bluuebunny/crossref_metadata_2025 huggingface dataset:
Interimplant Papilla Reconstruction: Assessment of Soft Tissue Changes and Results of 12 Consecutive Cases
Authors: Grossberg David E.
Published: February 2005

Background: Loss of soft tissue between adjacent implants is a frequent occurrence. Reconstruction of the papilla between adjacent implants is often necessary where there are esthetic demands. The purpose of this article is to describe a fixed and reproducible reference line which can be used to measure changes in the height of the interimplant papillae. A surgical technique carried out at the time of the abutment connection surgery is also described to show the changes that may occur over a 12‐month period. Assessment of changes in the soft tissue dimension is shown following a modified flap technique at the time of abutment connection.

Methods: With the aid of clinical photographs taken preoperatively, a reference line can be drawn between the highest point of the gingival margins on teeth distal to the intended site of soft tissue surgery. This reference line can be reproduced on clinical photographs postoperatively. Using this reference line, the changes in soft tissue height using a modified flap technique in 12 consecutive patients are presented. Assessment of the vertical height of the interimplant papillae before and after treatment is described.

Results: Four patients showed an increase in the height of the papillae when reviewed 12 months following abutment connection. One patient showed no change in the height of the papillae, and 7 patients showed a loss in papillary height. There was an average loss of 0.5 mm in height of the interimplant soft tissue.

Conclusions: Use of a fixed reference line to assess the outcome of treatment is necessary when evaluating vertical changes in soft tissue. This reference line is used to assess a soft tissue flap technique carried out at the time of implant exposure. J Periodontol 2001;72:958‐962.
Short‐Chain Carboxylic Acids Produced by Gram‐Negative Anaerobic Bacteria Can Accelerate or Delay Polymorphonuclear Leukocyte Apoptosis in Vitro
Authors: Stehle Horst W. , Leblebicioglu Binnaz , Walters John D.
Published: February 2005

Background: Short‐chain carboxylic acids (SCCA) are metabolic byproducts of anaerobic subgingival bacteria associated with human periodontal disease. We examined the effect of 4 SCCA (butyric, propionic, succinic, and lactic acids) on human polymorphonuclear leukocyte (PMN) apoptosis over the range of concentrations (1 to 30 mM) found in the diseased periodontium.

Methods: PMN suspensions were incubated at 37°C with medium alone (control) or one of the 4 SCCA at concentrations of 1, 5, or 30 mM. Aliquots were withdrawn hourly to assess apoptosis and viability by fluorescence microscopy.

Results: Relative to untreated controls, PMN incubated for at least 5 hours with 1 mM butyric or propionic acids exhibited significant delays in apoptosis (P <0.05), while those incubated with succinic or lactic acids exhibited no significant differences from controls (P >0.05). At a concentration of 5 mM, propionic, succinic, and lactic acids had little effect on apoptosis (P >0.05), but butyric acid significantly accelerated apoptotic changes (P <0.05). At 30 mM, all SCCA except lactic acid significantly accelerated apoptosis (P <0.05). Incubation with SCCA did not adversely affect cell viability (typically >98%). Lysates from PMN incubated 6 hours with 30 mM butyric or propionic acids contained significantly more caspase‐3 activity than lysates from untreated control PMN (P <0.05). Moreover, pretreatment with a specific inhibitor of caspase‐3 blocked acceleration of PMN apoptosis by butyric or propionic acids (P <0.05).

Conclusion: Low concentrations of butyric or propionic acids delay PMN apoptosis and extend their functional lifespan, while higher concentrations accelerate apoptosis through a mechanism that appears to involve caspase‐3. J Periodontol 2001;72:1059‐1063.
A Combination of a Chemically Modified Doxycycline and a Bisphosphonate Synergistically Inhibits Endotoxin‐Induced Periodontal Breakdown in Rats
Authors: Llavaneras Analeyda , Ramamurthy Nungavaram S. , Heikkilä Pia , Teronen Olli , Salo Tuula , Rifkin Barry R. , Ryan Maria E. , Golub Lorne M. , Sorsa Timo
Published: February 2005

Background: Chemically modified non‐antimicrobial tetracyclines (CMTs) have been shown to inhibit pathologically elevated collagenase (and other matrix metalloproteinase, MMP) activity and bone resorption in vivo and in vitro.

Methods: In the current study, suboptimal doses of CMT‐8 (a non‐antimicrobial chemically modified doxycycline) and a bisphosphonate (clodronate, an anti‐bone resorption compound) were administered daily, either as a single agent or as a combination therapy, to rats with experimental periodontitis induced by repeated injection of bacterial endotoxin (LPS) into the gingiva. At the end of the l‐week protocol, the gingival tissues were dissected, extracted, and the extracts analyzed for MMPs (collagenases and gelatinases) and for elastase, and the defleshed jaws were morphometrically analyzed for alveolar bone loss.

Results: LPS injection significantly (P <0.00l) increased alveolar bone loss and increased collagenase (MMP‐8), gelatinase (MMP‐9), and elastase activities. Treatment of the LPS‐injected rats with suboptimal CMT‐8 alone or suboptimal clodronate alone produced slight reductions in the tissue‐destructive proteinases and no significant reductions in alveolar bone loss. However, a combination of suboptimal CMT‐8 and clodronate “normalized” the pathologically elevated levels of MMPs, elastase, and alveolar bone loss, indicating synergistic inhibition of tissue breakdown in this animal model of periodontitis.

Conclusions: Combination of a CMT and a bisphosphonate may be a useful treatment to optimally suppress periodontal destruction and tooth loss and in other tissue‐destructive inflammatory diseases such as arthritis. J Periodontol 2001;72:1069‐1077.
Subperiosteal Connective Tissue Grafts for Pocket Reduction and Preservation of Gingival Esthetics: A Case Report
Authors: Nelson Stephen W.
Published: February 2005

Background: Clinical studies and recent histological evidence following mucogingival surgery for the treatment of gingival recession have documented that when closely adapted to a previously exposed root surface, connective tissue is capable of forming a new attachment. Despite these findings, no clinical tests have been conducted to examine the ability of connective tissue to reduce probing depth (PD) and increase clinical attachment levels (CAL) when it is implanted into periodontal osseous defects. The purpose of this paper is to report the clinical results on a patient following 2 subperiosteal connective tissue grafts.

Methods: Subperiosteal connective tissue grafts were placed in 2 sites of periodontal bone loss and deep pocketing in one patient. Following flap reflection and root preparation, a connective tissue graft 1.5 to 2.0 mm in thickness was draped and sutured over each osseous defect and then completely covered by the external flap.

Results: Ten months following subperiosteal connective tissue grafting, tooth #7 had 4 mm of CAL gain. Tooth #10 had 3 mm of CAL gain 8 months postoperatively. Both teeth had 1 mm gain in gingival recession. Both teeth probed 3 mm postoperatively.

Conclusions: When connective tissue was grafted into 2 periodontal osseous defects, there were significant reductions in probing depth and gains in CAL. There was minimal postoperative gingival recession. The new clinical attachment gain remained stable for 8 to 10 months following subperiosteal connective tissue grafting. J Periodontol 2001;72:1092‐1099.
Root Coverage of a Palatal Recession Defect: A Case Report
Authors: Harris Randall J.
Published: February 2005

Background: Obtaining predictable root coverage has become an important part of periodontal therapy. However, little has been reported concerning the treatment of palatal recession defects. This is a case report which demonstrates a technique to obtain root coverage of a palatal recession defect.

Methods: The technique involved elevating a partial‐thickness palatal flap and placing a connective tissue graft beneath the flap and over the recession defect (subepithelial graft). The portion of the connective tissue graft placed over the recession defect was not covered by the flap.

Results: Clinically significant amounts of root coverage were obtained (84.6%), although the connective tissue graft was not covered by the flap.

Conclusion: Root coverage of a palatal recession defect can be obtained with a subepithelial graft. J Periodontol 2001;72:1103‐1107.
The Putative Collagen Binding Peptide Hastens Periodontal Ligament Cell Attachment to Bone Replacement Graft Materials
Authors: Lallier Thomas E. , Yukna Raymond , Marie Stacy St. , Moses Randy
Published: February 2005

Background: Bone replacement graft (BRG) materials are often used to treat periodontal defects, to promote cellular invasion, and to encourage bone regrowth. Periodontal ligament fibroblasts (PDLF) incorporate these materials and form the basis of the renewed connection between the existing and newly formed alveolar bone and the tooth surface. A peptide (P‐15) that mimics the putative cell‐binding domain of collagen has been reported to promote dermal fibroblast attachment and proliferation.

Methods: PDLF were quantitatively examined for their ability to adhere to a variety of BRG materials fluorometrically. In addition, scanning electron microscopy was used to examine the changes in morphology exhibited by these cells as they attached and spread on several BRG materials. Finally, BRG materials containing the P‐15 peptide were quantitatively examined for their ability to promote PDLF attachment and proliferation.

Results: Freeze‐dried allograft bone supports greater PDLF attachment than does several xenograft and alloplastic anorganic bone replacement materials. An anorganic BRG material containing the P‐15 peptide promoted more rapid cell attachment and spreading than a similar anorganic BRG material lacking this peptide. Finally, none of the BRG materials examined promoted PDLF proliferation.

Conclusions: Our data indicate that the addition of the P‐15 peptide increases the rapidity of PDLF attachment to xenogeneic bone replacement materials. This increase in the rate of attachment may have clinical significance in the context of the dynamic regulation of cell attachment during periodontal regeneration. However, this peptide does not promote an increase in stable cell attachment or proliferation in vitro. J Periodontol 2001;72:990‐997.
Sinus Floor Augmentation on at the Time of Maxillary Molar Extraction: Success and Failure Rates of 137 Implants in Function for Up to 3 Years
Authors: Fugazzotto Paul A. , De Paoli Sergio
Published: February 2005

Background: Implant restoration of the posterior maxilla poses significant challenges to the clinician. In an effort to increase the apical occlusal dimension of available bone for implant placement, a number of sinus augmentation approaches have been suggested. This paper describes a simplified technique for predictable sinus augmentation at the time of maxillary molar extraction.

Methods: A modified trephine and osteotome technique was utilized to implode the interradicular bone following maxillary molar extraction. Particulate material and a membrane were then placed to maximize regeneration of alveolar bone.

Results: One hundred sixty‐seven (1 67) implants were subsequently placed in regenerated bone following the above technique. One hundred thirty‐seven (137) of these implants were restored and in function for up to 3 years at the time of statistical compilation, and 136 of the 137 implants were functioning successfully by the Albrekteson criteria for a cumulative success rate of 97.8%.

Conclusions: The technique presented for simultaneous sinus augmentation at the. time of molar extraction, followed by subsequent implant placement after maturation of regenerating tissues, demonstrates a high success rate for up to 3 years in function. Long‐term studies may be useful in evaluating the continual efficacy of such an approach. J Periodontol 2002; 73:3944.
Evaluation of Matrix Metalloproteinase‐1 and Tissue Inhibitor of Metalloproteinase‐1 Levels in Gingival Fibroblasts of Cyclosporin A‐Treated Patients
Authors: Tüter Gülay , Serdar Muhittin A. , Yalim Mehmet , Gürhan Ismet S. , Baloş Köksal
Published: February 2005

Background: Cyclosporin A (CsA) is a potent immunosuppressant used to prevent organ transplant rejection and to treat various autoimmune diseases. CsA‐induced gingival overgrowth (CsA GO) is the most widely seen side effect of this drug; its pathogenesis is not completely understood. The aim of this study was to identify and compare matrix metalloproteinase‐1 (MMP‐1) and tissue inhibitor of metalloproteinase‐1 (TIMP‐1) levels in gingival fibroblast cultures of tissues derived from renal transplant patients receiving CsA and exhibiting gingival overgrowth and from periodontally healthy control subjects.

Methods: Gingival overgrowth samples were obtained from patients undergoing therapy with CsA, and control tissues were obtained from systemically healthy donors. Gingival fibroblasts were grown using explant cultures. Three different study groups were identified: 1) CsA GO fibroblast culture; 2) CsA‐treated healthy gingival fibroblast culture (H+CsA); and 3) healthy gingival fibroblast culture (H). The levels of MMP‐1 and TIMP‐1 in these groups of gingival fibroblasts were analyzed by enzymelinked immunoabsorbent assay (ELISA).

Results: The levels of TIMP‐1 were significantly lower in CsA GO than H (P <0.05). There was no statistically significant difference in the levels of MMP‐1 between H and CsA GO (P ‐0.505). The ratio of MMP‐1 to TIMP‐1 was significantly higher in CsA GO than H (P <0.05).

Conclusions: The results of this study indicate that CsA therapy does not have a significant effect on MMP‐1 levels. However, low TIMP‐1 levels can be an important factor in the pathogenesis of CsA GO, since the balance between MMP‐1 and TIMP‐1 levels was changed by CsA. J Periodontol 2002;73:1273‐1278.
Root Coverage of Advanced Gingival Recession: A Comparative Study Between Acellular Dermal Matrix Allograft and Subepithelial Connective Tissue Grafts
Authors: Tal Haim , Moses Ofer , Zohar Ron , Meir Haya , Nemcovsky Carlos
Published: February 2005

Background: Acellular dermal matrix allograft (ADMA) has successfully been applied as a substitute for free connective tissue grafts (CTG) in various periodontal procedures, including root coverage. The purpose of this study was to clinically compare the efficiency of ADMA and CTG in the treatment of gingival recessions ≥4 mm.

Methods: Seven patients with bilateral recession lesions participated. Fourteen teeth presenting gingival recessions ≥4 mm were randomly treated with ADMA or CTG covered by coronally advanced flaps. Recession, probing depth, and width of keratinized tissue were measured preoperatively and 12 months postoperatively. Changes in these clinical parameters were calculated within and compared between groups and analyzed statistically.

Results: Baseline recession, probing depth, and keratinized tissue width were similar for both groups. At 12 months, root coverage gain was 4.57 mm (89.1%) versus 4.29 mm (88.7%) (P = NS), and keratinized tissue gain was 0.86 mm (36%) versus 2.14 mm (107%) (P <0.05) for ADMA and CTG, respectively. Probing depth remained unchanged (0.22 mm/0 mm), with no difference between the groups.

Conclusions: Recession defects may be covered using ADMA or CTG, with no practical difference. However, CTG results in significantly greater gain of keratinized gingiva. J Periodontol 2002;73:1405‐1411.
Coverage of Previously Carious Roots Is as Predictable a Procedure as Coverage of Intact Roots
Authors: Goldstein M. , Nasatzky E. , Goultschin J. , Boyan B.D. , Schwartz Z.
Published: February 2005

Background: Coverage of roots exposed by gingival recession is one of the main objectives of periodontal reconstructive surgery. A variety of highly predictable and esthetically acceptable mucogingival grafting procedures are available for treating intact root surfaces. One of the indications for root coverage procedures is prevention of root caries. However, little is known about the ability to treat previously carious roots by mucogingival grafting, and even less is known about the outcome of such treatment.

Methods: Sixty patients with gingival recession were treated with subepithelial connective tissue grafts. During initial examination, 33 intact teeth with longstanding gingival recessions of 4.09 ± 0.16 mm (mean ± SEM) and 27 teeth with carious roots restored and unrestored) and longstanding gingival recessions 3.44 ± 0.22 mm (mean ± SEM) were found. Prior to grafting, any carious dentin and plastic restorations were removed. The exposed roots were thoroughly planed and covered by a subepithelial connective tissue graft without any further root treatment or conditioning. Patients were evaluated periodically between 1 and 6 years. Residual recession, defect coverage, and caries incidence were assessed.

Results: Recession was reduced to a similar extent on all teeth whether root caries was present (0.31 ± 0.11 mm) or not (0.15 ± 0.04 mm). This resulted in comparable defect coverages of 92.41 ± 2.38% for previously carious roots and 97.46 ± 0.79% for intact roots. In 44 cases, complete coverage of the recession was achieved. The results were stable, and no further recessions or recurrent caries were found during the periodic evaluations.

Conclusions: These results indicate that coverage of previously carious roots with subepithelial connective tissue grafts is a very predictable procedure with results similar to those found on intact roots. This procedure may provide a definitive biological alternative for conventional restorative treatment modalities for root caries. Moreover, the results are more esthetic, biologically acceptable, and maintainable. J Periodontol 2002;73: 1419‐1426.
Effects of Basic Fibroblast Growth Factor on Human Gingival Epithelial Cells
Authors: Takayama Shin‐ichi , Yoshida Joji , Hirano Hiroyuki , Okada Hiroshi , Murakami Shinya
Published: February 2005

Background: Our previous reports found that basic fibroblast growth factor (FGF‐2; bFGF) influences the proliferation and extracellular matrix production of periodontal ligament (PDL) cells. In this study, we examined FGF‐2 expression in gingival epithelium and the effect of FGF‐2 on proliferative responses by gingival epithelial (GE) cells.

Methods: Human GE cells were isolated from healthy gingival epithelium, and the mRNA expression of FGF‐2 and FGF receptors (FGFRs) was examined by reverse transcription‐polymerase chain reaction (RT‐PCR). The distribution of FGF‐2 in gingival tissues was detected by immunohistological analysis using the monoclonal antibody for human recombinant FGF‐2, which was newly established and designated as BF‐2. Further, the proliferative responses of GE cells to FGF‐2 were investigated by measuring [3H]‐thymidine uptake.

Results: RT‐PCR revealed that GE cells express FGFR‐1, FGFR‐2, FGFR‐3, and FGFR‐4 mRNA; however, not that of FGF‐2. Employing immunohistochemical staining with BF‐2, FGF‐2 was observed localized in the intercellular spaces of gingival epithelium, though not in the cytoplasm of epithelial cells. Interestingly, staining by BF‐2 in the intercellular spaces was diminished after treatment of the tissue sections with heparitinase. Further, an in vitro analysis revealed that FGF‐2 enhanced the proliferative responses of human GE cells. However, costimulation with fetal calf serum inhibited the FGF‐2‐induced proliferation of GE cells, whereas the same costimulation synergistically enhanced FGF‐2‐induced PDL cell proliferation.

Conclusions: FGF‐2 is anchored in the intercellular spaces of gingival epithelium via heparansulfate and may regulate the growth and cytodifferentiation of GE cells via cell‐type specific receptors. J Periodontol 2002;73:1467‐1473.
Effect of Surgical Implantation of Recombinant Human Bone Morphogenetic Protein‐2 in a Bioabsorbable Collagen Sponge or Calcium Phosphate Putty Carrier in Intrabony Periodontal Defects in the Baboon
Authors: Blumenthal Neil M. , Koh‐Kunst Grace , Alves Mario E.A.F. , Miranda Dario , Sorensen Rachel G. , Wozney John M. , Wikesjö Ulf M.E.
Published: February 2005

Background: Recombinant human bone morphogenetic protein‐2 (rhBMP‐2) in a proper carrier has been shown to induce clinically relevant bone formation for several oral/maxillofacial and periodontal indications and to stimulate regeneration of the periodontal attachment. The objective of this study is to evaluate regeneration of alveolar bone, cementum, periodontal ligament, and associated root resorption and ankylosis following surgical implantation of rhBMP‐2 in an absorbable collagen sponge (ACS) or a calcium phosphate putty (αBSM) carrier in 3‐wall intrabony periodontal defects in the baboon.

Methods: rhBMP‐2/ACS and rhBMP‐2/αBSM were implanted in surgically produced, maxillary and mandibular, large size, 3‐wall intrabony defects in 4 baboons. Contralateral jaw quadrants were implanted with buffer/ACS, buffer/ αBSM, or served as sham‐operated surgical controls. Treatments were allocated to left and right, maxillary and mandibular, jaw quadrants following a randomization schedule. Four months following implantation, block biopsies of defect sites were obtained, processed, and subjected to histologic and histometric analysis.

Results: Defect sites receiving rhBMP‐2/ACS and rhBMP‐2/αBSM demonstrated significantly greater regeneration than controls. No significant differences were observed between defect sites receiving rhBMP‐2/ACS or rhBMP‐2/αBSM regarding epithelial migration and connective tissue attachment and new bone formation. However, rhBMP‐2/ACS supported signifi‐cantly greater new cementum formation. Ankylosis or root resorption were not observed.

Conclusions: The results of this study support the use of rhBMP‐2 to enhance periodontal regeneration of intrabony periodontal defects. While this novel technology holds promise, refinement in carrier systems may provide the key to enhancement of the regenerative potential. J Periodontol 2002;73:1494‐1506.
The Effect of Sociocultural Status on Periodontal Conditions in Pregnancy
Authors: Yalcin Funda , Eskinazi Esti , Soydinc Mahtaban , Basegmez Cansu , Issever Halim , Isik Gulden , Berber Lacin , Has Recep , Sabuncu Hilmi , Onan Utku
Published: February 2005

Background: The effects of sociocultural status on periodontal conditions in pregnant women have been reported by a number of researchers and there have been speculations about the effects of hormonal changes, patients' systemic health, and socio‐cultural characteristics on periodontal health during pregnancy.

Methods: This study evaluates the periodontal condition of 61 pregnant women at their first, second, and third trimesters, and the relation between the demographic (age, professional level, education) and clinical variables (previous periodontal care, frequency of tooth brushing). The clinical indices, including plaque index, gingival index, and probing depth measurements were repeated at the first, second, and third trimesters. The statistical tests used were stepwise analysis and paired sample test.

Results: The results of the study showed that the plaque index, gingival index, and probing depth scores increased gradually in the first, second, and third trimesters, although oral hygiene instructions were given to the entire study population. The level of statistical significance was established at P <0.05. When the clinical parameters and demographic variables were compared, only educational level and periodontal care seemed to be statistically significant (P <0.05).

Conclusions: Our clinical index scores were related to the educational level of the study population. When the educational level of the study group decreased, the plaque, gingival index, and probing depth scores contrarily increased. Also non‐attendance for previous periodontal care increased the scores of plaque index and probing depth. In view of the results of our study, it might be suggested that simple preventive oral hygiene programs may help maintain healthy gingiva during pregnancy. J Periodontol 2002;73:178‐182.
Comparison of Platelet‐Rich Plasma, Bovine Porous Bone Mineral, and Guided Tissue Regeneration Versus Platelet‐Rich Plasma and Bovine Porous Bone Mineral in the Treatment of Intrabony Defects: A Reentry Study
Authors: Lekovic Vojislav , Camargo Paulo M. , Weinlaender Michael , Vasilic Nikola , Kenney E. Barrie
Published: February 2005

Background: A combination of platelet‐rich plasma (PRP), bovine porous bone mineral (BPBM), and guided tissue regeneration (GTR) has been shown to be effective in promoting reduction in probing depth, gain in clinical attachment, and defect fill in intrabony periodontal lesions. The individual role played by PRP, BPBM, and GTR in this combined therapy is unclear and needs to be elucidated. The purpose of this study was to compare the clinical effectiveness of 2 regenerative techniques for intrabony defects in humans: a combination of PRP/BPBM/GTR versus a combination of PRP/BPBM.

Methods: Twenty‐one patients participated in the study. Using a split‐mouth design, interproximal bony defects were surgically treated with either a combination of PRP/BPBM/GTR or PRP/BPBM. The primary outcomes of the study included changes in probing depth, attachment level, and defect fill as revealed by reentry surgeries at 6 months post‐treatment.

Results: At 6 months postoperatively, clinical examination of the treated defects revealed that both treatment modalities resulted in significant probing depth reduction and clinical attachment gain compared to baseline values. Probing depth improvement was 3.98 ± 1.02 mm on buccal and 3.94 ± 0.94 mm on lingual sites for the PRP/BPBM group and 4.19 ± 0.88 mm on buccal and 4.21 ± 0.92 mm on lingual sites for the PRP/BPBM/GTR group. Gain in clinical attachment was 3.78 ± 0.72 mm on buccal and 3.84 ± 0.76 mm on lingual sites for the PRP/BPBM group and 4.12 ± 0.78 mm on buccal and 4.16 ± 0.83 mm on lingual sites for the PRP/BPBM/GTR group. Reentry surgeries revealed similar defect fill for both treatment groups (PRP/BPBM group: 4.82 ± 1.34 mm on buccal and 4.74 ± 1.30 mm on lingual sites; PRP/BPBM/GTR group: 4.96 ± 1.28 mm on buccal and 4.78 ± 1.32 mm on lingual sites). None of the differences between the 2 treatment groups was statistically significant.

Conclusions: The results of this study show that both combinations of PRP/BPBM/GTR and PRP/BPBM are effective in the treatment of intrabony defects present in patients with advanced chronic periodontitis. The results also suggest that GTR adds no clinical benefit to PRP/BPBM. Further studies are necessary to assess the individual role played by PRP and BPBM in the clinical outcome achieved with their combination. J Periodontol 2002;73:198‐205.
A Method to Assess the Clinical Outcome of Ridge Augmentation Procedures
Authors: Proussaefs Periklis T. , Valencia Gloria , Lozada Jaime , Tatakis Dimitris N.
Published: February 2005

Background: Alveolar ridge augmentation procedures are often needed prior to implant placement or prosthetic rehabilitation. The purpose of this study was to develop a quantitative method to assess the clinical outcome of such procedures.

Methods: Two volumetric methods, based on the volume difference between the pre‐ and postoperative ridge, were developed. Either a transparent vacuum stent material (method A) or a silicone impression material in a custom acrylic tray (method B) was used to make an impression of the postoperative stone cast. This impression was then filled with polyvinylsiloxane bite registration material (PBRM) and placed on the preoperative cast. The volume of PBRM at the site of the augmented ridge (corresponding to the achieved ridge volume increase, in ml) was measured gravimetrically. Two independent examiners used both methods, in random order, to assess the outcome of 6 diverse clinical cases. Triplicate measurements were made (method precision). Method accuracy was assessed by fabrication of metal castings (known volumes) applied on a preoperative cast to simulate an augmentation procedure.

Results: Intra‐ and inter‐examiner reproducibility was high (intraclass correlation coefficients ≥0.84) for both methods. The volumetric measurements obtained by method B showed excellent correlation with the predetermined augmentation volumes (r2 = 0.99; y = 0.94x + 0.12), in contrast to the measurements obtained by method A (r2 = 0.46; y = 0.43x + 1.37).

Conclusions: The developed volumetric method (method B) is both precise and accurate in assessing the outcome of ridge augmentation. This simple, cost‐effective, and easy to implement method should be helpful in clinical studies of ridge augmentation procedures. J Periodontol 2002;73:302‐306.
Periodontal Changes in Liver Cirrhosis and Post‐Transplantation Patients. II: Radiographic Findings:
Authors: Oettinger‐Barak Orit , Machtei Eli E. , Barak Shlomi , Baruch Yaacov , Ardekian Leon , Peled Micha
Published: February 2005

Background: Liver disease and transplantation affect bone turnover. The role of cylosporin A (CsA) in aggravating bone loss is controversial. The aim of the present study was to examine the effect of liver cirrhosis, transplantation, and immunosuppressive therapy with either CsA or tacrolimus on alveolar bone height.

Methods: The experimental group consisted of 13 liver cirrhosis (LC) patients. A second experimental group included 24 post‐liver transplantation patients (PT) receiving CsA or tacrolimus. Seventeen healthy subjects formed a control group. Panoramic x‐rays were taken and digitized using a computerbased measurement software to assess alveolar bone height of all available teeth.

Results: Bone loss in the PT group (4.57 ± 0.56 mm) was significantly higher than the control (C) (2.73 ± 0.38 mm); however, it was significantly lower (P = 0.0005) than the LC (6.47 ± 0.75 mm). Likewise, alveolar bone loss showed a trend for negative correlation (R = 0.404, P = 0.06) with the duration of immunosuppressive therapy post‐liver transplantation.

Conclusions: Liver cirrhosis patients demonstrated greater bone loss compared to healthy controls. Restoration of liver functions following transplantation seems to have the potential to reverse some of these radiographic changes. Further longitudinal studies will be necessary to substantiate these findings. J Periodontol 2002;73:313‐316.
Formation of a Cyst‐Like Area After a Connective Tissue Graft for Root Coverage
Authors: Harris Randall J.
Published: February 2005

Background: Many techniques have been developed to obtain root coverage. There have been few complications reported with these techniques. This case report chronicles the development of a cyst‐like area after a connective tissue partial‐thickness double pedicle graft was used to obtain root coverage.

Methods: The root coverage procedure was performed as previously reported. Postoperatively, in the surgical area, the patient developed occasional swelling. It was possible to express a white material from the area. A biopsy was taken to determine the cause of the clinical findings.

Results: Histological evaluation revealed the development of a cyst‐like area.

Conclusion: The development of cysts does not seem to be a common event. However, this case report demonstrates that they are a possible complication of root coverage procedures. J Periodontol 2002;73: 340‐345.
Clinical and Radiographic Evaluation Periodontal Intrabony Defects Treated With Guided Tissue Regeneration. A Pilot Study
Authors: Joly Julio Cesar , Palioto Daniela Bazan , de Lima Antonio Fernando Martorelli , Mota Luis Fernando , Caffesse Raul
Published: February 2005

Background: The aim of this clinical and radiographic study was to evaluate the effect of guided tissue regeneration using a bioabsorbable barrier in the treatment of intrabony defects in humans.

Methods: Intrabony osseous defects (2 or 3 walls) around mandibular canines and premolars were treated in 10 systemically healthy patients with ages ranging from 35 to 56 years. Prior to the surgical phase, patients were enrolled in a strict maintenance program including oral hygiene instructions and scaling and root planing (presurgical PI and GI <10%). Patients were seen for professional prophylaxis during the duration of the study. Clinical measurements were performed with an electronic probe at baseline and at reentry 8 months following surgical therapy. Measurements included clinical attachment levels (CAL), gingival margin levels (GML), probing depths (PD), bone defect levels (BDL), and alveolar crest level (ACL). A split mouth design was used. Quadrants were randomly assigned for treatment by GTR (experimental) or open flap debridement alone control). Standardized radiographs were taken at baseline and at reentry. Digital images were analyzed by subtraction to assess changes in area (A) and optical density (OD). Data were evaluated using paired t test.

Results: Statistically significant differences were found in both groups when comparing baseline and post‐treatment values for CAL, GML, PD, and BDL (P <0.01). Greater reductions in BDL and gain in A and OD were observed in the GTR group when compared to control (P <0.01). Both therapies were effective in improving the clinical parameters assessed.

Conclusion: Clinical and radiographic findings from this study demonstrated more bone fill in sites treated with GTR. J Periodontol 2002;73:353‐359.
A Clinical Comparison of a Bovine‐Derived Xenograft Used Alone and in Combination With Enamel Matrix Derivative for the Treatment of Periodontal Osseous Defects in Humans
Authors: Scheyer E. Todd , Velasquez‐Plata Diega , Brunsvold Michael A. , Lasho David J. , Mellonig James T.
Published: February 2005

Background: Enamel matrix protein derivative (EMD) and particulate anorganic cancellous bovinederived bone xenograft (BDX) have both shown favorable clinical results in reducing intrabony periodontal defects as compared to open flap debridement alone. These materials have shown results comparable to those obtained with guided tissue regeneration. The primary aim of the present study was to evaluate the effectiveness of EMD combined with BDX as compared to BDX alone, with a secondary aim to compare the treatment outcomes of the 2 modalities.

Methods: Seventeen patients with paired intrabony defects and probing depths measuring ≥5 mm who were being treated for chronic periodontitis were selected for this controlled, blinded, split‐mouth study. Following non‐surgical periodontal therapy, sites were randomly selected to receive either a combination of EMD and BDX (test group) or BDX alone (positive control group). Baseline and 6‐month surgical reentry measurements were taken by a calibrated examiner blinded to the treatment. A paired Student t test was utilized to evaluate differences between baseline and post‐treatment and between the treatment groups.

Results: Favorable clinical outcomes for both hard and soft tissue measurements were achieved for both treatment groups when compared to baseline (P <0.001). There was no statistically significant difference for any of the measured clinical parameters. Probing depth reduction for the test group and control group was 4.2 ± 1.1 mm and 3.9 ± 1.3 mm, respectively (P >0.8). Mean gain in clinical attachment levels for the test and control groups was 3.8 ± 0.9 mm and 3.7 ± 1.5 mm, respectively (P >0.6). Hard tissue measurements obtained at surgical reentry were used to calculate the bone fill (BF) and percent bone fill (%BF). The BF was 3.2 ± 1.4 mm and 3.0 ± 1.2 mm (P >0.6), and the %BF was 63.3 ± 16.3% and 67.0 ± 19.0% (P >0.4) for the EMD + BDX and BDX groups, respectively.

Conclusions: In summary, both the particulate anorganic cancellous bovine‐derived bone xenograft used alone and in combination with enamel matrix derivative are effective for the treatment of human intrabony periodontal lesions. J Periodontol 2002;73:423‐432.
Subgingival Calculus Detection With Fluorescence Induced by 655 nm InGaAsP Diode Laser Radiation
Authors: Folwaczny Matthias , Heym Richard , Mehl Albert , Hickel Reinhard
Published: February 2005

Background: It has been suggested that the 655 nm InGaAsP diode laser radiation can induce considerably higher amounts of fluorescence in subgingival calculus than in cementum. This in vitro study evaluated the use of fluorescence induced by the diode laser radiation for the detection of subgingival calculus.

Methods: The study sample consisted of 30 extracted molars, premolars, canines, and incisors. The root surface of each sample was partially covered with subgingival calculus. The source of laser radiation was an InGaAsP diode laser emitting visible radiation at a wavelength of 655 nm. The fluorescent radiation reflected from the cementum and calculus was detected by a photoelectric cell integrated within the diagnostic system. The samples were randomly assigned to 3 experimental groups of 10 teeth each for detection of calculus in various media. Specifically, the fluorescence was determined in air (group A), in electrolytic salt solution (group B), and in blood (group C). For each sample, the intensity of the fluorescent light was evaluated separately for cementum and calculus in triplicate measurements. The statistical analysis was performed using a t test at a level of significance of 5% (P <0.05).

Results: The intensities of fluorescence radiation emitted by cementum were 0.4 (±0.51) in air, 0.4 (±0.51) in electrolytic solution, and 2.13 (±0.59) in blood. For calculus, the relative intensities of fluorescence radiation were 54.1 (±29.09) in air, 60.77 (±28.35) in electrolytic salt solution, and 39.63 (±29.79) in blood. The differences in fluorescence between cementum and calculus within each experimental unit were significant (group A: P = 0.0002, group B: P = 0.0001, group C: P = 0.031). The intensity of fluorescence in calculus was also significantly different between the 3 experimental groups.

Conclusion: The present study indicates that subgingival calculus can be reliably detected on extracted teeth using laser fluorescence induced by the 655 nm diode‐laser radiation. In vivo studies are necessary to evaluate the clinical utility of this procedure. J Periodontol 2002;73:597‐601.
Lactoferrin Iron Levels Are Reduced in Saliva of Patients With Localized Aggressive Periodontitis
Authors: Fine D.H. , Furgang D. , Beydouin F.
Published: February 2005

Background: Actinobacillus actinomycetemcomitans (Aa) is associated with localized aggressive periodontal disease in juveniles (LAgP). Lactoferrin (LF) is an iron‐binding salivary protein that has been shown to kill Aa in its iron‐free form (apo) and reduce binding to host cells in its iron‐saturated form (halo). However, recent in vitro studies show that LF does not kill clinical isolates of Aa, and LF with reduced levels of bound iron does not interfere with its attachment. These findings suggest that colonization of Aa may occur more readily in an environment containing LF with low iron levels. The purpose of this study was to examine the relationship of LF iron levels in saliva of LAgP patients as compared to their age‐, gender‐, and racematched controls.

Methods: Whole and parotid saliva was collected from LAgP patients and matched controls. Micrograms of LF/mg of protein as well as nanograms of iron/μg of LF were determined. Iron binding was determined in parotid saliva by addition of nonlabeled and 59Fe labeled iron.

Results: LAgP patients' whole saliva had higher LF levels than controls, but their LF contained less iron (P ≤0.005). No iron was found in LF from parotid saliva in either group. When iron was added to parotid saliva, the LAgP saliva bound 20 to 30 times less iron than controls (P ≤0.001). Finally, LF was identified as the major iron‐binding protein in parotid saliva by 59Fe autoradiography and Western blotting.

Conclusions: This study shows that the level of bound iron in LF is significantly reduced in LAgP patients compared to controls. These data suggest that LF from LAgP patients has a reduced capacity to bind iron and that LF iron levels may play an important role in Aa‐induced LAgP. J Periodontol 2002;73:624‐630.
Probing Bone Level Measurements for Determination of the Depths of Class II Furcation Defects
Authors: Suh Young‐Il , Lundgren Tord , Sigurdsson Thorarinn , Riggs Matt , Crigger Max
Published: February 2005

Background: Probing bone measurements as an alternative to open bone measurements to evaluate regenerative procedures in furcation defects do not seem to be used as yet. The purpose of the present study was to investigate the reliability of probing bone measurements in such defects.

Methods: Fifteen patients scheduled for surgical treatment of a total of 30 mandibular molars with buccal or lingual Class II furcation defects were studied. During treatment, duplicate vertical and horizontal recordings of probing attachment levels, probing bone levels, and open bone levels were taken by independent examiners.

Results: Deviations of both vertical and horizontal recordings between the first and second examiners were within ±1 mm in 90% to 100% of examined sites for all 3 measurements. Standard deviations of differences between pairs of duplicate recordings were also similar for the 3 measurements both for vertical and horizontal defect dimensions and amounted to 0.7 to 0.9 mm. On average, vertical and horizontal open bone levels were 0.9 to 1.1 mm deeper than probing bone levels. Probing bone levels, in turn, were 1.1 to 1.5 mm deeper than probing attachment levels.

Conclusions: In view of the consistency demonstrated between probing bone level and open bone level measurements in mandibular Class II defects, coupled with the additional discomfort for the patient of a reentry surgery and a possible reentry traumatic effect, open bone level measurements do not seem necessary or even justified to evaluate effects of periodontal therapy in these defects, and can be substituted by probing bone measurements. J Periodontol 2002;73:637‐642.
Implant Placement in Maxillary First Premolar Fresh Extraction Sockets: Description of Technique and Report of Preliminary Results
Authors: Fugazzotto Paul A.
Published: February 2005

Background: The postextraction morphology of the maxillary first premolar extraction socket presents a number of challenges to clinicians seeking ideal implant position, including the morphology of the lateral walls of the extraction socket and the presence of the interradicular septum. A technique for simpli‐fication of implant placement at the time of maxillary first premolar extraction is described.

Methods: Sixty‐three implants were placed in maxillary first premolar immediate extraction sockets in 57 patients (36 females and 21 males), utilizing a technique which includes removal of residual interradicular bone prior to preparing the osteotomy, use of the removed interradicular bone in the extraction socket defect surrounding the implant, and swaging of the buccal and palatal osseous plates against the implant.

Results: All implants demonstrated clinical stability upon uncovering. Forty‐one of the implants placed have been restored and in function for a period of up to 2 years.

Conclusions: The technique described affords a simplified and predictable manner for placement of implants into immediate maxillary first premolar extraction sockets. Further studies should be carried out to document long‐term success and failure rates of implants placed utilizing this technique, and subsequently restored. J Periodontol 2002;73:669‐674.
Gingival Cysts in the Adult
Authors: Giunta John L.
Published: February 2005

Background: Gingival cysts in the adult are unusual cysts of odontogenic origin with less than 100 reported, including this series. Even rarer are cases of multiple gingival cysts. This paper reports the second largest retrospective study of biopsy cases of adult gingival cysts with a spectrum of their features and another case of multiple gingival cysts.

Methods: The files of a biopsy service were reviewed for the most recent 10‐year period. Data collected included location, age, gender, clinical features, clinical diagnosis, and histologic features. These were compared to previous reports. There was also a case report of multiple cysts.

Results: Twenty‐two adult gingival cysts were retrieved, 2 of which were multiple. They are uncommon cysts of odontogenic origin, noted primarily the fifth and sixth decades with only a slight predilection for females. They occur more in the mandible the labial attached gingiva of the anterior teeth. Histology shows a very thin, uninflamed wail lined a very thin squamoid or cuboidal epithelium. Multiple cysts are very rare.

Concluslons: Gingival cysts in the adult are uncommon cysts that are diagnosed at the clinical level about 50% of the time, with others being confused with a mucocele. They may be bluish due to the fluid and may cause pressure resorption of the labial bone, yielding a radiolucency sometimes confused with a lateral periodontal cyst. Treatment consists of an excisional biopsy. J Periodontol 2002;73:827‐831.
Effect of Locally Delivered Minocycline Microspheres on Markers of Bone Resorption
Authors: Oringer R.J. , Al‐Shammari K.F. , Aldredge W.A. , Iacono V.J. , Eber R.M. , Wang H.L. , Berwald B. , Nejat R. , Giannobile W.V.
Published: February 2005

Background: Gingival crevicular fluid (GCF) biomarkers associated with bone resorption may be useful to determine periodontal disease status and response to therapy. The pyridinoline cross‐linked carboxy‐terminal telopeptide of type I collagen (ICTP), a bone‐specific degradation product, and interleukin 1‐beta (IL‐1), a potent bone‐resorptive cytokine, have both been associated with periodontal disease activity. Minocycline is a tetracycline derivative possessing antimicrobial effects on periodontal pathogens and inhibitory properties on matrix metalloproteinases (MMPs) associated with tissue destruction. The aim of this study was to evaluate the effect of periodontal treatment in the form of scaling and root planing (SRP) and locally administered minocycline microspheres on the GCF levels of ICTP and IL‐1.

Methods: Forty‐eight chronic periodontitis patients were randomly assigned to 2 groups (SRP plus subgingival application of vehicle control [SRP + V], or SRP plus subgingival application of minocycline microspheres [SRP + M]) and monitored at 8 sites per subject at baseline and 1, 3, and 6 months. Four shallow (PD ≤3 mm) and 4 deep (PD ≥5 mm) sites were evaluated for both marker levels and for probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Eight periodontally healthy control subjects with no probing depths >3 mm and no loss of attachment were also monitored at the same time intervals. GCF levels of ICTP and IL‐1 were determined using radioimmunoassay and enzyme‐linked immunosorbent assay techniques, respectively.

Results: Significant differences (P <0.001) in GCF levels of ICTP and IL‐1 were found between deep and shallow sites at all time points in both treatment groups. In addition, healthy subjects demonstrated significantly reduced levels of both markers compared to both shallow and deep sites in periodontitis patients (P <0.001). Only the SRP + M treated patients exhibited significant reductions (P <0.05) in both ICTP and IL‐1 levels 1 month after treatment. Furthermore, the SRP + M group demonstrated significantly lower IL‐1 levels (P <0.02) at 1 month compared to the SRP + V group.

Conclusions: Results of this study indicate that GCF levels of ICTP and IL‐1 correlate with clinical measures of periodontal disease and may aid in assessing disease status and response to periodontal therapy. Furthermore, local administration of minocycline microspheres led to a potent short‐term reduction in GCF IL‐1 levels. Additional studies are needed to address whether repeated administration of scaling and root planing along with minocycline microspheres will achieve long‐term reductions in GCF ICTP and IL‐1 levels. J Periodontol 2002;73:835‐842.