bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Periodontitis and Hyperlipidemia: Cause or Effect?
Authors: Cutler Christopher W. , Shinedling Edward A. , Nunn Martha , Jotwani Ravi , Kim Byung‐Ock , Nares Salvador , Iacopino Anthony M.
Published: February 2005

Background: Epidemiological studies suggest a relationship between periodontitis and coronary artery disease, but the mechanism has not been established. Recent studies in animals indicate that low dose endotoxin, as in a Gram‐negative infection, can induce hyperlipidemia and myeloid cell hyperactivity. The association between periodontitis, systemic exposure to Porphyromonas gingivalis, lipopolysaccharides (LPS), and hyperlipidemia has not been examined in humans.

Methods: Sera were obtained from 26 adult periodontitis patients and 25 healthy control (C) subjects selected from patients and staff. Serum antibodies against Porphyromonas gingivalis and its LPS were analyzed by enzyme‐linked immunosorbent assay (ELISA) and Western blotting, respectively. Serum triglycerides (TG) and cholesterol (CHOL) were assayed by a commercial laboratory. The associations between AP and blood levels of TG, CHOL, and anti‐P. gingivalis whole cells and LPS were examined by logistic regression analysis. Peripheral blood polymorphonuclear leukocytes (PMNs) from 6 healthy fasted donors were incubated with purified TG (0.1 mg/ml) for 2 hours at 37°C, stimulated with 100 ng/ml P. gingivalis LPS, and the release of IL‐1β measured by ELISA.

Results: The presence of periodontitis was significantly associated with age (odds ratio = 3.5, P = 0.04), elevated TG levels (odds ratio = 8.6, P = 0.0009), elevated CHOL levels (odds ratio = 7, P = 0.004), elevated ELISA titer (odds ratio = 35, P = 0.003) and reactivity with P. gingivalis LPS (odds ratio = 41, P = 0.001). PMNs from all 6 healthy patients released modest levels of IL‐1β (10 to 60 pg/ml) when stimulated with 100 ng/ml P. gingivalis LPS. Addition of TG resulted in a significant increase (P <0.05) in IL‐1β secreted that ranged from 7 to 150% over LPS alone. No IL‐1β was elicited by TG or vehicle alone.

Conclusions: The results of this study indicate the presence of a significant relationship between periodontitis, hyperlipidemia, and serum antibodies against P. gingivalis LPS that warrants further examination in a larger patient population. Furthermore, these studies indicate that elevated triglycerides are able to modulate IL‐1β production by PMNs stimulated with P. gingivalis LPS. J Periodontol 1999;70:1429‐1434.
Effects of Butyrate and Propionate on the Adhesion, Growth, Cell Cycle Kinetics, and Protein Synthesis of Cultured Human Gingival Fibroblasts
Authors: Jeng Jiiang‐Huei , Chan Chiu‐Po , Ho Yuan‐Soon , Lan Wan‐Hong , Hsieh Chi‐Chuan , Chang Mei‐Chi
Published: February 2005

Background: Various periodontal and root canal pathogens, such as the Bacteroides species, can produce significant amounts of short chain fatty acids (SCFA). The roles of SCFA in the pathogenesis of periodontal disease are still not fully understood.

Methods: We therefore investigated 2 main SCFA, butyrate and propionate, on the functional behavior of cultured human gingival fibroblasts (GF) such as cell growth, protein synthesis, cell adhesion capacity, and cell cycle progression.

Results: Butyrate and propionate inhibited the growth of healthy (HGF) and inflamed gingival fibroblasts (IGF) in a dose dependent manner. At concentrations of 4, 8, and 16 mM, butyrate suppressed the cell growth by 11 to 58%, 16 to 60%, and 50 to 71%, respectively. The response of cultured gingival fibroblasts to SCFA showed individual differences. Morphologically, GF became larger and more flattened in appearance following exposure to butyrate (>8 mM) and propionate (>24 mM) for 5 days. Inhibitory effects of butyrate (>2 mM) and propionate (>8 mM) on the growth of GF were due possibly to their inhibition of cell‐cycle progression. At concentrations of 2 and 8 mM, butyrate led to G0/G1 arrest. Elevation of the exposure concentration to 8 to 24 mM further result in G2/M phase arrest of GF. On the other hand, propionate, at concentrations ranging from 4 to 24 mM, led to G0/G1 arrest. Butyrate (>2 mM) inhibited the proline‐rich protein synthesis of GF. At concentrations of 4, 8, 16, and 24 mM, butyrate inhibited the protein synthesis of HGF‐1 by 42%, 43%, 51%, and 54%, respectively. In all strains of cultured GF, the suppressive effect of propionate is less than that of butyrate. At concentration range of 4 to 24 mM, propionate suppressed the protein synthesis of HGF‐1 by 23 to 43%. However, both butyrate and propionate (4 to 48 mM) exerted little effects on the adhesion of GF to type I collagen within 3 hours of incubation.

Conclusions: These results suggested that SCFA released by pathogenic microorganisms can contribute to the gingival tissue dysfunction and breakdown through their actions on specific biological functions of GF. J Periodontol 1999;70:1435‐1442.
Periodontal Findings and Systemic Antibody Responses to Oral Microorganisms in Behçet's Disease
Authors: Çelenligil‐Nazliel Haviye , Kansu Emin , Ebersole Jeffrey L.
Published: February 2005

Background: Behçet's disease is a multisystem disorder of unknown etiology, affecting predominantly the oral mucosa, skin, and eyes. Recurrent and painful episodes of oral ulcerations interfere with regular oral hygiene leading to rapid bacterial plaque accumulation. The aims of this study were to evaluate the periodontal status of patients with Behçet's disease and determine serum antibody responses to selected oral microorganisms, including major periodontopathogens in these patients.

Methods: Thirty‐three patients with Behçet's disease and 15 healthy subjects were included in the study. Plaque, sulcular bleeding, periodontal index scores, probing depths, and total number of teeth were recorded. Serum IgG antibody levels to a panel of 13 oral microorganisms were determined.

Results: Significantly higher values for each of the clinical measures were observed in patients with Behçet's disease compared to healthy subjects (P <0.0001). Antibody levels to selected members of plaque, including Actinomyces viscosus, Streptococcus mutans, Streptococcus sanguis, Streptococcus oralis, Eikenella corrodens, Campylobacter rectus, and Prevotella intermedia were significantly lower in patients with Behçet's disease than in controls (P <0.001‐0.05). In contrast, these patients exhibited significantly elevated antibody levels to Actinobacillus actinomycetemcomitans Y4 compared to controls (P <0.01).

Conclusions: Our data indicate that the patients with Behçet's disease generally exhibit clinical findings of established periodontal disease. Decreased antibody responses to early colonizers of both supra‐ and subgingival plaque were observed along with the elevation in antibody levels to A. actinomycetemcomitans. These results suggest that the bacterial plaque ecology and/or immune responses to these microorganisms may be affected in Behçet's disease which could lead to changes in the expression of periodontal disease. J Periodontol 1999;70:1449‐1456.
Increased Interleukin‐1β Concentration in Gingival Crevicular Fluid as a Characteristic of Periodontitis
Authors: Figueredo C.M.S. , Ribeiro M.S.M. , Fischer R.G. , Gustafsson A.
Published: February 2005

Background: The levels of interleukin‐1β (IL‐1β) have been reported to be higher in sites with periodontitis than in healthy controls. This may be the result of a more severe inflammation and/or constitutional differences in IL‐1β production. Our aim was to test the hypothesis that the level of IL‐1β in gingival crevicular fluid (GCF) is a characteristic trait of periodontitis, regardless of the degree of tissue destruction. As a secondary aim, we investigated the correlation between IL‐1β and neutrophil elastase. An untreated population was used.

Methods: GCF samples from inflamed sites in 13 patients with gingivitis (GG), and from inflamed sites with shallow (GP) and deep (PP) pockets in 18 patients with periodontitis were collected. Interleukin‐1β, elastase‐α‐1‐antitrypsin complex (E‐A1AT), α‐1‐antitrypsin (A1AT), and α‐2‐macroglobulin (A2MG) were measured with ELISA. Elastase activity was measured with a specific substrate.

Results: The concentration of IL‐1β was significantly higher in PP than in GG, but no significant differences were detected between PP and GP. A weak positive correlation between the elastase activity and IL‐1β was also observed. The elastase activity had a tendency to be higher in PP, although no significant difference was found among the 3 groups. The concentrations of E‐A1AT, A1AT, and A2MG were similar in the 3 types of sites.

Conclusions: The levels of IL‐1β in GCF were increased in samples from periodontitis patients, regardless of the severity of disease at the sampled site, suggesting that the levels of IL‐1β are typical of a given patient. J Periodontol 1999;70:1457‐1463.
Evidence for Healing of Class II and Class III Furcations 24 Months After Guided Tissue Regeneration Therapy: Digital Subtraction and Clinical Measurements
Authors: Eickholz Peter , Hausmann Ernest
Published: February 2005

Background: The aim of this study was to compare bone regeneration as assessed by subtraction radiography with clinical attachment measurements 24 months after regenerative surgery.

Methods: In 24 patients with advanced periodontitis, 34 Class II and 10 Class III furcations were treated by guided tissue regeneration using expanded polytetrafluoroethylene (n = 18) or bioabsorbable barriers (n = 26). Clinical parameters were assessed and 40 pairs of standardized radiographs were taken before and 24 months after surgery. Bony gain within furcations was assessed using subtraction analysis.

Results: In Class II furcations, statistically significant (P <0.001) vertical (CAL‐V: 1.06 ± 1.56 mm) and horizontal (CAL‐H: 2.05 ± 1.24 mm) attachment gain was observed 24 months postsurgically. Within Class III defects CAL‐V gain was assessed 1.78 ± 1.43 mm (P <0.005). CAL‐H gain in buccal and lingual Class II furcations was explained by the relative density gain, baseline CAL‐H, gingival index (GI) reduction, and individual patients (P <0.001) whereas, multiple regression analysis failed to show a relation between CAL‐H gain and any of the subtraction parameters for interproximal furcations. Vertical attachment gain in interproximal sites was explained by net bony area gain (subtraction), PD and GI reduction, baseline CAL‐V, defect type, smoking, and individual patients (P <0.001).

Conclusions: There was a statistically significant correlation between clinical and radiographic improvements within furcation defects. However, this correlation was modulated by other factors such as baseline CAL‐V or CAL‐H, PD and GI reduction, or smoking. The relative density gain seemed to sufficiently describe bony changes related to clinical changes within buccal and lingual furcations, whereas bone area gain suitably described bony changes in interproximal Class II and III furcations. J Periodontol 1999;70:1490‐1500.
Role of Intramarrow Penetration in Osseous Repair: A Pilot Study in the Rabbit Calvaria
Authors: Majzoub Zeina , Berengo Mario , Giardino Roberto , Nicoli Aldini Nicolò , Cordioli Giampiero
Published: February 2005

Background: The use of intramarrow penetration in combination with osseous reconstructive surgery has been recommended in various periodontal and oral surgical applications. The purpose of this pilot study was to evaluate the effect of intramarrow penetration on the rate of bone neogenesis in protected spaces created on the calvarial bone using occlusive titanium domes in 16 adult white rabbits.

Methods: In each rabbit, 2 standardized circular 1 mm deep slits were prepared in the bone, one on each side of the midline using a trephine. Within the perimeter of one of the slits, the external cortical surface of the skull bone was mechanically perforated using a carbide round bur (experimental site), while the bone surface within the other slit (control site) was left intact. Subsequently, 2 prefabricated titanium domes with an inner diameter of 4.8 mm and an inner height of 3.0 mm were anchored in the prepared slits. The animals were divided into 4 groups of 4 rabbits each and were sacrificed at 10, 21, 42, and 60 days. The specimens were assessed for the percentage bone fill and density of the newly formed bone within the boundaries of the domes.

Results: Histomorphometric analysis showed significantly increased bone neogenesis within the experimental domes at 10, 21, 42, and 60 days. A mean total area of 29% newly formed bone was demonstrated in the experimental sites at 21 days, while negligible bone formation (9%) occurred with the control domes at the same evaluation interval. Bone density was consistently higher in experimental domes at all healing intervals.

Conclusions: Within the limits of this study, the results demonstrate that intramarrow penetration accelerates initial bone neogenesis and results in increased bone fill and density, suggesting that its use can be beneficial in bone regenerative procedures. J Periodontol 1999;70:1501‐1510.
A Comparison of Endosseous Dental Implant Surfaces
Authors: Cochran David L.
Published: February 2005

Endosseous dental implants are available with various surface characteristics ranging from relatively smooth machined surfaces to more roughened surfaces created by coatings, blasting by various substances, by acid treatments, or by combinations of the treatments. Studies characterizing these implants and surfaces include in vitro experimentation, animal studies, and human clinical trials. Both descriptive and functional testing of the bone‐implant interface includes histomorphometrics and biomechanical testing such as torque removal values and push out/pull out strength. Using these assays to evaluate and compare different surfaces, the data demonstrate that rough implant surfaces have increased bone‐toimplant contact and require greater forces to break the bone‐implant interface compared to more smooth surfaces. The objective of this report was to evaluate publications of human clinical experiences evaluating implant use in patients and to determine if differences existed in success rates of implants with relatively smooth surfaces compared to implants having roughened implant surfaces. Human trials were reviewed to determine the clinical efficacy of implants under various clinical indications. Synopsis tables were constructed and the experiences segregated by implant surface characteristics. Meta‐analyses were performed on all implants in all locations, on implants placed only in the maxilla or the mandible, and, finally, on implants placed in the maxilla compared to implants placed in the mandible. Evaluation of the data revealed that predictably high success rates can be achieved for implants with both rough and smooth titanium surfaces and for hydroxyapatite‐coated implants. When studies were clustered by specific indications or patient populations, rough surfaced implants had significantly higher success rates compared to implants with more smooth surfaces except in the case of single tooth replacements where the success rates were comparable. In general, implants placed in the mandible had significantly higher success rates than implants placed in the maxilla. However, in the partially edentulous patient group, titanium implants with a rough surface had significantly higher success rates in the maxilla compared to the mandible and, in cases of single tooth replacement, success rates were similar in the maxilla and in the mandible as was the case for hydroxyapatite‐coated implants. The documented advantage of implants with a roughened surface in animal and in vitro experiments has been demonstrated in clinical cases when studies were compared in which specific indications or patients were treated. Additionally, implants placed in the mandible have, in general, higher success rates than implants placed in the maxilla, with only a few exceptions noted. These data from human clinical experiences support the documented advantage of implants with a roughened surface in animal and in vitro experimentation and indicate that the magnitude of the advantage is significant for patient care. J Periodontol 1999;70:1523‐1539.
A Minimally Invasive Surgical Approach for Periodontal Regeneration: Surgical Technique and Observations
Authors: Harrel Stephen K.
Published: February 2005

Increasingly, patients referred to periodontists have undergone some form of non‐surgical periodontal treatment prior to their referral. As a result of this, there is an increased need to treat isolated, rather than generalized, periodontal defects. A surgical technique that utilizes small incisions and a limited access approach for treating isolated periodontal defects is described. Results from the use of the minimally invasive surgical (MIS) technique for periodontal regeneration in a comparison study appear to be similar to those where a more traditional surgical approach has been used. Some of the apparent advantages and disadvantages of using the MIS approach are discussed. J Periodontol 1999;70: 1547‐1557.
Radiological Findings of the Post‐Sinus Lift Maxillary Sinus: A Computerized Tomography Follow‐Up
Authors: Peleg Michael , Chaushu Gavriel , Mazor Ziv , Ardekian Leon , Bakoon Mati
Published: February 2005

The purpose of this paper is to present radiological findings of a short‐term (8 to 10 months) computerized tomography (CT) follow‐up study on 1‐stage maxillary sinus lift cases. Pre‐ and postoperative dental CT scans of 21 patients (24 sinuses) after sinus lift procedures were compared. CT scans were used to assess newly formed bone and its interface with the implants, condition of the sinus membrane, evidence of buccal window cortication, and presence of any sinus pathology. Of the 57 implants placed, 28 had bone fully covering the implant on all sides which did not extend above the apical portion; 20 had bone fully covering the implant which did extend above the apex; and 9 exhibited incomplete bone coverage. All implants supported a fixed ceramo‐metal prosthesis, and no implant failures were recorded after 3 years follow‐up. There was evidence of cortication of the buccal window in 10 sinuses; in the 14 remaining sinuses, bone consolidation on the buccal aspect was evident, but no evidence of cortication was seen. All sinuses healed without complications or clinical signs of sinusitis. In 11 sinuses, no changes in membrane thickness were noted. Membrane thickness decreased postoperatively in 12 sinuses, and in one, there was evidence of membrane thickening. Bone cortication the anterior wall window may serve as an indicator for the remodeling status of the entire graft. Postoperative findings showed a significant improvement in overall membrane thickness. No clinical symptoms of sinusitis were evident, indicating that sinus lift procedures can be considered safe and not predispose the sinus to acute or chronic sinusitis. J Periodontol 1999;70:1564‐1573.
Microbiota of Successful Osseointegrated Dental Implants
Authors: Lee K.H. , Maiden M.F.J. , Tanner A.C.R. , Weber H.P.
Published: February 2005

Background: The long‐term survival of dental implants depends, in part, on control of bacterial infection in the peri‐implant region. Periodontal pathogens colonized implants symptomatic through infection, whereas the microbiota of successful implants was similar to that of periodontal health. This study examined the impact on the peri‐implant microbiota of crown restorations; implant type; length of time of loading; history of implant or periodontal infections; and whether implants replaced single or multiple teeth. It was of particular interest to evaluate implant colonization by species in a newly described red complex of periodontal pathogens, Porphyromonas gingivalis and Bacteroides forsythus.

Methods: This study sampled 43 partially edentulous subjects with successfully osseointegrated titanium root‐form dental implants. Eighty‐one (81) non‐submerged and 20 submerged asymptomatic implants, 83 crowned, and 36 uncrowned teeth were sampled from peri‐implant or subgingival sites. The microbiota of samples was evaluated using whole genomic DNA probes in a checkerboard assay to 23 subgingival species.

Results: Implants were colonized principally by oral streptococci, capnocytophagae, Veillonella parvula, Peptostreptococcus micros, and Fusobacterium nucleatum. The periodontal species, P. gingivalis, B. forsythus, Prevotella intermedia, Prevotella nigrescens, andCampylobacter rectus were detected in a few subjects. The microbiota around crowned implants and crowned teeth was similar. Streptococcus oralis, P. intermedia, and Selenomonas noxia were elevated in samples from uncrowned teeth compared to crowned teeth and implants. Microbial complexity increased as loading time increased, but colonization by periodontal pathogens, including red complex species, was higher in subjects with previous periodontal disease. No differences were observed in the microbiota of 1‐ and 2‐stage implants, or between implants supporting single or multiple restorations.

Conclusions: While presence of crowns had only a minor impact on the peri‐implant microbiota, microbial changes were observed the longer the implants had been in function and in those patients with a history of periodontal or peri‐implant infections. A history of periodontitis had a greater impact on the peri‐implant microbiota than implant loading time. The major influence on the peri‐implant microbiota was, however, the microbiota on remaining teeth. P. gingivalis and B. forsythus, red complex periodontal pathogens, colonized several implants, although all implants were successfully osseointegrated. J Periodontol 1999; 70: 131‐138.
Comparison of Enamel Matrix Proteins and Bioabsorbable Membranes in the Treatment of Intrabony Periodontal Defects. A Split‐Mouth Study
Authors: Sculean Anton , Donos Nikolaos , Blaes Anja , Lauermann Markus , Reich Elmar , Brecx Michel
Published: February 2005

Background: Enamel matrix proteins (EMP) have recently been introduced as a new modality for regenerative periodontal treatment. However, limited information is available concerning the comparison of the treatment of intrabony periodontal defects with enamel matrix proteins and other regenerative treatment alternatives.

Methods: The aim of the present controlled clinical trial was to compare the treatment of deep intrabony periodontal defects with EMP to that with guided tissue regeneration (GTR) with bioabsorbable membranes. Sixteen patients, each of whom displayed one pair of intrabony defects located contralaterally in the same jaw, were randomly treated with EMP or with a bioabsorbable membrane. Prior to surgery and 8 months later the following parameters were evaluated by a blinded examiner: Plaque index (PI), gingival index (Gl), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Antibiotics (amoxicillin and metronidazole) were given during the first 10 days after surgery. No statistical significant differences in any of the investigated parameters between the 2 groups were observed at baseline.

Results: No serious adverse events (e.g., allergic reactions or abscesses) after any of the treatments were noted during the entire observation period. Membrane exposure occurred in 7 out of the 16 GTR treated sites. Clinical examination was performed again 8 months postoperatively. Sites treated with EMP demonstrated a reduction of PD from 8.1±1.7 mm to 4.3±1.2 mm (P <0.001) and a change in CAL from 10.3±1.8 mm to 7.2±1.2 mm (P <0.001). The sites treated with GTR showed a reduction of PD from 8.3±1.7 mm to 4.3±0.7 mm (P <0.001) and a change of CAL from 10.1±1.9 mm to 7.1±1.7 mm (P <0.001). Both treatment procedures led to significant improvements of PD and CAL. However, no statistically significant differences in any of the investigated parameters were observed between the test and control group.

Conclusions: It may be concluded that both therapies led to shortterm improvements of the investigated clinical parameters. Further studies of much higher power are needed to support equivalence. J Periodontol 1999; 70:255‐262.
A Bioactive Glass Particulate in the Treatment of Molar Furcation Invasions
Authors: Anderegg Charles R. , Alexander David C. , Freidman M.
Published: February 2005

Background: Procedures for the treatment of molar furcation invasion defects range from open flap debridement, apically repositioned flap, hemisection, tunneling or extraction, to regenerative therapies.

Methods: The results of surgical therapy consisting of the clinical parameters of probing depth and bleeding on probing were compared in 15 patients with moderate to advanced adult periodontitis. Each patient received surgical therapy consisting of regenerative therapy using bioactive glass compared to open flap debridement alone in human mandibular molar furcation defects.

Results: The results of therapy were statistically significant in the defects treated with the bioactive glass.

Conclusions: This study revealed the benefits of bioactive glass in the treatment of Class II furcation defects regarding the clinical parameters of probing depth reduction and the reduction in bleeding on probing. J Periodontol 1999;70:384‐387.
Pronounced Palatal and Mandibular Tori Observed in Patient With Chronic Phenytoin Therapy: A Case Report
Authors: Sasaki Hideki , Ikedo Dai , Kataoka Masatoshi , Kido Jun‐ichi , Kitamura Seiichiro , Nagata Toshihiko
Published: February 2005

Phenytoin, an anticonvulsant drug for epileptic patients, has many adverse effects, including calvarial thickening and coarsening of the facial features. Previous studies have demonstrated that phenytoin has an anabolic action on bone cells. This report describes pronounced palatal and mandibular tori found in a 45‐year‐old Japanese man undergoing chronic phenytoin therapy. The tori were extremely large, lobular, and symmetrical. A palatal torus appeared along the middle of the hard palate and mandibular tori consisted of 2 pairs of nodular masses extensively filling the lingual floor of the oral cavity. Pronounced osseous outgrowth occurred for the duration of a doseincrease of phenytoin from 1985 to 1997. His parents did not have any palatal or mandibular tori. These facts suggest that these unusual tori may have been the result of chronic phenytoin therapy, rather than association with the familial background. J Periodontol 1999;70:445‐448.
Comparison of Bioactive Glass to Demineralized Freeze‐Dried Bone Allograft in the Treatment of Intrabony Defects Around Implants in the Canine Mandible
Authors: Hall E. Ellen , Meffert Roland M. , Hermann Joachim S. , Mellonig James T. , Cochran David L.
Published: February 2005

Background: The purpose of this study was to evaluate and compare the healing of different bone grafting materials adjacent to titanium plasma‐sprayed (TPS) endosseous dental implants.

Methods: Implant osteotomy sites were prepared and standardized 3‐walled intrabony defects (3 mm x 5 mm x 5 mm) were created at the mesial of each implant site. Thirty‐two TPS implants were placed in edentulous mandibular ridges of the 4 dogs. Periodontal dressings were placed in the defect sites so as to create a defect simulating bone loss around an implant. After 3 months, the periodontal dressing was removed, the defect sites debrided and evaluated for size, and intramarrow penetration performed. The graft materials tested were 1) canine demineralized freeze‐dried bone allograft (cDFDBA); 2) bioactive glass granules of a broad size range 90 to 710 microns (BRG); and 3) bioactive glass granules of narrow size range 300 to 355 microns (NRG). One site on each side of the mandible was not filled and served as a control. Dogs were sacrificed 4 months after graft placement.

Results: Histologically, differences in percent bone‐to‐implant contact in the defect area were observed between the treatment groups. cDFDBA>control=BRG=NRG with statistical significance found between cDFDBA and control (P = 0.0379), but no statistically significant difference between control or either bioactive glass material. When comparing percent bone height fill of the defect in the grafted area, cDFDBA (65.7%) was significantly better than the control (48.9%; P ≤ 0.05) with no statistically significant difference between control, broad range bioactive glass (57.3%) and narrow range bioactive glass (56.6%). When total bone area was measured, the percentage of new bone in the grafted area was cDFDBA (42.1%), broad range glass (33.1%) and narrow range glass (22.6%) with significance found between cDFDBA and NRG (P = 0.0102). The content of residual graft particles in soft tissue was significant (P = 0.0304) between cDFDBA (1.4%) and NRG (11.4%) with no significant difference between graft material for residual particle content in bone tissue.

Conclusions: The results of this study indicate that percent bone‐toimplant contact and percent bone height fill in an intrabony defect around titanium plasma‐sprayed implants are statistically significantly higher with the use of DFDBA when compared to bioactive glass material. J Periodontol 1999;70:526‐535.
Adverse Effects Associated With a Bioabsorbable Guided Tissue Regeneration Device in the Treatment of Human Gingival Recession Defects. A Clinicopathologic Case Report
Authors: Tatakis Dimitris N. , Trombelli Leonardo
Published: February 2005

This clinicopathologic case report documents an adverse effect associated with the use of a polylactic acid‐based barrier in the treatment of human gingival recession defects. A total of 27 consecutively treated patients, in whom guided tissue regeneration with a polylactic acid barrier was used to correct gingival recession defects, were evaluated. This adverse effect consisted of a midradicular‐apical swelling, generally asymptomatic, with no apparent predilection for gender, age, tooth type or location (maxilla/mandible), or surgical procedure. It was observed in 14 of 27 (52%) patients and 22 of 41 (54%) defects. The swelling decreased in size over time and in most cases, it completely resolved within 12 months postsurgery. Histopathologic evaluation of a 14‐week specimen indicated characteristics (multinucleated giant cells, foamy macrophages) consistent with a foreign body reaction. These findings suggest that patients undergoing GTR procedures with synthetic absorbable devices for the treatment of gingival recession defects should be advised of the possible occurrence of such an adverse effect. J Periodontol 1999;70:542‐547.
Compliance With Supportive Periodontal Therapy. Part 1. Risk of Non‐Compliance in the First 5–Year Period
Authors: Novaes Arthur B. , Novaes Arthur B.
Published: February 2005

Background: Supportive periodontal therapy (SPT) is needed for the success of periodontal therapy; however, patient compliance is poor. This study evaluates records from non‐compliant patients in an attempt to identify a profile of patients with a higher risk of becoming non‐compliant.

Methods: Data on 874 patients who had completed active periodontal treatment up to 5 years earlier and who had begun SPT were analyzed for risk of non‐compliance. The factors evaluated were gender (326 males and 548 females); type of therapy (surgical or non‐surgical) and age (≤20; 21 to 30; 31 to 40; 41 to 50; and ≥51 years) and the relationships among them.

Results: The overall rate of non‐compliance was 46.8%, and the relative risk for non‐compliance was greater in the younger age groups (≤40 years old) when compared to the older groups. Gender, age, and type of therapy as independent factors were not significant risk factors for non‐compliance, but the association of the 3 factors produced interesting results.

Conclusions: This study suggests that certain patient groups have a higher risk of non‐compliance and that clinicians should intensify their efforts in motivating and instructing these patient groups in the importance of SPT. J Periodontol 1999;70:679‐682.
Myoepithelioma of the Gingiva. Report of a Case
Authors: Piattelli A. , Fioroni M. , Rubini C.
Published: February 2005

Myoepithelioma is a rare form of salivary gland tumor composed entirely of myoepithelial cells. It represents about 1 to 1.5% of all salivary gland tumors and is most frequently located in the parotid. The authors present a case of myoepithelioma of the gingiva. The tumor presented a focal strong positivity for cytokeratins, a diffuse positivity for S– 100 protein, and a rare focal positivity for actin. No duct formation was observed. Myoepithelioma must be differentiated from several benign and malignant epithelial and mesenchymal tumors. J Periodontol 1999;70:683‐687.
Antibody Reactive With Porphyromonas gingivalis Serotypes K1‐6 in Adult and Generalized Early‐Onset Periodontitis
Authors: Califano Joseph V. , Schifferle Robert E. , Gunsolley John C. , Best Al M. , Schenkein Harvey A. , Tew John G.
Published: February 2005

Background: Six serotypes of Porphyromonas gingivalis have recently been described. We sought to test the hypothesis that serotype specific carbohydrates from these strains are important antigens that elicit potent immune responses.

Methods: Serum concentrations of IgG reactive with P. gingivalis serotypes K1‐K6 were determined for 28 adult (AP) and 28 generalized early‐onset (G‐EOP) periodontitis patients previously determined to be seropositive for a broken cell preparation of P. gingivalis. To confirm relationships suggested for K1, K2, and K6 in the analysis of initial data, the study population was increased to 133.

Results: Frequency of seropositivity for the 6 serotypes ranged from 26 to 54% of subjects. IgG concentrations ranged from 0 to 453 μg/ml with many subjects seropositive to more than one serotype. Concentrations for the subset of patients who was seropositive were high (mean responses ranged from 20 to 105 µg/ml for the 6 serotypes). Significant correlations between seropositivity to serotypes K1 and K5 as well as between K5 and K6 were found.

Conclusions: We examined the relationship of diagnosis, race, gender, smoking, probing depth, attachment loss, and antibody reaction with the P. gingivalis serotypes by analysis of variance. Initial findings suggested potential relationships between diagnosis, smoking, race, gender, and antibody reactive with serotypes K1, K2, and K6. A significant relationship did exist between smoking and decreased antibody reactive with P. gingivalis serotype K2. No other relationships were substantiated. We also examined the IgG subclass distribution and found that responses were almost exclusively IgG2. These data support the concept that antibody responses to all 6 serotypes are common in both AP and G‐EOP and that these K serotype carbohydrates elicit potent IgG2 responses. J Periodontol 1999; 70: 730‐735.
Role of Oral Bacteria in Respiratory Infection
Authors: Scannapieco Frank A.
Published: February 2005

An association between oral conditions such as periodontal disease and several respiratory conditions has been noted. For example, recent evidence has suggested a central role for the oral cavity in the process of respiratory infection. Oral periodontopathic bacteria can be aspirated into the lung to cause aspiration pneumonia. The teeth may also serve as a reservoir for respiratory pathogen colonization and subsequent nosocomial pneumonia. Typical respiratory pathogens have been shown to colonize the dental plaque of hospitalized intensive care and nursing home patients. Once established in the mouth, these pathogens may be aspirated into the lung to cause infection. Other epidemiologic studies have noted a relationship between poor oral hygiene or periodontal bone loss and chronic obstructive pulmonary disease. Several mechanisms are proposed to explain the potential role of oral bacteria in the pathogenesis of respiratory infection: 1. aspiration of oral pathogens (such as Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, etc.) into the lung to cause infection; 2. periodontal disease‐associated enzymes in saliva may modify mucosal surfaces to promote adhesion and colonization by respiratory pathogens, which are then aspirated into the lung; 3. periodontal disease‐associated enzymes may destroy salivary pellicles on pathogenic bacteria to hinder their clearance from the mucosal surface; and 4. cytokines originating from periodontal tissues may alter respiratory epithelium to promote infection by respiratory pathogens. J Periodontol 1999;70:793‐802.
Relationships Between Longitudinal Changes in Radiographic Alveolar Bone Height and Probing Depth Measurements: Data From Postmenopausal Women
Authors: Pilgram Thomas K. , Hildebolt Charles F. , Yokoyama‐Crothers Naoko , Dotson Mary , Cohen Sheldon C. , Hauser Jay F. , Kardaris Eugenia
Published: February 2005

Background: The relationship between loss of radiographic alveolar bone height and probing attachment loss has been studied by a number of investigators, with mixed results. Recent studies have found weak correlations and have suggested that the relationship between bone loss and attachment loss is complex, perhaps because changes in bone height and attachment level are separated in time.

Methods: The 85 patients in this report were part of a prospective estrogen replacement interventional study. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure‐sensitive probe at 6 sites on each tooth. Vertical bitewing radiographs were taken of each patient, radiographs were digitized, and 6 linear measurements (corresponding to probing site measurements) were made from the cemento‐enamel junction to the alveolar crest. These procedures were performed at baseline and at annual intervals; this study reports results after 2 years. Data were analyzed both by individual site and by averaging identical sites from all measured teeth for each patient.

Results: Very weak direct relationships between change in alveolar bone height and change in attachment level were found in both the site data (r2=0.0022; P = 0.189) and the patient average data (r2=0.031;P = 0.104).

Conclusions: The changes in these patients were probably due to systemic changes in bone health rather than to periodontal disease. However, the weak correlations between changes in attachment level and bone height are similar to recent studies of periodontal disease. Our results support suggestions in the literature that the link between changes in attachment and alveolar bone height is complex, perhaps because changes in the 2 tissue types are separated by a considerable time delay. J Periodontol 1999;70:829‐833.
Use of Lyodura for Bone Augmentation of Osseous Defects Around Dental Implants
Authors: Peleg Michael , Chaushu Gavriel , Blinder Daniella , Taicher Shlomo
Published: February 2005

Background: Lyodura has been used in periodontology and maxillofacial surgery to overcome different clinical conditions. The use of lyodura to induce new bone formation in humans has not been widely reported. The purpose of this article is to describe the use of lyodura as a resorbable barrier to promote bone formation in osseous defects around dental implants.

Methods: The study group consisted of 22 healthy patients (12 women and 10 men), with a mean age of 32 (range 20 to 45). A total of 44 implants (9 titanium screw‐type and 35 hydroxyapatitecoated cylinder implants) were placed. Of these, 27 implants were placed in the maxilla and 17 in the mandible. At 27 extraction sites bony vertical defects were measured on the buccal, lingual, mesial and distal sides of the implant. In the remaining 17 cases, where either immediate or staged implantation was performed, and a dehiscence was present, its vertical length was measured from the alveolar crest. All bony defects were grafted with autogenous bone harvested from the tuberosity. Each site was covered with lyodura.

Results: Healing was uneventful; no inflammation, infection, or soft tissue dehiscence was observed. At all extraction sites and in 76% of the dehiscence defects, hard tissue appearing clinically similar to bone completely filled the defect. Of those defects not completely filled, a mean vertical bone increase of 2.5 mm was recorded. A mean vertical bone increase of 2.6 mm was achieved at extraction sites and a mean increase of 2.79 mm was achieved at dehiscence sites.

Conclusions: Lyodura can safely and effectively be used for guided bone regeneration at both extraction sites and for dehiscence defects. J Periodontol 1999;70:853‐860.
Long‐Term Evaluation of 282 Implants in Maxillary and Mandibular Molar Positions: A Prospective Study
Authors: Becker William , Becker Burton E. , Alsuwyed Abdulaziz , Al‐Mubarak Sultan
Published: February 2005

Background: Placement of implants into molar positions presents diagnostic, surgical and prosthetic challenges. There are few reported studies for implants placed into molar positions. The purpose of this prospective longitudinal study is to report long‐term clinical outcomes for 282 implants placed into molar positions.

Methods: Two‐hundred‐twelve patients received 282 implants. Implant size, location, jaw shape, and bone quality were recorded for all implants placed into molar positions. Seventy implants were inserted in maxillae and 212 in mandibles. Marginal bone level changes in maxillae and mandibles were measured from non‐standardized periapical radiographs taken at abutment connection and an average follow‐up of 3.9 years. Mesial‐distal implant measurements were made from the top of the implant cylinder to the first point of bone to implant contact. In mandibles, 39 implants were used for single molar replacements, 67 implants were placed into excellent bone quality (type I) and 113 were in good bone quality (type II); 145 implants were placed into bone with moderate bone resorption (type B); 166 implants were placed in first molar positions and 46 in second molar sites.

Results: At 6 years the cumulative success rate (CSR) for mandibular implants is 91.5%, and the success rate from the 2 to 3 year follow‐up is 100%. Of the 70 implants placed in maxillae, 16 replaced single molars. Thirty‐two implants were placed in jaw shape B with type 2‐bone quality. For maxillary implants, the 6‐year CSR was 82.9% and the success rate remained steady at 100% after the 2 to 3 year follow‐up. For maxillary implants, at abutment connection the average marginal bone level was 1.67 mm, while at follow‐up it was 1.98 mm. These differences were statistically significant (P = 0.04), but are not considered to be clinically significant. For mandibular implants, at abutment connection the mean marginal bone level as measured from radiographs was 2.11 mm, and at follow‐up was 2.02 mm. This slight gain in bone level was not statistically significant and is not considered to be clinically significant.

Conclusions: Results of this prospective longitudinal study of implants placed into molar positions indicates favorable clinical outcomes. These CSR rates (91.5% mandibles, 82.9% maxillae) are less than what has been reported for implants placed into mandibular and maxillary anterior segments. Differences in outcomes between anterior and posterior locations may be related to bone quality and quantity.J Periodontol 1999;70:896‐901.
Risk Assessment of Bovine Spongiform Encephalopathy Transmission Through Bone Graft Material Derived From Bovine Bone Used for Dental Applications
Authors: Sogal A. , Tofe A.J.
Published: February 2005

Background: Several commercial products are currently available for clinical application as bone graft substitutes. These products can be broadly classified into two categories: synthetic and natural. Bovine bone is a popular source for several of the natural bone substitutes. The availability of bovine derived xenogenic bone substitutes has made it possible to avoid traumatic and expensive secondary surgery to obtain autogenous bone once thought essential for effective bone replacement. While autogenous bone still remains the undisputed “gold standard” in bone grafting, the realization that bone requirement in several clinical applications is as effectively met by xenografts has lead to their widespread use. But the convenience of using xenografts is tempered by the possibility of disease transmission from cattle to humans. The recent incidents of bovine spongiform encephalopathies (BSE) in humans have underscored this likelihood. In this paper, we report a risk analysis performed to assess the possibility of such disease transmission from a commercially available bone graft substitute (BGS) that is popularly used in clinical dentistry.

Methods: An extensive review of current literature on the status of risk assessment of BSE transmission was conducted, and two risk assessment models were identified as applicable to the present study. Risk assessment models developed by the German Federal Ministry of Health and by the Pharmaceutical Research and Manufacturers Association of America were applied to BGS.

Results: Results from the analyses conducted using both models showed that the risk of disease (BSE) transmission from BGS was negligible and could be attributed to the stringent protocols followed in sourcing and processing of the raw bovine bone used in the commercial product.

Conclusions: Based on the risk analysis, it is evident that the risk of BSE infection from BGS is several orders of magnitude less than that posed by the risk of death related to, lightning, tornadoes, or similar remote events. However, this low risk can only be maintained as long as an effective and active risk management program is implemented in operations that involve processing xenogenic tissue for human use. J Periodontol 1999;70:1053‐1063.
Increasing the Amount of Attached Gingiva Using a Modified Apically Repositioned Flap
Authors: Carnio João , Miller Preston D.
Published: February 2005

The purpose of this study is to describe a modification in the apically repositioned flap technique. Unlike the original technique, this technique preserves the marginal gingiva thus avoiding the risk of recession. It is recommended in cases where an increase in attached gingiva is desired. This study reports on the results of 54 single buccal areas consecutively treated in 38 healthy patients. The increase in the amount of attached gingiva, the impact on marginal tissue recession, and the impact on probing depth were analyzed. All 54 areas were evaluated at 8 weeks; 21 areas were analyzed for 24 weeks; and 19 areas for a period of 72 weeks. The final measurements were compared to baseline values. The analysis of variance of measurement (ANOVA) shows a significant increase of keratinized and attached gingiva (P <0.001). There was no statistical change in marginal tissue recession (P = 0.370) or probing depth. The results of this study demonstrate that this modification of the apically repositioned flap is effective and efficient for increasing the height of attached gingiva. This surgical procedure produces minor surgical trauma and does not require palatal donor tissue or membrane placement. It is simpler since it is less time‐consuming, requires no suturing, and results in an ideal color match of tissue. J Periodontol 1999;70:1110‐1117.