bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Occlusal Discrepancies on Periodontitis. II. Relationship of Occlusal Treatment to the Progression of Periodontal Disease
Authors: Harrel Stephen K. , Nunn Martha E.
Published: February 2005

Background: A causal relationship between occlusal discrepancies and periodontal disease has been postulated in the past. However, minimal data are available concerning the effect of treatment of occlusal discrepancies on periodontitis.

Methods: The records from a private practice limited to periodontics were reviewed to find patients who had complete periodontal examination records, including occlusal analysis, that were recorded at least 1 year apart. Patients who fit these criteria were divided into a group that had none of the recommended treatment (untreated n = 30), those who had only nonsurgical treatment (partially treated n = 18), and a control group that had completed all recommended treatment (surgically treated n = 41). The data for each tooth of each patient, including occlusal status, were placed in a database and analyzed using the generalized estimating equations method.

Results: Worsening in overall clinical condition, as measured by worsening in prognosis, indicated that teeth with no initial occlusal discrepancies and teeth with treated initial occlusal discrepancies were only about 60% as likely to worsen in overall clinical condition over time compared to teeth with untreated occlusal discrepancies. Teeth with untreated occlusal discrepancies were also shown to have a significantly greater increase in probing depth per year than either teeth without initial occlusal discrepancies or teeth with treated initial occlusal discrepancies (P <0.001). In addition, teeth with untreated occlusal discrepancies had a significant increase in probing depth per year (P<0.001), whereas teeth without initial occlusal discrepancies and teeth with treated initial occlusal discrepancies had no significant increase in probing depth per year (P >0.05).

Conclusions: This study provides strong evidence of an association between untreated occlusal discrepancies and the progression of periodontal disease. In addition, this study shows that occlusal treatment significantly reduces the progression of periodontal disease over time and can be an important adjunct therapy in the comprehensive treatment of periodontal disease. J Periodontol 2001;72:495‐505.
The Effect of Membrane Exposure on the Outcome of Regenerative Procedures in Humans: A Meta‐Analysis
Authors: Machtei Eli E.
Published: February 2005

Background: The significance of early membrane exposure on the regenerative outcome in guided tissue regeneration (GTR) and guided bone regeneration (GBR) procedures is somewhat controversial. Several clinical trials have shown better response when the membranes remained submerged (S) compared to those that have become exposed (E) during healing. Other studies have failed to show any such difference. Small sample size and/or large standard deviation of the changes might account for these discrepancies. The purpose of this meta‐analysis is to critically combine the existing data in order to provide meaningful information based on a large database.

Methods: Studies of GTR in Class II furcation and intrabony defects (IBD), together with GBR around dental implants, where the membrane became exposed during the postoperative period, were combined to form 3 separate databases. A meta‐analysis was employed to compare the 2 subgroups (E versus S) in each of the databases. First, weighted mean changes and weighted standard errors were calculated for each subgroup. Next, an individual study P value was calculated (1‐tailed Student t test); finally, a combined Fisher's P statistic (with 5% significance level) was calculated from the individual P values.

Results: Five studies with a total of 101 sites were included in the furcation database; 43 of these sites became exposed. Mean horizontal attachment level (AL) gain for the S sites (3.72 ± 0.15 mm) was slightly greater than that of the E sites (3.06 ± 0.15 mm; P = 0.030257). For the intrabony group, there were 309 sites in 5 studies: of these, 142 sites became exposed. Mean gain in vertical AL was 4.22 ± 0.15 mm and 4.69 ± 0.13 mm for the E and S group, respectively (P = 0.011415). The GBR group included 60 sites in 2 studies: new bone formation in the 24 S sites (3.01 ± 0.38 mm) was 6‐fold greater compared with the 36 E sites (0.56 ± 0.45 mm). These differences were also statistically significant (P = 0.001875).

Conclusions: Membrane exposure during healing had a major negative effect on GBR around dental implants but only a minimal effect on GTR around natural teeth. J Periodontol 2001; 72:512‐516.
Apoptosis in Chronic Adult Periodontitis Analyzed by In Situ DNA Breaks, Electron Microscopy, and Immunohistochemistry
Authors: Gamonal J. , Bascones A. , Acevedo A. , Blanco E. , Silva A.
Published: February 2005

Background: Apoptosis is an evolutionary form of physiological cell death. Previous studies suggest that apoptosis is involved in the pathogenesis of periodontal diseases. Therefore, we studied the apoptotic events in the gingival tissue of chronic adult periodontitis patients.

Methods: Gingival tissue biopsies from 22 patients with chronic adult periodontitis and from 11 healthy controls were obtained. Criteria for patient inclusion in the periodontitis group were a minimum of 14 natural teeth, excluding third molars, with at least 10 posterior teeth; 5 to 6 sites with probing depth ≥5 mm; attachment loss ≥3 mm; and extensive radiographic bone loss. The control group included healthy subjects with no prior history of periodontal disease. Apoptosis was determined using the terminal TdT‐mediated dUTP‐biotin nick end labeling (TUNEL) technique; electron microscopic analysis; and expression of Caspase‐3, Fas, FasL, Bcl‐2, and p53 by immunohistochemistry.

Results: TUNEL‐positive cells and cells exhibiting chromatin condensation by electron microscopy were observed in the inflammatory infiltrate of biopsies obtained from periodontitis patients. Most of the TUNEL‐positive cells belonged to neutrophil cell populations as they were stained with anti‐myeloperoxidase. Positive staining for active‐caspase 3, Fas, FasL, and p53 was only observed in the inflammatory infiltrate from periodontitis biopsies, whereas Bcl‐2 cells were present in both periodontitis patients and healthy controls.

Conclusions: Our findings establish that apoptosis is induced in the periodontal tissue by host and microbial factors and support the hypothesis that apoptotic mechanisms could be implicated in the inflammatory process associated with gingival tissue destruction observed in adult periodontitis patients. J Periodontol 2001;72:517‐525.
Does Nifedipine Aggravate Cyclosporin‐ Induced Gingival Overgrowth? An Experiment in Rats
Authors: Chiu Hsien‐Chung , Fu Earl , Chiang Cheng‐Yang , Liu Demeral
Published: February 2005

Background: Nifedipine (NIF) may aggravate cyclosporin A (CsA)‐induced gingival overgrowth because the potentiated gingival overgrowth has been observed in the patients treated with CsA and NIF. The purpose of this study was to evaluate whether NIF could aggravate the CsA‐induced gingival overgrowth in a rat model.

Methods: Ninety male Sprague‐Dawley rats were divided into 6 groups: the first group received 8 mg/kg of CsA daily by gastric feeding for 6 weeks; the second and third groups received NIF daily at a dosage of 10 or 50 mg/kg; the fourth and fifth groups received CsA (8 mg/kg) and NIF (10 or 50 mg/kg); and the sixth group received solvents as a negative control. Gingival dimensions (including bucco‐lingual depth, mesio‐distal width, and vertical height) were assessed bi‐weekly from impressed stone models of the mandibular incisal region. At the end of the experiment, the animals were sacrificed. Following histopathological procedures, serial horizontal sections were obtained at the base of the central incisal papilla. Two tissue levels were selected for histometric analysis. Level 1 was defined as the point where the lingual gingiva embraced the bucco‐lingual midpoint of the roots and the level 2 as the point where the lingual gingiva at the enamel‐dentinal junction approximated the bucco‐proximal angle of the roots. The bucco‐lingual depth and the mesio‐distal width of the papilla were recorded on 5 consecutive sections at the 2 levels, respectively.

Results: At the 6‐week observations, the gingival dimensions (including the depth, width, and height) significantly increased after CsA therapy and the increasing treatment duration; however, only the mesio‐distal width increased after NIF therapy. For NIF therapy alone, a positive linear relation was noted by increased NIF treatment dosages in all gingival dimensions at week 6. But, this relationship was not found in the combined therapies. By histometry, tissue dimensions increased following single drug therapy, either CsA or NIF, at both levels. In animals with the combined therapies, the tissue dimensions decreased if the animals received 10 mg NIF, while they rebounded to control levels with the 50 mg dosage. A dose‐dependent positive pattern by NIF was noted in tissue dimensions, but the pattern did not occur in animals that received combined therapy.

Conclusions: The gingival dimensions increased after CsA or NIF therapy, although they were more prevalent with CsA. But the augmenting pattern in gingival morphology observed with CsA therapy decreased when the animals received additional NIF. Therefore, we question whether NIF is a critical factor in aggravating the CsA‐induced gingival overgrowth. J Periodontol 2001;72:532‐537.
Treatment of a Human Transosseous Mandibular Defect By Guided Bone Regeneration
Authors: Barboza Eliane P. , Lugão Carlos Eduardo B.
Published: February 2005

The treatment of through‐and‐through human periapical lesions by barrier membrane techniques has not been reported in the periodontal literature. However, periodontists frequently perform this treatment. The authors present a case that demonstrates radiopacity after regeneration surgery of a human periapical transosseous mandibular defect, suggesting local bone regeneration. The surgical technique performed in this case was based on the principles of guided bone regeneration using a demineralized freeze‐dried bone membrane (DFDBM). The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissue. Radiographic findings demonstrated bone fill after 8 months. J Periodontol 2001;72:538‐541.
Microsurgical Approach to Periodontal Regeneration. Initial Evaluation in a Case Cohort
Authors: Cortellini Pierpaolo , Tonetti Maurizio S.
Published: February 2005

Background: Improvements in flap design and soft tissue manipulation are considered key elements in improving the outcomes of regenerative periodontal surgery. Improved visual acuity and better soft tissue handling resulting from the application of a microsurgical approach hold great promise to further improve predictability of periodontal regeneration. The aim of this study was to preliminarily evaluate the outcomes of a microsurgical approach in the regenerative therapy of deep intrabony defects.

Methods: This patient cohort study involved 26 patients with one deep interdental intrabony defect each. They were treated with periodontal regeneration using guided tissue regeneration membranes. Defects were accessed with previously described papilla preservation flaps performed with the aid of an operating microscope and microsurgical instruments. A stringent plaque control regimen was enforced in all the patients during the 1‐year observation period. Outcomes included evaluation of the complete primary closure of the interdental space (closure), gains in clinical attachment (CAL), and reductions in probing depths (PD).

Results: Closure was achieved in all treated defects and was maintained in 92.3% of cases for the entire healing period. Associated gains in CAL were 5.4 ± 1.2 mm on average, corresponding to a CAL gain of 82.8 ±14.7% of the initial intrabony component of the defect. Average PD reduction was 5.8 ±1.4 mm and was associated with minimal increase in gingival recession (0.4 ±0.7 mm).

Conclusions: The use of a microsurgical approach was associated with very high ability to obtain and maintain primary closure of the interdental tissues over the barrier membranes. The procedure resulted in clinically important amounts of CAL gains and minimal recessions. J Periodontol 2001;72:559‐569.
Root Trunk Concavities as a Risk Factor for Regenerative Procedures of Class II Furcation Lesions in Dogs
Authors: Novaes Arthur B. , Tamani Juliana P. , Oliveira Paulo T. , Palioto Daniela B. , Almeida Adriana L.G.
Published: February 2005

Background: The purpose of this study was to evaluate the influence of root trunk concavities on guided tissue regeneration.

Methods: The second, third, and fourth mandibular bicuspids of 4 healthy mongrel dogs were used. Full flaps were elevated and furcation lesions (5 mm in height and 2 mm in depth) were surgically created. One mm deep concavities were prepared on the root trunks and part of the crown of all teeth. The second bicuspids remained as controls (C); the left third and fourth bicuspids received normal expanded polytetrafluoroethylene (ePTFE) membranes (NM) and the right bicuspids received modified ePTFE membranes (MM). The MM were made by removing the collar from an NM, cutting it into 2 mm segments, and suturing each of the segments to the collar of each MM. Normal and modified membranes were sutured to their corresponding teeth and the flaps sutured. After the healing period, the mandibles were removed and the teeth processed for histomorphometry.

Results: The results showed that the junctional epithelium measured a mean of 0.71 mm for C, 0.64 mm for NM, and 0.14 mm for MM. The differences between C and MM and between NM and MM were both statistically significant at the 5% level (Kruskal‐Wallis test). Mean bone height measurements for the buccal surfaces from the furcation roofs were 2.79 mm for C, 2.60 mm for NM, and 1.06 mm for MM and for the mid‐portion 1.10 mm for C, 1.23 mm for NM, and 0.30 mm for MM. Differences were statistically significant at the 1% level between C and MM and between NM and MM for the buccal measurements, and at the 5% level between NM and MM for the mid‐portion measurements.

Conclusions: Root trunk concavities are important risk factors for regenerative procedures. The collars of the membranes should be modified to improve results when concavities are present. J Periodontol 2001;72:612‐;619.
Soluble CD 14 Levels in Ginigival Crevicular Fluid of Subjects With Untreated Adult Periodontitis
Authors: Jin Lijian , Darveau Richard P.
Published: February 2005

Background: This study determined soluble CD14 (sCD14) levels in gingival crevicular fluid (GCF) and their potential relationship to periodontal conditions in adult periodontitis.

Methods: GCF was collected from 15 patients with untreated adult periodontitis. sCD14 levels were determined by ELISA and presented as total amount (ng/site) and concentration (µg/ml). The periodontal exarhination consisted of plaque index (PI), bleeding index (BI), probing depth (PD), and clinical attachment level (CAL). PD and CAL were measured with an electronic probe.

Results: sCD14 was detected in all 15 subjects and was found in 59% (62/105) of the sampled sites. The percentage of sites with sCD14 vaned greatly, ranging from 14% to 100%. The mean total amount of sCD14 was 1.71 ± 0.40, range 0.03 to 5.41 ng/site; the concentration of sCD14 was 14.04 ± 4.15, range 0.16 to 51.74 µg/ml. No significant difference in clinical data was found between the sites with and without detectable levels of sCD14. However, on the basis of the individual profile of sCD14 levels, i.e., those individuals with >50% of the sites containing sCD14 and mean levels of sCD14 >5.0 pg/ml, the 15 subjects were divided into a high sCD14 group (9 subjects) and a low sCD14 group (6 subjects). Compared to the high group, the low group showed greater mean PD and a higher percentage of sites with PD ≥ 5.0 mm (P > 0.05). Consistent with this, sCD14 concentrations showed a negative correlation with PD (rs = –0.636, P = 0.0174).

Conclusions: The present study shows that sCD14 levels in GCF varied greatly among subjects with untreated adult periodontitis. Individuals with higher levels of sCD14 in GCF and more sites containing sCD14 had fewer deep pockets. The negative correlation between GCF sCD14 levels and probing depth implies a crucial role of sCD14 in bacterially induced periodontal destruction. The relationship between GCF sCD14 levels and probing depth warrants further investigations. J Periodontol 2001; 72:634‐640.
Effects of Cyclosporin A on Dental Alveolar Bone: A Histomorphometric Study in Rats
Authors: Shen E‐Chin , Fu Earl , Hsieh Yao‐Dung
Published: February 2005

Background: We have previously reported cyclosporin A (CA)‐induced osteopenia around the dental alveoli of the mandibular incisors of rats. The drug‐induced tooth displacement and the regional anatomical complexity around the mandibular incisors might complicate the local effects of CA. Therefore, the purpose of this study was to evaluate the dental alveolar bone histomorphology around maxillary secondary molars in CA‐treated rats and to further elucidate the effects of CA on the dental alveolus.

Methods: Twenty Sprague‐Dawley rats were assigned to a CA and a control group. Animals in the CA group received CA (15 mg/kg) daily and the control rats received only mineral oil. At the end of weeks 2 and 4, five animals in each group were sacrificed. Dental alveoli around the maxillary second molar region were frontally sectioned and stained with toluidine blue by undecalcified histological processing. Ten serial tissue sections, 80 µm apart, were selected for histometric evaluation. Bone volume, bone‐specific surface, and osteoid formation were measured at buccal, apical, and palatal locations in dental alveolus.

Results: Overall bone mass in dental alveolus decreased more in the CA group than in the control group at both observation intervals. All histometric measurements, except the bone‐specific surface, were significantly affected by the alveolar location (palatal, apical, and buccal) and CA therapy (P = 0.004 and <0.001, 0.001 and <0.001, 0.004 and <0.001 for drug therapy and location of the dental alveolus in bone volume, marrow volume, and the ratio of bone surface to volume, respectively). Decreased bone volume, but increased marrow volume, were noted in the CA group compared to the control group. Although the alveolar bone surface area did not differ between the CA group and the control group, greater alveolar surface‐to‐volume ratio was noted in the CA group. For osteoid, more decreased volume, seam width, and fractional formation surface were observed in the CA group compared to the control group (P <0.001, <0.001, and = 0.046 in osteoid volume, seam width volume, and formation surface, respectively).

Conclusions: Because the bone mass and the osteoid formation in the dental alveolus around the maxillary molar region showed a decrease after CA exposure, we conclude that this drug has inhibitory effects on the dental alveoli. J Periodontol 2001;72:659‐665
Metastatic Transitional Cell Carcinoma of the Urinary Bladder Presenting as a Mandibular Gingival Swelling
Authors: de Courten Alain , Irle Claudius , Samson Jacky , Lombardi Tommaso
Published: February 2005

Oral cavity metastases mostly originate from the breasts, lungs, or kidneys. Transitional cell carcinoma TCC), the most frequent malignant tumor of the urinary bladder, rarely metastasizes to the jaws. To the best of our knowledge, only 8 cases of bladder carcinoma have been reported in the English literature to metastasize to the jawbones. A new case of mandibular metastasis of urinary bladder TCC with extension to the gingiva is presented in a 64‐year‐old white man. The patient was referred for a periodontal infection of the upper right first molar. The clinical examination also showed a gingival swelling located in the lower left premolar region with a hypoasthesia of the left side of the lower lip. The gingival mass was biopsied, and the microscopy showed a mandibular metastatic TCC of the urinary bladder extending to the gingiva. Periodontists should be aware that, although gingival metastases are rare, when they occur they may mimic other local benign pathological conditions. J Periodontol 2001;72:688‐690.
Clinical Application of a New Compact Computed Tomography System for Evaluating the Outcome of Regenerative Therapy: A Case Report
Authors: Ito Koichi , Yoshinuma Naoto , Yoshinuma Eiji , Arai Yoshinori , Shinoda Koji
Published: February 2005

Background: The limitations of conventional 2‐dimensional (2‐D) radiographs have been emphasized in many studies. Because the image is a 2‐D map of the 3‐dimensional (3‐D) tooth and periodontal tissue, these structures may be superimposed on each other. Recently, 3‐D image analysis by computed tomography (CT) was introduced to dentistry, but it has been used only rarely in the periodontal field.

Methods: The purpose of this case report was to introduce the clinical application of a newly developed, compact computed tomography system for evaluating the outcome of regenerative therapy in an adult patient with periodontitis (male, aged 55 years). To evaluate the bone defects including furcation involvement, we took an intraoral radiograph and performed CT scanning on tooth #19. We recorded a number of clinical parameters at the time of surgery. We compared the images of the bone defect obtained by CT images and the conventional radiograph with the true bone defect morphology at the surgical site.

Results: One year after the periodontal surgery, we again took CT scans and a conventional radiograph, and the new images of the bone defect were compared and evaluated. The new CT images were reconstructed for 3‐D evaluation and compared with those taken before surgery. The CT provides 3‐D images of excellent quality for evaluating the morphology of the periodontal bone defect and furcation involvement.

Conclusions: We consider that CT is a useful aid in periodontal examination and diagnosis, and in the prediction and evaluation of periodontal treatment outcomes. J Periodontol 2001;72:696‐702.
Implants in Regenerated Bone in a Primate Model
Authors: Fritz M.E. , Jeffcoat M.K. , Reddy M. , Koth D. , Braswell L.D. , Malmquist J. , Lemons J.
Published: February 2005

Background: Earlier publications from our laboratory described the use of guided bone regeneration to fill large bone voids in the mandible created through en bloc resection in primates. The present report describes placement of implants into the regenerated bone with subsequent prostheses construction and loading.

Methods: Lesions were created in the mandibles of 9 monkeys in a standardized mandibular defect of 8 × 19 mm. Reinforced expanded polytetrafluoroethylene membranes were placed in the animals and held in place with mini screws and sutures for anywhere from 1 to 12 months. No material was added to the defect. In each animal a root‐form implant was placed 12 mm distal to the abutment teeth into the regenerated bone and was loaded with a prosthesis for 12 months. These implants were compared to original implants placed in the same monkeys years earlier in the same location in non‐regenerated bone. Digital radiology and histomorphometry are described.

Results: The results show that root‐form implants placed in regenerated bone show the same radiological and histomorphometric characteristics as in normal bone when loaded. In addition, the percentage of bone contact with implants seen in regenerated bone versus non‐regenerated bone is the same when both are loaded (65 ± 13% SD in regenerated bone versus 59 ± 15% SD in non‐regenerated bone).

Conclusions: In a primate model root‐form implants placed in regenerated bone and prosthetically loaded show no difference when compared to root‐form implants placed in non‐regenerated bone and prosthetically loaded. J Periodontol 2001;72:703‐708.
Effects of Dipeptide Bestatin on Porphyromonas gingivalis and Epithelial Cells
Authors: Labbé Sonia , Grenier Daniel , Plamondon Pascale , Uitto Veli‐Jukka , Mayrand Denis
Published: February 2005

Background: Dipeptide bestatin has been previously reported to selectively inhibit the growth of Porphyromonas gingivalis. The aims of this study were to investigate the mechanism of action of bestatin and to evaluate its effect on epithelial cells.

Methods: The inhibitory effect of bestatin on P. gingivalis was tested in vitro (culture medium) and in vivo (guinea pig model). Radiolabeled compounds were used to investigate the effect of bestatin on the uptake of amino acids and peptides. The cytotoxic effect of bestatin was evaluated using a keratinocyte cell line.

Results: The growth inhibition of P. gingivalis by bestatin was concentration‐dependent. Even at high concentrations, compounds possessing a chemical structure or an aminopeptidase inhibitor activity related to bestatin had no effect on growth of P. gingivalis. When injected in the presence of P. gingivalis, bestatin was able to prevent the development of a necrotic abscess in a guinea pig model. Data were obtained suggesting that bestatin does not act on proteinases of P. gingivalis. Rather, bestatin was found to inhibit the intracellular uptake of radioactivity from 14C‐labeled amino acids or heat‐denatured type I collagen. This was not observed with a spontaneous mutant of P. gingivalis, whose growth was not affected by bestatin. In the second part of the study, bestatin was found to have no effect on epithelial cell viability in culture at concentrations effective on P. gingivalis. In addition, bestatin did not show effects on epithelial cell migration or production of gelatinases.

Conclusions: This study suggests that bestatin selectively inhibits growth of P. gingivalis by affecting the intracellular uptake of amino acids and peptides, which serve as energy and nitrogen sources for this bacterial species. Bestatin has no cytotoxicity and may represent a therapeutic molecule for local treatment of P. gingivalis‐associated periodontitis. J Periodontol 2001;72:714‐721.
Upregulation of Keratinocyte Growth Factor in Cyclosporin A‐Induced Gingival Overgrowth
Authors: Das Swarga Jyoti , Parkar Mohamed H. , Olsen Irwin
Published: February 2005

Background: Drug‐induced gingival overgrowth (GO) is a frequent and adverse side‐effect associated principally with the administration of the immunosuppressive drug cyclosporin A (CsA) and also certain anti‐epileptic and anti‐hypertensive drugs. It is characterized by a marked increase in the thickness of the epithelial layer and the accumulation of excessive amounts of connective tissue. Although the mechanism by which the drugs cause GO is not yet understood, keratinocyte growth factor (KGF), which is a potent epithelial cell mitogen, has been implicated in other hyperplastic conditions, including mammary and prostatic hyperplasia, and could also be involved in the molecular pathology of GO.

Methods: Immunohistochemistry was used to examine the expression of KGF in normal gingiva (NG) and GO tissue sections. The relative level of KGF mRNA in GO tissue and cells was compared with that of NG tissue and fibroblast cells using the semi‐quantitative reverse transcribed‐polymerase chain reaction (RT‐PCR) and DNA sequencing was carried out to confirm the identity of the PCR product.

Results: KGF antigen and mRNA were readily detected in the GO tissue immunohistochemically and by RT‐PCR, respectively, but were not expressed in the NG tissue. Moreover, KGF transcripts were found to be approximately 2 times higher in the GO than in the NG fibroblasts in vitro, although the difference was not statistically significant.

Conclusions: This study has shown, for the first time, that the level of KGF is elevated in GO and suggests that KGF may have an important role in the enhanced epithelial proliferation associated with GO. J Periodontol 2001;72:745‐752.
Relationship Between Rheumatoid Arthritis and Periodontitis
Authors: Mercado F.B. , Marshall R.I. , Klestov A.C. , Bartold P.M.
Published: February 2005

Background: Because of several similar features in the pathobiology of periodontitis and rheumatoid arthritis, in a previous study we proposed a possible relationship between the two diseases. Therefore, the aims of this study were to study a population of rheumatoid arthritis patients and determine the extent of their periodontal disease and correlate this with various indicators of rheumatoid arthritis.

Methods: Sixty‐five consecutive patients attending a rheumatology clinic were examined for their levels of periodontitis and rheumatoid arthritis. A control group consisted of age‐ and gender‐matched individuals without rheumatoid arthritis. Specific measures for periodontitis included probing depths, attachment loss, bleeding scores, plaque scores, and radiographic bone loss scores. Measures of rheumatoid arthritis included tender joint analysis, swollen joint analysis, pain index, physician's global assessment on a visual analogue scale, health assessment questionnaire, levels of C‐reactive protein, and erythrocyte sedimentation rate. The relationship between periodontal bone loss and rheumatological findings as well as the relationship between bone loss in the rheumatoid arthritis and control groups were analyzed.

Results: No differences were noted for the plaque and bleeding indices between the control and rheumatoid arthritis groups. The rheumatoid arthritis group did, however, have more missing teeth than the control group and a higher percentage of these subjects had deeper pocketing. When the percentage of bone loss was compared with various indicators of rheumatoid arthritis disease activity, it was found that swollen joints, health assessment questionnaire scores, levels of C‐reactive protein, and erythrocyte sedimentation rate were the principal parameters which could be associated with periodontal bone loss.

Conclusions: The results of this study provide further evidence of a significant association between periodontitis and rheumatoid arthritis. This association may be a reflection of a common underlying disregulation of the inflammatory response in these individuals. J Periodontol 2001;72:779‐787.
Gingival, Dermal, and Periodontal Ligament Fibroblasts Express Different Extracellular Matrix Receptors
Authors: Palaiologou Archontia A. , Yukna Raymond A. , Moses Randy , Lallier Thomas E.
Published: February 2005

Background: Fibroblasts are the predominant cells of the periodontal ligament and the gingiva and have important roles in the function and regeneration of the tooth support apparatus. The goal of this study was to investigate the possible differences in the adhesion properties and expression of extracellular matrix (ECM) receptors among different fibroblast populations.

Methods: The adhesion of gingival (GF), dermal (DF), and periodontal ligament fibroblast (PDLF) cultures to ECM proteins (fibronectin, laminin, vitronectin, RGD peptide, collagen type I, and collagen type IV) adsorbed to tissue culture plastic was evaluated fluorometrically. Quantitative reverse transcriptionpolymerase chain reactions (RT‐PCR) were performed using primers specific for 19 integrin subunits to quantify ECM receptor transcript expression.

Results: Our data demonstrated that GF and PDLF adhere to vitronectin and collagen types I and IV more avidly than do DF. PDLF adhered well to laminin, whereas GF and DF did not. Quantitation of integrin expression demonstrated that the different fibroblast types expressed different integrin transcripts, further demonstrating their innate differences.

Conclusions: The 3 fibroblast types studied behave differently and expressed different ECM receptors. However, gingival fibroblasts and periodontal ligament fibroblasts are more similar in their attachment and integrin expression than either is to dermal fibroblasts. Therefore, experiments using DF will not necessarily be valid for oral tissues. J Periodontol 2001;72:798‐807.
Metal Piercing Through the Tongue and Localized Loss of Attachment: A Case Report
Authors: Kretchmer Michael C. , Moriarty John D.
Published: February 2005

The piercing of intraoral structures to accommodate different types of jewelry has increased in popularity in the last few years. The association of an intraoral piercing with localized periodontitis is not well documented in the literature. A 22‐year‐old male presented to our clinic with a tongue stud placed through the mid‐dorsum of his tongue. The inferior sphere was coated with plaque and calculus. Teeth #24 and #25 exhibited 6 mm interproximal probing depth and recession, horizontal radiographic bone loss, and tissue indentations consistent with the shape of the inferior ball of the tongue stud directly on the lingual surfaces of both teeth. The treatment consisted of an adult prophylaxis, flap curettage of the mandibular anterior region, oral hygiene instructions, and removal of the tongue stud. At our follow‐up visit, the patient's oral hygiene had improved, he has removed the jewelry, and the attachment loss appears to have stabilized. J Periodontol 2001;72:831‐833.
The Expression of Plasminogen Activator System in a Rat Model of Periodontal Wound Healing
Authors: Xiao Yin , Li Huika , Bunn Clive , Bartold P. Mark
Published: February 2005

Background: The plasminogen activator system has been proposed to play a role in proteolytic degradation of extracellular matrices in tissue remodeling, including wound healing. The aim of this study was to elucidate the presence of components of the plasminogen activator system during different stages of periodontal wound healing.

Methods: Periodontal wounds were created around the molars of adult rats and healing was followed for 28 days. Immunohistochemical analyses of the healing tissues and an analysis of the periodontal wound healing fluid by ELISA were carried out for the detection of tissue‐type plasminogen activator (t‐PA), urokinase‐type plasminogen activator (u‐PA), and 2 plasminogen activator inhibitors (PAI‐1 and PAI‐2).

Results: During the early stages (days 1 to 3) of periodontal wound healing, PAI‐1 and PAI‐2 were found to be closely associated with the deposition of a fibrin clot in the gingival sulcus. These components were strongly associated with the infiltrating inflammatory cells around the fibrin clot. During days 3 to 7, u‐PA, PAI‐1, and PAI‐2 were associated with cells (particularly monocytes/macrophages, fibroblasts, and endothelial cells) in the newly formed granulation tissue. During days 7 to 14, a new attachment apparatus was formed during which PAI‐1, PAI‐2, and u‐PA were localized in both periodontal ligament fibroblasts (PDL) and epithelial cells at sites where these cells were attaching to the root surface. In the periodontal wound healing fluid, the concentration for t‐PA increased and peaked during the first week. PAI‐2 had a similar expression to t‐PA, but at a lower level over the entire wound‐healing period.

Conclusions: These findings indicate that the plasminogen activator system is involved in the entire process of periodontal wound healing, in particular with the formation of fibrin matrix on the root surface and its replacement by granulation tissue, as well as the subsequent formation of the attachment of soft tissue to the root surface during the later stages of wound repair. J Periodontol 2001;72:849‐857.
Orthodontic Tooth Movement Enhances Bone Healing of Surgical Bony Defects in Rats
Authors: Vardimon Alexander D. , Nemcovsky Carlos E. , Dre Eleni
Published: February 2005

Background: The question of whether the repair of an alveolar bony defect can be enhanced by orthodontic tooth movement was addressed.

Methods: Alveolar bone defects were created in 52 Wistar male rats anterior to both maxillary first molars. After 1 week of healing, orthodontic protraction was applied for 2 weeks on the right side, resulting in mesial tipping and displacement movement. Subsequently, a retention appliance was inserted for 1 week. The left side served as the untreated (control) group. Vital bone staining (procion brilliant red H‐8) was administered before and after orthodontic traction. Histomorphometric analysis was performed on 62 hemimaxillae using UV confocal microscopy and an imaging program. The total area of the bony defect was divided into 4 equal quadrants, and the area of bony apposition in each quadrant was measured.

Results: The total area of bony apposition was 6.5‐fold larger in the treated (26.41 × 104 ± 28.92 × 104 µm2) than in the control group (4.07 × 104 ± 2.82 × 104 µm2), approaching statistical significance (P = 0.065). The treated occlusal quadrants demonstrated highly significant (P = 0.010), greater bone apposition compared to the control group (13.8‐fold) and to the treated apical quadrants (P = 0.04, 5‐fold).

Conclusions: This study confirms that orthodontic tooth movement is a stimulating factor of bone apposition. A conversion in the repair pattern of the bony defect from apicoocclusal in the control group (no tooth movement) to occlusoapical in the treated group (with tooth movement) further supports the linkage between tooth movement and enhanced bone deposition. Clinical implication suggests incorporation of orthodontic tooth movement in regenerative therapy. J Periodontol 2001;72:858‐864.
Molecular Analysis of Peptostreptococcus micros Isolates From Patients With Periodontitis
Authors: Alpha Craig X. , Guthmiller Janet M. , Cummings Hector E. , Schomberg Lori L. , Noorani Shahriar M.
Published: February 2005

Background: Recent studies provide strong evidence implicating Peptostreptococcus micros in the pathogenesis of various oral infections, including oropharyngeal abscesses and periodontal disease. To date, very little is known regarding the role of P. micros in periodontal disease. Therefore, a genetic analysis was initiated to differentiate among strains of P. micros infecting periodontal patients.

Methods: Sixty DNA samples of P. micros isolated from 15 patients with periodontal disease were evaluated. Arbitrarily primed polymerase chain reactions (AP‐PCR) were performed using primer 3 (AGTCAGCCAC) and primer 13 (CAGCACCCAC). The PCR products were analyzed by gel electrophoresis.

Results: The primers produced several unique patterns among the strains tested. Primer 3 resulted in 30 different patterns, whereas primer 13 resulted in 31 different patterns, which were distinct from those seen with primer 3. In 8 of 15 patients, the PCR profile was identical for all isolates cultured from that patient, indicating a clonal infection. In 4 of 15 patients, 2 different genotypes were identified. In the remaining 3 patients, all isolates cultured from these patients exhibited a unique genotype.

Conclusions: While P. micros appears to be heterogeneous throughout a population of periodontal patients, each patient is, for the most part, infected with a limited number of genotypes. These results demonstrate the genetic diversity of P. micros and the usefulness of AP‐PCR for future epidemiological studies in understanding the role P. micros plays in periodontal disease pathogenesis. J Periodontol 2001;72:877‐882.
Cyclosporin‐Induced Gingival Overgrowth at the Newly Formed Edentulous Ridge in Rats: A Morphological and Histometric Evaluation
Authors: Fu Earl , Hsieh Yao‐Dung , Shen E‐Chin , Nieh Shin , Mao Tai‐Kum , Chiang Cheng‐Yang
Published: February 2005

Background: Since cyclosporin A (CsA)‐induced overgrowth seldom occurs at sites distant from teeth, the periodontal ligament has been considered significant. The aim of this study was to examine overgrowth occurrence at the edentulous ridge—the sites without the ligament—after CsA therapy in rats.

Methods: After extracting all right maxillary molars, 16 Sprague‐Dawley rats underwent a 2‐week healing period. The animals were separated into CsA and control groups. CsA rats received 15 mg/kg of CsA by gastric feeding for 4 weeks, while the control group received only mineral oil. At the end of study, all animals were sacrificed and stone models were immediately obtained by rubber‐based impressions. The edentulous ridge morphology, including the bucco‐lingual width and the vertical height, was measured on the models. For histometry, 10 sections were selected from the edentulous ridge of each animal after undecalcified tissue preparation. The soft tissue areas of the edentulous ridge and the trabecular bone morphology of the dental alveolus were measured.

Results: CsA therapy produced a significant increase of the ridge width and height, measured from the stone models, when compared to the control group. Under histometry, CsA resulted in a significant increase of the epithelium, connective tissue, and total soft tissue areas. The measured trabecular bone volume was affected by both examining factors: the drug therapy and the location of the dental alveolus. CsA therapy produced a significant loss of bone volume but a significant increase of the bone‐specific surface area. Although the mean osteoid volume was similar between CsA and control groups, a significant decrease of the fractional formation surface in the CsA group was revealed.

Conclusions: An enlarged edentulous ridge and an altered dental alveolar bone morphology were observed in CsA‐treated animals at the end of the study; therefore, we suggest that CsA may induce not only a soft tissue overgrowth but also an alveolar bone alteration at the edentulous ridge. The hypothesis that tooth or periodontal ligament is an essential component for the overgrowth development is questioned. J Periodontol 2001;72:889‐894.
Intrapocket Anesthesia for Scaling and Root Planing: Results of a Double‐Blind Multicenter Trial Using Lidocaine Prilocaine Dental Gel
Authors: Jeffcoat Marjorie K. , Geurs Nico C. , Magnusson Ingvar , MacNeill Simon R. , Mickels Nancy , Roberts Frank , Robinson Peter , Salamati Afshin , Yukna Ray
Published: February 2005

Background: The efficacy of a novel anesthetic gel (lidocaine 25 mg/g plus prilocaine 25 mg/g in thermosetting agents) for non‐invasive periodontal pocket anesthesia was evaluated.

Methods: One hundred twenty‐two (122) patients in 8 centers with moderate to severe periodontitis requiring scaling and root planing (SRP) were enrolled in this multicenter, randomized, double‐blind, controlled clinical trial. The active dental gel or a matching placebo gel was applied into the periodontal pocket using a blunt applicator. Following a waiting period of 30 seconds to 2 minutes, scaling and root planing were performed. If the patient had any discomfort, a second application of the gel was applied. If the patient continued to experience discomfort, conventional anesthesia was offered. After all teeth in the test quadrant had received SRP, the overall pain was assessed by the patient using a 100 mm horizontal, ungraded visual analog scale in which the left side was marked “no pain” and the right side marked “worst pain imaginable.” Patients also assessed pain by using a 5‐point verbal rating scale, from “no pain” to “very severe pain.”

Results: The visual analog scale showed significant reductions in reported pain, favoring the active gel over the placebo (mean reduction, 8 mm; P <0.0005). The verbal rating scale revealed that 90% of patients treated with active gel reported no pain or mild pain compared to 64% of placebo‐treated patients (P <0.001).

Conclusions: Intrapocket administration of lidocaine 25 mg/g plus prilocaine 25 mg/g and thermosetting agents may be effective for pain control for scaling and root planing and may offer an alternative to infiltration anesthesia. J Periodontol 2001;72:895‐900.
Evaluation of the Dentogingival Area During Early Plaque Formation
Authors: Weidlich Patrícia , de Souza Maria Antonieta Lopes , Oppermann Rui Vicente
Published: February 2005

Background: The aims of this investigation were to evaluate the pattern of supragingival plaque formation in the dentogingival area within 96 hours after abstinence from mechanical plaque control and to clinically analyze the gingival inflammatory response observed.

Methods: Six male volunteers, 20 to 23 years of age, had their upper incisors and cuspids polished. Four independent periods of no mechanical plaque control – 24, 48, 72, and 96 hours – were instituted. In each period, plaque was disclosed and standardized individual photographs were taken. Impressions were taken and replicas were analyzed by scanning electron microscopy. Gingival crevicular fluid (GCF) was collected at baseline and 96 hours. The height of the gingival papilla was measured at baseline, 24, and 96 hours.

Results: Results showed the presence of a plaque‐free zone (PFZ) along the gingival margin up to 72 hours. After 96 hours, there was a significant reduction in the presence of PFZ in the proximal thirds of the buccal surface when compared to the other experimental periods. At the end of the study, there was a significant increase in the GCF flow as well as edema of the interdental papilla, when compared to baseline values.

Conclusions: The PFZ observed during the initial phase was less apparent at the 96‐hour period. At this time, there was an increase in the gingival inflammatory response, represented clinically by increased GCF flow and edema. J Periodontol 2001;72:901‐910.
Histopathological Morphometric Evaluation of 2 Different Hydroxyapatite‐Bone Derivatives in Sinus Augmentation Procedures: A Comparative Study in Humans
Authors: Artzi Zvi , Nemcovsky Carlos E. , Tal Haim , Dayan Dan
Published: February 2005

Background: Xenografts to augment the maxillary sinus have been used extensively. The aim of the present study was to evaluate, qualitatively and quantitatively, two different HA derivatives of natural and synthetic sources on newly formed bone in the augmented sinus.

Methods: A bilateral sinus augmentation procedure with simultaneous (16 out of 20 sites) or subsequent implant placement was performed in 10 patients. The antrum was randomly filled with a deproteinized, bovine hydroxyapatite mineral (B‐HA) on one side and a non‐ceramic resorbable hydroxyapatite (NC‐HA) on the other. Cylindrical specimens were harvested from the augmented core at 12 months. Decalcified specimens were sectioned at a cross‐horizontal plane and stained with hematoxylin and eosin for histopathologic and histomorphometric examinations. Tissue area fractions of bone, marrow, and the grafted particles were calculated for each specimen from the lateral to the deep region, and changes in values were compared within each material and between them.

Results: New bone formation was evident. B‐HA and NC‐HA particles were observed in all specimens surrounded by newly formed bone in direct connection or by soft tissue marrow. Morphometrically in the B‐HA sites, from the lateral to deeper area, bone area fraction increased from 29.8% to 54.2% (average 42.1%) and marrow area fraction decreased from 37.9% to 26.7% (average 33.3%). The mineral area fraction decreased from 32.3% to 19.1% (average 24.7%). All increasing/decreasing patterns were statistically significant (P <0.001). In the NC‐HA sites, from the lateral to deeper area, bone area fraction increased from 25% to 36.5% (average 32.3%) and marrow area fraction decreased from 51.6% to 41.9% (average 43.2%) (P <0.001). The mineral area fraction decreased from 29% to 21.7% (average 24.6%) (P = 0.038). Comparison between the two HA derivative groups showed a significant difference between the bone area fraction averages (P = 0.0053) and between the increasing patterns along the core depth (P = 0.0006). There was also a significant difference between the decreasing marrow patterns (P = 0.003), but not between their averages. Comparison between the mineral area fractions showed no differences.<

Conclusions: B‐HA and NC‐HA were proven to be biocompatible materials. Although the B‐HA–augmented sites showed a higher percentage of bone formation at 12 months, both are suitable bone derivatives in sinus augmentation procedures and can accommodate osseointegrated implants. J Periodontol 2001;72:911‐920.