Influences of race/ethnicity in periodontal treatment response and bacterial distribution, a cohort pilot study.

Objectives: Periodontitis disproportionately affects different racial and ethnic populations. We have previously reported the higher levels of Porphyromonas gingivalis and lower ratios of Streptococcus cristatus to P. gingivalis may contribute to periodontal health disparities. This prospective cohort study was designed to investigate if ethnic/racial groups responded differently to non-surgical periodontal treatment and if the treatment outcomes correlated to the bacterial distribution in patients with periodontitis before treatment. Methods: This prospective cohort pilot study was carried out in an academic setting, at the School of Dentistry, University of Texas Health Science Center at Houston. Dental plaque was collected from a total of 75 African Americans, Caucasians and Hispanics periodontitis patients in a 3-year period. Quantitation of P. gingivalis and S. cristatus was carried out using qPCR. Clinical parameters including probing depths and clinical attachment levels were determined before and after nonsurgical treatment. Data were analyzed using one-way ANOVA, the Kruskal-Wallis test, the paired samples t-test and the chi-square test. Results: The gains in clinical attachment levels after treatment significantly differed amongst the 3 groups-Caucasians responded most favorably, followed by African-Americans, lastly Hispanics, while numbers of P. gingivalis were highest in Hispanics, followed by African-Americans, and lowest in Caucasians (p = 0.015). However, no statistical differences were found in the numbers of S. cristatus amongst the 3 groups. Conclusion: Differential response to nonsurgical periodontal treatment and distribution of P. gingivalis are present in different ethnic/racial groups with periodontitis.

Combining Observation and Physical Practice: Benefits of an Interleaved Schedule for Visuomotor Adaptation and Motor Memory Consolidation.

Visuomotor adaptation to novel environments can occur via non-physical means, such as observation. Observation does not appear to activate the same implicit learning processes as physical practice, rather it appears to be more strategic in nature. However, there is evidence that interspersing observational practice with physical practice can benefit performance and memory consolidation either through the combined benefits of separate processes or through a change in processes activated during observation trials. To test these ideas, we asked people to practice aiming to targets with visually rotated cursor feedback or engage in a combined practice schedule comprising physical practice and observation of projected videos showing successful aiming. Ninety-three participants were randomly assigned to one of five groups: massed physical practice (Act), distributed physical practice (Act+Rest), or one of 3 types of combined practice: alternating blocks (Obs_During), or all observation before (Obs_Pre) or after (Obs_Post) blocked physical practice. Participants received 100 practice trials (all or half were physical practice). All groups improved in adaptation trials and showed savings across the 24-h retention interval relative to initial practice. There was some forgetting for all groups, but the magnitudes were larger for physical practice groups. The Act and Obs_During groups were most accurate in retention and did not differ, suggesting that observation can serve as a replacement for physical practice if supplied intermittently and offers advantages above just resting. However, after-effects associated with combined practice were smaller than those for physical practice control groups, suggesting that beneficial learning effects as a result of observation were not due to activation of implicit learning processes. Reaction time, variable error, and post-test rotation drawings supported this conclusion that adaptation for observation groups was promoted by explicit/strategic processes.

Utilization of Chinese Herbal Medicine for Selected Oral Conditions in Two Pediatric Populations.

PURPOSE: To characterize traditional Chinese medicine (TCM) use, emphasizing herbal remedies, for oral conditions among two Chinese pediatric populations in the United States. METHODS: 318 unique ethnic Chinese parental units in Houston and Boston with children younger than 12 years old were interviewed for themselves and their children. Questionnaire included age, gender, duration in the United States, frequency of TCM use, and the five selected oral conditions for which TCM agents might be used. RESULTS: Parents (45.6 percent) and children (19.1 percent) used TCM for oral conditions, most commonly for aphthous ulcers (64.2 percent). Most commonly used TCM agents included watermelon frost (37.4 percent), niuhuang jiedu pian (15.5 percent), and honey/propolis (9.9 percent). Chi-square tests with logistic regression (P<0.05) showed duration of U.S. residency significantly affected (P=0.002), parental TCM usage, age group (P=0.003), and birth location (P=0.02) related to child use. Parental TCM use increased child likelihood of use (P<0.0001). CONCLUSIONS: In this study, traditional Chinese medicine was widely used for oral conditions by Chinese immigrants. Factors such as duration of U.S. residency, age, birth location, and parental use affect utilization of TCM in this population. Future studies are needed to explore the therapeutic properties of the various components of TCM.

Color Range and Color Distribution of Healthy Human Gingiva: a Prospective Clinical Study.

The aim of this study is to compile a comprehensive database on color range and color distribution of healthy human gingiva by age, gender and ethnicity. Spectral reflection of keratinized gingiva at upper central incisors was measured by spectroradiometer and converted into CIELAB values. Lightness range (ΔL*) for all groups together was 26.8. Corresponding a* (green-red) and b* (blue-yellow) ranges (Δa* and Δb*) were 18.3 and 13.0. Significant differences (p < 0.05) were recorded by age for L* and a* coordinates, by gender for b* coordinate, and by ethnicity for L*, a* and b* coordinates. R(2)-values between color coordinates were 0.01 (L*/a*), 0.03 (L*/b*), and 0.12 (a*/b*). The smallest color differences were recorded between age groups 46-60 and 60 + (ΔE* = 0.9), and between Caucasians and Hispanics (ΔE* = 1.1). Color difference by gender was 1.3. When total L*a*b* ranges were divided into four equal segments, 51.7% of subjects had L* value within the third segment (from lightest to darkest), 47.1% had a* value within the third segment (from less red to redder), and 59.3% had b* value within the second segment (from less yellow to yellower). It was found that ethnicity and age had statistically significant influence on the color of human gingiva.

Esthetic outcomes in relation to implant-abutment interface design following a standardized treatment protocol in a multicenter randomized controlled trial--a cohort of 12 cases at 1-year follow-up.

The design of an implant-abutment interface may have an impact on the peri-implant soft tissue esthetics. In an ongoing randomized controlled trial (RCT) with 141 participants, the authors evaluated the peri-implant tissue responses around three different implant-abutment interface designs used to replace single teeth in the esthetic zone. The aim of this report is to describe the treatment protocol utilized in this ongoing RCT by (1) demonstrating in detail a clinical case treated under this protocol and (2) reporting peri-implant soft tissue responses in a cohort of 12 representative cases from the RCT at 1-year follow-up. Male and female adults requiring single implants in the anterior maxilla were enrolled in the RCT according to the study protocol. Five months following any required extraction and/or socket bone grafting/ridge augmentation, one of the following three implant-abutment interfaces was placed and immediately provisionalized: (1) conical interface (CI; OsseoSpeed, Dentsply Implants), n = 4; (2) flat-to-flat interface (FI; NobelSpeedy Replace, Nobel Biocare), n = 4; or (3) platform-switch interface (PS; NanoTite Certain Prevail, Biomet 3i), n = 4. Twelve weeks later, definitive crowns were delivered. Throughout the treatment, peri-implant buccal gingival zenith height and mesial/distal papilla height were measured on stereotactic device photographs, and pink esthetic scores (PES) were determined. The demographics of the participants in each of the three implant-abutment interface groups were very similar. All 12 study sites had ideal ridge form with a minimum width of 5.5 mm following implant site development performed according to the described treatment protocol. Using this treatment protocol for single-tooth replacement in the anterior maxilla, the clinicians were able to obtain esthetic peri-implant soft tissue outcomes with all three types of implant-abutment interface designs at 1-year follow-up as shown by the Canfield data and PES. The proposed treatment protocol for single-tooth replacement in the esthetic zone provides a reliable method to obtain and assess the esthetic outcome as a function of implant-abutment interface design and is now in its fifth year of follow-up.

Evaluation of root coverage with and without connective tissue graft for the treatment of single maxillary gingival recession using an image analysis system: a randomized controlled clinical trial.

The aim of this prospective randomized clinical study was to evaluate, by means of an image analysis system, the efficacy of two different surgical procedures for the treatment of Miller Class I and II maxillary gingival recession. Patients treated for maxillary gingival recession were recruited and randomly divided into two groups: patients who received a coronally advanced flap with connective tissue graft (CAF + CTG) or CAF alone. Outcome parameters included complete root coverage, recession reduction, and keratinized tissue amount. Twenty-five patients completed the 12-month follow-up period. Patients in the CAF + CTG group showed a better primary outcome- gingival recession at 12 months-than CAF patients (P = .0001). Gingival recession at 12 months had a median of 0.5 (interquartile range [IQR] 0.5 to 0.6) in the CAF + CTG group and a median of 1.0 (IQR 0.9 to 1.1) in the CAF group. CAF + CTG and CAF groups had similar complete root coverage at 6 and 12 months. Recession and keratinized tissue width significantly decreased over time (P < .0001), with no effect of treatment or of treatment over time. Buccal probing depth had similar values over time (P = .28) and in the two groups (P = .52). Buccal clinical attachment level had similar values in the two groups (P = .87); moreover, mesial and distal clinical attachment levels did not show any variation over time (P = .88 and P = .68, respectively). By means of a computerized image analysis system better outcomes in terms of recession reduction after 12 months of follow-up were measured for maxillary gingival recessions treated with CAF and CTG. Adjunctive application of a CTG under a CAF increased the probability of achieving complete root coverage in maxillary Miller Class I and II defects (61.5% versus 83.3%; P = .38). Both treatments were equally effective in providing a consistent reduction of the baseline recession.

Platform switching and abutment emergence profile modification on peri-implant soft tissue.

Although the peri-implant hard tissue advantages of platform switching abutments have been well documented by many authors, the peri-implant soft tissue advantages of platform switching abutments has had limited mention. This article illustrates how the amount of peri-implant soft tissue volume is influenced by the dimensional extent of platform switching and the degree that an abutment's sulcular emergence profile has been modified. This article also introduces the term "abutment sulcular emergence profile enhancement" (ASEPE) to describe the combined effect of platform switching and abutment emergence profile modification. Three unrecognized clinical advantages of ASEPE are described by different clinical cases. First, elimination of excessive abutment impingement on gingival tissue adjacent to implants is achieved. Second, allowance for sufficient interproximal space between implant and adjacent tooth/implant for the entry of interproximal toothbrush is made possible. Third, excessive soft tissue blanching during abutment seating at prosthesis delivery is eliminated. Together, the combined application of platform switching and abutment emergence profile modification represents the opening of a new realm for managing soft tissue around implants to resolve dimensional problems.

Coordinated transcriptional regulation of bone homeostasis by Ebf1 and Zfp521 in both mesenchymal and hematopoietic lineages.

Bone homeostasis is maintained by the coupled actions of hematopoietic bone-resorbing osteoclasts (OCs) and mesenchymal bone-forming osteoblasts (OBs). Here we identify early B cell factor 1 (Ebf1) and the transcriptional coregulator Zfp521 as components of the machinery that regulates bone homeostasis through coordinated effects in both lineages. Deletion of Zfp521 in OBs led to impaired bone formation and increased OB-dependent osteoclastogenesis (OC-genesis), and deletion in hematopoietic cells revealed a strong cell-autonomous role for Zfp521 in OC progenitors. In adult mice, the effects of Zfp521 were largely caused by repression of Ebf1, and the bone phenotype of Zfp521(+/-) mice was rescued in Zfp521(+/-):Ebf1(+/-) mice. Zfp521 interacted with Ebf1 and repressed its transcriptional activity. Accordingly, deletion of Zfp521 led to increased Ebf1 activity in OBs and OCs. In vivo, Ebf1 overexpression in OBs resulted in suppressed bone formation, similar to the phenotype seen after OB-targeted deletion of Zfp521. Conversely, Ebf1 deletion led to cell-autonomous defects in both OB-dependent and cell-intrinsic OC-genesis, a phenotype opposite to that of the Zfp521 knockout. Thus, we have identified the interplay between Zfp521 and Ebf1 as a novel rheostat for bone homeostasis.

Growth factor-mediated combination therapy to treat large local human alveolar ridge defects.

The purpose of this case report is to demonstrate the effectiveness of a matrix consisting of recombinant human platelet-derived growth factor BB (rhPDGF-BB)-hydrated cancellous allogenic block graft in the reconstruction of large local human alveolar ridge defects. The results suggest improved bone regeneration when combining rhPDGF-BB with the allogenic block graft. The clinical and histologic evidence of new bone formation as well as bone remodeling supports the clinical potency of this growth factor-mediated therapy.

Gamma testing experience with the ACL TOP hemostasis testing system.

As a gamma testing site or a limited early release site for the ACL TOP, St. Michael's Hematology Laboratory evaluated the ACL TOP for its ability to fit into a laboratory whose workflow includes large volumes of routine and specialty hemostasis assays. This evaluation included the determination of the ACL TOP's precision, normal ranges, and reagent sensitivities. Analytical correlation studies for the ACL TOP were performed in comparison to the ACL ADVANCE. The ACL TOP was also tested for its ability to handle large volumes of not only routine assays but also more specialized coagulation assays. Instrument precision, normal reference range assignment, and factor sensitivities met the requirements of this laboratory. The ACL TOP correlated favorably to the ACL ADVANCE, and in a workup for thrombophilia its throughput was twice what was seen with the ACL ADVANCE. The speed of the ACL TOP was impressive, generating results at a rate of almost 5 results/min. In this gamma testing study, the ACL TOP has demonstrated suitability as a precise coagulation analyzer for use in the settings of a high-volume, fast-paced, specialized coagulation laboratory faced with demanding turnaround times.

Experience of implementing a quality management system in an Ontario hospital laboratory.

This article describes the process of building and implementing a quality management system in the Department of Laboratory Medicine at St. Michael's Hospital in Toronto. This was done in part to fulfill the requirements of the Ontario Laboratory Accreditation program. During the process, we revised and created new procedure manuals and documents through the use of focus groups and inter-departmental committees. The entire project took approximately two-and-a-half years to complete and required teamwork, personal commitment, and professional sacrifices by key personnel.

CXC chemokine ligand 12-induced focal adhesion kinase activation and segregation into membrane domains is modulated by regulator of G protein signaling 1 in pro-B cells.

CXCL12-induced chemotaxis and adhesion to VCAM-1 decrease as B cells differentiate in the bone marrow. However, the mechanisms that regulate CXCL12/CXCR4-mediated signaling are poorly understood. We report that after CXCL12 stimulation of progenitor B cells, focal adhesion kinase (FAK) and PI3K are inducibly recruited to raft-associated membrane domains. After CXCL12 stimulation, phosphorylated FAK is also localized in membrane domains. The CXCL12/CXCR4-FAK pathway is membrane cholesterol dependent and impaired by metabolic inhibitors of G(i), Src family, and the GTPase-activating protein, regulator of G protein signaling 1 (RGS1). In the bone marrow, RGS1 mRNA expression is low in progenitor B cells and high in mature B cells, implying developmental regulation of CXCL12/CXCR4 signaling by RGS1. CXCL12-induced chemotaxis and adhesion are impaired when FAK recruitment and phosphorylation are inhibited by either membrane cholesterol depletion or overexpression of RGS1 in progenitor B cells. We conclude that the recruitment of signaling molecules to specific membrane domains plays an important role in CXCL12/CXCR4-induced cellular responses.

Evidence that DeltaNp73 promotes neuronal survival by p53-dependent and p53-independent mechanisms.

The p53 family member, p73, is essential for the survival of sympathetic neurons during the developmental period of naturally occurring neuronal death. Here, we have asked whether DeltaNp73, which is the only p73 isoform expressed in sympathetic neurons, mediates this survival by p53-dependent and/or p53-independent mechanisms. Initially, we used a genetic approach and crossed p53+/- and p73+/- mice. Quantitation of neurons in the sympathetic superior cervical ganglion during the period of naturally occurring cell death revealed that the loss of p53 partially rescued the death of neurons seen in p73-/- animals. Moreover, exogenous expression of DeltaNp73 in cultured p53-/- sympathetic neurons rescued these neurons from apoptosis after NGF withdrawal. Biochemical studies asking how DeltaNp73 inhibited NGF withdrawal-induced apoptosis in wild-type neurons demonstrated that it prevented the upregulation of the direct p53 targets p21 and Apaf-1 as well as cleavage of caspase-3. It also inhibited events at the mitochondrial apoptotic checkpoint, suppressing the induction of BimEL and the release of mitochondrial cytochrome c. Interestingly, DeltaNp73 expression also inhibited one very early event in the apoptotic cascade, the activation of c-Jun N-terminal protein kinase (JNK), likely by binding directly to JNK. Finally, we show that neuronal cell size is decreased in p73-/- mice, and that this decrease is not rescued by the lack of p53, suggesting a role for p73 in regulating cell size that does not involve interactions with p53. Thus, DeltaNp73 promotes neuronal survival via p53-dependent and -independent mechanisms, and it does so at multiple points, including some of the most proximal events that occur after NGF withdrawal.