Description

The Journal of Periodontology publishes articles relevant to the science and practice of periodontics and related areas. Manuscripts are accepted for consideration with the understanding that text, figures, photographs, and tables have not appeared in any other publication, except as an abstract prepared and published in conjunction with a presentation by the author(s) at a scientific meeting, and that material has been submitted only to this journal.

Publications in this journal

• Prophylactic vaccination against periodontal disease: a systematic review of preclinical studies

  Authors: Kunaal Dhingra, Vandana K.L

  Journal of Periodontology.

  Background: Periodontal vaccine against periodontopathic bacteria has been tested in various animal models, such as in non-human primates and murine species. The aim of this preliminary study is toBackground: Periodontal vaccine against periodontopathic bacteria has been tested in various animal models, such as in non-human primates and murine species. The aim of this preliminary study is to systematically review all preclinical (i.e., animal) studies that present supporting evidence for the feasibility of formulating a prophylactic human periodontal vaccine. Methods: A manual and electronic literature search was made for animal studies up to February 2010 that presented clinical,morphologic (alveolar bone level), and immunologic data for the efficacy of a prophylactic periodontal vaccine. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, quality assessment, determination of outcome measures, screening method, data extraction, data synthesis, and drawing of conclusions. Results: Only two randomized controlled animal trials qualified, and they reported exactly opposite effects of vaccine administration in Macaca fascicularis experimental periodontitis models by administration of two different agents (i.e., a negative effect with combined whole-cell antigens of Porphyromonas gingivalis and Prevotella intermedia in contrast to a positive effect with cysteine proteases of P.gingivalis). However, no statistical process could be applied to their results (data inadequately reported) in order to pool and evaluate the changes in outcome measures after vaccine administration, which, highlighted their mediocre study quality. Conclusions: Because of the insufficient quantity and quality of animal trials, no adequate evidence could be gathered to use the beneficial effects of these animal experiments to formulate a prophylactic human periodontal vaccine. Thus, good-quality animal trials are needed in this field of vaccine testing.

• Prophylactic vaccination against periodontal disease: a systematic review of preclinical studies

  Authors: Kunaal Dhingra, Vandana K.L

  Journal of Periodontology. 81(11):1529-1546.

  Background: Periodontal vaccine against periodontopathic bacteria has been tested in various animal models, such as in non-human primates and murine species. The aim of this preliminary study is toBackground: Periodontal vaccine against periodontopathic bacteria has been tested in various animal models, such as in non-human primates and murine species. The aim of this preliminary study is to systematically review all preclinical (i.e., animal) studies that present supporting evidence for the feasibility of formulating a prophylactic human periodontal vaccine. Methods: A manual and electronic literature search was made for animal studies up to February 2010 that presented clinical,morphologic (alveolar bone level), and immunologic data for the efficacy of a prophylactic periodontal vaccine. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, quality assessment, determination of outcome measures, screening method, data extraction, data synthesis, and drawing of conclusions. Results: Only two randomized controlled animal trials qualified, and they reported exactly opposite effects of vaccine administration in Macaca fascicularis experimental periodontitis models by administration of two different agents (i.e., a negative effect with combined whole-cell antigens of Porphyromonas gingivalis and Prevotella intermedia in contrast to a positive effect with cysteine proteases of P.gingivalis). However, no statistical process could be applied to their results (data inadequately reported) in order to pool and evaluate the changes in outcome measures after vaccine administration, which, highlighted their mediocre study quality. Conclusions: Because of the insufficient quantity and quality of animal trials, no adequate evidence could be gathered to use the beneficial effects of these animal experiments to formulate a prophylactic human periodontal vaccine. Thus, good-quality animal trials are needed in this field of vaccine testing.

• One-stage full-mouth versus partial-mouth scaling and root planing during the effective half-life of systemically administered azithromycin.

  Authors: Akihiro Yashima, Kazuhiro Gomi, Nobuko Maeda, Takashi Arai

  Journal of periodontology. 80(9):1406-13.

  Background: One-stage full-mouth scaling and root planing (FM-SRP) in combination with systemically administered azithromycin was shown to be clinically and bacteriologically effective in theBackground: One-stage full-mouth scaling and root planing (FM-SRP) in combination with systemically administered azithromycin was shown to be clinically and bacteriologically effective in the treatment of chronic periodontitis. However, FM-SRP requires 2 hours for completion. Azithromycin has a long half-life. Therefore, if SRP of the full mouth is performed within 7 days while an effective concentration of azithromycin remains in the gingiva, the effects may be the same as FM-SRP. The aim of this study was to compare the clinical and bacteriologic effects of FM-SRP and partial-mouth scaling and root planing (PM-SRP) in patients with chronic periodontitis, which was performed in three sessions within 7 days, during the effective half-life of systemically administrated azithromycin. Methods: Thirty adult subjects with chronic periodontitis were randomly divided into three groups (FM-SRP, PM-SRP, and control). A clinical examination was conducted to record the probing depth, clinical attachment level gain, bleeding on probing, gingival index, and volume of gingival crevicular fluid; bacterial samples were obtained before treatment and 1, 3, 6, 9, and 12 months thereafter. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method. Results: All clinical parameters showed better improvement in FM-SRP and PM-SRP groups compared to the control group, with no significant differences between the two test groups. Periodontal bacteria were well controlled in the two test groups, but they tended to increase gradually 3 months after treatment in the control group. Conclusion: PM- and FM-SRP demonstrated comparable clinical and bacteriologic results.

• Correlation of gingival crevicular fluid interleukin-18 and monocyte chemoattractant protein-1 levels in periodontal health and disease.

  Authors: A R Pradeep, Happy Daisy, Parag Hadge, Garima Garg, Manojkumar Thorat

  Journal of periodontology. 80(9):1454-61.

  Background: Interleukin (IL)-18 is a proinflammatory cytokine of the IL-1 superfamily and is unique, with the capacity to induce T-helper (Th)1 or Th2 differentiation depending on the immunologicBackground: Interleukin (IL)-18 is a proinflammatory cytokine of the IL-1 superfamily and is unique, with the capacity to induce T-helper (Th)1 or Th2 differentiation depending on the immunologic context. Monocyte chemoattractant protein (MCP)-1 is a CC chemokine responsible for chemotaxis of monocytes. A previous study showed the induction of MCP-1 by IL-18 in mice macrophages. The present study was carried out to examine the gingival crevicular fluid (GCF) levels of IL-18 and MCP-1 in periodontal health and disease and to evaluate any correlation between IL-18 and MCP-1 GCF levels. Methods: Sixty subjects (30 males and 30 females; age range: 26 to 49 years) participated in the study. The subjects were initially divided into three groups, consisting of 20 subjects in each group, based on the gingival index, probing depth (PD), clinical attachment loss (AL), and radiologic parameters (bone loss): healthy (group 1), gingivitis (group 2), and periodontitis (group 3), whereas patients in group 3 after treatment constituted group 4. GCF samples were collected from all of the groups to estimate the levels of IL-18 and MCP-1 using enzyme-linked immunosorbent assay. Results: The mean IL-18 and MCP-1 concentrations in GCF were highest in group 3 (330.61 pg/mul and 73.3 pg/mul, respectively). The results suggest that IL-18 and MCP-1 levels increased in GCF from periodontal health to disease and decreased after periodontal therapy. Levels of IL-18 and MCP-1 positively correlated with PD and clinical AL in group 3. In addition, IL-18 and MCP-1 levels significantly correlated with each other in groups 2, 3, and 4. Conclusions: GCF IL-18 and MCP-1 concentrations increased in periodontal disease compared to health and correlated positively with the severity of disease. Further, based on the positive correlation of IL-18 and MCP-1 found in this study, it can be proposed that IL-18 may promote an inflammatory response by the induction of MCP-1 production and the subsequent recruitment and activation of circulating leukocytes at the inflammatory site.

• Bacterial penetration through antibiotic-loaded guided tissue regeneration membranes.

  Authors: Chi-Fang Cheng, Ya-Yun Lee, Lin-Yang Chi, Yen-Ting Chen, Shan-Ling Hung, Li-Jane Ling

  Journal of periodontology. 80(9):1471-8.

  Background: This study compared bacterial penetration through guided tissue regeneration (GTR) membranes impregnated with antibiotics. Methods: Three barrier membranes, expandedBackground: This study compared bacterial penetration through guided tissue regeneration (GTR) membranes impregnated with antibiotics. Methods: Three barrier membranes, expanded polytetrafluoroethylene (ePTFE) membrane, collagen membrane, and glycolide fiber composite membrane, were loaded with amoxicillin or tetracycline. The penetration of Streptococcus mutans and Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) through the GTR membranes was achieved using a device consisting of an inner tube and an outer bottle filled with culture media. Results: The penetration of S. mutans or A. actinomycetemcomitans into the inner tubes significantly decreased with all of the antibiotic-loaded membranes compared to membranes without antibiotics. However, differences were found in the behavior of the three membranes. The antibiotic-loaded ePTFE membranes showed the best barrier effect. Moreover, the inhibitory effect of tetracycline on S. mutans was greater than that of amoxicillin for all GTR membranes. Furthermore, the inhibitory effect of tetracycline on A. actinomycetemcomitans was lower than that of amoxicillin with the glycolide fiber membrane. Conclusions: The results showed that penetration of S. mutans and A. actinomycetemcomitans through amoxicillin- or tetracycline-loaded ePTFE membrane, glycolide fiber membrane, and collagen membrane was delayed and/or reduced. Thus, incorporation of an antibiotic into the membrane may be of value when controlling membrane-associated infection during GTR therapy.

• Venodilatory effect of vascular endothelial growth factor on rat gingiva.

  Authors: Milán Gyurkovics, Zsolt Lohinai, Adrienne Gyorfi, Iván Iványi, Ibolya Süveges, Mária Kónya, Csaba Bodor, Andrea D Székely, Elek Dinya, Arpád Fazekas, László Rosivall

  Journal of periodontology. 80(9):1518-23.

  Background: Endothelial cell proliferation, angiogenesis, and increased vascular permeability are among the effects of vascular endothelial growth factor (VEGF) in various organs. However, theBackground: Endothelial cell proliferation, angiogenesis, and increased vascular permeability are among the effects of vascular endothelial growth factor (VEGF) in various organs. However, the effects of VEGF on gingival hemodynamics, especially on venules, have not been thoroughly investigated. This study investigated the acute circulatory effects of VEGF on rat gingival venules. Methods: Fifty-six anesthetized rats were divided into five study groups; each rat received 10 mul of experimental solution dripped onto the lower interincisal gingiva. The groups included: 1) saline control (after the experiment, gingiva was excised for VEGF receptor 2 [VEGFR2] immunohistochemistry); 2) VEGF (0.1, 1, 10, or 50 mug/ml); 3) VEGF2 receptor antagonist 5-((7-benzyloxyquinazolin-4-yl)amino)-4-fluoro-2-methyl-phenol-hydrochloride (ZM323881; 20 mug/ml); 4) ZM323881 (20 mug/ml) followed by VEGF application (50 mug/ml after 15 minutes); and 5) VEGF (10 mug/ml), these rats were premedicated with nitric oxide (NO) synthase blocker (N(G)-nitro-L-arginine-methyl-ester [L-NAME]; 1 mg/ml in drinking water) for 1 week before the experiment. Changes in gingival superficial venule diameter were measured by vital microscopy prior to and 1, 5, 15, 30, and 60 minutes after the administration of the experimental solutions. Results: VEGF dose-dependently increased the venular diameter compared to saline. ZM323881 alone did not cause any alteration. Premedication with ZM323881 or L-NAME decreased the dilatory effects of VEGF. VEGFR2 immunohistochemical labeling was observed in the wall of the venules. Conclusions: There is no remarkable VEGF production under physiologic circumstances in rat gingiva, but VEGF is able to increase gingival blood flow through the activation of VEGF2 receptors. Furthermore, NO release may contribute to VEGF's vasodilatory effect.

• An atypical form of necrotizing periodontitis.

  Authors: Dilek Guvenc, Aslan Y Gokbuget, Serdar Cintan, Goze Kara, Emine Yek Cifcibasi, Emin Unuvar, Sevgi Ciftci, Fahriye Keskin, Guven Kulekci, Mehmet Yaltirik, Hulya Kilicoglu

  Journal of periodontology. 80(9):1548-53.

  Background: Necrotizing ulcerative gingivitis/periodontitis are considered necrotizing periodontal diseases. This case report presents an atypical form of necrotizing periodontitis, which does notBackground: Necrotizing ulcerative gingivitis/periodontitis are considered necrotizing periodontal diseases. This case report presents an atypical form of necrotizing periodontitis, which does not fit into this classification. Methods: A 12-year-old child was referred to our clinic for gingival inflammation, extensive alveolar bone loss, and tooth mobility. Clinical and microbiologic examinations were carried out, and radiographs were taken. Clinical examination revealed soft and hard tissue destruction up to the mucogingival junction at the right maxillary premolar and mandibular incisors. Unusual infections or abnormalities in systemic functions were not detected through clinical and laboratory evaluations made at the Pediatrics Department, Istanbul University. Although an intensive established treatment protocol for necrotizing periodontitis was completed, management of long-standing health conditions could not be achieved because of recurrence of the disease, which caused us to repeat this treatment protocol at short intervals. Results: Investigation led to a diagnosis of an atypical form of necrotizing periodontitis because the disease had a recurrent acute phase even under a standard treatment protocol. Conclusions: Our patient exhibits an unusual, necrotizing form of periodontal disease. The reason for the rapid rate of periodontal disease progression remains unclear.

• Antibiotics in periodontics: right or wrong?

  Authors: Arie J van Winkelhoff, Edwin G Winkel

  Journal of periodontology. 80(10):1555-8.

• Letter to the editor: authors' response.

  Authors: Brandon D Frodge, Jeffrey L Ebersole, Richard J Kryscio, Mark V Thomas, Craig S Miller

  Journal of periodontology. 80(10):1566-7.

• Non-surgical periodontal therapy lowers serum inflammatory markers: a pilot study.

  Authors: Syed Akhtar Hussain Bokhari, Ayyaz Ali Khan, Dimitris N Tatakis, Mohammad Azhar, Mohammad Hanif, Mateen Izhar

  Journal of periodontology. 80(10):1574-80.

  Background: Evidence suggests an association between periodontal disease and coronary heart disease (CHD). C-reactive protein (CRP), fibrinogen, and white blood cell (WBC) counts are markers ofBackground: Evidence suggests an association between periodontal disease and coronary heart disease (CHD). C-reactive protein (CRP), fibrinogen, and white blood cell (WBC) counts are markers of inflammation, and their systemic levels have been associated with CHD risk. This pilot study investigated the effect of non-surgical periodontal therapy on systemic levels of CRP, fibrinogen, and WBC counts in subjects with CHD or no CHD (NCHD). Methods: Twenty-seven angiographically defined patients with CHD and 18 subjects with NCHD aged >/=40 years were recruited for the study. Periodontal disease was measured through the clinical parameters bleeding on probing (BOP) and probing depth (PD). All subjects received non-surgical periodontal therapy that included oral hygiene instructions and subgingival scaling and root planing. Systemic levels of inflammatory markers (CRP, fibrinogen, and WBC counts) were measured prior to and 1 month after periodontal therapy. Results: Seventeen subjects with CHD and 11 subjects with NCHD completed the study. Subjects with CHD or NCHD experienced significant reductions in BOP (59% and 34%, respectively; P <0.05) and PD (41% and 35%, respectively; P <0.05), with non-significant intergroup differences (P >0.05). In all subjects, CRP, fibrinogen, and WBC counts were reduced significantly (21% to 40%) after periodontal therapy (P <0.05). Conclusions: Periodontal treatment resulted in significant decreases in BOP and PD and lowered serum inflammatory markers in patients with CHD or NCHD. This may result in a decreased risk for CHD in the treated patients. These findings will allow pursuit of a large-scale randomized intervention trial in this population.

• Interleukin-1 gene cluster polymorphisms associated with periodontal disease in type 2 diabetes.

  Authors: Néstor J López, Carlos Y Valenzuela, Lilian Jara

  Journal of periodontology. 80(10):1590-8.

  Background: Epidemiologic studies have shown an increased frequency, severity, and risk of periodontitis in patients with diabetes. Periodontitis is associated with certain interleukin (IL)-1 geneBackground: Epidemiologic studies have shown an increased frequency, severity, and risk of periodontitis in patients with diabetes. Periodontitis is associated with certain interleukin (IL)-1 gene cluster polymorphisms. Diabetes is a proinflammatory state with increased levels of circulating cytokines suggesting a causal role for inflammation in its etiology. Common genetic factors may be involved in the susceptibility for diabetes and periodontitis. We evaluated the relationships among IL-1 gene polymorphisms, type 2 diabetes, and periodontitis. Methods: One hundred twelve patients with diabetes and chronic periodontitis, 224 patients without diabetes but with chronic periodontitis, and 208 healthy subjects without periodontitis were studied. All received a clinical periodontal examination and assessment of standard periodontal parameters. IL-1A -889, -1B +3954, and -1B -511 polymorphisms were identified by polymerase chain reaction (PCR) amplification followed by restriction enzyme digestion and gel electrophoresis. Variable numbers of IL-1RN tandem repeats were detected by PCR amplification and fragment-size analysis. Results: The severity and extent of periodontitis was significantly greater in patients with diabetes than in patients without diabetes. No significant differences in IL-1A -899, -1B +3954, or -1RN genotype frequencies were found between patients with diabetes and patients without diabetes. The IL-1A -889 TT genotype (odds ratio [OR] = 2.90; 95% confidence interval [CI] = 1.20 to 7.02), IL-1B +3954 TT genotype (OR = 3.54; 95% CI = 1.15 to 10.85), and IL-1B -511 CC genotype (OR = 2.10; 95% CI = 1.25 to 3.58) were significantly associated with periodontitis. The presence of an IL-1 positive genotype was significantly associated with periodontitis (OR = 1.61; 95% CI = 1.04 to 2.49). No interaction between smoking status and polymorphisms was found. Conclusions: Periodontitis was significantly associated with some IL-1 gene polymorphisms. No association between diabetes and IL-1A and -1B gene polymorphisms was found.

• Effect of Dental Plaque Control on Infection of Helicobacter pylori in Gastric Mucosa.

  Authors: Chun-Ling Jia, Guang-Shui Jiang, Chun-Hai Li, Cui-Rong Li

  Journal of periodontology. 80(10):1606-9.

  Background: Data on the role of dental plaque in the transmission of Helicobacter pylori have varied. Furthermore, there has been few reports on the relationship between dental plaque control and H.Background: Data on the role of dental plaque in the transmission of Helicobacter pylori have varied. Furthermore, there has been few reports on the relationship between dental plaque control and H. pylori infection of gastric mucosa. The purpose of this study was to elucidate this potential relationship. Methods: The (13)C urea breath test was conducted on 56 subjects who received dental plaque control and 51 subjects who did not. Results: The prevalence of H. pylori in the gastric mucosa was 19.64% in patients who received dental plaque control, which was significantly lower than in those without dental plaque control (84.31%). Conclusion: Long-term professional dental plaque control was associated with less gastric reinfection by H. pylori, suggesting that dental plaque control may help to prevent H. pylori-induced gastric disease or reinfection.

• Dental implants placed in extraction sites grafted with different bone substitutes: radiographic evaluation at 24 months.

  Authors: Roberto Crespi, Paolo Capparè, Enrico Gherlone

  Journal of periodontology. 80(10):1616-21.

  Background: Reduction of alveolar height and width after tooth extraction may provide some problems in implant placement, especially in the anterior maxilla for esthetic reasons. Different graftBackground: Reduction of alveolar height and width after tooth extraction may provide some problems in implant placement, especially in the anterior maxilla for esthetic reasons. Different graft materials have been advocated to prevent bone-volume reduction. The aim of this study was to evaluate radiographic parameters of implants positioned in grafted alveoli with three different biomaterials: magnesium-enriched hydroxyapatite (MHA), calcium sulfate (CS), and heterologous porcine bone (PB). Methods: In 15 patients, 45 fresh extraction sockets with three bone walls were selected. Fifteen sockets received MHA, 15 sockets received CS, and 15 sockets received corticocancellous PB as a graft material. Three months after bone filling, titanium dental implants were placed in grafted sites. Three months after implant placement, temporary restoration was performed. Follow-up examinations were conducted, and intraoral digital radiographs were taken at baseline and 12 and 24 months after implant placement to evaluate the marginal bone level in each patient. Comparisons for marginal bone loss over time between groups were performed by the Student two-tailed t test. Results: At the 24-month follow-up, a survival rate of 100% was reported for all implants. For the MHA group, a mean mesial bone loss of -0.21 +/- 0.08 mm and a mean distal bone loss of -0.22 +/- 0.09 mm (mean bone loss: 0.21 +/- 0.09 mm) were reported; for the CS group, a mesial bone loss of -0.14 +/- 0.07 mm and a distal bone loss of -0.12 +/- 0.11 mm (mean bone loss: -0.13 +/- 0.09 mm) were measured; for the PB group, a mean mesial bone loss of -0.15 +/- 0.10 mm and a mean distal bone loss of -0.16 +/- 0.06 mm (mean bone loss: -0.16 +/- 0.08 mm) were reported. No statistically significant differences were reported among groups (P >0.05). Conclusion: At the 24-month follow-up, the present study showed that placement of implants in grafted sockets was not influenced by the three different biomaterials because they did not negatively impact the clinical outcome.

• Enamel Matrix Derivative Protein Stimulated Wound Healing via Phosphoinositide 3-Kinase.

  Authors: Seiji Goda, Yuki Kaneshita, Hiroshi Inoue, Eisuke Domae, Takashi Ikeo, Joji Iida, Naochika Domae

  Journal of periodontology. 80(10):1631-7.

  Background: Enamel matrix derivative (EMD) protein has been clinically used for periodontal regeneration, but the molecular mechanisms are not clear. Previous studies suggested that the activation ofBackground: Enamel matrix derivative (EMD) protein has been clinically used for periodontal regeneration, but the molecular mechanisms are not clear. Previous studies suggested that the activation of phosphoinositide 3-kinase (PI 3-kinase) plays a key role in facilitating cell migration. Given that the migration of osteoblasts is one of the key steps in the wound-healing processes, we hypothesized that EMD protein would stimulate osteoblast migration by activating PI 3-kinase. In this study, we tested this hypothesis using MG-63 cells as model systems to evaluate mechanisms of migration by stimulation with EMD protein. Methods: Confluent MG-63 cells were mechanically scratched using a sterilized 1-mm pipette tip that removed the cells within a circular area. The wells were incubated for 24 hours in various stimulation conditions (25, 50, or 100 mug/ml EMD protein) with or without the PI 3-kinase inhibitor wortmannin (1, 10, and 100 nM) or LY294002 (1, 10, and 100 muM). Migrated cells in the wound section were counted by randomly selecting three areas from one well. The activation of PI 3-kinase by EMD protein was evaluated by the phosphorylation of Akt using Western blot analysis. Results: Although EMD protein did not affect proliferation, it enhanced migration into wounds on MG-63 cells. We showed that EMD protein enhanced the phosphorylation of Akt in a dose-dependent manner. We demonstrated that the PI 3-kinase inhibitors wortmannin and LY294002 blocked migration into wounds and the phosphorylation of Akt enhanced by EMD protein in MG-63 cells. Conclusion: These results demonstrated that the activation of PI 3-kinase plays a key role in the EMD protein-stimulated migration of osteoblasts.

• Effect of laser-induced dentin modifications on periodontal fibroblasts and osteoblasts: a new in vitro model.

  Authors: Carlo Galli, Giovanni Passeri, Antonio Cacchioli, Giacomo Gualini, Francesca Ravanetti, Erida Elezi, Guido M Macaluso

  Journal of periodontology. 80(10):1648-54.

  Background: The erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been shown to be a promising tool for root treatment in periodontitis, but little information is available regarding theBackground: The erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser has been shown to be a promising tool for root treatment in periodontitis, but little information is available regarding the surface characteristics after this treatment, mainly because it is difficult to obtain standardized dentin samples for in vitro studies. Methods: Commercially available standardized dentin disks were treated with an Er:YAG laser at different settings and used as a substrate for human primary osteoblastic cells (hOBs) and periodontal ligament fibroblasts (PLFs). Cell proliferation on untreated dentin was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay after 3, 6, 12, 24, and 48 hours of culture. The effects of the laser on dentin and cell morphology on treated and untreated samples were investigated by scanning electron microscopy after 3, 6, 24, and 48 hours of culture. Results: Dentin samples supported proliferation for both cell types, although growth kinetics were different. The laser dramatically affected the dentin profile, creating a rough and irregular surface. Cells grew easily on untreated dentin, but fewer cells were present on treated areas, often displaying long filopodes. hOBs showed poorer adhesion to treated dentin than PLFs. Conclusions: The dentin disks provide a standardized and useful tool to study dentin surface modifications in vitro. PLFs behaved differently from hOBs on dentin, possibly because of their different affinity to this tissue and/or their differentiation state. The changes induced by the laser produced a less favorable environment for cell adhesion or growth, and treated dentin seemed to be more suitable for PLF adhesion compared to hOB adhesion.

• Mechanical tension alters semaphorin expression in the periodontium.

  Authors: Amber Y Spencer, Thomas E Lallier

  Journal of periodontology. 80(10):1665-73.

  Background: Periodontal remodeling requires coordinated cell movement. Semaphorins are cell-surface signals that regulate cell migration and may be differentially regulated by periodontal cells.Background: Periodontal remodeling requires coordinated cell movement. Semaphorins are cell-surface signals that regulate cell migration and may be differentially regulated by periodontal cells. Mechanical tension can regulate periodontal ligament (PDL) remodeling. We predicted that mechanical tension alters the expression of the subset of semaphorins in the periodontium likely to be most involved with regulating the remodeling of this tissue. Methods: PDL and gingival cells were exposed to mechanical tension, and their attachment and movement on collagen matrices were evaluated. Alterations in extracellular matrix and semaphorin transcript expression were monitored by semiquantitative reverse transcription-polymerase chain reaction. Results: Mechanical tension induced osteoclast regulatory transcripts in the PDL cells to a greater extent than gingival fibroblasts, increasing the expression of osteoprotegerin and decreasing receptor activator of nuclear factor-kappa B ligand. These mechanical forces reduced PDL cell mingling, without altering cell attachment or motility. Concurrently, these forces induced dynamic changes in several semaphorin molecules in PDL cells, increasing semaphorin 3D and 5B and decreasing semaphorin 7A. In addition, plexin transcript expression was altered, decreasing plexin A1 and increasing plexin C1. These changes were different than those observed in gingival fibroblasts. Conclusions: These data suggest that a subset of semaphorins and plexins are dynamically regulated in the PDL. Because these molecules may be involved in cell guidance, changes in semaphorins may play a pivotal role in periodontal remodeling, affecting angiogenesis or PDL cell invasion into sites of injury.

• Treatment of multiple areas of gingival recession using a simple harvesting technique for autogenous connective tissue graft.

  Authors: Dwight E McLeod, Elio Reyes, Grishondra Branch-Mays

  Journal of periodontology. 80(10):1680-7.

  Background: A clinical case is presented describing a simple approach to harvest a connective tissue graft from the palate. This technique involves partial palatal deepithelialization and procurementBackground: A clinical case is presented describing a simple approach to harvest a connective tissue graft from the palate. This technique involves partial palatal deepithelialization and procurement of a layer of thin and uniform abundant connective tissue to treat multiple areas of gingival recession. Methods: A 52-year-old European American male was referred for treatment of root sensitivity associated with gingival recession stemming from toothbrush abrasion. The areas of gingival recession associated with teeth #18 through #22 and teeth #27 through #31 were classified as Miller Class III gingival recession. A tunnel technique was planned for both areas in the mandible. The right palate, which served as the donor site, was deepithelialized, and a large connective tissue graft approximately 1 mm thick was harvested. A periodontal probe was used to pass the graft through the tunnel, and the grafted areas were sutured using one or two vertical mattress sutures per interdental area. Results: The patient was followed until complete healing was achieved. At 3 months, there was improvement in gingival thickness, keratinized tissue width, and root coverage. Complete root coverage occurred in three of the 10 treated teeth, and the remaining teeth obtained 80% to 90% root coverage. The patient's root sensitivity symptoms were resolved. Conclusions: The technique is practical and simple to perform. This approach, involving partial palatal deepithelialization and the applied tunnel surgical procedure, resulted in a successful clinical outcome with increased gingival tissue thickness, keratinized tissue, and root coverage.

• Assessment of self-report measures for predicting population prevalence of periodontitis.

  Authors: Paul I Eke, Bruce Dye

  Journal of periodontology. 80(9):1371-9.

  Background: Self-report measures have been used successfully for the surveillance of chronic diseases in adult populations. This pilot study assessed the use of self-report oral health measures forBackground: Self-report measures have been used successfully for the surveillance of chronic diseases in adult populations. This pilot study assessed the use of self-report oral health measures for predicting the population prevalence of periodontitis in United States adults. Methods: Data were collected from 456 subjects participating in a 2007 study conducted by the Centers for Disease Control and Prevention. Each subject answered eight predetermined oral health self-report questions obtained from in-person interviews and were given a full-mouth periodontal examination using the National Health and Nutrition Examination Survey protocol. The predictiveness of measures from these self-report questions was assessed by multivariable logistic regression modeling measuring receiver operating characteristic (ROC) statistics, sensitivity, and specificity. Results: Multivariable modeling incorporating self-report measures on gum disease, loose teeth, and tooth appearance alone were most useful in predicting the prevalence of severe periodontitis and improved with the addition of demographic and risk factor variables, yielding an ROC value of 0.93, sensitivity of 54.6%, and specificity of 98% at the observed 4.8% prevalence of disease. Scaling and root planing treatments, loose teeth, and the use of mouthwash, combined with demographic and risk factor covariates, were moderately useful in predicting total periodontitis. Conclusions: Multivariable modeling of specific self-report oral health measures is promising for predicting the population prevalence of severe periodontitis, confirming earlier assessments from a national survey. These results justify further assessments of self-report oral health measures for use in the surveillance of periodontitis in the adult United States population.

• The positive relationship between excess cement and peri-implant disease: a prospective clinical endoscopic study.

  Authors: G Wilson Thomas

  Journal of periodontology. 80(9):1388-92.

  Background: Cement-retained restorations are commonly used on dental implants. Residual excess cement after placement of fixed partial dentures has been associated with clinical and radiographicBackground: Cement-retained restorations are commonly used on dental implants. Residual excess cement after placement of fixed partial dentures has been associated with clinical and radiographic signs of peri-implant disease. The purpose of this study was to explore the relationship between excess dental cement and peri-implant disease using the dental endoscope. Methods: Thirty-nine consecutive patients with implants exhibiting clinical and/or radiographic signs of peri-implant disease were studied. Patients were enrolled in the study during a 5-year period in a private periodontal practice. Twelve of these patients had similar implants without signs of inflammation; these implants served as controls. There were 20 controls and 42 test implants. All were evaluated using a dental endoscope initially, and all but one implant was evaluated at a 30-day follow-up. Results from both groups were assessed by two trained operators and recorded. Results: None of the controls and all 42 of the test implants had clinical signs of peri-implant disease at initial treatment. Excess cement was found in none of the controls and 34 of the test sites. Thirty days after cement removal, 25 of 33 test sites from which the cement was removed had no clinical or endoscopic signs of inflammation. Conclusions: Excess dental cement was associated with signs of peri-implant disease in the majority (81%) of the cases. Clinical and endoscopic signs of peri-implant disease were absent in 74% of the test implants after the removal of excess cement.

• Periodontal conditions of sites treated with gingival-augmentation surgery compared to untreated contralateral homologous sites: a 10- to 27-year long-term study.

  Authors: G Agudio, M Nieri, R Rotundo, D Franceschi, P Cortellini, G P Pini Prato

  Journal of periodontology. 80(9):1399-405.

  Background: The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures to untreated homologousBackground: The aim of this retrospective long-term split-mouth study was to compare the periodontal conditions of sites treated with gingival-augmentation procedures to untreated homologous contralateral sites over a long period of time (10 to 27 years). Methods: Fifty-five subjects with 73 sites (test group) lacking attached gingiva associated with recessions were treated by means of submarginal free gingival grafts (SMFGGs) and marginal free gingival grafts (MFGGs). The 73 contralateral homologous sites (control group), with or without recession and with or without attached gingiva, were not treated. Patients were recalled every 4 months during the follow-up period (10 to 27 years). Clinical variables, including recession depth, amount of keratinized tissue (KT), and probing depth (PD), were measured in treated and untreated sites at baseline, at 1 year, and at the end of the follow-up period. Results: At the end of the follow-up period, recession was reduced in all treated sites (1.5 +/- 1.0 mm for SMFGG and 1.3 +/- 0.9 mm for MFGG), whereas it was increased in the untreated sites (-0.7 +/- 0.7 mm for SMFGG and -1.0 +/- 0.5 mm for MFGG). In the treated sites, the increased KT remained quite stable during the follow-up period. PD remained stable (1 mm) in the treated and untreated sites. Conclusions: The sites treated with gingival-augmentation surgery showed a tendency for coronal displacement of the gingival margin with a reduction in recession. The contralateral untreated sites showed a tendency for apical displacement of the gingival margin with an increase in the existing recessions.

• Anti-tumor necrosis factor-alpha therapy and periodontal parameters in patients with rheumatoid arthritis.

  Authors: Yaniv Mayer, Alexandra Balbir-Gurman, Eli E Machtei

  Journal of periodontology. 80(9):1414-20.

  Background: The aim of this study was to evaluate the influence of anti-tumor necrosis factor-alpha (TNF-alpha) therapy on the clinical and immunologic parameters of the periodontium. Methods: TenBackground: The aim of this study was to evaluate the influence of anti-tumor necrosis factor-alpha (TNF-alpha) therapy on the clinical and immunologic parameters of the periodontium. Methods: Ten patients with rheumatoid arthritis (RA) who routinely received infusions of infliximab, 200 mg (RA+), 10 patients with RA without anti-TNF-alpha therapy (RA-), and 10 healthy controls (C) were included. Clinical parameters, including the plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment loss (AL), and bleeding on probing (BOP), were assessed, and total gingival crevicular fluid (GCF) TNF-alpha level was determined using enzyme-linked immunosorbent assay. Analysis of variance with Scheffe modification and the Pearson correlation test were used for statistical analysis. Results: The ages of the patients ranged from 22 to 76 years (mean, 50.73 +/- 9.1 years). The mean PI was similar among the groups. However, mean inflammatory parameters in the three groups varied significantly; GI was greater in the RA- group compared to RA+ and C groups (P = 0.0042). The RA+ group exhibited less BOP than RA- and C groups (21.1% +/- 3.0%, 45.9% +/- 6.2%, and 39.1% +/- 7.2%, respectively; P = 0.0146). The mean PD in the RA+ group was shallower than in RA- and C groups (3.22 +/- 0.13 mm, 3.85 +/- 0.22 mm, and 3.77 +/- 0.20 mm, respectively; P = 0.055). Clinical AL in the RA+ group was lower than in RA- and C groups (3.68 +/- 0.11 mm, 4.52 +/- 0.26 mm, and 4.35 +/- 0.24 mm, respectively; P = 0.0273). TNF-alpha levels in the GCF of the RA+ group were the lowest compared to RA- and C groups (0.663, 1.23, and 0.949 ng/site, respectively; P = 0.0401). A significant positive correlation was found between TNF-alpha levels in the GCF and clinical AL (r = 0.448; P = 0.0283). Conclusions: Patients with RA receiving anti-TNF-alpha medication had lower periodontal indices and GCF TNF-alpha levels. Thus, suppression of proinflammatory cytokines might prove beneficial in suppressing periodontal diseases.

• Evidence for calcifying nanoparticles in gingival crevicular fluid and dental calculus in periodontitis.

  Authors: Song-Mei Zhang, Fei Tian, Xin-Quan Jiang, Jing Li, Chun Xu, Xiao-Kui Guo, Fu-qiang Zhang

  Journal of periodontology. 80(9):1462-70.

  Background: Calcifying nanoparticles (CNPs), also known as nanobacteria, can produce carbonate apatite on their cell walls and initiate pathologic calcification. The objective of this study was toBackground: Calcifying nanoparticles (CNPs), also known as nanobacteria, can produce carbonate apatite on their cell walls and initiate pathologic calcification. The objective of this study was to determine whether CNPs are present in the gingival crevicular fluid (GCF) from subjects with periodontal disease and whether they can induce the pathologic calcification of primary cultured human gingival epithelial cells. Methods: GCF and dental calculus samples were collected from 10 subjects with gingivitis and 10 subjects with chronic periodontitis. CNPs in GCF and calculus filtrates were detected with nanocapture enzyme-linked immunosorbent assay kits. The CNPs in cultures of dental calculus filtrates were also identified using immunofluorescence staining, transmission electron microscopy (TEM), and chemical analysis. Pathologic changes in the CNP-treated gingival epithelial cells were observed with TEM, alizarin red staining, and disk-scanning confocal microscopy. Results: CNPs were found in GCF samples from two subjects with chronic periodontitis. Based on chemical analysis, the surface-associated material from CNPs isolated and cultured from calculus has a composition similar to dental calculus. The pathologic calcification of CNP-treated gingival epithelial cells was also observed. Conclusions: Self-replicating calcifying nanoparticles can be cultured and identified from dental calculus. This raises the issue of whether CNPs contribute to the pathogenesis of periodontitis.

• Degradation of Vascular Endothelial Thrombomodulin by Arginine- and Lysine-Specific Cysteine Proteases From Porphyromonas gingivalis.

  Authors: Megumi Inomata, Yuichi Ishihara, Takashi Matsuyama, Takahisa Imamura, Ikuro Maruyama, Toshihide Noguchi, Kenji Matsushita

  Journal of periodontology. 80(9):1511-7.

  Background: The endothelial cell surface glycoprotein thrombomodulin (TM) inhibits vascular coagulation and inflammation via regulation of thrombin-mediated activation of protein C. PorphyromonasBackground: The endothelial cell surface glycoprotein thrombomodulin (TM) inhibits vascular coagulation and inflammation via regulation of thrombin-mediated activation of protein C. Porphyromonas gingivalis is the major periodontopathic bacterium and has been found in vessel walls and atherosclerotic lesions in humans. P. gingivalis-derived cysteine proteases (gingipains) are known to enhance inflammatory and coagulant responses of vascular endothelial cells. However, it has not been elucidated whether gingipains affect vascular endothelial TM. Methods: Purified arginine-specific gingipains (Rgps) and lysine-specific gingipain (Kgp) from P. gingivalis were used to investigate the effects of gingipains on recombinant human TM by immunoblot analyses. Flow cytometry and activated protein C assay were carried out to examine the effects of gingipains on vascular endothelial cell surface TM. Immunohistochemistry was performed to investigate TM expression in microvascular endothelia in gingival tissues taken from patients with periodontitis. Results: Rgps and Kgp cleaved TM in vitro. Endothelial cell surface TM was also degraded by Rgps. Thrombin-mediated activation of protein C was reduced by Rgps through TM inactivation. Gingival microvascular endothelial TM was reduced in patients with periodontitis. Conclusions: P. gingivalis gingipains induced the degradation and inactivation of endothelial TM, which may promote vascular coagulation and inflammation. In addition, in vivo relevance was demonstrated by reduced expression of TM in gingival microvascular endothelia in patients with periodontitis, which may be involved in the pathogenesis of periodontitis.

• Clinical decisions and the quality of evidence available for dental implants.

  Authors: Neel Bhatavadekar

  Journal of periodontology. 80(10):1559-61.

  As more types of implants have become available, clinicians have been faced with the task of choosing a specific implant from a wide array of options for a given clinical situation, which has led toAs more types of implants have become available, clinicians have been faced with the task of choosing a specific implant from a wide array of options for a given clinical situation, which has led to an ever-increasing need for clinical evidence to help clinicians choose an implant. This article highlights the need for clinicians to look beyond the claims proposed by manufacturers because several of those claims are not substantiated by randomized controlled trials but by in vitro data alone. Recent advances in clinical evidence-based decision portals might enable busy clinicians to adopt an evidence-based approach to choosing implant systems. Also, the standardization of study-reporting criteria might enable comparisons across implant systems in the future.

• Letter to the editor: re: "bone remodeling biomarkers of periodontal disease in saliva".

  Authors: Susana N Zeni

  Journal of periodontology. 80(10):1565-6.

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