bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Clinical Depression to Periodontal Treatment Outcome
Authors: Elter John R. , White B. Alex , Gaynes Bradley N. , Bader James D.
Published: February 2005

Background: Depression has been associated with periodontal disease; however, its relationship to periodontal treatment outcome (PTO) has not been investigated.

Methods: Data were obtained by chart abstraction and computer databases on 1,299 health maintenance organization (HMO) patients aged 30 to 64 who had concurrent medical, dental, and pharmacy benefits, and who had an initial periodontal examination during 1996, 1997, or 1998. Depression (yes/no) was the main independent variable and was determined by presence of any diagnosis code for depression on the patient record. PTO was determined by the difference in percent of sites with probing depth (PD) ≥5 mm between the initial and 1‐year post‐treatment periodontal exams. Sub‐median periodontal treatment outcome (SMPTO) was defined as a reduction in fewer than the median percent of sites (7.33%) with PD ≥5 mm. Information on sociodemographics, periodontal therapy, calculus and plaque, number of remaining teeth, smoking, antidepressant medications, and diabetes were collected.

Results: A total of 697 patients had a periodontal exam at both baseline and follow‐up. Of these, 12.2% had depression. In a multivariable logistic model, depression (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.12 to 4.16) and 4‐month recall treatment (OR 2.34, CI 1.46 to 3.75) were associated with SMPTO, while percent of sites at baseline with PD ≥5 mm (OR 0.93, CI 0.91 to 0.94), number of remaining teeth at baseline (OR 0.94, CI 0.89 to 0.99), and number of teeth lost during the study period (OR 0.75, CI 0.58 to 0.96) were negatively associated. Periodontal surgery, age, gender, smoking, plaque, calculus, diabetes, and antidepressant medication were not significant in the model.

Conclusion: Clinical depression may have a negative effect on periodontal treatment outcome in this group model HMO population. J Periodontol 2002;73:441‐449.
Long‐Term Results of Guided Tissue Regeneration Therapy With Non‐Resorbable and Bioabsorbable Barriers. II. A Case Series of Infrabony Defects
Authors: Kim Ti‐Sun , Holle Rolf , Hausmann Ernest , Eickholz Peter
Published: February 2005

Background: The aim of this 5‐year follow‐up case series was to clinically and radiographically evaluate the long‐term results after guided tissue regeneration (GTR) therapy of infrabony defects using nonresorbable and bioabsorbable barriers.

Methods: In 12 patients with advanced chronic periodontitis 12 pairs of contralateral infrabony defects were treated. Within each patient one defect received a non‐resorbable (expanded polytetrafluoroethylene [ePTFE]; control: C) and the other a bioabsorbable (polyglactin 910; test: T) barrier by random assignment. At baseline and at 6 and 60 ±3 months after surgery clinical parameters and standardized radiographs were obtained. Gain of bone density within infrabony defects was assessed using subtraction radiography.

Results: Eight of 12 patients were available for the 60‐month reexaminations. Six and 60 ±3 months after GTR therapy statistically significant (P <0.05) vertical attachment (CAL‐V) gain was observed in both groups (C6: 2.6 ±1.4 mm; C60: 1.6 ± 1.5 mm; T6: 3.0 ±1.7 mm; T60: 3.0 ±0.7 mm). However at 60 months, 2 infrabony defects in the control group had lost all the attachment that had been gained 6 months after therapy and a clinically relevant but statistically insignificant mean CAL‐V loss of 1.0 ±2.1 mm was observed from 6 to 60 months. The case series failed to show statistically significant differences between test and control regarding CAL‐V gain 60 months after surgery. Also subtraction analysis failed to reveal statistically significant differences regarding density gain between both groups 6 and 60 months postsurgically (C6: 26.4 ± 54.2; C60 62.8 ±112.7; T6: 68.7 ±72.8; T60. 84.1 ±83.6).

Conclusions: CAL‐V gain achieved after GTR therapy in infrabony defects using both non‐resorbable and bioabsorbable barriers was quite stable after 5 years in 14 of 16 defects. J Periodontol 2002;73:450‐459.
Informational Paper: Modulation of the Host Response in Periodontal Therapy
Authors:   Research, Science, and Therapy Committee
Published: February 2005

This paper was prepared by the Research, Science, and Therapy Committee of the American Academy of Periodontology to provide the dental profession an overview of current and potential methods to modulate the host response in the treatment of periodontal diseases. Specifically, it discusses components of periodontal disease pathogenesis (i.e., immune and inflammatory responses, excessive production of matrix metalloproteinases and arachidonic acid metabolites, and regulation of bone metabolism) and their modulation. J Periodontol 2002;73:460‐470.
New Biomarker Evidence of Oxidative DNA Damage in Whole Saliva From Clinically Healthy and Periodontally Diseased Individuals
Authors: Takane Masatoshi , Sugano Naoyuki , Iwasaki Hiroyasu , Iwano Yoshihiro , Shimizu Noritaka , Ito Koichi
Published: February 2005

Background: There is an increasing body of evidence implicating reactive oxygen species in the pathogenesis of periodontal tissue destruction. 8‐hydroxy‐deoxyguanosine (8‐OHdG) is one of the most commonly used markers to evaluate oxidative damage in a number of disorders including chronic inflammatory diseases. The aim of the present study was to evaluate 8‐OHdG levels in whole saliva of patients with periodontitis and to assess the changes after initial treatment.

Methods: Saliva samples were collected from 78 patients with untreated periodontitis and 17 healthy control subjects. Clinical parameters and levels of 8‐OHdG were assessed first to establish a baseline and again after initial periodontal treatment from 15 patients. 8‐OHdG levels were determined by enzymelinked immunosorbent assay.

Results: The mean value of 8‐OHdG in the saliva of periodontally diseased subjects, 4.28 ± 0.10 ng/ml, was significantly higher (P <0.01) than that of clinically healthy subjects (1.56 ± 0.10 ng/ml). A significant decrease in salivary 8‐OHdG was observed after therapy (P <0.01).

Conclusion: In the present study, we evaluated for the first time 8‐OHdG levels in whole saliva of patients with periodontitis and assessed changes after initial periodontal treatment. Our study indicated that 8‐OHdG levels in saliva appear to reflect the status of periodontal health. J Periodontol 2002;73:551‐554.
Large Cell Carcinoma of the Lung Metastatic to the Mandibular Gingiva
Authors: Yoshii Takashi , Muraoka Shigetada , Sano Nobuya , Furudoi Shungo , Komori Takahide
Published: February 2005

Background: Although metastases of malignant tumors to the jaws are not unusual, metastases to the gingival soft tissues are relatively rare.

Methods: The clinicopathologic features of a metastatic tumor in the mandibular gingiva originating from lung cancer are described. The patient, a 61‐year‐old man, was admitted to the hospital with complaints of bloody sputum and chest pain while coughing. The patient's chest radiograph showed an abnormal mass in the left upper lobe. After admission, the patient noticed a swelling of the right mandibular gingiva. Histological and immunohistochemical analysis for tumors of the gingiva and the lung were performed.

Results: Radiographic examination did not indicate involvement of the underlying bone. The histopathological findings showed that the gingival tumor consisted of a large cell carcinoma, and the mass of the upper lobe displayed the same histology as that found in the gingiva. Immunohistochemical investigation of the gingival tumor revealed similar results to those found in the mass of the lung. Based on the clinicopathologic findings, this case was diagnosed as primary lung cancer with the gingival tumor deemed metastatic. Multiple metastases were found in areas other than the oral cavity; radiation and chemotherapy for the gingival tumor were performed due to persistent bleeding and pain.

Conclusions: The resemblance of this gingival mass to an inflammatory lesion demonstrates the need for a detailed examination. This case also emphasizes the need to evaluate positive treatment needed to relieve complications in the mouth, even if the prognosis of the primary tumors remains unfavorable. J Periodontol 2002;73:571‐574.
Squamous Odontogenic Tumor: Diagnosis and Management
Authors: Haghighat Kamran , Kalmar John R. , Mariotti Angelo J.
Published: February 2005

The squamous odontogenic tumor (SOT) is a rare, benign, locally infiltrative neoplasm of the jaws that appears to originate from the rests of Malassez. It has been confused with other pathologic entities such as ameloblastomas, carcinomas, and fibromas and clinically may resemble localized periodontal disease. The tumor is often asymptomatic, although it can present with symptoms of pain and tooth mobility. A characteristic radiographic appearance is that of a triangular‐shaped or semi‐circular lucency associated with the roots of erupted teeth. Histologically, the tumor is characterized by the formation of variably sized nests and cords of uniform, benign‐appearing, squamous epithelium with occasional vacuolization and keratinization. Treatment of SOT by conservative surgical excision is normally curative with rare episodes of recurrence reported. Since the clinical presentation of SOT may mimic more common pathologic entities, this case report reinforces the need for careful histologic evaluation of all lesions found in the periodontium. J Periodontol 2002;73:653‐656.
Comparative Histologic Analysis of Coronally Advanced Flap With and Without Collagen Membrane for Root Coverage
Authors: Lee Eun‐Ju , Meraw Stephen J. , Oh Tae‐Ju , Giannobile William V. , Wang Hom‐Lay
Published: February 2005

Background: Guided tissue regeneration (GTR)‐based root coverage has been utilized to correct gingival recession defects with promising results. However, limited histologic information is available. Therefore, the aims of this study were to clinically and histologically evaluate the efficacy of GTR‐based root coverage using collagen membrane (GTRC) and to compare the healing response to that of coronally advanced flaps (CAF).

Methods: Standardized gingival recession defects were surgically created on the labial surfaces of the maxillary cuspids of 8 mongrel dogs. Plaque was allowed to accumulate for 8 weeks to develop a plaque‐infected recession defect. Full‐mouth scaling and root planing was then performed coincident with 4 weeks of oral hygiene. Defects were randomly assigned to receive either GTRC or CAF surgery. Four dogs each were sacrificed at 4 and 16 weeks post‐treatment. Clinical measurements included: percent root coverage, the amount of keratinized gingiva (KG), and probing depth (PD). Sulcular depth, junctional epithelium and connective tissue attachment, new cementum formation, and new bone formation were evaluated histomorphometrically.

Results: Clinically, both treatments (CAF and GTRC) achieved statistically significant (P <0.05) root coverage compared to baseline. KG was significantly increased in CAF‐treated sites at 16 weeks, while no significant differences were found for other clinical parameters between treatments. Histometrically, GTRC showed a statistically significant increase of new attachment and newly formed connective tissue when compared to CAF at 16 weeks.

Conclusion: Within the limits of this preclinical study, both GTRC and CAF can be successfully used for the treatment of gingival recession defects. J Periodontol 2002;73:779‐788.
Full‐Mouth Therapy Versus Individual Quadrant Root Planing: A Critical Commentary
Authors: Greenstein Gary
Published: February 2005

Background: This commentary compares the abilities of full‐mouth disinfection (FDIS), full‐mouth root planing (FRP), and partial‐mouth disinfection (PDIS) to improve periodontal health. FDIS consists of 4 quadrants of root planing completed within 24 hours with adjunctive chlorhexidine therapies (e.g., rinsing, subgingival irrigation, tongue brushing). FRP denotes 4 quadrants of root planing performed within 24 hours, and PDlS refers to root planing individual quadrants of the dentition, spaced 2 weeks apart. A basic premise of administering full‐mouth therapy (FDlS or FRP) is to eliminate or reduce bacterial reservoirs within the oral cavity that could inhibit optimal healing of treated sites or cause periodontal disease initiation or progression.

Methods: Controlled clinical trials that compared the abilities of PDIS and full‐mouth root planing with and without adjunctive chlorhexidine chemotherapy to alter periodontal status were reviewed.

Results: Several studies conducted at one treatment center indicated that FDlS and FRP attained greater therapeutic improvements than PDlS with respect to decreasing probing depths (FD), gaining clinical attachment (CAL), diminishing bleeding upon probing, and reducing the subgingival microflora. However, the magnitude of PD reductions and gains of clinical attachment must be carefully interpreted, because initial PD measurements were usually determined after scaling and root planing, which may have caused the results to be overstated. Furthermore, in studies that addressed the utility of FDIS, it was not possible to determine if benefits induced beyond PDlS were due to FRP or administration of multifaceted intra‐oral chlorhexidine treatments or a combination of both therapies. One investigation that had protocol limitations indicated that similar results were attained by FRP with and without adjunctive chemotherapy. In contrast, recent studies from 2 other treatment centers indicated that there were no significant differences when the efficacy of quadrant‐by‐quadrant root planing was compared to FRP or FDIS with regard to PD reduction, gains of clinical attachment, and impact on the magnitude and quality of the immune response.

Possible Clinical Implications: Conceptually, full‐mouth therapy (FRP or FDIS) could reduce the number of patient visits and facilitate more efficient use of treatment time. In addition, there appears to be no major adverse reactions to full‐mouth mot planing with or without adjunctive chemotherapy. However, small study populations and non‐corroborating data from different treatment centers indicate that additional randomized clinical trials are needed to determine if full‐mouth therapy provides clinically relevant improvements beyond PDIS. J Periodontol 2002;73:797‐812.
Bisphosphonates and Periodontics: Potential Applications for Regulation of Bone Mass in the Periodontium and Other Therapeutic/ Diagnostic Uses
Authors: Tenenbaum Howard C. , Shelemay Avi , Girard Bruno , Zohar Ron , Fritz Peter C.
Published: February 2005

Bisphosphonates are widely utilized in the management of systemic metabolic bone disease due to their ability to inhibit bone resorption. Recently, new uses of this unique class of pharmacological agents have been suggested. Given their known affinity to bone and their ability to increase osteoblastic differentiation and inhibit osteoclast recruitment and activity, there exists a possible use for bisphosphonates in the diagnosis and management of periodontal diseases. These bone‐specific properties could also provide an interesting management strategy to stimulate osteogenesis in conjunction with regenerative materials around osseous defects and may also result in the promotion of bone formation around endosseous implants. The objective of this article is to reoiew the scientific evidence regarding the potential applications of bisphosphonate drugs in the therapeutic management of periodontal diseases. Moreover, the mechanism of action and the pharmacology of these drugs will be reviewed. Finally, the potential role of bisphosphonates regarding their potential to accelerate bone formation, in addition to their usual uses for inhibition of bone resorption, is discussed. J Periodontol 2002;73:813‐822.
Nifedipine Induces Gingival Epithelial Hyperplasia in Rats Through Inhibition of Apoptosis
Authors: Shimizu Yasuki , Kataoka Masatoshi , Seto Hiroyuki , Kido Jun‐ichi , Nagata Toshihiko
Published: February 2005

Background: Nifedipine is used as a long‐acting vasodilator; one of its side effects is gingival overgrowth, characterized by an accumulation of collagenous components within the gingival connective tissue and epithelial hyperplasia with elongated, branched rete pegs penetrating into the connective tissue. We investigated the effect of nifedipine on apoptosis of gingival keratinocytes of rats to elucidate the mechanism of nifedipineinduced gingival epithelial hyperplasia.

Methods: Twenty‐day‐old rats were fed a powdered diet containing or lacking nifedipine for 8 to 30 days. The mandibular gingiva and palatal mucosa were removed on days 8, 15, or 30, and epithelial thickness was examined by light microscopy. In situ terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end labeling (TUNEL) assay was used to examine apoptosis of keratinocytes in the epithelium. In addition, we examined the effects of nifedipine on proliferation of keratinocytes and epithelial cell life on day 8 by 5‐bromo‐2′‐deoxyuridine (BrdU) staining.

Results: Microscopic examination showed gingival epithelial hyperplasia in nifedipine‐treated rats after day 15. Apoptosis of gingival keratinocytes was seen to be inhibited in nifedipinetreated rats on day 8 and 15. Also, nifedipine did not induce an increase of keratinocyte proliferation activity in terms of the number of cells showing positive staining with BrdU. Prolongation of cell life by nifedipine was observed on day 8 in gingival epithelium through a delay of upward cell movement compared to controls. However, epithelial hyperplasia was not detected in palatal mucosa, and there were no significant differences in apoptotic rates of keratinocytes and cell life between nifedipinetreated rats and control rats.

Conclusions: These results suggest that nifedipine induces epithelial hyperplasia in gingival overgrowth not by an increase in keratinocyte proliferation, but by prolongation of cell life through reduction of apoptosis before epithelial hyperplasia is detectable. J Periodontol 2002;73:861‐867.
The Effect of Aspirin on the Periodontal Parameter Bleeding on Probing
Authors: Schrodi Janet , Recio Luisa , Fiorellini Joseph , Howell Howard , Goodson Max , Karimbux Nadeem
Published: February 2005

Background: The absence or presence of bleeding on probing (BOP) is a sign of periodontal health or disease, but the presence of BOP is not an accurate predictor of disease progression. Aspirin is increasingly used in the prevention of cerebrovascular and cardiovascular diseases and is a non‐disease factor that may modify bleeding indices given its antithrombolytic activity. The purpose of this double‐blind placebo‐controlled randomized clinical trial was to study the effect of short‐term daily aspirin ingestion on the clinical parameter BOP.

Methods: A total of 46 periodontally healthy subjects were included in this study: 16 received placebo, 15 low‐dose aspirin (81 mg), and 15 regular dose (325 mg) aspirin. Clinical parameters assessed included plaque index, periodontal probing depth, and BOP using an automated pressure‐sensitive probe. Measurements were recorded before and after 7‐day exposure to placebo and aspirin regimens.

Results: A statistically significant difference in BOP was found in patients with ≥20% of bleeding sites during the visit prior to placebo or aspirin exposure (n = 11). The group treated with 325 mg aspirin exhibited a moderate yet statistically significant increase in BOP (12.4%) compared to the placebo group (there was no significant difference between the 81 mg aspirin group and placebo). The tendency to bleed was not statistically significant in the group which exhibited <20% (n = 35) of bleeding sites during the visit prior to exposure.

Conclusion: Aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing in a population that had ≥20% BOP sites. J Periodontol 2002;73:871‐876.
Calculation of Simplified Single‐Root Surface Area From Simulated X‐Ray Projection
Authors: Chen Ssu‐Kuang , Chen Chung‐Ming , Jeng Jeng‐Ywan
Published: February 2005

Background: The prognosis of a tooth affected by periodontitis might depend on the amount of bone remaining around the root surface. The surface area of a single tooth root relates to a simulated x‐ray projection.

Methods: The aim of the study was to determine root surface area from radiographs. Two methods were used. In the first, cross‐sections of a single‐tooth root were simulated using ellipses with different eccentricities. Projection data from 90 directions at 1° intervals were obtained, which were then used to estimate circumferences that were then compared with the known circumference. In the second model, circumference was estimated from projection data derived from the projection of an ellipse with the central ray parallel to the long axis. The estimated circumference was compared with possible circumferences resulting from this projection data.

Results: In the first model, all estimated circumferences are less than the true circumferences. The largest error in each case decreased rapidly as the eccentricity of the simulated ellipse decreased. Less than 6% of the largesrerrors were found when the eccentricity is 0.83. In the second model, the estimation should be within less than 2% of error when the asymmetry factor is less than 0.6.

Conclusions: The circumference of an elliptical object can be approximated from the projection data of this ellipse. Therefore, the surface area of a single tooth root may be estimated with clinically useful accuracy from the projection data. J Periodontol2002;73:906‐97 0.
Primary Extranodal Malignant Lymphoma Affecting the Periodontium
Authors: Mealey Brian L. , Tunder George S. , Pemble Charles W.
Published: February 2005

Background: Non‐Hodgkin's lymphoma may arise in extranodal tissues within the head and neck region. These lesions may occur in the oral cavity, but rarely appear on the gingiva. Due to their malignant nature, rapid identification, diagnosis, and treatment of non‐Hodgkin's lymphomas are essential to patient survival.

Methods: An unusual case of primary extranodal non‐Hodgkin's lymphoma is described. The small lesion arose on the gingiva and alveolar rnucosa. Upon excision, the tissue was submitted for microscopic examination, with the expectation that the lesion would be benign and excision would constitute the entirety of treatment. However, a diagnosis of primary extranodal large B‐cell lymphoma was returned.

Results: In addition to excision of the lesion, the patient underwent a complete work‐up to rule out other systemic lesions. Chemotherapy and radiation therapy were performed. The patient has remained healthy, without recurrence of lymphoma for3 years.

Conclusions: This case reinforces the importance of submitting excised tissues for microscopic examination euen when the lesion appears totally benign. In addition, it highlights the need for complete excision of suspected lesions, with generous borders of normal tissue. With current periodontal plastic surgical techniques, most defects remaining after soft tissue biopsy can be managed with good esthetic results. J Periodontol 2002;73:937‐941.
Partial‐ or Full‐Mouth Approaches to Assessing the Prevalence of and Risk Factors for Periodontal Disease in Young Adults
Authors: Thomson W.M. , Williams S.M.
Published: February 2005

Background: While partial‐mouth recording is often used in epidemiological studies of periodontal disease because of the efficiencies afforded in data collection, there has been no investigation of the extent to which information is lost in studies of young adults using the combined attachment loss (CAL) approach.

Methods: A random sample of 25‐ and 26‐year‐olds was periodontally examined at 3 sites per tooth in all 4 quadrants. The analysis obtained fullmouth prevalence estimates for gingival recession (GR), probing depth (PD), and CAL. The half‐mouth analyses took 3 forms: 1) estimates from each of the left and right sides were obtained and compared; 2) estimates were obtained separately and compared for quadrants 1 and 3 (upper right and lower left), and quadrants 2 and 4 (upper left and lower right); and 3) estimates were obtained from a diagonal half‐mouth count, whereby quadrants 1 and 3 were analyzed for study participants whose identification number was odd, and quadrants 2 and 4 were analyzed for the remainder. The utility of the half‐mouth and full‐mouth approaches in analytical epidemiology was examined by estimating the strength of the association between periodontitis prevalence and smoking, male gender, and episodic use of dental care.

Results: Of the 169 participants examined, 100 (59.2%) were female, 54 (32.0%) were smokers, and 78 (46.2%) were episodic dental visitors. The difference in prevalence estimates obtained from the different methods was considerably greater for GR than for PD and CAL. The unadjusted odds ratio (OR) for the prevalence of 1 or more teeth with ≥4 mm of CAL among smokers was 2.3 (95% confidence interval [CI] 1.0, 5.3) using the full data set and 2.4 (95% CI 0.9, 6.1) using the diagonal half‐mouth approach. Similarly close odds ratios were observed for males and, to a lesser extent, for episodic dental visitors.

Conclusions: Wherever possible, full‐mouth data should be collected for descriptive epidemiological studies of periodontal disease, but where resource and time constraints mean that half‐mouth examinations must be used, analytical studies of periodontitis should not be unduly affected by the loss of information. However, where the primary focus of the latter is upon gingival recession, the full‐mouth design should be used in order to capture all relevant information, and attention should be directed to making economies in other areas of the data collection process. J Periodontol 2002;73:1010‐1014.
Effect of Selective Cyclooxygenase‐2 Inhibition on the Development of Ligature‐Induced Periodontitis in Rats
Authors: Holzhausen Marinella , Rossa Carlos , Marcantonio Elcio , Nassar Patrícia O. , Spolidório Denise M.P. , Spolidório Luis C.
Published: February 2005

Background: The purpose of this study was to evaluate the effect of a selective cyclooxygenase‐2 inhibitor on the progression of alveolar bone loss in an experimental periodontitis model in rats.

Methods: One hundred eighty (180) Wistar rats were separated into 3 experimental groups. Cotton ligatures were placed at the gingival margin level of lower right first molars. The rats were randomly assigned to one of the following groups that received: a daily oral dose of 10 mg/kg body weight of celecoxib (Cel); 20 mg/kg body weight of celecoxib (Ce2); or 10 ml/kg of saline solution (C). Serum levels of celecoxib and white blood cell count were determined. Standardized digital radiographs were taken after sacrifice at 3, 5, 10, 18, and 30 days to measure the amount of bone loss around the mesial root surface of the first molar tooth in each rat.

Results: Two‐way analysis of variance (ANOVA) indicated that groups treated with celecoxib had significantly less bone loss compared to controls (P <0.0001) and that there was a sig‐nificant interaction between treatment with celecoxib and time (P <0.03). Post‐hoc comparisons showed that in both groups treated with celecoxib, the bone loss became significant only after 10 days of ligature placement, while in the control group it was already significant after 5 days. However, differences in mean bone loss between control and Ce1 were significant only at 18 days and, between control and Ce2, at 5 and 18 days. There was no significant difference in bone loss among experimental groups at the end of the experimental period.

Conclusion: These data provide evidence that systemic therapy with celecoxib can modify the progression of experimentally induced periodontitis in rats.J Periodontol2002;73:1030‐1036.
Patient Perceptions of Periodontal Therapy Completed in a Periodontal Practice
Authors: Fardal Øystein , Johannessen Anne C. , Linden Gerard J.
Published: February 2005

Background: The perceptions that patients have of periodontal therapy have not been extensively studied and are not well understood. The purpose of this study was to assess the degree of discomfort associated with periodontal therapy carried out in a specialist practice.

Methods: A consecutive group of 150 patients (90 females, 60 males; mean age 54.5 years) who had completed periodontal therapy, which included surgery, in a periodontal practice in Norway was studied. The patients indicated the discomfort they had experienced with periodontal therapy on a visual analog scale (VAS). Other factors associated with postoperative discomfort such as the use of analgesics were recorded.

Results: The mean VAS scores were low for all procedures investigated. The highest mean score was recorded for anesthesia in the upper anterior region. There were small differences between the levels of discomfort reported by males compared to females. The VAS scores decreased with increasing age for anesthesia in the lower arch (P = 0.004) and surgery in the lower arch (P = 0.003). Virtually all (97%) of the patients perceived periodontal treatment to be associated with no more discomfort than conventional dental treatment.

Conclusions: Very low reported levels of discomfort were associated with both non‐surgical and surgical periodontal therapy by Norwegian patients treated in a specialist periodontal practice. J Periodontol 2002;73:1060‐1066.
Radiographic and Histologic Evaluation of a Sinus Augmentation with Composite Bone Graft: A Clinical Case Report
Authors: Armand Serge , Kirsch Axel , Sergent Christophe , Kemoun Philippe , Brunel Gérard
Published: February 2005

Background: The purpose of the present study was to present a clinical case report of a sinus augmentation with a composite bone graft and delayed implant placement with a 5‐year follow‐up.

Methods: A 40‐year‐old female in good health required replacement of her partial upper removable denture with a prosthesis supported by implants. Due to insufficient bone, she had to undergo a sinus lift. A block graft of autogenous chin bone, along with anorganic bovine bone covered by collagen, was utilized. Eight months postsurgery, a biopsy core was taken and 3 endosseous implants were placed.

Results: The sinus lift and implantation site are illustrated with clinical, radiological, and histological data. The discussion covers the problems raised by the choice of the surgical technique, grafting material, and immediate or delayed placement of the appropriate implant design.

Conclusion: Our results show that a maxillary sinus augmentation with a composite bone graft is a possible method for creating adequate bone volume before implantation. J Periodontol 2002;73:1082‐1088.
Ecological and Immunopathological Implications of Oral Bacteria in Helicobacter pylori‐Infected Disease
Authors: Okuda Katsuji , Kimizuka Ryuta , Katakura Akira , Nakagawa Taneaki , Ishihara Kazuyuki
Published: February 2005

Increasing evidence has linked colonization by Helicobacter pylori with the development of gastritis and peptic ulcer disease. H.Pylori resides primarily in the gastric mucosa without invading the gastric epithelium, causing persistent mild gastric inflammation. There are many reports examining the relationship between colonization by microorganisms in the stomach and oral cavity. We found that some oral bacteria are able to trap H.Pylori cells, but oral bacteria inhibit H.Pylori growth in vitro. In cases where H.Pylori was detected in oral cavity samples, including oral cancer surface samples, we suggested that this species had colonized the stomach and were present in the oral cavity only as a transient organism. We demonstrated that periodontopathic Campylobacter rectus strains posses proteinaceous antigens, including heat shock proteins that share antigenicity with antigens of H.Pylori strains. These cross‐reactive antigens between H.Pylori and C. rectus may be related to the induction of immunopathological responses in periodontal tissues and the stomach. We concluded that H.Pylori could not survive in the human oral cavity; however, there would be an interrelationship between periodontal disease due to C. rectus and stomach diseases due to H.Pylori. J Periodontol 2003;74:123‐128.
High Prevalence of Helicobacter pylori Detected by PCR in the Oral Cavities of Periodontitis Patients
Authors: Umeda Makoto , Kobayashi Hiroaki , Takeuchi Yasuo , Hayashi Joichiro , Morotome‐Hayashi Yoko , Yano Kazuko , Aoki Akira , Ohkusa Toshifumi , Ishikawa Isao
Published: February 2005

Background: Helicobacter pylori has been associated with the development of peptic ulcers and gastric cancer. Although it may be transmitted through the oral cavity, it is unknown whether the oral cavity acts as a permanent reservoir for this bacterium. The purpose of this study was to use nested polymerase chain reaction (PCR) to clarify whether the oral cavity acts as a reservoir for H.Pylori.

Methods: The existence of H.Pylori in the oral cavity was determined by nested PCR in 57 subjects and by culture method in 18 subjects. The presence of periodontopathic bacteria was also determined by 16S rRNA‐based PCR method.

Results: Although H.Pylori was rarely detected in the oral cavity by culture technique, it was frequently detected (35.1%) by nested PCR in the oral cavity, especially among periodontitis patients who had the bacterium in the gastrointestinal tract (46.4%). Among the subjects who harbored H.Pylori in the stomach or duodenum, 41.2% of patients with periodontal pockets ≥4 mm and 9.1% of subjects without pockets showed H. pylori in dental plaque, although a statistically significant difference was not observed. One patient who had periodontal pockets retained H.Pylori in the oral cavity even after eradication of the bacterium from the stomach and duodenum. Most (8/10) of the patients who had H.Pylori in dental plaque harbored Bacteroides forsythus in their oral cavities.

Conclusion: Close attention should be given to periodontitis patients who harbor H.Pylori in the oral cavity. J Periodontol 2003;74:129‐134.
Neurotrophins in Cultured Cells from Periodontal Tissues
Authors: Kurihara Hidemi , Shinohara Hiroaki , Yoshino Hiroshi , Takeda Katsuhiro , Shiba Hideki
Published: February 2005

We review the basic functions of neurotrophins and their receptors and discuss the expression and functions of neurotrophins and their specific receptors based on recent data using cultured cells from human periodontal tissues. Neurotrophins, nerve growth factor (NGF), brain‐derived neurotrophic factor (BDNF), and neurotrophin‐3 (NT‐3) play crucial roles in the differentiation and survival of neural cells. Neurotrophins activate 2 different receptor classes: the tropomyosin‐related kinase (Trk) family of receptor tyrosine kinases (TrkA, TrkB, and TrkC) and the p75 receptor, a member of the tumor necrosis factor receptor superfamily. Neurotrophins regulate both cell death and cell survival through activations of Trk receptors and/or p75 neurotrophin receptor. It has been reported that neurotrophins are also produced from non‐neuronal cells, such as leukocytes, osteoblasts, or fibroblasts, and act in many other ways on nonneuronal cells. Neurotrophin expression during bone fracture healing is especially interesting, and neurotrophins are now implicated in hard tissue regeneration. It is well known that neurotrophins and their receptors are expressed in tooth development. Recent studies have found that neurotrophins and Trk receptors are expressed in mouse osteoblastic cell lines. Human periodontal ligament cells, human gingival fibroblasts, and human gingival keratinocytes expressed mRNA for NGF and TrkA. The secretion of bioactive NGF peptides from human periodontal ligament cells and human gingival keratinocytes was confirmed by bioassay using PC12 cells (rat adrenal pheochromocytoma cells). The expression of NGF and TrkA mRNA was regulated by interleukin (IL)‐1β NGF increased DNA synthesis and expressions of mRNA for bone‐related proteins, alkaline phosphatase, and osteopontin in human periodontal ligament cells. Neurotrophins and Trk receptors expressed in human periodontal tissue may contribute to regeneration as well as innervation of periodontal tissue through local autocrine and paracrine pathways. Recent data suggest that some functions of neurotrophins and Trk receptors relate to periodontal disease and periodontal tissue regeneration. However, in vivo studies will be required to clarify the roles of neurotrophins and their receptors, including p75, in periodontal disease and periodontal tissue regeneration. J Periodontol 2003;74:76‐84.
Molecular Interaction of Porphyromonas gingivalis with Host Cells: Implication for the Microbial Pathogenesis of Periodontal Disease
Authors: Amano Atsuo
Published: February 2005

Porphyromonas gingivalis is a predominant periodontal pathogen, which expresses a number of potential virulence factors involved in the pathogenesis of periodontitis. Among them, fimbriae are a critical factor to mediate the bacterial interaction with host tissues, which promotes the bacterial adhesion to and invasion of the targeted sites. Fimbriae are capable of binding to human salivary components, commensal bacteria, and a variety of host cells including macrophages, epithelial cells, and fibroblasts. Human extracellular matrix (ECM) proteins such as vitronectin and fibronectin play important roles in cellular signal transduction via binding to receptor integrins. Fimbriae showed signifi‐cant binding affinity to ECM proteins and clearly inhibited the molecular interactions between vitronectin/fibronectin and their receptor αvβ3 and α5β1 integrins overexpressed on Chinese hamster ovary (CHO) cell strain. P. gingivalis fimbriae are likely to interrupt the cellular signaling via ECM proteins/integrins in periodontal regions. Fimbriae are also thought to be critically important in invasive events of the organism to host cells. The fimA genes, encoding FimA (a subunit of fimbriae), of P. gingivalis strains are classified into 5 types, I to V. Recent clinical investigations demonstrated the close relationship between the organisms with type II fimA and periodontitis development. Recombinant FimA (rFimA) proteins of types I to V were generated to compare their adhesion/invasion abilities to human gingival fibroblasts (HGF) and a human epithelial cell line (HEp‐2 cells), respectively. There were no significant differences in the adhesion ability of microspheres (MS) coated with these rFimAs to HGF; however, the adhesion of type II rFimA‐MS to HEp‐2 cells was significantly greater than that of other rFimA types. It was also observed that the type II rFimA‐MS markedly invaded the epithelial cells and accumulated around the nuclei. Collectively, these findings suggest that fimbriae of P. gingivalis, especially type II, are involved in the initiation and progression of human periodontitis. J Periodontol 2003;74:90‐96.
A Comparative Study on the Effect of Nicotine Administration and Cigarette Smoke Inhalation on Bone Healing Around Titanium Implants
Authors: César‐Neto João B. , Duarte Poliana M. , Sallum Enilson A. , Barbieri Deise , Moreno Heitor , Nociti Francisco H.
Published: February 2005

Background: A series of isolated studies has focused on the influence of smoking on bone around titanium implants. This study proposes to investigate the impact of two conditions, i.e., nicotine administration and cigarette smoke inhalation, on the healing around implants.

Methods: Forty‐five Wistar rats were used. After anesthesia, the tibiae surface was exposed and a screw‐shaped titanium implant was placed bilaterally. The animals were randomly assigned to one of the following groups: Group 1: control, n = 19; Group 2: intermittent cigarette smoke inhalation, n = 15; and Group 3: subcutaneous administration of nicotine (3 mg/kg) twice daily, n = 11. After 60 days, the animals were sacrificed. The degree of boneto‐ implant contact (BIC) and the bone area (BA) within the limits of the threads of the implant were measured in the cortical (zone A) and cancellous bone (zone B) areas.

Results: In zone A, cigarette smoke presented a significant negative influence on BIC and BA (Kruskal‐Wallis test, P <0.05). In contrast, the administration of nicotine did not influence either parameter (P >0.05). In zone B, cigarette smoke inhalation also resulted in a decreased percentage of BIC compared to the control group (P <0.05). In addition, the BA was significantly decreased in groups 2 and 3 when compared to controls (P >0.05).

Conclusion: The negative impact of smoking on implant outcomes may be related to more than one molecule present in the cigarette smoke and nicotine seems to partially contribute, especially in the cancellous bone. J Periodontol 2003;74:1454‐1459.
Periodontal Referral Patterns, 1980 Versus 2000: A Preliminary Study
Authors: Cobb Charles M. , Carrara Alexa , El‐Annan Erica , Youngblood Lou Ann , Becker Burton E. , Becker William , Oxford Gregory E. , Williams Karen B.
Published: February 2005

Background: A review of the periodontal literature offers little information concerning trends in referral patterns of patients for periodontal therapy. Over the last 2 decades, there has been a significant increase in the knowledge base concerning inflammatory periodontal disease. It might be assumed that the collective advances in knowledge have impacted periodontal referral patterns. Thus, the purpose of this study was to examine the differences in periodontal referral patterns in the same offices separated by a 20‐year interval (i.e., 1980 and 2000).

Methods: A retrospective chart analysis was conducted on a total of 782 patient charts from three conveniently selected periodontal practices. Charts were randomly selected from two time periods: 1980‐ 1981 and 2000‐2001. The following information was obtained from each patient record: gender, age at time of initial examination, tobacco smoking status at time of initial examination, periodontal case type, number of missing teeth at initial examination (not including third molars), and number of teeth scheduled for extraction per periodontal treatment plan. Descriptive data were analyzed using frequency distributions, measures of central tendency, and measures of dispersion. Non‐parametric statistics were used to examine the relationship of disease severity as a function of site, time period, and patient age.

Results: The following trends were noted: 1) an increase in the average age of patients at the time of the initial examination; 2) a decrease in the percentage of patients using tobacco at the time of the initial interview; 3) an increase in the percentage of periodontal Case Type IV patients with a concomitant decrease in the number of periodontal Case Type III patients; 4) an increase in the average number of missing teeth per patient at the initial examination; and 5) an increase in the average number of teeth scheduled for extraction per periodontal treatment plan.

Conclusions: Characteristics of patients referred in 1980 compared to those referred in the year 2000 indicate that, although fewer patients used tobacco, there were several noteworthy trends. At referral, patients exhibited a greater loss of teeth, had more severe disease, and required extraction of a greater number of teeth in 2000 compared to 1980. Possible reasons for these trends are discussed. J Periodontol 2003;74:1470‐1474.
Bone‐Implant Interface Around Titanium Implants Under Different Loading Conditions: A Histomorphometrical Analysis in the Macaca fascicularis Monkey
Authors: Romanos George E. , Toh Chooi Gait , Siar Chong Huat , Wicht Helmut , Yacoob Hashim , Nentwig Georg‐Hubertus
Published: February 2005

Background: Bone healing around endosseous dental implants is associated with peri‐implant loading conditions. Therefore, the aim of this study was to evaluate histomorphometrically the bone response around unloaded, delayed, and immediately loaded implants with a progressive thread design that were placed in the posterior regions of the lower jaw in monkeys.

Methods: Nine adult monkeys (Macaca fascicularis) were used in this study. After extraction of the second premolars and first and second molars in the mandible, the bone was allowed to heal for a period of 3 months. Forty‐eight 8 mm long implants with a diameter of 3.5 mm were placed according to the following protocol. In two of the monkeys, six implants were placed and left to heal submerged for 3 months (group A). In seven monkeys, 21 implants were placed in one side of the mandible and loaded after 3 months of submerged healing (group B). The group B implants were loaded with temporary resin bridges at the same time as another 21 implants that were loaded immediately (group C) after placement in the contralateral side of the mandibles of the same monkeys. The occlusion of group B and C implants was checked for optimal relationship of the resin bridges that were replaced 1 month later with metal bridges and loaded for an additional 2 months. The group A animals were sacrificed after 3 months of submerged healing without loading; group B and C animals were sacrificed after 3 months of implant loading. Specimens were examined histologically and histomorphometrically.

Results: All implants osseointegrated without presenting any gap in the metal‐bone interface. Compact cortical bone was found in contact with the implant surfaces. Group A implants demonstrated in the interface cancellous bone with loose connective tissue. Group B and C implants showed a thick cortical plate with extensive bone trabeculae formation. There was a significant difference in bone‐to‐implant contact (BIC) between the various loading conditions. No significant difference (P <0.05) was found between groups B and C. There was an increased area of bone (BA) within the threads as well as around the apices of group B and C implants.

Conclusions: Implant loading might have stimulated increased bone formation and thus may be a key factor in influencing positive osseointegration. In addition, immediately loaded implants may osseointegrate in a similar manner as delayed loaded implants. J Periodontol 2003;74:1483‐1490.
Position Paper: Oral Features of Mucocutaneous Disorders
Authors:   Research, Science and Therapy Committee
Published: February 2005

Part of periodontology involves the diagnosis and treatment of a variety of non–plaque‐related diseases of the periodontium. The International Workshop for a Classification of Periodontal Diseases and Conditions noted that the periodontist may be called upon to manage non–plaque‐related mucocutaneous disorders either alone, or as part of a treatment team consisting of physicians, dentists or other allied health care professionals. This informational paper will review the etiology, clinical manifestations, diagnosis, and treatment of the most common chronic mucocutaneous diseases, including those that may present as desquamative gingivitis or intraoral vesiculobullous lesions. This paper is intended for the use of periodontists and other members of the dental profession. J Periodontol 2003;74:1545‐1556.