Description

The aim and scope of this Journal is to convey scientific progress in periodontology to those concerned with application of this knowledge for the benefit of the dental health of the community. It will address itself primarily to clinicians general practitioners periodontists as well as to teachers and administrators involved in the organisation of prevention and treatment of periodontal disease. The Journal will publish original contributions of high scientific merit in the field of physiology and pathology of the periodontium diagnosis epidemiology and prevention and therapy of periodontal disease review articles by experts on new developments in basic and applied periodontal science advances in periodontal technique and instrumentation and case reports which illustrate important new information. The language of the Journal is English but all articles will be published with summaries in German and French. The usual selective criteria for acceptance of manuscripts apply for this Journal. The members of the Advisory Board will serve primarily as referees. Publication time will be kept to a minimum in order that new findings can be made generally available in the shortest possible time.

Publisher details

Blackwell Publishing

Publications in this journal

• Characterization and immunosuppressive properties of mesenchymal stem cells from periapical lesions

  Authors: Jelena Đokić, Sergej Tomić, Snežana Cerović, Vera Todorović, Rebeka Rudolf, Miodrag Čolić

  Journal Of Clinical Periodontology.

  Aim: Mesenchymal stem cells (MSCs) isolated from healthy dental tissues are being investigated as an alternative source of MSCs for the treatment of damaged tissues and inflammatory diseases. HereAim: Mesenchymal stem cells (MSCs) isolated from healthy dental tissues are being investigated as an alternative source of MSCs for the treatment of damaged tissues and inflammatory diseases. Here we investigated whether MSCs from periapical lesions (PL-MSCs) also possess multi-lineage differentiation capacity and immunomodulatory properties. Materials and methods: PL-MSCs, isolated by collagenase/DNAse digestion from surgically extracted PLs, were compared with MSCs from non-inflamed dental pulp (DP-MSCs) and dental follicle (DF-MSCs) for their phenotype and multi-potent differentiation potential. The antiinflammatory and immunomodulatory effects of PL-MSCs were studied in co-culture with peripheral blood mononuclear cells (PB-MNCs) and PL-inflammatory cells (PL-ICs). Results: PL-MSCs were characterized by typical MSCs phenotype, lower clonogenicity and selfrenewal rate, compared to DF-MSCs and DP-MSCs. These cells possess the potential to differentiate into adipocyte-, osteoblast- and chondrocyte-like cells in vitro, which differs from that of DP-MSCs and DF-MSCs. PL-MSCs inhibited phytohemaglutinine-induced proliferation of PB-MNCs and production of IL-2, IFNγ and IL-5 in the co-culture, probably via TGF-β-dependent mechanisms. These cells also suppressed the production of IL-1β, IL-6, and TNF-α by PL-ICs via soluble mediators, whereas the suppression of IL-8 production required a direct cell-to-cell contact. Conclusion: The differentiation potential of PL-MSCs and their immunosuppressive/antiinflammatory properties could be beneficial for the treatment of chronic periodontal diseases.

• A New Index Proposed for Determination of Outcome of Recession Coverage Procedures

  Authors: Nymphea Pandit, Amit K. Gaba, Rajvir Malik, I. K. Pandit

  Journal Of Clinical Periodontology.

• Siebert,T.,Jurkovic,R., Erdelsky,I.: Extraction of third mandibular molar to promote periodontal healing. Journal of Clinical Periodontology, 2009 June 36, Suppl., 9:212

  Authors: Siebert T, Jurkovic R, Erdelsky I

  Journal Of Clinical Periodontology. 2009(June36-6):9:212.

• Researching periodontitis: challenges and opportunities.

  Authors: Anwar T Merchant, Waranuch Pitiphat

  Journal of clinical periodontology. 34(12):1007-15.

  AIM AND METHODS: The evidence-based approach, voted in January 2007 as one of the 15 most important medical advances in the last 166 years, has increasingly shaped medical practice and education. InAIM AND METHODS: The evidence-based approach, voted in January 2007 as one of the 15 most important medical advances in the last 166 years, has increasingly shaped medical practice and education. In this paper, we apply the evidence-based approach to evaluate the aetiology of periodontitis; for comparison, we provide a brief description of the evidence-based method applied to the study of cardiovascular disease aetiology. We then discuss the challenges and opportunities to enhance the evidence base for periodontitis aetiology. RESULTS AND CONCLUSION: While evidence for medical treatments has mostly come from clinical trials, evidence for primary prevention in medicine has largely emerged from cohort studies evaluating disease risk factors. The high cost of conducting large cohort studies makes it challenging to fund these investigations, particularly for primary dental outcomes such as periodontitis. Studies of periodontitis outcomes integrated into larger ongoing cohorts provide one way to overcome this problem. Other potential barriers to the conduct of these studies include outcome definition, prevention of bias, data analysis, and the focus on teeth at risk (rather than people at risk) of the outcome. We analyse these questions and provide possible solutions. As many of these issues are generic to dentistry, possible solutions can improve the quality of future studies and the evidence base for primary prevention in dentistry.

• Dental biofilm, gingivitis and interleukin-1 adjacent to approximal sites of a bonded ceramic.

  Authors: Katarina Konradsson, Rolf Claesson, Jon W V van Dijken

  Journal of clinical periodontology. 34(12):1062-7.

  AIM: The aim of this study was to investigate in vivo the influence of aged, resin-bonded, ceramic restorations on approximal dental biofilm formation and gingival inflammatory response, associatedAIM: The aim of this study was to investigate in vivo the influence of aged, resin-bonded, ceramic restorations on approximal dental biofilm formation and gingival inflammatory response, associated with and without customary oral hygiene. MATERIAL AND METHODS: In a cross-sectional and in a 10-day experimental gingivitis study, Quigley-Hein plaque index, gingival index (GI), crevicular fluid and its levels of interleukin (IL)-1alpha, -1beta and receptor antagonist were measured at appoximal surfaces of leucite-reinforced bonded ceramic coverages, resin composite restorations and enamel and compared intra-individually in 17 participants. RESULTS: No differences were found between the ceramic, composite and enamel regarding plaque index, GI, levels of IL-1alpha, -1beta and the receptor antagonist. Throughout, higher crevicular fluid amounts were observed at ceramic sites compared with the enamel (p<0.05). In the experimental gingivitis, plaque index, GI, crevicular fluid and its IL-1alpha levels increased significantly. CONCLUSION: The need for optimal oral hygiene and professional preventive oral health care does not seem to be reduced with regard to approximal surfaces of aged, resin-bonded, leucite-reinforced ceramic restorations in comparison with those of a hybrid, resin composite and enamel.

• Automatic mining of the literature to generate new hypotheses for the possible link between periodontitis and atherosclerosis: lipopolysaccharide as a case study.

  Authors: Kristina M Hettne, Marc Weeber, Marja L Laine, Hugo Ten Cate, Scott Boyer, Jan A Kors, Bruno G Loos

  Journal of clinical periodontology. 34(12):1016-24.

  AIM: The aim of the current report was to generate and explore new hypotheses into how, in a pathophysiological sense, atherosclerosis and periodontitis could be linked. MATERIAL AND METHODS: TwoAIM: The aim of the current report was to generate and explore new hypotheses into how, in a pathophysiological sense, atherosclerosis and periodontitis could be linked. MATERIAL AND METHODS: Two different biomedical informatics techniques were used: an association-based technique that generated a ranked list of genes associated with the diseases, and a natural language processing tool that extracted the relationships between the retrieved genes and lipopolysaccharide (LPS). RESULTS: This combined approach of association-based and natural language processing-based literature mining identified a hit list of 16 candidate genes, with PON1 as the primary candidate. CONCLUSIONS: Further study of the literature prompted the hypothesis that PON1 might connect periodontitis with atherosclerosis in both an LPS-dependent and a non-LPS-dependent manner. Furthermore, the resulting genes not only confirmed already known associations between the two diseases, but also provided genes or gene products that have only been investigated separately in the two disease states, and genes or gene products previously reported to be involved in atherosclerosis. These findings remain to be investigated through clinical studies. This example of multidisciplinary research illustrates how collaborative efforts of investigators from different fields of expertise can result in the discovery of new hypotheses.

• Plaque and gingivitis in the elderly: a randomized, single-blind clinical trial on the outcome of intensified mechanical or antibacterial oral hygiene measures.

  Authors: Ulrich Schiffner, Mathias Bahr, Susanne Effenberger

  Journal of clinical periodontology. 34(12):1068-73.

  OBJECTIVES: To study the outcome of intensified mechanical oral hygiene compared with the effect of an adjunctive antibacterial mouth rinse on plaque and gingivitis in elderly people. MATERIAL ANDOBJECTIVES: To study the outcome of intensified mechanical oral hygiene compared with the effect of an adjunctive antibacterial mouth rinse on plaque and gingivitis in elderly people. MATERIAL AND METHODS: In a randomized, single-blind, 6-month controlled clinical study, 106 subjects, 55 years or older, were divided into four groups: (I) Participants were instructed on improved mechanical oral hygiene, including interdental hygiene; (II) subjects used an antibacterial mouth rinse containing amine and stannous fluoride in addition to their usual oral hygiene practices; (III) both intensive mechanical and antibacterial measures were combined; and (IV) a control group with no specific regimen. Gingivitis and plaque were examined. RESULTS: After 6 months, both plaque and gingivitis scores were significantly lower than at baseline in all groups. Reductions in gingivitis differed significantly between the control group and all other groups but not between the three intervention groups. Only groups with improved mechanical oral hygiene showed significant improvements in plaque scores compared with control. CONCLUSIONS: Intensive mechanical oral hygiene resulted in greater plaque reduction than the combination of an antibacterial rinse and usual oral hygiene procedures. Gingivitis was reduced by both intensive oral hygiene and use of the amine/stannous fluoride rinse. Combining intensive mechanical oral hygiene with the antibacterial rinse did not result in further gingivitis reduction.

• Influence of platform switching on crestal bone changes at non-submerged titanium implants: a histomorphometrical study in dogs.

  Authors: Jürgen Becker, Daniel Ferrari, Monika Herten, Axel Kirsch, Alex Schaer, Frank Schwarz

  Journal of clinical periodontology. 34(12):1089-96.

  OBJECTIVES: The aim of the present study was to investigate histomorphometrically the influence of platform switching on crestal bone changes at non-submerged wide-body titanium implants in a dogOBJECTIVES: The aim of the present study was to investigate histomorphometrically the influence of platform switching on crestal bone changes at non-submerged wide-body titanium implants in a dog model. MATERIAL AND METHODS: One-stage insertion of sand-blasted and acid-etched screw-type implants with either matching (CAM) or smaller-diameter healing abutments (CPS) were randomly assigned to the lower jaws of nine beagle dogs. The animals were killed after 7, 14, and 28 days of non-submerged healing. Dissected blocks were processed for histomorphometrical analysis. Measurements were made between the implant shoulder (IS) and:--the apical extension of the long junctional epithelium (aJE), --the most coronal level of bone in contact with the implant (CLB), and --the level of the alveolar bone crest (BC). RESULTS: At 7, 14, and 28 days, the mean IS-aJE values were significantly the lowest at CPS implants. However, after 28 days of healing, both groups revealed significantly increased mean IS-BC values at the buccal aspect of the alveolar bone. The difference in IS-CLB and IS-BC between groups was not significant. CONCLUSIONS: Within the limits of the present study, it was concluded that both CAM and CPS implants revealed crestal bone-level changes after 28 days of healing.

• Does tooth brushing influence the development and progression of non-inflammatory gingival recession? A systematic review.

  Authors: P Sunethra Rajapakse, Giles I McCracken, Erika Gwynnett, Nick D Steen, Arndt Guentsch, Peter A Heasman

  Journal of clinical periodontology. 34(12):1046-61.

  AIM: The aim of this systematic review was to produce the best available evidence and pool appropriate data to evaluate the effect of tooth brushing on the initiation and progression ofAIM: The aim of this systematic review was to produce the best available evidence and pool appropriate data to evaluate the effect of tooth brushing on the initiation and progression of non-inflammatory gingival recession. MATERIAL AND METHODS: A protocol was developed a priori for the question: "Do factors associated with tooth brushing predict the development and progression of non-inflammatory gingival recession in adults?" The search covered six electronic databases between January 1966 and July 2005. Hand searching included searches of the Journal of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of narrative reviews, conference proceedings and relevant texts known to the authors were also searched. Inclusion of titles, abstracts and ultimately full texts was based on consensus between three reviewers. RESULTS: The full texts of 29 papers were read and 18 texts were eligible for inclusion. One abstract from EuroPerio 5 reported a randomized-controlled clinical trial [Level I evidence] in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over 18 months. Of the remaining 17 observational studies, two concluded that there appeared to be no relationship between tooth brushing frequency and gingival recession. Eight studies reported a positive association between tooth brushing frequency and recession. Other potential risk factors were duration of tooth brushing, brushing force, frequency of changing the toothbrush, brush (bristle) hardness and tooth brushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal and a valid appraisal of the quality of the randomized-controlled trial was not possible. CONCLUSION: The data to support or refute the association between tooth brushing and gingival recession are inconclusive.

• Role of IL-6, TNF-A and LT-A variants in the modulation of the clinical expression of plaque-induced gingivitis.

  Authors: Chiara Scapoli, Elisabetta Mamolini, Leonardo Trombelli

  Journal of clinical periodontology. 34(12):1031-8.

  AIM: The purpose of the present study was to assess the association of interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-A) and lymphotoxin alpha (LT-A) gene polymorphisms with the clinicalAIM: The purpose of the present study was to assess the association of interleukin-6 (IL-6), tumour necrosis factor alpha (TNF-A) and lymphotoxin alpha (LT-A) gene polymorphisms with the clinical parameters of gingivitis in a large experimental gingivitis trial and with each of two subgroups, "high responder" (HR, n=24) and "low responder" (LR, n=24), with distinct susceptibility to gingivitis. MATERIAL AND METHODS: Ninety-six systemically and periodontally healthy non-smokers, 46 males (mean age: 23.9+/-1.7) and 50 females (mean age: 23.3+/-1.6), were included in a randomized split-mouth localized 21-day experimental gingivitis trial. Plaque index, gingival index, gingival crevicular fluid volume and angulated bleeding score were recorded. HR and LR subgroups were characterized by substantially different severities of gingival inflammation despite a similar plaque accumulation rate. All subjects were genetically characterized for IL-6(-174), IL-6(-597), TNF-A(-308) and LT-A(+252) polymorphisms. RESULTS: None of the variants analysed, either as single polymorphisms or as a combined genotype, was associated with the clinical parameters in the overall population. For the polymorphisms studied, genotypic distributions in HR and LR subjects were not significantly different. CONCLUSIONS: The present results suggest an absence of association between IL-6, TNF-A and LT-A polymorphisms and subject-based clinical behaviour of the gingiva in response to de novo plaque accumulation.

• Alveolar bone loss in liver transplantation patients: relationship with prolonged steroid treatment and parathyroid hormone levels.

  Authors: Orit Oettinger-Barak, Elena Segal, Eli E Machtei, Shlomi Barak, Yaacov Baruch, Sofia Ish-Shalom

  Journal of clinical periodontology. 34(12):1039-45.

  AIM: To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees. PATIENTS AND METHODS: Twenty-one liver transplantees underwent aAIM: To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees. PATIENTS AND METHODS: Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined. RESULTS: Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33+/-2.32 mm (range 0.67-9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2+/-26.4). The mean 25(OH)D(3) was 11.68+/-4.7, range 3.5-21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D(3) levels > or =30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment (r =-0.474, p=0.03). A positive correlation was found between ABL, PTH (r =0.419, p=0.059) and hip bone mineral density (BMD) (r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD (r =0.810, p=0.004). CONCLUSIONS: The majority of liver transplant patients had insufficient 25(OH)D(3) serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials.

• Effect of smoking on folic acid and vitamin B12 after nonsurgical periodontal intervention.

  Authors: Ebru Olgun Erdemir, Jan Bergstrom

  Journal of clinical periodontology. 34(12):1074-81.

  AIM: The main purpose of this study was to investigate the effect of smoking on the serum levels of folic acid and vitamin B(12) in smokers and nonsmokers with chronic periodontal disease afterAIM: The main purpose of this study was to investigate the effect of smoking on the serum levels of folic acid and vitamin B(12) in smokers and nonsmokers with chronic periodontal disease after nonsurgical intervention. MATERIAL AND METHODS: The study base consisted of 45 current smokers and 43 nonsmokers. The clinical parameters included plaque index (PI), gingival index (GI), pocket depth (PD), and clinical attachment level (CAL). Folic acid and vitamin B(12) were determined from peripheral blood samples. Clinical measurements and blood samples were collected at baseline and 1, 3, and 6 months after the intervention. RESULTS: Mean PI was significantly greater in smokers compared with non-smokers throughout the observation period (p<0.001). During the first month, GI levels significantly decreased in both groups. From months 1 through 6, a significant return towards an increased GI level was observed in smokers (p<0.001). PD and CAL levels significantly decreased during the first month in both groups. Thereafter, increasing levels of PD and CAL were seen in both groups, although significantly more pronounced in smokers. Throughout the observation period, the mean CAL was significantly greater in smokers relative to nonsmokers (p<0.001). In smokers, the mean folic acid level gradually and significantly decreased and a slight and significant decrease in mean vitamin B(12) levels was observed in both groups over the entire observation period (p<0.001). CONCLUSION: The clinical response to nonsurgical intervention is impaired by smoking and smoking seems to negatively influence the serum level of folic acid following non-surgical intervention.

• Minimally invasive surgical technique and enamel matrix derivative in intra-bony defects. I: Clinical outcomes and morbidity.

  Authors: Pierpaolo Cortellini, Maurizio S Tonetti

  Journal of clinical periodontology. 34(12):1082-8.

  AIMS: This case cohort study was designed to evaluate the clinical performance and the intra-operative and post-operative morbidity of the minimally invasive surgical technique (MIST) associated withAIMS: This case cohort study was designed to evaluate the clinical performance and the intra-operative and post-operative morbidity of the minimally invasive surgical technique (MIST) associated with the application of an enamel matrix derivative (EMD) in the treatment of isolated deep intra-bony defects. MATERIAL AND METHODS: Forty deep isolated intra-bony defects in 40 patients were surgically accessed with the MIST. This technique was designed to limit the mesio-distal flap extension and the corono-apical flap reflection in order to reduce the surgical trauma and increase flap stability. The incision of the defect-associated papilla was performed according to the principles of the papilla preservation techniques. EMD was applied on the debrided and dried root surfaces. Stable primary closure of the flaps was obtained with modified internal mattress sutures. Surgery was performed with the aid of an operating microscope and microsurgical instruments. Clinical outcomes were collected at baseline and at 1 year. Intra-operative and post-operative morbidity was evaluated with questionnaires. RESULTS: The 1-year clinical attachment gain was 4.9+/-1.7 mm (p<0.0001 compared with baseline). This corresponded to a 77.6+/-21.9% resolution of the defect. Residual probing pocket depths were 3+/-0.6 mm. A minimal increase of 0.4+/-0.7 mm in gingival recession between baseline and 1 year was recorded. No patients experienced intra-operative pain, while only 14 reported a very moderate perception of the hardship of the surgical procedure [7+/-12 visual-analogue scale (VAS) units, on average]. Primary closure was obtained in all treated sites. At the 1-week follow-up visit, 38 sites (95%) were still closed. Only 12 subjects reported moderate post-operative pain (VAS 19+/-10) that lasted for 26+/-17 h. CONCLUSIONS: These data indicate that the minimally invasive surgical technique, in combination with EMD, can be successfully applied in the treatment of isolated deep intra-bony defects, resulting in excellent clinical outcomes with very limited intra- and post-operative morbidity.

• The extent of periodontal disease and the IL-6 -174 genotype as determinants of serum IL-6 level.

  Authors: Taina Raunio, Marianne Nixdorf, Matti Knuuttila, Riitta Karttunen, Olli Vainio, Tellervo Tervonen

  Journal of clinical periodontology. 34(12):1025-30.

  AIM: To study the extent of periodontal disease and the IL-6(-174) genotype as determinants of serum and mouthwash IL-6 concentration in subjects with moderate to severe periodontal disease. MATERIALAIM: To study the extent of periodontal disease and the IL-6(-174) genotype as determinants of serum and mouthwash IL-6 concentration in subjects with moderate to severe periodontal disease. MATERIAL AND METHODS: Fifty-two generally healthy subjects volunteered to participate. Probing pocket depth (PD) and periodontal attachment level (AL) were clinically examined and alveolar bone level (BL) was measured on orthopantomographs. IL-6 concentrations in mouthwash, collected by rinsing with 3 ml saline for 30 s and in serum, obtained by venipuncture, were measured using ELISA. IL-6(-174) polymorphism was studied using a polymerase chain reaction. RESULTS: Eleven subjects carried the GG genotype, and 41 subjects, carried the CG/CC genotype. The mean (+/- SD) concentration of IL-6 in serum was 1.6 (+/- 1.5) pg/ml and, 2.8 (+/- 5.04) pg/ml in mouthwash. The serum concentration of IL-6 was higher in subjects with the GG genotype than with the CG/CC genotype. In regression analyses the percentages of sites with PD> or =6 mm, AL> or =6 mm and BL> or =8 mm, the IL-6(-174) genotype, body mass index and gender associated significantly with serum IL-6 concentration. CONCLUSIONS: The extent of moderate to severe periodontal disease and the IL-6(-174) genotype contribute significantly to serum IL-6 concentration.

• Evaluation of bone surface registration applying a micro-needle array.

  Authors: Kurt Schicho, Rudolf Seemann, Vered Cohen, Hannes Traxler, Uriel Weinstein, Michal Shohat, Zvika Slovin, Michael Figl, Christian Czerny, Rolf Ewers, Haim Tal

  Journal of clinical periodontology. 34(11):991-7.

  AIM: In this study we present and evaluated a new registration technology for the jaw-bone surface. It is based on a micromechatronic device for the generation of a "mechanical image" of the boneAIM: In this study we present and evaluated a new registration technology for the jaw-bone surface. It is based on a micromechatronic device for the generation of a "mechanical image" of the bone surface by means of an array of micro-needles that are penetrating the soft tissue until they touch the surface of the bone. This "mechanical impression image" is aligned with the CT data set. MATERIAL AND METHODS: Based on laboratory measurements on 10 specially prepared jawbone models we evaluate the accuracy of this new registration method. Results: Our measurements of the 10 specimens revealed a maximum overall location error of 0.97 mm (range: 0.35-0.97 mm). CONCLUSIONS: From the technical point of view the presented registration technology has the potential to improve the performance (i.e. accuracy and avoidance of errors) of the registration process for bony structures in selected applications of image-guided surgery.

• Hyper-reactive PMNs in FcgammaRIIa 131 H/H genotype periodontitis patients.

  Authors: E A Nicu, U van der Velden, V Everts, A J van Winkelhoff, D Roos, B G Loos

  Journal of clinical periodontology. 34(11):938-45.

  BACKGROUND: Receptors for the Fc part of IgG (FcgammaRIIa) on polymorphonuclear leukocytes (PMN) mediate phagocytosis and cell activation. Previous results show that one of the genetic variants ofBACKGROUND: Receptors for the Fc part of IgG (FcgammaRIIa) on polymorphonuclear leukocytes (PMN) mediate phagocytosis and cell activation. Previous results show that one of the genetic variants of the FcgammaRIIa, the 131 H/H, is associated with more periodontal breakdown than the R/R. This may be due to hyper-reactivity of the H/H-PMNs upon interaction with bacteria. AIM: To study whether the FcgammaRIIa genotype modifies the PMN reactivity in periodontitis patients. MATERIAL AND METHODS: A cohort of 98 periodontitis patients was genotyped. From these, 10 H/H and 10 R/R consented to participate. PMNs were incubated with immune serum-opsonized Actinobacillus actinomycetemcomitans (A.a.). Phagocytosis, degranulation (CD63 and CD66b expression), respiratory burst and elastase release were assessed. Results: Patients of the H/H genotype showed more bone loss than those with the H/R or R/R genotype (p=0.038). H/H-PMNs phagocytosed more opsonized A.a. than did R/R-PMNs (p=0.019). The H/H-PMNs also expressed more CD63 and CD66b than did the R/R-PMNs (p=0.004 and 0.002, respectively) and released more elastase (p=0.001). CONCLUSIONS: The genotyping results confirm previous reports that more periodontal destruction occurs in the H/H genotype than in the H/R or R/R genotype. The functional studies indicate a hyper-reactivity of the H/H-PMN in response to bacteria, which may be one of several pathways leading to more periodontal breakdown.

• Surgical guided tissue regeneration treatment of advanced periodontal defects: a 5-year follow-up study.

  Authors: Christer Slotte, Barbro Asklöw, Dan Lundgren

  Journal of clinical periodontology. 34(11):977-84.

  OBJECTIVES: To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects. MATERIAL AND METHODS: In each of 24 patients, oneOBJECTIVES: To study the 5-year outcome of combined use of guided tissue regeneration (GTR) barriers and bovine bone in advanced periodontal defects. MATERIAL AND METHODS: In each of 24 patients, one defect was surgically exposed, debrided, filled with bovine bone, and covered with a bioresorbable barrier. Re-examinations were made after 1, 3, and 5 years. RESULTS: Average full-mouth plaque scores (FMPS) were 14.5% at baseline and 10.7%, 9.8%, and 18.9% after 1, 3, and 5 years, respectively. Mean probing pocket depth (PPD) was 10.0 mm at baseline. Mean PPD reduction was 5.2 mm after 1 year, 5.6 mm after 3 years, and 5.3 mm after 5 years. Mean gingival recession was 1.0 mm after 1 year, 1.6 mm after 3 years, and 1.3 mm after 5 years. Mean gain in clinical attachment level (CAL) was 4.2 mm at the 1-year, 4.1 mm at the 3-year, and 4.3 mm at the 5-year examination. Smoking significantly influenced CAL change at all re-examinations. FMPS were significantly correlated with radiographic defect depth at the 5-year examination and CAL with smoking and FMPS at the 3-year examination. CONCLUSION: Advanced periodontal defects can be successfully treated with the combined use of GTR barriers and bovine bone to substantially reduce PPD and achieve a stable, long-term gain of CAL.

• Effect of intermittent loading and surface roughness on peri-implant bone formation in a bone chamber model.

  Authors: Joke Duyck, Elke Slaets, Kenichi Sasaguri, Katleen Vandamme, Ignace Naert

  Journal of clinical periodontology. 34(11):998-1006.

  Both implant surface characteristics and mechanical loading are known to affect implant osseointegration. Their interaction and the underlying mechanisms by which they affect peri-implant healingBoth implant surface characteristics and mechanical loading are known to affect implant osseointegration. Their interaction and the underlying mechanisms by which they affect peri-implant healing processes are still unknown. The aim of this study is therefore to investigate the influence of a turned versus a rough (Plus), Dentsply Friadent) implant surface on peri-implant bone formation in case of unloaded or loaded implant healing. Material and Methods: Bone formation was evaluated around screw-shaped implants under four experimental conditions using a repeated sampling bone chamber methodology: (1) unloaded turned implant (CU), (2) unloaded implant with a rough surface (TU), (3) loaded turned implant (CL), and (4) loaded implant with a rough surface (TL). Peri-implant tissue samples were paraffin embedded after implant removal and examined histologically and histomorphometrically. A mixed model was used for statistical analysis. Results: The surface of bone tissue relative to the total tissue area (bone area fraction) was not affected by the experimental conditions. The areas of bone trabeculae relative to the bone area (bone fraction) were significantly higher for TL compared with CU and TU. The bone fraction in the vicinity (100 microm zone) of the implant (BFZ) was significantly the highest around the loaded roughened implants (TL). Conclusion: Implant loading did not affect bone formation in the absence of surface roughness, and implant surface roughness had no effect in the absence of loading. However, a bone-stimulating effect in the implant's vicinity was assigned to the rough surface when the implant was loaded.

• Periodontal infections and diabetes mellitus: when will the puzzle be complete?

  Authors: Evanthia Lalla

  Journal of clinical periodontology. 34(11):913-6.

• Masticatory dysfunction is associated with osteoporosis in older men.

  Authors: Alice Laudisio, Emanuele Marzetti, Livia Antonica, Silvana Settanni, Ioannis Georgakakis, Roberto Bernabei, Claudio Franceschi, Giuseppe Zuccalà

  Journal of clinical periodontology. 34(11):964-8.

  AIM: Thirty per cent of hip fractures occur in men. Nevertheless, the determinants of osteoporosis in men are unclear. Masticatory dysfunction is associated with malnutrition, and might represent anAIM: Thirty per cent of hip fractures occur in men. Nevertheless, the determinants of osteoporosis in men are unclear. Masticatory dysfunction is associated with malnutrition, and might represent an emergent cause of osteoporosis. The aim of this study was to assess the association of bone mineral density and self-assessed masticatory dysfunction in a general older population. MATERIAL AND METHODS: We assessed the association of masticatory dysfunction with standard parameters of bone mineral density (T-score, Z-score and the stiffness index) in all 310 subjects aged 75+ living in Tuscania (Italy). RESULTS: Among men, self-assessed masticatory dysfunction was associated with T-score [beta=0.86, confidence intervals (CI)=0.15-1.57; p=0.019], Z-score (beta=0.86, CI=0.16-1.56; p=0.017) and the stiffness index (beta=9.12, CI=0.47-17.77; p=0.039) in linear regression modeling, after adjusting. No significant associations were observed in women. CONCLUSIONS: Masticatory dysfunction is independently associated with osteoporosis in elderly men. Evaluation of masticatory function should enter the routine assessment of older men with osteoporosis.

• Gradients in periodontal status in Japanese employed males.

  Authors: Ichizo Morita, Haruo Nakagaki, Saori Yoshii, Shinji Tsuboi, Junko Hayashizaki, Junko Igo, Kinichiro Mizuno, Aubrey Sheiham

  Journal of clinical periodontology. 34(11):952-6.

  AIM: The objective was to assess whether there was a social gradient in periodontal status by job classification in Japanese male workers. MATERIAL AND METHODS: Study participants were 15,803AIM: The objective was to assess whether there was a social gradient in periodontal status by job classification in Japanese male workers. MATERIAL AND METHODS: Study participants were 15,803 Japanese male workers aged 20-69 years. There were seven groups classified by jobs. Oral examinations were conducted using community periodontal index (CPI). RESULTS: The percentages of sextants with a CPI score of 3 or 4 of professionals were significantly lower than for other job classes. The gradient also existed for the percentage of sextants with CPI score 4. After adjusting for age, a history of diabetes mellitus and smoking status, those lower on the gradient, namely, drivers, service occupations, salespersons and managers were 2.0, 1.5, 1.4 and 1.4, times, respectively more likely to have one or more sextants with CPI score 3 or 4 compared with professionals. Odds ratios of having more than one or more sextants with CPI score 4 after adjusting for age, clinical history of diabetes mellitus and smoking status for drivers, service occupations, salespersons and managers were 2.1, 1.5, 1.5 and 1.2, respectively, compared with professionals. CONCLUSIONS: There was a gradient in periodontal status by job classification. Professional and office workers had better periodontal status than salespersons, service occupations and drivers.

• Clinical characteristics and microbiota of progressing slight chronic periodontitis in adults.

  Authors: Anne C R Tanner, Ralph Kent, Eleni Kanasi, Shulin C Lu, Bruce J Paster, Steven T Sonis, Lora A Murray, Thomas E Van Dyke

  Journal of clinical periodontology. 34(11):917-30.

  AIM: This study sought clinical and microbial risk indicators for progressing slight periodontitis. MATERIAL AND METHODS: One hundred and seventeen periodontally healthy or slight periodontitisAIM: This study sought clinical and microbial risk indicators for progressing slight periodontitis. MATERIAL AND METHODS: One hundred and seventeen periodontally healthy or slight periodontitis adults (20-40 years) were monitored clinically at 6-month intervals followed by supragingival cleaning. Inter-proximal sites with >1.5 mm increase in clinical attachment over 18 months were considered disease active. Subgingival plaque was analysed by 78 16S rDNA and 38 whole-genomic DNA probes and by PCR to Porphyromonas gingivalis and Tannerella forsythia. Characteristics were compared between active and inactive subjects. RESULTS: Twenty-two subjects showed disease activity principally at molars. Mean baseline gingival and plaque indices, bleeding on probing, probing depth and clinical attachment level (CAL) were higher in active subjects. DNA probes detected species and not-yet-cultivated phylotypes from chronic periodontitis, although few species were associated with active subjects. By PCR P. gingivalis (p=0.007) and T. forsythia (p=0.075) were detected more frequently during monitoring in active subjects. Stepwise logistic analysis associated baseline levels of gingival index, clinical attachment and bleeding with subsequent clinical attachment loss. CONCLUSIONS: Gingivitis and CAL were significantly associated with progressing slight periodontitis in 20--40-year-old adults. Species associated with moderate and advanced chronic periodontitis were detected in slight periodontitis.

• Root coverage assessment: validity and reproducibility of an image analysis system.

  Authors: Stéphane Kerner, Daniel Etienne, Jacques Malet, Francis Mora, Virginie Monnet-Corti, Philippe Bouchard

  Journal of clinical periodontology. 34(11):969-76.

  AIM: The aim of this methodological study was to validate a new method for root coverage evaluation following periodontal plastic surgery. MATERIAL AND METHODS: Thirty recessions were treated in 21AIM: The aim of this methodological study was to validate a new method for root coverage evaluation following periodontal plastic surgery. MATERIAL AND METHODS: Thirty recessions were treated in 21 consecutive patients, using a subepithelial connective tissue graft technique. Clinical measurements and photographs were taken at baseline and 12+/-6 months after treatment. The mean percentage of root coverage for linear and surface area measurements was calculated using conventional clinical evaluation, and compared with ImageJ, a public domain Java image processing program. Bland-Altman plots were used for assessing repeatability and agreement between clinical and ImageJ measurements. The strength of the relationship was calculated using the Pearson product moment correlation coefficient. RESULTS: The repeatability of ImageJ was excellent for both linear and surface area measurements. The agreement between clinical and ImageJ measurements was good for the linear evaluation, showing lower and upper limits of -13.14% and 17.42%, respectively. Significant correlations (p<0.001) were found between clinical and ImageJ measurements, ranging from 0.93 to 0.94 for linear evaluation, and from 0.89 to 0.90 for surface evaluation. CONCLUSIONS: The outcomes of this study show that the ImageJ analysis is a reliable, reproducible method to evaluate the percentage of root coverage after periodontal plastic surgery, when a midfacial linear measurement is used.

• Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort.

  Authors: W Murray Thomson, Jonathan M Broadbent, David Welch, James D Beck, Richie Poulton

  Journal of clinical periodontology. 34(10):828-34.

  BACKGROUND: Smoking is recognized as the primary behavioural risk factor for periodontal attachment loss (AL), but confirmatory data from prospective cohort studies are scarce. AIM: To quantify theBACKGROUND: Smoking is recognized as the primary behavioural risk factor for periodontal attachment loss (AL), but confirmatory data from prospective cohort studies are scarce. AIM: To quantify the association between cigarette smoking patterns and AL by age 32. METHODS: Periodontal examinations were conducted at ages 26 and 32 in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Longitudinal categorization of smoking exposure was undertaken using data collected at ages 15, 18, 21, 26 and 32. RESULTS: Complete data were available for 810 individuals of whom 48.9% had ever smoked (31.5% were current smokers). Compared with never-smokers, long-term smokers (and other age-32 smokers) had very high odds ratios (ORs of 7.1 and 5.7, respectively) for having 1 +sites with 5 +mm AL, and were more likely to be incident cases after age 26 (ORs of 5.2 and 3.2, respectively). Two-thirds of new cases after age 26 were attributable to smoking. There were no significant differences in periodontal health between never-smokers and those who had quit smoking after age 26. CONCLUSIONS: Current and long-term smoking in young adults is detrimental to periodontal health, but smoking cessation may be associated with a relatively rapid improvement in the periodontium.

• Trends in periodontal health among 35-year-olds in Oslo, 1973-2003.

  Authors: Rasa Skudutyte-Rysstad, Harald M Eriksen, B Frode Hansen

  Journal of clinical periodontology. 34(10):867-72.

  AIM: The aim of the present study was to describe trends in periodontal health and oral hygiene using data available from four epidemiological studies on 35-year-olds in Oslo performed from 1973 toAIM: The aim of the present study was to describe trends in periodontal health and oral hygiene using data available from four epidemiological studies on 35-year-olds in Oslo performed from 1973 to 2003. MATERIAL AND METHODS: Periodontal status of randomly selected 35-year-olds was assessed clinically and radiographically. Clinical registrations were based on the Community Periodontal Index of Treatment Needs (CPITN) and the Simplified Oral Hygiene Index. In addition, the proportion of individuals with marginal bone loss was assessed using available orthopantomograms. RESULTS: The proportion of persons with CPITN score 4 (one or more pockets > or = 6 mm) decreased from 21.8% in 1984 to 8.1% in 2003. In addition, the mean number of sextants with deep pockets per person was considerably lower in 2003 than previously. The proportion of persons without recorded bone loss increased from 46% in 1973 to 76% in 2003. An improvement in oral hygiene scores was also observed during this period. CONCLUSIONS: The results suggest that periodontal health and oral hygiene have been improving among 35-year-olds in Oslo during the last 30 years.

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