bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Periodontal Regenerative Technique in Human Intrabony Defects by Collagen Membranes and Anorganic Bovine Bone. A Controlled Clinical Study
Authors: Paolantonio Michele
Published: February 2005

Background: Combined periodontal regenerative technique (CPRT) is a surgical procedure that combines the use of barrier membranes with a filling material in the treatment of periodontal defects. The effectiveness of CPRT has been evaluated in many studies in comparison to GTR with membranes alone, but conflicting results have been obtained by different clinicians, particularly in the treatment of intrabony defects. The aim of the present study was to compare CPRT to GTR with collagen membranes in the treatment of human intrabony defects characterized by a relevant 1‐wall component.

Methods: Thirty‐four (34) healthy, non‐smoking patients affected by moderate to severe chronic periodontitis participated in this study. Each patient had good oral hygiene and at least 1 radiographically detectable intrabony defect ≥4 mm, with a 1‐wall component of at least 50% of the defect, involving 2 tooth surfaces or more with a probing depth (PD) ≥6 mm. Seventeen (17) subjects were randomly assigned to the test group and underwent CPRT by anorganic bovine bone and a collagen membrane, and 17 randomly assigned to the control group who received GTR with a collagen membrane alone. Pre‐ and post‐therapy clinical parameters (probing depth [PD]; clinical attachment level [CAL]; gingival recession [GR]) and intrasurgical parameters (depth of intraosseous component [IOC]; level of the alveolar crest [ACL]) were compared between test and control groups 1 year after treatment. Vertical bone gain (VBG) from the base of the defect to the cemento‐enamel junction was also evaluated in both groups.

Results: At the 1‐year examination, clinical and intrasurgical parameters showed statistically significant changes within each experimental group from baseline. A statistically greater CAL gain was reported in the test group (P <0.05), whereas the control group exhibited more GR and alveolar crest resorption at a statistically signifi‐cant level (P <0.01). VBG was significantly greater (P <0.01) at test sites (5.23 ± 1.30 mm) compared to controls (3.82 ± 1.28 mm).

Conclusions: The results suggest that the use of CPRT may be preferred when bioabsorbable membranes are used to treat intrabony defects characterized by unfavorable architecture. J Periodontol 2002;73:158‐166.
The Effects of Periodontal Therapy on Intracrevicular Prostaglandin E2 Concentrations and Clinical Parameters in Pregnancy
Authors: Yalcin Funda , Basegmez Cansu , Isik Gulden , Berber Lacin , Eskinazi Esti , Soydinc Mahtaban , Issever Halim , Onan Utku
Published: February 2005

Background: The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters.

Methods: This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis.

Results: The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P <0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non‐significant (P >0.05).

Conclusions: Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis. J Periodontol 2002;73:173‐177.
Dentin Morphology and Permeability After Brushing With Different Toothpastes in the Presence and Absence of Smear Layer
Authors: Prati Carlo , Venturi Lucia , Valdré Giovanni , Mongiorgi Romano
Published: February 2005

Background: The purpose of this study was to evaluate the morphology and permeability of dentin after brushing with different toothpastes in the presence and absence of smear layers.

Methods: Dentin discs were prepared from extracted third molars. Dentin permeability was measured using a hydraulic pressure apparatus working at 70 cm H2O pressure. Dentin was treated with 0.5 M EDTA for 5 minutes and washed to remove a smear layer and to establish the maximum permeability of each dentin disc, which was expressed as 100%. A new smear layer was then created on the upper surface using a #400 carbide paper under water for 30 seconds. Dentin permeability of the smear layer‐covered dentin was measured and expressed as a percentage of the maximum permeability of that specimen, permitting each specimen to serve as its own control. Each sample was then brushed by a mechanical device under water for 3 minutes with constant pressure of 250 g using a medium toothbrush and permeability remeasured. Finally, 1 of 5 different toothpastes was applied on the dentin and brushed for 3 minutes. In another group, the same procedures were performed with the exception of the smear layer production, so it was possible to calculate changes in the permeability of dentin with open tubules following brushing. Scanning electron microscopic (SEM) examination of dentin was obtained before and after treatments with brushing and toothpastes.

Results: Dentin permeability was reduced by brushing procedures when the smear layer was absent, but it was increased when the smear layer was present. Toothpaste application reduced dentin permeability when no smear layer was present on the top of the surface, but modified and increased permeability of samples with smear layers. SEM observations demonstrated the presence of dentifrice particles on dentin surfaces and inside dentinal tubules, and this may be responsible for the observed reductions in permeability. Smear plugs produced during dentin brushing were not removed by the dentifrices.

Conclusions: Dentin permeability and morphology are significantly affected by toothbrushing and by the type of dentifrice used. The presence of smear plugs in the dentin may decrease severity. J Periodontol 2002;73:183‐190.
Influence of Nicotine Administration on Different Implant Surfaces: A Histometric Study in Rabbits
Authors: Stefani Cristine M. , Filho Getúlio R. Nogueira , Sallum Enilson A. , De Toledo Sérgio , Sallum Antonio W. , Nociti Francisco H.
Published: February 2005

Background: This study investigated the influence of implant surface on osseointegration around titanium implants inserted in the tibiae of rabbits administered with nicotine.

Methods: Thirty‐two (32) New Zealand rabbits were included in the study. After anesthesia, the tibia surface was exposed and 2 screw‐shaped commercially available pure titanium implants 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. A total of 128 implants were inserted: 64 blasted with Al2O3 particles (Group 1) and 64 with a machined surface finish (Group 2). The animals were randomly assigned to 1 of 4 treatment subgroups, and daily subcutaneous injections of nicotine were administered: A) saline solution; B) 0.37 mg/kg; C) 0.57 mg/kg; and D) 0.93 mg/kg. In order to label regenerated bone, a 2% calcein green solution was administered by intramuscular injection at 0, 7, and 15 days after implant insertion. After 42 days, the animals were sacrificed and undecalcified sections were prepared. The degree of bone contact with the implant surface, the bone area, and the intensity of bone labeling were measured into the limits of the implant threads.

Results: Statistical analysis (2‐way ANOVA) revealed no significant difference regarding the effect of nicotine on bone healing around the implants (P >0.05). However, a significant influence of the implant surface on the degree of bone‐to‐implant contact was detected in groups C (30.13 ± 4.97 and 37.85 ± 8.85, for machined and Al2O3‐blasted surfaces, respectively) and D (27.79 ± 3.93 and 33.13 ± 8.87, for machined and Al2O3‐blasted surfaces, respectively) (P< 0.05).

Conclusions: Although nicotine administration may not statistically influence bone healing around titanium implants, implant surface design may enhance osseointegration after nicotine administration. J Periodontol 2002;73:206‐212.
Evaluation of Frozen Subepithelial Connective Tissue Grafts to Increase the Zone of Attached Gingiva. Report of 5 Cases
Authors: Soileau Kristi M. , Aydin Betul Gofteci , Davenport William D.
Published: February 2005

Background: In the past decade, gingival tissue has been regenerated using subepithelial connective tissue grafts (SECT). This report presents the use of frozen subepithelial connective tissue (FSECT) for increasing the zone of attached keratinized gingiva (KG).

Methods: Five cases, 4 females and 1 male, aged 55 to 73 years, presented with inadequate attached KG. The SECT grafts were harvested from the palatal flap during conventional flap surgery. All grafts were frozen immediately. Five weeks to 10 months later, the grafts were placed in areas in which patients had inadequate KG.

Results: In all cases, healing was uneventful. All cases were followed up 3 months to 1.5 years. An increase of 1 to 3 mm of KG was achieved.

Conclusions: These cases show that the FSECT graft is useful in treating mucogingival problems. Further randomized controlled trials over long periods of time are necessary to establish whether this procedure offers long‐term benefits to patients. J Periodontol 2002;73:220‐230.
A Critical Assessment of Interleukin‐1 (IL‐1) Genotyping When Used in a Genetic Susceptibility Test for Severe Chronic Periodontitis
Authors: Greenstein Gary , Hart Thomas C.
Published: February 2005

Background: This review addresses the ability of commercially available genetic susceptibility test to determine the risk of developing severe chronic periodontitis. The test is used to detect the simultaneous occurrence of allele 2 at the IL‐1A +4845 and IL‐1B +3954 loci. If both of these polymorphisms are present, patients are referred to as being genotype‐positive and considered predisposed to becoming afflicted with severe chronic periodontitis. A basic premise of this test is the assumption that individuals who are genotype‐positive produce increased amounts of IL‐ β in response to microbial lipopolysaccharides, which allegedly predisposes them to an exaggerated inflammatory response and an increased incidence of chronic periodontitis.

Methods: Controlled clinical trials were selected that evaluated the ability of the genetic test to predict which patients were susceptible to bleeding upon probing, periodontitis, peri‐implantitis, and tooth loss.

Results: Comparison of results from test (genotypepositive) and control groups (genotype‐negative) revealed that there is ambiguity with regard to predicting which patients will manifest elevated subgingival levels of IL‐ β. Similarly, it is questionable if the test is able to forecast which individuals will demonstrate an increased occurrence of bleeding upon probing, diminished clinical attachment, decreased osseous support, or loss of teeth.

Conclusions: There are many unanswered questions concerning the utility of detecting allele 2 at the IL‐1A +4845 and IL‐1B +3954 loci to foretell which patients will develop severe chronic periodontitis. Therefore, clinicians must cautiously interpret results obtained with the commercially available genetic susceptibility test before they alter maintenance schedules or treatment regimens of symptomatic or asymptomatic patients. J Periodontol 2002;73:231‐247.
Periodontopathic Bacteria in Young Healthy Subjects of Different Ethnic Backgrounds in Los Angeles
Authors: Sirinian Garo , Shimizu Tota , Sugar Catherine , Slots J⊘rgen , Chen Casey
Published: February 2005

Background: The present study determined risk indicators for oral colonization by Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola in 150 children and adolescents, 4 to 16 years of age, living in Los Angeles, California.

Methods: Fifty Caucasians, 50 Hispanics, and 50 Asian‐Americans completed a questionnaire on demographic characteristics. 16S rRNAbased polymerase chain reaction identification was employed to determine the presence of test bacteria in unstimulated saliva. Step‐wise logistic regression analysis identified explanatory variables (risk indicators) accounting for the salivary presence of periodontopathic bacteria.

Results: A. actinomycetemcomitans occurred in 15%, P. gingivalis in 15%, B. forsythus in 14%, and T. denticola in 18% of all subjects. Two or more pathogens were detected in 20% of Hispanic subjects and in 12% of Asian‐American subjects but not in any Caucasians (P = 0.0005, chi square test). However, no stable multivariate model including ethnicity was found for multiple pathogens. Risk for harboring any pathogens increased with the length of time lapse from last dental visit (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.83 to 12.21), and decreased with higher education level of the mother (OR, 0.258; 95% CI, 0.052 to 0.875). Risk for harboring 2 or more periodontal pathogens decreased with the years the parents had resided in the United States (OR, 0.95; 95% CI, 0.901 to 0.992). Risk for harboring A. actinomycetemcomitans decreased as the number of years the parents had resided in the United States increased (OR, 0.91; 95% CI, 0.86 to 0.95), and decreased with higher income level of the father (OR, 0.201; 95% CI, 0.038 to 0.948). Girls were at higher risk for harboring P. gingivalis (OR, 2.55; 95% CI, 1.02 to 7.03), but at lower risk for carrying T. denticola (OR, 0.42; 95% CI, 0.17 to 0.98).

Conclusions: This study showed that salivary occurrence of periodontopathic bacteria in young individuals was related to the length of time the parents had lived in the United States, education level of the mother, length of time since last dental visit, and gender, but apparently not to ethnicity per se. J Periodontol 2002;73:283‐288.
Tongue Piercing: Impact of Time and Barbell Stem Length on Lingual Gingival Recession and Tooth Chipping
Authors: Campbell Allison , Moore Alisa , Williams Elly , Stephens Joni , Tatakis Dimitris N.
Published: February 2005

Background: The increasing popularity of tongue piercing has prompted several case reports documenting oral complications of this practice. However, there are no studies assessing potentially significant parameters. The purpose of this study was to evaluate the effect of time (years of wear) and tongue barbell size (stem length) on gingival recession and tooth chipping.

Methods: Fifty‐two adults (mean age 22) with tongue piercings were examined for gingival recession on the lingual aspect of the 12 anterior teeth and for tooth chipping anywhere in the mouth. Subjects were grouped according to years of wear (0 to 2, 2 to 4, and 4+ years) and barbell stem length (long ≥1.59 cm, or short <1.59 cm). Data analysis was based on binomial test and non‐parametric tests.

Results: No subject with a tongue piercing <2 years (group 0‐2) exhibited lingual recession or tooth chipping. Lingual recession was found on mandibular central incisors in 50% of subjects wearing long barbells for 2 or more years. Tooth chipping was found on molars and premolars in 47% of subjects with a tongue piercing for 4+ years.

Conclusions: Tongue piercing is associated with lingual recession of mandibular anterior teeth and chipping of posterior teeth. Long‐term use of a tongue barbell increases the prevalence of these complications. Barbell stem length appears to differentially affect prevalence of recession and chipping. Since the overwhelming majority of subjects with tongue piercings are young adults, cessation efforts are needed to target this population. J Periodontol 2002;73:289‐297.
External Root Resorption Following Partial‐Thickness Connective Tissue Graft Placement: A Case Report
Authors: Hokett Steven D. , Peacock Mark E. , Burns William T. , Swiec Gary D. , Cuenin Michael F.
Published: February 2005

We report an unusual case of external root resorption (ERR) that developed in a 37‐year‐old black male approximately 1 year following routine partial thickness connective tissue graft surgery. The lesion was accessed via flap surgery, thoroughly root planed, and the mucoperiosteal flap replaced. The site healed uneventfully and the patient has been closely observed for over 1 year without symptoms or recurrence of the resorptive lesion and the affected tooth remained vital. Clinicians performing partial‐thickness connective tissue grafts should be alert to the possible occurrence of root resorption over extended periods of time. The authors speculate that retention of the donor periosteum with placement on the recipient dentin and root biomodification may limit the resorptive response following connective tissue graft procedures to treat tooth root recesssion. J Periodontol 2002;73:334‐339.
Subgingival Microbiota of Brazilian Subjects With Untreated Chronic Periodontitis
Authors: Colombo Ana Paula V. , Teles Ricardo P. , Torres Maria Cynésia , Souto Renata , Rosalém Wilson , Mendes Maria Cláudia S. , Uzeda Milton
Published: February 2005

Background: Different periodontopathogenic microbiota have been associated with periodontal diseases in several populations. The present investigation determined the subgingival microbiota of untreated chronic periodontitis Brazilians using the checkerboard DNA‐DNA hybridization technique.

Methods: Twenty‐five periodontitis patients (mean age, 41 ± 2; mean probing depth [PD], 3.3 ± 0.2; mean attachment level [AL], 3.6 ± 0.2) with no history of previous periodontal therapy and a control group of 14 healthy subjects (mean age, 34 ± 0.6; mean PD, 1.8 ± 0.2; mean AL, 1.7 ± 0.1) were selected. Measurements of PD, AL, bleeding on probing, plaque accumulation, and suppuration were recorded at 6 sites/tooth. Subgingival plaque samples were obtained from 4 sites in each tooth/subject in both groups. The presence and levels of 41 subgingival species were determined in 4,032 plaque samples using whole genomic DNA probes and the checkerboard method.

Results: Periodontal pathogens, as well as some unusual species (E. faecalis, E. coli and Bartonella sp.), were detected significantly more often and/or in higher levels in the periodontitis group (P <0.05). Most species were more frequently detected in interproximal sites. B. forsythus, P. gingivalis, E. nodatum, and F. nucleatum ss vincentii showed a significant positive correlation with mean PD and AL (P <0.05).

Conclusions: The subgingival microbiota of Brazilians with untreated chronic periodontitis were complex, including high proportions of periodontopathogens commonly found in other populations, as well as some unusual species. J Periodontol 2002;73:360‐369.
Effect of Estrogen Deficiency on Skeletal and Alveolar Bone Density in Sheep
Authors: Johnson R.B. , Gilbert J.A. , Cooper R.C. , Parsell D.E. , Stewart B.A. , Dai X. , Nick T.G. , Streckfus C.F. , Butler R.A. , Boring J.G.
Published: February 2005

Background: This study provides a longitudinal assessment of changes in alveolar and skeletal bone mineral density (BMD) in ovariectomized animals.

Methods: Following ovariectomy (OVX) (n = 6) or shamoperation (n = 6) intraoral radiographs were made at 4‐month intervals and serum 17‐β‐estradiol, osteocalcin, and interleukin (IL)‐6, urinary deoxypyridinium, and salivary IL‐6, deoxypyridinium, and osteocalcin concentrations were evaluated. Twelve months after surgery, animals were sacrificed and the mandible and radius/ulna removed. Bones were sectioned and radiographed. Mean BMD and cortical thicknesses were calculated from each region.

Results: OVX animals had a progressive decrease in serum 17‐β‐estradiol, increased serum osteocalcin and IL‐6, urinary deoxypyridinium and salivary IL‐6, osteocalcin and deoxypyridinium (P <0.001), suggesting that they were becoming osteoporotic. The BMD of the radius/ulna and mandibular alveolar bone was significantly reduced in OVX animals (P <0.05 and P <0.001, respectively). Reduced alveolar bone BMD became evident in OVX animals 6 months after surgery and became more severe during the subsequent 6 months. Alveolar crestal height was also significantly reduced in OVX animals (P <0.001). These biochemical and density changes preceded a significant reduction in serum 17‐β‐estradiol, which occurred between 4 and 8 months following surgery.

Conclusions: Serial measurements of alveolar BMD predicts loss of skeletal BMD in OVX sheep. Changes in alveolar BMD precede estrogen deficiency, suggesting that early signs of reduced BMD may be detected in peri‐menopausal women. The presence of biomarkers of bone metabolism within saliva and their correlation with reduced BMD suggests that saliva could be used as an adjunct screening method for assessment of skeletal bone density. J Periodontol 2002;73:383‐391.
Clinical Evaluation of an Enamel Matrix Protein Derivative Combined With a Bioactive Glass for the Treatment of Intrabony Periodontal Defects in Humans
Authors: Sculean Anton , Barbé Giovanni , Chiantella Giovanni C. , Arweiler Nicole B. , Berakdar Mohammad , Brecx Michel
Published: February 2005

Background: The purpose of the present study was to compare the treatment of deep intrabony defects with a combination of an enamel matrix protein derivative (EMD) and a bioactive glass (BG) to BG alone.

Methods: Twenty‐eight patients with chronic periodontitis, each of whom displayed 1 intrabony defect, were randomly treated with a combination of EMD and BG or with BG alone. Soft tissue measurements were made at baseline and at 1 year following therapy.

Results: No differences in any of the investigated parameters were observed at baseline between the 2 groups. Healing was uneventful in all patients. At 1 year after therapy, the sites treated with EMD and BG showed a reduction in mean probing depth (PD) from 8.07 ± 1.14 mm to 3.92 ± 0.73 mm and a change in mean clinical attachment level (CAL) from 9.64 ± 1.59 mm to 6.42 ± 1.08 mm (P <0.0001). In the group treated with BG, the mean PD was reduced from 8.07 ± 1.32 mm to 3.85 ± 0.66 mm and the mean CAL changed from 9.78 ± 1.71 mm to 6.71 ± 1.89 mm (P <0.0001). No statistically significant differences in any of the investigated parameters were observed between the test and control group.

Conclusions: Within the limits of the present study, it can be concluded that both therapies led to significant improvements of the investigated clinical parameters, and the combination of enamel matrix derivative and bioactive glass does not seem to additionally improve the clinical outcome of the therapy. J Periodontol 2002;73:401‐408.
Clinical Comparison of an Enamel Matrix Derivative Used Alone or in Combination With a Bovine‐Derived Xenograft for the Treatment of Periodontal Osseous Defects in Humans
Authors: Velasquez‐Plata Diega , Todd Scheyer E. , Mellonig James T.
Published: February 2005

Background: The combination of bone replacement graft materials has been suggested for the treatment of periodontal osseous defects. The purpose of this study was to evaluate the effectiveness of enamel matrix derivative (EMD) combined with a bovine‐derived xenograft (BDX) as compared to EMD alone in the treatment of intraosseous defects in patients with moderate to advanced periodontitis.

Methods: Sixteen adult patients with at least 2 intrabony defects were entered in this split‐mouth design study. Defects were treated with EMD alone or EMD + BDX. Reentries were performed 6 to 8 months after initial surgery. The following soft and hard tissue measurements were recorded prior to initial surgery and at reentry: probing depth (PD), gingival margin location, clinical attachment level (CAL), depth of defect, and crestal bone level. Statistical analyses were performed to determine changes in PD, CAL, fill of osseous defect, and crestal resorption. Percentages of bone fill (%BF) and defect resolution (%DR) were also calculated.

Results: The most significant results were that gingival recession was greater for the group treated with EMD alone (0.8 ± 0.8 mm) compared to EMD + BDX (0.3 ± 0.6 mm) (P = 0.04) and bone fill was greater for EMD + BDX (4.0 ± 0.8 mm) compared to EMD alone (3.1 ± 1.0 mm) (P = 0.02). The measures for PD reduction, attachment level gain, crestal resorption, %BF, and %DR did not present a statistically significant difference (P >0.10).

Conclusions: This study evaluated the performance of EMD + BDX and EMD alone. The results demonstrated that a significant improvement in clinical parameters was observed. When comparing both modalities, a statistically significant difference was only found for gingival recession and bone fill, yielding a more favorable outcome towards the combined approach. J Periodontol 2002;73:433‐440.
Effects of Serum on Hepatocyte Growth Factor Secretion and Activation by Periodontal Ligament and Gingival Fibroblasts
Authors: Ohshima Mitsuhiro , Yokosuka Ryoji , Yamazaki Yoshitaka , Tokunaga Tsuyoshi , Maeno Masao , Otsuka Kichibee
Published: February 2005

Background: Hepatocyte growth factor (HGF)/scatter factor is a paracrine growth factor secreted by mesenchymal cells, which exerts an effect on a variety of epithelial cell types. Our recent study revealed that periodontal ligament fibroblasts (PLF) and gingival fibroblasts (GF) cultured in the presence of serum which contains various stimulants produced HGF or HGF‐like factor, a predominant chemoattractant for gingival epithelial cells, and suggested that it could be involved in epithelial downgrowth in periodontitis.

Methods: To clarify whether serum in medium stimulates PLF and GF to synthesize or activate HGF, the effect of fetal bovine serum (FBS) on HGF production was determined by enzymelinked immunoabsorbent assay (ELISA), and its chemotactic activity for gingival epithelial cells was examined by modified Boyden chamber assay.

Results: One to 10% FBS in the culture medium stimulated HGF secretion in a dose‐dependent manner and the chemotactic activity was decreased by treatment with anti‐hHGF neutralizing antibody. Furthermore, fibroblast‐conditioned medium incubated with FBS and aprotinin reduced its chemotactic activity. Interestingly, serum‐free culture of PLF and GF produced potent chemoattractants for gingival epithelial cells other than HGF.

Conclusions: These results show that FBS stimulates both HGF secretion and activation by PLF and GF. J Periodontol 2002;73:473‐478.
Effects of Topical Administration of Clodronate on Alveolar Bone Resorption in Rats With Experimental Periodontitis
Authors: Mitsuta T. , Horiuchi H. , Shinoda H.
Published: February 2005

Background: We examined whether topical administration of a bisphosphonate clodronate could prevent alveolar bone loss in rats with experimental periodontitis.

Methods: On day 0, elastic rings were placed around the cervix of the right and left maxillary first molars (M1) to induce inflammatory periodontitis. Fifty μl of clodronate solution at a concentration of either 0 (0.9% NaCl), 20, 40, or 60 mM was injected into the subperiosteal palatal area adjacent to the interdental area between M1 and M2 on either the left or right (experimental) side on days 0, 2, 4, and 6. The contralateral side served as a control and received 0.9% NaCl solution without clodronate. The animals were sacrificed on day 7.

Results: Histological examination and determination of bone mineral density in the interdental alveolar bone area between M1 and M2 revealed that placement of an elastic ring caused severe vertical and horizontal bone resorption on the control side, while the topical administration of clodronate significantly prevented such alveolar bone loss. The number of osteoclasts on the experimental side was decreased compared with the control side. Furthermore, many of the osteoclasts on the experimental side were detached from the surface of the alveolar bone and had degenerated appearances, such as rounded shapes and a loss of polarity.

Conclusions: These results suggest that topical administration of clodronate may be effective in preventing osteoclastic bone resorption in periodontitis. J Periodontol 2002;73:479‐486.
Effects of Phase I Periodontal Treatment on Gingival Crevicular Fluid Levels of Matrix Metalloproteinase‐1 and Tissue Inhibitor of Metalloproteinase‐1
Authors: Tüter Gülay , Kurtiş Bülent , Serdar Muhittin
Published: February 2005

Background: Matrix metalloproteinase‐1 (MMP‐1) is a member of a family of enzymes which are capable of degrading most extracellular matrix macromolecules. Extracellular control of MMPs is exerted by tissue inhibitors of metalloproteinases (TIMP) and by mechanisms of pro‐MMP activation. Levels of MMPs and TIMPs change during healing, inflammation, and normal tissue turnover. The aim of this study was to evaluate the effects of phase I periodontal treatment on gingival crevicular fluid (GCF) levels of MMP‐1 and TIMP‐1.

Methods: Ten patients with chronic periodontitis who had sites with probing depths ≥4 mm and 10 periodontally healthy persons (controls) were included in this study. Clinical measurements including plaque (PI) and gingival (GI) indexes, probing depths (PD), and clinical attachment loss (CAL) were recorded both at baseline (before treatment, BT) and after phase I periodontal treatment (AT). Assays for MMP‐1 and TIMP‐1 were performed by an enzyme‐linked immunosorbent assay (ELISA) method.

Results: All of the clinical conditions significantly improved and GCF volume decreased AT (P <0.05). Levels of MMP‐1 were higher in patients BT than in controls (C) (P <0.05). Levels of MMP‐1 were reduced AT compared to BT (P <0.05). In addition, TIMP‐1 levels were lower at BT than AT and in C (P <0.05). Statistically significant differences were found between levels of TIMP‐1 at BT and AT (P <0.05). The ratio of MMP‐1 to TIMP‐1 was significantly lower in C than patients at BT; this ratio was also significantly lower at AT than BT (P <0.05).

Conclusions: These results suggest that levels of MMP‐1 in GCF decreased and total levels of TIMP‐1 in GCF increased after phase I periodontal therapy. The ratio of MMP‐1 to TIMP‐1 changed after phase I periodontal therapy, becoming close to that of the controls. J Periodontol 2002;73:487‐493.
Association Between Periodontal Pockets and Elevated Cholesterol and Low Density Lipoprotein Cholesterol Levels
Authors: Katz Joseph , Flugelman Moshe Y. , Goldberg Avishai , Heft Marc
Published: February 2005

Background: Periodontitis is associated with increased prevalence of cardiovascular morbidity and mortality; however, the nature of this association is unclear. There is a rationale that indicates that the presence of periodontal pockets which can harbor pathogenic microorganisms and evoke a host response could elicit a systemic effect. The hypothesis of this study is that periodontal pockets may be associated with elevated blood lipid levels, a known risk factor for atherosclerotic disease.

Methods: The periodontal health of 10,590 Israeli military service men and women was assessed using the Community Periodontal Index of Treatment Needs (CPITN). The relationship of blood lipids and periodontal disease and CPITN index was tested, controlling for factors that are related to elevated cholesterol levels, including high body mass index (BMI), age, diastolic blood pressure, and smoking.

Results: The presence of periodontal pockets was positively associated with higher cholesterol and low density lipoprotein (LDL) cholesterol blood levels in men. No significant association was found in women.

Conclusions: In this large cohort study, the presence of periodontal pockets as measured by CPITN was positively associated with total cholesterol and LDL‐cholesterol. The findings of the study support the reports linking increased prevalence of cardiovascular mortality among patients with periodontal disease. J Periodontol 2002;73:494‐500.
Enamel Matrix Proteins in the Treatment of Deep Intrabony Defects
Authors: Cardaropoli Giuseppe , Leonhardt Åsa S.
Published: February 2005

Background: The present study evaluated the healing of enamel matrix derivative (EMD) proteins in the treatment of periodontal lesions with deep intrabony defects.

Methods: Ten deep intrabony defects in 7 periodontal patients were treated and followed for 1 year. The sites had a probing depth (PD) ≥8 mm; clinical attachment level (CAL) ≥9 mm, and intrabony component depth ≥5 mm. All subjects received therapy prior to surgery and had a plaque score (PI) ≤10%. Full thickness flaps were elevated buccally and lingually, granulation tissue was removed from the defects, and the root surfaces were planed. A 24% EDTA gel was applied followed by the enamel matrix protein preparation. The flaps were closed with interrupted sutures. The patients rinsed with a chlorhexidine solution twice a day for 6 weeks. They were recalled every 2 weeks for 6 months for professional tooth cleaning and then every 4 weeks for an additional 6 months. The experimental sites were reexamined 6 and 12 months after regenerative surgery.

Results: At the 1‐year examination, the mean CAL gain was 6.5 mm, the mean PD was 3.2 mm, and mean radiographic bone fill was 4.7 mm.

Conclusions: The application of enamel matrix proteins in combination with open flap curettage and root planing resulted in a gain of CAL and bone fill in deep intrabony defects. J Periodontol 2002;73:501‐504.
Effects of Porphyromonas gingivalis on the Central Nervous System: Activation of Glial Cells and Exacerbation of Experimental Autoimmune Encephalomyelitis
Authors: Shapira Lior , Ayalon Sharon , Brenner Talma
Published: February 2005

Background: Several studies have suggested that peripheral inflammation may be involved in the etiology of multiple sclerosis (MS), a demyelinating disease of the central nervous system (CNS). T‐cells activated in the periphery enter the CNS, leading to demyelination and axonal loss. We hypothesized that peripheral infection by Porphyromonas gingivalis can affect pathological processes in the CNS and aggravate MS.

Methods: Glial cells derived from rat brains were cultured and stimulated with P. gingivalis or P. gingivalis lipopolysaccharide (LPS). Secretion of nitric oxide (NO) and prostaglandin E2 (PGE2) was determined. In addition, we examined the proliferation of lymphocytes harvested from P. gingivalis‐immunized mice in response to stimulation by echephalitogenic proteins. The effect of peripheral inflammation induced by P. gingivalis on the clinical course of the disease was tested in experimental autoimmune encephalomyelitis (EAE), a mouse model used for the study of MS.

Results: P. gingivalis LPS and heat‐killed bacteria induced secretion of the proinflammatory mediators NO and PGE2 by CNS glial cells. Lymphocytes derived from P. gingivalis‐immunized mice proliferated in the presence of the echephalitogenic protein myelin basic protein. Injection of P. gingivalis into subcutaneous chambers in mice, followed by EAE induction led to aggravation of the disease.

Conclusions: The present study provides evidence that infection with a periodontal pathogen, such as P. gingivalis, may play a role in the pathogenesis of CNS inflammatory disorders such as MS. J Periodontol 2002;73:511‐516.
Er:YAG Laser Scaling of Diseased Root Surfaces
Authors: Frentzen M. , Braun A. , Aniol D.
Published: February 2005

Background: The removal of calculus and plaque is an essential component of a therapeutic approach to control periodontal disease. Er:YAG laser scaling was recently introduced as an alternative to conventional scaling procedures. In this histological study, the effects of laser instrumentation of diseased root surfaces are compared to mechanical removal of plaque and calculus with ultrasonic instruments and scalers.

Methods: Areas of subgingival calculus were identified on 40 freshly extracted human teeth. Each of these areas was randomly divided into 2 equal parts. The control site was treated either with scaling and root planing or with an ultrasonic instrument. The test site was cleaned using an Er:YAG laser according to the manufacturer's instructions. The end point of debridement was the inability to mechanically or visibly detect any remaining calculus. After pre‐ and postsurgical photographs and impressions for scanning electronic microscopic investigation, a plastic embedding technique was used to cut the undecalcified roots into 15 µm thick sections.

Results: Clinically and histologically, scaling resulted in complete debridement at all samples, producing a smooth root surface. At the test sites, laser scaling was accompanied by an increased removal of tissue and roughened surfaces.

Conclusions: Laser scaling results in an increased loss of cementum and dentin, which should be taken into account in clinical situations. J Periodontol 2002;73:524‐530.
Microscopic, Immunocytochemical, and Ultrastructural Properties of Peri‐Implant Mucosa in Humans
Authors: Marchetti Carla , Farina Aurora , Cornaglia Antonia Icaro
Published: February 2005

Background: Microscopic and immunocytochemical studies have demonstrated both similarities and differences between the gingival mucosa and the peri‐implant mucosa restored around dental implants.

Methods: This study was performed on 10 samples of periimplant mucosa from 10 patients who had undergone implant treatment 16 to 18 months before. Microscopic, ultrastructural, and immunocytochemical investigations were performed to characterize the epithelial and connective layers of the peri‐implant mucosa.

Results: All specimens showed the morphologic characteristics of well restored tissues. The immunocytochemical reactions used to detect cytokeratins demonstrated that the restored peri‐implant mucosa had a non‐keratinized epithelium. The apical part of the inner epithelium was a few cell layers thick, like the corresponding junctional epithelium, but it stained positively with the markers for the cytokeratins expressed by the stratified epithelia. Ultrastructurally the keratinocytes adjacent to the implant displayed nuclei containing a rich cytoplasm with filaments and specialized intercellular junctions right up to the more superficial strata. Immunocytochemical reactions and ultrastructural observations demonstrated the presence of non‐keratinocyte cells; i.e., Langerhans cells, melanocytes, and Merkel cells. Several cells were found to be proliferating by immunoreaction with mAb anti‐PCNA, while immunoreactions with mAbs to detect von Willebrand factor, CD34, and vascular endothelial growth factor marked the well‐developed networks of blood and lymphatic vessels in the connective tissue. S‐100 and protein gene product 9.5 positive nerve fibers were marked. Immunocytochemical reactions with mAbs anti‐vimentin, anti‐laminin were also performed.

Conclusions: Our results demonstrated that all the epithelial and connective components of the mucosa are involved in the substantial regrowth of the peri‐implant tissue and subsequently in the success of the implant. J Periodontol 2002;73:555‐563.
Relationship Between Compliance and Periodontal Treatment Outcome in Smokers
Authors: Jansson Leif E. , Hagström Karin E.
Published: February 2005

Background: Smoking is an established risk factor of periodontal disease and smokers are regarded as patients with a high risk of periodontitis recurrence during the maintenance phase. Lack of compliance and smoking constitute significant factors for the risk of further periodontitis progression. The purpose of the present study was to investigate the relationship between periodontal status and the tendency to interrupt periodontal treatment and determine if this relationship differs significantly between smokers and non‐smokers.

Methods: The investigation was conducted as a retrospective study on a sample of 325 patients referred for treatment. The patients had been offered full periodontal treatment and a fullmouth oral radiographic examination. In order to investigate any correlations between periodontal status and smoking or interrupted periodontal treatments, stepwise multiple regression analyses were adopted.

Results: The mean age of the sample was 49.7 years (range 25 to 83) and a majority were females (57%). The relative frequency of smoking was 52%. The relative frequency of interruption of periodontal treatment was 26% for non‐smokers and 31% for smokers. Smokers who interrupted periodontal treatment after the reevaluation were found to have significantly deeper periodontal probing depths at the reevaluation compared to those who did not interrupt the treatment irrespective of smoking habits (P <0.001).

Conclusions: The results of the study demonstrate that the non‐complying individuals had the highest risk of recurrent periodontitis even if they had completed the treatment plan. An important task in the future will be to find ways to reduce the frequency of non‐compliance and thus improve the prognosis. J Periodontol 2002;73:602‐607.
The Effect of Subgingival Controlled‐Release Delivery of Chlorhexidine Chip onClinical Parameters and Matrix Metalloproteinase‐8 Levels in Gingival Crevicular Fluid
Authors: Azmak Nezih , Atilla Gül , Luoto Hanne , Sorsa Timo
Published: February 2005

Background: The present study evaluated the efficacy of controlledrelease delivery of chlorhexidine gluconate (CHX) on clinical parameters and on gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)‐8 levels in chronic periodontitis patients.

Methods: Twenty patients with chronic periodontitis were screened for 6 months. Two interproximal sites were selected from mesial surfaces of anterior teeth with probing depths of 6 to 8 mm that bled on probing in each patient. There were at least 2 teeth between the selected sites. CHX chip was inserted into a randomly selected site following scaling and root planing (SRP+CHX), while the other selected site received only SRP in each patient. Probing depth (PD), clinical attachment level (CAL), plaque index (PI), and papilla bleeding index (PBI) were recorded at baseline and at 1, 3, and 6 months. GCF MMP‐8 levels were analyzed at baseline; 2 and 10 days; and at 1, 3, and 6 months by immunofluorometric assay (IFMA).

Results: At baseline, there were no statistically significant differences in the mean PD, CAL, PBI, and PI scores between SRP+CHX and SRP alone groups. At 1, 3, and 6 months, all clinical parameters in each group significantly decreased (P <0.0167) when compared to baseline. The reduction of PD and improvement in CAL were higher in the SRP+CHX group compared to SRP alone at 3 and 6 months. However, the differences between the 2 groups were not statistically significant. PBI and PI scores were not significantly different between SRP+CHX and SRP alone groups at any visit. GCF MMP‐8 levels were similar in both groups at baseline. Intragroup analysis showed significant decreases in the GCF MMP‐8 level for the SRP+CHX group between baseline and 1, 3, and 6 months (P <0.01). Intergroup analysis demonstrated significantly lower mean levels of GCF MMP‐8 at 1 month in the SRP+CHX group compared to the SRP alone group (P <0.05).

Conclusions: These data suggest that CHX chip application following SRP is beneficial in improving periodontal parameters and reducing GCF MMP‐8 levels for 6 months' duration. The use of a chairside MMP‐8 dipstick periodontitis test might be a useful adjunctive diagnostic tool when monitoring the course of CHX chip treatment. J Periodontol 2002;73:608‐615.
Lactoferrin Iron Levels Affect Attachment of Actinobacillus actinomycetemcomitans to Buccal Epithelial Cells
Authors: Fine D.H. , Furgang D.
Published: February 2005

Background: Prior reports have suggested that the iron‐binding protein lactoferrin (LF) may either kill Actinobacillus actinomycetemcomitans (Aa) or interfere with its binding to host cells. Other studies have indicated that the degree of iron saturation of LF might play a role in these interactions. However, these studies utilized strains that had lost critical attachment characteristics found in well‐preserved clinical isolates of Aa. The purpose of this work was to study the effect of LF iron levels on survival and attachment of well‐preserved clinical isolates of Aa.

Methods: LF containing 0%, 30%, and 100% iron saturation was tested for its ability to kill clinical isolates of Aa and to inhibit their binding to buccal epithelial cells (BECs).

Results: Neither iron‐free LF (apo‐LF) nor iron‐saturated LF killed Aa clinical isolates. Increasing the iron saturation of LF resulted in an increased inhibition of Aa binding to BECs (P ≤0.005). This effect was consistent for the 3 clinical isolates tested. Pretreatment of Aa with iron‐saturated LF reduced binding to BECs by 58%, 61.8%, and 64.2%, respectively, for each of the 3 clinical strains tested (P ≤0.005). Pretreatment of Aa strains with apo‐LF, iron alone, or bovine serum albumin had no effect on binding. Pretreatment of BECs with LF (either apo‐LF or iron‐containing LF) had no influence on Aa binding.

Conclusions: These results indicate that reduction in binding of Aa to epithelial cells is maximized by pretreatment of Aa cells with iron‐saturated lactoferrin. These in vitro results suggest that patients with lactoferrin containing lowered levels of iron would be more susceptible to Aa colonization. J Periodontol 2002;73:616‐623.
Oral Manifestations of Acute Myelomonocytic Leukemia: A Case Report and Review of the Classification of Leukemias
Authors: Wu Josephine , Fantasia John E. , Kaplan Robert
Published: February 2005

Background: Oral signs and symptoms may indicate a serious underlying systemic disease. The most frequently observed oral findings of leukemia are mucosal bleeding and ulceration, petechiae, and gingival hyperplasia. This case report describes a 53‐year‐old male who presented with gingival enlargement and bleeding, fatigue, and recent weight loss as initial manifestations of acute myelomonocytic leukemia.

Methods: A gingival biopsy was performed, revealing the presence of a hypercellular infiltrate of atypical myeloid and monocytic cells. Further work‐up consisted of a complete blood count, bone marrow biopsy, and immunohistochemical and histochemical analysis of biopsy material and flow cytometry of peripheral blood.

Results: Flow cytometry results confirmed that the infiltrate was of a myelomonocytic origin, and a diagnosis of acute myelomonocytic leukemia was rendered. The patient responded well to a chemotherapeutic induction regimen of cytosine arabinoside and idarubicin hydrochloride, with regression of gingival enlargement and remission of disease. The patient continued with consolidation chemotherapy and an autologous bone marrow transplant, but eventually died 22 months after initial diagnosis.

Conclusions: Oral health care professionals, especially periodontists, must recognize that gingival enlargement may represent an initial manifestation of an underlying systemic disease. Acute myelogenous leukemia is a hematological disorder with a predilection for gingival involvement. J Periodontol 2002;73:664‐668.