bluuebunny/crossref_metadata_2025 huggingface dataset:
Tension‐free vaginal tape procedure on genuine stress incontinent women with coexisting genital prolapse
Authors: Lo Tsia‐Shu , Chang Ting‐Chang , Chao An‐Shine , Chou Hung‐Hsueh , Tseng Ling‐Hong , Liang Ching‐Chung
Published: October 2003

Objective.  To study the efficacy of performing the tension‐free vaginal tape (TVT) procedure concurrently with vaginal pelvic relaxation surgeries in the management of genuine stress incontinence with genital prolapse.

Materials and methods.  Fifty‐eight women were surgically managed. Various vaginal pelvic reconstructive surgeries for prolapses were completed before the TVT procedure. Pre‐operative and postoperative urodynamic studies, 1‐h pad tests and symptom analysis were evaluated 1 year postoperatively. Surgical procedures and patient outcomes are discussed.

Results.  Objective data available for 55 patients. Fifty (91%) were dry 1 year postoperatively. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies and sacrospinous ligament fixations. No major surgical complications occurred. The average blood loss was 134 ml, the average operating time for the TVT procedure was 21 min, and the average postoperative hospital stay was 3.4 days. All patients voided spontaneously with adequate volumes of postvoid residual urine before being discharged. Two patients had a recurrent prolapse. Urodynamic parameters showed no significant differences before and after the surgery, except that the parameters related to voiding dysfunction were improved in the patients with severe cystocele. De nova detrusor instability was observed in one patient.

Conclusions.  The tension‐free vaginal tape procedure performed with concurrent vaginal pelvic relaxation surgery is safe and effective for genuine stress incontinence and pelvic prolapse. Concomitant procedures also appear to relieve bladder outlet obstructions caused by severe prolapse.
Fallopian tube sperm perfusion: the impact of sperm count and morphology on pregnancy rates
Authors: Strandell Annika , Bergh Christina , Söderlund Brita , Lundin Kersti , Nilsson Lars
Published: October 2003

Background and objective.  To evaluate the effect of changed criteria for sperm count and morphology when performing fallopian tube sperm perfusion (FSP) in unexplained infertility.

Patients and methods.  We report on a longitudinal study in which two periods of insemination cycles are compared. One hundred and eighty‐three couples who started 361 stimulation cycles intended for FSP were included in the first period and 190 couples starting 303 cycles in the second period. The sperm requirement in the first study period was at least 7 million sperm in the prepared test sample. The FSP cycle included downregulation, controlled ovarian hyperstimulation (COH), ovulation induction and intrauterine and intrafallopian tube insemination using a sperm suspension of 3 mL volume. To avoid high‐order multiple pregnancies, cycles at risk were converted to in vitro fertilization (IVF). Based on the results from the first period, sperm requirements were lowered to a sperm count of 3 million and at least 5% normal morphology according to strict criteria.

Results.  FSP was performed in 51% and 60% of started cycles during the two periods with similar pregnancy (24% and 23%) and birth (15% and 19%) rates. Neither sperm count nor morphology above the requirements affected pregnancy rates. IVF‐converted, completed cycles reached equal pregnancy (41%) and delivery (32%) rates in both periods. Multiple pregnancy rates were higher after IVF (38%) than after FSP (24%).

Conclusion.  The lowered requirements for sperm count and morphology have not impaired pregnancy results after FSP. Patients who either completed an FSP cycle or had their cycle converted to IVF were all at high risk of multiple pregnancy.
Embryo donation: a review
Authors: Lee Julinda , Yap Christine
Published: October 2003

Background. Embryo donation is currently an uncommon procedure associated with many ethical, legal and psychosocial implications. It is, however, the only answer to infertility in some patients. This article summarizes the indications for embryo donation as well as the procedure and considerations in the preparation of both the donors and the recipients.

Methods. A MEDLINE search was conducted for all English articles using the keywords embryo donation,in vitrofertilization and gamete donation.

Conclusion. Embryo donation might indeed be the answer to many infertile couples who would otherwise have to resort to childlessness or adoption. The advent ofin vitrofertilization and cryopreservation of the spare embryos make these embryos a ready source for potential donors. The success rates of both fresh and freeze‐thawed embryo transfers have been encouraging and there do not seem to be any long‐term clinical implications for the offspring. However, there remain many legal and psychosocial issues associated with embryo donation.
Microbiological and clinical effects of an antiseptic dental varnish after mechanical periodontal therapy
Authors: Dudic Vivien B. , Lang Niklaus P. , Mombelli Andrea
Published: October 2003

Abstract. The aim of this study was to explore the microbiological and clinical effects of an antiseptic dental varnish when applied to periodontally diseased teeth after mechanical therapy. 20 subjects participated in this placebo controlled, double blind prospective longitudinal study. 2 experimental sites with a pocket probing depth ≥5 mm were chosen in each subject. The control varnish, consisting of ethanol, ethylacetate and polyvinylbutyral, was applied to one of the selected teeth and the test varnish, containing 1% chlorhexidine and 1% thymol in addition, was applied to the other one. Clinical parameters were assessed, and microbiological samples were obtained from the two study sites at baseline (6–10 weeks after completion of conventional periodontal therapy), and 2, 4 and 12 weeks thereafter. The mean PLI at baseline was very low and, therefore, only a minimal potential for a further improvement existed. During the 12‐week observation period, the mean PLI increased significantly at sites treated with the placebo varnish, while no similar trend for an increase in PLI was detected in the test sites. The bleeding tendency seemed to remain unaffected by the application of the varnish. On the microbiological level, no relevant differences could be detected between placebo and test sites at baseline, or during the follow‐up period. In conclusion, the application of a dental varnish with antimicrobial properties after mechanical periodontal therapy had little effect in subjects with good oral hygiene.
Smoking and crevicular fluid levels of IL‐6 and TNF‐a in periodontal disease
Authors: Boström Lennart , Linder Lars E. , Bergström Jan
Published: October 2003

Abstract. Smoking is a well‐documented risk factor for periodontal disease, although the mechanisms of its negative influence are not well understood. In the present study, the influence of smoking on the gingival crevicular fluid (GCF) content of the pro‐inflammatory cytokines IL‐6 and TNF‐α was investigated in patients with moderate to severe forms of the disease. The study base consisted of 108 patients including 45 current smokers, 28 former smokers and 35 nonsmokers. The median GCF sample levels of IL‐6 and TNF‐α were 5.0 pg/ml and 61.0 pg/ml, respectively, for current smokers, 13.0 pg/ml and 51.0 pg/ml, respectively, for former smokers, and 10.0 pg/ml and 12.0 pg/ml, respectively, for nonsmokers. The differences between smoking groups with regard to IL‐6 were not significant suggesting that the IL‐6 content was not influenced by smoking. In contrast, the TNF‐α content was significantly increased in current smokers as compared to non‐smokers confirming our previous observations. The present results in patients with moderate to severe periodontal disease may indicate different mediator functions of IL‐6 and TNF‐α in response to smoking.
The gingival plasma cell infiltrate in HIV‐positive patients with periodontitis is disorganized
Authors: Myint M. , Odden K. , Schreurs O. , Halstensen T. S. , Schenck K.
Published: October 2003

Abstract. Patients infected with the human immunodeficiency virus (HIV) are highly susceptible to chronic marginal periodontitis (CMP) and the lesion is generally characterized by abundant plasma cell infiltration. HIV‐induced reduction of CD4+ T cells may indirectly affect local production of immunoglobulins (Ig). Gingival biopsies taken from 10 HIV+ and 12 HIV− control patients with CMP were washed, fixed in ethanol and embedded in paraffin. Sections were examined after immunohistochemical staining with monoclonal antibodies against IgA, IgA1–2, IgG, IgG1–4, IgM and IgE. Ig‐containing cells were counted in 3 separate connective tissue zones (subjacent to pocket epithelium, central zone and subjacent to oral epithelium). HIV+ patients showed a remarkably increased density of all Ig‐containing cells in the connective tissue zone subjacent to the oral epithelium (p<0.05) and a lower % of IgG2+ cells in the entire gingival section (p<0.05). In HIV+ patients, the density of IgG‐containing cells in the gingiva was strongly correlated with the serum IgG concentration. The altered topical distribution might imply impaired restriction of the inflammatory lesion, additional antigenic challenges by unusual microorganisms in the oral cavity, or be secondary to HIV‐induced dysregulation of the B‐cell system.
Extensive expression of TGF‐b1 in chronically‐inflamed periodontal tissue
Authors: Steinsvoll S. , Halstensen T. S. , Schenck K.
Published: October 2003

Abstract. The host immune response in chronic marginal periodontitis (CMP) raised against bacteria colonizing the dentogingival area is modulated by cytokines. This study examines the distribution of the transforming growth factor‐β1 containing (TGF‐β1 +) cells in formalin‐fixed and paraffinembedded gingival specimens from 11 patients with chronic marginal periodontitis and 7 persons with healthy gingiva. Inflamed periodontal tissue contained a 100‐fold more TGF‐β1 + cells than healthy gingiva. Diverse morphological TGF‐β1 + cell types were discerned. Double immuno‐enzymatic and ‐fluorescence staining revealed that TGFβ1 + cells comprised 21–29% macrophages 2–3% T‐cells, 3–9% B‐cells, 34–35% neutrophilic granulocytes and 7–10% mast cells. The densities of all TGF‐β1 + cell types in CMP were strongly increased in the connective tissue adjacent to the pocket epithelium, in the lamina propria and adjacent to the oral epithelium. In lesions with extensive inflammation, expression was also marked in pocket epithelium. TGF‐β1 is an immunosuppressive cytokine that stimulates wound healing. Upregulation of the cytokine in inflamed gingiva may counterbalance for destructive gingival inflammatory responses that are simultaneously taking place in patients with CMP.
Longitudinal study of predictive factors for periodontal disease and tooth loss
Authors: Machtei Eli E. , Hausmann Ernest , Dunford Robert , Grossi Sara , Ho Alex , Davis Glenn , Chandler Julie , Zambon Joseph , Genco Robert J.
Published: October 2003

Abstract. Longitudinal assessment of risk factors for periodontal disease is necessary to provide evidence that a putative risk factor or risk indicator is a true risk factor. The purpose of the present study was to explore longitudinally a variety of markers as possible periodontal risk factors in subjects with little or no periodontal disease at baseline. 415 subjects with mild or little periodontal disease were examined: medical and dental history; socioeconomic profile, clinical measurements, microbial samples and radiographic assessment of bone height were performed at baseline, and at a follow‐up examination 2 to 5 years later. Mean probing pocket depth (PPD) at baseline was 1.99±0.37 mm while mean overall change was 0.1 mm which amounts to an annual rate of 0.04 mm. Overall mean clinical attachment level (1.75±0.6 mm) at baseline resulted in mean attachment change of 0.28 mm (0.12 mm. annually). Alveolar crestal height (ACH) at baseline (mean 2.05±0.85 mm) resulting in a mean net loss of 0.1 mm. Approximately 10% of all sites presented for the second visit with attachment loss exceeding the threshold (4.4% annually), while only 2.2% of all sites exhibited attachment gain (0.88% annually). Older individuals exhibited greater mean bone loss but the least amount of attachment loss. Current smokers exhibited greater disease progression compared to non‐smokers. Tooth morbidity (0.17 teeth/patient/year) was associated with greater baseline CAL and ACH loss, and an assortment of systemic conditions. Subjects who harbored Bacteroides forsythus (Bf) at baseline had greater loss in ACH; likewise, these subjects experienced greater proportions of losing sites and twice as much tooth mortality compared to Bf‐negative patients. Baseline clinical parameters correlated strongly with the outcome, i.e., subjects with deeper mean pocket depth at baseline exhibited greater increase in pocket depth overtime; while subjects with greater attachment loss at baseline exhibited greater attachment loss between the 1st and 2nd visits.
Periodontal repair in dogs: histologic observations of guided tissue regeneration with a prostaglandin E1 analog/methacrylate composite
Authors: Trombelli Leonardo , Lee Michael B. , Promsudthi Ananya , Guglielmoni Paola G. , Wikesjö Ulf M. E.
Published: October 2003

Abstract. This report describes observations of healing following guided tissue regeneration (GTR) including surgical implantation of the prostaglandin E1 analog misoprostol with calcium‐layered methacrylate particles. Critical size, supraalveolar periodontal defects were surgically created around the 3rd and 4th mandibular premolar teeth in 4 beagle dogs. Wound management included soaking with a 24 μg/ml misoprostol solution and implantation of the misoprostol/methacrylate composite. One jaw quadrant per animal was prepared for GTR using expanded polytetrafluoroethylene membranes. The gingival flaps were coronally advanced and sutured to submerge the teeth. The tissues covering the surgical sites daily received topical misoprostol in an oral adhesive over the 4‐week healing interval. Upon euthanasia, tissue blocks were prepared for histometric analysis of regeneration of alveolar bone and cementum, root resorption and ankylosis. The defect area underneath the membrane and the density of methacrylate particles were recorded for the GTR defects. The methacrylate particles appeared encapsulated in a dense connective tissue without signs of an inflammatory reaction, some in contact to newly formed bone. Alveolar bone regeneration height averaged (±SD) 1.2±1.0 and 1.0±0.6 mm for GTR and non‐GTR defects, respectively. Corresponding values for bone regeneration area were 1.3±1.0 and 0.7±0.5 mm2. Cementum regeneration was confined to the apical aspect of the defects. Small areas of root resorption and ankylosis were observed for all teeth. Bone regeneration area correlated positively to the defect area and negatively to the density of methacrylate particles in the GTR defects. The histologic observations suggest that the methacrylate composite has marginal potential to promote bone and cementum regeneration under provisions for GTR.
Intra‐familial distribution of Fusobacterium nucleatumstrains in healthy families with optimal plaque control
Authors: Suchett‐Kaye G. , Décoret D. , Barsotti O.
Published: October 2003

Abstract. Fusobacterium nucleatum, a Gram‐negative anaerobic rod associated with periodontal disease, is also found in healthy individuals and is considered part of the indigenous oral microflora. Although intra‐familial transmission of periodontal pathogens has been documented, there are no data relating transmission of F. nucleatum. This study investigated the distribution of F. nucleatum strains in 4 strictly healthy families. 32 F. nucleatum strains were isolated from 19 individuals (8 parents and 11 children aged 1–13 years). DNA was extracted and digested with the restriction endonucleases EcoRI, TaqI and HindIII. The digests were separated by electrophoresis through 0.8% agarose gels at 40 V overnight, in TBE buffer containing 1 μg/ml ethidium bromide, and photographed. The DNA was transferred to nylon filters by Southern blotting and hybridized with a digoxigenin labelled E. coli rRNA probe (Kit Dig DNA Labelling mixture – Boehringer). Probed DNA was visualized colorimetrically (CSPD Luminescent Detection Kit Boehringer) and photographed (Amersham). We found that 10/11 children shared identical ribotypes with at least one of their respective parents. Some of the children also harbored a unique additional ribotype. On the basis of indistinguishable restriction endonuclease and ribotype patterns these results support the hypothesis that intra‐familial transmission of F. nucleatum is possible.
Conversion of plaque‐area measurements to plaque index scores
Authors: Renton‐Harper P. , Claydon N. , Warren P. , Newcombe R. G. , Addy M.
Published: October 2003

Abstract. Plaque areas recorded graphically or photographically provide a permanent record of plaque accumulations on teeth at a moment in time. As such, these records could be re‐evaluated and converted into other index scores. The purpose of this study was to determine the reproducibility of scoring a plaque index from previously recorded plaque areas and to compare such scores with the original scores of the same index. A randomised blind, crossover study comparing 5 treatments for plaque inhibition scored by plaque area and index was chosen. 2 examiners, the original scorer PRH and another, NC, 2× scored the plaque area tooth charts according to the criteria of the plaque index system used in the original study. Standard deviations of the differences showed intraexaminer repeatability to be high particularly for the original examiner. Interexaminer reproducibility for the original index scores was considered good but less than for intra‐examiner repeatability. Correlation coefficients were complimentary to the differences analysis, being very high within examiners and less high for between examiners and original and rescored index. Separation between distributions of plaque area measurements for consecutive values of the index were particular good for scores 2 versus 3 and 3 versus 4 and less good for 1 versus 2 and 4 versus 5. Reanalysis of the study for treatment differences using rescored data revealed a similar level of significance as using the original data. Rescored index had similar discriminatory power for the study as plaque area and original plaque index when both were derived from the same buccal tooth surfaces. However, discriminatory power was less by comparison with original plaque index derived from the buccal surfaces of all teeth. It is concluded that plaque area provides a permanent record of plaque distribution which can be converted into index data at a later date. Such data collection could make possible comparisons between studies using different indices.
Measurement of clinical attachment levels using a constant‐force periodontal probe modified to detect the cementoenamel junction
Authors: Preshaw P. M. , Kupp L. , Hefti A. F. , Mariotti A.
Published: October 2003

Abstract. The handpiece of a Florida sleeve probe was modified to create a flange with the capability to detect the cemento‐enamel junction (CEJ). This new instrument (the Pressure‐controlled, Automated, Standardised Handpiece or Florida PASHA probe) was used to determine whether (a) the CEJ could be reproducibly detected in dried, human skulls and (b) clinical attachment levels could be reliably measured in human subjects. When using the Florida PASHA probe to detect the CEJ at 157 different sites in four dried, human skulls, there were no statistically significant (p≥0.15) differences in mean CEJ detection measurements for any of the three participating examiners; either when the CEJ was visualised or obscured. The mean differences between first and second replicates ranged from 0.00 to 0.08 mm. Intraclass correlation coefficients (ICCs) of repeated measures in both conditions ranged from 0.70 to 0.83 for tactile CEJ detection (CEJ obscured), and from 0.95 to 0.96 for visual detection (CEJ visible). In human studies, the Florida PASHA probe was used by two examiners to determine clinical attachment levels (CAL) at 660 sites in 5 human subjects undergoing supportive periodontal therapy. Intra‐examiner agreement of replicate measurements recorded by the probe, as measured by calculating ICCs, ranged from 0.79 to 0.85 for the 2 examiners, respectively. A statistically significant inter‐examiner difference in mean CAL measurements when using the Florida PASHA probe was found (p<0.001). Notwithstanding this difference, inter‐examiner agreement was good, with an ICC of 0.83. These data suggest that the Florida PASHA probe can reproducibly detect the CEJ and is proposed as a tool for measuring CAL in humans.
Differences in the inflammatory response in young and old human subjects during the course of experimental gingivitis
Authors: Fransson C. , Mooney J. , Kinane D. F. , Berglundh T.
Published: October 2003

Abstract. The aim of the present experiment was to study changes in (i) the composition of the inflammatory cell infiltrates and (ii) levels of σ 2‐macroglobulin, lactoferrin and IgG subclasses in gingival crevicular fluid in young and old individuals during 3 weeks of plaque formation. To establish healthy gingival conditions, all subjects received professional tooth cleaning during a 4 week preexperimental period. The experimental sites included the mesio‐palatal, palatal, and disto‐palatal surfaces of all teeth present in the 15...25 tooth region. At baseline (day 0) assessments of plaque and gingivitis, microbial sampling and gingival fluid assessment were performed and one gingival biopsy harvested from each subject. Following the baseline examination, the participants abolished mechanical tooth cleaning measures in the palatal and approximal surfaces of 15... 25. The clinical examination and the gingival fluid measurement were repeated on days 7, 14 and 21 of no oral hygiene. The microbiological sampling and the biopsy procedure were repeated on days 7 and 21. The gingival crevicular fluid samples harvested from the old individuals had higher levels of a 2‐macroglobulin and IgG3 compared to young subjects. The immunohistochemical analyses of the biopsies demonstrated that the gingival lesion representing the old individuals harbored a higher proportion of B‐cells and a lower density of PMN cells compared to the infiltrate in the young group of subjects. It is suggested that differences exist in the inflammatory response to de novo plaque formation in young and old individuals.
Comparative antimicrobial activity of an essential oil and an amine fluoride/stannous fluoride mouthrinse in vitro
Authors: Pan P. H. , Finnegan M. B. , Sturdivant L. , Barnett M. L.
Published: October 2003

Abstract. Although laboratory studies are not necessarily predictive of clinical activity, they can help to elucidate mechanisms underlying clinical activity when the latter has been established. In a recent clinical study, an essential oil mouthrinse (Listerine® Antiseptic) was shown to be significantly more effective than an amine fluoride/stannous fluoride mouthrinse (Meridol®) in inhibiting supragingival plaque formation. This paper reports the results of laboratory studies comparing the antimicrobial effectiveness of these 2 mouthrinses using a kill kinetics assay and a plaque biofilm kill assay. In both assays, the essential oil mouthrinse was considerably more effective than the amine fluoride/stannous fluoride mouthrinse. These findings are consistent with the results of the clinical trial and may help to explain the observed differences in clinical activity.
Inability of intact cells of Treponema denticolato degradehuman serum proteins IgA, IgG and albumin
Authors: Hollmann Ricarda , Van der Hoeven Hans J. S.
Published: October 2003

Abstract. Treponema denticola has been shown to be associated with periodontitis in man and animals. The organism ferments amino acids and thrives on the proteins in the periodontal pocket. Accordingly, T. denticola possesses various proteolytic enzymes, including a chymotrypsin‐like protease, capable of hydrolyzing a whole range of proteins, including immunoglobulins. Yet, it is not clear whether the intact cells of T. denticola can degrade immunoglobulins and albumin. The purpose of this study was to clarify this point. Three strains of T. denticola were cultured in liquid medium, and cells were harvested by centrifugation. Protein degradation in cell suspensions was assayed by capillary electrophoresis and immunonephelometry. None of the T. denticola strains appeared to be able to degrade IgA, IgG, or albumin, while a strain of P. gingivalis completely hydrolyzed these proteins. The findings suggest that, in the periodontal pocket, T. denticola depends on proteinases from other bacteria for utilization of the available serum proteins. This is in accordance with clinical data showing a close relationship between T. denticola and strongly proteolytic bacteria, such as Porphyromonas gingivalis and Bacteroides forsythus.
Furcation diagnosis
Authors: Müller Hans‐Peter , Eger Thomas
Published: October 2003

Abstract. One of the most important and at present unsolved problems in clinical periodontology is the predictable successful treatment of periodontitis‐affected furcations of multirooted teeth. Since several therapeutic approaches are proposed, i.e., conservative, resective or regenerative, a proper diagnosis of these lesions is demanding. The aim of the present article is to review the current information on the impact of a proper diagnosis of a furcational lesion as well as tooth morphology on decision making with regard to different treatment modalities and to emphasize the need for a detailed clinical, radiographical and intraoperative diagnosis of the furcation lesion beyond the usually performed diagnosis of the degree of furcation involvement.
Necrotizing ulcerative periodontitis associated with severe congenital immunodeficiency in aprepubescent subject: clinical findings and response to intravenous immunoglobulin treatment
Authors: Batista Eraldo L. , Novaes Arthur B. , Calvano Luýza M. , Do Prado Evandro A. , Goudouris Ekaterini S. , Batista Felipe C.
Published: October 2003

Abstract. Common variable immunodeficieny (CVID) is a rare multifactorial congenital disease of genetic origin caused by an impairment in the secretion of specific immunoglobulins. It manifests systemically through recurrent respiratory infections, gastrointestinal disorders and autoimmune diseases. Oral manifestations may include gingivitis and lichenoid lesions with Wickham's striae. The treatment for CVID is supported by using intravenous infusion of immunoglobulins (IVIG) that allows for control of the disease and avoidance of recurrent opportunistic infections. This report presents a case of necrotizing ulcerative periodontitis (NUP) in a young patient with CVID, and correlates his periodontal status with systemic conditions before and after IVIG administration during 1 year of evaluation.
Actinobacillus actinomycetemcomitansin Chinese adults
Authors: Mombelli A. , Gmür R. , Lang N. P. , Corbet E. , Frey J.
Published: October 2003

Abstract. The aim of the present study was to examine the Actinobacillus actinomycetemcomitans carrier rate in Chinese subjects, and to determine serotype distribution, presence of the leukotoxin gene lktA and the structure of the lktA‐promoter region. Subgingival microbiological samples were obtained from 31 Chinese subjects with moderate to advanced adult periodontitis, 73 young factory workers, and 81 adult residents of a rural area. Bacterial isolates phenotypically identified as A. actinomycetemcomitans were found in 116 of the 185 subjects (detection frequency over‐all: 63%). Presence of the leukotoxin gene lktA was demonstrated for all 115 isolates that could be subcultured. The PCR analysis of the lktA‐promoter region showed that none of these strains had the deletion in the promoter region known to enhance expression of lktA. No significant difference in the frequency of A. actinomycetemcomitans could be observed between the subjects of the 3 study groups. Analysis by logistic multiple regression indicated a homogeneous distribution of A. actinomycetemcomitans in the 3 cohorts and a lack of significant influence of subject gender or age. Serotype a was found in 21 subjects, serotype b was found in 9, serotype c in 67 and serotype e in 11 individuals. Serotype d was not detected in any subject. Nontypeable isolates, lacking serotype a, b, c, d, or e antigens, were found in 9 individuals. A high prevalence irrespective of gender, age, and cohort suggests that A. actinomycetemcomitans is a common constituent of the normal flora in the Chinese subjects of this study and suggests differences in the microbiological com‐ position of subgingival plaque may exist for this population group as compared to north American and European populations.
Factors related to the quantity of subgingival calculus in proximal root surfaces
Authors: Martýnez‐Canut P. , Benlloch D. , Izquierdo R.
Published: October 2003

Abstract. The aim of this study was to determine the association between the quantity of subgingival calculus and the following factors: type and severity of periodontal disease, age, gender and tobacco consumption. A sample of 622 periodontal patients was studied. The radiographically detectable subgingival calculus in proximal root surfaces was recorded in periapical radiographs, considering the number of surfaces without calculus and the number of surfaces exhibiting deposits equal or greater than 1 mm. The association between the subgingival calculus and the factors under study was analyzed by distinct non‐parametric tests. A statistically significant association was found between the absence/presence of subgingival calculus and the type and severity of periodontal disease (p≤0.001), tobacco consumption (p=0.0049) and age (p≤0.001). The quantity of radiographicallydetectable subgingival calculus increased with increasing age and severity of the disease. However, the reverse association was found in smokers, which presented more surfaces free of calculus (p=0.0377) and less surfaces exhibiting deposits equal or greater than 1 mm. The amount of subgingival calculus decreased as the quantity of tobacco consumed increased (p=0.0129), and such differences were more significant in those smoker patients with severe periodontitis (p=0.0065). An explanation is presented to justify these latter findings, since most literature supports that the presence of calculus is higher in smokers. According to the results of this study, more radiographically‐detectable subgingival calculus in proximal root surfaces was found with increasing severity of the disease, with increasing age and with the absence of tobacco consumption.
Comparison between a short and a conventional blade periodontal curet: an in vitro study
Authors: Landry Colette , Long Barbara , Singer David , Senthilselvan Ambikaipakan
Published: October 2003

Abstract. This in vitro study was done to compare a short‐blade, long‐shank (test) curet designed for deeper pockets of incisors and a conventional Gracey 1/2 curet regarding (a) their ability to remove root surface material at different pocket depths, and (b) their effect on root surface roughness. 2 groups of 12 senior dental hygiene students used either the randomly assigned test or conventional curet for a defined period on maxillary and mandibular incisors in a cross‐over experimental design. Extent of root debridement was determined by assessing the removal of black enamel paint on root surfaces within pockets using a computerized video routine and root surface roughness measured using a profilometer. When each surface of the root was analyzed separately at 2‐mm increments, the test instrument exhibited superior material removal on all surfaces at the 4–6 mm CAL (p‐values<0.001). However, the test curet caused a rougher surface than the conventional curet on all surfaces (p<0.001), with a mean difference of 0.27 μm. While it is assumed that the ability of the test instrument to debride the root surface of deeper pockets more thoroughly is clinically more important than the rougher root surfaces it produces, this can only be assessed by further studies in vivo.
Neutrophil migration, oxidative metabolism and adhesion in early onset periodontitis
Authors: Biasi Domenico , Bambara Lisa Maria , Carletto Antonio , Caramaschi Paola , Andrioli Giuseppe , Urbani Giacomo , Bellavite Paolo
Published: October 2003

Abstract. The aim of this study was to evaluate neutrophil function in patients suffering from the generalized form of early onset periodontitis (EOP). We investigated neutrophil migration in vivo and neutrophil superoxide production and adhesion in response to a variety of compounds; neutrophils were isolated both from blood and a skin experimental exudate of 15 patients with EOP and of 15 sex‐ and age‐matched normal control subjects. No difference was found in neutrophil migration in vivo (71.2±16.4×106 and 68.8±10.7×106 PMN/cm2/24 h in patients affected by early onset periodontitis and normal subjects respectively) and in adhesion. The superoxide production in response to STZ and PMA was similar between the 2 groups, while superoxide production in response to fMLP was markedly lower in patients than in control subjects both in circulating neutrophils (5.6±2.2 versus 10.4±2.3 nmoles O2−/106 cells, p<0.0001) and in exudate neutrophils (16.3±4.3 versus 22.3±4.7 nmoles O2 −/106 cells, p<0.005). In general, neutrophil function in patients suffering from early onset periodontitis does not differ from control subjects, suggesting that the overall defence function of these cells is normal. The only parameter that we have found to be different between the 2 groups is the low superoxide production after fMLP stimulation. The stimulus‐ and function‐specificity of this defect in neutrophils from patients indicates the existence of a dysregulation of the signal transduction pathway distal to fMLP receptor and proximal to NADPH oxidase activation.
Variation in periodontal referral in 2 regions in theUK
Authors: Linden Gerard J. , Stevenson Mike , Burke F. J. Trevor
Published: October 2003

Abstract. This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0–80) in the year preceding the survey than those in NWE (median 2, range 0–50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non‐disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.
Sulfate‐reducing bacteria in periodontal pockets and in healthy oral sites
Authors: Langendijk P. S. , Hagemann J. , Van Der Hoeven J. S.
Published: October 2003

Abstract. The aim of this study was to monitor the presence of sulfate‐reducing bacteria (SRB) at different sites in the mouths of both healthy individuals and periodontitis patients. In 20 healthy subjects and 21 periodontitis patients, samples were taken from the palate, vestibulum, dorsum of the tongue, supragingival plaque, and periodontal pockets. In order to demonstrate growth of SRB, samples were incubated in an anoxic chamber in a reduced growth‐medium for SRB, with an iron‐indicator for sulfide production. The SRB were detected throughout the oral cavity. They were found on the mucosa in 10% of both healthy subjects and periodontitis patients. On the tongue and in supragingival plaque, the frequency of detection was slightly higher (22% of the subjects). In contrast, 86% of the periodontitis patients harbored SRB in one or more pockets. In 1/3 of the patients, SRB were present in all 3 pockets that were sampled. The data indicated that SRB belong to the normal oral microbiota, and have a preference for periodontal pockets.
Peri‐implant tissues at submerged and non‐submerged titanium implants
Authors: Abrahamsson I. , Berglundh T. , Moon I.‐S. , Lindhe J.
Published: October 2003

Abstract. The present experiment was performed to study the peri‐implant tissue response to non‐submerged (1‐stage) and initially submerged (2‐stage) implant installation procedures. 6 beagle dogs were used. All mandibular premolars and the 1st, 2nd and 3rd maxillary premolars were extracted. After 3 months of healing, 3 fixtures of the Astra Tech System were installed and submerged in the right (or the left) edentulous, premolar region in each of the 6 dogs. Radiographs were obtained immediately after fixture installation. In the radiographs, the distance between the abutment‐fixture junction and the most ''coronal'' bone in contact with the implant surface was determined. 3 months later, abutments were connected to the initially submerged fixtures and another 3 fixtures of the same system were installed in the contralateral, edentulous premolar region. Abutments were, however, immediately connected to the newly‐installed fixtures (nonsubmerged side; test side). The mucosal flaps were replaced, adjusted and sutured in such a way that the coronal portion of the abutments remained exposed in the oral cavity. A new set of radiographs were obtained from all 6 implant sites in each animal. A period of plaque control was initiated. Clinical examinations were performed and radiographs obtained from all implant sites after another 3 months and at the termination of the experiment. 9 months after the 1st fixture installation procedure, the animals were sacrificed, the mandibles were removed, and each implant region dissected. The most mesially‐located implant sites were processed for ground sectioning. The remaining biopsies were processed and embedded in EPON. The histometric analysis included assessment of the vertical dimension of the marginal soft and mineralized peri‐implant tissues. The ground sections were used for measurements describing (i) “bone to implant contact” and (ii) “bone density”. It was observed that the mucosa and bone tissue that formed at implants placed in a non‐submerged or a submerged procedure had many features in common. Thus, figures describing (i) the height of the mucosa, (ii) the length of the junctional epithelium and the height and quality of the zone of “connective tissue integration”, (iii) the % of bone to implant contact as well as (iv) the density of the peri‐implant bone, were similar in the submerged and the non submerged groups. It is therefore suggested that a non‐submerged (1‐stage) installation technique may provide conditions for tissue integration that are similar to those obtained using a submerged (2‐stage) approach.
Dental self‐efficacy as a determinant to oral health behaviour, oral hygiene and HbA1c level among diabetic patients
Authors: Syrjälä Anna‐Maija H. , Kneckt Mirka C. , Knuuttila Matti L. E.
Published: October 2003

Abstract. Because of a mutual association between severity of periodontitis and poor control of IDDM, regular dental visits and daily oral care are important among diabetics. The aim was to develop a method for analysing dental selfefficacy and to study the relationship between dental self‐efficacy and reported oral health behaviour and oral hygiene. The relationship between oral health behaviour and HbA1c level was also studied. Data were collected in relation to 149 IDDM patients by means of a quantitative questionnaire, evaluation of dental plaque and patient records. Results showed that tooth brushing self‐efficacy, approximal cleaning self‐efficacy and dental visiting self‐efficacy related to corresponding reported oral health behaviour (p<0.0005). Visible plaque index (VPI) correlated inversely with tooth brushing self‐efficacy (rs=−0.208, p=0.012) and dental visiting self‐efficacy (rs=−0.240, p=0.004). Approximal cleaning self‐efficacy correlated with age (rs=0.225, p=0.006) and dental visiting self‐efficacy was related to higher professional level of education (p=0.009). Those having better tooth brushing self‐efficacy (p=0.020), higher frequency of tooth brushing (p=0.032) and lower VPI (p<0.0005) had better HbA1c level. It was concluded that perception of dental self‐efficacy plays a decisive rǒle in relation to oral health behaviour in diabetic patients, and that compliance with dental recommendations is also related to HbA1c level.
Bone tissue reaction around implants placed in a compromised jaw
Authors: Carmagnola D. , Araújo M. , Berglundh T. , Albrektsson T. , Lindhe J.
Published: October 2003

Abstract. The present experiment was carried out to examine bone tissue alterations that occurred around implants at which the marginal level of bone support at fixture installation was different at buccal and lingual surfaces. 8 beagle dogs were randomly divided into one test group and one control group. The mandibular premolars in the left side of the mandible (P1, P2, P3, P4) were extracted. In the 4 dogs of the test group, the buccal bone plate in the mandibular premolar region was removed to establish a bone defect that was about 25 mm long, about 5–6 mm high, and about 4 mm wide. In the 4 dogs of the control group, no bone resection was performed. 8 months after tooth extraction, 3 fixtures (Astra Tech AB, Mölndal, Sweden;TiO‐blast; 8×3.5 mm) were installed in each dog. In the 4 dogs of the test group, the implants were positioned in the defect sites in such a way that (i) mechanical stability was achieved and (ii) their lingual surfaces were entirely invested in bone. At the buccal and approximal surfaces of the fixtures, however, the unthreaded portion (2 mm) and the 3 marginal threads remained exposed. In the control group, all implants were following installation entirely surrounded by bone tissue. After a healing period of 3 months, abutment connection was performed and a plaque control program initiated. 4 months later, the dogs were sacrificed. The mandibles were removed and placed in a fixative. Each implant region was dissected, the tissue samples were dehydrated, embedded, sectioned in a bucco‐lingual plane and used for light microscopic examination. The findings demonstrated that osseointegration occurred at implants, placed in a chronic defect with large discrepancies between the buccal and lingual bone. During the process of healing and function, however, marked modeling and remodeling of the bone tissue took place. Thus, at the buccal surface, some bone regrowth and osseointegration occurred while at the lingual wall, there was a substantial resorption of the marginal bone and an enhanced number of bone multicellular units. Concomitant with the bone tissue alterations described, there was some recession of the peri‐implant mucosa.
The effects of nicotine and age on replication and viability of human gingival fibroblasts in vitro
Authors: Checchi L. , Ciapetti G. , Monaco G. , Ori G.
Published: October 2003

Abstract. The aim of the present study was to examine: (1) the effects of nicotine on human gingival fibroblasts (HGF); (2) differences between smokers (≥10 cigarettes/day at least for 5 years) and non‐smokers; (3) differences between patients of different age. HGF were obtained, through biopsies during periodontal surgical procedures, from 15 patients which were divided in 4 groups: 4 patients, smokers aged ≤25 years; 4 patients, non‐smokers aged ≤25 years; 3 patients, smokers aged ≥40 years; 4 patients, non‐smokers aged ≥40 years. Nicotine has been tested in 3 different concentrations: 6 μg/ml; 60 μg/ml; 600 mg/ml. To assess cells viability, the neutral red (NR) test was used; to evaluate cell proliferation, the Hoechst test was employed. After 48 h of nicotine exposure, it was found that 600 mg/ml nicotine was strongly cytotoxic to HGF of all groups, with a significant reduction of both proliferation and viability of cells versus control. Comparison between groups of the same age: when comparing untreated HGF (i.e., control values) of smokers ≤25 years versus non‐smokers ≤25 years, cell proliferation, but not viability, was found to be increased in smokers. Both viability and proliferation of control cells of smokers ≥40 years were increased versus non‐smokers ≥40 years. HGF of non‐smokers ≤25 years, when exposed to nicotine 600 μg/ml, have less viability and proliferation than HGF of smokers of the same age. Comparison between groups of different age: In the smoker group, untreated HGF (i.e., control values) had similar viability and proliferation, irrespective of age, but nicotine 600 μg/ml kills more HGF in smokers ≤25 years than in smokers ≥40 years. In non‐smokers, untreated HGF ≤25 years replicate less, but are not less viable than HGF ≥40 years. When challenged with nicotine 600 μg/ml, HGF ≤25 years were less viable than HGF ≥40 years. From this study, it appears that the smoking history and the patient age could be relevant for final evaluation of the results, since HGF from smokers are less sensitive to nicotine than HGF from non‐smokers, and cells from older donors are more resistant to nicotine than cells from younger donors.
Calprotectin in gingival crevicular fluid correlates with clinical and biochemical markers of periodontal disease
Authors: Kido Jun‐ichi , Nakamura Teruo , Kido Reiko , Ohishi Keiji , Yamauchi Noriyuki , Kataoka Masatoshi , Nagata Toshihiko
Published: October 2003

Abstract. Clinical and biochemical markers of periodontal disease have been used for precise objective diagnosis of periodontal inflammation. Interleukin 1‐β (IL‐1β) and prostaglandin E2 (PGE2), inflammatory factors, levels in gingival crevicular fluid (GCF) of patients with periodontal disease are elevated and have been studied as biochemical markers. The levels of calprotectin, a leukocyte protein, in body fluids of patients with some inflammatory diseases are raised. Recently, we detected calprotectin in GCF and its concentrations in periodontal pockets were higher than those in healthy gingival crevices. In this study, we investigated the correlations between GCF calprotectin levels and clinical indicators (probing depth and bleeding on probing, BOP), and the IL‐1β or PGE2 levels in GCF. Probing depth and BOP at 130 sites of 110 subjects with periodontal or other oral diseases were examined, then GCF samples were collected and their calprotectin, IL‐1β and PGE2 were determined by ELISA. The calprotectin level correlated positively with the probing depth and was significantly higher at BOP‐positive than BOP‐negative sites. There were significant, positive correlations between the calprotectin and IL‐1β or PGE2 concentrations. These results indicate that the calprotectin level in GCF correlates well with clinical and biochemical markers of periodontal disease and suggest that calprotectin may be useful for evaluating the extent of periodontal inflammation.