The road not taken: beyond our embarrassment and skepticism

No abstract available.

An analysis on the factors responsible for relative position of interproximal papilla in healthy subjects

PURPOSE: This study examined the factors that can be associated with the appearance of the interproximal papilla. METHODS: One hundred and forty-seven healthy interproximal papillae between the maxillary central incisors were examined. For each subject, a digital photograph and periapical radiograph of the interdental embrasure were taken using a 1-mm grid metal piece. The following parameters were recorded: the amount of recession of the interproximal papilla, contact point-bone crest distance, contact point-cemento-enamel junction (CEJ) distance, CEJ-bone crest distance, inter-radicular distance, tooth shape, embrasure space size, interproximal contact area, gingival biotype, papilla height, and papilla tip form. RESULTS: The amount of recession of the interproximal papilla was associated with the following: 1) increase in contact point-bone crest, contact point-CEJ, and CEJ-bone crest distance; 2) increase in the inter-radicular distance; 3) triangular tooth shape; 4) decrease in the interproximal contact area length; 5) increase in the embrasure space size; and 6) flat papilla tip form. On the other hand, the amount of gingival recession was not associated with the gingival biotype or papilla height. In the triangular tooth shape, the contact point-bone crest distance and inter-radicular distance were longer, the interproximal contact area length was shorter, and the embrasure space size was larger. The papilla tip form became flatter with increasing inter-radicular distance and CEJ-bone crest distance. CONCLUSIONS: The relative position of the interproximal papilla in healthy subjects was associated with the multiple factors and each factor was related to the others. A triangular tooth shape carries a higher risk of recession of the interproximal papilla because the proximal contact point is positioned more incisally and the bone crest is positioned more apically. This results in an increase in recession of the interproximal papilla and flat papilla tip form.

Comparative study on the results of non-surgical periodontal treatment according to the location of the affected site

PURPOSE: The present study was performed to compare the treatment outcomes of non-surgical periodontal treatment according to the distribution of attachment loss of a given patient. METHODS: Forty-five patients with moderate to severe periodontitis were divided in two subgroups; Group I patients with teeth manifesting attachment loss of > or =6 mm at one or more sites on the buccal/labial aspect while maintaining an attachment level or =6 mm at more than one site on the lingual/palatal aspect while maintaining an attachment level or =6 mm at buccal/labial surfaces responded better to the nonsurgical periodontal therapy than those demonstrating comparable attachment loss at lingual/palatal surfaces.

Identification of immunological parameters associated with the alveolar bone level in periodontal patients

PURPOSE: The present study was performed to clarify the relationship between periodontal disease severity and selected immunological parameters consisting of serum IgG titer against periodontopathogenic bacteria, the expression of the helper T-cell cytokine by gingival mononuclear cells, and patients' immunoreactivity to cross-reactive heat shock protein (HSP) epitope peptide from P. gingivalis HSP60. METHODS: Twenty-five patients with moderate periodontitis had their gingival connective tissue harvested of gingival mononuclear cells during an open flap debridement procedure and peripheral blood was drawn by venipuncture to collect serum. The mean level of interproximal alveolar bone was calculated to be used as an index for periodontal disease severity for a given patient. Each of selected immunologic parameters was subject to statistical management to seek their correlations with the severity of periodontal disease. RESULTS: A significant correlation could not be identified between serum IgG titers against specific bacteria (Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Actinobacillus actinomycetemcomitans, and Streptococcus mutans) and the severity of periodontal disease. Expression of interleukin (IL)-10 by gingival mononuclear cells was statistically significant in the group of patients who had higher levels of alveolar bone height. However, a similar correlation could not be demonstrated in cases for IL-4 or interferon-gamma. Patients' serum reactivity to cross-reactive epitope peptide showed a significant correlation with the amount of alveolar bone. CONCLUSIONS: It was concluded that expression of IL-10 by gingival mononuclear cells and patients' sero-reactivity to the cross-reactive HSP peptide of P. gingivalis HSP60 were significantly correlated with alveolar bone height.

Vaccines against periodontitis: a forward-looking review

Periodontal disease, as a polymicrobial disease, is globally endemic as well as being a global epidemic. It is the leading cause for tooth loss in the adult population and has been positively related to life-threatening systemic diseases such as atherosclerosis and diabetes. As a result, it is clear that more sophisticated therapeutic modalities need to be developed, which may include vaccines. Up to now, however, no periodontal vaccine trial has been successful in satisfying all the requirements; to prevent the colonization of a multiple pathogenic biofilm in the subgingival area, to elicit a high level of effector molecules such as immunoglobulin sufficient to opsonize and phagocytose the invading organisms, to suppress the induced alveolar bone loss, or to stimulate helper T-cell polarization that exerts cytokine functions optimal for protection against bacteria and tissue destruction. This article reviews all the vaccine trials so as to construct a more sophisticated strategy which may be relevant in the future. As an innovative strategy to circumvent these barriers, vaccine trials to stimulate antigen-specific T-cells polarized toward helper T-cells with a regulatory phenotype (Tregs, CD4+, CD25+, FoxP3+) have also been introduced. Targeting not only a single pathogen, but polymicrobial organisms, and targeting not only periodontal disease, but also periodontal disease-triggered systemic disease could be a feasible goal.

Effects of non-carious cervical lesions and class V restorations on periodontal conditions / 대한치주과학회지

PURPOSE: The non-carious cervical lesion(NCCL) is a loss of tooth structure at the neck of affected teeth that is unrelated to tooth caries. The reported prevalence of NCCL varies from 5% to 85%. Prevalence and severity of lesions have been found to increase with age. They are becoming more significant as people live longer and become more aware of the importance of oral health. The purposes of this study were first, to examine the periodontal conditions associated with NCCL, and second, to investigate the clinical effects of class V restorations of NCCL on periodontal tissues. MATERIALS AND METHODS: The sample size was 982 teeth of 50 subjects(25 male, mean age 52+/-7) who were seen at the Department of Periodontology, Pusan National University Hospital. At the baseline examination, clinical periodontal parameters were measured. After the initial examination, 24 patients who were absent from hypersensitivity were selected. The teeth with NCCL were randomly divided into the test and control groups. The teeth in the test group were restored with flowable resin; the control teeth were not restored. Six months later, the clinical examinations were repeated. The data were analyzed using the SPSS program. RESULTS: The results were as follows: 1) NCCL occurred on 45.8% of examined teeth. The percentage of affected teeth was higher in maxillary and premolar teeth. 2) The shallow saucer type was the most common. 3) Teeth with NCCL had more gingival recession, lower attachment level, and higher incidences of bleeding on probing(BOP) and plaque than NCCL-free teeth. 4) Six months later, gingival recession, attachment level, the percentages of BOP and plaque in the test group were lower than in the control group(p<0.05). CONCLUSION: NCCLs were more found in maxillary teeth, especially in premolar teeth. The results suggest that the restoration of NCCL could affect some periodontal parameters favorably

Influence of gingival biotype on the amount of root coverage following the connective tissue graft / 대한치주과학회지

PURPOSE: The integrity of interproximal hard/soft tissue has been widely accepted as the key determinant for success or degree of root coverage following the connective tissue graft. However, we reason that the gingival biotype of an individual, defined as the distance from the interproximal papilla to gingiva margin, may be the key determinant that influence the extent of root coverage regardless of traditional classification of gingival recession. Hence, the present study was performed with an aim to verify that individual gingival scalloping pattern inherent from biotype influence the level of gingival margin following the connective tissue graft for root coverage. METHODS: Test group consisted of 43 single-rooted teeth from 21 patients (5 male and 16 female patients, mean age: 36.6 years) with varying degrees of gingival recession requiring connective tissue graft; 20 teeth of Miller class I and 23 teeth of Miller class III gingival recession, respectively. The control group consisted of contralateral teeth which did not demonstrate apparent gingival recession, and thus not requiring root coverage. For a biotype determination, an imaginary line connecting two adjacent papillae of a test tooth was drawn. The distance from this line to gingival margin at mid-buccal point and this distance (P-M distance) was designated as "gingival biotype" for a given individual. The distance was measured at baseline and 3 to 6 months examinations postoperatively both in test and control groups. The differences in the distance between Miller class I and III were subject to statistical analysis by using Student?s t-test while those between the test and control groups within a given patient were by using paired t-test. RESULTS: The P-M distance at 3 to 6 months postoperatively was not significantly different between Miller classI and Miller class III. It was not significantly different between the test and control group in a given patient, either, both in Miller classI and III. CONCLUSIONS: The amount of root coverage following the connective tissue graft was not dependent on Miller's classification, but rather was dependent on P-M distance, strongly implying that the gingival biotype of a given patient may play a critical impact on the level of gingival margin following connective tissue graft.

BBP(R) graft for periodontal intrabony defects and molar furcation lesions: Case Report / 대한치주과학회지

PURPOSE: Periodontal intrabony defects have great deal of importance since they contribute to the development of periodontal disease. Current treatment regimens for intrabony defects involve grafting of numerous bony materials, GTR using biocompatible barriers, and biomodification of root surface that will encourage the attachment of connective tissue. Xenograft using deproteinized bovine bone particles seems to be very convenient to adjust because it doesn't require any donor sites or imply the danger of cross infections. These particles are similar to human cancellous bone in structure and turned out to be effective in bone regeneration in vivo. We here represent the effectiveness of grafting deproteinized bovine bone particles in intrabony defect and furcation involvements that have various numbers of bony walls. MATERIALS AND METHODS: Open flap debridement was done to remove all root accretions and granulation tissue from the defects within persisting intrabony lesions demonstrating attachment loss of over 6mm even 3 months after nonsurgical periodontal therapy have been completed. Deproteinized bovine bone particles(BBP(R), Oscotec, Seoul) was grafted in intrabony defects to encourage bone regeneration. Patients were instructed of mouthrinses with chlorohexidine-digluconate twice a day and to take antibiotics 2-3 times a day for 2 weeks. They were check-up regularly for oral hygiene performance and further development of disease. Probing depth, level of attachment and mobility were measured at baseline and 6 months after the surgery. The radiographic evidence of bone regenerations were also monitored at least for 6 months. CONCLUSION: In most cases, radio-opacities increased after 6 months. 2- and 3-wall defects showed greater improvements in pocket depth reduction when compared to 1-wall defects. Class I & II furcation involvements in mandibular molars demonstrated the similar results with acceptable pocket depth both horizontally and vertically comparable to other intrabony defects. Exact amount of bone gain could not be measured as the re-entry procedure has not been available. With in the limited data based on our clinical parameter to measure pocket depth reduction following BBP(R) grafts, it was comparable to the results observed following other regeneration techniques such as GTR.

Production and characterization of cross-reactive anti-Porphyromonas gingivalis heat shock protein 60 monoclonal antibody / 대한치주과학회지

PURPOSE: Porphyromonas gingivalis (P. gingivalis) heat shock protein (HSP)60 may play a role in the immunopathogenesis of periodontitis as well as atherosclerosis by modulating autoimmune reaction due to its high level of sequence homology between bacteria and human counterpart. The purpose of this study was to identify immunodomiant epitope of P. gingivalis HSP60 that is reactive exclusively to the homologous bacteria without reacting with human HSP. MATERIALS AND METHODS: The present study was performed to identify the peptide specifically recognized by anti-P. gingivalis HSP60 monoclonal antibodies mono-reactive to P. gingivalis HSP60. RESULTS: Four different hybridomas were cloned producing monoclonal IgG antibodies exclusively to P. gingivalis HSP60. Thirty seven synthetic peptides (20-mer with 5-amino acid overlapping) were synthesized. All of these peptide were subject to SDS-PAGE for immunblot analysis. One peptide (TVPGGGTTYIRAIAALEGLK) and the other peptide (TLVVNRLRGSLKICAVKAPG) were recognized by all and one of the four monoclonal antibodies, respectively, that reacted solely with P. gingivalis HSP60. Immunohistochemistry to identify the localization of the HSP60 in the diseased gingival tissues revealed that all of the four monoclonal antibodies were highly reacted with the diseased gingival tissue than normal gingival tissue. CONCLUSION: The P. gingivalis HSP60 peptides (TVPGGGTTYIRAIAALEGLK and TLVVNRLRGSLKICAVKAPG, respectively) are positively involved in the immunopathologic process of periodontal disease. The peptide may potentially be developed as vaccine candidates. Further investigations are under way to identify more clones producing monoclonal antibodies reactive to P. gingivalis HSP and to other periodontopathogenic bacteria as well, while maintaining specificities to human counterpart.

Horizontal attachment loss in extracted teeth due to severe periodontitis / 대한치주과학회지

PURPOSE: The attachment level is strongly associated with tooth loss and provides useful information on patterns of destruction of the periodontium. The presence of horizontal attachment loss would not be detected in clinical measurement. Therefore, the purpose of the present study was to estimate the patterns of periodontal destruction based on the attachemnt area and horizontal attachment loss in extracted teeth due to severe periodontitis. MATERIALS AND METHODS: 307 teeth satisfied the criteria for assessment. An indirect method, based on digital images obtained from a digital camera and an image analysis program, was used to calculate the area of root surface and attachment loss and the extent of horizontal attachment loss. The data were analysed using SPSS. RESULTS: No statistically significant differences among root surfaces were observed in anterior teeth on the loss of attachment area. However, in posterior teeth statistically significant differences in palatal surfaces of maxillary and mandibular premolar and molar surfaces compared with buccal surfaces were observed. Horizontal attachment loss was observed in 21.5% of the teeth examined. Frequency of horizontal attachment loss was highest in the maxillary first premolar (34.8%), followed by the maxillary second premolar (27.3%) and maxillary canine (25%). The mean length of horizontal attachment loss was 1.5mm. CONCLUSION: More meticulous examination will be needed of the palatal surfaces of maxillary and mandibular premolar and molar teeth. The percentage of teeth with horizontal attachment loss greater than 2.1 mm was 5.2%. Considering the length of curette blades, about 5.2% of teeth were not properly debrided. Therefore, Additional supportive therapy such as local drug delivery has to be considered in treatment of the first maxillary, second premolar and canine due to the high prevalence of horizontal attachment loss.

Establishment of B-1 cell-derived polyreactive monoclonal antibodies and expression of costimulators by B-cell to antigenic stimulation / 대한치주과학회지

No abstract available.

Impact of nonsurgical periodontal therapy on oral malodor and microbial load of saliva / 대한치주과학회지

No abstract available.

Development of monoclonal antibody against Porphyromonas gingivalis heat shock protein / 대한치주과학회지

Heat shock protein (HSP) is one of cellular protein commonly present in major periodontopathogenic bacteria as well as mammalian cells. The protein may play a role in the immunopathogenesis by modulating autoimmune reaction due to its high level of sequence homology between bacteria and human counterpart. Hence, identifying immunodomiant epitope of bacteria HSP that is cross-reactive to periodontopathogenic bacteria with a specificity to human HSP may comprise a critical strategy for development of a periodontal vaccine. The present study was performed to establish clones producing monoclonal antibody reactive to Porphyromonas gingivalis (P. gingivalis) HSP with a specificity to human HSP. 4 different hybridomas were cloned producing monoclonal IgG antibodies to P. gingivalis HSP and evaluated for their reactivity and specificity to other periodontopathogenic bacteria as well as to human HSP. These four monoclonal antibodies reacted with P. gingivalis HSP only with specificities to other bacteria tested and human HSP as well. The antigenic epitopes producing the 4 monoclonal antibody may be potentially developed as vaccine candidates. Further investigations are under way to identify more clones producing monoclonal antibodies reactive to P. gingivalis HSP and to other periodontopathogenic bacteria as well, while maintaining specificities to human counterpart.

Perception of maxillary anterior esthetics by dental professionals and lay people and topographical tooth-gingiva interface / 대한치주과학회지

PURPOSE: This study was designed 1) to compare the perception of dental professionals and lay people with respect to minor variations in maxillary anterior tooth size and alignment and their relation to the surrounding soft tissues, and 2) to evaluate the normal tooth-gingiva topographical relationships in periodontally healthy young subjects. MATERIALS AND METHODS: Maxillary anterior teeth were intentionally diagrammed in varying degree of deviation with respect to one of three common anterior esthetic discrepancies including variations in crown length, shape of gingival margin, and length of interproximal contact. 17 images were generated to be preferentially selected by 2 groups consisting of dental professionals and lay people (total of 740). Smiling photographs of 120 dental students who had healthy periodontium were taken and the photographic images were analyzed to be classified as 17 kinds of altered image groups. RESULTS: The results demonstrated noticeable difference between the varying levels of discrepancy. Both group preferred gingival margin of lateral incisor to be 0.5mm lower than that of central incisor. Lay people preferred the gingival margin shape that has 2/9 horizontal component of the crown width, while dental professionals preferred the gingival margin shape that has 1/9 horizontal component of the crown width. Lay people preferred longer length of the interproximal contact (two thirds of the crown length), whereas dental professionals preferred shorter length of the interproximal contact (half of the crown length). Photographic analysis of normal esthetic gingival topography revealed 2/9 horizontal component and short length of the interproximal contact which was of the hybrid nature of the preferences shared by lay people and dental professionals. CONCLUSION: The results of this study show that dental professionals and lay people demonstrated significant difference in their preference of dental esthetic components, which may then influence the decision making process by dental professionals with respect to designing the anterior esthetic gingival line.

The effect of a full mouth disinfection on oral malodor in chronic periodontitis patients / 대한치주과학회지

Halitosis, defined as an unpleasant oral odor, is a commonly experienced condition with a variety of etiological factors and may cause a significant social or psychological handicap to those suffering from it. In most cases, halitosis originates within the oral cavity itself and patients with periodontal disease often suffer from oral malodor. The most common cause of this disease is related to microbiota which reside on the tongue and in the periodontal pocket. This study was undertaken to examine the effect of full mouth disinfection including tongue scraping on oral malodor in a group of patients with chronic periodontitis. The relationship between halitosis and oral health status was also investigated. The volatile sulfur compounds (VSC) scores were significantly correlated with Plaque Index, Bleeding Index, pocket depth, and tongue coating score. The organoleptic ratings were significantly associated with Plaque Index, Bleeding Index, and tongue coating score. The VSC scores and organoleptic ratings correlated strongly with each other. Full mouth disinfection resulted in a significant reduction in the VSC scores, organoleptic ratings, and self-perception of malodor up to 12 weeks. This study indicates that in patients with chronic periodontitis, a full mouth disinfection including tongue scraping has a significant effect in the treatment of oral malodor.

Clinical study of gingival recession and dentine hypersensitivity / 대한치주과학회지

Gingival recession is clinically manifested by an apical displacement of the gingival tissue and dentin hypersensitivity is often used to describe a painful condition in which exposed dentin is unduly sensitive to intraoral stimuli. The objects of this study were primarily to investigate the prevalence and distribution of gingival recession and hypersensitivity and secondarily to determine whether a relationship exists between gingival recession and hypersensitivity. The study population was 195 patients (102 males, 93 females) who were attended the department of periodontology, Pusan National University Hospital. 189 patients exhibited gingival recession at least more than 1 tooth, the prevalence was 96.9%. The maxillary and mandibular first premolar and mandibular incisors had the highest prevalence. The majority of patients (139 patients, 71.3%) were diagnosed as having dentin hypersensitivity. Dentin hypersensitivity was determined to 3 seconds application of cold air to the exposed root surface after isolating the test tooth and was commonest in maxillary and mandibular first premolars and mandibular incisors. Relationship between recession and hypersensitivity was analyzed using chi-square test (p=0.05), significant relation (p=0.000) was existed. Gingival recession was more severe, the prevalence of hypersensitivity was higher.

Periodontal attachment loss of extracted teeth for periodontal reasons / 대한치주과학회지

The factors influencing long-term prognosis of teeth must be carefully considered. Among these, attachment level is strongly associated with tooth loss. The purpose of the present study was to estimate pattern of attachment loss based on attachment area in extracted teeth. 197 satisfied the criteria for assessment after staining. The protocol described by Waerhaug(1975) was performed. An indir ect method, based on digital image abstracted from digital camera and digital imaging software program, was used to calculate the root surface area and the attachment loss area. The data were analysed using SPSS. Except maxillary central incisior and mandibular canine, no statistical significant differences between each root surfaces were observed in anterior teeth. In posterior teeth, statistical significant differences in palatal surface of maxillary molar and mandibular molar compared with others were observed. Statistical significant difference in buccal surface compared with others was lowly observed in single and multi rooted. This study did not reveal progressive loss pattern of attachment area in each root surface but clarified root surface that has relative high loss rate of attachment area at extraction. Thus understanding this pattern of attachment loss is helpful for dentist to treat the periodontitis.

Identification of differentially expressed proteins in the bacterial biofilm / 대한치주과학회지

No abstract available.

Suppression of nitric oxide and interleukin-6 production by methanol extract of Sophorae Flos in macrophage cells / 대한치주과학회지

Both nitric oxide (NO) and interleukin-6 (IL-6) have been thought to have a role in the pathogenesis of inflammatory periodontal disease as it does in other inflammatory diseases, and the inhibitors of NO and IL-6 production have been considered as potential anti-inflammatory agents. In this study, we evaluated methanol extract of Sophorae Flos for inhibition of NO and IL-6 production in Prevotella intermedia LPS-induced mouse macrophages RAW264.7 cells. Dried Sophorae Flos was sliced, and extracted with 100% methanol. LPS from P. intermedia ATCC 25611 was prepared by the standard hot phenol-water method. NO production was assayed by measuring the accumulation of nitrite in culture supernatants and IL-6 was measured using mouse IL-6 ELISA kit. Western blot analysis of iNOS and analysis of reverse transcription (RT)-PCR products were carried out. The methanol extract of Sophorae Flos concentration-dependently reduced the production of NO and the expression of iNOS protein and mRNA in RAW264.7 cells treated with P. intermedia LPS. Sophorae Flos also suppressed IL-6 production and the expression of IL-6 mRNA in RAW264.7 cells stimulated by P. intermedia LPS. The inhibition of NO and IL-6 production by Sophorae Flos may be useful in the therapy of inflammatory diseases such as periodontitis. This hypothesis, however, remains to be tested.

Expression of mRNA for matrix metalloproteinases and tissue inhibitors of metalloproteinases in human gingival and periodontal ligament fibroblasts treated with lipopolysaccharide from Prevotella intermedia / 대한치주과학회지

Matrix metalloproteinases (MMPs) are a family of host-derived proteolytic enzymes and implicated in the remodeling and degradation of extracellular matrix under both physiological and pathological conditions. Connective tissue degradation in periodontal diseases is thought to be due to excessive MMP activities over their specific inhibitors. The effects of lipopolysaccharide (LPS) from Prevotella intermedia, one of the major putative pathogens of periodontitis, on the expression of mRNA for MMPs and tissue inhibitors of metalloproteinases (TIMPs) in human gingival and periodontal ligament fibroblasts were examined by reverse transcriptase-polymerase chain reaction (RT-PCR). The expression of mRNAs encoding MMP-1, -2, -3, -10, and -14 was increased in human gingival fibroblasts treated with P. intermedia LPS, whereas MMP-11 and TIMP-2 mRNA expression was decreased in these cells stimulated with LPS. P. intermedia LPS increased the MMP-1, -2, -10, -11, and -14 mRNA expression and decreased TIMP-1 and -2 mRNA expression in human periodontal ligament fibroblasts. These findings imply that P. intermedia LPS may play an important role in the connective tissue degradation in periodontitis.