bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of Major Putative Periodontopathogens in Korean Advanced Adult Periodontitis Patients Using a Nucleic Acid‐Based Approach
Authors: Choi Bong‐Kyu , Park Seong‐Hee , Yoo Yun‐Jung , Choi Seong‐Ho , Chai Jung‐Kiu , Cho Kyoo‐Sung , Kim Chong‐Kwan
Published: February 2005

Background: Although extensive microbial analyses have been performed from subgingival plaque samples of periodontitis patients, systematic analysis of subgingival microbiota has not been carried out in a Korean population so far. The purpose of this study was to describe the prevalence of major putative periodontopathogens in Korean patients by culture‐independent methods.

Methods: A total of 244 subgingival plaque samples (5 sites in each participant) were taken from 29 advanced adult periodontitis (AP) patients and 20 periodontally healthy subjects. AP samples were obtained from the 4 deepest periodontal pockets (≥6 mm probing depth [PD]) and 1 healthy site (≤3 mm PD) in each patient. Polymerase chain reaction (PCR) of 16S ribosomal DNA (rDNA) of subgingival plaque bacteria was performed with eubacterial primers. Aliquots of PCR products were then applied on nylon membranes and hybridized with specific oligonucleotide probes labeled with digoxigenin.

Results: All diseased sites harbored Fusobacterium sp., while Porphyromonas gingivalis, Treponema sp.,and Bacteroides forsythus were detected in more than 96% of 116 diseased sites. Peptostreptococcus micros, Actinobacillus actinomycetemcomitans, and Prevotella intermedia were present in 82%, 74%, and 71% of diseased sites, respectively. In sites of periodontally healthy subjects, Fusobacterium sp. was present in the highest proportion (58%). Treponema sp., P. gingivalis, and B. forsythus were detected in 22%, 18%, and 18% of healthy sites, respectively. P. micros, P. intermedia, and A. actinomycetemcomitans were found in 8%, 2%, and 1% of healthy sites, respectively. The prevalence of the periodontopathogens, with the exceptions of Fusobacterium sp. and B. forsythus, was significantly higher in the healthy sites of periodontitis subjects than in the healthy sites of periodontally healthy subjects (P <0.05).

Conclusions: Using highly sensitive methods relying on 16S ribosomal RNA‐based oligonucleotide probes, we confirmed the strong association of 7 putative periodontopathogens with AP patients in a Korean population. With the exceptions of Fusobacterium sp. and B. forsythus, all the periodontopathogens were signifi‐cantly more associated with the healthy sites of periodontitis subjects than in the healthy sites of periodontally healthy subjects. J Periodontol 2000;71:1387‐1394.
Guided Bone Regeneration of Large Mandibular Defects in a Primate Model
Authors: Fritz M.E. , Jeffcoat M.K. , Reddy M. , Koth D. , Braswell L.D. , Malmquist J. , Lemons J.
Published: February 2005

Background: An earlier publication from our laboratory described the use of guided bone regeneration to fill large bone voids in the mandible created through en bloc resection in primates. The present report is an embellishment of this paper and describes bone regeneration experiments in 18 adult male Macaca mulatta monkeys to determine how long membranes must be in position to promote guided bone regeneration.

Methods: Thirty‐six lesions were created in the mandibles of 18 monkeys in a standardized mandibular defect of 8 × 19 mm. Reinforced ePTFE membranes were placed in the animals and held in place with mini screws and sutures for anywhere from 1 to 12 months. No material was added to the defect. In addition to clinical studies, digital subtraction radiology and fluorescent labeling with tetracycline and histomorphometry are described.

Results: The results indicate that no bone gain was observed in membranes exposed for 1 month or less, but bone gain (approximately well over 90% of defects) was observed at 12 months when membranes were left in situ for 2 to 12 months (P <0.0001). No significant difference in the amount of bone gained at 12 months was observed for membranes left in place for intervals ranging from 2 to 12 months. A significant correlation between the amount of bone gain observed at 3 and 12 months was observed (P <0.0001).

Conclusions: Data therefore suggest that membranes left in situ for 1 month or less result in minimal bone gain compared with membranes left in place from 2 to 12 months. In addition, labeling and stained sections clearly showed that the bone produced after 2 months of membrane placement is mature. J Periodontol 2000;71:1484‐1491.
The Relationship Between Peripheral Levels of Leukocytes and Neutrophils and Periodontal Disease Status in a Patient With Congenital Neutropenia
Authors: Goultschin J. , Attal U. , Goldstein M. , Boyan B.D. , Schwartz Z.
Published: February 2005

Background: Congenital neutropenia is characterized by an almost total absence of neutrophils and increased susceptibility to infection. Oral manifestations include ulcerations of mucous membranes, acute gingival inflammation with focal necrosis, and rapid loss of attachment. Treatment with recombinant human granulocyte colony‐stimulating factor (rhGCSF) increases neutrophil numbers and ameliorates the periodontal status.

Methods: We report the treatment of a 22‐year‐old male with congenital neutropenia (Kostman syndrome), referred to us due to periodontal disease, and the effect of treatment on peripheral neutropenia. Diagnosis of neutropenia was made at year 1; at age 15, the patient started to receive injections of rhG‐CSF, reducing the occurrence of infection and improving neutrophil count, although levels remained below normal. The patient underwent extraction of a molar at age 8; scaling, root planing, and modified Widman flaps at age 9; and oral hygiene maintenance every 2 to 3 months from age 18 to 21. At age 23, he initiated treatment at our periodontal clinic. The patient's gingiva was severely inflamed, and the dentition was covered with plaque and calculus. Attachment loss was advanced, all teeth were mobile, and bone loss was approximately 75% in most sites. Neutrophil counts were below normal, but other hematologic parameters were normal. Scaling and root planing were performed and the patient received antibiotics and chlorhexidine rinses twice each day for 2 weeks. Extracoronal splinting was performed, fluoride varnish was used to desensitize cervical areas, and tooth FDI #46 was restored. Root planing and deplaquing were repeated, and the patient received subgingival chlorhexidine irrigation 13 times over one year. Assessments were made on presentation, after the initial treatment, and at 1 and 2 years post‐treatment.

Results: Mean probing depth was reduced posttreatment with a further reduction during the maintenance period. This was correlated with an increase in attachment levels. Total white blood cells increased, due in part to an increase in neutrophils, reaching normal levels.

Conclusions: This report demonstrates for the first time that periodontal therapy, resulting in decreased bacterial load, may result in restoration of normal levels of circulating neutrophils in individuals with congenital neutropenia under treatment with rhG‐CSF. The results also suggest that periodontal pathogens may be associated with depressed neutrophil levels, even when patients receive treatment for neutropenia. J Periodontol 2000;71:1499‐1505.
A Comparative Study Utilizing Open Flap Debridement With and Without Enamel Matrix Derivative in the Treatment of Periodontal Intrabony Defects: A 12‐Month Re‐Entry Study
Authors: Froum Stuart J. , Weinberg Mea A. , Rosenberg Edwin , Tarnow Dennis
Published: February 2005

Background: Previous studies have demonstrated that enamel matrix derivative (EMD) has the ability to improve clinical parameters when used to treat intraosseous defects. The purpose of the present study was to compare at 12 months postsurgery sites treated with open flap debridement (OFD) alone to those treated with OFD and EMD.

Methods: Twenty‐three subjects with at least 2 intrabony defects were chosen. Fifty‐three defects received EMD in conjunction with OFD. Thirtyone defects in these same 23 subjects were treated with OFD alone. Stents were fabricated to serve as fixed reference points. Re‐entries were performed at least 1 year after initial surgery. Soft tissue measurements were recorded prior to initial surgery and prior to re‐entry for gingival (GI) and plaque (PI) indices, probing depth (PD), gingival margin position, and clinical attachment level (CAL). Hard tissue measurements were recorded during the initial and re‐entry surgery for level of crestal bone and depth of defect. Statistical analysis was conducted using the method of generalized estimating equations to determine changes in GI, PI, PD, CAL, fill of the osseous defect, and crestal resorption. Percent of defect fill was also calculated.

Results: In all categories, treatment with EMD (test) was superior to treatment without EMD (control). Average PI and GI were not significantly different either initially or prior to re‐entry. The average PD reduction was 2.7 mm greater with EMD than controls. The average CAL gains were 1.5 mm greater, and the average fill of osseous defect 2.4 mm greater with EMD than controls. The average percent of defect fill after adjusting for crestal bone loss was more than 3 times greater for EMD versus control‐treated sites (74% defect fill with EMD versus 23% defect fill for control sites).

Conclusions: This study indicates that treatment of periodontal intraosseous defects with EMD is clinically superior to treatment without EMD (open flap debridement) in every parameter evaluated. Re‐entry data demonstrate that percent fill of osseous defects treated with EMD compares favorably with the treatment results utilizing bone grafts or membrane barriers, according to published literature. J Periodontol 2001;72:25‐34.
Relationship Between Sulcular Sulfide Level and Oral Malodor in Subjects With Periodontal Disease
Authors: Morita Manabu , Wang Hom‐Lay
Published: February 2005

Background: The relationship between oral malodor and sulfide levels in periodontal pockets (pS) has not yet been determined. The aims of this study were: 1) to identify the correlation among oral malodor, pS levels, and the BANA (benzoyl‐DL‐arginine‐naphthylamide) test and 2) to recognize the interaction between oral malodor, demographic factors, tongue coating, and periodontal condition.

Methods: Eighty‐one peridontal patients participated in this study. A portable sulfide monitor and organoleptic method were used to evaluate oral malodor. Demographic data included age, gender, race, and smoking habits. The volume of tongue coating and periodontal condition for all teeth were assessed. The pS levels of 3 different radiographic bone loss (RBL) sites: RBL <2 mm, healthy; RBL ≥2 to <4 mm; low to moderate; RBL ≥ mm, severe, were measured using an industrial sulcular sulfidemonitoring device. Subgingival plaque samples from the above 3 sites and tongue scraping were examined by the BANA test.

Results: The volume of tongue coating (P <0.001), extent periodontal disease (P <0.05), pS levels of the sites with low moderate bone loss (P <0.05), and BANA score of tongue scrapings (P <0.05) were significantly associated with oral malodor. Stepwise multiple regression analysis examined the degree association between oral malodor and potential explanatory variables. The volume of tongue coating and percent of sites BOP (bleeding on probing) were significantly associated with oral malodor. Females and smoking habit were negatively correlated with organoleptic measurements.

Conclusions: The pS level of the representative sites with low to moderate bone loss demonstrated a modest association with oral malodor. Oral malodor in periodontal patients was primarily associated with tongue coating and gingival inflammation. J Periodontol 2001;72:79‐84.
Analysis of Single Nucleotide Polymorphisms in the 5′‐Flanking Region of Tumor Necrosis Factor‐Alpha Gene in Japanese Patients With Early‐Onset Periodontitis
Authors: Endo Motohiro , Tai Hideaki , Tabeta Koichi , Kobayashi Tetsuo , Yamazaki Kazuhisa , Yoshie Hiromasa
Published: February 2005

Background: Early‐onset periodontitis (EOP) is considered to have a genetic basis, which has not been clearly defined. The tumor necrosis factor‐alpha (TNF‐α) gene polymorphism as one of the genetic factors may influence the expression of several chronic inflammatory diseases. The aim of the present study was to evaluate whether the polymorphisms in the 5′‐flanking region of the TNF‐α gene are associated with Japanese EOP patients.

Methods: Forty‐six Japanese, generalized EOP (G‐EOP) patients and 104 Japanese healthy subjects were identified according to established clinical criteria. Twenty healthy subjects were analyzed by nucleotide sequence to screen polymorphisms of the 5′‐flanking region of the TNF‐α gene. Then, all subjects were analyzed by polymerase chain reaction and sequencespecific oligonucleotide probe (SSOP) methods.

Results: We determined 5 single nucleotide polymorphisms at positions −1031 (T/C), −863 (C/A), −857 (C/T), −308 (G/A), and −238 (G/A) in the 5′‐flanking region of the TNF‐α gene. There were no significant differences in the genotype and allele frequency when we compared G‐EOP patients to healthy subjects. Because the frequency of polymorphic alleles at positions −308 and −238 was very low in this study population, we demonstrated the existence of 4 detected haplotypes and 6 detected genotypes concerning 3 single nucleotide polymorphisms (−1031, −863, and −857). The frequency of the H1/H3 (TCC/TCT)‐detected genotype tended to decrease in G‐EOP patients compared to healthy subjects, but was not statistically significant.

Conclusion: These findings suggest there is no significant association between polymorphisms in the 5′‐flanking region of the TNF‐α gene and susceptibility to G‐EOP in Japanese patients. J Periodontol 2001;72:1554‐1559.
Epidemiology of Clinical Attachment Loss in Adolescents
Authors: López Rodrigo , Fernández Olaya , Jara Gisela , Baelum Vibeke
Published: February 2005

Background: Relatively little is known about the prevalence, severity, and determinants of clinical attachment loss among adolescents.

Methods: A multi‐stage random sampling procedure was used to obtain a sample of 9,203 high school students aged 12 to 21 years from the Province of Santiago, Chile. All but 41 students were examined for clinical attachment loss in 6 sites of first and second molars and incisors. The students were interviewed with respect to tooth brushing habits, smoking habits, dental visits, and diabetic status. Logistic regression analyses were used to assess the relative strength of the associations between age, gender, smoking, tooth brushing habits, dental attendance patterns, diabetic status, and governmental school support and the occurrence of clinical attachment loss.

Results: Overall, clinical attachment loss ≥1 mm was seen in 69.2% of the students; ≥2 mm in 16% of the students; and ≥3 mm in 4.5%. The distribution of clinical attachment loss was markedly skewed, but followed a continuum of disease severity. Logistic regression analyses showed that attachment loss was associated with higher age, female gender, infrequent tooth brushing, infrequent dental visits, and attending a high school receiving governmental support.

Conclusions: No sharp distinction exists between periodontal health and disease among Chilean adolescents. Higher age, poor oral hygiene, and a lower socioeconomic background play a role in the occurrence of clinical attachment loss. J Periodontol 2001;72:1666‐1674.
Transforming Growth Factor‐β1 Autocrine Stimulation Regulates Fibroblast Proliferation in Hereditary Gingival Fibromatosis
Authors: de Andrade C.R. , Cotrin P. , Graner E. , Almeida O.P. , Sauk J.J. , Coletta R.D.
Published: February 2005

Background: Hereditary gingival fibromatosis (HGF) is a rare oral disease characterized by a slow and progressive enlargement of both the maxilla and mandible gingiva. Increased proliferation, elevated synthesis of extracellular matrix, particularly collagen, and reduced levels of matrix metalloproteinases seem to contribute to the pathogenesis of gingival overgrowth in HGF patients. Transforming growth factor‐β1 (TGF‐β1) is an important cytokine thought to play a major role in fibrotic disorders such as HGF due to its ability to stimulate the synthesis and reduce the degradation of extracellular matrix. In HGF fibroblasts, TGF‐β1 autocrine stimulation reduces expression and production of matrix metalloproteinases. However, the role of TGF‐β1 in fibroblast growth modulation has not been established in this disease.

Methods: The aim of this study was to confirm the increased proliferation rate of HGF fibroblast cell lines and to explore a possible autocrine role of TGF‐β1 as a cell growth stimulator by blocking production of this endogenous cytokine using 2 wellestablished systems: antisense oligonucleotides and neutralizing antibodies.

Results: Four different cellular proliferation assays, bromodeoxyuridine labeling, argyrophilic nucleolar organizing region staining, proliferating cell nuclear antigen, and mitotic indexes, confirmed that fibroblasts from HGF proliferate significantly faster than those from normal gingiva. Antisense oligonucleotides reduced TGF‐β1 production as demonstrated by capture enzyme‐linked immunosorbent assay, whereas TGF‐β1 expression levels were not significantly modified. Blocking TGF‐β1 synthesis with oligonucleotides or its activity with specific antibodies resulted in a decreased magnitude of HGF fibroblast proliferation.

Conclusion: These results are consistent with the existence of an autocrine role of TGF‐β1 as a stimulator of HGF fibroblast proliferation. J Periodontol 2001;72:1726‐1733.
Papillon‐Lefèvre Syndrome: Serum Immunoglobulin G (IgG) Subclass Antibody Response to Periodontopathic Bacteria. A Case Report
Authors: Wara‐aswapati Nawarat , Lertsirivorakul Jinda , Nagasawa Toshiyuki , Kawashima Yoko , Ishikawa Isao
Published: February 2005

Background: Papillon‐Lefèvre syndrome (PLS) is a rare autosomal recessive disorder which is characterized by palmar‐plantar hyperkeratosis and rapid periodontal destruction of both primary and permanent dentitions. In this case report, we present clinical features, and microbiological and immunological findings of 40 month‐old Thai male PLS patient.

Methods: Microbiological examinations consisted of bacterial culture methods utilizing selective media, morphological identification, and biochemical tests. In addition, the specific serum IgG subclass antibody titers reactive with etiologic periodontal bacteria were determined by the dot‐blot immunological analysis and enzyme linked immunosorbent assay (ELISA).

Results: The examinations revealed that the patient harbored 3 major suspected periodontopathic microorganisms, A. actinomycetemcomitans, P. gingivalis, and P. intermedia. The patient's serum IgG1, IgG2, and IgG3, but not IgG4, titers against A. actinomycetemcomitanswere dramatically increased. The predominant IgG subclass was IgG1. In contrast, the IgG titers against other tested bacteria, P. gingivalis, P. intermedia, and F. nucleatum, appeared to be similar to those of a healthy control.

Conclusions: A. actinomycetemcomitans seems to play a pivotal role in the bacteria‐host interaction in PLS periodontal pathogenesis. Response of the specific serum IgG subclass antibody titers against the A. actinomycetemcomitans antigen has been demonstrated. This association warrants further investigation. J Periodontol 2001;72:1747‐1754.
Practice Management: Observations, Issues, and Empirical Evidence
Authors: Wong Henry Meng Yeong , Braithwaite Jeffrey
Published: February 2005

Background: The primary objective of this study is to provide objective, empirical, evidence‐based practice management information. This is a hitherto under‐researched area of considerable interest for both the practitioner and educator.

Methods: A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted.

Results: The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges.

Conclusions: Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidencebased practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs. J Periodontol 2001;72:196‐203.
One‐Stage Full‐Mouth Disinfection. Long‐Term Microbiological Results Analyzed by Checkerboard DNA‐DNA Hybridization
Authors: De Soete Marc , Mongardini Claudio , Pauwels Martine , Haffajee Anne , Socransky Sigmund , van Steenberghe Daniel , Quirynen Marc
Published: February 2005

Background: Recent studies reported significant, additional clinical and microbiological improvements when severe adult periodontitis was treated via the one‐stage full‐mouth (OSFM) disinfection approach, instead of a standard treatment scheme with staged instrumentation per quadrant. The OSFM disinfection involves dealing with the remaining oropharyngeal niches such as tonsils, saliva, tongue, and mucosa. The OSFM disinfection procedure involves scaling and root planing of all pockets within 24 hours in combination with chlorhexidine application to all oropharyngeal niches (chairside and at home for 2 months). This study aimed to compare the microbiological shifts with the OSFM approach versus standard therapy.

Methods: Nineteen patients with advanced chronic periodontitis (AP) and 12 patients with early‐onset periodontitis (EOP) were randomly assigned to the test and control groups. The control group (9 AP patients, 6 EOP patients) was scaled and root planed, per quadrant, with 2‐week intervals. The test group (10 AP patients and 6 EOP patients) underwent OSFM disinfection treatment. At baseline and after 2, 4, and 8 months, pooled subgingival plaque samples were taken from single‐ and multi‐rooted teeth. The presence and levels of 30 subgingival taxa were determined using whole genomic DNA probes and checkerboard DNA‐DNA hybridization.

Results: Both treatments resulted in important reductions of the pathogenic species up to 8 months after therapy, both for their detection level and frequency. The OSFM disinfection resulted in an additional improvement, especially in the AP group. P. gingivalis and B. forsythus were reduced below detection level. The number of beneficial species remained nearly unchanged.

Conclusions: The OSFM disinfection results in supplementary reductions of periodontal pathogens even after 8 months in the treatment of patients with advanced or early‐onset periodontitis. J Periodontol 2001;72:374‐382.
Heterogeneity of Host Immunological Risk Factors in Patients With Aggressive Periodontitis
Authors: Takahashi Keiso , Ohyama Hideki , Kitanaka Michitaka , Sawa Takamasa , Mineshiba Junji , Nishimura Fusanori , Arai Hideo , Takashiba Shogo , Murayama Yoji
Published: February 2005

Background: The pathogenesis of early‐onset periodontitis (EOP) can be explained by various host risk factors. Previous studies have focused on a single (among many possible) immunological risk factor and the association among the factors has not been assessed. We comprehensively investigated the associations among multiple host immunological risk factors in EOP patients to further elucidate their role in the pathogenesis of EOP.

Methods: Sixty‐eight EOP patients (50 generalized EOP, 18 localized EOP), 51 EOP‐suspected patients (S‐EOP), 43 adult periodontitis (AP) patients, and 36 periodontally healthy subjects (HS) participated in this cross‐sectional study. We examined peripheral neutrophil functions, phenotypic and functional characterization of peripheral lymphocytes (lymphocyte subsets, T‐cell proliferative activity), cytokine productivity (interleukin [IL]‐1, IL‐2, tumor necrosis factor [TNF]‐α, interferon [IFN]‐γ, IL‐4 and IL‐6), serum immunoglobulin G (IgG) antibody titers against 12 periodontal bacteria, and HLA class II genotypes.

Results: G‐EOP, S‐EOP, and AP patient groups showed significantly lower percentages of pan T cells and CD8‐positive cells (P <0.02) compared with the HS group. L‐EOP patients showed depressed IL‐4 and TNF‐α productivity compared with the HS group (P <0.02). The EOP group showed significantly elevated antibody levels against Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, and Fusobacterium nucleatum compared with the HS group (P <0.05). The frequency with DQB1*0503 was significantly higher in the EOP patient group than the HS group (P = 0.045) due to the higher frequency in L‐EOP patients than the HS group (P = 0.035). There were wide interindividual variations in each of the tests among patient and HS groups; however, EOP patients showed wider intradiagnostic group variations in certain host defensive cell functions than the other groups. There were some EOP patients who showed extremely low or high values in some tests; the EOP patients could be further divided into subgroups according to their host defensive and immunological profiles. However, there was heterogeneity in some of the other host immunological tests even in the subgroups.

Conclusions: The association of host immunological risk factors in EOP patients is widely varied and more complex than previously thought. These results indicate the difficulty of explaining the pathogenesis of EOP based on a single host risk factor and also emphasize the importance of critical assessment of not only EOP patient groups, but also individual patients. J Periodontol 2001;72:425‐437.
The Characteristic Cellular Organization and CEACAM1 Expression in the Junctional Epithelium of Rats and Mice Are Genetically Programmed and Not Influenced by the Bacterial Microflora
Authors: Heymann Robert , Wroblewski Joanna , Terling Catharina , Midtvedt Tore , Öbrink Björn
Published: February 2005

Background: The epithelial cell adhesion molecule CEACAM1 exhibits an interesting dynamic expression during tooth development. It is first expressed in the reduced enamel epithelium, its expression then increases in the orally faced reduced epithelium and the overlying oral epithelium that then fuse to give rise to the junctional epithelium. The expression of CEACAM1 remains at high levels in the junctional epithelium, in contrast to the surrounding oral sulcular epithelium which shows much lower expression levels. We investigated if the high expression levels of CEACAM1 and the loosely organized cells characteristic of the junctional epithelium are genetically programmed or result from bacterial infiltration.

Methods: Oral tissues from germ‐free rats and mice and animals with conventional bacterial flora were analyzed by transmission electron microscopy and immunohistochemical staining for CEACAM1.

Results: The junctional epithelium of both germ‐free and conventional animals was identical with respect to both CEACAM1 expression and morphology. Also the presence of leukocytes was the same in both types of animals.

Conclusions: The results indicate that the characteristic morphology and the high expression levels of CEACAM1 in the junctional epithelium are genetically programmed and not a result of bacterial infiltration. This suggests that CEACAM1 has an important role for the structural integrity of the junctional epithelium. This conclusion was supported by the observation that the junctional epithelium does not express any E‐cadherin, which is another abundant epithelial cell adhesion molecule. J Periodontol 2001;72:454‐460.
Epidermolysis Bullosa Acquisita: Clinical Manifestations, Microscopic Findings, and Surgical Periodontal Therapy. A Case Report
Authors: Hakki Sema Sezgin , Çelenligil‐Nazliel Haviye , Karaduman Ayşen , Usubütün Alp , Ertoy Dilek , Ayhan Ayşe , Ruacan Şevket
Published: February 2005

Background: Epidermolysis bullosa acquisita EBA) is an uncommon, acquired, chronic subepidermal bullous disease. This report describes a case of EBA with gingival involvement. A 43‐year‐old woman with EBA was referred to our clinic for periodontal therapy because of gingival tenderness and bleeding. She has been on cyclosporin A therapy for the last 2 years.

Methods: Clinical findings were analyzed. Anterior gingivectomy operations were performed in 2 stages. The samples obtained during the surgery were examined using histopathologic, immunohistologic, and electronmicroscopic methods. Long‐term effects of the surgical periodontal treatment on gingiva were evaluated both clinically and microscopically.

Results: The dentition displayed minimal enamel hypoplasia. Decayed, missing, and filled surfaces score was found to be elevated. Periodontal examination showed generalized diffuse gingival inflammation and gingival enlargement localized mainly to the anterior region. Nikolsky's sign was positive. However, wound healing was uneventful after the operations. Microscopic findings were similar to those obtained from the skin. Twenty‐one months after the operations, Nikolsky's sign was negative and no remarkable gingival inflammation was noted. Microscopic examination revealed that the blisters were fewer in number and smaller in size.

Conclusions: These results indicate that gingival tissues may also be involved in EBA. Uneventful wound healing after periodontal surgery in this case suggests that periodontal surgery can be performed in patients with EBA. Moreover, both our clinical and histopathologic findings imply that gingivectomy proves useful in maintaining gingival integrity in thesepatients. Our data may also suggest that the patients with EBA are highly likely to develop dental caries. J Periodontol 2001;72:550‐558.
Smoking Affects the Subgingival Microflora in Periodontitis
Authors: van Winkelhoff A.J. , Bosch‐Tijhof C.J. , Winkel E.G. , van der Reijden W.A.
Published: February 2005

Background: Tobacco smoking has been identified as one major risk factor for destructive periodontal disease. Scaling and root planing have been shown to be less effective in smokers with periodontitis. The aim of the present study was to compare the subgingival microbial flora of treated and untreated smokers and non‐smokers.

Methods: Four independent adult patient groups with periodontitis were included in this investigation: 88 untreated smokers (U‐S); 90 untreated non‐smokers (U‐NS); 119 treated non‐smokers (T‐NS); and 171 treated smokers (T‐S). Clinical variables included cumulative plaque index (CPI), probing depth (PD), clinical attachment level (CAL), cumulative bleeding index (CBI), and cumulative suppuration index (CSI). Paper point samples from the deepest bleeding pocket in each quadrant of the dentition were analyzed for the presence and levels of 6 periodontal bacterial pathogens using anaerobic culture techniques.

Results: U‐S showed a higher mean cumulative plaque index than U‐NS (3.5 versus 2.7). Mean PD and mean CAL were higher in the T‐S in comparison to the T‐NS group (7.0 versus 6.6 mm and 5.6 versus 4.7 mm, respectively). Microbiological characteristics of U‐S were a higher prevalence of Prevotella intermedia/nigrescens and higher mean levels of Peptostreptococcus micros (Pm) and Fusobacterium nucleatum (Fn). T‐S patients were characterized by higher prevalence of Bacteroides forsythus (Bf), Pm, and Campylobacter rectus (Cr) and higher mean levels of Pm and Fn. The mean percentage of B. forsythus tended to be higher in the T‐S group than in the T‐NS group (6.9% versus 5.6%). The relative risk to be infected with Bf, Pm, and Cr was statistically higher in smokers (odds ratios: 1.9, 1.9, and 1.6, respectively). The chance to find ≥10% of Bf, Pm, and/or Fn was 3.3 higher in smokers when A. actinomycetemcomitans and P. gingivalis were absent. Detection of ≥20% Pm/Fn in treated patients was strongly associated with smoking (odds ratio 13.8, P = 0.002).

Conclusions: Smoking is a determining factor for the composition of the subgingival microflora in adult patients with periodontitis and may select for a specific cluster of periodontal pathogens, notably Bf, Pm, Fn, and Cr. On the basis of these observations, smoking, among other criteria, may be one parameter to use in deciding to treat refractory periodontitis in smokers with a systemic antibiotic therapy directed against smoking‐associated periodontal bacteria. J Periodontol 2001;72:666‐671.
The Effect of Enamel Matrix Protein Derivative on Follicle Cells In Vitro
Authors: Hakki Sema S. , Berry Janice E. , Somerman Martha J.
Published: February 2005

Background: It is thought that during development of the periodontium, dental follicle cells, when appropriately triggered, have the ability to differentiate into periodontal ligament fibroblasts, cementoblasts, and osteoblasts. However, the exact mechanisms/factors responsible for initiating cell differentiation are not defined. The purpose of this in vitro study was to further characterize follicle cells and to determine the effects of an enamel matrix‐derived protein (EMD) on these cells.

Methods: Murine follicle cells, transformed with simian virus 40 (SV 40) T antigen‐containing virus (SVF cells), were used. SVF cells were cultured in Dulbecco's modified Eagle's medium (DMEM) plus 2% fetal bovine serum (FBS) or 2% FBS plus EMD (100 µg/ml), with and without ascorbic acid (50 µg/ml). For proliferation assays, cells were plated at 500 cells/cm2 in 24‐well plates and counted on days 3, 4, and 5. For Northern analysis, total RNA was isolated on days 8, 12, and 18. Induction of mineral nodules by SVF cells was determined by von Kossa staining.

Results: EMD had a significant proliferative effect on SVF cells, when compared with 2% FBS control. Based on investigations in situ, follicle cells at the time point used here do not express key mineral‐associated markers, e.g., osteocalcin (OCN) or bone sialoprotein (BSP). Significantly, by day 12 in culture, Northern analysis indicated that the follicle cells expressed transcripts for BSP, OCN, and osteopontin (OPN). EMD increased OPN mRNA and decreased OCN mRNA expression. SVF cells were capable of inducing mineralization on day 18, but EMD blocked this activity.

Conclusions: These results suggest the follicle cells have the capacity to act as cementoblasts or osteoblasts. Furthermore, EMD can regulate follicle cell activity, thus suggesting that epithelial‐mesenchymal interactions may be important during development of periodontal tissues. J Periodontol 2001;72:679‐687
Prevalence of Dehiscences and Fenestrations in Modern American Skulls
Authors: Rupprecht Robert D. , Horning Gregory M. , Nicoll Brian K. , Cohen Mark E.
Published: February 2005

Background: The purpose of this study was to examine the prevalence, distribution, and features of alveolar dehiscences and fenestrations in modern American skulls and correlate their presence with occlusal attrition, root prominence, and alveolar bone thickness.

Methods: A representative sample of 146 dentate modern American skulls from a collection at the National Museum of Natural History were examined.

Results: The skulls were from subjects ranging in age from 17 to 87 years old (mean 49.1 years). The mean number of teeth per skull was 22.7 and the mean number of either dehiscence or fenestration defects per skull was 3.0. Of the 3,315 individual teeth examined, 4.1% (135) had dehiscences and 9.0% (298) had fenestrations. A dehiscence was present in 40.4% of the skulls, and a fenestration was present in 61.6% of skulls. Mandibular canines were most often affected by dehiscences (12.9%), while maxillary first molars were most often affected by fenestrations (37.0%). Sixty‐seven percent of dehiscences were found in the mandible, and 58% of fenestrations were found in the maxilla.

Conclusions: The presence of dehiscences and fenestrations were positively correlated with thin alveolar bone and negatively correlated with occlusal attrition. African‐American males and Caucasian females were significantly more likely to have dehiscences, while African‐American females were significantly more likely to have fenestrations. J Periodontol 2001;72:722‐729.
Effects of Pretreatment Clinical Parameters on Bioactive Glass Implantation in Intrabony Periodontal Defects
Authors: Park Ji‐Sook , Suh Jong‐Jin , Choi Seong‐Ho , Moon Ik‐Sang , Cho Kyoo‐Sung , Kim Chong‐Kwan , Chai Jung‐Kiu
Published: February 2005

Background: The various methods for regeneration of periodontal tissue that have been developed can be classified into guided tissue regeneration and bone implantation. Since the implantation materials have shown both deficiencies and merits, dentists have begun exploring the bioactive glass first used in plastic surgery. This paper examines the effectiveness of this new material on periodontal intrabony defects.

Methods: Clinical effects of bioactive glass implantation in intrabony periodontal defects were evaluated 6 months after surgery in 38 intrabony defects from 38 patients with chronic periodontitis. Twenty‐one experimental defects received bioactive glass implantation (test group), while 17 control defects were treated with a flap procedure only (control group). The criteria for comparative observation were preoperative and postoperative probing depth (PD), clinical attachment level (CAL), bone probing depth (BPD), and gingival recession.

Results: Reductions in PD were observed in both groups (P <0.01). The reduction in PD was significantly greater in the test group when preoperative PD exceeded 7 mm (P <0.01). Improvements in CAL were also observed in both groups (P <0.01), with the test group showing significantly greater gains (P <0.05). In those cases where preoperative CAL was less than 7 mm, there was no statistically significant difference between the two groups. Reduction in BPD was observed in both groups, with the test group showing significantly greater reduction (P <0.01). There was no significant difference in BPD change, however, when preoperative BPD was ≤7 mm. Significantly greater reduction of BPD in the test group was observed when intrabony defect depth was >4 mm (P <0.05). Significant improvements in PD, CAL, and BPD were noted in the test group when the crestal involvement exceeded 100°. Correlation test between various clinical parameters indicated that greater changes in PD and CAL in the test group were observed when preoperative CAL was large (P <0.001), and greater changes in PD (P <0.05), CAL (P <0.01), and BPD (P <0.05) were noted when preoperative BPD was large. Correlation between crestal involvement and CAL change was noted only in the control group (P <0.01). High correlations were observed between PD changes and CAL changes and between CAL changes and BPD changes in both groups.

Conclusions: Use of a bone substitute in a flap operation resulted in significantly greater improvements in CAL and BPD over flap operation alone and seemed to have positive effects in postoperative PD, CAL, and BPD in those cases with more severe preoperative CAL and BPD. J Periodontol 2001;72:730‐740.
In Vitro Comparison of Bioabsorbable and Non‐Resorbable Membranes in Bone Regeneration
Authors: Marinucci Lorella , Lilli Cinzia , Baroni Tiziano , Becchetti Ennio , Belcastro Salvatore , Balducci Chiara , Locci Paola
Published: February 2005

Background: Barrier membranes are used to prevent downgrowth of the oral mucosa along the root surface and to allow alveolar bone regeneration in guided tissue regeneration. Several studies have demonstrated bone regenerates in the presence of bioabsorbable and non‐resorbable membranes, but no studies have compared multiple bioabsorbable barriers to one another and to non‐resorbable barriers. This study evaluated the in vitro influence of bioabsorbable and non‐resorbable membranes on specific parameters of human osteoblast activity.

Methods: Human osteoblasts were cultured on bioabsorbable membranes made of collagen, hyaluronic acid, and poly DL‐lactide, and the most common non‐resorbable membrane which is made of expanded polytetrafluoroethylene (ePTFE). The osteoblasts were cultured in vitro for 24 hours on barrier membranes in the presence of 3H‐thymidine and 3H‐proline to study cell proliferation and collagen synthesis. Transforming growth factor‐β1 (TGF‐β1) secretion was evaluated in conditioned media using an ELISA kit.

Results: The results showed that collagen and poly DL‐lactide stimulated DNA synthesis more than ePTFE and hyaluronic acid. All bioabsorbable membranes significantly increased collagen synthesis and alkaline phosphatase activity. Collagen and hyaluronic acid increased secretion of TGF‐β1, a growth factor involved in bone remodeling.

Conclusions: These data suggest bioabsorbable membranes, particularly collagen and hyaluronic acid, may promote bone regeneration through their activity on osteoblasts. J Periodontol 2001;72:753‐759.
The Effect of Antimicrobial Periodontal Treatment on Circulating Tumor Necrosis Factor‐Alpha and Glycated Hemoglobin Level in Patients With Type 2 Diabetes
Authors: Iwamoto Yoshihiro , Nishimura Fusanori , Nakagawa Masatsugu , Sugimoto Hikaru , Shikata Kenichi , Makino Hirofumi , Fukuda Tetsuya , Tsuji Takao , Iwamoto Masahiro , Murayama Yoji
Published: February 2005

Background: Tumor necrosis factor‐α (TNF‐α) may play an important role in insulin resistance. In this study, we hypothesized that TNF‐α produced due to periodontal inflammation synergistically affects insulin resistance as well as TNF‐α produced from adipose tissues in insulin‐resistant type 2 diabetes patients. Therefore, to understand the effects of antimicrobial periodontal therapy on serum TNF‐α concentration and subsequent metabolic control of diabetes, we examined the periodontal and diabetic status on 13 type‐2 diabetes patients.

Methods: These patients were treated with local minocycline administration in every periodontal pocket around all existing teeth once a week for a month. Before and after treatment, the number of total bacteria in the periodontal pockets and circulating TNF‐α concentration were measured and the HbA1c value was assessed.

Results: Antimicrobial therapy significantly reduced the number of microorganisms in periodontal pockets (P <0.01). After treatment, the circulating TNF‐α level was significantly reduced (P <0.015). The HbA1c value was also reduced significantly (P <0.007). In addition, the 6 patients who were not receiving insulin therapy demonstrated decreased fasting insulin levels (P <0.03), and HOMA‐R (P <0.03) indices. The average reductions in circulating TNF‐α concentration and HbA1c value were 0.49 pg/ml and 0.8%, respectively.

Conclusion: The results indicate that anti‐infectious treatment is effective in improving metabolic control in diabetics, possibly through reduced serum TNF‐α and improved insulin resistance. J Periodontol 2001;72:774‐778.
The Influence of Transforming Growth Factor‐β1 Gene Polymorphisms on the Severity of Gingival Overgrowth Associated With Concomitant Use of Cyclosporin A and a Calcium Channel Blocker
Authors: Linden Gerard J. , Haworth Simone E. , Maxwell A. Peter , Poulton Kay V. , Dyer Philip A , Middleton Derek , Irwin Christopher R. , Marley John J. , McNamee Peter , Short Colin D. , Hull Peter S. , James Jacqueline A.
Published: February 2005

Background: The purpose of this study was to determine whether the prevalence and severity of gingival overgrowth in renal transplant recipients concomitantly treated with cyclosporin and a calcium channel blocker was associated with functional polymorphisms within the signal sequence of the transforming growth factor‐(TGF)β1 gene.

Methods: The extent and severity of gingival overgrowth for 164 renal transplant recipients immunosuppressed with cyclosporin A and concomitantly taking a calcium channel blocker since transplant were entered into the study (86 in Manchester, 78 in Belfast). Two biallelic polymorphisms of the TGF‐β1 gene were studied at position +869, codon 10 (leucine to proline substitution), and position +915, codon 25 (arginine to proline substitution).

Results: Subjects who were homozygous for proline at codon 10 had significantly higher overgrowth scores than those who were heterozygous (P = 0.03) or homozygous for leucine (P = 0.01). Subjects who were heterozygous (arginine/proline) at codon 25 had a significantly higher (P = 0.04) gingival overgrowth score than those who were homozygous for arginine. Logistic regression analysis indicated that for codon 25 independent predictors of severe gingival overgrowth were the heterozygous arginine/proline genotype (P = 0.009) and whether the individual was young (P = 0.05).

Conclusions: Polymorphisms in the TGF‐β1 gene influence the expression of gingival overgrowth in renal transplant recipients concomitantly treated with cyclosporin and a calcium channel blocker. The polymorphism in the TGF‐β1 gene at codon 25 represented an independent genetic determinant of severe gingival overgrowth in the susceptible subjects studied. J Periodontol 2001;72:808‐814.
Interleukin‐1β Regulation of Adhesion Molecules on Human Gingival and Periodontal Ligament Fibroblasts
Authors: Joe Brandon H. , Borke James L. , Keskintepe Meral , Hanes Philip J. , Mailhot Jason M. , Singh Baldev B.
Published: February 2005

Background: Adhesion molecules have been implicated in the pathogenesis of rheumatoid arthritis and may also play a role in the pathogenesis of periodontal disease by promoting the recruitment and retention of leukocytes in gingival tissue.

Methods: The aim of the present study was to evaluate the capacity of interleukin‐1β (IL‐1β) to regulate adhesion molecule expression on clinically healthy human gingival (HGF) and periodontal ligament (PDL) fibroblasts. The HGF (n = 6) and PDL (n = 3) fibroblasts were treated with 1.0 ng/ml of IL‐1β for 24 hours and then incubated with primary intercellular adhesion molecule‐1 (ICAM‐1) and vascular cellular adhesion molecule‐1 (VCAM‐1) antibodies followed by FITC‐conjugated secondary antibodies. The expression of ICAM‐1 and VCAM‐1 was measured by immunofluorescence flow cytometry.

Results: The levels of ICAM‐1 expression in IL‐1β treated HGF and PDL fibroblasts were statistically significant (P ≤0.05) compared to normal untreated controls using log‐transformed data and 3‐way analysis of variance. Both cells expressed VCAM‐1 after IL‐1β treatment, but the levels were not statistically different from controls.

Conclusions: This study demonstrated that IL‐1β upregulated ICAM‐1 expression in both HGF and PDL fibroblasts. Even though the level of VCAM‐1 was not statistically different from both HGF and PDL fibroblasts treated with IL‐1β compared to controls, both cells do express the VCAM‐1 molecules. These results suggest that ICAM‐1 and VCAM‐1 might be involved in the pathogenesis of periodontal disease. J Periodontol 2001;72:865‐870.