Localized antimicrobial peptide expression in human gingiva.

The stratified epithelia of the oral cavity are continually exposed to bacterial challenge that is initially resisted by innate epithelial factors and by the recruitment of neutrophils. Antimicrobial peptides from phagocytes and epithelia contribute to this antimicrobial barrier. Using antibodies and in situ hybridization, we explored antimicrobial peptide expression in the varied epithelia of the periodontium and in cultured gingival epithelial cells. In gingival tissue, mRNA for the beta-defensins, human beta-defensin 1 (hBD-1) and human beta-defensin 2 (hBD-2) was predominately localized in suprabasal stratified epithelium and the peptides were detected in upper epithelial layers consistent with the formation of the stratified epithelial barrier. In cultured epithelial cells, both hBD-1 and -2 peptides were detected only in differentiating, involucrin-positive epithelial cells, although hBD-2 required stimulation by proinflammatory mediators or bacterial products for expression. Beta-defensins were not detected in junctional epithelium (JE) that serves as the attachment to the tooth surface. In contrast, alpha-defensins and cathelicidin family member LL-37 were detected in polymorphonuclear neutrophils (PMNs) that migrate through the JE, a localization that persists during inflammation, when the JE and surrounding tissue are highly infiltrated with PMNs. Thus, the undifferentiated JE contains exogenously expressed alpha-defensins and LL-37, and the stratified epithelium contains endogenously expressed beta-defensins. These findings show that defensins and other antimicrobial peptides are localized in specific sites in the gingiva, are synthesized in different cell types, and are likely to serve different roles in various regions of the periodontium.

Pluronic polyol effects on human gingival fibroblast attachment and growth.

BACKGROUND: Enhanced speed of human gingival fibroblast (HGF) spreading and attachment, as affected by ionic bonding interactions, may facilitate cell orientation and subsequent collagen synthesis to promote early wound healing. The purpose of this study was to determine the in vitro effects of pluronic polyols, a family of widely used surfactants currently used as drug carriers for antibiotic, anti-inflammatory, and anti-neoplastic agents, on the attachment and growth of human gingival fibroblasts (HGF) to dentin and plastic surfaces using established tissue culture techniques. METHODS: Plastic culture wells containing Eagle's minimal essential media (EMEM) with 10% fetal calf serum and Pluronic F-68 or F-127 in concentrations from 1.2 x 10(-2) to 1.2 x 10(-10) M were incubated with HGF and run in replicates of ten. Attached cells were quantified by measuring the optical density of methylene blue-stained cells. Additional experiments were conducted using human dentin sections as a substrate and Pluronic F-68 or F-127 at a concentration of 1.2 x 10(-8) M. In these experiments, HGF were stained with acridine orange and quantified per unit area of dentin by fluorescence microscopy. RESULTS: Attachment and growth of HGF to both plastic and dentin were significantly increased over serum controls by very low concentrations of Pluronic F-68 and F-127 by 30 minutes, with attachment reaching a plateau at 2 hours. CONCLUSIONS: Pluronic polyols, a family of widely used surfactants, in very low dosages may be beneficial in early postsurgical wound healing by facilitating early attachment and enhancing the growth rate of human gingival fibroblasts.

Utilization of a resorbable collagen membrane in repairing gingival recession defects.

Predictable coverage of exposed root surfaces and the corresponding treatment of gingival recession defects remain important objectives of periodontal therapy. A variety of techniques have been developed during the past several decades to address this common clinical challenge. Traditional surgical approaches have been relatively successful in achieving root coverage. Attempts have been made recently to achieve root coverage with surgical techniques based on the principles of guided tissue regeneration, using resorbable and nonresorbable materials. The learning objective of this article is to present case documentations of root coverage, using a resorbable collagen barrier. The results achieved illustrate the potential of this material in the treatment of gingival recession. The biologic properties of collagen as a barrier material, the surgical approach, and the principles of case selection are reviewed.

Evaluation of a collagen membrane with and without bone grafts in treating periodontal intrabony defects.

The aim of this study was to compare the clinical regenerative capacity of collagen membrane with and without demineralized freeze-dried bone allografts (DFDBA) in treating periodontal intrabony defects. Ten systemically healthy patients with similar bilateral periodontal defects were scheduled for surgery. Each patient had at least > or = 6 mm clinical probing depth and loss of attachment at selected sites. Baseline measurements included gingival index (GI), plaque index (PI), gingival recession (GR), clinical attachment level (CAL), probing depth (PD), and mobility. At the time of surgery, the defects were randomly assigned to either test (collagen membrane plus DFDBA) or control group (collagen membrane only). Stent to base of the defects, stent to crest bone, crest of bone to base of the defect, and width of the defects were recorded at the time of surgery and reentry. Eight patients returned after 6 months for reentry surgery. Statistical analysis with a paired t test was used to evaluate the treatment effect and comparison between test and control groups. In addition, a McNemar test was used to analyze the significance of GI, PI, and mobility at different times. The result of this study indicated that both the collagen plus DFDBA and the collagen alone treatment groups had a significant decrease of PD (3.4 +/- 0.4 and 3.2 +/- 0.4 mm), gain of CAL (2.3 +/- 0.5 and 2.0 +/- 0.4 mm), and defect fill (1.7 +/- 0.3 and 1.9 +/- 0.9 mm) (P < 0.05) when compared to the presurgery status. However, there was no significant difference in PD, AL, GR, defect fill, crestal bone resorption, GI, PI, or mobility between the test group and control group. No adverse tissue reaction, infection, or delayed wound healing was noted throughout the treatment in either group. This study suggests that the collagen membrane is well tolerated by the human tissues. Both treatments, either collagen membrane plus DFDBA or collagen membrane alone, promoted significant resolution of periodontal intrabony defects. The addition of a bone graft (DFDBA) with a collagen membrane appears to add no extra benefit to the collagen membrane treatment.

Evaluation of an absorbable collagen membrane in treating Class II furcation defects.

Recent research has focused upon the utilization of an absorbable collagen membrane in guided tissue regeneration (GTR). Concern exists as to whether this type of membrane is beneficial in the treatment of periodontal defects. The purpose of this study was to evaluate the effect of a type I bovine collagen membrane on treatment of Class II furcation defects. Twelve systemically healthy patients (six male and six female, ages 32 to 68) were treated. Each had bilateral mandibular furcation defects with attachment loss > or = 6 mm. Prior to surgery all patients completed initial therapy including scaling and root planing. At the time of the surgery, teeth were randomly assigned to either a control (flap debridement alone) or test (flap debridement plus collagen membrane) group. Data were collected on the day of surgery, and 2, 4, and 6 months post-surgery and at the 12 month re-entry surgery. Clinical measurements included probing depth (PD), clinical attachment level (CAL), gingival recession (GR), stent to base of defect (SB), crestal bone to base of defect (CB), width of defect, and mobility. Statistical analysis was performed utilizing the paired t test. Both control and test groups demonstrated significant (P < 0.05) improvement at 12 months re-entry in PD, CAL, SB, and CB when compared to the presurgery status. While there is no significant difference in PD, CAL, GR, width of defect, and mobility between control and test groups, sites treated with the collagen membrane had significantly higher bone fill (SB and CB) at re-entry.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of ferric oxalate as an agent for use during surgery to prevent post-operative root hypersensitivity.

The aim of this study was to evaluate the effectiveness of a 6% ferric oxalate solution applied during periodontal surgery to prevent post-operative tooth hypersensitivity. Twenty-five adult patients with similar bilateral periodontal defects participated in this study. Data were collected at baseline (1 week prior to surgery) and 1, 2, 4, and 6 weeks following surgery. Sensitivity level was determined using the visual analog scale (VAS) with the following stimuli: 1) mechanical stimulation with a No. 23 dental explorer; 2) water at 50 degrees C; 3) ice; and 4) electric pulp tester (EPT). Teeth were randomly assigned to either test (6% ferric oxalate in 0.9% saline) or control (0.9% saline) groups. Solutions were applied to the exposed root surfaces for 1 minute during surgery. Data were analyzed by repeated measures ANOVA, paired t-test, and Pearson's correlation test. Results from this study demonstrated statistically significant reduction in the responses to thermal stimuli, especially cold, between groups treated with ferric oxalate as compared to those treated with saline. For the cold test the difference increased with time from baseline to 6 weeks. Statistically significant (P < 0.05) differences in sensitivity to heat between groups were also observed, but only at 2 and 4 weeks following surgery. There were no differences at any time period between the test and control groups when tactile or EPT techniques were used. In addition, there was no correlation between sensitivity and other clinical parameters. It was concluded from this study that 6% ferric oxalate was effective in reducing post-surgical cold sensitivity when applied during periodontal surgical procedures.

Surgical treatment of induced peri-implantitis in the micro pig: clinical and histological analysis.

The purpose of this pilot study was to determine if lost osseous support adjacent to root form implants could be regenerated using a guided tissue regeneration technique. Three fixtures were placed in each edentulous mandibular bicuspid region of two micro pigs. A total of 6 fixtures were placed in each pig. Due to the presence of a pathologic condition, which was in no way related to the research, the results of one pig were not evaluated. Following osseointegration, peri-implantitis were induced by the use of ligatures and a soft diet. Three modalities of treatment were performed. Utilizing a surgical flap approach, one third of the fixtures (one per quadrant) were covered with expanded polytetrafluoroethylene (ePTFE) membrane and submerged under the soft tissue complex. The second group of fixtures were submerged under the soft tissue complex with no ePTFE membrane. The control fixtures along with their abutments were debrided and remained non-submerged. All fixtures were debrided using an air-abrasive polishing system. The osseous defects around the fixtures were measured from a fixed reference point at the time of surgery and after obtaining block sections.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of nicotine on reproduction and attachment of human gingival fibroblasts in vitro.

The ability of fibroblasts to reproduce and attach to teeth is of paramount importance in re-establishing the lost connective tissue attachment after periodontal therapy. This study examined the effect of nicotine, a major component of the particulate phase of tobacco smoke, on human gingival fibroblast (HGF) reproduction and attachment to tissue culture surfaces. Pooled HGF cultures made from explants of gingival biopsies were utilized between passages 5 and 10 and plated in 96-well plates at 1.0 x 10(4) cells per well. Cell numbers were determined using 3-(4,5-dimethylthiazol-2-y)-2,5-diphenyl tetrazolium bromide (MTT), which is a reflection of mitochondrial dehydrogenase activity. The concentrations of nicotine used were 0.025, 0.05, 0.1, 0.2, and 0.4 microM, the average serum concentration for a smoker being approximately 0.1 microM. The effect of continuous nicotine exposure on HGF reproduction was determined by incubating cell cultures and media containing nicotine for up to 48 hours. Residual toxicity was determined by preincubating cells with nicotine for 1 or 6 hours. HGF suspensions and increasing concentrations of nicotine were added together to determine the effect on attachment. Results showed an enhanced effect of nicotine on HGF attachment, with increasing numbers of cells attaching with increasing nicotine concentrations, compared to the control. Low concentrations of nicotine had a stimulatory effect on cell replication, while higher concentrations of nicotine appear to have no significant effect on HGF reproduction. The responses of cells to some concentrations of nicotine may persist after its removal.

Angioedema as a complication in periodontal surgery: report of a case.

Angioedema is a diffuse swelling of the subcutaneous or submucosal tissues that occurs in both hereditary and non-hereditary forms. It can be a temporarily disfiguring condition, but not usually a serious one unless the airway is compromised. In the majority of cases, no underlying cause can be identified. In this report, a case of "idiopathic" angioedema that occurred while performing a periodontal surgical procedure is presented. This case is interesting because the patient was on long-term use of an angiotensin-converting enzyme [ACE] inhibitor for hypertension, and recent evidence has shown that ACE inhibitors suppress the breakdown of circulating bradykinins. With high plasma levels of bradykinins, a local anesthetic, periodontal surgical procedures, or even emotional stress may trigger an attack of angioedema. Practitioners should be aware of the pharmacologic side effects of ACE inhibitors and be prepared to handle an emergency if a patient's airway becomes compromised.

The effect of chlorhexidine treatment of root surfaces on the attachment of human gingival fibroblasts in vitro.

Chlorhexidine mouthrinse is a widely used adjunct in periodontal therapy due to its bactericidal effects. The effect of this agent on chronic gingivitis and wound healing following surgical therapy in animals and humans has been favorable. The re-establishment of lost connective tissue attachment to the root surface following periodontal therapy is a desirable goal in which the ability of periodontal ligament fibroblasts to reattach to root surfaces of periodontally involved teeth is a critical event. Understanding the effect of chlorhexidine on fibroblast attachment will provide the rationale for its use during the healing phase of periodontal surgery. For this study, impacted third molars were sectioned into 4 pieces. Groups of 10 root pieces were exposed to 0.12% chlorhexidine or saline for 3 minutes followed by a distilled water rinse. The root pieces were incubated with human gingival fibroblasts (HGF) using standard tissue culture techniques for 1, 2, 4, 6, and 8 hours. HGF were prelabeled with 3H-thymidine to a standard specific activity. The surface area of each root piece was determined and the attached cells quantified by using scintillation spectroscopy. The number of cells per unit area was then calculated and the data expressed as cells/mm2. The repeated measures design was statistically analyzed by repeated measures analysis of variance. There was a significant difference between the number of attached cells in the chlorhexidine and the control groups (P less than 0.001). Exposure of root surfaces to chlorhexidine significantly inhibits subsequent fibroblast attachment which may interfere with regeneration of the periodontium. Hence, the data suggest that efforts should be made to minimize chlorhexidine contact with the root surface with physical barriers.

A variation from classic oral manifestations associated with acute myeloblastic leukemia. A case report.

A case representing previously misdiagnosed acute myeloblastic leukemia associated with an absence of classical intraoral manifestations is presented. Platelet count was less than 15,000, and hematocrit was 20.3, yet clinical signs were limited to malaise and extreme gingival and mucosal pallor. The typical initial signs of gingival enlargement or hemorrhage never appeared, probably due to excellent plaque control by this patient. Mucosal color changes dictated the need for laboratory studies leading to a rapid and relatively early diagnosis.

Splendore-Hoeppli phenomenon around blastomyces in cytologic preparation.

The Splendore-Hoeppli phenomenon was observed in bronchial washings and in the transbronchial lung biopsy specimen in a case of pulmonary blastomycosis. This is the first report of this phenomenon in a bronchial cytologic preparation.

Effect of polylactic acid on replanted teeth in dogs.

An attempt to inhibit root resorption and ankylosis of replanted roots in the mandibles of dogs was made by coating the root segments with a biodegradable compound. Resorption was not inhibited, but ankylosis response was apparently averted until the compound began to degrade.

Multiple pulmonary scar carcinomas in a patient with Hodgkin's disease: report of a case and review of the literature.

A case of multiple pulmonary scar carcinomas arising in a 53-year-old woman with Hodgkin's disease is reported. Review of the literature reveals that scar carcinoma is generally thought to arise in areas of bronchiolar epithelial proliferation occurring in association with pre-existing lung scars. However, we and others have emphasized that, given the usual gross and histologic picture of scar carcinoma, it is impossible to state with certainty whether the carcinoma arose in response to the scar tissue, or the scar tissue formed consequent to the occurrence of repeated small foci of tumor necrosis. The association of Hodgkin's disease and multiple malignancies is also discussed.

Submergence of roots for alveolar bone preservation. II. Reimplanted endodontically treated roots.

Root canal therapy was accomplished on the mandibular premolars of four dogs. These premolars were then extracted, contoured, reimplanted, and submerged. Resorption occurred up to 60 days; healing progressed satisfactorily, with some evidence of coronal osseous regeneration. Root canal sealer was expressed out the coronal orifice after the roots were submerged. This sealer appeared to affect normal healing over the coronal surface of the roots.

Submergence of roots for alveolar bone preservation. I. Endodontically treated roots.

Mandibular premolars in four dogs were endodontically treated and then totally submerged. Histologic and radiographic findings showed that this procedure should be considered as an alternative to extraction of key teeth in an effort to preserve alveolar bone. 1. Periodic follow-up on this procedure should be done to rule out cystic formation. 2. Beveling the coronal portion to the buccal is advocated to compensate for the thin buccal plate. 3. The procedure should be done in two steps to allow the root canal sealer to set, or an amalgam should be placed over the pulp canal. 4. New cementum and connective tissue will form over the coronal surface separating the dentin from new bone.

Nutritional status of main food preparers and of nutrition education assistants.

The dietary habits and nutritional status of nutrition education assistants (NEAS) in the Expanded Food and Nutrition Education Program in Missouri were compared with a representative population of Missouri main food preparers (MFPs) from the same regions of the state. Dietary histories indicated that the NEAs tended to have better habits than the MFPs. Using biochemical parameters for determining status for iron, vitamin A, ascorbic acid, and riboflavin, the differences between the two groups were not as great as for the dietary intakes. However, almost half of the MFPs were taking at least one vitamin or mineral supplement compared with 17 per cent of the NEAs. A low dietary intake, coupled with some anemia, probably relating to a low iron intake, was a major nutritional problem for both groups of subjects. Low plasma vitamin A values were also observed among a large proportion of both groups, and obesity was a widespread problem for both groups.