Journal of Periodontology

Background: One‐stage full‐mouth disinfection (FMD), in which full‐mouth scaling and root planing (SRP) is performed with adjunctive use of chlorhexidine, was introduced in 1995. There have been several reports on the effectiveness of this treatment protocol. However, FMD was reported to induce pyrexia frequently. We examined the effects of full‐mouth SRP in conjunction with azithromycin administered orally before SRP to control the number of bacteria. The purpose of this study was to compare the effects of full‐mouth SRP using azithromycin with conventional SRP.

Methods: Thirty‐four subjects (17 in the test group and 17 in the control group) with severe chronic periodontitis were selected. The subjects of the test group had azithromycin 3 days before full‐mouth SRP. Clinical parameters (probing depth [PD], gingival index [GI], bleeding on probing [BOP], and gingival crevicular fluid [GCF]), total number of bacteria, and number of black pigment‐producing rods (BPRs) were evaluated at baseline and 5, 13, and 25 weeks after baseline.

Results: All clinical parameters improved in the test group more than in the control group. In the bacteriologic examination, the total number of bacteria did not change during the examination. In the test group, BPRs were not detected until 13 weeks. However, BPRs were detected in the control group by 13 weeks.

Conclusion: It was shown that full‐mouth SRP using systemically administered azithromycin was a clinically and bacteriologically useful basic periodontal treatment for severe chronic periodontitis.

Background: Alanine aminopeptidase (ALAP) and dipeptidyl peptidase IV (DPPIV) are ectopeptidases that play a role in collagen degradation and are thought to be involved in the destruction of periodontal tissue. This study compared the activities of salivary ALAP and DPPIV in patients with periodontitis and periodontally healthy subjects. The correlations of enzyme activities with clinical variables and the presence of Porphyromonas gingivalis were also evaluated.

Methods: Whole saliva was collected from 30 periodontally healthy subjects, 30 localized chronic periodontitis (LCP) patients, and 30 generalized chronic periodontitis (GCP) patients to determine the activities of ALAP and DPPIV. The presence of P. gingivalis in subgingival plaque was detected by polymerase chain reaction. Periodontal clinical assessments included probing depth, clinical attachment level, and bleeding on probing.

Results: The activities of DPPIV in the LCP and GCP groups were not significantly different from one another, but both groups had significantly higher enzyme activities than the periodontally healthy group (P = 0.001). DPPIV activity was positively correlated with all clinical parameters and the prevalence of P. gingivalis. The ALAP activities were not significantly different among the three study groups. There was no significant correlation of ALAP activity with any of the clinical and bacterial parameters.

Conclusion: DPPIV, but not ALAP, activity is associated with periodontitis and the presence of P. gingivalis.

Background: Pluronic polyols are a family of non‐ionic surfactants currently used as drug carriers for antibiotic, anti‐inflammatory, and anti‐neoplastic agents. Therapeutic administration of non‐ionic surface‐active agents is known to facilitate early collagen synthesis and microcirculation, thus promoting wound healing. The purpose of this study was to determine the in vivo effects of pluronic polyols combined with either an allograft or an alloplast on the healing of critical‐sized calvarial defects.

Methods: One hundred fifty (150) adult (95 to 105 days old) male Sprague‐Dawley rats weighing between 375 and 425 g were randomly and evenly assigned to each of 15 separate treatment groups and anesthetized, and 8 mm calvarial critical‐sized defects were created. Pluronic F‐68 (F‐68) or pluronic F‐127 (F‐127) was administered either topically or systemically and in conjuction with demineralized bone powder (DBP), tricalcium phosphate (TCP), or non‐grafted controls. Pluronic polyols are easily mixed with either DBP or TCP to improve handling ease. Calvaria were harvested at 12 weeks postsurgery and evaluated histomorphometrically, by contact radiography with subsequent densitometric analysis, through energy spectrometry utilizing a scanning electron microscope, and by fluorescent microscopy.

Results: There was a significant difference in the percentage of bone fill among the control, TCP, and DBP only groups, P <0.05. The only significant difference within any of these groups was between the TCP control and TCP plus systemic F‐127, P <0.05.

Conclusions: Although there were isolated differences, the overall trend was that the pluronic polyol and the mode of administration did not result in a significant change in bone wound healing as measured by the percentage of bone fill. Pluronic polyols may be considered as carriers for osseous graft materials. J Periodontol 2002;73:191‐197.

This study was conducted to clinically compare freeze‐dried bone allograft (FDBA) and demineralized freeze–dried bone allograft (DFDBA). Twenty–two defects (11 intrapatient pairs) in 9 patients were grafted with either DFDBA or FDBA. Evaluations were based on standardized radiographs, presurgical and postsurgical soft tissue measurements using the cemento–enamel junction as a fixed reference point, and osseous measurements at the time of surgery. Grafted sites were re–entered at a minimum of 6 months following placement. A mean osseous repair of 1.7 mm (59%) occurred with DFDBA and 2.4 mm (66%) with FDBA. A mean clinical attachment gain of 1.7 mm was obtained with DFDBA and 2.0 mm with FDBA. Probing depths decreased a mean of 2.00 mm with both DFDBA and FDBA. These findings reveal no significant differences between the two materials in primarily intraosseous defects when evaluated at a minimum 6 months postsurgery. (Journal of Periodontology 1989;60:655–663)

Problems of patient compliance in periodontics are evident. This study explored factors which may contribute to the degree of adherence. Using the “Health Belief Model” a questionnaire was constructed and administered to 120 patients of the Department of Periodontology, University of Frankfurt Dental School. Compliance of these patients during the hygienic phase was assessed using a bleeding index. The data set for statistical evaluation comprised 96 patients. The loss was due to missing of appointments and incomplete questionnaires. There was no significant correlation between patient compliance on the one hand and sociodemographic variables (age, sex, family status), disease parameters, and the health beliefs “susceptibility,” “barriers,” “dentist‐patient‐relationship,” and “experience with therapy” on the other hand. “Motivation,” “seriousness,” “benefits,” “experience with affected organ,” and tooth‐loss‐index were significant predictors with Spearman correlation coefficients running from 0.17 to 0.32. When the predictor variables were combined the coefficient was 0.59. This study further supports the assumption that health beliefs play a significant role in the determination of health related behavior.

Background: Recent studies have suggested that periodontal disease is a risk factor for preterm low birth weight (PLBW). A randomized controlled trial was undertaken to help further evaluate the proposed association between periodontal disease and PLBW.

Methods: Four hundred pregnant women with periodontal disease, aged 18 to 35, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned to either an experimental group (n = 200), which received periodontal treatment before 28 weeks of gestation or to a control group (n = 200) which received periodontal treatment after delivery. Previous and current pregnancies and known risk factors were obtained from patient medical records and interviews. The primary outcome assessed was the delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g.

Results: Of the 400 women enrolled, 49 were excluded from the analyses for different reasons. The incidence of PLBW in the treatment group was 1.84% (3/163) and in the control group was 10.11% (19/188), (odds ratio [OR] 5.49, 95% confidence interval [CI] 1.65 to 18.22, P = 0.001). Multivariate logistic regression analysis showed that periodontal disease was the strongest factor related to PLBW (OR 4.70, 95% CI 1.29 to 17.13). Other factors significantly associated with such deliveries were: previous PLBW (OR 3.98, 95% CI 1.11 to 14.21), less than 6 prenatal visits (OR 3.70, 95% CI 1.46 to 9.38), and maternal low weight gain (OR 3.42, 95% CI 1.16 to 10.03).

Conclusions: Periodontal disease appears to be an independent risk factor for PLBW. Periodontal therapy significantly reduces the rates of PLBW in this population of women with periodontal disease. J Periodontol 2002;73:911‐924.

Background: An abundance of microvessels is the major phenotype of pyogenic granuloma, which has been considered a hormone‐related lesion based on clinical observations. Although angiogenic factors and inflammatory cytokines have been implied to play roles in the pathogenesis of pyogenic granuloma, their links to female steroid hormones still remain to be elucidated. Since apoptosis is important in limiting inflammation, we also investigated whether steroid hormones could protect granuloma cells from apoptosis and, therefore, lead to over‐reactive inflammatory response.

Methods: We employed immunoassays in a series of experiments, including human pyogenic granuloma in pregnancy, mouse air pouch granuloma and U937 (monoblastoid) cells in culture to clarify the relationship among vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), tumor necrosis factor‐alpha (TNF‐α), interleukin (IL)‐ 1 beta and female steroid hormones in granuloma formation. The apoptotic rates were analyzed in vivo and in vitro by terminal deoxynucleotidyl transferase‐mediated deoxyuridine 5‐triphosphate nick end labeling. (TUNEL) and flow cytometry, respectively.

Results: Both in human and animal studies, the immunoassays (enzyme‐linked immunoabsorbent assay [ELISA] and irnmunohistochemistry) detected significantly more VEGF and bFGF and less TNF‐α in hormones than the control group, while TUNEL assay revealed less apoptotic cells in groups with pregnancy levels of hormones. In vitro, progesterone enhanced the expression of VEGF in LPS‐treated U937 cells. Both estrogen and progesterone inhibited the apoptosis of U937 cells triggered by exogenous TNF‐α

Conclusions: Female steroid hormones may have dual effects on the pathogenesis of pyogenic granuloma in pregnancy. The hormones not only enhance the expression of angiogenic factors in inflamed tissue, but also decrease apoptosis of granuloma cells to extend angiogenic effect. J Periodontol 2002;73:701‐708.

The relative osteogenic potential of two different preparations of lyophilized human demineralized bone were evaluated using a heterotopic site in a rodent model. Human diaphyseal cortical bone (75‐850 μm) was demineralized according to two different protocols for decalcified bone allograft (A. H. Reddi and M. R. Urist). Equal volumes of mineralized lyophilized human bone and a proprietary hydroxylapatite served as controls. Thirty‐two Long‐Evans rats divided into four groups received subcutaneous implants of one of these four preparations. Implants were harvested at two, four, and six weeks. Histometric analysis of limited serial sections at six weeks demonstrated new bone formation by the two demineralized preparations only. The Reddi protocol produced significantly more bone formation (1.13 ± 1.21%) than the Urist preparation (0.53 ± 0.31%). Although bone induction by both the Reddi and Urist protocol was sparse within this xenogeneic system, the Reddi preparation may offer some slight advantage of greater osteogenic potential and ease of preparation. The low yields of induced bone in response to implants of human demineralized bone would limit the use of this model system in assessing osteogenic potential prior to clinical use.

The purpose of this investigation was to determine whether donor‐specific anti‐HLA antibodies could be detected against freeze‐dried cortical bone allograft (FDBA) placed in human periodontal osseous defects. Twenty patients with multiple periodontal bony defects amenable to treatment in two allografting procedures were enrolled. No patient had preexisting anti‐HLA antibodies. FDBA used for all allografting procedures was obtained from one donor of known HLA antigens, and all patients were tissue‐typed. Serum samples were taken two weeks after the first allograft (primary challenge), two weeks after the second allograft (secondary challenge) and at three months. Serum samples were assayed for the presence of anti‐HLA antibodies using an Amos modified microcytotoxicity assay.

At no time could any donor‐specific anti‐HLA antibodies be detected in any patient. All allografts were judged clinically successful, with no adverse tissue reactions to the donor material. FDBA may be regarded as a graft material lacking clinically significant antigenicity.