bluuebunny/crossref_metadata_2025 huggingface dataset:
Spreading of Epithelial Cells on Machined and Sandblasted Titanium Surfaces: An In Vitro Study
Authors: Di Carmine Maristella , Toto Paola , Feliciani Claudio , Scarano Antonio , Tulli Antonello , Strocchi Rita , Piattelli Adriano
Published: February 2005

Background: The purpose of this investigation was to determine the influence of the surface structure of dental implants on epithelial cell spreading and growth in vitro. Cell morphology on machined and sandblasted titanium surfaces was investigated.

Methods: A total of 10 machined and 10 sandblasted discs and 10 glass coverslips were used for the present study. Samples were analyzed using scanning electron microscopy (SEM) and the cell spreading area was determined using a video image analysis system.

Results: After 24 hours incubation, keratinocytes grown on sandblasted titanium samples displayed numerous, long, and branched or dendritic filopodia closely adapted to the surface roughness. Filopodia varied from 3 to 12 µm in length and 0.1 to 0.3 µm in width. Cells cultured on a machined surface did not present such cytoplasmic extensions and displayed a round morphology. Keratinocytes seeded on glass coverslips were flat and edged by filopodia (maximum length 7 to 8 µm) on the spreading site of the cluster. Though cell morphology is comparable with that observed on sandblasted specimens, cytoplasmic extensions suggestive of strong adhesion and spreading attitude were less pronounced.

Conclusion: These results indicate that sandblasted surfaces are the optimal substrata for epithelial cell adhesion and spreading. J Periodontol 2003;74:289‐295.
Effect of Transforming Growth Factor‐β1, Interleukin‐6, and Interferon‐γ on the Expression of Type I Collagen, Heat Shock Protein 47, Matrix Metalloproteinase (MMP)‐1 and MMP‐2 by Fibroblasts from Normal Gingiva and Hereditary Gingival Fibromatosis
Authors: Martelli‐Junior H. , Cotrim P. , Graner E. , Sauk J.J. , Coletta R.D.
Published: February 2005

Background: Increased collagen and extracellular matrix deposition within the gingiva is the main characteristic feature of hereditary gingival fibromatosis (HGF). To date, it is not well established if these events are a consequence of alterations in the collagen and other extracellular matrix molecules synthesis or disturbances in the homeostatic equilibrium between synthesis and degradation of extracellular matrix molecules. Cytokines are important regulators of expression of the profibrogenic genes, including type I collagen and its molecular chaperone heat shock protein (Hsp)47 and proteolytic enzymes degrading extracellular matrix such as matrix metalloproteinases‐1 and ‐2 (MMP‐1 and MMP‐2).

Methods: In this study, we analyzed the expression and production of type I collagen, Hsp47, MMP‐1, and MMP‐2 in normal gingiva (NG) and HGF fibroblasts, and investigated the effects of transforming growth factorbeta1 (TGF‐β1), interleukin‐6 (IL‐6) and interferon‐gamma (IFN‐γ) on the expression of these genes by NG and HGF fibroblasts.

Results: Our results obtained from semi‐quantitative reverse transcription‐polymerase chain reactions (RTPCR), Western blots, enzyme‐linked immunosorbent assays (ELISA), and enzymographies clearly demonstrated that the expression and production of type I collagen and Hsp47 were significantly higher in fibroblasts from HGF than from NG, whereas MMP‐1 and MMP‐2 expression and production were lower in fibroblasts from HGF patients. Addition of TGF‐β1 and IL‐6, which are produced in greater amounts by HGF fibroblasts, promoted an increase in type I collagen and Hsp47 and a decrease in MMP‐1 and MMP‐2 expression. IFN‐γ reduced both type I collagen and Hsp47 expression, whereas it had a slight effect on the expression of MMP‐1 and MMP‐2.

Conclusion: These patterns of expression and production suggest that enhanced TGF‐β1 and IL‐6 production simultaneously increase the synthesis and reduce the proteolytic activities of fibroblasts from patients with HGF, which may favor the accumulation of extracellular matrix observed in patients with this condition. J Periodontol 2003;74:296‐306.
Association of Increased Levels of Fibrinogen and the –455G/A Fibrinogen Gene Polymorphism with Chronic Periodontitis
Authors: Sahingur Sinem E. , Sharma Ashu , Genco Robert J. , De Nardin Ernesto
Published: February 2005

Background: Fibrinogen is one of the acute‐phase proteins whose levels are elevated during periodontal disease. Recent studies suggest that excessive fibrinogen production might play a role in upregulating host immune responses. In addition, there is a relationship between the –455G/A polymorphism (HaeIII) in the 5′ flanking region of the β‐fibrinogen gene promoter and increased fibrinogen levels. In this study, we investigated the distribution of the –455G/A polymorphism and the relationship of this specific genotype to fibrinogen levels in periodontitis patients.

Methods: In order to assess the –455G/A polymorphism, restriction fragment length polymorphism (RFLP) analysis with HaeIII enzyme was performed in the promoter region of the β‐fibrinogen gene. This was carried out on 79 chronic periodontitis patients as compared to 75 periodontally healthy subjects, matched to age, gender, and race. Fibrinogen levels were determined by the radial immunodiffusion assay (RID).

Results: The frequency of homozygocity for the rare allele of the β‐fibrinogen gene (H2H2) was 13% for the periodontitis patients and 3% for the control group (P = 0.01). The distributions of H1H1 and H1H2 genotypes were 48% and 39% in the patient group and 70% and 27% in the control group, respectively. Chisquare analysis indicated that the distribution of these genotypes between the 2 groups was significantly different (P = 0.01). Fibrinogen levels were significantly higher in the patient group (2,496.5 mg/l ± 105) compared to the control group (2,250.0 mg/l ± 118.3) after adjusting for age, gender, and smoking status (P = 0.04). Consistent with previous reports, in our study population, those subjects with the H2H2 genotype had significantly higher fibrinogen levels (3,005.7 mg/l ± 182.5) compared to subjects with the H1H1 genotype (2,325.0 mg/l ± 91.6) or H1H2 genotype (2,438.0 mg/l ± 117.4) (P = 0.001). Furthermore, the H1H2 and H2H2 genotypes were found at a higher frequency among periodontitis patients than controls. The odds ratios (OR) for these genotypes were 3.26 (95% confidence interval [CI]: 1.25 to 8.53) for the H1H2 genotype and 6.41 (95% CI: 1.15 to 35.83) for the H2H2 genotype as compared to individuals with the H1H1 genotype, after adjusting for age, gender, and smoking status.

Conclusions: The results indicate that a higher percentage of chronic periodontitis patients exhibit genotypes associated with higher plasma fibrinogen levels than healthy individuals. Furthermore, periodontitis patients have significantly higher fibrinogen levels compared to healthy individuals. The presence of H1H2 or H2H2 genotypes as well as elevated fibrinogen levels, in conjunction with other factors, may put individuals at higher risk of having periodontal disease, or may result from periodontal infection‐genetic interactions. J Periodontol 2003;74:329‐337.
Role of the Microgap Between Implant and Abutment: A Retrospective Histologic Evaluation in Monkeys
Authors: Piattelli Adriano , Vrespa Giuseppe , Petrone Giovanna , Iezzi Giovanna , Annibali Susanna , Scarano Antonio
Published: February 2005

Background: It has been hypothesized that a certain width of the peri‐implant mucosa is required to enable a proper epithelialconnective tissue attachment and, if this soft tissue dimension is not adequate, bone resorption will occur to ensure the establishment of attachment with an appropriate biological width. The reason for the accelerated bone loss around submerged 2‐piece implants in the first year after the restoration is not known, but one possibility is that the gap between components plays a role in this process. Recent studies have shown that for all 2‐part implants, the bone crest level changes appeared dependent on the location of the microgap.

Methods: The aim of the present study was a retrospective histologic evaluation in monkeys of the bone response to implants inserted 1 to 2 mm above the alveolar crest (group 1, 15 implants), at the level of the alveolar crest (group 2, 12 implants), or 1 to 1.5 mm below the alveolar crest (group 3, 13 implants). These implants had been early loaded, immediately loaded, and inserted immediately postextraction.

Results: In group 1, a 0.13 ± 0.12 mm bone increase in a coronal direction was seen. In group 2, a 2.1 ± 0.29 mm vertical bone loss was present. In group 3, a mean 3.6 ± 0.46 mm vertical bone loss extending in an apical direction was observed. Statistically significant differences were observed between all 3 groups.

Conclusions: Our results confirm data published previously that if the microgap was moved coronally away from the alveolar crest, less bone loss would occur and if the microgap was moved apical to the alveolar crest, greater amounts of bone resorption were present. This remodeling is not dependent on early and immediate loading of the implants or on immediate postextraction insertion. J Periodontol 2003;74:346‐352.
β‐Glucuronidase Activity in Saliva: Relationship to Clinical Periodontal Parameters
Authors: Lamster Ira B. , Kaufman Eliaz , Grbic John T. , Winston Leslie J. , Singer Robert E.
Published: February 2005

Background: β‐glucuronidase (βG) in gingival crevicular fluid (GCF), a marker of neutrophil influx into the crevicular environment, has previously been shown to be correlated with periodontal clinical parameters at individual sites (probing depth and clinical attachment level). Furthermore, elevated levels of βG were found to be a risk factor for periodontal attachment loss. Analysis of βG in saliva may be a measure of crevicular neutrophil influx for the whole mouth. The purpose of this cross‐sectional study was to evaluate the relationship between βG activity in saliva and periodontal clinical parameters in subjects demonstrating various levels of periodontal disease.

Methods: The study population consisted of 380 subjects (108 males and 272 females). A sample of unstimulated whole saliva and a venous blood sample were obtained from each subject, and a periodontal examination, which included measurement of probing depth (PD), attachment level (AL), and gingival index (GI) was performed. The unmodified saliva samples were frozen at –20°C and analyzed for βG activity. The blood samples were analyzed for number of white blood cells, neutrophils, monocytes, lymphocytes, and platelets. Statistical analysis was conducted to determine the association between salivary βG activity and the whole‐mouth clinical periodontal parameters, complete blood count, smoking status, and age.

Results: Highly significant correlations between salivary βG activity and mean probing depth (MPD), mean gingival index (MGI), and the number of sites with probing depth ≥5 mm were found. When subjects were divided into tertiles based on their MPD and MGI, elevated salivary βG activity was detected in subjects in the 2 upper tertiles. Logistic regression modeling was used to determine which of the clinical or laboratory parameters were able to identify patients with at least 4 sites with PD ≥5 mm. Salivary βG activity ≥100 produced an odds ratio (OR) of 3.77. In comparison, current and former smokers had an OR of 3.15 and 2.29, respectively.

Conclusions: The results suggest that a significant association exists between periodontal clinical parameters and salivary βG activity. Due to the non‐invasive and simple nature of saliva collection, this association should be studied to determine its usefulness as a screening test for periodontitis, and a means of monitoring the response to treatment. J Periodontol 2003;74:353‐359.
The Contribution of Interleukin‐1 and Tumor Necrosis Factor to Periodontal Tissue Destruction
Authors: Graves D.T. , Cochran D.
Published: February 2005

Interleukin (IL)‐1 and tumor necrosis factor (TNF) represent proinflammatory cytokines that stimulate a number of events which occur during periodontal disease. These include the induction of adhesion molecules and other mediators that facilitate and amplify the inflammatory response, the stimulation of matrix metalloproteinase, and bone resorption. The activity of these cytokines coincides with the critical events that occur during periodontal disease, namely, loss of attachment and bone resorption. The use of antagonists to IL‐1 and TNF in experimental periodontitis have demonstrated a cause‐and‐effect relationship between the activity of these cytokines and the spread of an inflammatory front to deeper areas in the connective tissue, loss of connective tissue attachment, osteoclast formation, and loss of alveolar bone. In addition, the loss of fibroblasts that occurs during infection with periodontal pathogens is, in part, mediated by TNF. Thus, much of the damage that occurs during periodontal tissue destruction can be attributed to IL‐1 and TNF activity. This destruction may very well represent an overreaction of the host response to periodontal pathogens caused by excessive production of IL‐1 and TNF. J Periodontol 2003; 74:391–401.
Immediate Implants Covered with Connective Tissue Membranes: Human Biopsies
Authors: Wilson Thomas G , Carnio João , Schenk Robert , Cochran David
Published: February 2005

Background: Osseointegration has been shown to occur around implants placed immediately after tooth extraction in humans. To date, such osseointegration has been achieved only with titanium plasma‐sprayed (TPS) implants placed in extraction sockets with a bone‐to‐implant distance of less than 2 mm. In a previous report, when this horizontal defect dimension (HDD) exceeded 2 mm, the resulting percentage of bone‐to‐implant contact was reduced, indicating that the immediate technique would be limited in most cases to non‐molar teeth. In an attempt to improve the bone‐to‐implant contact and the initial bone‐toimplant contact in a vertical dimension, the implant surface, the type of membrane, and the method of membrane placement used in a previous study by our group were modified.

Methods: Ten large‐grit sandblasted, acid‐attacked (SLA) titanium implants were placed into immediate extraction sites in 5 patients. HDDs of 0.0 to 1.5 mm (controls), 1.5 to 4.0 mm, and >4.0 mm were used. Following insertion, implants were completely covered with a connective tissue membrane. This was in contrast to the use of an expanded polytetrafluoroethylene (ePTFE) membrane penetrated by the neck of the implant in our previous report. Primary closure of soft tissue flaps was achieved in each case. Six months after placement, 7 of the implants were histologically examined.

Results: Osseointegration occurred across all HDDs, with the percentage of bone‐to‐implant contact in the 0.0 to 1.5 mm HDDs similar to that seen in the >4.0 mm HDDs. The first bone‐to‐implant contact measured vertically was similar in both the smaller and larger HDDs.

Conclusions: Osseointegration was successful in immediate implant placement sites with horizontal defect dimensions wider than 4 mm in humans when SLA titanium implants were completely covered with connective tissue membranes. It remains undetermined whether the different type of membrane, placement of the membrane, type of implant surface, or a combination of these 3 factors were responsible for the improved osseointegration in HDDs >4 mm. Further study is needed. J Periodontol 2003;74:402‐;409.
Probing Depth Changes Following 2 Years of Periodontal Maintenance Therapy Including Adjunctive Controlled Release of Chlorhexidine
Authors: Soskolne W. Aubrey , Proskin Howard M. , Stabholz Ayala
Published: February 2005

Background: Multicenter clinical trials have established that the adjunctive use of the subgingival controlled release of chlorhexidine, (CHX chip), significantly reduces probing depth (PD), improves clinical attachment levels, and reduces bleeding on probing compared to scaling and root planing (SRP) alone for periods of up to 9 months. The present report is based on a phase IV clinical trial to examine the adjunctive use of the CHX chip for routine periodontal maintenance therapy (RPMT) over 2 years.

Methods: Eight hundred thirty‐five (835) patients were recruited into the study. At baseline a CHX chip was placed in pocket sites with PD≥5 mm. The patients were scheduled to receive RPMT at 3‐month intervals with repeated CHX chip placement at sites where the PD remained ≥5 mm. Patients who did not attend the 24‐month recall visit or who failed to attend 2 consecutive time frame examinations were excluded from the analyses.

Results: The 595 patients included showed a continuous decrease in PD over 2 years of 0.95 mm. After 2 years, 23.2% of patients had at least 2 pockets showing a reduction in PD of 2 mm or more and 58.9% of the sites had been reduced to a PD of <5 mm. Only 2.9% (n=57) of the sites showed an increase in PD of ≥2 mm. Adverse events were mild to moderate in nature and resolved spontaneously without medication.

Conclusion: The results of this Phase IV or follow‐up trial indicate that the adjunctive use of the CHX chip is a clinically safe and effective treatment option for long‐term management of chronic periodontitis. J Periodontol 2003;74:420‐427.
The Putative Collagen‐Binding Peptide P‐15 Promotes Fibroblast Attachment to Root Shavings but Not Hydroxyapatite
Authors: Lallier Thomas E. , Palaiologou Archontia A. , Yukna Raymond A. , Layman Don L.
Published: February 2005

Background: Regenerative periodontal treatment aims to restore the attachment of the periodontal ligament and gingival collagen fibers to both the cementum of the root surface and alveolar bone. Fibroblasts are the predominant cells of the periodontal ligament and gingiva and have important roles in the function and regeneration of the tooth‐supporting apparatus. This study investigated whether a putative collagen‐based cellbinding peptide (P‐15) increases gingival fibroblast attachment to root shavings and bone replacement graft (BRG) materials.

Methods: Gingival and dermal fibroblast attachment to root shavings and BRG materials, and cell proliferation on root shavings and sections were measured fluorometrically. Root shavings and root sections obtained from periodontally healthy teeth were treated with P‐15 at 2 concentrations (200 ng/g or 400 ng/g). Citric acid (CA)‐treated root materials were also compared to untreated root shavings and root sections that served as negative control groups.

Results: Attachment of all cells to bone fragments (whether freeze‐dried or demineralized) was significantly greater than to hydroxyapatite (HA)‐based BRG materials. The addition of P‐15 to HA did not significantly increase gingival or dermal fibroblast attachment. At a concentration of 400 ng/g, P‐15 significantly increased gingival and dermal fibroblast attachment to root shavings as compared to untreated shavings. Bone fragments, HA‐based BRG materials, and untreated root shavings inhibited gingival fibroblast proliferation. Treatment of root sections with P‐15 did not have any effect on gingival fibroblast proliferation.

Conclusions: P‐15 is a potential alternative to CA for promoting fibroblast attachment to root surfaces. However, P‐15 did not enhance fibroblast proliferation on root sections. J Periodontol 2003;74:458‐467.
The Influence of Gingival Margin Recession on Loss of Clinical Attachment in Alcohol‐Dependent Patients without Medical Disorders
Authors: Khocht Ahmed , Janal Malvin , Schleifer Steven , Keller Steven
Published: February 2005

Background: The objective of this study was to examine the effects of alcohol and cocaine misuse on periodontal status in a group of alcohol‐dependent patients.

Methods: Forty verified alcoholics, either exclusively (n = 10) or with cocaine abuse (n = 30), and a matched comparison group of 25 non‐alcoholic subjects, 14 of whom abused cocaine, were entered in the study. All subjects were free from systemic illnesses. Blood levels of gamma glutamyl transpeptidase (GGTP), a liver enzyme indicator of alcohol drinking, were determined. A comprehensive periodontal examination was performed on 6 sites per tooth. The gingival index (GI) and plaque index (PI) were recorded. Attachment levels (AL) were computed as probing depth (PD) plus gingival margin level (GM).

Results: No statistically significant differences were noted between the groups for average AL, PD, GM, GI, and PI. In alcoholics, Pearson correlation showed a positive association between GGTP levels and loss of periodontal attachment (P <0.05). A series of regression analyses predicting AL from selected periodontal and demographic factors showed that alcoholics manifest AL by greater increases in GM than non‐alcoholics (P <0.07). Severe alcohol use as measured by GGTP >51 iu/l worsens PI (P <0.07), which adversely impacts GM, GI, PD, and ultimately AL. No significant associations were found between cocaine use and AL.

Conclusions: The results suggest that persistent alcohol abuse increases periodontitis development by heightening the loss of attachment through recession of gingival margins. J Periodontol 2003;74:485‐493.
Membrane Type (MT)1‐Matrix Metalloproteinase (MMP) and MMP‐2 Expression in Ligature‐Induced Periodontitis in the Rat
Authors: Achong Ron , Nishimura Ichiro , Ramachandran Hema , Howell Thomas H. , Fiorellini Joseph P. , Karimbux Nadeem Y.
Published: February 2005

Background: Matrix metalloproteinases (MMPs) have been shown to be involved in the degradation of the extracellular matrix (ECM). In particular, MMP‐2 and MMP‐9 (gelatinase A and gelatinase B, respectively) have been identified as the predominant MMPs during periodontitis. Recent studies have indicated that a novel transmembrane MMP, mebrane‐type 1 matrix metalloproteinase (MT1‐MMP), can activate pro‐MMP‐2 in tumor metastasis. This study aims to elucidate the presence and localization of MT1‐MMP and MMP‐2 in periodontitis in a rat model. Methods: In 2 groups of 40‐day‐old male Sprague‐Dawley rats, periodontitis was initiated by ligating floss around maxillary second molars. A group of control animals were left untreated. Maxillary dentoalveolar segments were isolated after 7 and 21 days postinduction and were prepared for gross and radiographic analysis of bone loss and for histological analysis. Samples were also prepared for gel zymography to detect the presence of MMP‐2, and for Northern blot analysis and in situ hybridization with MT1‐MMP probes.

Results: MMP‐2 expression increased at 21 days following ligature placement, in conjunction with MT1‐MMP expression. MT1‐MMP mRNA expression was observed in epithelial cells, fibroblasts, and in multinucleated cells in the periodontium.

Conclusion: Our data suggest that MT1‐MMP may play a role in extracellular matrix degradation during periodontitis, in concert with MMP‐2 and other proteinases. J Periodontol 2003;74: 494‐500.
The Segmental Osteotomy in the Management of Malposed Implants: A Case Report and Literature Review
Authors: Kassolis James D. , Baer Marvin L. , Reynolds Mark A.
Published: February 2005

Background: The segmental osteotomy provides an important treatment approach for the correction of skeletal‐dental malocclusions that would otherwise be unmanageable with conventional orthodontic care. The combined use of orthodontics and orthognathic surgery also has been adapted for use in the correction of developmental and traumatic deformities. Severely malpositioned implant fixtures may not permit restorative correction even with custom prosthetic appliances. As an alternative to implant removal, which can be associated with significant alveolar destruction, orthognathic surgery may offer a treatment modality to improve fixture alignment, thereby enabling a more favorable esthetic and functional prosthesis. This paper presents a case report and review of the segmental osteotomy procedure.

Methods: A 32‐year‐old female with congenitally missing maxillary lateral incisors underwent implant surgery for prosthetic replacement of these teeth. Due to severe labial positioning of the implant fixtures, acceptable prosthetic treatment was not possible. A segmental osteotomy procedure was used to reposition the implants. The implants were splinted using a ridged interim suprastructure during the 4‐month healing period. An occlusal appliance also was worn during the initial 8 weeks of this healing period.

Results: The surgical procedure permitted intrusion and palatal repositioning of the implants. Healing proceeded with no untoward effects. Clinical findings at second‐stage surgery were consistent with complete osseous repair and integration of the fixtures. Successful prosthetic treatment was subsequently completed for the patient.

Conclusion: The segmental osteotomy may provide an alternative treatment to the removal of severely malposed implants or their compromised prosthetic restoration J Periodontol 2003;74:529‐536.
Altered Healing Following Mucogingival Surgery in a Patient with Crohn's Disease: A Literature Review and Case Report
Authors: Andersen Kari‐M. , Selvig Knut A. , Leknes Knut N.
Published: February 2005

Background: Crohn's disease is a chronic inflammatory bowel disease characterized by uncertainty in etiology and pathogenesis occasionally with manifestations in oral mucous membranes. This report reviews the literature on Crohn's disease and presents a patient with Crohn's disease on continuous antiinflammatory and immunosuppressive medication who showed adverse healing response following surgical treatment of gingival recession type defects.

Methods: A 28‐year‐old male in generally good health apart from his bowel disease requested treatment of multiple maxillary gingival recessions due to esthetic concerns and root sensitivity. Following oral hygiene instruction, 3 coronally advanced flap procedures were performed in the maxillary anterior region to cover the defects. In 2 of the surgical areas, the exposed root surfaces were treated by etylenediaminetetraacetic acid (EDTA) in combination with enamel matrix derivative (EMD) before coronally positioning the buccal flap. Postoperatively, chlorhexidine gluconate was used for oral hygiene control.

Results: The first surgical procedure, performed as a coronally advanced flap, showed delayed and altered healing. Two weeks postoperatively, the flapped tissue remained intensely red and swollen. In the following 2 surgical sites where EDTA and EMD were applied the healing was uneventful. Differences in immediate tissue response, however, did not influence the 3‐month treatment outcome with respect to root coverage

Conclusions: Patients with Crohn's disease on recommended systemic medications may show a delayed and altered wound healing indicating that periodontal surgery must be closely monitored. Treatment planning should take into account the potential wound healing promoting effects of enamel matrix derivative as well as adverse healing effects of chlorhexidine gluconate administration. J Periodontol 2003;74:537‐546.
Severe Alveolar Bone Loss and Gingival Hyperplasia as Initial Manifestation of Burkitt Cell Type Acute Lymphoblastic Leukemia
Authors: Haytac M.C. , Antmen B. , Dogan M.C. , Sasmaz I.
Published: February 2005

Background: The purpose of this case report is to present severe alveolar bone destruction and gingival enlargement as initial manifestation of Burkitt cell type acute lymphoblastic leukemia (ALL‐L3) in a 14‐year‐old boy

Methods: The patient was referred to the periodontology department with a 4‐week history of gingival enlargement and loosening of teeth. The clinical examination revealed gingival enlargement and expansion of alveolar mucosa particularly in molar regions of both jaws. Almost all teeth had deep periodontal pockets and severe mobility. While the radiographs showed severe alveolar bone loss which extended to apical thirds of many teeth, the microbiologic analysis revealed that the patient did not harbor major periodontopathogenic bacteria species. The results of blood tests and bone marrow aspiration were compatible with ALL‐L3.

Results: Remission‐induction treatment with BFM‐90 ALL chemotherapy protocol was started; however, the patient died 4 weeks after the diagnosis due to neutropenic sepsis.

Conclusions: Although no biopsy was performed, it is possible that the severe periodontal destruction and gingival enlargement in this case may have been due to the infiltration of leukemic cells in gingiva, periodontal ligament, and alveolar bone. The similarities of these findings with numb chin syndrome (NCS) and Burkitt's lymphoma (BL) are discussed in this report. J Periodontol 2003;74:547‐551.
An Unusual Oral Chronic Graft‐Versus‐Host Disease‐Like Syndrome Following a Liver Transplant
Authors: Bunetel Laurence , Le Gall François , Delaval Yvonne , Sixou Jean‐Louis , Dabadie Alain , Bonnaure‐Mallet Martine
Published: February 2005

Background: Giving the immunosuppressive drug tacrolimus (FK506) to liver transplant patients has helped to considerably reduce oral side effects such as gingival hyperplasia. Patients taking cyclosporin who suffer from gingival hyperplasia are often switched to tacrolimus.

Methods: We present here a pediatric liver transplantation case study. The patient has been followed for 5.5 years. She developed oral lesions that resulted in the immunosuppressive therapy being changed from tacrolimus to cyclosporin. In clinical terms, the atypical pathology consisted of hyperpigmented patches on the gingival margin, the internal surfaces of the cheeks, and the intraoral surfaces of the lips. When located on the lips, the hyperpigmented patches were associated with pruriginous and edematous lesions.

Results: Optical and electronic microscopic examinations of a gingival tissue sample revealed the presence of melanin incontinence and lichenoid lesions with degenerated keratinocytes and a mild infiltrate of lymphocytes. This points to a chronic graft‐versushost disease (cGvHD)‐like syndrome linked to tacrolimus. This diagnosis was given further credence by improvement in the lesions following the switch to cyclosporin.

Conclusion: To our knowledge, this is the first reported case of tacrolimus‐associated chronic GvHDlike syndrome occurring in the oral mucosa. J Periodontol 2003;74:552‐556.
Dimensions of Peri‐Implant Mucosa: An Evaluation of Maxillary Anterior Single Implants in Humans
Authors: Kan Joseph Y.K. , Rungcharassaeng Kitichai , Umezu Kiyotaka , Kois John C.
Published: February 2005

Background: Attempts have been made to evaluate the biologic dimension of osseointegrated implants; however, most are histologic studies in animals, and the effect of soft tissue support from adjacent teeth on the interproximal dimension of the peri‐implant mucosa for anterior single implants has not been addressed. This study clinically evaluated the dimensions of the periimplant mucosa around 2‐stage maxillary anterior single implants in humans after 1 year of function. The influence of the peri‐implant biotype was also examined

Methods: Forty‐five patients (20 males and 25 females) with a mean age of 47.3 years were included in this study. A total of 45 maxillary anterior single implant crowns with a mean functional time of 32.5 months (range, 12 to 78) were evaluated. The dimensions of peri‐implant mucosa were measured by bone sounding using a periodontal probe at the mesial (MI), mid‐facial (F), and distal (DI) aspects of the implant restoration and the proximal aspects (MT, DT) of adjacent natural teeth. In addition, the peri‐implant biotype was evaluated and categorized as thick or thin. Statistical analysis was performed using an independent t test (P <0.05).

Results: The means and standard deviations of the dimensions of peri‐implant mucosa at MT, MI, F, DI, and DT were 4.20 ± 0.77 mm, 6.17 ± 1.27 mm, 3.63 ± 0.91 mm, 5.93 ± 1.21 mm, and 4.20 ± 0.64 mm, respectively. The dimensions of peri‐implant mucosa in the thick biotype were significantly greater than the thin biotype at MT, MI, and DT (P<0.05).

Conclusions: The mean facial dimension of periimplant mucosa of 2‐stage implants is slightly greater than the average dimension of the dentogingival complex. The level of the interproximal papilla of the implant is independent of the proximal bone level next to the implant, but is related to the interproximal bone level next to the adjacent teeth. Greater periimplant mucosal dimensions were noted in the presence of a thick peri‐implant biotype as compared to a thin biotype.J Periodontol 2003;74:557‐562.
Periodontal Terminology Revisited
Authors: Weinberg Mea A. , Eskow Robert N.
Published: February 2005

The body of knowledge that was the basis of the science and therapy of periodontics can be found in the literature of the 1950s and 60s. This information conveniently was presented in various textbooks. The evolution of research utilizing histochemistry and electron microscopy, along with disciplined clinical studies, has resulted in an exponential increase in information. A by‐product of this worldwide effort is confusion resulting from the misuse and interchangeable application of terms disregarding the definitions originally accepted. Even with workshops1‐3 designed in part to arrive at consensus to preclude confusion, the literature is replete with misleading use of nomenclature.

The lack of attention to the appropriate use of terms is, at best, confusing to the student, researcher, and clinician. In the worst case, it may result in poor performance on examinations and improper evaluation of techniques and materials.

Many periodontal terms are used inappropriately or are not completely understood, probably because these words have not been adequately described in the literature. Some of the more commonly used and confused terms will be discussed using literature to support the definitions.J Periodontol 2003;74:563‐565.
Spatial Extent of Gingival Cell Activation Due to Mechanical Stimulation by Toothbrushing
Authors: Sakamoto Tomonori , Horiuchi Masazumi , Tomofuji Takaaki , Ekuni Daisuke , Yamamoto Tatsuo , Watanabe Tatsuo
Published: February 2005

Background: Mechanical stimulation by toothbrushing enhances gingival fibroblast proliferation and collagen synthesis, and reduces inflammatory cell infiltration. The aim of this study was to investigate the spatial extent of proliferation of fibroblasts and endothelial cells in dog gingiva in response to mechanical stimulation by toothbrushing.

Methods: All maxillary fourth premolars and mandibular first molars of 6 mongrel dogs were used. Dental plaque was removed with a curet. One of each pair of bilateral teeth (in the same jaw) was assigned to the brushing group, and the corresponding tooth (opposite side) was assigned to the control group. The Bass method was used to brush the limited mesial half of the tooth at 1.96 N for 20 seconds with a fitted plastic stent. Immediately before fixation of tissue, the surface of brushed gingiva was notched to indicate the borderline between the brushed and nonbrushed areas. Histometrical analyses of the sections were performed using assays for proliferating cell nuclear antigen (PCNA) and von Willebrand factor.

Results: The numbers of fibroblasts and PCNA‐positive fibroblasts in the subepithelial connective tissue adjacent to oral sulcular epithelium significantly increased in brushed gingiva, not only in the brushed area but also in the non‐brushed area 0 to 0.5 mm from the notch. Increased numbers of vascular endothelial cells were observed only in the brushed area.

Conclusion: The effect of mechanical stimulation by toothbrushing on gingival cell proliferation was not observed more than 0.5 mm from the brushed area. These results indicate that effective activation of gingival cell proliferation requires mechanical stimulation of gingiva in all areas. J Periodontol 2003;74:585‐589.
Inhibitory Effects of Incadronate on the Progression of Rat Experimental Periodontitis by Porphyromonas gingivalis Infection
Authors: Tani‐Ishii Nobuyuki , Minamida Genshi , Saitoh Daisuke , Chieda Keiko , Omuro Hiromasa , Sugaya Akira , Hamada Nobushiro , Takahashi Yusuke , Kiyohara Shiro , Kashima Isamu , Teranaka Toshio , Umemoto Toshio
Published: February 2005

Background: Incadronate (YM175, disodium cycloheptylaminomethylenediphosphonate monohydrate), a bisphosphonate, has been suggested to prevent the bone resorption associated with periodontitis by inhibiting osteoclast activity. The purpose of this study was to investigate the effect of incadronate in preventing periodontal destruction in rats with Porphyromonas gingivalis‐induced periodontitis.

Methods: Periodontitis was induced in 35 Wister rats by inoculating P. gingivalis into the oral cavity and feeding the rats a soft diet for 4 weeks. Incadronate or placebo was administered to the oral cavity of the rats 2 days per week for 2, 4, or 8 weeks.

Results:P. gingivalis infection resulted in destruction of the periodontal ligament, reduced bone density, and caused inflammatory cell migration. Radiographic, morphometric, and histological results showed that incadronate had the ability to increase the bone mineral density (quantum level score; cortex 518.9 [placebo 612.8]; sponge 579.8 [placebo 672.0]) and to prevent periodontal ligament destruction (width 0.16 mm [placebo 0.20 mm]; area 0.36 mm2 [placebo 0.54 mm2]) after 8 weeks' administration. Furthermore, the polymorphonuclear leukocyte (PMN) infiltration in gingival tissue was significantly decreased.

Conclusion: These results showed that incadronate inhibits bone resorption and PMN migration in P. gingivalis‐induced periodontitis. J Periodontol 2003;74:603‐609.
Obesity and Periodontal Disease in Young, Middle‐Aged, and Older Adults
Authors: Al‐Zahrani Mohammad S. , Bissada Nabil F. , Borawski Elaine A.
Published: February 2005

Background: The growing prevalence of increased body weight and obesity in the United States has raised significant public health concerns. Obesity has been implicated as a risk factor for several chronic health conditions, as well as being associated with increased mortality. Recently, an association between obesity and periodontal disease was found in a Japanese population. The purpose of the present study is to examine the relation between body weight and periodontal disease in a representative United States sample.

Methods: Participants in the third National Health and Nutrition Examination Survey (NHANES III) who were ≥18 years and had undergone a periodontal examination were selected for the analysis (n = 13,665). Body mass index (BMI) and waist circumference (WC) were used as measures of overall and abdominal fat content, respectively. Univariable and multivariable logistic regression models were used to estimate the association between increased body weight and periodontal disease. BMI and WC were assessed independently in a multivariable logistic model containing the following variables: gender, race, education, poverty index, smoking, diabetes, and time elapsed since last dental visit. Significant interactions with age were found and analyses were then stratified by age: younger (18 to 34 years old), middle‐aged (35 to 59 years old), and older (60 to 90 years old) adults.

Results: A significant association between the measures of body fat and periodontal disease was found among the younger adults, but not middle or older adults. The adjusted odds ratios (OR) for having periodontal disease were 0.21 (0.080 to 0.565), 1.00 (0.705 to 1.407), and 1.76 (1.187 to 2.612) for subjects with BMI <18.5 kg/m2, 25−29.9 kg/m2, and ≥30 kg/m2, respectively. Young subjects with high WC had an adjusted OR of 2.27 (1.480 to 3.487) for having periodontal disease.

Conclusions: In a younger population, overall and abdominal obesity are associated with increased prevalence of periodontal disease, while underweight (BMI <18.5) is associated with decreased prevalence. Obesity could be a potential risk factor for periodontal disease especially among younger individuals. Promotion of healthy nutrition and adequate physical activity may be additional factors to prevent or halt the rate of progression of periodontal disease. J Periodontol 2003;74:610‐615.
Mouthrinses with Alcohol: Cytotoxic Effects on Human Gingival Fibroblasts In Vitro
Authors: Poggi Paola , Baena Ruggero Rodriguez Y. , Rizzo Silvana , Rota Massimo T.
Published: February 2005

Background: Mouthrinses are widely utilized in daily oral and dental hygiene to control plaque. However, most commercially available mouthrinses contain alcohol as an excipient. Most studies have focused on the clinical side effects related to the alcoholic fraction of mouthrinses, overlooking alcohol metabolism in the mouth. Due to this oral enzymatic process, the wellrecognized toxic compound acetaldehyde is emitted in the mouth. Since gingival fibroblasts play a key role in oral connective tissue health maintenance, we investigated the effects of different doses of acetaldehyde on human gingival fibroblasts (HGFs) in order to better define the effects of alcohol‐containing mouthrinses on oral tissue.

Methods: Cultured HGFs were exposed to different concentrations of acetaldehyde (10−4 M to 10−2 M). The cell adhesion rate was measured after a 3‐hour incubation period, and cell viability over a 5‐day period. In order to assess the reversibility of the damage produced by acetaldehyde, treatment was interrupted at critical doses (10−3 M and 3 × 10−3 M), and cell viability was evaluated on the third and fifth day of incubation. The HGF cytoskeleton was studied by immunocytochemical technique, and internal cell structures were observed with transmission electron microscopy to evaluate the morphological changes due to acetaldehyde.

Results: The results showed that acetaldehyde produced a dose‐ and time‐dependent inhibition on cell adhesion and viability, together with disruption of cytoskeletal structures and cytoplasmic organelles. Nevertheless, these quantitative and qualitative damages were reversible when the treatment was interrupted.

Conclusions: Although more knowledge is necessary, our results suggest that these deleterious effects may also occur in vivo. Pending further investigations, clinicians should be alerted to the potentially adverse effect of alcohol‐containing mouthrinses and, to promote oral health, patients should be warned about improper use of these products. J Periodontol 2003;74:623‐629.
Optimum Force and Duration of Toothbrushing to Enhance Gingival Fibroblast Proliferation and Procollagen Type I Synthesis in Dogs
Authors: Tomofuji Takaaki , Ekuni Daisuke , Yamamoto Tatsuo , Horiuchi Masazumi , Sakamoto Tomonori , Watanabe Tatsuo
Published: February 2005

Background: Toothbrushing enhances gingival fibroblast proliferation, which promotes wound healing. Optimum force and duration of toothbrushing for stimulation of fibroblast proliferation are key factors in maximizing effects of toothbrushing on periodontal wound healing. We therefore evaluated the effects of different durations and forces of toothbrushing on proliferative activity and procollagen synthesis of gingival fibroblasts.

Methods: Twelve dogs were used. In each dog, buccal gingivae of 12 teeth were examined for 3 weeks. Nine of these 12 teeth were each assigned to 1 of 9 different combinations of brushing force (0.98, 1.96, or 2.45 N) and duration (10, 20, or 40 seconds). The remaining 3 teeth received plaque removal without brushing, via a scaler.

Results: Force and duration of toothbrushing affected both proliferating cell nuclear antigen (PCNA)‐positive and procollagen Type I C‐peptide (PIP)‐positive fibroblast ratios (P <0.05). The highest ratio of PCNA‐positive fibroblasts was produced by brushing at 1.96 N for 20 seconds. The highest ratio of PIP‐positive fibroblasts was produced by brushing at 1.96 N for 10 seconds.

Conclusions: Toothbrushing at certain forces and durations enhanced the proliferative activity and procollagen synthesis of gingival fibroblasts. The toothbrushing duration that increased procollagen synthesis (10 seconds) was shorter than that which increased fibroblast proliferative activity (20 seconds). J Periodontol 2003;74:630‐634.
Evidence‐Based Mucogingival Therapy. Part 2: Ordinary and Individual Patient Data Meta‐Analyses of Surgical Treatment of Recession Using Complete Root Coverage as the Outcome Variable
Authors: Clauser Carlo , Nieri Michele , Franceschi Debora , Pagliaro Umberto , Pini‐Prato Giovanpaolo
Published: February 2005

Background: The literature (1970‐2000) on the outcome of surgical root coverage has been revised and summarized in a companion paper. The overall conclusion was that the various procedures are effective, but it was not possible to determine which procedure was best indicated in different clinical conditions. In this study, meta‐analysis techniques were used to seek evidence for guiding clinical decisions when planning root coverage surgery. The aim of this study was to illustrate the differences between meta‐analyses applied to summarized and individual patient data (IPD) and to present suggestions for reducing the costs of IPD meta‐analysis.

Methods: Only clinical trials and case series that included data on the number of teeth treated, baseline recession depth (BRD) and the proportions of postoperative complete root coverage (CRC) were considered. The first group of meta‐analyses (the outcome of each procedure based on summarized data) covered 65 studies dealing with coronally advanced flap (CAF), epithelial free gingival graft (EFGG), connective tissue graft (CTG), and guided tissue regeneration (GTR) procedures. The second group of metaanalyses was done to determine the outcome of each procedure on the basis of 26 studies that reported IPD for at least baseline recession depth (BRD) and final CRC for each site. The third group of meta‐analysis compared the outcomes of CTG and GTR in 5 randomized studies, 4 of which reported only summarized data.

Results: The first analysis showed that CRC was achieved more often in non‐randomized than in randomized studies. The heterogeneity tests revealed great variability of results in both the randomized and non‐randomized studies, which makes it difficult to draw any definite conclusions. In the second analysis all the tested techniques revealed similar trends: greater baseline recession depths were always associated with a decreased CRC. The third analysis showed that CRC was achieved more frequently in the sites treated with CTG as opposed to GTR. The small sample size and the lack of IPD rendered the analyses inconclusive despite the randomized design.

Conclusions: Few studies reported individual patient data; they are a valuable contribution to clinical decision making, but IPD published in the literature are still insufficient to provide a reliable guide for clinical decision making. Therefore, decisive steps should be taken to facilitate the publication of IPD, in electronic format, whenever a clinical study is published in a leading journal. J Periodontol 2003;74:741‐756.