bluuebunny/crossref_metadata_2025 huggingface dataset:
Periodontal Disease and Mortality From All Causes in the VA Dental Longitudinal Study
Authors: Garcia Raul I. , Krall Elizabeth A. , Vokonas Pantel S.
Published: October 2010

The role that oral conditions may play as risk factors or indicators for various medical outcomes, including mortality, is not well understood. We have examined the relationship of periodontal disease to mortality from all causes in the VA Dental Longitudinal Study and Normative Aging Study, a prospective cohort study of the determinants of disease in aging men. Subjects were screened for entry into the closed‐panel cohort in the mid‐1960s, based on good medical health. They are not VA patients. We have used proportional hazards regression models to assess the relationship of periodontal health status at baseline to all‐cause mortality over a 25+‐year follow‐up period. A total of 804 dentate subjects who were alive and medically healthy through their first follow‐up exam were used in the analysis; of these, 166 died during subsequent follow‐up through December 1996. Survival was calculated in years from baseline exam to death or censoring (most recent study examination date). To define periodontal health status at baseline, we separately used radiographic alveolar bone loss (ABL) (person‐level scores of mean whole‐mouth % ABL, measured with a Schei ruler using full‐mouth series of periapical films) and periodontal clinical probing depths. Covariates included age at baseline, and assessments at baseline of smoking and alcohol use, education, body mass index, serum cholesterol, white blood cell count, blood pressure, family history of heart disease, and number of teeth present. We found that periodontal status at baseline was a significant and independent predictor of mortality in this cohort, while controlling for other recognized predictors in multivariate models. For each 20% increment in mean whole‐mouth ABL, the subject's risk of death increased by 51% (RR = 1.51; 95%o CI = 1.11 – 2.04). The increase in risk attributable to periodontal status was found to be similar in magnitude to, and independent of, that attributable to cigarette smoking in this cohort. While the increased risk due to smoking was 1.52‐fold (95% CI = 1.06 – 2.19), being in the population quintile with highest ABL scores (i.e., worst periodontal status) was associated with a 1.85‐fold increase in risk (95% CI = 1.25 – 2.74) using multivariate analyses. The hypothesis that chronic oral infections, as in periodontitis, may have important systemic sequelae merits further investigation in prospective controlled studies. Ann Periodontol 1998;3:339–349.
Early‐Onset Periodontitis Associated With Down's Syndrome–A Clinical Interventional Study
Authors: Cichon P. , Crawford L. , Grimm W‐D
Published: October 2010

Individuals with Down's syndrome (DS) have an increased prevalence of periodontal disease compared with otherwise normal, age‐matched control groups and other mentally handicapped patients of similar age distribution. The exaggerated immune‐inflammatory response of the tissues cannot be explained by poor oral hygiene alone and might be the result of an impaired cell‐mediated and humoral immunity and a deficient phagocytic system. As far as the progression and severity of destruction, the oral manifestations of DS patients are consistent with the juvenile periodontitis (JP) disease pattern. The purpose of the present study was 1) to assess the periodontal clinical and microbiological status of 10 DS patients aged 20 to 31 years (mean: 26.3 years) relative to that of 11 patients with cerebral palsy (CP) aged 23 to 53 years (mean: 36 years) without defective immunological functions, and 2) to determine the effect of supragingival plaque control and oral hygiene instruction in these patient groups. Subsequent to the initial examination and a professional tooth cleaning program, clinical and microbiological parameters were monitored over a period of 12 weeks. The clinical examination included the recording of plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL). Subgingival plaque samples were always obtained from the same pocket with the highest disease activity (deepest bleeding site at baseline examination) in each subject for a morphotype analysis by dark‐field microscopy and for identification and quantitation of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Eikenella corrodens, Bacteroides forsythus, Fusobacterium nucleatum, Treponema denticola, and Campylobacter rectus by DNA probes. The results of the baseline examinations demonstrated that DS patients and patients with cerebral palsy had inflamed gingiva associated with a high amount of plaque. The mean probing depth and percentage of sites with probing depth ≥ 4 mm corresponded to age and poor oral hygiene in CP patients. Deep pockets in DS patients demonstrated a high prevalence of periodontal disease compared with agematched children with mental retardation and non‐handicapped patients. Regarding the young age of onset, the severe destruction of periodontal tissues and pathogenesis of periodontitis in DS patients are consistent with the juvenile periodontitis disease pattern. The missing clinical benefit and alteration of the subgingival flora following supragingival plaque control in DS patients underlined the alteration in the immunological response. Ann Periodontol 1998;3:370–380.
Alterations of Neutrophil Oxidative Burst by In Vitro Smoke Exposure: Implications for Oral and Systemic Diseases
Authors: Ryder Mark I. , Fujitaki Ron , Johnson Greg , Hyun William
Published: October 2010

Alterations of neutrophil functions by tobacco products may play a central role in the pathogenesis of periodontal diseases and several smoking‐related systemic diseases. In the present study, we examined the in vitro effects of cigarette smoke on neutrophils at times and concentrations that may be encountered during smoke exposure. We measured the level of smoke exposure in the in vitro system by measuring the levels of nicotine and comparing these to levels in the oral cavity in smokers before and after smoking. We examined both the unstimulated and stimulated release of 2 oxidative burst products: Superoxide (O2−) and hydrogen peroxide (H2O2). Salivary washings were collected from 7 smokers (> 1 pack/day) before smoking a cigarette. Immediately after they smoked a cigarette, a second set of washings was collected. In vitro exposure to smoke involved incubating aliquots of neutrophils in phosphate‐buffered saline for 1 to 5 minutes. Nicotine and cotinine levels were quantitated using gas chromatography, with detection by electron impact mass spectrometry. Peripheral neutrophils were isolated from medically healthy non‐smoking volunteers via a doubledensity gradient technique and incubated in vitro with whole cigarette smoke for 0 to 5 minutes. Phorbol myristate acetate (PMA; 10−7 M) was used to stimulate half of the cell aliquots. Superoxide generation was assessed through the Superoxide dismutase (SOD) inhibitable reduction of ferricytochrome c. H2O2 production was assessed through the H2O2‐dependent breakdown of dichlorofluorescin diacetate to its fiuorophore and measured by flow cytometry. There was a marked elevation in salivary nicotine concentration from before smoking (mean: 80.8 ng) to after smoking (mean: 1,685 ng/mL). In the in vitro smoke box system, there was a time‐related elevation in nicotine from 1 to 5 minutes (50→136 ng/mL). In PMA‐stimulated cells exposed to smoke, there was a time‐related inhibition of both Superoxide and H2O2 production. However, in unstimulated cells exposed to smoke, there was a time‐related increase in the release of Superoxide and H2O2. A novel finding in unstimulated cells exposed to smoke was that there appeared to be 2 distinct populations of cells—one of “high” H2O2 producers and one of “low” H2O2 producers. The proportion of high H2O2 producers increased relative to smoke exposure. The relative production of H2O2 in the unstimulated high producers was comparable to PMA‐stimulated cells at 5 minutes. This release of Superoxide and H2O2 in unstimulated cells exposed to smoke may alter the pathogenic processes both in periodontal diseases and other systemic diseases. Ann Periodontol 1998;3:76–87.
Cigarette Smoking and Periodontal Diseases: Etiology and Management of Disease
Authors: Tonetti Maurizio S.
Published: October 2010

Cigarette smoking has long been suspected to be associated with a variety of oral conditions including periodontal diseases. Experimental evidence accumulated over the last 2 decades has indicated that cigarette smoking is probably a true risk factor for periodontitis. This environmental exposure has been associated with 2‐ to 3‐fold increases in the odds of developing clinically detectable periodontitis. Smokers have both increased prevalence and more severe extent of periodontal disease, as well as higher prevalence of tooth loss and edentulism, compared to non‐smokers. The greater severity of periodontal destruction may be partly accounted for by the reported increases in the rate of periodontal disease progression. The noxious effect of smoking has been shown to be dose dependent and to be particularly marked in younger individuals; in these subjects, up to 51% of the observed risk of periodontitis was associated with smoking. Much of the literature has also indicated that smokers affected with periodontitis respond less favorably to both non‐surgical, surgical, and regenerative periodontal treatments. The success rate of dental implants has also been shown to be compromised in smokers. Furthermore, longterm studies have pointed out that smoking was associated with recurrence of periodontitis during periodontal maintenance; the effect appeared to be dose dependent, with heavy smokers (> 10 cigarettes I day) presenting with higher levels of disease progression. The indication that previous smokers have lower levels of risk for periodontitis compared to current smokers is considered to be the strongest available evidence that smoking cessation will result in improved periodontal health and that smoking cessation counseling should be an integral part of periodontal therapy and prevention. So far, however, no randomized controlled clinical trial establishing the effect of smoking cessation and/or reduction on the periodontal outcomes has been reported. Given the present state of uncertainty about the periodontal benefits, but in light of the established general health gains for the patient that could be derived from a smoking cessation program, practitioners are incorporating smoking cessation counseling as an integral part of periodontal therapy. Furthermore, smoking status represents a key parameter to assess the periodontal risk of an individual subject and therefore to make evidence‐based clinical decisions. Ann Periodontol 1998;3:88–101.
Some Microbiological and Histopathological Features of Periodontal Disease in Man
Authors: Lindhe J. , Liljenberg B. , Listgarten M.
Published: October 2010

The present investigation was designed to study the microbial flora of periodontal pockets and certain histopathological features of adjacent tissues from healthy and diseased sites in humans. Twenty‐two individuals, aged 21 to 28 years, participated in the study. They were selected on the basis of advanced periodontal disease in at least 2 areas of the dentition where pockets could be probed to 8 mm or more and where 50% of the alveolar bone had been lost. In other areas of the dentition sites were found where no bone loss was discernible and where the gingiva was either “healthy” or showed signs of “established gingivitis.” In each patient six sites were selected; two sites with “advanced disease,” two sites with “established gingivitis” and two sites with “healthy gingiva.” From these sites bacterial samples were obtained and subjected to an examination by darkfield microscopy involving the identification of coccoid cells, straight, motile and curved rods, filaments, fusiforms and spirochetes. Biopsies of the adjacent gingival tissues were processed for histology. The infiltrated portion of the connective tissue was subjected to an analysis based on morphometric point counting. The results revealed that different microbiotas were associated with “healthy,” “established gingivitis” and “advanced disease” sites in humans. With increasing degrees of severity of the disease the relative number of motile organisms increased while coccoid cells and straight rods decreased. The composition of the cellular infiltrates in tissues characterized as “healthy,” “established gingivitis” and “advanced disease” differed markedly. Fibroblasts and lymphocytes were found to dominate the lesion in “healthy” units, with plasma cells and blast cells showing a gradual increase in units of “established gingivitis” and “advanced disease.”
Prevention of Phenytoin Associated Gingival Enlargement—A 15‐Month Longitudinal Study
Authors: Pihlstrom Bruce L. , Carlson Jeffery F. , Smith Quenton T. , Bastien Susan A. , Keenan Kathleen M.
Published: October 2010

The purpose of the present study was to investigate on a longitudinal basis, the effectiveness of a specific preventive dental program for outpatients who were taking phenytoin for seizure control. Plasma, mixed and parotid saliva were also monitored in relation to each other and gingival enlargement. The results confirmed that a preventive dental program consisting of frequent prophylaxis and oral hygiene reinforcement was effective in minimizing gingival enlargement associated with phenytoin therapy. However, a small but statistically significant increase in anterior gingival enlargement occurred within the first 6 months of phenytoin therapy. No further enlargement developed during the subsequent 9 months. Control subjects not receiving phenytoin demonstrated no change in the coronal position of the free gingival margin about anterior segments of the dentition. In the posterior segments, the control group exhibited statistically significant gingival recession which became evident at 12 months. Individuals taking phenytoin did not demonstrate any change in the coronal position of the free gingival margin within the posterior segments of the dentition. Combined with the dental prophylaxis, improvement in plaque control appeared to be consistent with the prevention of clinically significant gingival enlargement. Parotid and mixed salivary levels of phenytoin were approximately 10% that of plasma values. Both salivary levels rose when plasma levels increased as reflected by the relatively high coefficient of correlation between these parameters. Furthermore, neither plasma, mixed or parotid levels of phenytoin were correlated to the minimal degree of gingival enlargement which occurred in the anterior segments of individuals taking phenytoin.
A Selective Medium for Actinobacillus actinomycetemcomitans and the Incidence of the Organism in Juvenile Periodontitis
Authors: Mandell Robert L. , Socransky Sigmund S.
Published: October 2010

A selective medium, malachite green bacitracin agar, was developed for the isolation of Actinobacillus actinomycetemcomitans from subgingival plaque of periodontally diseased patients. The medium consisted of Trypticase soy agar 40 gm/liter, bacitracin 128 μg/ml, malachite green 8 μg/ml and 5% defibrinated sheep blood. The medium, when incubated in an atmosphere of air plus 10% CO2 for 5 days, permitted greater than 80% recovery of pure cultures of A. actinomycetemcomitans when compared with a nonselective medium. The most frequent contaminant in plaque samples from different clinical conditions was Haemophilus aphrophilus. Decomposition of H2O2 was useful in differentiating these two species. Clinical studies employing the malachite green bacitracin medium revealed a significant association between the presence of the organism, A. actinomycetemcomitans and juvenile periodontitis.
The Effectiveness of Subgingival Scaling and Root Planing in Calculus Removal
Authors: Rabbani Guity M. , Ash Major M. , Caffesse Raul G.
Published: October 2010

This study presents an evaluation of the effectiveness of subgingival scaling and root planing related to depth of pocket and type of teeth. A total of 119 teeth in 25 patients were selected; 62 were scaled and 57 were used as controls. All teeth were initially scored using the calculus index of the P.D.I. (Ramfjord). Six surface locations were probed to determine pocket depth. The levels of the gingival margin were marked on the teeth to locate supra and subgingival calculus after extraction. The experimental teeth then were scaled. Both scaled and unsealed teeth were extracted immediately after the experimental procedures. The teeth were washed with water and stained with methylene blue. They were viewed under a stereomicroscope which had a tenth grid on its eyepiece. Percent of surface covered by calculus was assessed on both scaled and unsealed teeth. The results demonstrated a high correlation between percent of residual calculus and pocket depth. It was shown that pockets less than 3 mm were the easiest sites for scaling and root planing. Pocket depths between 3 to 5 mm were more difficult to scale and pockets deeper than 5 mm were the most difficult. Tooth type did not influence the results.
The Polymorphonuclear Leukocyte (PMNL) Locomotor Defect in Juvenile Periodontitis: Study of Random Migration, Chemokinesis and Chemotaxis,
Authors: Van Dyke T. E. , Horoszewicz H. U. , Genco R. J.
Published: October 2010

Neutrophil locomotion was evaluated in three groups of periodontal patients, localized juvenile periodontitis (LJP), post‐localized juvenile periodontitis (post‐LJP), and generalized juvenile periodontitis (GJP). This was accomplished using regression line analysis, a new method for analysis of neutrophil locomotion in vitro. Neutrophil random migration, chemotaxis and chemokinesis were measured. The present study demonstrates that neutrophil locomotion is reduced in all three patient groups. The reduction in locomotion of the neutrophils in LJP, GJP and in post‐LJP patients is due to a decrease of neutrophil migration in the presence of a chemotactic gradient. Furthermore, this decrease in chemotactic response is likely due to a decrease in rate of migration of the population of neutrophils rather than the existence of a large population of poorly responsive neutrophils. Random migration and chemokinesis of these patients' neutrophils are normal. These findings are consistent with our previous findings that the neutrophil locomotor disturbance in juvenile periodontitis is cell‐associated and not due to humoral factors, and that there are a reduced number of chemotactic factor receptors present on the cell surface.
Bacterial Invasion of Gingiva in Advanced Periodontitis in Humans
Authors: Saglie R. , Newman M. G. , Carranza F. A. , Pattison G. L.
Published: October 2010

Using scanning electron microscopy, bacteria were found invading the epithelial wall of deep periodontal pockets in five out of eight cases. In one case, bacteria had reached the connective tissue. The following bacterial morphotypes were identified: cocci, short rods, filaments and spirochetes. A corncob‐like formation with a few scattered spirochetes was found in one case between the junctional epithelial cells. Numerous cocci, rods and filaments were found in intercellular spaces of the epithelium in the lateral wall of the pocket and accumulating on the epithelial side of the basement lamina. Bacterial invasion of gingival tissue may have important pathogenic and therapeutic implications.
The Effects of Immunosuppressive Drugs on Periodontal Inflammation in Human Renal Allograft Patients,
Authors: Been Valerie , Engel David
Published: October 2010

The periodontal status of four kidney allograft patients was determined before and at periodic intervals for 9 months after receipt of the allografts. These patients received immunosuppressive drugs as part of their therapy, beginning at the time of transplantation. Three hemodialysis patients with analogous kidney disease and six eye patients who were otherwise healthy served as controls. Comparisons of plaque levels, pocket depths and gingival inflammation were made between the three groups of subjects. The results suggest that the administration of the immunosuppressive drugs significantly reduces the level of gingival inflammation in the presence of high levels of bacterial plaque. Pocket depths did not change significantly in either the allograft or control groups. While not conclusive, the findings support the hypothesis that host inflammatory and immunological responsiveness to plaque bacteria is a primary factor in the pathogenesis of destructive periodontal disease in humans.
Relationship Between Alveolar Bone Measured by 125I Absorptiometry With Analysis of Standardized Radiographs: 1. Magiscan
Authors: Hausmann Ernest , Ortman Lance F. , McHenry Kenneth , Fallon John
Published: October 2010

Previous studies have shown that 125I absorptiometry gives an accurate and sensitive measure of alveolar bone mass. The purpose of this study was to determine the relationship between alveolar bone mass determined by 125I absorptiometry and bone density obtained by analysis of standardized intraoral radiographs by the Magiscan System. A defect of increasing size was made at one site of the alveolar bone in a human skull. The amount of bone remaining at each step was calculated using 125I absorptiometry. Standardized radiographs were also taken at each step and the relative density in the area of the defect was determined by the Magiscan System. The Magiscan's System Computer Memory permits analysis of identical areas on a longitudinal series of films of the same alveolar bone location. The results indicate that in estimating amounts of alveolar bone the Magiscan analysis of standardized intraoral radiography is similar in sensitivity and accuracy to 125I absorptiometry.
Connective Tissue Attachment to Periodontally Diseased Roots After Citric Acid Demineralization,
Authors: Albair William B. , Cobb Charles M. , Killoy William J.
Published: October 2010

Previous investigations have demonstrated that application of citric acid to a root surface results in exposure of dentin and/or cementum matrix collagen fibrils. Several studies have suggested a rapid and consistent connective tissue reattachment to citric acid treated roots. This study was initiated to determine if such an attachment was obtainable on human periodontally diseased teeth, in vivo, and could be confirmed through observations using the scanning electron and light microscopes. Full thickness flaps were raised on 18 single rooted teeth with moderate to advanced periodontitis. Citric acid (pH = 1.0) was applied to nine teeth with contralateral teeth serving as controls. Six to fifteen weeks later, the teeth with attached periodontal tissue were removed. Sagittal sections were obtained, with one‐half of the root being processed for light microscopy and the remaining half studied by scanning electron microscopy. Six of nine citric acid treated roots provided evidence of fibrous attachment. Connective tissue was apposed directly to old or newly formed cementum, but never directly to dentin. Fibrous attachment was usually functionally oriented, i.e., perpendicular to the root surface. No evidence of fibrous attachment was found among the control specimens.
Tooth Loss in 100 Treated Patients With Periodontal Disease: A Long‐Term Study
Authors: McFall Walter T.
Published: October 2010

A population of 100 patients with periodontal disease who had been treated and maintained for 15 years or longer was studied for tooth loss. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. Patients were examined and their dental records were reviewed. On the basis of response to therapy and tooth loss, the patients were classified as Well‐Maintained (77), Downhill (15), or Extreme Downhill (8). At the completion of initial treatment, 2,627 teeth were present. Of this number, during the maintenance period, 259 teeth (9.8%) were lost due to periodontal disease, while 40 teeth (1.5%) were lost due to other causes. Evaluation was made as to patterns of tooth loss, loss of questionable teeth, loss of teeth with furcations, surgical vs. nonsurgical therapy, and presence of fixed or removable prostheses. Considerable variation occurred between response groups. Periodontal disease appears to be bilaterally symmetrical and tooth loss emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids.
Monolithic Tetracycline‐containing Fibers for Controlled Delivery to Periodontal Pockets
Authors: Goodson J. M. , Holborow D. , Dunn R. L. , Hogan P. , Dunham S.
Published: October 2010

For the purpose of developing controlled delivery devices for periodontal therapy which would release over several days, six fiber types made of tetracycline‐loaded biocompatible polymers were manufactured and tested. Polyethylene, polypropylene, polycaprolactone, polyurethane and cellulose acetate propionate all released their drug load within 1 day. Ethylene vinyl acetate fibers, however, provided in vitro sustained release for periods up to 9 days. A bioassay was designed to measure levels of tetracycline achieved by local delivery which used growth inhibition of Bacillus cereus as a measure of the amount of tetracycline in measured volumes of gingival sulcus fluid on filter paper strips. By this assay, fibers made from 25% loaded ethylene vinyl acetate established initial concentrations of approximately 500 μg/ml. The measurement of tetracycline concentration resulting from the placement of these fibers into deep periodontal pockets as a packing material provided indication that concentrations of > 50 μg/ml could be maintained for months by weekly to monthly replacement. These studies indicate that monolithic fibers made of tetracycline‐loaded ethylene vinyl acetate have characteristics which could prove useful as the basis of a tetracycline delivery system for the treatment of periodontal disease.
Scanning and Transmission Electron Microscopic Study of Tissue‐invading Microorganisms in Localized Juvenile Periodontitis
Authors: Carranza F. A. , Saglie R. , Newman M. G. , Valentin P. L.
Published: October 2010

This transmission and scanning electron microscope study documents the invasion of microorganisms into the gingiva and along resorbing alveolar bone surfaces in a 15‐year‐old patient with localized juvenile periodontitis. The invading bacteria were mainly Gram‐negative fusiform, coccobacilli and spirochetes. Microorganisms identified as Mycoplasma were also found to invade in some areas. Polymorphonuclear neutrophils (PMNs) were seen in association with the bacteria. The majority of bacteria were covered by PMNs and enclosed by the phagocyte but did not appear to lie within phagosomes. High numbers of PMNs were found in the gingival connective tissue inflammatory infiltrate and in the pocket epithelium. Invasion into the gingiva and alveolar bone by bacteria and Mycoplasma in localized juvenile periodontitis may be of importance in the therapy of this infection.
Actinobacillus actinomycetemcomitans in Human Periodontal Disease: Prevalence in Patient Groups and Distribution of Biotypes and Serotypes Within Families
Authors: Zambon Joseph J. , Christersson Lars A. , Slots Jørgen
Published: October 2010

Actinobacillus actinomycetemcomitans is a Gram‐negative oral bacterium which has been implicated in the etiology of localized juvenile periodontitis. In this study, 403 subjects from four study groups were examined for A actinomycetemcomitans in subgingival dental plaque. Samples pooled from at least six periodontal sites were included from each subject. A actinomycetemcomitans was detected in 28 of 29 localized juvenile periodontitis patients but in only 15% of the other subjects including 28 of 134 adult periodontitis patients, 24 of 142 periodontally healthy subjects and 5 of 98 insulin dependent juvenile diabetics with varying degrees of gingivitis.

A actinomycetemcomitans isolates from members of five families with localized juvenile periodontitis patients were biotyped on the basis of variable fermentation of dextrin, maltose, mannitol and xylose and serotyped by indirect immunofluorescence using serotype specific rabbit antisera. Individuals within a family all harbored A actinomycetemcomitans of the same biotype and serotype. However, even in families with individuals heavily infected with A actinomycetemcomitans, some family members did not appear to be infected with the organism. The apparent poor transmissibility of A actinomycetemcomitans between individuals may, in part, explain the overall low prevalence of localized juvenile periodontitis and the familial pattern of the disease.

The high prevalence of A actinomycetemcomitans in the subgingival plaque of localized juvenile periodontitis patients, compared to the much lower prevalence in other patient groups, supports the hypothesis that A actinomycetemcomitans is an etiologic agent in this periodontal disease. The reason(s) an infection with A actinomycetemcomitans may result only in a localized type of periodontal breakdown is not known; this paper presents some hypotheses which may explain this characteristic clinical feature.
Fibrin Linkage: A Precursor for New Attachment
Authors: Polson Alan M. , Proye Michel P.
Published: October 2010

Previous studies indicated that connective tissue attachment to the root surface appeared to be dependent upon a chronologic healing sequence related to fibrin and collagen interactions. It was the purpose of the present study to try and substantiate this hypothesis by using histologic techniques designed to differentiate between fibrin and collagen during healing at the root surface interface. In four squirrel monkeys, 24 normal teeth were extracted and reimplanted after either (i) surgically denuding the coronal root surface of connective tissue fibers and cementum by root planing or, (ii) surgical denudation followed by topical application of citric acid (pH = 1; 3 minutes). Three specimens were available for histological analysis 1, 3, 7 and 21 days after reimplantation. Mallory's phosphotungstic acid hematoxylin staining technique was used to differentiate between fibrin and collagen.

Epithelium migrated rapidly along the denuded, non‐acid‐treated, root surfaces, had reached the alveolar crest at 3 days, and was within the ligament space to the level of root denudation at 21 days. Epithelium did not migrate apically along denuded root surfaces treated with citric acid. At 1 and 3 days, inflammatory cells were enmeshed in a fibrin network which appeared to be attached to the root surface by arcade‐like structures. At 7 and 21 days, the region had repopulated with connective tissue cells, and collagen fibers had replaced the fibrin. It was concluded that collagen fiber attachment to the root surface was preceded by fibrin linkage, and that the linkage process occurred as an initial event in the wound healing response.
The Periodontal Microflora of Juvenile Diabetics: Culture, Immunofluorescence, and Serum Antibody Studies
Authors: Mashimo Paul A. , Yamamoto Yoichi , Slots Jørgen , Park Byung H. , Genco Robert J.
Published: October 2010

These studies demonstrate a unique constellation of organisms populating the subgingival area in periodontitis lesions of patients with juvenile or insulin‐dependent diabetes mellitus (IDDM). The cultivable microflora was predominated by Capnocytophaga and anaerobic vibrios in the patients studied. In some patients, Actinobacillus actinomycetemcomitans were also found. This distinguishes the subgingival flora of IDDM patients suffering from periodontitis from that of patients with localized juvenile periodontitis (LJP), and that of adult periodontitis patients. In LJP most patients harbor both A actinomycetemcomitans and Capnocytophaga subgingivally; and in periodontitis lesions from nondiabetic adults, black‐pigmented Bacteroides such as B gingivalis or B melaninogenicus subspecies intermedius are often found. Antibiotic susceptibility patterns suggest that penicillin or tetracycline or its analogs such as minocycline may be effective against the predominant cultivable microflora in periodontal lesions of IDDM patients; however, individual patients may harbor flora with significant resistance to these antibiotics.
Clinical, Microbiological and Immunological Studies of a Family With a High Prevalence of Early‐Onset Periodontitis
Authors: Vandesteen G. E. , Williams B. L. , Ebersole J. L. , Altman L. C. , Page R. C.
Published: October 2010

Extensive clinical, laboratory and microbiological studies were performed on members of a family with an unusually high prevalence of early‐onset severe periodontitis. Clinical observations included intraoral photographs and assessment of inflammation, plaque, probing depths and bone loss. Pocket bacteria were sampled, cultivated and identified. Immunological studies included assessment in vitro of neutrophil (PMN) and monocyte (MN) Chemotaxis, assessment of PMN phagocytosis and other functions using the iodination assay, measurement of serum opsonic and chemoattractant activities and determination of levels of serum antibodies specific to various putative periodontal pathogens.

The proband, a 19‐year‐old white woman, had rapidly progressive periodontitis (RP). Of her six siblings available for study, all had juvenile periodontitis (JP), and both parents had been edentulous since early adulthood. Early edentulism and recurrent infections, especially otitis media, were prevalent in the forebearers, especially on the maternal side. Two married sisters of the proband had young male children with recurrent infections. Abnormalities in leukocyte Chemotaxis were found in the proband, in two of her siblings and in both parents. The pocket flora was predominantly Gram‐negative, anaerobic rods with a high prevalence of Bacteroides species, and serum antibodies specific to Bacteroides species were detected in the sera of five of the seven patients studied. Actinobacillus actinomycetemcomitans was not found in any of the pockets studied, nor were antibodies specific to any of the three known serotypes of this bacterium detected in the serum of any of the patients. There was a relatively good correlation between the bacterial species isolated from the periodontal pockets and the antibodies found in the serum. PMN iodination and serum opsonic activity were normal in all of the patients. Thus not all JP patients have detectable Actinobacillus species in their periodontal pockets, nor do all have antibody detectable with the techniques we used specific to these bacteria in their serum. In contrast, JP patients may have Bacteroides species in their periodontal pockets and antibody specific to Bacteroides species in their serum. Although abnormal leukocyte Chemotaxis is generally common in RP and JP patients, in this family the correlation between this defect and the presence of these diseases was poor.
Metronidazole in Periodontitis: I. Clinical and Bacteriological Results after 15 to 30 Weeks
Authors: Loesche W. J. , Syed S. A. , Morrison E. C. , Kerry G. A. , Higgins T. , Stoll J.
Published: October 2010

The statistical association of certain anaerobic organisms such as black pigmented bacteroides (BPB) species and spirochetes with clinical signs of active periodontitis, i.e. bleeding upon probing and bone loss, suggests that the lesions may actually reflect a “specific infection” involving these or unidentified species. All the known oral species of BPB and spirochetes are anaerobes which suggests that antimicrobial treatment directed specifically against anaerobes might be effective in periodontal therapy. In this report, the short‐term results of metronidazole treatment plus mechanical debridement in patients with extensive periodontal disease and of a double‐blind clinical study in which metronidazole plus mechanical debridement is compared to placebo plus mechanical debridement are described. The findings indicate that 1 week of systemic metronidazole can optimize the clinical reduction of pockets and increase the apparent attachment in periodontitis patients who receive concurrent mechanical debridement of their root surfaces. In patients with extensive clinical involvement, metronidazole resulted in a significant reduction in the number of sites exhibiting pocket depths and attachment loss ≥7 mm. When metronidazole plus mechanical debridement was compared with placebo plus mechanical debridement in a double‐blind study, the metronidazole patients exhibited a significant improvement in those sites initially ≥7 mm. The beneficial effect of the metronidazole was associated with a significant and sustained reduction of certain anaerobic organisms such as Bacteroides gingivalis and the large spirochetes. These data indicate that treatment aimed specifically toward the anaerobic component of the plaque flora can be associated with impressive clinical improvements 15 to 30 weeks after the initiation of treatment.
Immunologic Profile of Juvenile Periodontitis: II. Neutrophil Chemotaxis, Phagocytosis and Spore Germination
Authors: Suzuki Jon B. , Collison B. Christine , Falkler William A. , Nauman Robert K.
Published: October 2010

Patients with juvenile periodontitis (jp) were grouped into one of the two recognized forms of the disease: a localized form affecting incisors and first molars (LJP) and a generalized form affecting more than 14 teeth (GJP). The role of the neutrophil in the etiology and pathogenesis of LJP has recently been recognized. Experiments aimed at confirming previous information related to neutrophil Chemotaxis defects in LJP were performed. Additional experiments aimed at demonstrating significant differences in phagocytosis of bacterial spores and inducing spore germination were also completed. Age‐ and sex‐matched healthy subjects were used as “internal” controls (experiments run concomitantly). Peripheral blood neutrophils from 29 LJP, 24 GJP and 24 healthy subjects were assessed for Chemotaxis. This assay was performed in a Boyden diffusion chamber using 10−8 m N‐formylmethionylleucylphenylalanine as chemoattractant. A chemotactic defect was defined being 2 standard deviations below the mean of healthy subjects. Twenty‐three of 29 LJP (79%) and 14 of 25 GJP (58%) had a neutrophil defect. Peripheral blood neutrophil phagocytosis assays were performed in vitro using radiolabeled bacterial spores [45Ca]Bacillus cereus. Eighteen of 29 LJP (62%) and 7 of 24 GJP (29%) had a phagocytic defect. Neutrophil‐induced spore germination assessed in vitro showed that 13 of 20 LJP (65%) and 3 of 8 GJP (38%) had this defect. These observations indicate that patients with JP have abnormalities in neutrophil functions of Chemotaxis, phagocytosis and spore germination.
Molar and Nonmolar Teeth Compared Over 6½ Years Following Two Methods of Periodontal Therapy
Authors: Pihlstrom Bruce L. , Oliphant Thomas H. , McHugh Richard B.
Published: October 2010

Limited information is available comparing the relative longitudinal effectiveness with respect to tooth type of scaling and root planing alone and scaling and root planing followed by flap procedures. The purpose of this study was to investigate these treatment methods as applied to molar and nonmolar teeth on a longitudinal basis in humans. Seventeen subjects with chronic periodontitis received thorough scaling and root planing as well as oral hygiene instruction. A modified Widman flap was then randomly performed for one‐half of each subject's dentition. Routine recall prophylaxis and oral hygiene reinforcement were administered postsurgically every 3 to 4 months. Pocket depth and clinical attachment levels were recorded by a single calibrated examiner before therapy and at intervals up to 6[h years following active treatment. Ten subjects remained as participants after 6½ years. A paired t test was used to test for the mean difference in pocket depth and clinical attachment level between molar and nonmolar teeth for each treatment method. For pockets initially 4 to 6 mm, the results indicated greater pocket depth and more apical clinical attachment level on molars than nonmolars treated by either method of therapy. For pockets initially ≥7 mm there was no difference between pocket depth on molar and nonmolar teeth following scaling and root planing alone. However, there was less overall pocket depth on nonmolars than molars following the flap procedure, indicating a greater effect of pocket reduction on nonmolar than molar teeth with the flap procedure. No difference between tooth types was found for clinical attachment level in pockets initially >7 mm with either treatment method. Both treatment methods resulted in at least maintenance of pretreatment attachment levels adjacent to molar and nonmolar teeth.
Periodontal Treatment Without Maintenance: A Retrospective Study in 44 Patients
Authors: Becker William , Becker Burton E. , Berg Lawrence E.
Published: October 2010

This study presents our findings on 44 patients who were treated for periodontal disease and for varying reasons elected not to participate in the maintenance aspect of periodontal care. All patients were initially given intensive instructions in personal oral hygiene, along with initial scaling and root planing. Each patient had two or more quadrants of pocket reduction therapy. Tooth mortality revealed a mean annual adjusted tooth loss rate of 0.22 (4.7%). Between examinations, breakdown in the health status of furcations was noted. Mean probing depth scores at the second examination showed no significant differences from the first examination scores. Measurements of bone levels revealed a worsening of bone scores between examinations. The results of this study show that periodontal therapy without maintenance is of little value in terms of restoring periodontal health.
Subepithelial Connective Tissue Graft Technique for Root Coverage
Authors: Langer Burton , Langer Laureen
Published: October 2010

This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. The success of these grafts has been attributed to the double‐blood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap. Four cases have been illustrated to demonstrate the versatility of this procedure for areas of single or multiple root coverage especially in the maxillary arch, coverage of existing crown margins and areas requiring a combination of ridge augmentation and root coverage. An increase of 2 to 6 mm of root coverage has been achieved in 56 cases over 4 years with minimal sulcus depth and no recurrence of recession. The donor site is a closed wound which produces less postoperative discomfort.
Bacterial Profiles of Subgingival Plaques in Periodontitis
Authors: Loesche W. J. , Syed S. A. , Schmidt E. , Morrison E. C.
Published: October 2010

In this report over 400 subgingival plaque samples taken from over 110 patients were examined microscopically and culturally for 30 bacterial parameters. The patients could be placed into six disease categories based upon clinical criteria. The bacterial profile of each clinical category was generally distinctive of that category. Periodontal patients who had been successfully treated and maintained had plaques that were populated by significantly higher proportions of Streptococcus sanguis, Actinomyces viscosus, A. odontolyticus and S. mutans and significantly lower proportions of B. gingivalis and spirochetes compared to the five untreated disease categories. The spirochetes were the overwhelming microbial type in the plaques of adult periodontitis (AP) patients, averaging about 45% of the microscopic count. The bacteriological results could not distinguish between ADA Type III and IV periodontitis, suggesting that the same type of infection was occurring in an active site in any AP patient. The patients designated as early onset periodontitis (EOP) differed from the other patients by their relative youth and by their significantly higher proportions of Bacteroides gingivalis and/or B. intermedius. Two types of EOP were recognized in which the most diseased variant was characterized by having an average of 49% spirochetes in the plaque. Four localized juvenile periodontitis (LJP) patients were notable in not having detectable A. actinomycetemcomitans. The data indicate that the various types of periodontitis, with the possible exception of LJP are specific anaerobic infections involving spirochetes and to a lesser extent B. gingivalis and B. intermedius.
The Subpedicle Connective Tissue Graft
Authors: Nelson Stephen W.
Published: October 2010

A mucogingival grafting procedure has been developed to cover denuded root surfaces. This procedure, the subpedicle connective tissue graft, is a bilaminar graft that is composed of a free connective tissue graft and an overlying pedicle graft. By overlaying grafted free connective tissue with a pedicle, the otherwise compromised section of free graft which covers a denuded root surface is supplied by plasmatic circulation from capillaries in the vascular portion of the pedicle allowing it to survive.

In this report 29 teeth were treated and monitored for as long as 42 months. In the group with advanced recession of 7 to 10 mm, there was an average of 88% coverage. The subpedicle graft created a healthy, functional, and esthetic result that appeared resistant to further breakdown. The subpedicle graft is indicated when a single surgical procedure is desired that will predictably cover denuded root surfaces when there is inadequate keratinized gingiva available for a pedicle graft and where the prognosis is poor for root coverage with a free gingival graft.
New Attachment Formation Following Controlled Tissue Regeneration Using Biodegradable Membranes
Authors: Magnusson I. , Batich C. , Collins B. R.
Published: October 2010

The present study evaluated the potential for reestablishment of connective tissue attachment after exclusion of the gingival connective tissue and epithelium during healing after periodontal surgery in a dog model. Buccal mucoperiosteal flaps were elevated in all four premolar regions in two dogs. The buccal bone was reduced to approximately 25% of its original level on 24 roots. Before the elevated flaps were replaced and sutured, membranes were adjusted to cover the exposed root surfaces. On eight surfaces Millipore® filters were used and on eight surfaces biodegradable polylactic acid membranes were used. No membranes were placed over the remaining eight root surfaces which served as controls. After two months of healing, the animals were sacrificed and all the roots were subjected to histological analysis. In all of the roots covered with the polylactic acid membrane, newly formed cementum with inserting collagen fibers was observed and covered on the average 46% of the initial defect. Newly formed bone covered 39% of the initial defect. The roots covered by Millipore® filters were characterized by significantly less new attachment and bone. In the control roots only minor new attachment was found in the bottom of the defect in some roots. The results suggest that the establishment of a connective tissue attachment is clearly favored by the placement of a polylactic acid membrane to exclude the epithelium and gingival connective tissue during healing.