bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Evaluation of Calcium Sulfate in Combination With Demineralized Freeze‐Dried Bone Allograft for the Treatment of Human Intraosseous Defects
Authors: Aichelmann‐Reidy Mary E. , Heath Carlette D. , Reynolds Mark A.
Published: February 2005

Background: Medical‐grade calcium sulfate (CS) is a biocompatible, bioabsorbable, and clinically versatile ceramic for use in bone repair. This study compared the clinical efficacy of a combination of calcium sulfate dihydrate, as a binder and barrier, and demineralized freezedried bone allograft (DFDBA) to polytetrafluoroethylene (ePTFE) and DFDBA for the treatment of human periodontal defects.

Methods: Two intrabony defects were compared in each of 19 patients with chronic periodontitis. After initial preparation, full‐thickness mucoperiosteal flaps were elevated, osseous defects debrided, and the roots prepared (ultrasonic, hand curets, and tetracycline conditioning). Defects were randomly treated with either a combination graft of DFDBA with CS (4:1) covered by a CS barrier or with DFDBA and fitted with an ePTFE barrier. Flaps were coronally positioned to obtain primary closure. Clinical soft tissue measurements were recorded at 6 months, and all study sites were surgically reentered for evaluation.

Results: The mean presurgical measurements for defects randomized to the CS and ePTFE treatments, respectively, were similar for attachment level (AL; 6.2 ± 1.8 mm and 6.1 ± 1.7 mm), probing depth (PD; 6.3 ± 1.1 mm and 6.2 ± 1.1 mm), and gingival recession (0.1 ± 1.9 mm and 0.2 ± 1.4 mm). Defects treated with CS or ePTFE demonstrated statistically significant (P ≤0.0001) reductions in mean PD (2.7 ± 1.4 mm and 3.4 ± 1.3 mm, respectively) and gains in mean AL (1.8 ± 1.5 mm and 1.7 ± 1.4 mm, respectively). Recession increased by 0.8 ± 1.4 mm at CS sites and 1.6 ± 1.7 mm at ePTFE‐treated sites (P ≤0.05). Pretreatment mean defect depths were 4.1 ± 1.0 mm and 3.7 ± 1.0 mm for CS and ePTFE sites, respectively. Reentry evaluations revealed a mean defect fill of 2.7 ± 1.5 mm and 2.5 ± 0.9 mm for the CS and ePTFE sites, respectively, with a corresponding mean defect resolution of 80.3 ± 18.7% and 76.7 ± 18.5%. The CS and ePTFE sites did not differ significantly in mean defect fill or defect resolution.

Conclusions: The results of this study indicate that calcium sulfate, when used as a binder and barrier in combination with DFDBA, supports significant clinical improvement in intrabony defects, as evidenced by reductions in probing depth, gains in clinical attachment level, and defect fill and resolution. Calcium sulfate represents an important alternative to non‐resorbable ePTFE barriers in combination with DFDBA for the treatment of intrabony defects. J Periodontol 2004;75:340‐347.
Inhibition of Cyclosporin A‐Induced Gingival Overgrowth by Azithromycin Through Phagocytosis: An In Vivo and In Vitro Study
Authors: Paik Jeong‐Won , Kim Chang‐Sung , Cho Kyoo‐Sung , Chai Jung‐Kiu , Kim Chong‐Kwan , Choi Seong‐Ho
Published: February 2005

Background: The objective of the present study was to investigate the effect of cyclosporin A (CsA) and azithromycin (AZI) on collagen metabolism in the gingiva of rats.

Methods: Fifty 6‐week‐old male Sprague‐Dawley (SD) rats (weight 120 to 150 g) were randomly distributed into five groups. All groups received various drugs via gastric feeding for 7 weeks. The first group (Mo group) received mineral oil for 7 weeks as a control; the CsA group received CsA in mineral oil for 7 weeks (dosage 30 mg/kg); the CsA/Mo group received CsA in mineral oil for 6 weeks and mineral oil only for the seventh week; the CsA/AZI group received CsA in mineral oil for 6 weeks and AZI (dosage 10 mg/kg) in mineral oil simultaneously with CsA in the seventh week; and the Mo/AZI group received mineral oil for 6 weeks and AZI in mineral oil for the seventh week. All animals were sacrificed for clinical and histological analyses. Gingival fibroblasts were cultured at the fourth passage, and the amount of collagen was measured. Type I collagen and collagenase mRNA were measured by reverse transcription‐polymerase chain reaction. Collagen phagocytosis assay also was performed.

Results: Clinically, CsA induced gingival overgrowth in rats, whereas AZI reduced gingival overgrowth. Histological results of the CsA group showed a marked increase of tissue volume compared to the other groups. High collagen amounts were found when gingival overgrowth was induced. However, type I collagen mRNA and collagenase mRNA expressions did not statistically differ among groups. Phagocytosis assay showed that CsA decreased phagocytic activity of gingival fibroblasts, whereas AZI increased the activity. These results suggest that the induction and reduction of CsA‐induced gingival overgrowth were closely associated with phagocytic activity.

Conclusion: Cyclosporin A decreases collagen degradation by lowering phagocytic activity of rat gingival fibroblasts. Azithromycin partially compensates for this lowered phagocytic activity. J Periodontol 2004;75:380‐387.
Tetracycline Conditioning Augments the In Vivo Inflammatory Response Induced by Cementum Extracts
Authors: Houri‐Haddad Yael , Karaka Lamis , Stabholz Ayala , Soskolne Aubrey , Shapira Lior
Published: February 2005

Background: Studies have shown that extracts of cementum from periodontally involved teeth stimulated cytokine secretion from cultured human monocytes and that this stimulatory effect is inhibited by conditioning of the cementum with tetracycline. Using the subcutaneous chamber model in mice, the present study was designed to test the ability of cementum extracts from periodontally diseased teeth to induce an inflammatory response in vivo and to evaluate the effect of cementum conditioning with tetracycline.

Methods: Subcutaneous chambers were implanted in 24 mice. Two weeks later, the animals received intrachamber injection of one of the following: diseased‐cementum extract, healthy‐cementum extract, diseased‐cementum extract preconditioned with tetracycline, or medium alone. Chamber exudates were harvested and analyzed for leukocyte levels, tumor necrosis factor (TNF)‐α, interferon (IFN)‐γ, and interleukin‐10 (IL‐10).

Results: Injection of healthy‐ or diseased‐cementum extracts increased the intrachamber levels of leukocytes. Extracts of diseased cementum were found to significantly increase the levels of TNF‐α, IFN‐γ, and IL‐10, compared with extracts of healthy cementum or media alone. Peak cytokine levels were observed 2 hours postinjection. Conditioning of diseased cementum with tetracycline before extraction resulted in augmented levels of TNF‐α and IFN‐γ, and reduced levels of IL‐10, compared with untreated diseased cementum.

Conclusions: The present results demonstrate that conditioning of diseased cementum with tetracycline may induce an intense inflammatory response in a mouse model, and they suggest that local application of tetracycline for root conditioning should be carefully reinvestigated. J Periodontol 2004;75:388‐392.
Radiographic Parameters for Prognosis of Periodontal Healing of Infrabony Defects: Two Different Definitions of Defect Depth
Authors: Eickholz Peter , Hörr Torten , Klein Filip , Hassfeld Stefan , Kim Ti‐Sun
Published: February 2005

Background: The aim of the present study was to evaluate defect width and two different definitions of defect depth as prognostic factors of periodontal healing in infrabony defects treated by regenerative therapy 6 and 24 months after surgery.

Methods: In 32 patients with moderate to advanced periodontitis, 50 infrabony defects were treated by the guided tissue regeneration (GTR) technique using non‐resorbable or bioabsorbable barriers. Clinical parameters were assessed, and 50 triplets of standardized radiographs were taken before surgery and 6 and 24 months after surgery. Using a computer‐assisted analysis, the distances cemento‐enamel junction (CEJ) to alveolar crest (AC), CEJ to bony defect (BD), horizontal projection of the most coronal extension of the bony wall to the root surface to BD, width, and angle of the bony defects were measured. Depth of the bony defect was 1) calculated as CEJ‐BD minus CEJ‐AC (INFRA1) and 2) measured as horizontal projection of the most coronal extension of the bony wall to the root surface to BD (INFRA2).

Results: Whereas statistically significant vertical clinical attachment level gains (CAL‐V: 3.36 ± 1.59 mm/ 3.41 ± 1.72 mm; P <0.001) could be found both 6 and 24 months after surgery, bony fill (0.70 ± 2.52 mm; P = 0.056/1.21 ± 2.55 mm; P <0.005) was significant 24 months post‐surgically only. In a multilevel regression analysis, CAL‐V gain was predicted by bioabsorbable membrane (P = 0.005), baseline probing depths (PD) (P <0.001), and actual smoking (P <0.05). Bony fill could be predicted by baseline depth of the infrabony component as determined by INFRA2 (P <0.05), angulation of bony defect (P <0.005), and gingival index at baseline (P <0.001). In narrow (<37°) and deep (≥4 mm) infrabony defects, bony fill was more pronounced than in wide and shallow defects (P <0.001).

Conclusions: Improvement achieved by GTR in infrabony defects can be maintained up to 24 months after surgery. Narrow and deep infrabony defects respond radiographically and are to some extent clinically more favorable to GTR therapy than are wide and shallow defects. The infrabony component of bony defects, as determined by the distance from the most coronal extension of the lateral bony wall to BD (INFRA2), is a better predictor of bony fill than that determined by AC‐BD (INFRA1). J Periodontol 2004;75:399‐407.
Effect of Systemic Matrix Metalloproteinase Inhibition on Periodontal Wound Repair: A Proof of Concept Trial
Authors: Gapski R. , Barr J.L. , Sarment D.P. , Layher M.G. , Socransky S.S. , Giannobile W.V.
Published: February 2005

Background: The adjunctive use of matrix metalloproteinase (MMP) inhibitors with scaling and root planing (SRP) promotes new attachment in patients with periodontal disease. This pilot study was designed to examine aspects of the biological response brought about by the MMP inhibitor low dose doxycycline (LDD) combined with access flap surgery (AFS) on the modulation of periodontal wound repair in patients with severe chronic periodontitis.

Methods: Twenty‐four subjects were enrolled into a 12‐month, randomized, placebo‐controlled, double‐masked trial to evaluate clinical, biochemical, and microbial measures of disease in response to 6 months therapy of either placebo capsules + AFS or LDD (20 mg b.i.d.) + AFS. Clinical measures including probing depth (PD), clinical attachment levels (CAL), and bleeding on probing (BOP) as well as gingival crevicular fluid bone marker assessment (ICTP) and microbial DNA analysis (levels and proportions of 40 bacterial species) were performed at baseline and 3, 6, 9, and 12 months.

Results: Patients treated with LDD + AFS showed more potent reductions in PD in surgically treated sites of >6 mm (P <0.05, 12 months). Furthermore, LDD + AFS resulted in greater reductions in ICTP levels compared to placebo + AFS. Rebounds in ICTP levels were noted when the drug was withdrawn. No statistical differences between the groups in mean counts were found for any pathogen tested.

Conclusions: This pilot study suggests that LDD in combination with AFS may improve the response of surgical therapy in reducing probing depth in severe chronic periodontal disease. LDD administration also tends to reduce local periodontal bone resorption during drug administration. The use of LDD did not appear to contribute to any significant shifts in the microbiota beyond that of surgery alone. J Periodontol 2004;75:441‐452.
Esthetic and Dimensional Evaluation of Free Connective Tissue Grafts in Prosthetically Treated Patients: A 1‐Year Clinical Study
Authors: Orsini Marco , Orsini Giovanna , Benlloch Dunia , Aranda Juan José , Lázaro Pedro , Sanz Mariano
Published: February 2005

Background: The aim of this study was to evaluate the predictability of the free connective tissue graft in prosthetically treated patients needing gingival augmentation. The following outcome variables were studied 1) dimensional changes of free connective gingival grafts; 2) color blending with adjacent tissues; and 3) periodontal and marginal health status, when compared to a non‐surgical control group.

Methods: Two groups of patients without periodontitis were investigated. The test group (group A) consisted of 16 patients. The inclusion criteria for surgical correction were: 1) at least 1 site lacking (<1 mm) keratinized tissue and/or lacking vestibular depth; 2) insuf‐ ficient plaque control; and 3) the selected site was scheduled to undergo or had already received a fixed prosthetic restoration. The control group (group B) included 14 patients with the same inclusion criteria, but declining to undergo surgery. Group A patients were treated with a free connective tissue graft to augment the keratinized tissue at the selected sites. The size of the graft was recorded at baseline (surgical intervention) and the width of keratinized tissue was measured at 1, 4, 26, and 52 weeks. Gingival inflammation and plaque accumulation were assessed at baseline and 52 weeks in both groups. Probing depth and clinical attachment levels were recorded at baseline and 26 and 52 weeks in both groups. Evaluation of the esthetic results was carried out at the end of the study. All patients in both groups received oral hygiene instructions and supragingival plaque and calculus removal before and at the end of the investigation.

Results: In group A, the results showed a mean amount of keratinized tissue of 5.81 ± 1.42 mm at 26 weeks and 5.25 ± 1.34 mm at 52 weeks. Mean shrinkage of the graft was 10.2% (P = 0.001) at 1 week, 28.4% (P = 0.0004) at 4 weeks, 37.2% (P = 0.0004) at 26 weeks, and 43.25% (P = 0.0004) at 52 weeks. All the dimensional changes were statistically significant, when compared compared to baseline. Evaluation of color blending with the surrounding gingiva demonstrated an “excellent result” at 52 weeks with an 87.5% agreement among the three masked examiners. In the test group, the periodontal indices improved or remained stable; in the control group, there was a minor improvement of the indices, with three patients showing a worse gingival inflammation score and two a worse plaque score.

Conclusion: Although these results are not conclusive, mostly due to a lack of a large enough sample population, the statistically significant results shown in this investigation tend to support the use of gingival augmentation procedures in prosthetic patients with insufficient keratinized gingiva and/or shallow or absent vestibules, when they cannot demonstrate adequate plaque control. J Periodontol 2004;75:470‐477.
Intraosseous Sarcoidosis of the Jaws Mimicking Aggressive Periodontitis: A Case Report and Literature Review
Authors: Suresh Lakshmanan , Aguirre Alfredo , Buhite Robert J. , Radfar Lida
Published: February 2005

Background: Sarcoidosis is a relatively common systemic granulomatous disease of unknown etiology. The skeletal system is affected in up to 39% of patients, but intraosseous sarcoidosis affecting the maxilla and mandible is rare. Only 20 cases have been reported previously in the English literature. This paper presents a case of generalized intraosseous sarcoidosis of the jaw bones that mimicked rapidly progressive periodontitis.

Methods: A 46‐year‐old male patient presented with loose teeth for assessment of implants. He had been gradually losing his teeth since 1999. His past medical history was significant, with sarcoidosis diagnosed in 1998. A panoramic radiograph showed a bilateral cotton‐wool appearance of the mandible. A soft tissue and bone biopsy was performed and sent for histological examination.

Results: Microscopic examination of hematoxylin and eosin‐stained sections revealed non‐caseating granulomatous inflammation consistent with skeletal sarcoidosis.

Conclusions: Intraosseous sarcoidosis of the jaw bones is rare and presents commonly as progressive and rapid alveolar bone loss similar to periodontitis. Therefore, it is important for periodontists to be knowledgeable and able to diagnose this condition, as rapid alveolar bone loss may be the first sign of sarcoidosis. J Periodontol 2004;75:478‐482.
Severe Gingival Bleeding in a Myelodysplastic Patient: Management and Outcome
Authors: Pereira Claudio M. , Gasparetto Patrícia F. , Coracin Fábio L. , Marquês José F. , Lima Carmen S.P. , Corrêa Maria E.P.
Published: February 2005

Background: The myelodysplastic syndromes (MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. Oral manifestations of the disease and oral complications of medical management may result in significant symptoms and have an impact on the systemic condition of the patient. The removal of the infectious focus, such active teeth infection or severe periodontal disease, remains controversial in these patients, due to the increased risk of bleeding and systemic infection.

Methods: This paper reports a case of MDS with spontaneous gingival hemorrhage and generalized gingival hyperplasia associated with periodontal disease. This patient underwent several platelet transfusions due to these oral complications. The patient received periodontal therapy, resulting in an improvement of the oral clinical situation and a decrease of gingival hyperplasia.

Results: The patient did not present any episode of gingival hemorrhage after the periodontal treatment.

Conclusion: The results of this study suggest that periodontal therapy should be performed in MDS patients presenting thrombocytopenia, gingival hyperplasia, and gingival bleeding, with the intent of preventing further hemorrhagic episodes and possible systemic infection. J Periodontol 2004;75:483‐486.
Esthetic Management of Peripheral Giant Cell Granuloma
Authors: Sahingur Sinem Esra , Cohen Robert E. , Aguirre Alfredo
Published: February 2005

Background: Peripheral giant cell granuloma (PGCG) is a relatively rare hyperplastic lesion of the oral cavity. The lesion occurs in females more frequently than males and more often in the mandible than the maxilla. Although the precise etiology of PGCG is unknown, it might represent a local reaction to trauma or irritation.

Methods: In general, treatment requires a wide excision of the lesion due to its possible recurrence.

Results: This report describes the clinical and histopathological findings of PGCG diagnosed in the maxilla of a young male, as well as the successful treatment of a gingival defect that occurred following excision of the lesion, by placement of a subepithelial connective tissue graft concurrently with the biopsy procedure.

Conclusions: This report emphasizes the importance of having histopathological data to confirm the clinical diagnosis, and the importance of an adequate excision to prevent recurrence even in less extensive cases. J Periodontol 2004;75:487‐492.
Clinical Relevance of Adjunctive Minocycline Microspheres in Patients With Chronic Periodontitis: Secondary Analysis of a Phase 3 Trial
Authors: Paquette D.W. , Hanlon A. , Lessem J. , Williams R.C.
Published: February 2005

Background: A recent Phase 3 trial demonstrated that adjunctive treatment with minocycline microspheres resulted in significant reductions in patient mean probing depths as compared to scaling and root planing (SRP) alone. The objective of the present study was to evaluate clinical relevance of these changes within the trial using proposed site‐based criteria.

Methods: A total of 499 patients with moderate to advanced chronic periodontitis were enrolled in a multi‐center trial and randomized to either: 1) SRP alone or 2) SRP plus minocycline microspheres. Subjects received complete probing examinations including the measurement of probing depths at baseline, and 1 and 3 months. Probing depth reductions were tabulated by treatment, examination time, and baseline depths, and intergroup differences were evaluated with logistic regression models for correlated data.

Results: Significantly more sites treated with adjunctive minocycline microspheres exhibited probing depths <5 mm at 1 (P = 0.0009) and 3 (P = 0.01) months as compared to sites treated with SRP alone, both in the overall population and in smokers. In addition, significantly more sites decreased by 1, 2, or 3 mm in the adjunctive minocycline group than in the SRP alone group at 1 and 3 months, both overall as well as in smokers (P <0.05).

Conclusion: This secondary analysis indicates that treatment with SRP plus minocycline microspheres is consistently more effective than SRP alone in providing clinically relevant site‐based responses in patients with chronic periodontitis. J Periodontol 2004;75:531‐536.
Lymphocyte Numbers and Function in Relation to Periodontitis and Smoking
Authors: Loos Bruno G. , Roos Marijke T.L. , Schellekens Peter Th.A. , Velden Ubele van der , Miedema Frank
Published: February 2005

Background: T and B lymphocytes play important roles in periodontitis. Smoking is considered a risk factor for periodontitis and may exert its negative effects through leukocytes. Taking smoking into consideration, the aim of this study was to analyze numbers of circulating T (CD3+) cells and their CD4+ and CD8+ subpopulations, B (CD19+) cells, and T‐cell proliferative capacity in periodontitis.

Methods: Lymphocyte immunophenotyping for T cells, their CD4+ and CD8+ subsets, and B cells was performed on peripheral blood from 76 periodontitis patients and 36 controls. Proliferative capacity of T cells was determined in whole‐blood lymphocyte culture assays after mitogenic stimulation.

Results: Total T cells, CD4+ and CD8+ subpopulations, and responsiveness to specific T‐cell stimuli did not differ between patients and controls; in addition, B cells were not significantly elevated in periodontitis patients. However, more periodontal breakdown in smoking patients was associated with higher numbers of CD3+ T cells, as well as with CD4+ and CD8+ T‐cell subsets, and increased T‐cell proliferation. Numbers of B cells were not affected by smoking.

Conclusions: The increased numbers of T‐cells and elevated T‐cell responsiveness in patients who smoke may be one of several explanations why smoking is a risk factor for periodontitis. The mechanism of how T‐cell function contributes to increase the severity of periodontal breakdown in smoking periodontitis patients needs to be investigated further. J Periodontol 2004;75:557‐564.
The In Vivo Expression of Membrane‐Bound CD14 in Periodontal Health and Disease
Authors: Jin Lijian , Ren Lei , Leung W. Keung , Darveau Richard P.
Published: February 2005

Background: Membrane‐bound CD14 (mCD14) is a myeloid differentiation antigen expressed on monocytes/macrophages and neutrophils. It is a key molecule responsible for the innate recognition of bacteria by host cells and functions as an important receptor for bacterial lipopolysaccharide. This study investigated the in vivo expression profile and levels of mCD14 in healthy and diseased gingival tissues.

Methods: Gingival biopsies were obtained from 24 patients with chronic periodontitis, including 22 periodontal pocket tissues, 13 clinically healthy tissues, and 18 inflamed connective tissues (i.e., granulation tissues). Gingival biopsies from seven periodontally healthy subjects were used as controls. mCD14 was detected by immunohistochemistry.

Results: mCD14 was detected in 21 of 22 periodontal pocket tissues and all other categories of tissues. The mCD14‐positive cells were mainly confined to the gingival epithelium‐connective tissue interface. The expression levels in periodontally healthy subjects were significantly higher than in the patients. Within the patients, clinically healthy tissues showed greater levels of mCD14 than periodontal pocket tissues and granulation tissues.

Conclusions: mCD14 was commonly expressed in both healthy and diseased gingival tissues and was predominantly confined to the epithelium‐connective tissue interface. The positive relationship observed between mCD14 expression levels and periodontal health may imply that mCD14 is associated with favorable host responses to bacterial challenge and contributes to maintaining periodontal homeostasis. J Periodontol 2004;75:578‐585.
A Multicenter Comparative Study of Two Root Coverage Procedures: Coronally Advanced Flap With Addition of Enamel Matrix Proteins and Subpedicle Connective Tissue Graft
Authors: Nemcovsky Carlos E. , Artzi Zvi , Tal Haim , Kozlovsky Avital , Moses Ofer
Published: February 2005

Background: Free grafts, pedicle flaps, and barrier membranes have been used to cover exposed root surfaces. The aim of the present study was to evaluate the clinical efficacy of a coronally advanced flap procedure with the additional use of enamel matrix protein derivative (EMD) to treat gingival recession and to compare it to the subpedicle connective tissue graft procedure (CTG).

Methods: The study was conducted in six different periodontal clinics. Miller Class I or II buccal recession type defects in the anterior or premolar teeth were treated in 70 consecutive patients, 30 with EMD and 40 with CTG. At baseline and 6 and 12 months post‐surgical treatment, vertical recession defect, defined as the distance from cemento‐enamel junction to gingival margin; width of keratinized tissue; and probing depth were recorded and the percentage of coverage of the original defect was calculated. Statistical analyses consisted of t‐test, analysis of variance, and analysis of covariance

Results: At 6 months, percent of root coverage was 77.4% ± 11.92% in EMD and 84.1% ± 11.97% in CTG (statistically significant at P = 0.024). At 12 months, percent of root coverage in EMD was 71.7% ± 16.14% and 87.0% ± 12.22% in CTG; again, differences between groups were statistically significant (P <0.001). Differences between the 6‐ and 12‐month vertical recession defect and percent of root coverage recordings within each group were also statistically significant.

Conclusions: The connective tissue graft procedure was superior to the coronally positioned flap with the addition of enamel matrix proteins derivative in percentage of coverage and increase in width of keratinized tissue. The EMD procedure is a predictable treatment for root coverage that is relatively easy to perform and presents low patient morbidity, and is appropriate especially where a substantial increase in the width of keratinized tissue is not of prime importance. J Periodontol 2004;75:600‐607.
Sarcoidosis With Gingival Involvement: A Case Report
Authors: Armstrong Conor , Napier Seamus , Linden Gerard J.
Published: February 2005

Background: The case outlined is a rare presentation of sarcoidosis intraorally associated with gingival ulceration.

Methods: The diagnosis was made following a gingival biopsy.

Results: The patient was subsequently referred to a physician for clinical management and the condition resolved without active treatment.

Conclusions: Sarcoidosis should be considered in the differential diagnosis of persistent swellings and ulceration of the oral mucosa. Intraoral sarcoid lesions are often the first indication of systemic involvement. It is important to make the diagnosis and monitor the condition as sarcoidosis is progressive if untreated in a small number of those affected. J Periodontol 2004;75:608‐612.
Hemorrhaging Associated With Endosseous Implant Placement in the Anterior Mandible: A Review of the Literature
Authors: Kalpidis Christos D.R. , Setayesh Reza M.
Published: February 2005

The placement of endosseous dental implants is largely considered a safe surgical procedure. However, upper airway obstruction secondary to severe bleeding in the floor of the mouth has been occasionally reported as a rare but potentially fatal complication of implant surgery. This review presents critical hemorrhagic episodes, related to dental implantation in the anterior segments of the mandible, published to date. Massive internal bleeding in the highly vascularized region of the floor of the mouth is the result of an arterial trauma induced by instrumentation, usually through a perforation of the lingual cortical plate. Depending on the clinical situation, hemorrhage may commence immediately or with some delay after the vascular insult. The progressively expanding lingual, sublingual, submandibular, and submental hematomas have the tendency of displacing the tongue and floor of the mouth to obstruct the airway. Because the course of airway deterioration to complete occlusion may be rapid, ensuring a patent airway is of highest priority. Even though upper airway obstruction is potentially life‐threatening, a secure airway was successfully established in all patients without fatal consequences. In most cases, resolution of hemorrhage required a surgical intervention for ligation of the bleeding vessels and hematoma evacuation. To reduce the probability of such a grave complication, preventive and precautionary measures to be taken before, during, and after implant placement in the anterior mandible are presented. Issues related to the level of surgical experience, fine regional arterial anatomy, radiographic and clinical evaluation of the osseous morphology, angulation and length of implants, and timing of hemorrhage onset are discussed. In addition, airway and bleeding management strategies are provided. J Periodontol 2004;75:631‐645.
Alveolar Bone Regeneration for Immediate Implant Placement Using an Injectable Bone Substitute: An Experimental Study in Dogs
Authors: Boix Damien , Gauthier Olivier , Guicheux Jérôme , Pilet Paul , Weiss Pierre , Grimandi Gaël , Daculsi Guy
Published: February 2005

Background: The aim of the present study was to assess the efficacy of a ready‐to‐use injectable bone substitute for bone regeneration around dental implants placed into fresh extraction sockets.

Methods: Third and fourth mandibular premolars were extracted from three beagle dogs and the interradicular septa were surgically reduced to induce a mesial bone defect. Thereafter, titanium implants were immediately placed. On the left side of the jaw, mesial bone defects were filled with an injectable bone substitute (IBS), obtained by combining a polymer and biphasic calcium phosphate ceramic granules. The right defects were left unfilled as controls. After 3 months of healing, specimens were prepared for histological and histomorphometric evaluations.

Results: No post‐surgical complications were observed during the healing period. In all experimental conditions, histological observations revealed a lamellar bone formation in contact with the implant. Histomorphometric analysis showed that IBS triggers a significant (P <0.05) increase in terms of the number of threads in contact with bone, bone‐to‐implant contact, and peri‐implant bone density of approximately 8.6%, 11.0%, and 14.7%, respectively. In addition, no significant difference was observed when number of threads, bone‐to‐implant contact, and bone density in the filled defects were compared to the no‐defect sites.

Conclusion: It is concluded that an injectable bone substitute composed of a polymeric carrier and calcium phosphate significantly increases bone regeneration around immediately placed implants. J Periodontol 2004;75:663‐671.
The Effect of Aspirin Intake on Bleeding on Probing in Patients With Gingivitis
Authors: Royzman Daniel , Recio Luisa , Badovinac Rachel L. , Fiorellini Joseph , Goodson Max , Howell Howard , Karimbux Nadeem
Published: February 2005

Background: Bleeding indices are used as a screen for periodontal disease activity, a measure of disease prevalence, and a measure of effectiveness in clinical trials. Bleeding on probing (BOP) is widely interpreted as a sign of disease activity whereas its absence is interpreted as both a sign and predictor of health. Aspirin use has become increasingly common in the prevention of cerebrovascular and cardiovascular diseases. Because of its anti‐platelet activity, aspirin is a non‐disease factor that has the potential to affect the appearance of BOP. The hypothesis being tested is that short‐term aspirin use in doses of 81 mg and 325 mg will increase the number of bleeding sites in a population with gingivitis.

Methods: Fifty‐four subjects were screened initially, those subjects with 20% to 30% whole mouth BOP were randomly assigned to one of three arms: placebo group, 81 mg aspirin group, or 325 mg aspirin group. Before and after exposure to the respective regimens, clinical parameters were measured on all the teeth: the plaque index was recorded at four sites per tooth, and probing depth and BOP were evaluated at six sites per tooth using an automated pressure‐sensitive probe.

Results: The data obtained in this clinical trial were analyzed utilizing a linear regression analysis to control for confounding variables. The primary measure of interest was BOP in patients clinically demonstrating naturally occurring gingivitis. The results of this study indicate that while controlling for age, gender, and plaque, “low dose” 81 mg and “regular dose” 325 mg of aspirin demonstrated a statistically significant 5.30 (P = 0.001) and 4.13 (P = 0.010) increase from baseline, respectively, in percent BOP.

Conclusion: Failure to consider the effects of aspirin on BOP could impair proper diagnosis and treatment planning for clinicians and introduce a significant confounding variable in research situations. J Periodontol 2004;75:679‐684.
Clinical Evaluation of a Composite Bone Graft With a Calcium Sulfate Barrier
Authors: Harris Randall J.
Published: February 2005

Background: The goal of this study was to evaluate the effectiveness of a composite bone graft (demineralized freeze‐dried bone allograft, calcium sulfate, tetracycline, and porous hydroxyapatite) and calcium sulfate barrier to treat non‐furcation osseous defects.

Methods: One hundred patients were treated with the technique. The preoperative measurements were compared to the postoperative measurements (mean 5.2 months) to determine whether the technique had a statistically significant effect. Various factors were evaluated to determine whether they could be related to improved or diminished results.

Results: The surgical procedure produced a statistically significant change in the clinical measurements. The mean recession increased from 0.8 to 1.8 mm; the mean probing depth decreased from 8.5 to 3.8 mm; and the attachment level improved from 9.3 to 5.5 mm. Non‐smokers, defects in the mandibular arch, defects with deeper probing depths, or defects with greater attachment loss had statistically significant changes in one or more of the clinical parameters evaluated.

Conclusion: The technique examined in this study (composite bone graft + calcium sulfate barrier) was an effective method to improve the clinical measurements. J Periodontol 2004;75:685‐692.
Role of Ascorbic Acid in Periodontal Ligament Cell Differentiation
Authors: Ishikawa Satoshi , Iwasaki Kengo , Komaki Motohiro , Ishikawa Isao
Published: February 2005

Background: Periodontal ligament (PDL) cells form mineralized nodules in vitro. Ascorbic acid is known to be required in this process, although its effect on osteoblastic differentiation of PDL cells remains unclear. The purpose of this study was to determine the role of ascorbic acid on the early osteoblastic differentiation of PDL cells, with regard to alkaline phosphatase (ALP) activity, type I collagen production and integrin expression.

Methods: Cultured PDL cells were stimulated at confluence with ascorbic acid in the presence or absence of type I collagen inhibitor and blocking antibodies to integrins. After stimulation, the cells and culture supernatants were examined for ALP activity, type I collagen production, and integrin expression. The ALP activity was measured using a colorimetric assay with p‐nitrophenyl phosphate and ALP staining. Enzyme‐linked immunosorbent assay (ELISA) was used to determine type I collagen production, and ELISA and flow cytometric analysis were employed for assessment of integrin expression.

Results: Both ALP activity and type I collagen production were upregulated when PDL cells were cultured in the presence of ascorbic acid (200 µM). Inhibitor of the formation of collagen triple helices and blocking antibodies to α2β1 integrin inhibited ALP activity by 50% in ascorbic acid‐stimulated PDL cells. Furthermore, ascorbic acid increased the cell surface expression of α2β1 integrin.

Conclusions: Our findings indicated that ascorbic acid increases the ALP activity of PDL cells via type I collagen production and also enhances the expression of α2β1 integrin, which is a major receptor of type I collagen. These results suggest that ascorbic acid promotes the osteoblastic differentiation of PDL cells by modulating type I collagen‐α2β1 integrin interaction. J Periodontol 2004;75:709‐716.
Traumatic Lesions of the Gingiva: A Case Series
Authors: Rawal Swati Y. , Claman Lewis J. , Kalmar John R. , Tatakis Dimitris N.
Published: February 2005

Background: The most recent classification of periodontal diseases includes a new section on traumatic gingival lesions. Traumatic lesions of the gingiva are thought to be highly prevalent, yet the periodontal literature contains few references on the topic. The purpose of this article is to present a broad spectrum of traumatic gingival lesions of iatrogenic, accidental, and factitious origin.

Methods: Twelve clinical cases were selected to document chemical (due to aspirin, snuff, and peroxide), physical (due to malocclusion, flossing, removable partial denture, oral piercing, and self‐inflicted trauma), and thermal (due to overheated ultrasonic scaler, hot food, and ice) injury to the gingiva.

Results: Chemical, physical, and thermal gingival injuries of iatrogenic, accidental, or factitious origin can have a variety of presentations with overlapping clinical features. Although the appearance and associated symptoms of a gingival lesion may be suggestive of a particular traumatic etiology, useful or confirmatory diagnostic information is often discovered through careful history‐taking. The management of gingival injuries typically requires elimination of the insult and symptomatic therapy. If permanent gingival defects resulted from the injury, periodontal plastic surgery may be necessary.

Conclusions: A variety of chemical, physical, and thermal injuries may involve the gingiva. Accidental and iatrogenic injuries are often acute and self‐limiting, while factitious injuries tend to be more chronic in nature. J Periodontol 2004;75:762‐769.
Hereditary Gingival Fibromatosis Associated With Generalized Aggressive Periodontitis: A Case Report
Authors: Casavecchia Piero , Uzel M. Ilhan , Kantarci Alpdogan , Hasturk Hatice , Dibart Serge , Hart Thomas C. , Trackman Philip C. , Van Dyke Thomas E.
Published: February 2005

Background: Hereditary gingival fibromatosis is a rare, genetically inherited overgrowth condition that is clinically characterized by a benign fibrous enlargement of maxillary and mandibular keratinized gingiva. A syndromic association between gingival fibromatosis and a wide variety of other genetically inherited disorders has been described. However, its coexistence with aggressive periodontitis has not been reported.

Methods: A 24‐year‐old African‐American female, patient (proband X, [Px]) reported with a chief complaint of tooth mobility and gingival enlargement. Clinical examination revealed moderate to severe gingival overgrowth on both mandible and maxilla. Generalized attachment loss and mobility of the teeth were observed. Radiographic evaluation demonstrated severe alveolar bone loss. The patient was diagnosed with gingival fibromatosis and aggressive periodontitis based on the clinical and radiographic findings. Her brother (Bx) and her mother (Mx) were evaluated and diagnosed with gingival fibromatosis suggesting that this is a dominant trait in the family and gingival fibromatosis might be of hereditary origin. In addition, the brother also exhibited localized aggressive periodontitis. Medical history revealed no other systemic or local contributory factors associated with the oral findings in any of the subjects.

Results: Surgical therapy included internal bevel gingivectomy combined with open flap debridement procedures for Px and Bx. Only internal bevel gingivectomy was performed for Mx since there was mild bone resorption and no intrabony defects. At the time of surgery, gingival biopsies were obtained and fixed in 4% paraformaldehyde. Multiple serial sections were stained with hematoxylin and eosin. Microscopic evaluation of the gingival specimens revealed large parallel collagen bundles associated with scarce fibroblasts in the connective tissue. The collagen bundles reached into the subepithelial connective tissue where elongated rete‐pegs were also observed. Following the completion completion of the treatment, no signs of recurrence or bone resorption were observed over 2‐year follow‐up.

Conclusions: This is the first report of hereditary gingival fibromatosis associated with aggressive periodontitis. Combined treatment comprising removal of fibrotic gingival tissue and traditional flap surgery for the elimination of intrabony defects represents a unique treatment approach in periodontal therapy. Two‐year follow‐up revealed that both the gingival overgrowth and the destructive lesions were successfully treated. J Periodontol 2004;75:770‐778.
Relationship Between Electrocardiographic Abnormalities and Periodontal Disease: The Hisayama Study
Authors: Shimazaki Yoshihiro , Saito Toshiyuki , Kiyohara Yutaka , Kato Isao , Kubo Michiaki , Iida Mitsuo , Koga Toshihiko
Published: February 2005

Background: Recent studies have suggested a relationship between periodontitis and cardiovascular disease (CVD). This study investigated the relationship between periodontitis and electrocardiographic (ECG) abnormalities, which are known predictors of CVD.

Methods: We examined the periodontal status of 1,111 residents of Hisayama Town, Fukuoka, Japan. Nine hundred fifty‐seven (957) subjects (374 males, 583 females) with ≥10 teeth and without a medical history of CVD were included in the analysis. Probing depth (PD) and clinical attachment level (CAL) were measured on two randomly selected quadrants, one maxillary and one mandibular. A 12‐lead ECG was recorded using a standard electrocardiograph. ECG abnormalities included left ventricular hypertrophy (Minnesota code 3‐1) and ST depression (4‐1, 2, 3). The relation of periodontal condition and ECG abnormalities was assessed with logistic regression analysis.

Results: Univariate analysis revealed that mean probing depth, mean attachment loss, number of teeth, and plaque index were significantly associated with ECG abnormalities, as well as with known risk factors of CVD. In multivariate analysis, the subjects with deep pockets (mean probing depth ≥2 mm) had an increased risk for ECG abnormalities (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.01 to 2.50) compared to the subjects with mean PD <2 mm. Subjects with severe attachment loss (mean CAL ≥2.5 mm) had also significant risk for ECG abnormalities (OR = 1.7; 95% CI = 1.07 to 2.67) compared to those whose mean CAL was <2.5 mm.

Conclusion: This study clearly shows the relationship between periodontitis and ECG abnormalities, which are important predictors of CVD. J Periodontol 2004;75:791‐797.
The Association of Smoking With Vertical Periodontal Bone Loss
Authors: Baljoon Mostafa , Natto Suzan , Bergstrom Jan
Published: February 2005

Background: Knowledge about the relation between smoking and vertical periodontal bone loss is scant. The objective of the present study was to investigate the association between smoking and the prevalence and severity of vertical bone defects.

Methods: Full sets of intraoral radiographs of 249 individuals in 1982 and 229 individuals in 1992 both with an age range 21 to 70 years were assessed with regard to presence or absence of vertical bone defects. A vertical defect was defined as a resorption of the interdental marginal bone ≥2 mm that had a typical angulation towards either the mesial or distal aspect of the root.

Results: The prevalence of vertical defects in 1982 was 47% for current smokers, 49% for former smokers, and 24% for nonsmokers. In 1992 the prevalence was 42%, 28%, and 19% for current smokers, former smokers, and non‐smokers, respectively. Both in 1982 and 1992 the prevalence was significantly related to smoking status (χ2 = 14.4 and χ2 = 9.9, P <0.01). Furthermore, the severity of vertical defects was significantly associated with smoking after controlling for age both in 1982 and 1992 (P <0.05). The relative risk associated with current smoking was 2.0‐fold increased in 1982 and 3.4‐fold increased in 1992 (P <0.05).

Conclusions: The observations suggest that smoking is associated with increased levels of prevalence as well as severity of vertical bone loss. Smoking is considered a potential risk factor for vertical periodontal bone loss. J Periodontol 2004;75:844‐851.
Relative Connective Tissue Graft Size Affects Root Coverage Treatment Outcome in the Envelope Procedure
Authors: Yotnuengnit Pusadee , Promsudthi Ananya , Teparat Thitiwan , Laohapand Penpan , Yuwaprecha Wipasara
Published: February 2005

Background: This study investigated the correlation between the connective tissue graft size and the percentage of root coverage.

Methods: Fifteen patients with Miller Class I or II recession defects (one tooth/defect per patient) were treated using an envelope connective tissue graft procedure. Clinical parameters including gingival recession depth (RD), clinical attachment level (CAL), keratinized tissue width (KW), and the probing depth (PD) were measured. Visible denuded area (VDA) and graft tissue area (GTA) were indirectly measured in mm2 using computer software. Graft tissue thickness (GTT) and graft tissue width (GTW) were also measured. All clinical parameters and VDA were recorded at baseline and 3 and 6 months. The RD, CAL, KW, PD, and VDA were evaluated by Friedman test. The correlation between the percentage of root coverage (PRC) and factors related to graft size were determined by Spearman rank correlation and nonparametric regression analysis.

Results: The percent of root coverage at 3 and 6 months postoperatively was statistically significantly associated with the GTA:VDA ratio (P <0.01); it did not correlate with GTA, GTT, or RD, and was inconsistently correlated to GTW and VDA. In patients who had 100% root coverage, the GTA:VDA ratio ranged between 10.92:1 and 21.95:1; in patients with <100% root coverage, the ratio was between 4.54:1 and 11.06:1.

Conclusion: The GTA:VDA ratio should be at least 11:1, which is a significant factor for optimal root coverage result in the envelope procedure. J Periodontol 2004;75:886‐892.