bluuebunny/crossref_metadata_2025 huggingface dataset:
Age‐Dependent Changes in the Distribution of BrdU‐ and TUNEL‐Positive Cells in the Murine Gingival Tissue
Authors: Sakai Takako , Kiyoshima Tamotsu , Kobayashi Leyoshi , Moroi Ryoji , Ibuki Teiichi , Nagadome Mieko , Terada Yoshihiro , Sakai Hidetaka
Published: February 2005

Background: Age‐dependent morphological and cell kinetic changes of the gingival tissue seem to be related to the occurrence of periodontal disease. The purpose of this study was to investigate the age‐dependent changes in the distribution of BrdU‐ and TUNEL‐positive cells in murine gingival tissue.

Methods: Gingival tissue of the lower first molar region of 2‐, 3‐, 5‐, 7‐, 10‐, 15‐, 20‐, 30‐, 40‐, 50‐, 60‐, 70‐ and 80‐week‐old mice was used in this study. BrdU‐ and TUNEL‐positive cells were evaluated at the following 4 sites: 1) gingival epithelium (GE); 2) junctional epithelium (JE); 3) submucosal connective tissue of the gingival epithelium (GECT); and 4) submucosal connective tissue of the junctional epithelium (JECT).

Results: No significant differences in the mean number of BrdU‐positive cells at each site were demonstrated among the various age groups. No significant change in the mean number of TUNEL‐positive cells was demonstrated in either the GE or JE groups among the various age groups. Meanwhile, a significant increase in the TUNEL‐positive cells was observed in the GECT of mice 40 weeks or older, and in the JECT of mice 20 weeks or older.

Conclusions: These results indicate that no age‐dependent change in the cell proliferation or cell death occurred in the gingival and junctional epithelial layers as well as in the cell proliferation in the submucosal connective tissue. Meanwhile, a significant decrease in the cellular component of the submucosal connective tissue of both gingival and junctional epithelial layers caused by apoptosis occurred with aging. The decreased cellular component in the submucosal connective tissue thus seems to be related to either gingival recession or to the apical migration of the JE with aging. These morphological changes with aging possibly occur in humans and may be related to the susceptibility to periodontal disease in aged individuals. J Periodontol 1999;70:973‐981.
Levels of Leukotriene B4 and Platelet Activating Factor in Gingival Crevicular Fluid in Renal Transplant Patients Receiving Cyclosporine A
Authors: Emingil Gülnur , Çoker Işil , Atilla Gül , Hüseyinov Afig
Published: February 2005

Background: Cyclosporine A (CsA) is a potent immunosuppressant effectively used to prevent organ transplant rejection and also to treat several systemic diseases. CsA‐induced gingival overgrowth (CsA GO) is the most widely seen side effect of this drug; its pathogenesis is not completely understood. The aim of the present study was to identify the role of leukotriene B4 (LTB4) and platelet activating factor (PAF) in the pathogenesis of CsA GO.

Methods: LTB4 and PAF levels were detected in gingival crevicular fluid (GCF) samples from renal transplant patients receiving CsA therapy and exhibiting CsA GO, from patients with gingivitis and from periodontally healthy subjects. Plaque index, papilla bleeding index, and hyperplastic index were recorded at each study site. GCF samples and clinical data were obtained from: 2 sites exhibiting CsA GO (CsA GO+) and 2 sites not exhibiting CsA GO (CsA GO–) in each CsA‐treated patient; 2 diseased sites in each patient with gingivitis; and 2 healthy sites in each subject with clinically healthy periodontium. LTB4 was extracted from the samples by solid‐phase method using C18 cartridge and purified by high‐performance liquid chromatographic (HPLC) method and analyzed by radioimmunoassay (RIA). PAF was extracted from GCF samples passing through amberlit resin columns, purified by HPLC, and analyzed by RIA.

Results: Total amounts of LTB4 and PAF in GCF were higher in CsA GO+ sites compared to the healthy sites from healthy controls. However, the amount of LTB4 and PAF elevation in CsA GO+ sites was not significantly higher than those in diseased sites. Clinical degrees of gingival inflammation were also similar between CsA GO+ and diseased sites. LTB4 and PAF total amounts in GCF were higher in CsA GO+ sites compared to CsA GO– sites in the same subjects, but this difference just failed to reach significance. Similar findings were obtained with concentration data.

Conclusions: The results of this study indicate that CsA therapy does not have a significant effect on GCF LTB4 and PAF levels and that gingival inflammation seems to be the main reason for their elevation. In CsA‐treated patients, alterations in LTB4 and PAF levels might play a role in CsA GO through some asyet unknown mechanism. To our knowledge, this is the first report describing the levels of lipid mediators in GCF of CsA‐treated patients. We assume that further studies will contribute to the understanding of the pathogenesis of CsA‐induced gingival overgrowth. J Periodontol 2000;71:50‐57.
Repeated Metronidazole and Amoxicillin Treatment of Periodontitis. A Follow‐Up Study
Authors: López Néstor J. , Gamonal Jorge A. , Martinez Benjamin
Published: February 2005

Background: The prevailing concept is that little or no clear benefit is derived from antibiotic therapy in chronic periodontitis. Studies to determine the effect of metronidazole plus amoxicillin (M+A) on adult periodontitis are questionable because standard design for clinical trials was usually not used. In addition, there is no information about the effect of M+A as the sole therapy for periodontitis.

Methods: A randomized, triple‐blind, controlled clinical trial was used to determine the effect of systemic administration of M+A, as the sole therapy, in progressive adult periodontitis. Forty‐six subjects with moderate to advanced adult periodontitis who showed ≥2 mm attachment loss in at least 2 sites in the previous 2 months were entered in the study. Subjects were randomly distributed to a group who received 21 tablets of metronidazole 250 mg plus amoxicillin 500 mg, or to a group receiving a placebo (1 tablet every 8 hours for 1 week). Patients were examined every 2 months for 12 months. The M+A or placebo regimen was repeated at 4 and 8 months. No effort was made to change the oral habits of patients and they received no additional therapy. Differences between groups were assessed using the Mann‐Whitney U test. The differences at every 2‐month interval within each group were assessed using the ANOVA test.

Results: Seven subjects abandoned the study; at 12 months the M+A group had 20 subjects and the placebo group 19. There were no significant differences in the clinical parameters at baseline between the 2 groups. After 2 months and thereafter, the M+A group showed significant clinical improvement while the placebo group showed a progressive deterioration of periodontal status. At 12 months compared to baseline, subjects of the M+A group showed: 1) a significant overall mean attachment gain of 0.43 mm (P = 0.005); 2) a significant decrease of active sites (P ≤0.03); 3) a significant increase of sites gaining attachment level (P ≤0.01); 4) a significant reduction of pocket depth (P ≤0.00006); and 5) a significant decrease in percentage of bleeding on probing sites (BOP) (P ≤0.0005). Significant differences between both groups at all 2‐month evaluations were found in overall mean attachment level (P ≤0.000004), in percent of active sites (P ≤0.03), and in percent of BOP sites (P ≤0.02). Sites exhibiting ≥2 mm of attachment loss in 2 successive or alternate evaluations, and periodontal abscess were noticed only in the placebo group.

Conclusions: A 1‐week course of systemic M+A every 4 months, as the only therapy, arrests the progression of adult periodontitis and significantly improves the clinical parameters of the disease. J Periodontol 2000;71:79‐89.
Treatment of Peri‐Implant Defects With Combination Growth Factor Cement
Authors: Meraw Stephen J. , Reeve Charles M. , Lohse Christine M. , Sioussat Tracy M.
Published: February 2005

Background: The use of growth factor agents in the regeneration of oral tissues is an area of current investigation. Combinations of growth factors have been used synergistically to improve tissue regeneration. The aim of this study was to determine the effects of a combination growth factor cement (GFC) on guided bone regeneration around dental implants.

Methods: A combination of bone morphogenetic protein‐2 (BMP‐2), transforming growth factor‐β (TGF‐β), platelet‐derived growth factor (PDGF), and basic fibroblast growth factor (bFGF) was used in a bioabsorbable, non‐hydroxyapatite, calcium phosphate cement. Five adult hound dogs were used to compare the effects of GFC, plain cement, and control (no cement). The right and left second, third, and fourth mandibular premolar teeth were extracted; the implant osteotomies were prepared; and a uniform circumferential gap was prepared 1.5 mm beyond the width of the implant in the coronal half of the osteotomy for cement placement. Titanium machine‐polished dental implants were placed in the prepared sites, and coronal defects were treated according to previously randomized, assigned modality. A bioabsorbable collagen membrane was secured over the control site, and the flaps were closed primarily. The dogs were maintained on a soft diet to avoid soft tissue trauma. The dogs were sacrificed at 3 months. The specimens were sectioned, mounted, and stained with Stevenel's blue and van Gieson's picric fuchsin. The boneto‐implant contact and bone 1 mm peripheral to the implant surface were recorded with a computerized microscopic digitizer.

Results: The findings of this study indicate a significant effect of GFC on increased bone‐to‐implant contact and amount of bone per surface area compared with the other treatment modalities (P <0.0009). Plain cement demonstrated slight but nonsignificant increases compared with the control (P >0.05).

Conclusions: GFC increases bone‐to‐implant contact and bone surface area within peri‐implant defects. Further studies may be beneficial to determine the feasibility of its use for other regenerative applications. J Periodontol 2000;71:8‐13.
Intraoral Fluoride Releasing Device: A New Clinical Therapy for Dentine Sensitivity
Authors: Marini Ida , Checchi Luigi , Vecchiet Federico , Spiazzi Luigi
Published: February 2005

Background: Dentinal sensitivity (DS) occurs frequently in adult populations in western countries. The purpose of this work was to assess the effectiveness of a new intraoral fluoride releasing device (IFRD) in reducing the level of pain in patients with primary or postsurgical dentine sensitivity.

Methods: A total of 49 individuals were selected for this study, 15 of whom had post‐periodontal surgery dentine sensitivity and 34 with primary sensitivity. An IFRD was applied to 39, while 10 received a placebo device. All individuals in the control group suffered from primary sensitivity. The IFRD used in this study consists of sodium fluoride encased in an acrylic polymer which releases fluoride at a rate of approximately 0.04 mg/day. All patients were asked to rinse with cold water (10°C) and to indicate the level of pain on a 0 to 10 visual analog scale, 0 equalling “no pain” and 10 “maximum bearable pain.” All subjects were evaluated once a week during 4 months. Statistical analysis of dentine sensitivity was performed as a univariate study, in relation to the main factors: age, gender, and primary sensitivity or postsurgical etiology.

Results: Symptoms decreased dramatically in all treated patients. The level of sensitivity did not change during the first week after IFRD application, but decreased significantly within the fourth week and remained absent through the duration of the treatment (P <0.01). Difference in sensitivity with respect to different etiology was significant only after 4 weeks (P = 0.01), while there was no statistical difference with respect to age or gender.

Conclusions: This paper is an initial study to evaluate the effectiveness of the IFRD. The method is fast, painless, inexpensive, and it appears to be suitable as a routine treatment. The presented data support the conclusions at this stage and warrant more comprehensive evaluation. J Periodontol 2000; 71:90‐95.
Elevation of Systemic Markers Related to Cardiovascular Diseases in the Peripheral Blood of Periodontitis Patients
Authors: Loos Bruno G. , Craandijk Jeroen , Hoek Frans J. , Dillen Paulien M.E. Wertheim‐van , Van Der Velden Ubele
Published: February 2005

Background: Periodontitis is a common, often undiagnosed, chronic infection of the supporting tissues of the teeth, epidemiologically associated with cardiovascular diseases. Since Creactive protein (CRP) and other systemic markers of inflammation have been identified as risk factors for cardiovascular diseases, we investigated whether these factors were elevated in periodontitis.

Methods: Consecutive adult patients with periodontitis (localized n = 53; generalized n = 54), and healthy controls (n = 43), all without any other medical disorder, were recruited and peripheral blood samples were taken.

Results: Patients with generalized periodontitis and localized periodontitis had higher median CRP levels than controls (1.45 and 1.30 versus 0.90 mg/L, respectively, p = 0.030); 52% of generalized periodontitis patients and 36% of the localized periodontitis patients were sero‐positive for interleukin‐6 (IL‐6), compared to 26% of controls (p = 0.008). Plasma IL‐6 levels were higher in periodontitis patients than in controls (p = 0.015). Leukocytes were also elevated in generalized periodontitis (7.0 × 109/L) compared to localized periodontitis and controls (6.0 and 5.8 × 109/L, respectively, p = 0.002); this finding was primarily explained by higher numbers of neutrophils in periodontitis (p = 0.001). IL‐6 and CRP correlated with each other, and both CRP and IL‐6 levels correlated with neutrophils. The current findings for periodontitis were controlled for other known factors associated with cardiovascular diseases, including age, education, body mass index, smoking, hypertension, cholesterol, and sero‐positivity for CMV, Chlamydia pneumoniae, and Helicobacter pylori.

Conclusions: Periodontitis results in higher systemic levels of CRP, IL‐6, and neutrophils. These elevated inflammatory factors may increase inflammatory activity in atherosclerotic lesions, potentially increasing the risk for cardiac or cerebrovascular events. J Periodontol 2000;71:1528‐1534.
Identification of Periodontal Pathogens in Atheromatous Plaques
Authors: Haraszthy V.I. , Zambon J.J. , Trevisan M. , Zeid M. , Genco R.J.
Published: February 2005

Background: Recent studies suggest that chronic infections including those associated with periodontitis increase the risk for coronary vascular disease (CVD) and stroke. We hypothesize that oral microorganisms including periodontal bacterial pathogens enter the blood stream during transient bacteremias where they may play a role in the development and progression of atherosclerosis leading to CVD.

Methods: To test this hypothesis, 50 human specimens obtained during carotid endarterectomy were examined for the presence of Chlamydia pneumoniae, human cytomegalovirus, and bacterial 16S ribosomal RNA using specific oligonucleotide primers in polymerase chain reaction (PCR) assays. Approximately 100 ng of chromosomal DNA was extracted from each specimen and then amplified using standard conditions (30 cycles of 30 seconds at 95°C, 30 seconds at 55°C, and 30 seconds at 72°C). Bacterial 16S rDNA was amplified using 2 synthetic oligonucleotide primers specific for eubacteria. The PCR product generated with the eubacterial primers was transferred to a charged nylon membrane and probed with digoxigenin‐labeled synthetic oligonucleotides specific for Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis, and Prevotella intermedia.

Results: Eighty percent of the 50 endarterectomy specimens were positive in 1 or more of the PCR assays. Thirty‐eight percent were positive for HCMV and 18% percent were positive for C. pneumoniae. PCR assays for bacterial 16S rDNA also indicated the presence of bacteria in 72% of the surgical specimens. Subsequent hybridization of the bacterial 16S rDNA positive specimens with species‐specific oligonucleotide probes revealed that 44% of the 50 atheromas were positive for at least one of the target periodontal pathogens. Thirty percent of the surgical specimens were positive for B. forsythus, 26% were positive for P. gingivalis, 18% were positive for A. actinomycetemcomitans, and 14% were positive for P. intermedia. In the surgical specimens positive for periodontal pathogens, more than 1 species was most often detected. Thirteen (59%) of the 22 periodontal pathogen‐positive surgical specimens were positive for 2 or more of the target species.

Conclusions: Periodontal pathogens are present in atherosclerotic plaques where, like other infectious microorganisms such as C. pneumoniae, they may play a role in the development and progression of atherosclerosis leading to coronary vascular disease and other clinical sequelae. J Periodontol 2000;71:1554‐1560.
Some Effects of Non‐Surgical Therapy on Gingival Inflammatory Cell Subsets in Patients With Adult and Early‐Onset Periodontitis
Authors: Kleinfelder Jörg W. , Lange Dieter E. , Böcker Werner
Published: February 2005

Background: Limited information is available to determine if there is a distinction in local cellular immunity between adult and early‐onset periodontitis. Furthermore, the effect of scaling and root planing on various lymphocyte subsets is sparsely described.

Methods: Clinical measurements were recorded and gingival biopsies were performed before and after scaling and root planing in 10 subjects with adult (AP) and in 10 with early‐onset periodontitis (EOP).The specimens were cut into serial sections and, using the alkaline phosphatase‐anti‐alkaline phosphatase technique, monoclonal antibodies to CD20 (B‐cells), CD30 (plasma cells), and CD45RO (T‐memory cells) were applied, as well as polyclonal antibodies to alpha, gamma, and mu chains (Ig A, G, and M). Areas showing the largest infiltration cells were counted.

Results: Mean counts of all cell phenotypes in the AP versus the EOP group did not show any significant differences before therapy (P >0.05). Following scaling and root planing, numbers of all phenotypes decreased in both groups. Comparing the data before and after therapy, P values were >0.05 in the AP group, except for IgA‐positive cells. In the EOP group, the differences before and after therapy reached statistical signifi‐cance (P <0.05) for all cell counts, except for IgM‐positive cells. Furthermore, reduction of probing depth and gain of clinical attachment reached the 0.05 level of statistical significance only in EOP subjects.

Conclusions: Local cellular immunity in patients with adult onset periodontitis does not appear to differ from the immune response in patients with early onset periodontitis. Scaling and root planing causes a decrease in the inflammatory cells subsets tested, however, this decline seems to be more pronounced in EOP than in AP subjects. J Periodontol 2000;71:1561‐1566.
The Effect of Age on Proliferating Cell Nuclear Antigen Expression in Oral Gingival Epithelium of Healthy and Inflamed Human Gingiva
Authors: Çelenligil‐Nazliel Haviye , Ayhan Ayşe , Uzun Hakan , Ruacan Şevket
Published: February 2005

Background: Age‐related changes in proliferative activity in human gingival epithelium are uncertain. Proliferating cell nuclear antigen (PCNA) is a nuclear protein associated with the cell cycle. Nuclear PCNA immunoreactivity is found in the proliferative compartment of normal tissues. The aims of this study were to investigate the localization of PCNA expression in oral gingival epithelium (OGE) and to define the age‐related changes as to PCNA‐proliferative index (PI) in inflamed as well as healthy gingiva. Mitotic index (MI) was also used as a conventional marker of cell proliferation. Additionally, the effect of aging upon the maximum epithelial thickness (MET) was determined.

Methods: Twenty older (65 to 85 years) (study) and 20 middle‐aged (35 to 45 years) (controls) subjects were included in the study. Biopsies were obtained both from healthy and inflamed gingiva. The expression of PCNA was evaluated in formalin‐fixed, paraffin‐embedded gingival samples using an immunoperoxidase technique and PC10 monoclonal antibody to PCNA. Hematoxylin and eosin stained sections were used for the quantitative measurement of MI and MET.

Results: All the tissue sections contained positive staining cells for PCNA in the gingival epithelium. Although PCNA expression was observed both in the basal and suprabasal layers, it was more prominent in the suprabasal layers. PI in inflamed gingiva was significantly higher in the older group. However, no significant difference was observed between the study and control groups with respect to PI in healthy gingiva. When all the subjects taken into the study were analyzed as a single group, PI in the inflamed gingival samples were found to be increased with aging. Nevertheless, no age‐related change was noted in MI and MET. In both the study and the control groups, PI, MI, and MET were found to be increased due to inflammation.

Conclusions: Our data indicate that PCNA expression in inflamed gingiva is higher in older subjects. Furthermore, a significant correlation was noted between aging and PCNA expression in inflamed gingiva. As there is no increase in mucosal epithelial thickness despite increased proliferation, we speculate that the duration of the PCNA+ phase in cell cycle may be longer in older subjects. This study also implies that PCNA immunolocalization can be used as an index of the state of cell proliferation in both biological and pathological events of the gingiva and/or other mucosal tissues. J Periodontol 2000;71:1567‐1574.
The Effect of Topical Delivery of Novel Bisacylphosphonates in Reducing Alveolar Bone Loss in the Rat Model
Authors: Yaffe A. , Golomb G. , Breuer E. , Binderman I.
Published: February 2005

Background: Periodontal surgery stimulates osteoclast activity, leading to varying amounts of alveolar crest loss. We have established that topical application of 20 mg/ml of alendronate placed at the surgical mucoperiosteal site produced a striking reduction of alveolar bone loss in the rat model. The aim of this investigation was to examine the antiresorptive efficacy of 3 novel bisacylphosphonates topically delivered at the surgical site, in comparison to alendronate and etidronate which are in clinical use.

Methods: Mucoperiosteal flap (MF) surgery was performed on the buccal and lingual aspects next to molars on both sides of the rat mandible. A gelatin sponge soaked in the bisphosphonate solution prepared by dissolving 20 mg of the bisphosphonate (alendronate, etidronate, VS‐5, VS‐6, ISA‐13, SuBP) in 1 ml of saline was applied to exposed bone on the right side of the mandible (experimental, MF + BPs) and the left side was treated with saline only (control, MF + S). Sections were evaluated for bone loss using microradiography pattern and amount.

Results: The 3 novel bisacylphosphonates, VS‐5 VS‐6, and ISA‐13 were more effective than etidronate, and less effective than alendronate. The most effective among this group was ISA‐13 followed by VS‐5 and VS‐6.

Conclusion: We conclude that ISA‐13‐like alendronate is effective in reducing alveolar bone loss when delivered at surgical sites. Since ISA‐13 is well absorbed through mucose tissues, we suggest that ISA‐13 efficacy on reducing bone loss should be tested by its application on the mucosal tissue. J Periodontol 2000;71:1607‐1612.
Evidence of a Substantial Genetic Basis for Risk of Adult Periodontitis
Authors: Michalowicz Bryan S. , Diehl Scott R. , Gunsolley John C. , Sparks Brandon S. , Brooks Carol N. , Koertge Thomas E. , Califano Joseph V. , Burmeister John A. , Schenkein Harvey A.
Published: February 2005

Background: A few previous studies have suggested that risk for adult periodontitis (AP) has a genetic (heritable) component. We estimated genetic and environmental variances and heritability for gingivitis and adult periodontitis using data from twins reared together.

Methods: One hundred seventeen (117) pairs of adult twins (64 monozygotic [MZ] and 53 dizygotic [DZ] pairs) were recruited. Probing depth (PD), attachment loss (AL), plaque, and gingivitis (GI) were assessed on all teeth by two examiners. Measurements were averaged over all sites, teeth, and examiners. Extent of disease in subjects was defined at four thresholds: the percentage of teeth with AL ≥2, AL ≥3, PD ≥4, or PD ≥5 mm. Genetic and environmental variances and heritability were estimated using path models with maximum likelihood estimation techniques.

Results: MZ twins were more similar than DZ twins for all clinical measures. Statistically significant genetic variance was found for both the severity and extent of disease. AP was estimated to have approximately 50% heritability, which was unaltered following adjustments for behavioral variables including smoking. In contrast, while MZ twins were also more similar than DZ twins for gingivitis scores, there was no evidence of heritability for gingivitis after behavioral covariates such as utilization of dental care and smoking were incorporated into the analyses.

Conclusions: These results confirm previous studies and indicate that approximately half of the variance in disease in the population is attributed to genetic variance. The basis for the heritability of periodontitis appears to be biological and not behavioral in nature. J Periodontol 2000;71:1699‐1707.
Periodontal Health of Orthodontically Extruded Impacted Teeth. A Split‐Mouth, Long‐Term Clinical Evaluation
Authors: Quirynen Marc , Heij Danny G. Op , Adriansens Annelies , Opdebeeck Heidi M. , van Steenberghe Daniel
Published: February 2005

Background: Impaction of front teeth (often upper canines) can result in esthetic, functional, and phonetic problems, in addition to root resorption and chronic or acute infections. Most impacted front teeth can be extruded orthodontically after minor periodontal surgery. The purpose of this retrospective study was to examine the periodontal outcome of surgically exposed and orthodontically extruded impacted teeth compared with the spontaneously erupted contralateral teeth.

Methods: A total of 38 patients, who had been treated by a combined surgical and orthodontic approach (closed eruption technique by same periodontist and 2 associated orthodontists), underwent a periodontal re‐examination after 4 to 10 years. Periodontal parameters (plaque and gingivitis indices, probing depth, bleeding on probing, gingival recession and width, bone level, and root resorption) of the orthodontically extruded teeth (test) were scored and compared with those of the contralateral naturally erupted teeth (control) in a masked set‐up.

Results: No significant differences could be detected between test and control teeth, except for the gingival width, which was 1 mm larger for the spontaneously erupted teeth.

Conclusions: The data indicate that orthodontic extrusion of impacted front teeth does not jeopardize their periodontal health. This procedure appears to be a satisfactory alternative to extraction and/or transplantation. J Periodontol 2000;71:1708‐1714.
Changes in Alveolar Bone Height and Width Following Ridge Augmentation Using Bone Graft and Membranes
Authors: Simon Barry I. , Von Hagen Stanley , Deasy Michael J. , Faldu Mitesh , Resnansky Dasha
Published: February 2005

Background: Clinical observation suggests the amount of bone height and width created during guided bone regeneration (GBR) to augment alveolar ridges is not retained during healing. A study was designed to determine: 1) whether the amount of osseous structure 4 months postoperatively after GBR was significantly less than the amount surgically created; and 2) if this change was uniform over the area treated.

Methods: Nineteen extraction sites (10 patients) were treated with GBR prior to placing endosseous implants. Allograft (DMFDB) and a bioabsorbable membrane were employed. Standardized measurements were taken of alveolar height and width 1) prior to augmentation; 2) after placement of graft and membrane; and 3) following 4 months of healing. Width measurements were taken 3 mm, 5 mm, and 10 mm from the crest at 3 intervals: the mesio‐distal midpoint of the edentulous area and 3 mm mesial and distal to the midpoint. Height measurements were recorded at the mesio‐distal midpoint and points 3 mm mesial and distal to the midpoint.

Results: Loss in width of supplemented bone after 4 months of healing ranged from 52.1% to 58.0% 3 mm from the crest, 47.6% to 67.4% 5 mm from the crest, and 39.1% to 46.7% 10 mm from the crest. Loss of augmented height averaged 14.7% in the center of the edentulous area but ranged from 60.5% to 76.3% 3 mm mesial and distal to the midpoint.

Conclusions: The results indicate significant nonuniform loss of augmented alveolar height and width during GBR healing. The implications of these findings impact preoperative augmentation planning for endosseous implantology. J Periodontol 2000;71:1774‐1791.
Position Paper Dental Implants in Periodontal Therapy
Authors:   The Research, Science and Therapy Committee of the American Academy of Periodontology
Published: February 2005

Over the past 30 years, research has validated the success of osseointegrated implants as a viable alternative to fixed or removable prosthetic restorations. Periodontists are extensively trained in surgical procedures to treat and maintain patients with edentulous and partially edentulous arches. They also have a primary role in treatment planning and maintenance therapy. Thus, periodontists routinely integrate endosseous implants into periodontal therapy. This paper was prepared by the Research, Science and Therapy Committee of the American Academy of Periodontology and is intended to inform the dental profession regarding the utility of endosseous dental implants in the treatment of full and partial edentulism. J Periodontol 2000;71:1934‐1942.
Mucogingival Interceptive Surgery of Buccally‐Erupted Premolars in Patients Scheduled for Orthodontic Treatment I. A 7‐Year Longitudinal Study
Authors: Pini Prato Giovanpaolo , Baccetti Tiziano , Magnani Cristina , Agudio Giancarlo , Cortellini Pierpaolo
Published: February 2005

Background: Mucogingival interceptive therapy in patients with buccally erupting teeth is performed to prevent the ectopic permanent tooth from developing periodontal lesions. The keratinized tissue entrapped between the erupting tooth and the deciduous tooth is retained to maintain a satisfactory width of the gingiva for the permanent tooth. The aim of the present study on buccally‐erupted premolars scheduled for orthodontics was to evaluate the keratinized tissue width 3 months, 2 years, and 7 years subsequent to mucogingival interceptive therapy and orthodontic treatment.

Methods: Twenty‐nine patients participated. Three different surgical techniques were used according to specific indications. Eight patients were treated with double pedicle flaps (DPF), 10 patients with apically positioned flaps (APF), and 11 with free gingival grafts (FGG).

Results: The amount of keratinized tissue on the treated (test) sites was not significantly less than on the control (untreated) sites showing normally erupting premolars at all observation periods. All 3 surgical procedures appeared to be effective in saving the keratinized tissue for the permanent tooth. Preoperative periodontal parameters such as gingival width, probing depth, and bleeding on probing significantly influenced the outcome 3 months after surgery (P <0.01).

Conclusions: Mucogingival interceptive surgery is an effective approach to conserve the keratinized buccal gingiva of ectopically erupting premolars. J Periodontol 2000;71:172‐181.
Development of an In Vitro Wound Healing Model For Periodontal Cells
Authors: Lackler Karl P. , Cochran David L. , Mai Hoang A. , Takacs Vincent , Oates Thomas W.
Published: February 2005

Background: Periodontal wound healing and regeneration are influenced by a multitude of factors. While many in vitro investigations have compared the proliferation of periodontal ligament (PDL) cells and gingival fibroblasts (GF), there are no reports directly comparing the abilities of these 2 cell types to fill a wound site. As such, the goals of this research were: 1) to develop an in vitro model of wound healing which would allow for the investigation of the biologic basis of periodontal wound healing and regeneration and 2) to compare the rates of PDL cells and GF to fill an in vitro wound site.

Methods: Using both human PDL cells and GF confluent cultures, in vitro wounds were mechanically created, removing a 3 mm wide band of the cell layer. Wounded cultures were then incubated for time periods up to 12 days in media containing fetal bovine serum (FBS) concentrations (0, 0.1, 1, 5, 10, and 20%) as appropriate for each experiment. Slides were fixed, stained, and cells quantified within the wound boundaries by computer‐assisted histomorphometry. The effect of wounding a cell layer was determined by comparing wounded cells as described above with a cell layer margin created without physically disrupting the cell layer.

Results: The in vitro model for periodontal wound healing established in this study showed that GF fill in the wound site at a significantly (P <0.0025) faster rate than PDL cells over 12 days of healing. In addition, PDL cells and GF were found to have unique concentration‐dependent responses to FBS (P <0.0025). It was also shown that wounding resulted in a significant delay (P <0.01) in the initial healing response of an in vitro wound.

Conclusion: This in vitro model demonstrated that the characteristics of wound healing are dependent on cell type, disruption (wounding) of the cell layer, and serum concentration. In addition, this model has incorporated both proliferation and migration to provide the first direct evidence demonstrating GF has a significantly greater ability to fill a wound site than PDL cells. This in vitro model may be utilized in future investigations of the biologic basis of periodontal wound healing. J Periodontol 2000;71:226‐237.
Gingival Recession Treatment: Guided Tissue Regeneration With Bioabsorbable Membrane Versus Connective Tissue Graft
Authors: Tatakis Dimitris N. , Trombelli Leonardo
Published: February 2005

Background: Gingival recession represents a significant concern for patients and a therapeutic problem for clinicians. Several techniques have been proposed to achieve root coverage. The purpose of this randomized clinical trial was to evaluate the effect of a guided tissue regeneration (GTR) procedure in comparison to connective tissue graft (CTG) in the treatment of gingival recession defects.

Methods: Twelve patients, each contributing a pair of Miller Class I or II buccal gingival recessions, were treated. In each patient one randomly chosen defect received a poly(lactic acid)‐based bioabsorbable membrane, while the paired defect received a CTG. Clinical recordings included oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT).

Results: Mean RD statistically significantly decreased from 2.5 mm presurgery to 0.5 mm with GTR (81% root coverage), and from 2.5 mm to 0.1 mm with CTG (96% root coverage), at 6 months postsurgery. Prevalence of complete root coverage was 58% for the GTR group and 83% for the CTG group. Mean CAL gain was 2.0 mm for the GTR group and 2.2 mm for the CTG group. No statistically significant differences between treatment groups were observed for changes in RD, RW, PD, CAL, and KT.

Conclusions: Treatment of human gingival recession defects by means of either GTR or CTG results in clinically and statistically significant improvement of the soft tissue conditions of the defect when pre‐ and post‐treatment measurements were compared. Although differences between CTG and GTR in mean root coverage and prevalence of complete coverage consistently favored the CTG procedure, the differences in measurements were not statistically significant. J Periodontol 2000;71:299‐307.
Interproximal Papillae Reconstruction in Maxillary Implants
Authors: Nemcovsky Carlos E. , Moses Ofer , Artzi Zvi
Published: February 2005

Background: Gingival esthetics has become an important factor in the overall success of most maxillary implant‐supported restorations. Periodontal plastic surgery procedures may be used to enhance esthetics in the maxillary anterior region. The purpose of the present study was to evaluate a new surgical approach, performed at implant exposure, to reconstruct interdental papillae around maxillary implant‐supported restorations.

Methods: The surgical procedure was performed on 32 patients, in which 36 consecutive single tooth osseointegrated implants were exposed in the anterior and premolar maxillary region. Previous to implant exposure and 6 months postoperatively, once the implant‐supported restoration was in place, mesial and distal papilla contour measurements were calculated, based on a modification of the papillary index score (PIS). Statistical analysis consisted of paired t test, Pearson's correlation, and ANOVA with repeated measures.

Results: Preoperative PIS ranged from 0 to 3 and from 1 to 3 at the 6 months follow‐up control. A mean of mesial and distal papilla, within the same tooth, was used for paired t test statistical analysis. A mean increase of 1.07 (SD 0.43) in PIS was statistically significant (P <0.001). At the second measurement, in no site was PIS smaller (0%) while in 64 sites PIS was higher (89%). In 51 papilla (71%) there was an increase of 1 PIS unit and 13 (18%) of 2 PIS units between both measurements.

Conclusions: The presented surgical technique performed at second stage implant surgery was useful for partial or total interproximal papilla reconstruction adjacent to maxillary single‐implant restorations. J Periodontol 2000;71:308‐314.
Treatment of Gingival Hyperpigmentation for Esthetic Purposes by Nd:YAG Laser: Report of 4 Cases
Authors: Atsawasuwan Phimon , Greethong Kitiman , Nimmanon Vanida
Published: February 2005

Gingival hyperpigmentation may cause esthetic problems and embarrassment, especially in patients with a gummy smile. This report presents the use of the Nd:YAG laser for gingival depigmentation. Four cases, 3 females and 1 male, ages between 24 to 28 years old, presented with the same chief complaint of unesthetic gingiva caused by melanin hyperpigmentation. The Nd:YAG laser was set at 6 watts, 60 millijoules per pulse, and 100 pulses per second. The procedures were performed with contact mode in all pigmented areas by using a handpiece with a 320 µm diameter fiber optic. Ablation of the gingival hyperpigmented areas were accomplished without any bleeding complications or significant postoperative pain. Three to 4 weeks after the procedures, the hyperpigmented gingiva appeared healthy, pink, and firm. No recurrence of hyperpigmentation had been found in 11 to 13 months of follow‐up. However, in delicate areas such as the marginal gingiva, the Nd:YAG laser should be used cautiously. J Periodontol 2000;71:315‐321.
Comparison of Morphological Measurements Extracted From Digitized Dental Radiographs With Lumbar and Femoral Bone Mineral Density Measurements in Postmenopausal Women
Authors: Shrout M.K. , Hildebolt C.F. , Potter B.J. , Brunsden T.K.B. , Pilgram T.K. , Dotson M. , Yokoyama‐Crothers N. , Hauser J. , Cohen S. , Kardaris E. , Civitelli R. , Hanes P.
Published: February 2005

Background: We set out to determine whether morphologic measurements extracted from digitized images of bite‐wing radiographs correlated with lumbar and femoral bone mineral density (BMD) measurements in 45 postmenopausal women who had no or only mild periodontal disease (no probing depths >5 mm).

Methods: Lumbar spine and femoral BMDs were determined by dual‐energy x‐ray absorptiometry. Vertical bite‐wing radiographs were taken and digitized. Crestal and apical regions of interest (ROIs) were drawn on the digital images of the maxillary and mandibular alveolar bone on the patient's right and left sides. For each patient, a single morphologic measurement was made for each of 8 ROIs. Correlation analysis was performed to determine the strengths of the relationships between the morphologic measurements made at the 8 locations and between these morphologic measurements and BMD measurements.

Results: The correlations (r) between the morphologic operator (MO) measurements and lumbar spine and femoral BMDs were weak (mean r = 0.02, range = 0.32 to –0.26) and not statistically significant, with no clear trends discernible. Correlations between MO measurements made at the 8 alveolar sites were also weak (mean r = 0.05, range = 0.35 to –0.38) and not statistically significant.

Conclusions: The MO measurements used in this study were weakly correlated with lumbar spine and femoral BMDs, with no clear trends discernible in this population of postmenopausal women with no or mild periodontal disease. J Periodontol 2000; 71:335‐340.
Analysis of In Situ Protease Activity in Chronic Adult Periodontitis Patients: Expression of Activated MMP‐2 and a 40 kDa Serine Protease
Authors: Korostoff Jonathan M. , Wang Jian Fei , Sarment David P. , Stewart Jeffrey C.B. , Feldman Roy S. , Billings Paul C.
Published: February 2005

Background: Periodontitis is characterized by extensive destruction of the gingival tissues and associated supporting structures of the teeth. Although the pathogenesis of the various forms of this disease is not completely understood, host‐derived proteases are believed to have an important role. In this study, we analyzed human tissue samples from chronic adult periodontitis patients to assess the levels of specific proteases and determine the effect of pH and tetracyclines on their activity.

Methods: Gingival tissue samples were obtained from patients with chronic adult periodontitis (probing depths ranged from 5 to 9 mm) and periodontally healthy controls. Tissue extracts were prepared and analyzed for protease activity by zymography and Western blotting.

Results: Maximal protease activity from clinically normal and diseased tissues was observed at pH 8. Latent matrix metalloproteinase (MMP)‐9 and MMP‐2 were expressed in all samples examined, while active MMP‐2 was detected only in tissues obtained from patients with clinical disease. The MMP activities were differentially inhibited by derivatives of tetracycline. At pH 6, a protease with a mass of approximately 40 kDa was observed in diseased samples. The enzymatic activity was inhibited by phenylmethylsulfonyl fluoride, suggesting it is a serine protease.

Conclusions: The results of the current study substantiate the proposed role of host‐derived proteases in the pathogenesis of chronic adult periodontitis. Specifically, they indicate that activated MMP‐2 and a 40 kDa serine protease are involved in tissue destruction associated with this form of periodontal disease and also suggest that tissue pH influences protease activity in situ. J Periodontol 2000;71:353‐360.
The Association of Calprotectin Level in Gingival Crevicular Fluid With Gingival Index and the Activities of Collagenase and Aspartate Aminotransferase in Adult Periodontitis Patients
Authors: Nakamura Teruo , Kido Jun‐ichi , Kido Reiko , Ohishi Keiji , Yamauchi Noriyuki , Kataoka Masatoshi , Nagata Toshihiko
Published: February 2005

Background: Calprotectin, a major cytosol protein of leukocytes, exists in plasma and other body fluids of healthy human subjects. Since the calprotectin concentration rises markedly in some inflammatory diseases including rheumatoid arthritis, this protein has been thought to be a marker of inflammatory disease. Recently, we identified calprotectin in human dental calculus and gingival crevicular fluid (GCF), and found that the calprotectin concentration in GCF from patients with periodontitis was significantly higher than that in GCF from healthy subjects. In the present study, the association of GCF calprotectin level with GCF volume, gingival index (GI), and levels of biochemical markers including collagenase and aspartate aminotransferase (AST) in GCF was investigated to clarify the relationship between GCF calprotectin level and periodontal inflammation.

Methods: Ninety GCF samples collected from periodontal pockets with a probing depth of more than 4 mm in 54 patients with adult periodontitis were used for these assays. The GCF volume was measured, and GI in each site was recorded. The calprotectin content in GCF samples was determined by ELISA using a specific antibody. The activity of collagenase or AST was measured by a respective assay kit.

Results: The total amount of calprotectin and GCF volume showed a highly significant correlation (r = 0.64, P <0.0001), whereas the calprotectin concentration had no correlation with the GCF volume (r = 0.01, P = 0.924). The mean calprotectin concentration in GCF increased with the degree of GI, and the concentration in individual samples was significantly correlated with the GI score (r = 0.56, P <0.0001). Significant positive correlations were observed in GCF calprotectin versus collagenase (r = 0.57, P <0.0001) and GCF calprotectin versus AST levels (r = 0.40, P <0.005).

Conclusions: From the present results and our previous findings, it is shown that the GCF calprotectin level significantly correlates not only with clinical indicators but also with current biochemical marker levels and that calprotectin may be a useful marker for periodontal inflammation. J Periodontol 2000;71:361‐367.
Bactericidal Activity of a Monoclonal Antibody Against a Recombinant 40‐kDa Outer Membrane Protein of Porphyromonas gingivalis
Authors: Katoh Mitsunobu , Saito Shigeno , Takiguchi Hisashi , Abiko Yoshimitsu
Published: February 2005

Background: We have cloned the gene for a 40‐kDa outer membrane protein (40‐kDa OMP) from Porphyromonas gingivalis 381. The recombinant (r)40‐kDa OMP has become the subject of considerable interest because of its potential role in the development of a vaccine useful for passive immunization. To develop such a vaccine, it is essential to fully understand the functions of anti‐r40‐kDa OMP antibody in the host defense against P. gingivalis. To that end, we developed a panel of monoclonal antibodies by immunizing mice with purified r40‐kDa OMP. The objective of this study was to determine the bactericidal activity on P. gingivalis by the IgG1 monoclonal antibody Pg‐ompA2.

Methods: Bacterial growth measurement, a complementmediated anti‐P. gingivalis assay based on [3H]thymidine uptake, and a 14C‐release assay were performed to test the bactericidal activity of Pg‐ompA2 to P. gingivalis.

Results: In the presence of complement, Pg‐ompA2 was lethal to P. gingivalis 381 as well as to the more virulent P. gingivalis strains, including ATCC 53977 and W83. Using component‐defi‐cient complement, we determined that Pg‐ompA2 killed P. gingivalis by activating both the classical and alternative complement pathways.

Conclusions: Pg‐ompA2 has an in vitro complement‐mediated bactericidal activity to P. gingivalis. Pg‐ompA2 may contribute to the development of a local immunotherapy that can be applied in the gingival crevice of a patient with P. gingivalis related periodontitis, or be a vaccine candidate. J Periodontol 2000;71:368‐375.