bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiological Relationships Between Periodontitis and Systemic Disease: Recent Concepts Involving Serum Lipids
Authors: Iacopino Anthony M. , Cutler Christopher W.
Published: February 2005

Periodontitis has been traditionally regarded as a chronic inflammatory oral infection. However, recent studies indicate that this oral disease may have profound effects on systemic health. The search for cellular/molecular mechanisms linking periodontitis to changes in systemic health and systemic physiology has resulted in the evolution of a new area of lipid research establishing linkages between existing multidisciplinary biomedical literature, recent observations concerning the effects of serum lipids on immune cell phenotype/function, and a heightened interest in systemic responses to chronic localized infections. There appears to be more than a casual relationship between serum lipid levels and systemic health (particularly cardiovascular disease, diabetes, tissue repair capacity, and immune cell function), susceptibility to periodontitis, and serum levels of pro‐inflammatory cytokines. In terms of the potential relationship between periodontitis and systemic disease, it is possible that periodontitis‐induced changes in immune cell function cause metabolic dysregulation of lipid metabolism through mechanisms involving proinflammatory cytokines. Sustained elevations of serum lipids and/or pro‐inflammatory cytokines may have a serious negative impact on systemic health. The purpose of this paper is to present the background, supporting data, and hypotheses related to this concept. As active participants in this emerging and exciting area of investigation, we hope to stimulate interest and awareness among biomedical scientists and practitioners. J Periodontol 2000;71:1375‐1384.
HLA‐B27 Transgenic Rats Are Susceptible to Accelerated Alveolar Bone Loss
Authors: Tatakis Dimitris N. , Guglielmoni Paola
Published: February 2005

Background: HLA‐B27 transgenic rats exhibit generalized, severe inflammatory reactions and spontaneously develop arthritis and chronic gastrointestinal inflammation, as well as inflammatory lesions in other tissues. Our hypothesis was that HLA‐B27 rats would also be susceptible to inflammatory periodontal disease, and therefore alveolar bone loss. The purpose of this investigation was to compare the naturally occurring alveolar bone loss in HLA‐B27 and wild type rats.

Methods: Age‐ and sex‐matched HLA‐B27 transgenic (TG) and wild type Fischer 344 (WT) female retired breeders, and their age‐matched male WT breeding mates, were examined for alveolar bone loss (ABL). Thirty‐eight animals were used: twelve, 20, and 6 animals were 6, 8, and 12 months old, respectively. ABL was measured as the exposed root surface area (mm2) in the defleshed maxilla and mandible.

Results: The coefficient of variation for replicate ABL measurements was 4.4%. For the 6‐ and 8‐month age groups, ABL was significantly greater in TG rats compared to WT rats. The observed difference in ABL between TG and WT animals did not reach statistical significance for the 12‐month age group. Within each of the two animal groups (TG and WT), ABL was significantly different between age groups. The ABL rate of TG female rats was 42% to 250% greater than that of WT female rats, depending on the age range examined.

Conclusions: HLA‐B27 rats are susceptible to accelerated alveolar bone loss and could serve as an animal model of alveolar bone loss pathogenesis. J Periodontol 2000;71:1395‐1400.
The Fcγ Receptor Genotype as a Risk Factor for Generalized Early‐Onset Periodontitis in Japanese Patients
Authors: Kobayashi Tetsuo , Sugita Noriko , van der Pol W‐Ludo , Nunokawa Yasuko , Westerdaal Nomdo A.C. , Yamamoto Kouji , Van De Winkel Jan G.J. , Yoshie Hiromasa
Published: February 2005

Background: Genetic polymorphisms of immunoglobulin G (IgG) Fc receptors (FcγR) were recently shown to be associated with recurrence rates of adult periodontitis (AP). The purpose of this study was to evaluate whether FcγR polymorphisms are also associated with generalized early‐onset periodontitis (G‐EOP) in Japanese patients.

Methods: Thirty‐eight Japanese patients with G‐EOP and 83 Japanese patients with AP were identified according to established clinical criteria, including measurements of probing depth, clinical attachment level, and alveolar bone level. FcγR genotypes for 3 bi‐allelic polymorphisms were determined in these G‐EOP and AP patients and 104 race‐matched healthy controls by means of allele‐specific polymerase chain reactions.

Results: There was a significant difference in the distribution of FcγRIIIb genotypes between G‐EOP patients and healthy controls (P = 0.02). Additionally, a significant over‐representation of FcγRIIIb‐NA2 allele was observed in G‐EOP patients as compared to AP patients and controls (P = 0.02, P = 0.009, respectively). Moreover, we found a strong association between GEOP and the composite genotype comprising FcγRIIIb‐NA2 and FcγRIIIa‐158F (G‐EOP versus controls: odds ratio 2.4, 95% CI 1.0‐6.0, X2 = 4.13, P = 0.04).

Conclusions: This study indicates that the FcγRIIIb‐NA2 allele and possibly FcγRIIIa‐158F could be associated with susceptibility to G‐EOP in Japanese patients. J Periodontol 2000;71:1425‐1432.
Long‐Term Treatment With Subantimicrobial Dose Doxycycline Exerts No Antibacterial Effect on the Subgingival Microflora Associated With Adult Periodontitis
Authors: Walker Clay , Thomas John , Nangó Sonia , Lennon Jennifer , Wetzel Jeanne , Powala Christopher
Published: February 2005

Background: The purpose of this study was to determine whether treatment with subantimicrobial dose doxycycline (SDD), 20 mg bid, exerted an antimicrobial effect on the microflora associated with adult periodontitis.

Methods: Following the approval of the protocol and informed consent forms by the respective IRBs at the University of Florida and West Virginia University, 76 subjects with adult periodontitis were entered and randomly assigned to receive SDD or placebo. A split‐mouth design was utilized, with each subject receiving subgingival scaling and root planing (SRP) in two quadrants immediately following baseline data collection, while the remaining two quadrants were left unscaled (non‐SRP). Microbial samples were collected prior to treatment, after 3, 6, and 9 months of treatment, and after 3 months of no treatment. The samples were examined by microscopy and by enumeration on selective and non‐selective media.

Results: All treatments resulted in statistically significant decreases in the proportions of spirochetes and motile rods (P <0.05) and in an increase in the proportion of coccoid forms (P <0.0001) relative to baseline. No between‐treatment differences were detected between the SDD and placebo treatments in either the SRP or non‐SRP design, with the exception of the small and large spirochetal groups. The spirochetal proportions present in the SDD group were significantly lower (P <0.05) than the paired placebo group during the 9‐month treatment and was preceded by a significant decrease (P <0.01) in the proportion of microbiologic sample sites that bled on probing. No betweentreatment differences were detected in any of the other microbial parameters.

Conclusion: The microbial differences observed were attributed to the anticollagenase and anti‐inflammatory properties of SDD and not to an antimicrobial effect. J Periodontol 2000;71:1465‐1471.
Long‐Term Use of Subantimicrobial Dose Doxycycline Does Not Lead to Changes in Antimicrobial Susceptibility
Authors: Thomas John , Walker Clay , Bradshaw Mark
Published: February 2005

Background: Adjunctive subantimicrobial dose doxycycline (SDD) with scaling and root planing leads to improved clinical parameters of adult periodontitis, but has raised questions about potential changes in antibiotic susceptibility of the host microflora. Our four studies assessed whether long‐term SDD changes antibiotic susceptibility of the oral microflora in adults with periodontitis.

Methods: In studies 1 and 2, adult patients with periodontitis were randomized to receive SDD 10 mg qd, 20 mg qd, 20 mg bid, or placebo. In study 3, patients were randomized to receive SDD 20 mg bid or placebo. No medication was administered in study 4, a follow‐up to study 3. Subgingival plaque samples were collected at baseline (all studies) and at 12, 15 to 18, and 24 months (study 1); 12, 18, and 27 months (study 2); 3, 6, and 9 months (study 3); and 3 months post‐study 3 (study 4). Antimicrobial susceptibility of isolated bacteria was assessed by: 1) minimum inhibitory concentration (MIC) levels (studies 1 and 2); 2) cross‐resistance to non‐tetracycline antibiotics (studies 2 and 3); and 3) the proportion of doxycyclineresistant isolates (studies 3 and 4).

Results: Organism MIC levels remained constant among all treatment groups at 18 and 24 months compared with baseline (study 1). Observed changes in susceptibility at 12 and 18 months for the 20 mg groups were attributed to the limited number of isolates tested (study 1). There were no statistically significant differences in the proportion of doxycycline‐resistant isolates among treatment groups (studies 3 and 4), and no evidence of multi‐antibiotic resistance (studies 3 and 4) or crossresistance (studies 2 and 3) at any timepoint.

Conclusion: Long‐term SDD does not contribute to changes in antibiotic susceptibility. J Periodontol 2000;71:1472‐1483.
Effects of Erbium, Chromium:YSGG Laser Irradiation on Canine Mandibular Bone
Authors: Kimura Yuichi , Yu Da‐Guang , Fujita Akiko , Yamashita Akinori , Murakami Yoshiko , Matsumoto Koukichi
Published: February 2005

Background: Only relatively few reports have described the morphological effects on bone produced by erbium,chromium: yttrium,scandium,gallium,garnet (Er,Cr:YSGG) laser irradiation, and none has investigated the atomic changes or estimated the temperature increases involved. The objectives of this study were to investigate the morphological, atomic, and temperature changes in irradiated areas during and after laser irradiation, and to evaluate the cutting effect on canine mandibular bone in vitro.

Methods: Two canine mandibular bones were cut into 3 to 5 cm pieces and irradiated by an Er,Cr:YSGG laser utilizing a water‐air spray at 5 W and 8 Hz for 10 or 30 seconds. During and after laser irradiation, temperature increases in the irradiated areas were measured by thermography. The samples were then observed by stereoscopy and scanning electron microscopy to determine morphological changes and by energy dispersive x‐ray spectroscopy to evaluate atomic alterations.

Results: Regular holes or grooves having sharp edges and smooth walls were produced, but no melting or carbonization was observed. The maximum temperature increase was an average 12.6°C for 30‐second irradiation. The continuous time of a temperature increase of more than 10°C was consistently less than 10 seconds. An atomic analytical examination revealed that the calcium:phosphorus ratio was not significantly changed between the lased and unlased areas (P >0.01).

Conclusion: These results showed that the Er,Cr:YSGG laser cuts canine mandibular bone effectively without burning, melting, or altering the calcium:phosphorus ratio of the irradiated bone. J Periodontol 2001;72:1178‐1182.
A Sensitive Method for Detecting Porphyromonas gingivalis by Polymerase Chain Reaction and Its Possible Clinical Application
Authors: Nozaki Takenori , Kusumoto Yutaka , Kitamura Masahiro , Hirano Hiroyuki , Kohyama Akira , Hayakawa Mitsuo , Takiguchi Hisashi , Abiko Yoshimitsu , Murakami Shinya , Okada Hiroshi
Published: February 2005

Background: It is useful for the clinical diagnosis of periodontitis to monitor the colonization of periodontopathic bacteria in periodontal pockets. In this study, we attempted to establish and possibly identify the clinical application of a sensitive method to detect Porphyromonas gingivalis (P.g.), one of the putative periodontopathic bacteria related to chronic periodontitis.

Methods: Genomic DNA extracted from cultured P.g. 381 and clinically isolated subgingival plaque samples were used as a template of polymerase chain reaction (PCR). We designed primers to amplify the genomic DNA coding 40 kDa outer membrane protein (OMP), one of the unique proteins to all strains of P.g. The efficiency and specificity of amplification were evaluated by agarose gel electrophoresis and subsequent Southern hybridization with a digoxygenin‐labeled oligonucleotide probe.

Results: Fewer than 100 P.g. bacterial cells in the specimen were reproducibly detected by PCR‐hybridization assay. This PCR‐hybridization assay was at least 100 times more sensitive than the conventional indirect immunofluorescence assay (IIF). Furthermore, the imaging analysis showed that there is a linear correlation between the strength of the signal and the cell number of P.g. from which the template DNA was extracted semiquantitatively. It is noteworthy that the PCR assay could also be applied to detect P.g. from clinical plaque samples and that it was approximately 100 times more sensitive than a conventional IIF assay.

Conclusion: The PCR assay established in this study can be a powerful tool to detect P.g. in periodontal pockets and monitor the colonization and/or recolonization of P.g. at the very early phase. J Periodontol 2001;72:1228‐1235.
Leptin Within Healthy and Diseased Human Gingiva
Authors: Johnson R.B. , Serio F.G.
Published: February 2005

Background: Plasma leptin concentrations are reported to be elevated in patients with inflammatory diseases. There is no consensus concerning the biological mechanism for this phenomenon. To date, tissue leptin concentrations have not been assessed within normal or inflamed gingiva. The purpose of this study was to assess concentrations of human leptin within healthy and diseased gingiva to define its possible role in periodontal disease progression.

Methods: Healthy (non‐hemorrhagic gingiva adjacent to ≤3 mm gingival sulcus) and inflamed gingiva (hemorrhagic gingiva adjacent to a ≥3 mm periodontal pocket) were studied. Leptin, vascular endothelial growth factor (VEGF; to assess potential vascular expansion), and interleukin‐6 (IL‐6; to assess periodontal disease activity and severity) concentrations were assessed within solubilized gingival biopsies by enzyme‐linked immunosorbent assay. Data were grouped by sulcular depth and compared by factorial analysis of variance, regression analysis, and Scheffé comparisons.

Results: Leptin concentrations were highest within gingiva adjacent to a ≤3 mm sulcus and progressively declined within gingiva adjacent to a ≥3 mm sulcus. VEGF concentrations were highest within gingiva adjacent to 4 to 6 mm pockets and nearly equivalent in healthy (≤3 mm sulcus) and severely diseased gingiva (>6 mm sulcus). IL‐6 was positively correlated and leptin negatively correlated with adjacent probing depth; IL‐6 concentration was significantly higher and leptin significantly lower in gingiva adjacent to >6 mm pockets compared to sites adjacent to <6 mm pockets (P <0.001).

Conclusions: Human leptin is present within healthy and marginally inflamed gingiva and decreases in concentration as the adjacent probing depth increases. When leptin concentrations decreased (≥3 mm sulcus), VEGF concentrations increased, suggesting that leptin could be released from gingiva coincident to vascular expansion. Thus, gingiva, in addition to adipose tissue, could be a source of circulating leptin in patients with periodontal disease. This possibility requires further investigation. J Periodontol 2001;72:1254‐1257.
Oral Acanthosis Nigricans as a Marker of Internal Malignancy. A Case Report
Authors: Cairo Francesco , Rubino Ida , Rotundo Roberto , Prato Giovanpaolo Pini , Ficarra Giuseppe
Published: February 2005

Background: Acanthosis nigricans (AN) is a rare mucocutaneous condition that can involve the oral tissues. There are 2 clinical forms of AN: benign and malignant. Benign AN is related to systemic diseases such as diabetes and obesity or can be induced by drugs such as systemic corticosteroids, nicotinic acid, estrogens, insulin, and fusidic acid. Malignant AN appears in association with tumors such as lung, ovarian, breast, and gastric carcinoma.

Methods: A rare case of malignant AN that initially manifested in the oral cavity of a 73‐year‐old patient is reported.

Results: A bladder and lung carcinoma were detected following the diagnosis of AN .

Conclusions: The diagnostic importance of oral AN is emphasized because, in our patient, its recognition led to the detection of 2 occult malignant tumors. J Periodontol 2001;72:1271‐1275.
Gingival Overgrowth as the Initial Paraneoplastic Manifestation of Hodgkin's Lymphoma in a Child. A Case Report
Authors: Nicolatou‐Galitis Ourania , Papadaki Theodora , Moshovi Maria , Kamma Joanna J. , Van Vliet‐Constantinidou Cathrine , Tsoumakas Constantine , Kattamis Antonis , Tzortzatou‐Stathopoulou Fotini
Published: February 2005

Background: The purpose of this paper is to present the first case of gingival overgrowth, premature root resorption, and alveolar bone loss, which preceded the diagnosis of a stage IVB Hodgkin's lymphoma (HL) in a 9‐year‐old boy.

Methods: The child presented complaining of gingival pain which first appeared 3 months prior. Clinical examination revealed inflamed, hyperplastic gingivae, while x‐ray showed premature root resorption and alveolar bone loss. Medical work‐up was significant for cervical lymphadenopathy. Gingival biopsy, followed by lymph node resection, was performed twice.

Results: Histological examination of both gingival biopsies disclosed a mixed inflammatory infiltrate, while classical Hodgkin's lymphoma of the nodular sclerosis type was diagnosed from the second lymph node biopsy. Chemotherapy was instituted with mustard‐vincristine‐procarbazine‐prednizone and adriamycine‐bleomycine‐vinblastine‐dacarbazine. Remission of the lymphoma was observed with concomitant regression of the gingival overgrowth.

Conclusions: The inflammatory gingival overgrowth, premature root resorption of deciduous teeth, and alveolar bone loss in this case, in conjunction with the regression of gingival overgrowth which followed the completion of chemotherapy, are strongly indicative of a paraneoplastic manifestation of HL. The postulated mechanism for the development of the manifestation is the constitutive activation of the transcription factor NF‐κB. The gingival inflammatory reaction was probably further aggravated by the bacterial‐stimulated cytokine secretion released by monocytes. J Periodontol 2001;72:107‐112.
Detection of Hepatitis C Virus RNA From Gingival Crevicular Fluid and Its Relation to Virus Presence in Saliva
Authors: Matičičr Mojca , Poljak Mario , Kramar Barbara , Seme Katja , Brinovec Vladimir , Meglič‐Volkar Jelka , Zakotnik Branko , Skalerič Uroš
Published: February 2005

Background: To search for a possible source of hepatitis C virus (HCV) in saliva, the presence and shedding patterns of HCV in gingival crevicular fluid (GCF) and saliva of HCV viremic patients were assessed based on clinical, biochemical, histological, virological, and oral health parameters.

Methods: Saliva and GCF samples of 50 HCV viremic patients were collected to detect HCV RNA by a modified commercial polymerase chain reaction (PCR) assay. Clinical oral examination was performed and periodontal status at the collection sites was monitored. The results were correlated to specified parameters.

Results: HCV RNA was detected in 59% (29/49) of the GCF specimens and in 35% (17/48) of the saliva specimens. In saliva specimens, HCV RNA was detected only in cases which also had detectable HCV RNA in the GCF samples (P = 0.00002) and was significantly related to the presence of blood in saliva (P = 0.03). Higher, but not significant, values of oral clinical parameters at the sites of fluid collection were found in GCF specimens harboring HCV RNA. In GCF specimens with no blood detected, HCV RNA was more often present in cases with higher plasma viral load (P = 0.05).

Conclusions: The results suggest that besides blood, the other most probable source of HCV in saliva is GCF. Unknown endogenous HCV inhibitory mechanisms in the oral cavity may explain the discrepancies in HCV appearance between saliva and GCF. The results provide a biologic basis for further investigation of the role of HCV in the pathogenesis of periodontal disease. J Periodontol 2001;72:11‐16.
Relationship Between Crevicular Aspartate Aminotransferase Levels and Periodontal Disease Progression
Authors: Oringer Richard J. , Howell T. Howard , Nevins Marc L. , Reasner David S. , Davis Gordon H. , Sekler Julio , Fiorellini Joseph P.
Published: February 2005

Background: Aspartate aminotransferase (AST), an enzyme released from necrotic cells, has been identified in gingival crevicular fluid (GCF), and elevated levels are associated with periodontal tissue destruction. The aim of this study was to examine the relationship between elevated GCF levels of AST and periodontal disease progression.

Methods: Over a 12‐month period, 8 to 10 interproximal sites in 41 periodontitis subjects (PS) and 15 healthy subjects (HS) were monitored. Clinical measurements included relative attachment level (RAL), probing depth, and bleeding on probing (BOP). Semiquantitative levels of GCF AST (<800 µIU, ≥800 µIU, and ≥1,200 µIU) were determined using a chairside assay. At the 6‐and 12‐month visits, scaling and root planing and prophylaxis were performed in the PS and HS, respectively. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were calculated for 2 diagnostic criteria (AST ≥800 µIU, AST ≥1,200 µIU) utilizing 4 thresholds of disease progression as determined by 2 methods (absolute change in relative attachment level and cumulative sum [CUSUM]).

Results: The percentage of sites exhibiting AST ≥800 µIU, AST ≥1,200 µIU, and BOP in the PS was significantly (P <0.02) lower at 6 and 12 months compared to baseline. The use of crevicular AST activity to monitor periodontal disease progression was associated with many false‐positive results. Overall, low specificities, PPV, and odds ratios were demonstrated by the assay when using 2 diagnostic criteria and 4 thresholds of disease progression. The high NPV suggest that a negative AST test result was indicative of a periodontally stable site.

Conclusions: These results demonstrate that elevated levels of AST were present at sites that did not subsequently exhibit disease progression. The high prevalence of AST‐positive sites due to gingival inflammation diminished the test's ability to discriminate between progressive and stable, but inflamed, sites. J Periodontol 2001;72:17‐24.
Long‐Term Results of Guided Tissue Regeneration Therapy With Non‐Resorbable and Bioabsorbable Barriers. I. Class II Furcations
Authors: Eickholz Peter , Kim Ti‐Sun , Holle Rolf , Hausmann Ernest
Published: February 2005

Background: The aim of this 5‐year follow‐up study was to clinically and radiographically evaluate the long‐term results after guided tissue regeneration (GTR) therapy of Class II furcation defects using non‐resorbable and bioabsorbable barriers.

Methods: Nine pairs of contralateral Class II furcation defects were treated in 9 patients with advanced periodontitis. Within each patient, one defect received a non‐resorbable (expanded polytetrafluoroethylene [ePTFE]; control, C) barrier and the other a bioabsorbable (polyglactin 910; test, T) barrier by random assignment. At baseline, 6, and 60 ± 3 months after surgery, clinical parameters and standardized radiographs were obtained. Gain of bone density within furcation areas was assessed using subtraction radiography.

Results: Six and 60 months after GTR therapy, statistically significant (P <0.05) horizontal attachment (CAL‐H) gain was observed in both groups (C6: 1.7 ± 0.8 mm; C60: 1.6 ± 1.2 mm; T6: 2.0 ± 0.7 mm; T60: 2.2 ± 0.9 mm). However, 1 furcation assessed as Class I six months after GTR therapy with a bioabsorbable barrier had progressed to Class III after 5 years, and in another patient, 5 years after placement of an ePTFE barrier, 1 furcation had lost all the CAL‐H gain that had been observed at 6 months. Subtraction analysis revealed similar area gain in both groups 6 and 60 months postsurgically (C6: 0.3 ± 0.5; C60 1.0 ± 1.7; T6: 0.4 ± 0.4; T60: 1.1 ± 1.7).

Conclusions: CAL‐H gain achieved after GTR therapy in Class II furcations was stable after 5 years in 16 of 18 defects. The study failed to show a statistically significant difference in stability of CAL‐H gain between control and test groups 5 years after GTR therapy. J Periodontol 2001;72:35‐42.
Cigarette Smoking Negatively Affects Healing Response Following Flap Debridement Surgery
Authors: Scabbia Alessandro , Cho Kyoo‐Sung , Sigurdsson Thorarinn J. , Kim Chong‐Kwan , Trombelli Leonardo
Published: February 2005

Background: The purpose of the present parallel design, controlled clinical trial was to evaluate the treatment outcome following flap debridement surgery (FDS) in cigarette smokers compared to non‐smokers.

Methods: After initial therapy, 57 systemically healthy subjects with moderate to advanced periodontitis who presented with one area (at least 3 teeth) where surgery was required were selected. Twenty‐eight patients (mean age: 39.6 years, 20 males) were smokers (≥10 cigarettes/day); 29 patients (mean age: 43.9 years, 7 males) were non‐smokers. Full‐mouth plaque (FMP) and bleeding on probing (BOP) scores, probing depth (PD), clinical attachment level (CAL), and recession depth (RD) were assessed immediately before and 6 months following surgery. Only sites with presurgery PD ≥4 mm were used for statistical analysis.

Results: Presurgery FMP and BOP were similar in smokers and non‐smokers and significantly decreased postsurgery in both groups. Overall, PD reduction and CAL gain were greater, although not significantly, in non‐smokers (2.4 ±0.9 mm and 1.6 ±0.7 mm, respectively) than in smokers (1.9 ±0.7 mm and 1.2 ±0.7 mm, respectively). For moderate sites (PD 4 to 6 mm), no significant differences in PD and CAL changes were found between groups. For deep sites (PD ≥7 mm), PD reduction was 3.0 ±1.0 mm in smokers and 4.0 ±0.8 mm in non‐smokers, and CAL gain amounted to 1.8 ±1.1 mm in smokers and 2.8 ±1.0 mm in nonsmokers (P = 0.0477). In smokers, 16% of deep sites healed to postsurgery PD values ≤3 mm as compared to 47% in non‐smokers (P = 0.0000); 58% of deep sites in smokers showed a CAL gain ≥2 mm, as compared to 82% in non‐smokers (P = 0.0000).

Conclusions: Results of the study indicated that: 1) FDS determined a statistically significant PD reduction and CAL gain in patients with moderate to advanced periodontitis; 2) smokers exhibited a trend towards less favorable healing response following FDS compared to non‐smokers, both in terms of PD reduction and CAL gain; and 3) this trend reached clinical and statistical significance at sites with initial deep PD. J Periodontol 2001;72:43‐49.
Relationship of Sulcular Sulfide Level to Severity of Periodontal Disease and BANA Test
Authors: Morita Manabu , Wang Hom‐Lay
Published: February 2005

Background: Volatile sulfur compounds (VSC), such as hydrogen sulfide and methyl mercaptan, are toxic metabolites produced by periodontal pathogens. Their relationship to periodontal disease severity is not yet fully understood. Hence, the aims of this study were to: 1) examine the relationship between sulcular sulfide (pS) levels and severity of periodontal disease and 2) examine the link between pS level and the BANA (benzoyl‐DLarginine‐naphthylamide) test.

Methods: Seventy systemically healthy subjects with a mean age of 53.0 ± 13.8 years participated. Three sites were selected from each subject based upon radiographic bone loss (RBL): RBL <2 mm, healthy; RBL≥2 to <4, low to moderate; RBL≥4 mm, severe. Periodontal parameters, probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP), were recorded. The pS level was measured using a portable sulfide monitor in a digital score ranging from 0.0 (<10‐7 M of S) to 5.0 (≥10‐2 M of S) in increments of 0.5. The presence of specific bacteria in subgingival plaque was detected using BANA test.

Results: The mean pS level was 0.10 ± 0.23, 0.36 ± 0.48, and 1.10 ± 0.87 for healthy, low to moderate, and severe disease sites, respectively, and was statistically different (P <0.001). The pS level was positively correlated with the BANA test, and was higher in untreated subjects than maintenance subjects (P <0.01).

Conclusions: The pS level may be a potential indicator for detecting severity of periodontal disease and identifying bacteria that are capable of hydrolyzing BANA. J Periodontol 2001; 72:74‐78.
Interactions of Lymphotoxin α (TNF‐β), Angiotensin‐Converting Enzyme (ACE), and Endothelin‐1 (ET‐1) Gene Polymorphisms in Adult Periodontitis
Authors: Hollá Lydie Izakovičová , Fassmann Antonín , Vašků Anna , Znojil Vladimír , Vaněk Jiří , Vácha Jiří
Published: February 2005

Background: Adult periodontitis is a complex multifactorial disease whose etiology is not well defined. To investigate whether the genes encoded within the HLA class III region may confer susceptibility to periodontitis, polymorphisms in the ET‐1 and TNF‐β genes were analyzed together with the I/D polymorphism of the ACE gene.

Methods: We determined allele and genotype frequencies of the NcoI bi‐allelic polymorphism of the TNF‐β gene, the I/D (insertion/deletion) polymorphism of the ACE gene, and the TaqI polymorphism of the ET‐1 gene in 63 Caucasian patients with adult periodontitis and 95 orally healthy controls.

Results: We found a significant difference in a 3 locus combination of genotypes between patients and controls (P <0.05). In the next analyses, no significant differences were found in allele frequencies of single genes, but we did find a significant difference in the genotype distribution between cases and controls for TNF‐β (P <0.03). Differences were also observed for 2 locus combinations of ACE and TNF‐β genotypes (P <0.03), and the ET‐1 and TNF‐β (P <0.05) genes. Evidence of deviation from Hardy‐Weinberg equilibrium was observed in the periodontitis group for TNF‐β, with an absence of the B1B1 homozygotes in patients.

Conclusions: This study is of an exploratory nature. Considering the number of significant results, however, at least a part of the observed associations may obviously be real and our findings suggest that interactions of the TNF‐β, ET‐1, and ACE genes may be involved in susceptibility to adult periodontitis. J Periodontol 2001;72:85‐89.
Tobacco Smoking and Neutrophil Activity in Patients With Periodontal Disease
Authors: Persson Lena , Bergström Jan , Ito Hiroshi , Gustafsson Anders
Published: February 2005

Background: Tobacco smoking has considerable negative effects on periodontal health. The mechanisms behind these effects are incompletely understood but may be related to the host response. The aim of the present study was to investigate the influence of tobacco smoking on the gingival crevicular fluid (GCF) levels of elastase, lactoferrin (LF), α‐1‐antitrypsin (α‐1‐AT), and α‐2‐macroglobulin (α‐2‐MG) under periodontally diseased conditions.

Methods: The study population included 15 smokers (5 women and 10 men) aged 34 to 69 years and 17 non‐smokers (5 women and 12 men) aged 31 to 81 years. Clinical registration of gingival index (GI), plaque index (PI), probing depth, as well as sampling of GCF were made at 3 sites with severe lesions and 3 sites with moderate lesions in each individual. The elastase activity was measured with a chromogenic low molecular substrate and the LF, α‐1‐AT, and α‐2‐MG concentrations with ELISA.

Results: The results showed that, with regard to severe lesions, smokers had a significantly lower concentration of α‐2‐MG as well as significantly lower total amounts of α‐2‐MG and α‐1‐AT than non‐smokers. With regard to moderate lesions, smokers tended to exhibit a lower concentration of α‐2‐MG, but the difference was not statistically significant. Comparing moderate and severe lesions, smokers exhibited no gradual increase with disease severity in contrast to non‐smokers, who showed significantly or almost significantly increased levels of LF and α‐2‐MG in severe as compared to moderate lesions.

Conclusions: The present results indicate that the levels of α‐2‐MG and α‐1‐AT are suppressed in smokers with periodontitis, suggesting that smoking interferes with these protease inhibitors. This may be one mechanism by which smoking affects the inflammatory response. J Periodontol 2001;72:90‐95.
A Multidisciplinary Approach to the Diagnosis and Treatment of Early‐Onset Periodontitis: A Case Report
Authors: Worch Kai P. , Listgarten Max A. , Korostoff Jonathan M.
Published: February 2005

Background: The diagnosis and treatment of earlyonset forms of periodontitis (EOP) represent a major challenge to periodontists. In this case report, we describe a multidisciplinary approach for the treatment of a patient with severe generalized juvenile periodontitis (GJP). Our approach incorporates clinical laboratory evaluation with conventional concepts of periodontal pathogenesis and therapeutics to diagnose and effectively treat EOP.

Methods: The 17‐year‐old female patient presented with clinical and radiographic evidence of severe attachment loss. Microbiological testing showed the presence of known periodontal pathogens including Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Routine immunological tests did not reveal any of the functional defects thought to play a role in the pathogenesis of EOP. After initiation of therapy, which consisted of scaling and root planing, supplemented with administration of systemic antibiotics, a reduction in probing depth and gain in clinical attachment could be demonstrated. Microbiological testing was used to monitor the composition of the periodontal microbiota and to adjust antimicrobial therapy accordingly.

Results: Using a non‐surgical approach to treatment, except for 2 root amputations performed without flap reflection, we have been able to stabilize this patient's periodontal condition over the course of a 2‐year follow‐up period.

Conclusions: This treatment strategy provides an efficacious alternative to more aggressive forms of therapy and should therefore be considered for the treatment of patients with severe EOP. J Periodontol 2001;72:96–106.
Effect of Diode Laser Irradiation on the Attachment Rate of Periodontal Ligament Cells: An In Vitro Study
Authors: Kreisler Matthias , Meyer Christine , Stender Elmar , Daubländer Monika , Willershausen‐Zönnchen Britta , d'Hoedt Bernd
Published: February 2005

Background: The present study is part of a basic research program investigating the cellular effects of an 810 nm GaAlAsdiode laser on human periodontal tissues. The aim of the investigation was to evaluate the effects of laser treatment of root surface specimens on the attachment of periodontal ligament (PDL) cells in vitro.

Methods: Root specimens were prepared from periodontally diseased teeth. PDL cells were obtained from human third molar ligaments. Cells were cultured under simple, standardized, and reproducible experimental conditions. One hundred fifty root specimens were scaled and root planed with curets followed by air‐powder abrasive treatment; 75 were then lased and 75 served as controls. The irradiation time was 20 seconds at a power output of 1 W. The root segments were placed into culture dishes, covered with a solution of PDL cells, and incubated for 72 hours. The specimens were then washed with phosphate buffer to remove cells not attached to the surface, and the adherent cells were stained with methylene blue. Cells were counted using a reflected light microscope and the cell density per mm2 was calculated.

Results: The analysis of 150 specimens revealed no signifi‐cant differences between the groups (P = 0.347, Wilcoxon test). The cell numbers, however, were slightly higher on laser specimens. The mean was 66 cells/mm2 in the laser group and 63.7 cells/mm2 in the control group.

Conclusions: The application of the diode laser at the parameters used did not have a substantially positive effect on the new attachment of PDL cells on the tooth specimens. It remains to be investigated whether the difference detected is really clinically relevant. J Periodontol 2001;72:1312‐1317.
Phagocytosis of Fibronectin and Collagens Type I, III, and V by Human Gingival and Periodontal Ligament Fibroblasts In Vitro
Authors: van der Pauw Monique T. , Van den Bos Theo , Everts Vincent , Beertsen Wouter
Published: February 2005

Background: Electron microscopic studies have suggested that the volume density of collagen‐containing vacuoles in fibroblasts is higher in the periodontal ligament (PDL) than in the gingiva. Whether this difference reflects intrinsic differences in phagocytic capacity among the cells in these tissues is not known.

Methods: PDL and gingival fibroblasts were isolated from subjects and cultured under identical conditions in the presence of fluorescent beads coated with collagen type I, III, or V or fibronectin. Control beads were coated with bovine serum albumin or an enamel matrix protein mixture that does not constitute part of the extracellular matrix of PDL and gingiva. After various time intervals (1 to 24 hours), the percentage of cells that had internalized beads was assessed by flow cytometry. Since alkaline phosphatase activity has been suggested to play a role in collagen phagocytosis, the activity of this enzyme was determined for all cell populations.

Results: The results demonstrated the following order in the percentage of cells internalizing protein‐coated beads: fibronectin > collagen type I > III > V. Internalization of collagen type Icoated beads exceeded that of beads coated with bovine serum albumin or enamel matrix proteins by 6 and 3 times, respectively. No differences were observed in collagen phagocytic activity between PDL and gingival fibroblasts, and no relationship could be demonstrated between collagen phagocytosis and alkaline phosphatase activity.

Conclusions: We conclude that differences in collagen phagocytosis between PDL and gingiva, as observed in vivo, are not likely to be explained in terms of intrinsic phagocytic capacities of these cells. J Periodontol 2001;72:1340‐1347.
Alveolar Bone Resorption Following Coronal Versus Apical Approach in a Mucoperiosteal Flap Surgery Procedure in the Rat Mandible
Authors: Binderman I. , Adut M. , Zohar R. , Bahar H. , Faibish D. , Yaffe A.
Published: February 2005

Background: In several publications, we have reported that a distinct resorptive phase of alveolar bone developed during 3 weeks following elevation of a mucoperiosteal flap in rats by a coronal surgical approach. In the present study, we compared the alveolar bone loss after mucoperiosteal flap surgery by a coronal approach (COR) to a surgical approach incising the mucosa close to the tooth apices and separating the mucoperiosteum toward the tooth crown (apical approach, AP).

Methods: Eighteen Wistar rats were divided into 2 experimental groups; each group consisted of 9 rats. In the first group, COR was performed on both buccal and lingual aspects on the right side of the rat mandible, while the left side served as a sham‐operated control. In the second experimental group, AP was performed.

Results: In the AP group, the outer aspect (buccal or lingual) of the alveolar bone was slightly resorbed usually at the level where the mucosa was incised. In many sections, extensive modeling of new trabecular bone was seen, coronal to the surgical incision. On the contrary, the coronal surgical approach revealed an extensive resorptive phase, mainly of the periodontal aspect of the alveolar bone.

Conclusions: The results of this study show that periodontal surgery by a coronal surgical approach stimulates a burst of remodeling of the alveolar bone in a very specific pattern. J Periodontol 2001;72:1348‐1353.
The Effect of an Immunosuppressive Therapy and Its Withdrawal on Bone Healing Around Titanium Implants. A Histometric Study in Rabbits
Authors: Duarte Poliana M. , Nogueira Filho Getúlio R. , Sallum Enilson A. , de Toledo Sérgio , Sallum Antonio W. , Nociti Francisco H.
Published: February 2005

Background: Immunosuppressive agents have been recognized as a factor affecting bone metabolism. We investigated the consequences of the administration and withdrawal of cyclosporin A/nifedipine on bone around titanium implants to observe whether these changes occur and if they are reversible.

Methods: Twenty‐eight New Zealand rabbits were included in the study. Following anesthesia, the tibiae surface was exposed, and 2 screw‐shaped implants 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. The animals were randomly assigned to 1 of 4 experimental groups and received daily subcutaneous injections for 14 days: groups A and C were injected with vehicle while groups B and D received cyclosporin A (10 mg/kg) plus nifedipine (0.5 mg/kg). Groups A and B were sacrificed 14 days and groups C and D 42 days postoperatively. The degree of bone contact with the implant surface and the bone area within the limits of the threads of the implant were measured.

Results: Intergroup analysis revealed no significant difference (P >0.05) in the degree of bone contact with the implant surface between the control and test groups on days 14 and 42. In contrast, the treated animals demonstrated a significant (P <0.05) decrease in the bone area within the limits of the threads of the implant in both periods.

Conclusions: The data of the present study suggest that the use of cyclosporin A/nifedipine may influence bone healing around titanium implants. This observation may have important clinical implications. J Periodontol 2001;72:1391‐1397.
Mechanisms of Actinobacillus Actinomycetemcomitans‐Induced Expression of Interleukin‐8 in Gingival Epithelial Cells
Authors: Sfakianakis Andreas , Barr Charles E. , Kreutzer Don
Published: February 2005

Background: Gingival epithelial cells (GEC) are the first cells of the periodontium to encounter known periodontal pathogens, such as Actinobacillus actinomycetemcomitans (A.a.) and, therefore, the role of this pathogen in the initiation of the inflammatory response is critical. However, little is known about the interactions of A.a. with GEC. In the present study, the mechanisms by which extracts from A.a. induced expression of the chemotactic cytokine interleukin‐8 (IL‐8) in GEC, in vitro, were examined.

Methods: An established GEC line, PP, was co‐cultured with sonicated extracts of A.a. under various in vitro experimental conditions, and the IL‐8 secretion was determined with enzymelinked immunosorbent assay.

Results: A.a. extracts induced a time‐ and dose‐dependent expression of IL‐8 from the cells. Dose‐response studies indicated that the highest IL‐8 secretion (7‐fold, P <0.01) was at the level of 50 µg/ml of A.a. extract. Time‐course studies revealed a dramatic increase of IL‐8 expression after 12 hours of continuous stimulation. Pretreatment with polymyxin B (lipopolysaccharide [LPS] inhibitor) did not reduce the IL‐8 expression induced by A.a. extracts (P >0.10). The introduction of p38 mitogen‐activated protein kinase (MAPK) inhibitor SB 203580 markedly inhibited (>75%, P <0.01) A.a.‐induced expression of IL‐8. It is concluded that A.a. extracts upregulated the basal IL‐8 expression in GEC.

Conclusions: The effect was LPS‐independent and involved a p38 MAPK signal transducing pathway. Understanding mechanisms of proinflammatory cytokine induction is important in periodontal pathology as it may lead to novel therapeutic approaches for periodontitis, thus controlling host inflammatory responses. J Periodontol 2001;72:1413‐1419.
A Possible “Rescue” Procedure for Dental Implants With a Textured Surface Geometry: A Case Report
Authors: Deporter Douglas A. , Todescan Reynaldo
Published: February 2005

Dental implants with textured surfaces are a valuable adjunct in restoring edentulous sites of poor bone quality and quantity, but on occasion may become denuded of bone and require “rescue.” We report here the successful management of an intrabony crater affecting a single porous‐surfaced dental implant using a combination of citric acid decontamination and grafting with freeze‐dried, demineralized allograft covered with a barrier of calcium sulfate. J Periodontol 2001;72:1420‐1423.
Subperiosteal and Intraosseous Connective Tissue Grafts for Pocket Reduction: A 9‐ To 13‐Year Retrospective Case Series Report
Authors: Nelson Stephen W.
Published: February 2005

Background: Recent histological evidence has documented that grafted palatal connective tissue is capable of forming a new attachment to previously exposed roots in the treatment of gingival recession. No clinical studies have tested the ability of connective tissue that has been implanted beneath the periosteum into periodontal osseous defects to reduce probing depth and increase clinical attachment levels. This study reports the long‐term clinical effect of subperiosteal and intraosseous connective tissue grafts on deep periodontal pockets.

Methods: Connective tissue (CT) grafts were placed in 32 periodontal pockets on 27 patients. Grafts were classified into 3 groups. Type I grafts had 50% or more vascular surface contact and were ≤2.5 mm thick. Type II grafts had 50% or more contact but were >2.5 mm thick, and Type III grafts had less than 50% vascular contact regardless of thickness. Twelve of 14 Type I sites, 9 of 15 Type II sites, and 3 of 3 Type III sites were analyzed 9 to 13 years following treatment.

Results: Clinical attachment level change differed significantly between the graft types on survivor teeth (P <0.05): Type III had 2 mm loss (95% confidence interval [CI]: 0.4 to 3.6), while Type II and Type I grafts had a 2.7 mm gain (95% CI: 2.0 to 3.4) and 4.3 mm gain (95% CI: 3.3 to 5.2), respectively. Similar substantial differences were presented for changes in probing depth and recession.

Conclusions: This long‐term (9 to 13 years) retrospective case‐series analysis suggests substantial improvements in periodontal clinical measures for Type I CT grafts in deep periodontal pockets. Randomized trials are required to evaluate this promising procedure. J Periodontol 2001;72:1424‐1435.