel.
Carboxypeptidase‐mediated metabolism of calcitonin gene‐related peptide in human gingival crevicular fluid – a rôle in periodontal inflammation?
Authors: Lundy Fionnuala T. , Salmon Amanda L. , Lamey Philip‐John , Shaw Christopher , Linden Gerard J.
Published: March 2003

Background: Metabolism by peptidases plays an important rôle in modulating the levels of biologically‐active neuropeptides. The metabolism of the anti‐inflammatory neuropeptide calcitonin gene‐related peptide (GCRP), but not the pro‐inflammatory neuropeptides substance P (SP) and neurokinin A (NKA) by components of the gingival crevicular fluid (GCF), could potentiate the inflammatory process in periodontitis.

Aims: To characterise the extracellular hydrolysis of CGRP as a mechanism for the selective inactivation of this neuropeptide in GCF from periodontitis sites.

Methods: Samples of GCF from periodontitis patients and periodontally‐healthy subjects were incubated with synthetic human SP, NKA or CGRP. Reaction between the GCF constituents and synthetic peptides was allowed to progress from 0–180 min. Results of neuropeptide metabolism at each time were analysed by matrix‐assisted laser desorption/ionisation mass spectrometry.

Results: There was no evidence of metabolism of SP, NKA or CGRP by constituents of healthy GCF. Metabolism of synthetic SP and NKA was minimal even after extensive incubation with periodontitis GCF. However, loss of carboxy‐terminal amino acids was evident after only 1 min incubation with periodontitis GCF. The pattern of CGRP metabolism, which proceeded from the C‐terminus, indicated that the neuropeptide was degraded by a carboxypeptidase. After 180 min, there was extensive carboxypeptidase degradation of CGRP to an 11 amino acid peptide.

Conclusions: It is concluded that carboxypeptidase activity in GCF from periodontitis patients is responsible for rapid breakdown of CGRP but not SP or NKA. The rapid action of this carboxypeptidase on the anti‐inflammatory neuropeptide CGRP is suggestive of a pathophysiological rôle for the enzyme in selectively degrading CGRP, thereby potentiating periodontal inflammation.
Root‐dentin sensitivity following non‐surgical periodontal treatment
Authors: Tammaro Stefano , Wennström Jan L. , Bergenholtz Gunnar
Published: March 2003

Background, aims: Little clinical data exist on the incidence and severity by which root dentin sensitivity (RDS) results from periodontal therapy. The aim of the present clinical trial was to study the degree to which a sample of patients requiring non‐surgical periodontal treatment develops RDS.

Material and methods:

Alterations in RDS was followed in 35 patients (29–65 years of age) requiring non‐surgical treatment for moderate to advanced periodontal disease. Inclusion criteria for participation were need for periodontal treatment in at least 2 quadrants comprising a minimum of 4 teeth with vital pulps, no open caries lesions, no dental treatment in the last 3 months and no ongoing treatment for RDS. Baseline and follow‐up recordings included responses of teeth to pain stimuli (directed compressed air) at buccal surfaces as graded by the patient on a 10‐cm visual analogue scale (VAS). Periodontal therapy consisted of oral hygiene instruction (OH) followed by supra‐ and subgingival scaling/root planing by hand and ultrasonic instrumentation of one quadrant per each of the subsequent weeks. Thus, follow‐up data included pain assessment after 1–3 weeks of OH alone, and 1–4 weeks post‐instrumentation.

Results: There was a statistically significant reduction in mean VAS‐scoring over time in quadrants where only meticulous plaque control had been maintained, while VAS mean values increased significantly after instrumentation (p<0.001). Also the % of subjects reporting higher mean VAS values increased after instrumentation. Changes in mean VAS scores were generally moderate and only 9 patients gave an increase on VAS of >2 cm for 3 or more teeth. A statistically significantly higher increase of RDS was observed for initially sensitive teeth (VAS>0) than for teeth not responding at baseline (p<0.001). Although a reduction in the intensity of RDS could be noticed during the later phase of the 4‐week follow‐up period after scaling and root planing, the percentage of sensitive teeth remained unchanged.

Conclusion: The data confirm that meticulous plaque control will diminish RDS problems and that scaling and root planing procedures in periodontal therapy result in an increase of teeth that respond to painful stimuli. However, pain experiences in general appeared minor and only a few teeth in a few patients developed highly sensitive root surfaces following instrumentation.
Clinical and radiographic findings following application of enamel matrix derivative in the treatment of intrabony defects
Authors: Parashis A. , Tsiklakis K.
Published: March 2003

Aim: The purpose of this case report study was to evaluate the clinical and radiographic findings following application of enamel matrix derivative (EMD) in the treatment of 2‐ or 3‐wall intrabony defects in a private periodontal practice one year after surgery.

Method: 15 consecutive patients (age range 38–67 years, 9 females, 6 males, 3 smokers) with 25 intrabony defects were included in the study. The decision to use reconstructive surgery was taken at least 3 months after termination of the presurgical treatment phase. Inclusion criteria were: presence of an interproximal area with residual probing depth (PD) 6 mm, probing attachment level (PAL) 6 mm and an associated intrabony defect 4 mm deep and 2 mm wide as measured during surgery (defects were not associated with adjacent furcation lesions). Open‐flap surgery was performed to expose the defects and the EMD gel was applied after proper debridement. The patients were instructed to rinse 2× daily for 6 weeks with a 0.12% solution of chlorhexidine.

Results: At 12 months, mean PD decreased from 8.4 mm to 4.0 mm and PAL from 10.2 mm to 6.6 mm, while recession increased from 1.8 mm to 2.6 mm. Residual PD greater than 4 mm was observed only in 7 sites. 14 sites demonstrated a PAL gain of 2–3 mm, 9 sites a gain of 4–5 mm and 2 sites a gain of 6 mm. Radiographic assessment indicated a mean crestal bone resorption of 20.7% and a mean improvement in the distance between the CEJ and the base of the defect of 22.9%. The combination of defect fill from the bottom of the defect and crestal resorption resulted in a mean defect resolution of 61%.

Conclusion: Within the limits of this study, the application of EMD gel in 2‐ or 3‐wall intrabony defects resulted in clinically significant gain of PAL and radiographic bone. Further controlled clinical studies are required to confirm the effectiveness of the EMD gel in the treatment of various osseous defects.
A clinical application of autotransplantation using furcation‐involved root
Authors: Yoshino Takashi , Okamoto Hiroshi
Published: March 2003

Background, aims: The present case report describes the clinical application of autotransplantation using furcation involved roots.

Method: After initial therapy, root resection was performed upon the patient’s molar teeth with furcation involvement in the mandible. 2 distal roots of the molar teeth were autotransplanted as abutments to replace missing premolar and molar teeth in the mandible.

Results: On re‐examination, 1 year after the transplantation, these roots showed no signs of periodontal or technical complications. The results suggest the potential use of autotransplantation techniques using furcation involved roots in reconstructive therapy. This may be a new approach in periodontal therapy.
Soluble antagonists to interleukin‐1 (IL‐1) and tumor necrosis factor (TNF) inhibits loss of tissue attachment in experimental periodontitis
Authors: Delima A. J. , Oates T. , Assuma R. , Schwartz Z. , Cochran D. , Amar S. , Graves D. T.
Published: March 2003

Background, aims: Periodontal disease is a significant cause of tooth loss among adults and is characterized by the alteration and permanent destruction of the deeper periodontal tissues. Although the presence of pathologic microbes is required to trigger this process, the amplification and progression of the diseased state is believed to rely heavily on the production of host mediators in response to bacteria or their metabolic products. The inflammatory response is effective in preventing large‐scale colonization of the gingival tissues by bacteria that lie in close proximity to the tooth surface or within the gingival sulcus. It has been postulated that the host‐response in some individuals may lead to an over‐reaction to invading oral pathogens resulting in the destruction of periodontal tissues.

Methods: Several host‐derived mediators are believed to contribute to this response. Two agents considered to be essential in periodontal destruction are interleukin‐1 (IL‐1) and tumor necrosis factor (TNF). We investigated the role of IL‐1 and TNF in the loss of connective tissue attachment in a Macaca fascicularis primate model of experimental periodontitis. Silk ligatures impregnated with the periodontal pathogen, Porphyromonas gingivalis were wrapped around the posterior teeth and the activity of IL‐1 and TNF were inhibited by soluble receptors to these proinflammatory cytokines via local injection into interdental papillae.

Results: Histomorphometric analysis indicates that IL‐1 and TNF antagonists significantly reduced the loss of connective tissue attachment by approximately 51% and the loss of alveolar bone height by almost 91%, both of which were statistically significant.

Conclusion: This investigation demonstrates that the loss of connective tissue attachment and progression of periodontal disease can be retarded by antagonists to specific host mediators such as IL‐1 and TNF and may provide a potential treatment modality to combat the disease process.
The erosive effects of some mouthrinses on enamel
Authors: Pontefract H. , Hughes J. , Kemp K. , Yates R. , Newcombe R. G. , Addy M.
Published: March 2003

Abstract Background: There are both anecdotal clinical and laboratory experimental data suggesting that low pH mouthrinses cause dental erosion. This evidence is particularly relevant to acidified sodium chlorite (ASC) formulations since they have plaque inhibitory properties comparable to chlorhexidine but without the well known local side effects.

Aim: Studies in situ and in vitro were planned to measure enamel erosion by low pH mouthrinses. The study in situ measured enamel erosion by ASC, essential oil and hexetidine mouthrinses over 15‐day study periods. The study was a 5 treatment, single blind cross over design involving 15 healthy subjects using orange juice, as a drink, and water, as a rinse, as positive and negative controls respectively. 2 enamel specimens from unerupted human third molar teeth were placed in the palatal area of upper removable acrylic appliances which were worn from 9 a.m. to 5 p.m., Monday to Friday for 3 weeks. Rinses were used 2× daily and 250 ml volumes of orange juice were imbibed 4× daily. Enamel loss was determined by profilometry on days 5, 10 and 15. The study in vitro involved immersing specimens in the 4 test solutions together with a reduced acid ASC formulation for a period of 4 h under constant stirring; Enamel loss was measured by profilometry every hour.

Results: Enamel loss was in situ progressive over time with the 3 rinses and orange juice but negligible with water. ASC produced similar erosion to orange juice and significantly more than the two proprietary rinses and water. The essential oil and hexetidine rinses produced similar erosion and significantly more than water. Enamel loss in vitro was progressive over time, and the order from low to high erosion was reduced acid ASC, ASC, Essential oil, and hexetidine mouthrinses and orange juice.

Conclusion: Based on the study in situ, it is recommended that low pH mouthrinses should not be considered for long term or continuous use and never as pre‐brushing rinses. In view of the plaque inhibitory efficacy of ASC, short‐ to medium‐term applications similar to those of chlorhexidine would be envisaged.
Pocket elimination surgery with simultaneous connective tissue graft. A case report with 3‐year follow‐up
Authors: Castellani R. , Wolffe G. N. , Renggli H. H.
Published: March 2003

Abstract Background, aims: The purpose of the present case report was to present 2 ways of treating recession in a periodontal patient combined with regular pocket elimination surgery. The techniques used enabled the operator to reduce the number of surgical sessions and clinically evaluate the 3‐year coverage of gingival recessions using a subpedicle connective tissue graft.

Methods: Surgery consisted of pocket elimination procedures to treat adult periodontitis as a way to harvest connective tissue to be placed in the areas of recession. The grafted tissue was covered by the primary flap or left uncovered in a pouch, according to 2 different techniques described in the literature.

Results: In this case, we observed that, with this approach, we were successful in reducing the number of surgical session as well as achieving objective and subjective goals of therapy in treated areas.
In vitro effect of oral antiseptics on human immunodeficiency virus‐1 and herpes simplex virus type 1
Authors: Baqui A. A. M. A. , Kelley Jacqueline I. , Jabra‐Rizk Mary Ann , DePaola Louis G. , Falkler William A. , Meiller Timothy F.
Published: March 2003

Aim: The antiviral effectiveness of widely used commercial mouthrinses has not been well studied. A project was undertaken to evaluate and compare the in vitro antiviral effectiveness of essential oil‐containing mouthrinses (LA & TLA) and chlorhexidine mouthrinses (PX & CHX) on 2 different enveloped viruses, human immunodeficiency virus (HIV‐1) and Herpes simplex virus (HSV‐1) McIntyre strain.

Method: HIV‐189.6 (1×105/ml) and HSV‐1 (1×106/ml) in RPMI‐1640 medium were treated with two commercially available forms of LA & TLA (tartar control LA), and 2 formulations of chlorhexidine [(PX), 0.12% chlorhexidine & (CHX), 0.2% chlorhexidine] for 30 sec. The antiviral effect was estimated by inhibition of the syncytia formation or the cytopathic effect (CPE) for HIV‐1 on MT‐2 cells and by inhibition of the plaque formation for HSV‐1 on Vero cell monolayers.

Results: Undiluted LA, TLA, PX and CHX completely inhibited both HIV‐189.6 and HSV‐1 McIntyre strain. PX and CHX inhibited HIV‐1 up to 1:4 dilution, whereas, LA and TLA inhibited HSV‐1 up to 1:2 dilution. The antiviral effects of LA and TLA were found to be similar and also the antiviral effect of PX and CHX were also found to be comparable.

Conclusions: The methods used in this investigation allow easy and reproducible evaluations of antiviral efficacy. The anti‐HIV‐1 and anti‐HSV‐1 effects of LA, TLA, PX and CHX as evidenced in our in vitro study suggest that we should investigate potential in vivo effects during the use of essential oil‐containing or chlorhexidine containing products when used by patients as mouthrinses. If the clinical studies confirm the in vitro data, pre‐procedural use by clinicians may be beneficial in reducing viral contamination of bio‐aerosols during the delivery of dental care.
Cytokine gene expression in chronic periodontitis
Authors: Bickel Matthias , Axtelius Björn , Solioz Catherine , Attström Rolf
Published: March 2003

Background: Cytokines play an important rôle in controlling inflammatory processes and tissue homeostasis. Periodontitis, as any other chronic inflammatory disease, results from a disarrangement of host factors, mainly cytokines and the initiating agent. Modulation of the cytokines is not only controlled by the host but also by infecting bacteria and their products.

Aim: In the present study, we examined the cytokine mRNA expression profiles in six patients, each presenting sites affected with (1) severe progressive periodontitis, (2) chronic, but stable periodontal lesions, and (3) with healthy sites. Analysis using a quantitative RT‐PCR included IFN‐γ, IL‐1β, IL‐2, IL‐4, IL‐5, IL‐6, and TNF‐α.

Material and Methods: 6 patients with chronic periodontitis were following treatment observed for a period of six years for local sites staying healthy, local sites with periodontal pathology but without signs of progression of attachment loss and sites with verified progression were biosied. The biopsies were lyzed and analyzed for levels of cytokine mRNAs.

Results: Results revealed considerable variation not only between patients, but also between individual sites. Each patient’s site has thus to be looked at as an independent entity.

Conclusions: The local action of cytokines, which is heavily dependent on recruitment, interaction and activation of immunocompetent cells can explain the site‐specific nature of cytokine expression. Cytokine data from individual sites together with the local clinical status and data from the literature demonstrate the complexity of periodontal disease pathogenesis. To gain insight to specific mechanisms further studies are needed.
Porphyromonas gingivalis‐specific IgG subclass antibody levels as immunological risk indicators of periodontal bone loss
Authors: Sakai Yoko , Shimauchi Hidetoshi , Ito Hiro‐O. , Kitamura Masahiro , Okada Hiroshi
Published: March 2003

Background: It has been well demonstrated a positive association between the magnitude of host antibody response and periodontal disease status. Previous studies also reported that Porphyromonas gingivalis‐specific IgG subclass antibodies were elevated in sera from adult periodontitis patients. However, the rôle and the association of these IgG subclass antibodies to the development of periodontal diseases are poorly understood.

Aim: The aim of present investigation was to examine the relation of serum IgG subclass antibody levels and alveolar bone loss in treated and untreated periodontitis patients.

Methods: Serum samples were taken from 20 treated and maintained periodontitis patients (SPT patients), 30 untreated patients and 19 periodontally healthy subjects. We determined the IgG subclass antibody titers to P. gingivalis whole cells using an enzyme‐linked immunosorbent assay (ELISA). Subgingival plaque samples were taken from the mesio‐buccal surface of 6 randomly selected teeth of SPT patients and evaluated for the presence of P. gingivalis by immunofluorescence microscopy. Clinical measurements were also taken including full mouth intraoral radiographs to measure interproximal alveolar bone loss at baseline (BLS1) and at a 5‐year recall visit in the SPT patients (BLS2).

Results: Our results indicated that both patient groups had detectable levels of IgG1, IgG2, and IgG4. Significantly higher IgG1 was observed in both patient groups compared to the healthy subjects. The untreated patients also exhibited significantly elevated IgG2 response (p<0.05). The mean IgG4 level of the SPT patients was significantly higher compared to the other subject group (p<0.05). A statistically significant positive correlation between IgG2 levels and changes in bone levels (ΔBLS: BLS2‐BLS1) was seen in the SPT patients (p<0.001). SPT patients with high IgG2 and low IgG4 showed greater bone loss than those with low IgG2 and high IgG4 (p<0.05), although the mean prevalence of P. gingivalis in the 2 groups did not differ significantly.

Conclusion: Our data suggest that the prolonged IgG2 response after periodontal treatment may be indicative of recurrent or persistent periodontal destruction.
Herpes viruses and periodontopathic bacteria in early‐onset periodontitis
Authors: Kamma Joanna J. , Contreras Adolfo , Slots Jørgen
Published: March 2003

Objectives: This study examined the occurrence of human herpes viruses and suspected periodontopathic bacteria in early‐onset periodontitis patients who experienced progressive disease in at least 2 periodontal sites during the maintenance phase of therapy.

Material and methods: In each of 16 individuals (9 male and 7 female; mean age 33.1±2.6 years), subgingival plaque samples were collected from 2 deteriorating and 2 stable periodontitis sites. A nested polymerase chain reaction method determined the presence of human cytomegalovirus (HCMV), Epstein‐Barr virus type 1 (EBV‐1) and herpes simplex virus (HSV). A 16s rRNA polymerase chain reaction method identified Porphyromonas gingivalis, Dialister pneumosintes, Bacteroides forsythus and Actinobacillus actinomycetemcomitans.

Results: HCMV was detected in 59.4% of active and in 12.5% of stable sites (p<0.001), EBV‐1 in 43.8% of active and in 12.5 % of stable sites (p=0.01), HSV in 34.5% of active and in 9.4% of stable sites (p=0.03), and co‐infection with any of the 3 test herpesviruses in 43.8% of active and in 3.1% of stable sites (p<0.001). P. gingivalis was detected in 71.9% of active and in 37.5% of stable sites (p=0.01), D. pneumosintes in 62.5% of active and in 18.8% of stable sites (p=0.04), co‐infection with P. gingivalis and D. pneumosintes in 50% of active and in 0% of stable sites (p<0.001), and co‐infection with any 3 or 4 of the test bacteria in 40.6% of active and in 0% of stable sites (p=0.001). All periodontitis sites showing herpesvirus co‐infection and all but one site showing P. gingivalis and D. pneumosintes co‐infection revealed bleeding upon probing.

Conclusions: HCMV, EBV‐1, HSV and herpesvirus co‐infection, as well as P. gingivalis, D. pneumosintes and P. gingivalis‐D. pneumosintes co‐infection were statistically associated with active periodontitis. Herpesviruses are immunosuppressive and may set the stage for overgrowth of subgingival P. gingivalis, D. pneumosintes and other periodontopathic bacteria. Understanding the significance of herpesviruses in human periodontitis may allow for improved diagnosis, more specific therapy and, ultimately, disease prevention.
Prevalence of Actinobacillus actinomycetemcomitans in an ethnic adult Chinese population
Authors: Tan Kai Soo , Woo Chee Hoe , Ong Grace , Song Keang Peng
Published: March 2003

Aim: The aim of this study was to determine the prevalence and the structure of the leukotoxin promoter region of Actinobacillus actinomycetemcomitans in an ethnic Chinese population.

Method: Subgingival plaque samples were collected from 42 patients with moderate to advanced periodontitis and 50 periodontally healthy patients. A. actinomycetemcomitans was detected directly from the crude subgingival plaque by PCR using leukotoxin gene specific primers. The presence of A. actinomycetemcomitans was determined by a single 285 bp PCR amplicon.

Results: A. actinomycetemcomitans was found to be present in the subgingival plaque of 68 out of a total of 92 patients examined (74%). 29 out of the 42 periodontitis patients tested were carriers of A. actinomycetemcomitans (69%). Among the periodontally healthy patients studied, 39 out of 50 subjects possessed the bacteria (78%). PCR analysis of the promoter region of the ltx operon revealed that none of the 42 moderate to advanced periodontitis patients examined harboured A.actinomycetemcomitans strains with the JP2‐like promoter of the ltx operon, known to enhance leukotoxin expression. 2 out of the 27 advanced periodontitis patients clinically diagnosed as suffering from rapidly progressive periodontitis were found to be carriers of the mildly toxic strain of A. actinomycetemcomitans with the characteristic 652‐like promoter.

Conclusions: The high prevalence of A. actinomycetemcomitans, regardless of whether the subgingival samples were analysed from patients with healthy or diseased periodontium suggests that this bacterial species is part of the normal oral flora of ethnic Chinese. Our preliminary results also suggested that subjects who harboured the mildly toxic strain of A. actinomycetemcomitans were potentially susceptible to aggressive forms of periodontitis.
Tongue coating and salivary bacterial counts in healthy/gingivitis subjects and periodontitis patients
Authors: Mantilla Gómez S. , Danser M. M. , Sipos P. M. , Rowshani B. , Van Der Velden U. , Van Der Weijden G. A.
Published: March 2003

Background: The papillary structure of the dorsum of the tongue forms a unique ecological site that provides a large surface area favoring the accumulation of oral debris and microorganisms. These micro‐organisms of the tongue may be of influence on the flora of the entire oral cavity. The normal appearance of the dorsum of the tongue is either pinkish or has a thin white coating. For the present study a scoring method was developed to describe the appearance of the dorsum of the tongue in relation to the extent of color and thickness of tongue coating.

Aim: The purpose of this study was to investigate the discoloration and coating of the tongue in healthy/gingivitis subjects and periodontitis patients. Furthermore, to determine the relationship between the appearance of the tongue and the bacterial load in salivary samples.

Material and Methods: 2 groups of patients were studied, 70 healthy/gingivitis subjects and 56 periodontitis patients. After scoring of the tongue a salivary sample of each patient was taken and analyzed using a phase‐contrast microscope.

Results: This investigation showed that most discoloration was found on the distal part of the tongue. The mean number of bacteria per ml sample in relation to a pink, white and yellow appearance of the tongue was 948, 855 and 900 (×106) respectively. The mean number of bacteria per ml sample in relation to no, thin and thick coating was 948, 863, and 895 (×106), respectively. Analysis did not reveal a relationship between discoloration, coating thickness and total bacterial load. The mean number of bacteria per ml in healthy/gingivitis subjects was 860 and in periodontitis patients 918 (×106).

Conclusion: No relationship between the appearance of the tongue and salivary bacterial load could be detected. There was no difference in bacterial load between the healthy/gingivitis and the periodontitis group within the present study population.
Changes in subgingival microflora and humoral immune response following periodontal therapy
Authors: Darby I. B. , Mooney J. , Kinane D. F.
Published: March 2003

Objectives: To investigate the effect of scaling and root planing (SRP) on the microflora and humoral immune response in adult periodontitis.

Materials & Methods:

Clinical measurements, subgingival plaque samples, gingival crevicular fluid and sera were taken from 4 sites in 28 adult periodontitis patients before and after SRP. Polymerase chain reaction was used to determine the presence of A. actinomycetemcomitans, P. gingivalis,B. forsythus, P. intermedia, and T. denticola. ELISA was used to investigate the systemic and local antibody titres to these organisms, and thiocyanate dissociation for the determination of serum antibody avidity.

Results: SRP produced a good clinical improvement. On a subject basis there was little significant change in the microflora. However, on a site basis, there were significant reductions in P. intermedia, B. forsythus and T. denticola. There was little change in systemic and local antibody titres following SRP, although there was a significant reduction in antibody avidity to P. gingivalis and P. intermedia

Conclusion: Post‐therapy clinical improvement was associated with a reduction in bacterial prevalence, but statistical significance was only reached at a site level and this microbial reduction was not significant for all organisms. No significant post‐therapy effects on the humoral immune response were noted other than a reduced antibody avidity to P. gingivalis and P. intermedia. The lack of a clear pattern in the humoral immune response may reflect a failure of the host response to produce adequate levels of biologically functional antibodies, and complex interactions between the subgingival flora and the host response.
Testing the efficacy of 2 prototype brush heads for a powered toothbrush: refining the model
Authors: McCracken G. I. , Heasman L. , Stacey F. , Steen N. , De Jager M. , Heasman P. A.
Published: March 2003

Objectives: To compare 2 prototype powered toothbrush (PTB) heads (A, B) to a marketed head (Sensiflex 2000) for plaque removing efficacy on the Philips/Jordan HX2550 PTB.

Materials and Methods: A 2‐week, 3‐group, single‐blind trial recruited 78 volunteers (18–25). Plaque indices (PIs) were recorded at screening and 14 days later at baseline. Subjects were stratified (gender and PI) and then asked to abstain from oral hygiene measures for 48 h. A supervised episode of brushing with the allocated PTB head followed. Subjects then used the PTBs at home for the next 12 days before being asked to abstain from all oral hygiene measures for another 48 h prior to a second supervised brushing episode. Plaque was scored using a new modification of the Quigley & Hein Index (PI) at full mouth (FM), interproximal (IP) and smooth surfaces (SS). PIs were recorded before and after the supervised brushing episodes to enable the means of the within subject differences (pre‐ to post‐brushing) to be compared between groups (ANOVA/t‐tests).

Results: There were no significant differences in PI between groups at baseline or prior to the supervised brushings (p>0.05). Highly significant, mean reductions in PIs (approximately 1/2 of one PI unit) were observed for design B compared with the Sensiflex 2000 at FM and IP sites (p<0.0001) for both supervised brushing episodes. A significant reduction in PI at SS was seen only after the first brushing episode (p=0.0004). For design A, PI reductions were consistently greater than those for the Sensiflex 2000 but differences were only significant at the p<0.05 level.

Conclusion: It is concluded that this model of clinical trial has sufficient power to demonstrate clinical superiority with respect to plaque removal for PTBs and can be used for testing one or more prototype designs of brush heads.
The effects of subgingival calculus on the clinical outcomes of locally‐delivered controlled‐release doxycycline compared to scaling and root planing
Authors: Johnson Lonnie R. , Stoller Norman H. , Polson Alan , Harrold Charles Q. , Ryder Mark , Garrett Steve
Published: March 2003

Background, aim: The effect of subgingival calculus on the clinical outcomes of the local delivery of antimicrobials is unknown. This study examines the clinical outcomes of treatment with locally delivered controlled‐release doxycycline (DH) or scaling and root planing (SRP) in subsets of adult periodontitis patients with known baseline levels of subgingival calculus.

Methods: The data examined were obtained from 393 patients who participated in 2 multi‐center trials. All patients had baseline subgingival calculus levels assessed and were then treated at baseline and month 4 with either DH or SRP. Clinical attachment levels (CAL), pocket depth (PD) and bleeding on probing (BOP) were assessed at baseline and months 1, 2, 4, 5, 6, 8 and 9.

Results: Treatment with either DH or SRP resulted in significant statistical and clinical improvements in CAL, PD and BOP. These clinical outcomes were equivalent regardless of the extent of subgingival calculus present at baseline.

Conclusions: The results indicate that the primary clinical effects of these therapies are the result of a disruption and reduction of the subgingival plaque and not the effect of the removal of subgingival calculus and contaminated cementum.
Subgingival microbial profiles in refractory periodontal disease
Authors: Socransky Sigmund S. , Smith Claire , Haffajee Anne D.
Published: March 2003

Background/aim: The purpose of the present investigation was to examine subgingival microbial profiles associated with refractory periodontitis and to seek such profiles in periodontally healthy, periodontally well‐maintained elder and untreated periodontitis subjects.

Methods: 36 subjects were defined as refractory on the basis of further attachment loss after scaling and root planing, surgery and systemically administered antibiotics. A total of 890 subgingival plaque samples (mean/subject=24.7) were taken from the mesial aspect of each tooth in each subject at baseline and individually processed for their content of 40 subgingival taxa using checkerboard DNA‐DNA hybridization. Cluster analysis was performed on mean within subject species counts using the chord coefficient and an average unweighted linkage sort. Significant differences among clusters for individual and complexes of species were sought using the Kruskal Wallis test. The microbial profiles of the refractory subjects were compared with those of 27 periodontally healthy subjects (n plaque samples=708), 35 periodontally well‐maintained elder subjects (n plaque samples=801) and 115 untreated adult periodontitis subjects (n plaque samples=2871).

Results: 28 of 36 refractory subjects fell into 4 clusters with >29% similarity. 10 of 40 species and 4 of 7 complexes differed significantly among clusters. Profile (Cluster) I (n=4) was characterized by high proportions of “yellow” and “green” complex species, profile II (n=3) by low total counts and high proportions of “orange” and “purple” complex species, profile III (n=9) by high total counts and counts of Actinomyces and “purple” complex species, profile IV (n=12) by high proportions of “red” and “orange” complex species. The mean profiles of each cluster were subjected to cluster analysis with microbial data from 4380 (mean 24.7) baseline subgingival plaque samples from 27 periodontally healthy, 35 treated, well‐maintained elders and 115 untreated adult periodontitis subjects. 12 clusters were formed with >41% similarity. 3 of the refractory profiles were detected in 3 cluster groups. Profile II in a cluster of 1 healthy, 1 elder and 4 untreated periodontitis subjects; profile III in a cluster of 1 healthy, 2 elder and 12 periodontitis subjects; Profile IV, with 1 healthy and 5 untreated periodontitis subjects. The profile not detected in non refractory subjects was dominated by Streptococcus species. 9 clusters did not harbor refractory profiles. 11.1% of healthy, 8.6% of elder and 18.3% of periodontitis subjects were in clusters exhibiting refractory microbial profiles.

Conclusions: 4 subgingival microbial profiles were detected among refractory subjects. “Refractory microbial profiles” could be detected in subjects who had not yet exhibited refractory disease.
Cervical tooth wear and sensitivity: erosion, softening and rehardening of dentine; effects of pH, time and ultrasonication
Authors: Vanuspong W. , Eisenburger M. , Addy M.
Published: March 2003

Background: Cervical dentine wear is commonly observed and may be associated with dentine hypersensitivity. Erosion is thought to play a part in both conditions but compared to enamel has been little studied in dentine.

Aim: The aims of these studies in vitro were to: (i) determine the effects of citric acid on dentine at different pH values and over time; (ii) measure the depth of dentine demineralisation or softening using ultrasonication; (iii) determine whether softened dentine can be remineralised or rehardened using artificial saliva.

Methods: Groups of flat dentine specimens prepared from unerupted human third molar teeth were: (a) exposed to citric acid at pH 3.2 for periods up to 4 h with mineral water as control; (b) exposed to citric acid at pH 2.54, 3.2, 4.5, 5.5 and 6.0 for 2 h and then subjected to ultrasonication stepwise up to 480 s; (c) exposed to citric acid at pH 2.54, 3.2, and 4.5, placed into artificial saliva for 24 h and then subjected to ultrasonication as in (b). Loss of dentine was measured by profilometry, after, each phase of erosion, ultrasonication and immersion in artificial saliva.

Results: Depth of erosion significantly increased non‐linearly with time and significantly decreased with increasing pH. Ultrasonication had minimal albeit significant effects on control specimens. Removal of softened dentine increased with ultrasonication time. Depth of softening significantly increased with increasing erosion time to 2 h, plateauing at 2 μm. Depth of softening increased to 2 μm from pH 2.54 to pH 3.2 and decreased at higher pH values thereafter. 24 h in artificial saliva provided no protection to the soften zone against ultrasonicaion. Citric acid at all pH values and exposure times removed the dentine smear layer to expose tubules. Ultrasonication did not remove the smear layer on control specimens but removed all deposits formed after exposure to artificial saliva.

Conclusion: It is concluded that dentine is susceptible to erosion even at relatively high pH, the tubule system is readily exposed and dentine, unlike enamel, shows little propensity to remineralise.
Maintenance of periodontal attachment levels in prosthetically treated patients with gingivitis or moderate chronic periodontitis 5–17 years post therapy
Authors: Moser Peter , Hammerle Christoph H. F. , Lang Niklaus P. , Schlegel‐Bregenzer Bettina , Persson Rutger
Published: March 2003

Objectives: The present retrospective analysis was performed to evaluate the long‐term results of initial periodontal and fixed prosthodontic treatment in patients with gingivitis or moderate chronic periodontitis during post‐therapeutic irregular maintenance of 5–17 years.

Material and methods: Thirty‐four patients participated in the study. Baseline data were taken from the patients' records when the periodontal and the prosthetic treatment was finished. A follow‐up examination was performed in conjunction with the radiographic examination including assessment of plaque, bleeding on probing, probing pocket depth, recession and probing attachment loss. Information regarding the oral hygiene habits of the subjects as well as the amount of dental and initial therapy received between the observation time was obtained from the patients' records.

Results: The results from the clinical trial revealed that during the mean examination period of 11 years only 31 teeth were lost. The remaining restored and non‐restored teeth did not show any significant differences in attachment loss (from 2.9 mm to 3.0 mm) in spite of a higher plaque value at the follow‐up examination (from 42% to 48%). The BoP remained stable in the same time period and scored 31% to 28%.

Conclusions: The periodontal attachment levels were maintained during a prolonged period despite irregular maintenance care. This indicates that in a population of obviously decreased susceptibility to chronic periodontitis, it is possible that fixed reconstructions will not − even under suboptimal supportive care — jeopardize the periodontal status.
Learning root debridement with curettes and power‐driven instruments
Authors: Rühling A. , Schlemme H. , König J. , Kocher T. , Schwahn C. , Plagmann H. C.
Published: March 2003

Background/aims: In a dummy‐head trial, we assessed how effectively untrained operators were able to learn scaling with curettes and power‐driven instruments.

Methods: Two untrained operator groups (n = 11 each) received six 2‐h lessons during a 10‐week period following a training program. Subgingival scaling was performed with curettes (GRA) and a power‐driven system (PP). At 6 test days each subject had to instrument 10 test teeth. The percentage of debrided area was assessed with an image analysis program. Learning success was measured as a percentage of debrided root area and scaling time. Furthermore, the effectivity was related to difficulty in anatomical situations and access to root surfaces. Statistical analysis was carried out with SPSS.

Results: At baseline, effectivity was 63.1% (GRA) vs. 52.3% (PP). Between weeks 9 and 11, operators reached a plateau for group GRA at 84.7% and group PP at 81.3%. Scaling time did not differ between the two groups. Debridement of teeth with complex root shapes that were hard to access was less effective with the power‐driven system.

Conclusion: Independent of the instrument used, untrained operators were only able to debride root surfaces at low levels of efficacy. With systematical training, effective scaling with the power‐ driven system was as easy to learn as with hand instruments. On root surfaces with complicated shape and anatomy or difficult accessibility, the power‐driven system works significantly less effectively.
Effect of initial periodontal therapy on sulcular/tongue sulfide level
Authors: Morita Manabu , Wang Hom‐Lay
Published: March 2003

Background : Volatile sulfur compounds (VSC), such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide, are toxic metabolites produced by periodontal pathogens. These VSC are also released from the tongue dorsum. Currently, limited data are available on how periodontal treatments may affect sulcular/tongue sulfide level. The aim of this study was to determine effect of initial therapy including oral hygiene instruction and scaling and root planing (SRP) on sulcular/tongue sulfide level.

Methods : Thirteen subjects diagnosed with chronic periodontitis and having three representative periodontal pocket depth (PD) strata in one quadrant (PD ≤ 3.0 mm: healthy, 4.0 mm ≤ PD ≤ 6.0 mm: moderate, and PD ≥ 7.0 mm: severe disease sites) were selected. Clinical periodontal parameters were recorded at baseline and 3 weeks after completion of the initial therapy. The sulfide levels in three representative periodontal pockets (pS) and on three parts (anterior, middle, and posterior) of the tongue dorsum (tS) were measured using a commercial sulfide‐monitoring device.

Results : The pS levels of the three representative sites were reduced significantly following the initial therapy (p < 0.05). However, there was no significant reduction of the tS level in all three parts of the tongue.

Conclusions : The initial periodontal therapy such as oral hygiene and SRP reduces the sulcular sulfide level but not the tongue sulfide level. This suggests that sulcular sulfide level may be a possible indicator for assessing the outcome of initial periodontal treatment.
Efficacy of a prototype brush head for a powered toothbrush
Authors: McCracken G. I. , Chapple I. L. , Milward M. , Steen N. , DeJager M. , Heasman P. A.
Published: March 2003

Primary objective: To evaluate a multicentre clinical trial design for testing powered toothbrushes.

Secondary objective:  To compare the efficacy of a prototype brush head (N2.3) for the Philips Jordan Sensiflex 2000 powered toothbrush (PTB) to that of Braun Oral‐B D15 PTB in removing dental plaque

Material and methods:  137 volunteers (ages 18–25 years) were recruited to this 3‐centre, 2‐week, 2‐group, 2‐treatment, single‐blind trial. Plaque was recorded at screening and again 14 days later at baseline. Stratification of subjects, for gender and screening PI, occurred at baseline. Subjects were then asked to abstain from all oral hygiene measures for 48 h followed by a supervised episode of brushing for 3 min with the allocated PTB. The allocated PTB was used at home for the next 12 days before a second abstinence from all oral hygiene measures for the 48 h prior to a second supervised brushing episode. Plaque levels were scored using a modification of the Quigley & Hein plaque index (PI) at full mouth (FM), interproximal (IP) and smooth surfaces (SS). To enable the means of the within subject differences (pre to postbrushing) to be compared between groups PIs were recorded before and after the supervised brushing episodes, differences between centres, groups and visits were examined.

Results: No significant differences in PI between groups at screening, baseline or prior to the supervised brushings were detected (P > 0.05 anova). The results of the analysis of variance showed there to be a highly significant difference (P < 0.001) between brushing groups, but, significant differences between centres (P < 0.001) and a significant interaction effect between centre and brushing group (P < 0.001) was also detected. Therefore the difference between groups was not present at all three centres. Further examination of the single centre data showed there to be greater levels of plaque removed by the N2.3 compared to the D15 (FM reduction in PI 1.95 vs. 1.13, respectively) at centre 3 in contrast to the other two centres where no difference was detected. The precise reason for these differences could not be established.

Conclusions:  A multicentre study design is applicable for evaluating PTBs but a minimum of 3 centres should be included so that differences between centres can be identified. The prototype brush head N2.3 for the Philips Jordan Sensiflex 2000 PTB has comparable plaque removal efficacy to the Braun Oral‐B D15 PTB at FM, IP and SS sites.
Antibody‐based diagnostic for ‘refractory’ periodontitis
Authors: Levine M. , LaPolla S. , Owen W. L. , Socransky S. S.
Published: March 2003

Objective: About 10–15% of US adults are ‘refractory’ to therapy for chronic periodontitis. Recently, studies suggest that these patients have elevated lysine decarboxylase activity in the sulcular microbiota. The aim of this study was to determine whether an elevated IgG antibody response to lysine decarboxylase, alone or with antibody to other bacterial antigens and baseline clinical measurements, would predict ‘refractory’ patients with high accuracy.

Methods: Chronic periodontitis patients were treated using scaling and root planing (SRP) followed by maintenance SRP and 3‐monthly re‐examinations. If there was a loss of mean full mouth attachment or more than three sites appeared with > 2.5 mm new loss within a year, the subjects were re‐treated (modified Widman flap surgery and systemically administered tetracycline). If attachment loss as above recurred, the subjects were ‘refractory’. Baseline clinical measurements and specific antibody responses were used in a logistic regression model to predict ‘refractory’ subjects.

Results: Antibody to a peptide portion of lysine decarboxylase (HKL‐Ab) and baseline bleeding on probing (BOP) prevalence measurements predicted attachment loss 3 months after initial therapy [pIAL = loss (0) or gain (1)]. IgG antibody contents to a purified antigen from Actinomyces spp. (A‐Ab) and streptococcal d‐alanyl glycerol lipoteichoic acid (S‐Ab) were related in ‘refractory’ patients (R2 = 0.37, p < 0.01). From the regression equation, the relationship between the antibodies was defined as linear (pLA/S‐Ab = 0) or non‐linear pLA/S‐Ab = 1). Using pLA/S‐Ab, pIAL and age, a logistic regression equation was derived from 48 of the patients. Of 59 subjects, 37 had 2–4 mm attachment loss and were assigned as ‘refractory’ or successfully treated with 86% accuracy.

Conclusion: HKL‐Ab facilitated an accurate prediction of therapeutic outcome in subjects with moderate periodontitis.