Oral session: Diagnosis and risk factors

ORALS
Oral session: Diagnosis and risk factors
Subgingival in vivo calculus detection using
655 nm diode laser irradiation.
P. Purucker*, R. Bluehdorn and J.-P. Bernimoulin
Charit
, University Medicine Berlin, Germany
Background: Clinical subgingival calculus detection has a poor test
sensitivity. The aim of this in vivo study was to compare a
diagnostic laser with an explorer in their ability of subgingival
calculus detection.
Methods: Fifteen teeth with untreatable periodontitis were
analysed directly before their extraction. At the mesial and distal
surface of each tooth calculus was diagnosed either by a thin
explorer (EXD 11/12) or by a diagnostic InGaAsP diode laser
(KaVo KEY 3 laser) with a headpiece for the irradiation (655 nm
wavelength) of the root surface. The intensity of the resulting
uorescence was analysed and a peak value >30 was counted as
presence of calculus. The clinical detection was performed before
or after laser detection. On each surface ve areas were assessed
separately. After extraction, digital images were taken and the
presence of calculus was determined.
Results: The result shows that 64 out of 150 surfaces were covered
with calculus. The explorer method discovered 24 of the 64 surfaces
(sensitivity 37.5%) and the laser method was positive on 52 of the
64 areas with calculus (sensitivity 81.3%). Areas free of calculus
were detected on 64 out of 86 (explorer: specicity 74.4%) vs. 69
out of 86 (laser: specicity 80.2%) surfaces.
Conclusion: Within the limits of this study it can be concluded, that
the sensitivity of subgingival calculus detection by laser induced
uorescence (655 nm excitation wavelength) is signicantly higher
than the detection sensitivity of an explorer.

Quantification of the periodontal attachment area in

fully dentate humans by computed tomography
P. Solar*, C. Kropf, J. Gruber and A. Gahleitner
Bernhard-Gottlieb Dent. Univ. Clin., Vienna, Austria
Current literature does not provide data of the total periodontal
attachment area measured in single individuals. This presentation
focuses on a study using Computed tomography (CT)-data of fully
dentate, periodontal healthy subjects to determine the total root
surface area of humans. CT-data of 57 patients, who underwent
CT-scanning for other than periodontal indications, were analysed.
After image processing the root surface of every single tooth was
calculated. In the next step every root area was vertically divided in
thirds (coronal, middle, apical) and the surface area of each third
calculated. Statistic processing of the data was performed to
determine mean values and standard deviations for the root surface
area of single teeth, the root thirds, the upper and lower jaw
separately and the total of all 28 teeth. The results for the total
periodontal attachment area show a mean value of 75.4 cm2 (SD

*Presenting author

18.3 cm2). 39.3 cm2 and 36.9 cm2 are the mean values for the upper
and lower jaw respectively (SD 9.3 cm2 and 8.7 cm2). The mean
value for the coronal root thirds is 33.3 cm2 (SD 7.8 cm2), for the
middle thirds 28.3 cm2 (SD 6.3 cm2) and for the apical thirds
14.3 cm2 (SD 3.9 cm2). On the basis of the single teeth-data it
seems to be possible to get a better estimation of the area of
attachment loss in patients with periodontal disease. It needs to be
shown whether the extent of inamed periodontal area plays a role
for the severity of systemic response.

Periodontal disease in 3-generation Brazilian

families genetic power estimation
G. E. Rapp*, N. P. Trujillo, P. M. Brett and M. S. Tonetti
UFBA, Brazil, UA, Columbia, UCL, UK, UC, USA
Linkage analysis is a powerful method to detect predisposing
gene(s), providing there is sucient pedigree information. The aim
was to estimate the power of 3-generation families to detect linkage
for future detection of genetic eects in periodontal disease (PD).
Three Brazilian families were selected after conrmed diagnoses of
generalized aggressive periodontitis in the probands. A 6 site/tooth
full-mouth probing was performed by a calibrated examiner in 58
family members (all non-smokers). The phenotype was dichotomized based on questionnaire (edentulous cases) and clinical
attachment loss of 4 mm due to pocketing in at least 4 sites of
dierent teeth. A dominant mode of inheritance (autosomal) and
recombination fraction Q = 0 were adopted in the model. Penetrance values (F) of 0.98, 0.75, 0.5 and phenocopy rates (P) 0 and
0.02 were tested using the SLINK simulation method in 100
replicas. A lod score of 3 is considered signicant for genetic
linkage analysis. The highest values were found in F = 0.98 and
P = 0, followed by F = 0.98 and P = 0.02. The average/maximum expected lod scores were 5.90/9.67 and 4.80/8.83 respectively.
Bearing in mind the heterogeneity of periodontal disease (genetic
and/or environmental contributors), the authors conclude that the
analysed pedigrees provide sucient power for future genotyping.

Genetic influences on neutrophil function as risk

factors for aggressive periodontitis
L. Nibali*, G. Griffiths, M. Parkar and M. Tonetti et al.
Univ.
Background: Neutrophils (PMN) in Aggressive Periodontitis
(AgP) patients are hyper active especially with regards to
superoxide production. Polymorphisms in genes inuencing PMN
function have been proposed as candidate risk factors for AgP. The
aim of this study was to test the association of specic gene
polymorphisms aecting PMN functions with AgP.
Methods: Two hundred and twenty four patients with conrmed
diagnosis of AgP and 231 subjects with healthy periodontium took
part in the study. A blood sample was collected from subjects and
genotypes for C242T p22phox NADPH oxidase, FP, Fca and Fcc
receptors were analysed in a blind fashion.

23

Oral session: Diagnosis and risk factors

Results: The C242T p22phox NADPH oxidase T allele was
signicantly associated with AgP in a multiple logistic regression
model adjusting for confounders, both in Caucasian (P = 0.009,
OR = 2.07, 95% CI = 1.203.59) and Black subgroups (P =
0.032, OR = 3.16, 95% CI = 1.287.76). The same genotype and
FccR IIIb polymorphism were associated with the Generalised
AgP phenotype both in all subjects and Caucasians. FccR
haplotypes were associated with AgP in Blacks (P = 0.034).
Discussion: The C242T p22phox NADPH oxidase and FccR
polymorphisms may predispose to Aggressive Periodontitis,
probably through a modulation of neutrophil superoxide
production.

marked reduction in OPG expression (66% of healthy subject

levels). However, the G-AgP group showed strong induction in
RANKL expression, whereas in CP patients there was no increased
RANKL expression. When RANKL/OPG ratios were calculated,
this was markedly increased in both AgP and CP compared with
controls, there was no signicant dierence between CP and
G-AgP in RANKL/OPG ratios.
Conclusion: These preliminary results suggest that the increased
RANKL/OPG ratio in CP patients may account for a downregulation of OPG expression, whereas in G-AgP patients this may
be due to up-regulation of RANKL expression.

VDR, osteoprotegerin and IL-6 gene polymorphisms in

Turkish population with aggressive and chronic
periodontitis

Salivary pro-inflammatory cytokine arrays for diagnosis

of periodontitis

P. Emecen*, E. Ylmaz, P.
. Geyik and R. M. Nohutcu

H.U. Dental and Medical School, Turkey
Epidemiologic studies suggest that there is a genetic component of
susceptibility to periodontitis. In this study, the VDR, osteoprotegerin (OPG) and IL-6 gene polymorphisms, which are thought to
play roles in bone metabolism, were evaluated in Turkish population with aggressive periodontitis (AP) patients, chronic periodontitis (CP) patients and periodontally healthy controls (HC).
Sixty-two AP patients, 63 CP patients and 64 HC were enrolled in
the study. A full-mouth periodontal examination including probing
depth (PD), clinical attachment level (CAL), plaque index (PI) and
bleeding on probing (BOP) were performed. DNAs isolated from
peripheral blood were analysed for the polymorphisms in VDR,
OPG and IL-6 genes by PCR followed by restriction enzyme
digestion and gel electrophoresis. There were no signicant
dierences between AP, CP and HC groups for VDR, OPG and
IL-6 genotype analysis or allele frequencies investigated. When the
patient groups (AP and CP) were classied as mild-moderate
(CAL < 4 mm) and severe (CAL > 4 mm) according to CAL,
genotype 1/1 and allele 1 were found signicantly higher in CP
patients severe group in OPG gene polymorphism and although it
was not signicant allele 1 was found to be higher in CP severe
group in IL-6 gene polymorphism. The investigated polymorphisms may not be the markers to designate susceptibility to
periodontitis but when the disease is present OPG gene polymorphism might be related with the severity of attachment loss in
CP.

RANKL and OPG mRNA expression in chronic and

aggressive periodontitis

C. A. Ramseier*, J. Kinney, A. Kim, A. Singh and W. Giannobile

University of Michigan, Ann Arbor, USA
Aims: Increased levels of pro-inammatory cytokines may be
found in oral uids of patients aicted with chronic periodontitis.
The identication of multiple analytes from the same biological
sample remains a challenge in the evaluation of periodontal disease
biomarkers. The aim of the present cross-sectional study was to
measure salivary-derived pro-inammatory cytokines in
periodontally healthy and diseased subjects.
Materials and methods: Clinical attachment levels (CAL), probing
depths (PPD), bleeding on probing (BOP) were assessed from a
total of 20 patients with periodontal health or periodontitis. Whole
saliva (WS) was collected and analysed using protein microarray
techniques for IL-6, IL-1b, IL-2, IL-13, IL-4, IFN-c, IL-5 and
TNF-a. These assays are based on a miniaturized immunoassay
using microarrays of biotinylated monoclonal antibodies and
streptavidin-conjugated uorophores.
Results: In WS, a > 20 fold increase of IL-1b was found in
subjects with periodontal disease compared to healthy individuals
(P < 0.05), while >2 fold increases in IL-4, IL-6 and IL-10 were
found in disease vs. health. A statistical signicant correlation
between PPD and CAL, was found in WS with multiple cytokines
evaluated (Spearmans rank correlation rho: 0.570.72).
Conclusion: The evaluation of WS via multiplexed cytokine arrays
may give valuable information about the pathophysiological
processes in periodontitis and provide a more robust assessment
of periodontal disease risk.

Gingival squamous cell carcinoma (GSCC): diagnostic

delay or rapid invasion?

N. Bostanci*,1,2, B. Han1and G. N. Belibasakis2 et al.

1
Ege University, Turkey, 2Barts and The London, UK

P. I. Varela-Centelles*, T. F. Walsh, J. Seoane and J. Lopez et al.

SERGAS, Spain, University of Sheffield, UK, University of Santiago,
Spain

Aim: The receptor activator of NF-kappa B ligand (RANKL) and

its decoy receptor osteoprotegerin (OPG) are the main regulators of
osteoclast formation. Their relative expression ratio is a key factor
for the occurrence of bone destruction in periodontitis. The aim of
this study was to investigate RANKL and OPG mRNA expression
in gingival tissues of patients with dierent periodontal diseases.
Methods: Gingival biopsies were obtained from ve patients with
generalized aggressive periodontitis (G-AgP), ve with chronic
periodontitis (CP), ve with gingivitis and ve periodontally
healthy subjects. RANKL and OPG mRNA levels were
quantied by real time quantitative RT-PCR.
Results: Osteoprotegerin expression levels were signicantly lower
in Gingivitis and CP patients, compared to healthy subjects (13%
and 1%, respectively). In contrast, the G-AgP group showed less

Background: The similarity between GSCC and common

periodontal lesions may cause delay in diagnosis or misdiagnosis.
These cancers are frequently diagnosed at an advanced stage.
Methods: To assess the relative time from when the patient rst
became aware of the problem to histopathological diagnosis (total
diagnostic time), 59 consecutive oral cancer cases were examined.
Variables studied: age, gender, smoking habits, tumour stage at
diagnosis and total diagnostic time. The median of the patients
total diagnostic time (1.5 months) was used as a cut-o point to
distinguish delayed from non-delayed cases. Statistical analysis was
undertaken using the Chi square and Student t-tests, with a
condence interval of 95%.
Results: The total diagnostic time was less than 1.5 months for
75% of GSCC, 50% of tongue cancers and 78% of oor of the

24

Oral session: Antimicrobial therapy

mouth carcinomas. It was more than 1.5 months for 25% of
GSCC, 50% of tongue carcinomas and 21% of oor of the
mouth cancers. No signicant dierences in time before
diagnosis were found when GSCC were compared to other oral
tumours (v2 = 0.21; 95% CI = -0.400.26). However, by the time
of diagnosis, GSCCs had invaded adjacent structures more

frequently than other oral cancers (v2 = 13.51; 95% CI = 0.18

0.85).
Conclusions: Gingival squamous cell carcinomas were associated
with advanced stages at diagnosis, due to early invasion of
contiguous bone tissue (T4-primary tumour). This would indicate
that even earlier referral and diagnosis was necessary.

Oral session: Antimicrobial therapy

The effects of a 0.1% chlorhexidine mouthwash on
the subgingival biofilm in patients with gingivitis:
a 3-month study
A. Echeverra*, S. M. P. Correa, D. M. Vargas, D. Herrera and M. Sanz
Department of Periodontics, University Complutense, Madrid, Spain
Aim: To compare the microbiological ecacy and safety of a 0.1%
chlorhexidine (CHX) mouth rinse during a 3-month trial using a
placebo and a 0.2% CHX solutions as controls.
Materials and methods: A prospective, parallel, randomised
clinical trial was designed to evaluate the microbiological eects
of the test mouth rinse. 37 patients were assessed at baseline, and
days 7 and 84. Pooled microbiological samples were taken from the
mesial sites of the upper rst molars, from the lingual side
for culturing and from the buccal side for DNA probes analysis.
DNA probes identied A. actinomycetemcomitans, P. gingivalis,
T. forsythensis and T. denticola. Statistical comparisons were
performed by anova and Dunnetts test.
Results: The total bacterial counts (expressed in log) were reduced
in the three groups after 84 days, and the 0.1% CHX achieved the
highest level of reduction (0.19) vs. the placebo (0.13). With
culture, a reduction in the percentage of ora for F. nucleatum,
P. intermedia and M. micros was observed for the CHX groups. No
statistically signicant dierences were observed when comparing
the results obtained with DNA probes. No overgrowth of
opportunistic species was detected by culture.
Conclusion: A limited microbiological eect of the test mouth rinse
on the subgingival ora was observed, and no microbiological
adverse eects were detected.
Supported by Pierre-Fabre.

Antimicrobiological photodynamic therapy apt for

treatment of chronical periodontitis
T. Eberhard*, J. Neugebauer, F. Vizethum and J. Zller
Private Practise, Waldstetten, Uni. Cologne, Germany
The eective reduction of colonisation of periodontal pockets is the
success parameter for chronical periodontitis. A clinical study with
62 patients and a minimum recall for 12 month was evaluated. The
intra-oral disinfection was performed by photodynamic therapy
and for 12 patients with additional administration of antibiotics. A
thiazin based photosensitizer is applied to the infected area for
1 min. After the coloration of the bacteria the activation of the
photosensitizer is performed with non-thermal laser light of
660 nm for 1 min for each area. The photodynamic reaction
leads to a singlet oxidation at the membrane of the bacteria and
performs a selective cell death. The amount of AA; TG; TI and PG
was determined prior, 1 week, 6 and 12 months after therapy. An
average of 23.2 teeth were treated for each patient. A signicant
reduction of the bacterial load occurred in all tested sides for the

1 year control. All patients showed immediately a reduction of

bacterial load for all marker specimens. The combination therapy
of APT and antibiotics showed no improvement in comparison to
APT alone. The reduction of clinical pathological signs could be
reached with an average reduction of SBI by 0.84. Attachment level
gain was 0.9 mm in average. The APT is an ecient method for
bacterial load reduction in periodontal therapy. The treatment is
non invasive and can be repeated without the risk of allergies and
resistance in comparison to antibiotic therapy.

Adjunctive amoxicillin and metronidazole in the

treatment of generalized aggressive periodontitis:
response in molars and anteriors.
A. Guerrero*, R. Lambertenghi and M. Tonetti et al.
Department of Perio, Eastman Dental Institute, London, UK
Aim: To assess the adjunctive benet of amoxicillin and
metronidazole in generalized aggressive periodontitis (GAP) in
terms of reduction in the need for corrective periodontal therapy in
molar and anteriors 6 months post treatment.
Methods: Forty one GAP patients were randomly assigned to
either test (TG) or placebo group (PG). 20 subjects (TG) received
full-mouth root instrumentation (FRI) with systemic amoxicillin
(500 mg/TID/7 days) and metronidazole (500 mg/TID/7 days). 21
subjects (PG) received FRI with placebo medication. Clinical
parameters were evaluated at baseline and 26 months.
Results: Median percentage of pockets converting from 5 mm to
4 mm at 6 months was, in anteriors, 89.4% and 69.2% in the TG
and PG, respectively (P = 0.002, MannWhitney). In molars, the
gures were 56.6% and 34.6% in TG and PG, respectively
(P = 0.011). In anteriors, median percentage of pockets
converting from 4 mm at baseline to 3 mm at 6 months was
75.6% and 50% for TG and PG, respectively (P = 0.007). The
same gure in molars was 24.1% and 20.1% in TG and PG,
respectively (P = 0.220). The additional benet of the antibiotic
treatment was larger in anteriors (25.6%) as compared to molars
(4.1%).
Conclusions: The adjunctive use of amoxicillin and metronidazole
resulted in higher additional reductions in the need for corrective
periodontal therapy in anteriors as compared to molars when using
4 mm as the discriminant value.

Adjunctive systemic antibiosis in patients with

aggressive and severe chronic periodontitis
T. Kim*, C. Geenen, P. Eickholz and H. Schuster
Sect. of Periodontal, University of Heidelberg, Germany
Aims: The goal of this study was to nd out if the treatment results
in patients with aggressive (AgP) and severe chronic periodontitis
(sCP) can be improved with adjunctive systemic antibiosis if

25

Oral session: Periodontal molecular mechanisms of tissue damage

patients have been tested positive for Actinobacillus
actinomycetemcomitans (A.a.).
Methods: A total of 39 patients with either AgP (n = 10) or sCP
(n = 29) participated in the study. Subgingival samples of 22
patients were positive for A.a. at the beginning of the study.
Results: The patient groups with and without A.a. did not dier
signicantly at the beginning of the study, with regard to their
hygiene-(PCR) and inammation parameters (GBI, BOP). Mean
pocket probing depths (PD) and clinical attachment levels (AL)
were comparable in both groups. During periodontal therapy, a
signicant overall reduction of GBI (from 16% to 3%), PCR (from
44% to 21%) and BOP (from 34% to 14%) could be observed.
Mean increase of AL was 0.96 mm in patients with A.a. and
0.50 mm in patients without A.a. The mean reduction of pocket
probing depths was signicantly higher in patients with A.a.
(1.65 mm) compared to patients without A.a. (0.72 mm).
Conclusion: In patients with A.a., adjunctive systemic antibiosis
can help to establish a better clinical outcome compared to patients
without A.a. that receive no adjunctive antibiosis.

Reinfections with Aa and Pg after adjunctive antibiotic

therapy in aggressive and chronic periodontitis
J. Weyer* and T. Eger
German Armed Forces Central Hospital, Germany
Out of the large variety of subgingival bacterial species only a few
have biochemical abilities, which are of importance for the
pathogenesis of Periodontitis. All molecular biological mechanisms, host responsibility and non-acquired risk-factors are genetically determined. Microbiological testing is important for the
determination of adjunctive antibiotical treatment. During periodontal non surgical treatment 230 patients with aggressive
(n = 82) or generalised progressive chronic periodontitis
(n = 148) got adjunctive systemic antibiotic regime and were
followed by periodontal maintenance for 210 years. In 10 cases
(20.4%) of an actinobacillus actinomycetemcomitans (Aa)-associated aggressive periodontitis and 15 cases (22.7%) of an Aa-associated chronic periodontitis an Aa-reinfection and additional loss
of attachment 25 years postoperatively made periodontal retreatment necessary. In three cases (9.1%) of a porphyromonas
gingivalis (Pg)-associated aggressive periodontitis and 23 cases
(28.0%) of a chronic Pg-associated periodontitis with later

Aa-infection 3.510 years postoperatively caused also immediate

retreatment. Reinfections with Aa were diagnosed in 25 patients
(21.7%) with former Aa-associated periodontitis. In 98 patients
(85.2%) with a former Pg-associated periodontitis Pg-reinfections
were found. Microbiological testing in the daily periodontal
practise is only sucient, if therapeutical consequences follow
and a positive cost-eect relation is realized.

Effect of adjunctive low-dose doxycycline therapy

on clinical parameters and gingival crevicular fluid
t-PA levels in chronic periodontitis
G. Emingil*, A. Grkan, G. Atilla and A. Berdeli et al.
_
Ege University of Izmir,
Turkey
Objectives: The present study examined eectiveness of low-dose
doxycycline (LDD) in combination with mechanical therapy on
gingival crevicular uid (GCF) tissue plasminogen activator (t-PA)
levels and clinical parameters in chronic periodontitis over
12-month period.
Methods: Gingival crevicular uid samples were collected, probing
depth (PD), clinical attachment level (CAL), gingival index (GI)
and plaque index were recorded at baseline, 3,6,9 and 12 months.
65 chronic periodontitis patients were randomized either to LDD
or to placebo groups. LDD group received LDD (20 mg) b.i.d for
3 months plus scaling and root planing (SRP), while placebo group
was given placebo capsules b.i.d for 3 months plus SRP. GCF t-PA
levels were determined by ELISA. Friedman and Wilcoxon test
was used to test signicance of changes over time. Dierences
between LDD and placebo groups were analysed by Mann
Whitney test.
Results: Signicant improvement was observed in all clinical
parameters in both groups over 12-month period (P < 0.01).
LDD group had lower PD, CAL and GI scores compared to
placebo group at 6, 9 and 12 months (P < 0.05). GCF t-PA levels
was signicantly reduced in both groups over 12-month period
(P < 0.01). However, GCF t-PA levels in LDD group was
signicantly lower than that of placebo group at 6 and 9 months
(P < 0.05).
Conclusion: These results provide additional information about the
usefulness of LDD therapy as an adjunct to mechanical therapy in
the long-term management of periodontal disease.

Oral session: Periodontal molecular

mechanisms of tissue damage
Hydrocortisone affects the mRNA expression for matrix
metalloproteinases and tissue inhibitors of
metalloproteinases in gingival fibroblast cells
P. R. Cury*, V. C. Araujo, F. Canavez, K. Leite and N. Araujo
Sao Leopoldo Res. Inst., University of Sao Paulo, Brazil
Background: Disruption of the balance between matrix
metalloproteinases (MMPs) and endogenous tissue inhibitors of
metalloproteinases (TIMPs) production results in periodontal
breakdown. The aim of this study was to evaluate the eect of
the hydrocortisone, which is important in the hypothalamicpituitary-adrenal axis regulation of the periodontal inammation,

26

in the mRNA expression for MMPs and TIMPs by human gingival

broblasts.
Materials and methods: Human gingival broblast cells were
stimulated with com hydrocortisone at 10-7 M, 10-9 M, 10-12 M
for 24, 48 and 72 h in DMEM without fetal calf serum. Untreated
cells in DMEM without fetal calf serum served as controls. The cells
were lysed and the RNA was extracted. Alterations in expression of
MMP-1, MMP-2, MMP-3, MMP-7, MMP-11, TIMP-1 and TIMP2 mRNA were determined using real-time RT-PCR. b-actin was
used as a housekeeping gene to normalize the results.
Results: It was observed an increased MMP-1, MMP-2, MMP-3
and MMP-7 expressions independently of the concentration or

Oral session: Periodontal molecular mechanisms of tissue damage

time of exposition. MMP-11, TIMP-1 and TIMP-2 expressions
were dose- and time-dependents, in general, MMP-11 and TIMP-2
expressions were up-regulated at longer exposition to the drug, and
TIMP-1 was down-regulated at lower hydrocortisone
concentrations.
Conclusion/Discussion: Hydrocortisone can aect the balance of
the mRNA expression for MMPs and TIMPs, and is likely
involved in the periodontal breakdown.

Stromelysin-1 gene expression is up-regulated with the

progression of periodontal disease
C. Mendieta*,1, J. Duran2 and L. Badimon2
1
U. Barcelona and 2Cardiov. Res. Ctr., CSIC-ICCC, Spain
Background and Aim: It was previously described that collagenases
(MMP-1, MMP-8, MMP-13) play an important role in periodontal
destruction. In the present study we have investigated the
regulation of the coordinated expression of other metalloproteinases (MMPs), gelatinases and stromelysin, and tissue
inhibitor of MMPs (TIMP-1) gene expression in gingival tissues
with increased severity of periodontal damage.
Materials and methods: Normal gingival tissues (control) and
diseased tissues (from patients with periodontal disease) were
obtained during periodontal resective procedures. Diseased tissues
were clinically classied according to disease severity. Tissues were
immediately frozen in liquid nitrogen and stored at -80
C. Tissues
were processed to obtain m-RNA and gene expression of
gelatinases (MMP-2 and MMP-9), stromelysin-1 (MMP-3) and
TIMP-1 analysed by real time PCR microfuidic cards (ABIPRISM 7000).
Results: Expression of gelatinases was not signicantly modied
but expression of stromelysin-1 was positively correlated with
disease severity (P < 0.05). TIMP-1 expression was signicantly
reduced in inammed tissues (P < 0.05).
Conclusion: In addition to collagenases, tissue destruction in
periodontal disease is also associated to up-regulation of
stromelysin and down-regulation of TIMP-1 gene expression,
hence favouring un-inhibited tissue degradation. Future studies
will have to address the study of MMP-3-protein expression levels
and their functional implications.

Elastolysis triggers collagenolysis in gingiva

equivalent
S. Lorimier*, A. Cozlin, S. Barthelemy and R. Garnotel et al.
INSERM ERM 0203; CNRS UMR 6198, Reims, France
Elastin derived peptides (EDPs) were shown to enhance the
expression of MMP-3 in human gingival broblasts (HGF)
cultures while having no inuence on levels of uPA, MMP-2,
MMP-13, MMP-14, TIMP-1 and TIMP-2. EDPs-inducing eect
on MMP-3 production was S-Gal mediated since it was signicantly inhibited by lactose and reproduced by peptides containing
the VGVAPG sequence recognized by this plasma membrane
receptor. To assess the contribution of EDPs in collagenolysis,
collagen lattices were used; in contracted lattices, EDPs were found
to synergize the inuence of Plasminogen (Plgn) on collagen
degradation and MMPs-activation. Those eects could be accounted for by EDPs-mediated up-regulation of MMP-3/MMP-1
cascade associated with signicant down-regulation of TIMP-1
and TIMP-2 production. EDPs or Plgn alone did not signicantly
induced collagenolysis in attached collagen lattices; however,
combination of both agents led to collagenolysis that could be
attributed to MMP-3 over expression, MMP-1 activation and
TIMP-2 down-regulation.

The mitogenic effect of TGF b1 and 17-b estradiol on

human periodontal ligament cells. An in vitro study
A. Lagou*, K. Markopoulou, A. Mamalis and I. Vrotsos et al.
Department of Periodontology, Dental School, University of Athens,
Athens, Greece
Growth factors and hormones are known to play a major role in
the periodontal healing procedures. TGF-b1 is a polypeptide
growth factor considered to aect mitogenesis of periodontal
ligament (PDL) cells in a dose- and time-dependent manner. This
factor is regulated by hormones as estrogens, while these hormones
seem to act directly on the PDL cell proliferation. The aim of this
in vitro study was to assess the eect of TGF-b1 and 17-b estradiol
on the proliferation of human PDL cells when these factors are
applied in various dosages and time periods. Cell cultures were
developed from the periodontal ligament of three human premolars
extracted for orthodontic reasons. TGF-b1 in concentrations of
1 ng/mL jai 25 ng/mL and 17-b Estradiol (E2) in concentration of
1 nM jai 100 nM were applied on PDL cells. The mitogenic eect
of these factors on PDL cells was tested at 48 and 72 h. The Trypan
Blue exclusion assay was used for determining absolute cell
numbers. An increase in the cell number was obtained at 48 h
and 72 h. Compared to control, this was statistically signicant
(P < 0.05), for TGF-b1 1 ng/mL and E2 100 nM at 48 h and for
E2 100 nM at 72 h. Concluding, TGF-b1 and E2 aect PDL cell
proliferation in a dose and time-dependent manner. Further
investigation of the exact mechanism of action of these factors
on human PDL cells may give useful information about the healing
of the periodontal tissues in vivo.

Functional significance of female sex hormone

receptors in the periodontium.
D. Jnsson*, . Wahlin, G. Bratthall and B. O Nilsson
Lund University, Sweden, Malm University, Sweden
Aim: Several studies have addressed the association between
changes in estrogen and progesterone levels and changes in
parameters of periodontitis. The purpose of this project is to
investigate the mechanisms by which estrogen inuence structure
and function of the periodontal ligament by aecting the properties
of periodontal ligament cells (PDL cells).
Materials and methods: Periodontal ligament cells were obtained
from teeth extracted for orthodontic reasons. The cells were
cultured from periodontal tissue explants and used in passages 35.
Estrogen (ER) and progesterone receptor (PR) expression
was
investigated
by
immunocytochemistry.
Subcellular
distribution of ERb was determined using immunogoldlabeling
and electronmicroscopy. DNA and collagen synthesis was
measured using incorporation of [3H]-thymidine and L-[3H]proline, respectively.
Results: ERb but not ERa or PR immunoreactivity was observed
in the PDL cells. Preliminary results show that ERb is distributed
not only in the nucleus but also in the mitochondria and cytosol.
Estrogen increased DNA synthesis in human breast cancer cells but
had no eect on PDL cell DNA or collagen synthesis.
Conclusions: Human PDL cells express ERb suggesting that
estrogen aects PDL cellular function via this ER subtype.
Estrogen has no eect on DNA and collagen synthesis, showing
that estrogen has no benecial eect on the periodontium via this
mechanism. Instead estrogen via ERb acts on the periodontium via
another still unknown mechanism.

27

Oral session: Clinical tips and cases implants

The effect of age on prostaglandin-synthesising
enzymes in the development of gingivitis
R. Mengel*, Siegel, E. S. Weihe and L. Flores-de-Jacoby
Periodontology, Philipps University, Marburg, FRG
The aim of the study was to evaluate the dierence in the
expression of Cox-1, Cox-2, Cox-3 and mPGES-1 in experimental
gingivitis of periodontally healthy young and aging test persons.
The test persons were divided into two groups aged from 18 to
30 years (n = 7) and from 46 to 77 (n = 7). After establishing a
high level of oral hygiene, clinical data were recorded and a tissue
biopsy was taken. After establishing an experimental gingivitis the
clinical examination was repeated and a new tissue biopsy was
taken. Cox-1, Cox-2 and mPGES-1 were analysed in the connective tissue and epithelium. In both periodontally healthy age
groups, Cox-1 and mPGES-1 was demonstrated in epithelium
cells, endothelium and broblast-like connecting tissue cells.
Additionally Cox-1 was found in Langerhans cells. Cox-2 was
discovered in cells exhibiting the morphology of epithelial mitosis
cells. In the older test persons the amount was statistically
signicantly lower (P = 0.014). During the experimental gingivitis
there were no signicant dierences in Cox-1 and m-PGES-1. In
contrast, the Cox-2 expression increased statistically (P < 0.05).
Cox-3 was not found in either age group. In conclusion, there were
no signicant dierences in Cox-1 and m-PGES-1 to be seen in
either of the age groups. Cox-1 was demonstrated in Langerhans
cells. In both the older and the younger age groups, the
experimental gingivitis was accompanied by a signicant increase
Cox-2 expression.

The effect of AGE on MIF and PGE2 in the development

of gingivitis
R. Mengel, K. Helms and L. Flores-de-Jacoby*
Periodontology, Philipps-University Marburg, FRG
The aim of the study was to evaluate the dierence in the
expression of MIF and PGE2 in experimental gingivitis of
periodontally healthy young and aging individuals. These persons
were divided into two groups aged from 18 to 30 years (n = 11)
and from 46 to 77 (n = 10). After establishing a high level of oral
hygiene, clinical data were recorded and sulcus uid samples were
taken. The samples were analysed using ELISA with regard to
PGE2 and MIF. After establishing an experimental gingivitis
immunological examinations were repeated on days 7 and 14. In
both age groups there was a increase in PGE2 (statistically not

signicant) during the course of the study (group 1: from

12.74 12.62 ng/mL to 17.87 10.61; group 2: from 18.26
12.62 ng/mL to 23.17 35.88). At baseline, high concentrations
of MIF were detected in both groups (1542.48 792.96 ng/mL
and 1503.81 804.27 respectively). During the course of the
study, MIF increased in the younger group (+652.39
1315.58 ng/mL), while in the older persons a decrease was observed
(-46.66 795.49 ng/mL). In conclusion, the study showed for the
rst time that high concentrations of MIF are present in the sulcus
uid of periodontally healthy persons. During the course of an
experimental gingivitis, MIF increased in the younger age group
while it decreased in the older group. PGE2 did not signicantly
increase in either group. It was not possible to prove a correlation
between MIF and PGE2.

Osteoprotegerin (OPG) levels in gingival crevicular

fluid (GCF) during orthodontic tooth movement in human
H. Uslu*,1, B. Kircelli1, S. Bulut1 and G. Seydaoglu2
1
Baskent University, Ankara, 2Cukurova University, Adana, Turkey
Osteoprotegerin is an inhibitor of osteoclast dierentiation. Tooth
movement is mediated by coupling of bone resorption on the
compressed side of PDL and bone formation on the stretched side
of PDL. Aim was to determine OPG levels in GCF during tooth
movement. Six patients requiring extraction of the 1 pm participated. At time points, PI, GI, PD, BOP were recorded. A canine of
each patient undergoing distal movement served as test whereas the
contralateral, free from any orthodontic force, were used as
control. GCF was collected from mesial and distal sides before
activation, at six time points after activation. OPG was measured
by ELISA. At baseline while concentration median (CM) was 73.0
(13205) at test mesial, 56.3 (10180) at distal (P > 0.05), it was
38.2 (3156) at control mesial, 32.1 (2.6212) at distal (P > 0.05).
CM decreased to 18.7 at 24 h and to 10.3 at 3 month, at test mesial
sides and to 11.6 and 10.3 respectively at control. There was a timedependent decrease in GCF OPG levels in groups and dierence
was signicant compared to baseline at all time points (P < 0.001).
No signicant dierence was observed between groups and sides at
time points. Multiple analyses demonstrated that while time is an
independent factor, side or orthodontic force are not risk factors.
During the treatment, GI and PI were increased by time in groups
(P < 0.001). These ndings suggest that during the tooth movement, OPG may not be an indicator or a specic marker for
evaluating alveolar bone remodelling.

Oral session: Clinical tips and cases implants

A CT scan-derived customized surgical template and
fixed prosthesis for flapless surgery and immediate
loading utilizing the electroforming technique
J. M. Navarro-Alonso* and J. M. Navarro-Martinez
Branemark Osseointegration Center, Spain, N.Y.U, USA
Numerous techniques on immediate occlusal loading of the
edentulous patient have been presented. However, very few
preconize the placement of the nal xed restoration on the day
of xture installation. The rst oral implant protocol with which it
was possible to provide patients with a successful on-the-day
permanent treatment result, was the Branemark Novum Concept,
(1999). Recently, the Nobel Guide concept has been described.

28

Based on three-dimensional implant planning software for computed tomographic (CT) scan data, customized surgical templates
and nal dental prostheses can be designed to ensure high precision
transfer of the implant treatment planning to the operative eld
and an immediate rigid splinting of the installed implants,
respectively. Here a novel type of rehabilitation is presented, in
which utilizing three-dimensional implant planning software for
CT scan data, and a apless implant placement approach, the
implants are placed, and custom made screw-retained zirconia
abutments are connected in order to support a nal xed bridge
utilizing the electroforming technique. An ideal intraoral passive t
and an extremely rigid xation of the implant abutments to the
prosthesis can be achieved. Once the osseointegration process has

Oral session: Clinical tips and cases implants

taken place, the patient is instructed to retrieve the removable-xed
bridge regularly in order to maintain an excellent hygiene, and soft
tissue health, better than any other type of xed implant-supported
restoration.

A protocol for immediate implant placement in the

multirooted molar teeth sites
J. Y. Kim*
UCLA School of Dentistry
A Protocol for Predictable Immediate Implant Placement in MultiRooted Molars Despite numerous clinical advantages of immediate
implant placement following extraction, there are many limitations
to this approach, often due to anatomical limitations. In teeth with
divergent roots, inter-radicular osseous septum can be utilized to
achieve primary anchor for the implant. However technical
challenges are often met due to the narrow and sometimes angled
shape of the septum or septa. The molar tooth is decoronated by
sectioning with high speed rotary instrument, at the level of bone
crest. Sequence of osteotomy is initiated at the ideal anticipated
implant position. Osteotomy is stopped at drill diameter that is
approximately 0.71.0 mm less that the implant diameter, as to
preserve as much inter-radicular bone as possible. At this point the
remaining roots are sectioned using high-speed rotary instrument.
The separated roots are atraumatically luxated out by using
periotomes and root forceps. Tapering osteotome or bone dilator
may also be utilized. Tapping may be necessary in denser bone.
Implant is placed and remaining socket space grafted if necessary.
Initiating osteotomy steps whilst roots of the molars are
intact allows predictable drilling, in bi-rooted and tri-rooted
teeth. This technique is contraindicated in teeth with fused roots.
Successful clinical outcomes have been observed in excess of 43
cases, including maxillary and mandibular molars over the past
3 years.

Flapless implant placement in the esthetic zone:

technique evaluation and long term clinical results
C. Makary*, N. Nader and R. Younes
Oral Surg Department, St Joseph University, Beirut, Lebanon
Purpose: In implant dentistry, care should be taken in the esthetic
zones before planning treatment sequences. Potential changes,
following implant placement, such as bone resorbtion and/or soft
tissue retraction can jeopardize the esthetic outcome of the future
prosthesis. In this presentation we will discuss implant placement
immediately after tooth extraction without incision or ap
elevation and to correlate it with tissue preservation.
Materials and methods: Thirty four patients aged 18 to 62 years
old received 52 implants placed immediately into extraction socket
with a apless technique. Temporization is performed immediately
after surgery and nal restoration is delivered 3 months after
implant placement. Clinical and radiographic evaluation is done in
order to monitor hard and soft tissue outcome and establish
implant follow-up for a period of 6 to 54 months.
Results: All implants healed uneventfully but one leading to a
98.2% success rate. All restorations were satisfying regarding
implant osseointegration, tissue preservation and patient
satisfaction. Minor complications were noted.
Conclusion: This clinical study suggests the predictability of the
apless technique. Advantages of this procedure are mainly esthetic
but it also gives the patient minimal post-operative morbidity.
Nevertheless care is to be taken in order to either prevent or
manage potential complications encountered in our cases.

Clinical and Microbiological determinants of failing

dental implants.
G. Tabanella*, H. Nowzari and J. Slots
University of Southern California, California, USA
This cross-sectional split-mouth study aimed to identify clinical
radiographic, and bacterial characteristics of peri-implant disease.
In 15 patients with bilateral implants, sites with peri-implantitis
(radiographic bone loss beyond the third implant thread) and periimplant healthy tissues (radiographic bone level above the rst
implant thread) were identied in periapical radiographs using a
long-cone paralleling projection technique. Branemark and 3i
implants were studied. Microbiological identication was carried
out using established anaerobic culture techniques. Logistic
regression analysis determined signicant predictors of disease.
Peri-implant pocket depth was positively associated with bleeding
on probing and the diameter of the implant (P < 0.03), and was
negatively associated with the presence of radiographic crestal
lamina dura (P = 0.02) and the length of the implant (P = 0.006).
Signicant predictors of peri-implant bone loss were the absence of
radiographic crestal lamina dura ( P = 0.000), peri-implant pocket
depth (P = 0.001) pain (P = 0.004), and the submucosal presence
of the periodontopathogens Tamarella forsythia (P = 0.008).
Campylobacter species (P < 0.05), and Peptostreptococcus micros
(P = 0.014). Pain was associated with P. micros (P = 0.04),
Fusobacterium species (P < 0.02), Eubacterium species (P < 0.05).
The absence of radiographic crestal lamina dura and the presence
of suspected periodontal pathogens seem to be important
predictors of peri-implantitis.

Functional and aesthetic considerations for anterior

tooth replacement with immediate or delayed implants
placement.
T. Eccellente*,1, M. Piombino1, A. Rossi1 and E. Conserva2
1
Private Practice, Napoli, Italy 2University of Genova, Genova, Italy
Aim: To report the clinical success of 189 immediate implants in
the anterior region of maxilla.
Methods: Between January 1994 and November 2002, 101
immediate implants and 88 delayed implants were placed in 104
patients. 26 Branemark, 67 Straumann and 96 Ankylos Implants.
Bone augmentation procedures were combined with implant
placement. After a conventional healing period of 6 months, all
implants were osseo-integrated; subsequently, the abutments were
connected and xed restorations were inserted. In dierent time
intervals mPlI and mSBI, standardized peri-apical radiographs,
technical complications and patients satisfaction, have been
registered.
Results: After a total observation period of 210 years six implants
were lost and the cumulative success rate was 96.8%. The majority
part of implants presented healthy peri-implant soft tissue
conditions, showing low values of clinical parameters.
Conclusion: Immediate implants show a high survival rate which is
similar to those associated with conventional implant placement.
Technical or prosthetic complications and compromised soft tissue
outcome can have a negative inuence on the patients comfort.
These complications seem to be related to dierent designs of the
investigated implant-abutment connections. The internal-tapered
implant-abutment connection have been reported to provide more
mechanical stability, moreover this connection can have a positive
inuence on the healing and long term stability of peri-implant
tissues.

29

Oral session: Therapy and healing

Evaluation of CRESCO-TI system in the reduction of the
gap between implant and abutment
M. A. Lopez-Higuera* and J. Del Rio Highsmith
Departament of Prosthesis, UCM, Spain
Introduction: The aim of this poster is to explain the CRESCO-TI
system, as a tool to reduce or eliminate the gap between the
implant, the abutment and the crown. The exposure of the
implant threads can be produced by the microltration of the gap
between the abutment and the implant, so the reduction of the
gap and the improvement in the marginal t can reduce this
microltration which can lead to the failure of the implant. We

present the CRESCO-TI SYSTEM as a system to reduce the

microgap.
Materials and methods: Five cases from the Department of
Prosthesis of the Faculty of Dentistry of Madrid are presented.
By means of Laser weldings and cold-worked soldered joints we
optimize the reduction of the gap between the implant and the
abutment. The space is analysed by visual adaptation on the model,
patient, and by photographic magnication.
Results: The CRESCO-TI SYSTEM provides a clinical and
photographical reduction of the gap between the implant and the
abutment.

Oral session: Therapy and healing

Influence of different treatment approaches on
nonsubmerged and submerged healing of ligature
induced peri-implantitis lesions in dogs
M. Herten*, F. Schwarz, S. Jepsen and J. Becker
Heinrich Heine University, Dsseldorf, Germany
The aim of the present study was to evaluate wound healing
following nonsubmerged (ns) and submerged (s) healing of ligature
induced peri-implantitis in beagle dogs. Peri-implantitis was
induced by ligature placement and plaque accumulation in ve
beagle dogs for 3 months following implant installation (n = 30
implants). The defects were randomly treated either (a) nonsurgically + ns healing or (b) surgically + s healing (n = 15 implants
each) using an Er: YAG laser (ERL), an ultrasonic device (VUS),
or plastic curets and local application of metronidazole gel (PCM).
The animals were sacriced after 3 months of healing. Clinical,
radiological and histological (e.g. new bone-to-implant contact
BIC) parameters were assessed. After 3 months of both ns- and
s- healing, all treatment procedures resulted in statistically signicant improvements of all clinical parameters. Histomorphometrical analysis showed that ns-implants of ERL, VUS and PCM
groups generally exhibited comparable low amounts of new BIC,
ranging from 1.3% (ERL, PCM) to 1.6% (VUS). In contrast, mean
BIC values were statistically signicant higher in the respective
ERL-s (49.7%), VUS-s (11.4%) and PCM-s groups (22.4%).
Within the limits of the present study, it might be concluded that
(i) ERL seemed to be more suitable to promote re-osseointegration
of contaminated implant surfaces than VUS and PCM, and
(ii) s- healing seemed to improve the outcome of treatment in
comparison to ns- healing.

The effect of periodontal treatment on IL-6 production

of peripheral blood monocytes among aggressive
periodontitis and chronic periodontitis patients
M. Radvar*, J. Tavakkol-Afshari and H. R. Arab et al.
MUMS University, Mashhad, Iran
Background: The aim of present study was to evaluate the eect of
periodontal treatment on IL-6 production of peripheral blood
monocytes (PBM) among aggressive periodontitis patients (AG)
and chronic periodontitis patients (CP) before and after
stimulation by E. coli LPS.
Materials and methods: Fifteen AP patients, 15 CP patients and 15
periodontal healthy (PH) took part in the study. PBM IL-6
production was measured before and after stimulation of cultured
PBM cells by 0.1 lg/mL LPS of E. coli using ELISA. Following

30

periodontal surgical full-mouth treatment of AP and CP groups,

the same measurements were repeated for these two groups.
Results: The LPS-stimulated IL-6 production was signicantly
greater than non-stimulated IL-6 for all three groups. Before
periodontal treatment, LPS-stimulated IL-6 production of AP
group was signicantly greater than the other two groups.
Periodontal treatment did not result in signicant decrease in
LPS-stimulated IL-6 production or unstimulated IL-6 production
of PBM cells in AP and CP groups. No correlation existed between
IL-6 levels and changes in clinical parameters or baseline clinical
parameters.
Discussion and Conclusion: Peripheral blood monocytes cells in AP
and CP patients are hyper-responsive in terms of IL-6 production.
This hyper-responsiveness does not return to normal even after a
successful periodontal treatment.

Evaluation through cultural analysis of the bactericidal

effect of the radiation of two different ND:YAG laser
systems (k = 1064 nm) on a dental biofilm
C. Gmez, A. I. Garca*, A. Herrero and A. Costela et al.
CSIC and Dental School UCM Madrid, Spain
Background and Aim: The laser radiation can constitute a valuable
aid on the removal of the dental plaque. The aim of the present
work is to establish a natural biolm model which allows the
formation of dental plaque and to compare the bacterial reduction
on the accumulated dental biolm after laser irradiation with two
dierent Nd:YAG laser.
Materials and methods: An acetate splint was designed to maintain
four sterile disks of hydroxyapatite in contact with the teeth of the
maxillary arch of a patient. The disks were used to accumulate
dental plaque during 12 h. Immediately after the acetate splint was
removed, the disks were irradiated with two dierent Nd:YAG
laser systems [Q-switched Spectron SL282G and Diodium (Shutz
Weil-Dental)] operating at 1064 nm. Next, the microbiological
analysis of the disks and the bacterial count by means of CFU/mL
were carried out by culture. A double blind study was carried out
with 34 cases and 26 controls.
Results: The design employed allowed the accumulation of plaque
without any type of manipulation and its immediate examination.
The laser irradiation of the biolm induced considerable bacterial
elimination. The statistical analysis of the results obtained by
anova, KRUSKAL-WALLIS and DUNCAN, conrmed a signicant
reduction of aerobic and anaerobic microorganisms with the
dierent laser systems employed (P < 0.05).
Conclusions: The Nd:YAG Diodium clinical laser which delivers
radiation by optical bre is showed to be more ecient.

Oral session: Perio-systemic interactions

Impairment of wound healing and cell migration by
targeted water sensor AQP3 gene disruption
S. Tancharoen*, T. Matsuyama, M. Tori, I. Maruyama and Y. Izumi
Mahidol University, Thailand, Kagoshima University, Japan
Membrane water channel protein aquaporin3 (AQP3) is implicated
in water absorption in epithelial cells. The aim of this study is to
explore the role of AQP3 in re-organization of keratinocyte
cytoskeleton and its related-downstream mechanism in wound
healing process.
Materials and methods: Here, we show in vitro and in vivo model of
wound healing, with particular attention to cytoskeleton structures
in activated keratinocytes by using small interfering RNA (siRNA)
duplexes targeted against aqp3 gene.
Results: The TNF-a promote AQP3 expression as well as changes
in microtubule structure and induce increase in keratinocyte
motility seen typically at 24 h. Transfection of cells with siRNA
selectively knocked-down
the expression of AQP3 as
demonstrated by FACs analysis. AQP3-siRNA not only inhibits
BrdU labelling indices but also changes in cell shape and enhances
assemble of microtubule arrangement. The RNA interference levelinduced change in the arrangement of cytoskeleton and preceded
signicant impairment of wound healing in AQP3 knockdown
mice. The molecular dialogue between TNF-a and keratinocytes
involves modulation of the activity of MAPK family proteins along
with up-regulation of AQP3 expression.
Conclusion: These observations support a direct association
between aqp3 gene in cytoskeleton change and distribution
though MAPK-mediated signal transduction pathway. This study
provides novel therapies for speedy gingival wound healing in
Diabetes and aging patients.

Evaluation of MMP-1 levels in gingival fibroblasts of

CSA-treated patients with gingival overgrowth and
healthy periodontium
S. Sonmez*, C. Gunduz and N. Nizam et al.
Ege University and Dokuzeylul University, Izmir, Turkey
Gingival overgrowth is a common side eect following the
administration of CsA and the pathogenesis of this condition is
not fully understood. The aim of this study was to compare the
matrix metalloproteinase-1 (MMP-1) levels in gingival broblast
cultures derived from two groups of renal transplant patients
receiving CsA who exhibit gingival overgrowth and who have
healthy periodontium. Gingival broblasts obtained from four

patients with CsA-induced gingival overgrowth (CsA GO) and four

with healthy periodontium were incubated with increasing concentrations of CsA (200, 400 and 800 ng/mL) and cultured for
72 h. The expression of MMP-1 levels of all the groups were
measured for four repeated times on 0, 24, 48 and 72 h by Rapid
Collagenase Assay Kit. There was no statistically signicant
dierence between the MMP-1 levels of two patient groups at the
baseline. As the CsA concentration and the duration in the cell
media increases, the CsA GO derived broblasts presented
signicantly suppressed MMP-1 levels with respect to the baseline
where broblasts from CsA using patients with healthy periodontium exhibited the same result at the highest CsA concentration.
Since the overall pathogenesis of drug-induced gingival hyperplasia
has been accepted as multifactorial, it is thought that the down
regulation of MMP-1 expression has a role in the play.

Effect of shockwaves on fibroblasts of periodontal

ligaments in vitro
P. Polenik*
Charles University, Czech Republic
The aim of the present study was to explore the inuence of energy
density and the number of applied shockwaves on the viability and
transformation of broblasts of periodontal ligaments (PDL). PDL
broblasts were cultivated in a humidied incubator and 5% CO2.
The cell suspension samples were subjected to SW energy densities
of 0.15 mJ/mm2 and the samples were treated with 100, 250, 500
and 1000 shockwaves. After the SW treatment the cells were
incubated at 37 oC and after 1, 24 and 48 h the viability of cells was
assessed by spectrophotometrical analysis. We investigated the
eect of various SW energy ux densities on osteogenic transformation of PDL broblasts with and without SW treatment
(0.15 mJ/mm2; 200, 500 impulses). Cells were cultivated in osteogenic medium for 21 days and bone alkaline phosphatase activities
and bone nodule formations were measured. Seeding of viable cells
after the SW application showed that the decrease in the growth
potential was statistically dependent on the number of applied SW
only. We further demonstrated promotion of osteogenic dierentiation of PDL broblasts by SW treatment. Increased bone
alkaline phosphatase activity coincided with elevated osteogenic
transformation. Enhancement of bone mineralized matrix by SW
treatment (0.15 mJ/mm2 ux density, 200 impulses) was visibly
demonstrated by an increase in bone nodule formations after
culture for 21 days.

Oral session: Perio-systemic interactions

A prospective study to investigate the relationship
between periodontal disease and preterm and low birth
weight infants
A. gueda*, J. M. Ramon, C. Manau and J. J. Echeverra
School of Dentistry, University of Barcelona, Spain
Objectives: To determine the inuence of mother s periodontal
status on low birth weight and preterm births.
Materials and methods: One thousand three hundred pregnant
women were enrolled between the 20th and the 24th week of
gestation. Demographic data, state of health, pregnancy outcome
variables and information on others factors which may inuence

adverse pregnancy outcomes were collected. Dental plaque,

probing depth, bleeding on probing and clinical attachment level
were recorded in all teeth, except third molars. Pregnancy outcome
data was collected retrospectively
Results: The incidence of preterm birth and LBW infants was 6.8
and 6.3 respectively. Preterm birth was related to mothers age,
systemic diseases, complications of pregnancy and body mass index
(BMI) Low birth weight was related to mother s smoking habits,
race, BMI, systemic diseases and complications of pregnancy. No
relation was observed between mother s periodontal condition and
LBW. In the group of women without periodontal disease, the
infant mean weight (MW) was 3278 g, whereas in women with
periodontitis MW was 3175 g (P = 0.001) This dierence

31

Oral session: Perio-systemic interactions

remained signicant after adjusting for age, systemic diseases,
complications of pregnancy, race, smoking and BMI.
Conclusions: No relationship was observed between mother s
periodontal condition and preterm birth or LBW. However, the
average birth weight was signicantly lower in infants worn to
mothers with periodontal disease after adjusting for confounding
factors.

the GCF were 292.2 0.7 and 658.9 9.5 ng/mL in DII/cP and
25.5 7.6 and 18.5 9.3 ng/mL in controls.
Conclusion: This shows that AGEs interaction with monocytes
may lead to an increased cytokine production providing a
molecular mechanism for mutual diabetes periodontitis
interaction suggesting periodontitis to be a risk factor in regard
to pre-diabetes becoming diabetes type II.

Periodontal pathogens in human placentas of women

with severe preeclampsia

Sub-clinical atherosclerosis in young patients affected

by severe periodontits

O. Oettinger*, S. Barak, H. Sprecher, G. Ohel and E. Machtei

Rambam Med Ctr and Bnai-Zion Med Ctr, Haifa, Israel

F. Cairo*, S. Castellani and A. M. Gori et al.

Department of Periodontology, University of Florence, IT

Background: Preeclampsia (PET) is a pregnancy-specic syndrome

being one of the leading causes of maternal and fetal morbidity and
mortality. Lately, we and others reported a clinical and
immunological association between periodontal disease and PET.
Recent evidence also showed the presence of several periodontal
bacteria in atherosclerotic plaques. Since the pathogenesis of PET
remains elusive, and since the placental histopathologic lesions of
acute atherosis, seen in PET, bear resemblance to those seen in
atherosclerosis, we decided to examine the possibility that
periodontal bacteria might contaminate the placentas of women
with PET, and thus play a role in the pathogenesis of the syndrome.
Materials and methods: Sixteen placentas obtained from women
suering from PET were dissected and transferred into transport
medium. Microbiological analysis was performed by real-time
PCR technique for the detection and quantication of
Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum
ssp., Porphyromonas gingivalis (Pg), Prevotella intermedia,
Tannerella forsythensis (Tf) and Treponema denticola (Td).
Results: A total of 50% of the placentas were positive to one
periopathogen or more. All the examined periodontal bacteria were
detected in one or more of the placentas. The most prevalent
bacteria was Td (43% of samples), followed by both Pg and Tf
(31%).
Conclusion: Periodontal pathogens are present in placentas of
women suering from PET and thus might play a role in the
pathogenesis of this disorder.

Background: A signicant association between the extent and

severity of periodontal disease and cardiovascular diseases has
been reported in aged populations. The aim of this controlled study
was to evaluate the possible relationship between severe
periodontitis and sub-clinical atherosclerosis in young patients
( 40 years) with no systemic signs of atherosclerosis.
Method: Carotid artery intima-media wall thickness was assessed
by means of carotid ultrasonography in patients aected by severe
periodontal disease (test group) and sex and age-matched, healthy
periodontal patients with a similar risk prole for cardiovascular
disease (control group).
Results: Twenty patients (mean age 35.5 years) were enrolled in
the test group and 20 patients (mean age 33.3 years) in the control
group. Carotid intima-media thickness was higher in the test group
(0.88 mm 0.14) than in the control group (0.73 mm 0.07).
This dierence (0.15 mm) is statistically signicant (CI 95% 0.08;
0.22), P-value 0.0004 (t-test for matched cases).
Conclusions: This result suggests that severe periodontal disease in
young patients may be associated to sub-clinical atherosclerosis.
This association should be conrmed in a larger sample and may
have clinical relevance in preventing cardiovascular risks in young
periodontal patients.

Advanced glycosylation end products (AGES) induce

modulation of local monocytic cytokine release in
diabetes type II and periodontitis patients
J. Engl-Schmuecker* and W. D. Grimm et al.
University of Witten/Herdecke, Dortmund, Germany
Aims: Diabetes is an established risk factor for periodontitis. Still
cellular and molecular association is unclear. Therefore we
investigated AGEs distribution in human gingival tissues and
monocyte cytokine expression in diabetic patients with chronic
periodontitis (DII/cP).
Materials and methods: After informed consent a periodontal
exam comprising missing teeth (mt), bleeding on probing (BoP/
PBI), clinical and radiographic attachment level (cAL/rAL) was
carried out on 12 subjects. Within indicated surgical procedures
gingival biopsies were taken from 10 DII/cP and two healthy
controls. Tissue samples were prepared for immunohistochemistry
using a monoclonal antibody specic for AGEs (6D12, TransGenic
Inc.) and IMAGES J was used for quantication. GCF PGE2 and
IL-1b levels were determined by ELISA. For statistical analysis the
2-tailed students t test was used.
Results: Mean clinical parameters in DII/cP presented typical for
severe chronic periodontitis (mt: 10.5; BoP: 84%/PBI: 2.9; cAL:
5.5 mm; rAL: 6.9 mm). Enhanced accumulation of AGEs (17%)
compared to controls (13%) was found. PGE2 and IL-1b levels in

32

Eradication of periodontitis leads to reduced plasma

interleukin-6: correlation with cardiovascular risk
markers
B. Taylor*, G. Tofler, H. Carey and K. Schenck et al.
Sydney Dental and RNSH, Australia, University of Oslo, Norway
Background: Periodontal disease has been associated with
increased risk of cardiovascular disease (CVD), but the causal
relationship is uncertain. We previously reported that full mouth
extraction (FME) leads to reduced C-reactive protein and
brinogen, inammatory CVD risk markers.
Aim: To further study the link between periodontitis (PD) and
systemic inammation, by evaluating the eect of FME on
interleukin-6 (IL-6), a cytokine that promotes inammatory
marker production.
Methods: We studied 67 adults (age 57 11 years, 66% male)
with advanced PD requiring FME. Blood samples were collected at
three time points: T1, at initial presentation, before treatment of
presenting symptoms; T2, 12 weeks later, before FME; T3,
12 weeks after FME. Levels of IL-6 and CRP (high sensitivity)
were measured using commercial ELISA. Fibrinogen was assayed
by the Clauss method. IL-6 levels were compared before and after
FME using the Wilcoxon Signed Rank test. Associations between
IL-6, CRP and brinogen levels were sought using the Spearman
test.
Results: Interleukin-6 levels fell from T2 to T3 (from 3.46(2.49
4.41) to 2.93(2.233.92) ng/L, P = 0.006). Levels of IL-6 were also
highly correlated with CRP (r = 0.59, P < 0.001) and brinogen
(r = 0.39, P < 0.001).

Oral session: Prognostic factors

Conclusion: Periodontitis has systemic inammatory and
prothrombotic consequences. Its treatment leads to reduced
inammatory markers of CVD risk, mediated in part through
reduced IL-6 production.

Local periodontal therapy with subgingival controlled

release of chlorhexidine systemic influences
L. Harnack, J. Gonzales and J. Meyle* et al.
Department of Perio and Clin. Chem., University of Giessen, Germany
Studies on inammatory mediators during active periodontal
treatment are scarce. The aim of this randomized, prospective,
double-blinded, placebo-controlled study was to evaluate systemic
eects of the local periodontal therapy with the adjunctive use of
subgingival release of CHX (PerioChip) before, during and after
active treatment. 24 adults with severe chronic periodontitis (12
teeth with PPD 5 mm) were randomized in two groups (n = 12).
After a prophylaxis phase, in the test group (PC) PerioChips and
in the control group (PL) placebo chips were inserted in pockets
with PPD 5 mm. After 10 days, SRP was done and new chips
were placed. Venous blood was taken at baseline (T0), at the
beginning (T1a), 1 h after (T1m), at treatments end (T1e), and
after 6 months (T4). The serum levels of high sensitive C-reactive
(hs-CRP) and Lipopolysaccharide-binding (LBP) proteins were
measured. At T0, >25% of patients showed hs-CRP levels
>3 mg/L (means: 2.67 mg/L in PC and 2.40 mg/L in PL). At T4
mean hs-CRP was reduced to 1.33 mg/L in the PL and to
1.34 mg/L in the PC groups. Elevated levels of LBP were found at
T0 (means: 11.80 lg/mL in PC and 10.95 lg/mL in PL). After
6 months, a signicant reduction of LBP was determined in both
groups (means: 6.45 lg/mL in PC and 7.07 lg/mL in PL,
P < 0.05, U-test, a level: P < 0.05). These results clearly demonstrate that local periodontal therapy has an inuence on systemic
inammatory factors. This study was supported by DEXCELPHARMA, Germany.

Obesity and periodontal disease progression: cohort

study
N. Brodala*, J. Beck and D. Paquette et al.
University of North Carolina, Chapel Hill, USA
Current population statistics indicate that 30% of US adults are
obese and at increased risk for chronic, inammatory conditions
including cardiovascular disease, diabetes and periodontal disease.
Methods: Sample included 452 dentate community-dwelling
subjects, 65 years or older, participating the Piedmont
65 + Study of the Elderly. At baseline, demographics medical
information and body mass index (BMI in kg/m2) were evaluated.
Periodontal exams, which included pocket depth (PD), clinical

attachment level (CAL) and number of teeth, were performed at

baseline and repeated at 36 months. Periodontitis progression was
assessed as mean changes in PD, CAL and number of teeth over
the 36 months. Data were analysed using frequency and regression
procedures.
Results: Overall, 50.7% were classied as obese (BMI 30).
Although no signicant dierences in PD or CAL changes were
observed overall for obese vs. nonobese subjects, subgroup
analyses showed signicantly greater PD and CAL worsening for
obese black subjects vs. nonobese black subjects (P < 0.05). In
contrast, the incidence of tooth loss over the 36 months was
signicantly greater among obese subjects overall (49.3%) vs.
nonobese subjects (33.2%, P < 0.001).
Conclusions: These cohort data further implicate an association
between obesity and inammatory periodontal disease that extends
beyond the 7th decade of life.

Obesity and inflammatory periodontal

disease: cross-sectional human study
D. Paquette*, S. Offenbacher and J. Beck et al.
University of North Carolina, Chapel Hill, USA
Although obesity is commonly associated with insulin resistance,
new evidence indicates that obesity extenuates chronic inammation.
Objectives: To compare levels of inammatory periodontal disease
in obese (O) and non-obese (N) subjects.
Methods: Population
included
6,731
adults
(Dental
Atherosclerosis Risk in Communities Study). Demographics,
medical status and body mass index (kg/m2) measures were
collected. Periodontal outcomes included plaque (PI) and
gingival (GI) indices, bleeding on probing (BOP), pocket depth
(PD) and clinical attachment level (CAL). Data were analysed
using linear and logistic regression procedures.
Results: Obese subjects exhibited signicantly greater periodontal
disease (P < 0.01). The mean extent (%) of sites with PI 1,
GI 1, BOP, PD 4 mm and CAL 3 mm was 51.6, 43.4, 27.0,
8.3 and 24.9% respectively for O vs. 37.1, 29.1, 23.4, 6.9 and 22.5%
for N subjects. No signicant dierences in periodontal parameters
were detected for diabetic O vs. N subjects. For nondiabetics, O
subjects exhibited signicantly greater PI, GI, BOP, PD extent
scores and fewer teeth (P < 0.001) as compared to N controls. The
odds ratios for obesity and moderate (2 sites with CAL 4 mm)
or severe periodontal disease (2 sites with CAL 6 mm and
PD 5 mm) among nondiabetics were 1.23 (95% CI 1.031.48)
and 1.31 (95% CI, 1.041.66) respectively.
Conclusions: These data indicate a modest but signicant
association between obesity and periodontal disease among
nondiabetics.

Oral session: Prognostic factors

Tobacco use and rate of tooth loss among U.S. dentists
and other health professionals
T. Dietrich* and N. Maserejian
Boston University, Harvard University, Boston, USA
The purpose of this study was to estimate the eect of tobacco use on
risk of tooth loss. We used data on 43 518 participants of the Health
Professionals Follow-Up Study, an ongoing longitudinal cohort
study begun in 1986, who completed mailed questionnaires every

2 years. We evaluated the association between tobacco use and time

until rst incident tooth loss using Cox proportional hazards models,
adjusting for age, race, diabetes, BMI, caloric intake, alcohol
consumption, use of multivitamins, use of vitamin C supplements,
profession (dentist vs. non-dentist), and routine health examination
during the previous year. We found a strong, dose-dependent,
positive association between current cigarette smoking and risk of
tooth loss (45 + cigarettes/day, HR 3.14, 95% CI 2.454.01).
Compared to never smokers, former smokers had increased risk for

33

Oral session: Prognostic factors

tooth loss, dependent on time since cessation (<10 years: HR 1.66,
95% CI 1.571.76; 10 + years: HR 1.20, 95% CI 1.161.25). Ever
use of pipes or cigars (HR: 1.20, 95% CI 1.111.30) and smokeless
tobacco (HR: 1.13, 95% CI 1.041.23) also increased the risk for
tooth loss. Results were very similar in an analysis restricted to
dentists. In conclusion, tobacco use (including pipe, cigar and
smokeless tobacco) increases the risk for tooth loss. For cigarette
smokers, risk of tooth loss is a function of dose and time since
cessation, and remains elevated >10 years after cessation.
Supported by NIH R03DE016357, K24DE00419.

impacts. However, subjects with low daily hassles scores showed an

overall greater reduction in plaque scores post treatment when
compared with the subjects with low daily hassles scores.
(47.31 37% residual plaque postoperatively for high hassles
group, 32.97 20.68% for low hassles group; P < 0.05, Mann
Whitney U-test). The results suggest that psychosocial factors,
specically daily hassles, can impair patient responses to oral hygiene
instruction during non surgical periodontal treatment.

Oral, social and behaviour factors influencing patient

plaque control
Effects of smoking on clinical and microbiological
outcomes of adjunctive antibiotic periodontal
therapy a 24-months prospective study
N. Jalilvand*,1, S. Dogan2 and H. Gnay1
1
Med. University, Hannover, Germany, 2University of Washington, USA
The eect of smoking on the prevalence of periodontal pathogens
after periodontal therapy is still unclear. Aim of this study was to
evaluate the inuence of smoking on clinical and microbiological
outcomes of an adjunctive antibiotic periodontal therapy in
smokers with aggressive periodontitis.
Methods: The study included 40 patients, 20 smokers and 20 nonsmokers with the clinical symptoms of aggressive periodontitis.
Clinical and microbiological data were obtained before, 6 months
and 24 months after treatment. Subgingival plaque samples were
collected from ve randomly selected sites 4 mm in each subject.
PCR was used to detect the presence of A.a., P.g., T.f., T.d. and P.i.
All patients underwent an anti-infectious therapy including scaling
and root planing with antibiotics.
Results: Smokers and non-smokers beneted signicantly from the
adjunctive antibiotic periodontal therapy. A signicant
improvement of the clinical condition was found in both groups
after treatment. However, clinical improvement in smokers was less
than in non-smokers. Although, the anti-infectious therapy
combined with antibiotics reduced A.a. and P.i. signicantly in
smokers and non-smokers, T.f., P.g. and T.d. remained positive in
smokers and only T.f. in non-smokers during the study.
Conclusion: The long term results of this study showed that
smoking is negatively associated with periodontal health of
patients with aggressive periodontitis especially with the outcome
of periodontal pathogens.

Effects of psychosocial factors on initial outcomes of

nonsurgical periodontal treatment in aggressive
periodontitis
M. Syed*, B. Koshy, R. Croucher and F. J. Hughes
Queen Mary University, London, UK
As part of a larger study investigating prognostic factors in
aggressive periodontitis (AgP), we examined the relation between
psychosocial factors and initial periodontal clinical outcomes
following a course of non-surgical treatment. 63 patients with a
clinical diagnosis of AgP were recruited to the study. Psychosocial
factors were assessed by questionnaire using a life events inventory
and an inventory of daily hassles. Patients received a standardised
course of nonsurgical treatment including OHI and RSD over four
visits, and clinical outcomes reassessed after a further 10 weeks.
Clinical outcomes included % change in probing depth and CAL, %
change in bleeding and plaque scores. Eects of life events and eects
of daily hassles were analysed separately by dichotomising between
high and low score groups. There was no dierence between clinical
variables or smoking between the groups at baseline. No correlation
was found between any clinical outcomes and life events or their

34

K. Nylund*, C. Waldron and N. Claffey

Dublin Dental School, Trinity College, Ireland
Objectives: This retrospective study investigated if oral, social and
behavioural factors were associated with plaque control
performance following instruction by dental hygienist students.
Methods: Four hundred records were randomly selected. Data
were included if at least one plaque score was recorded at baseline
and/or 3 months, 6 months and >12 months. Subjects were
grouped by age, gender, employment status, dexterity limitation,
smoking, periodontal status, numbers of teeth and numbers of
teeth with restorations, orthodontic xed appliances and
removable prostheses. 224 records contained suitable information
and were analysed. Analysis of variance was used to assess the
eects of the independent variables on plaque scores decreases over
3, 6 and >12 months.
Results: Smoking was signicantly associated with less plaque
reduction over 3 months (mean 20.8% for smokers and mean
27.8% for non-smokers) (F ratio 4.48; P = 0.036). This dierence
between smokers and nonsmokers was not signicant over 6 and
12 months. Patients with dexterity limitation had signicantly less
plaque reduction (mean 11.2%) over 6 months compared to others
(mean 33.2%) (F ratio 7.78; P = 0.006).
Conclusion: Smoking habits were associated with poorer plaque
score reduction over 3 months. Patients with dexterity limitation
also had poorer plaque score reduction over 6 months. The other
factors investigated did not seem to inuence plaque control
performance either in the short or longer term.

Factors influencing the clinical outcome of

non-surgical periodontal treatment: a multilevel
approach
C. Tomasi* and J. L. Wennstrm
Dep. Period., Gteborg University, Sweden
Aim: The response to periodontal treatment varies between
subjects as well as within the dentition, and therefore multilevel
statistical approaches have been advocated to analyse the inuence
of subject, tooth and site related variables. The aim of this study
was to apply multilevel analysis to identify factors with potential
inuence for the outcome of non-surgical periodontal therapy.
Materials and methods: Forty one chronic periodontitis patients,
enrolled in a prospective clinical study, were examined before
treatment, 3 and 6 month from baseline. The outcome variables
were pocket closure (PPD 4mm), 6 months PPD and RAL
change. A regression multilevel model (logistic for pocket closure
)
was built and estimated for each outcome variable.
Result: The logistic regression model built explained 42% of the
observed variation (R2 = 0.424). The factors signicant for the
odds ratio of closing a pocket at 6 month were: at patient level
smoking, at tooth level molar associated pocket and at site level
plaque and infrabony defect. Initial PPD was included in the null
model and was signicant. For nal PPD, 8% of variability was
attributed to patient-level parameters, 9% at tooth- and 83% at

Oral session: Periodontal therapy

site-level. Same factors were found signicant for both continuous
outcome variables (PPD, RAL).
Conclusion: The outcome of non surgical periodontal therapy is
inuenced by factors related to the patient as well to tooth and site
level. The multilevel analysis allowed modelling the variance at the
dierent levels.

Baseline intrabony defect angle as predictor in

regenerative periodontal surgery with
GTR/deproteinized bovine bone mineral or
access flaps alone
A. Liares*, P. Cortellini and N. P. Lang et al.
University of Bern, Switzerland, University of Conn, USA
The aim of this study was to assess whether an association exists
between baseline defect angle and treatment outcomes when
regenerative periodontal surgery with GTR/deproteinized bovine
bone mineral or access aps alone are used in the treatment of
intrabony defects. Baseline and 12-month radiographs were collected from 122 patients as part of a multicenter trial. All patients had at
least one intrabony defect of 33 mm in depth. The treatment
consisted of papilla preservation aps to access the defect. GTR/
deproteinized bovine bone were applied in the test subjects and
omitted in the controls. 120 pairs of radiographs were obtained of
which 110 pairs were measurable. Clinical and radiographic
outcomes were signicantly superior in the test group when
compared with the controls 1 year after treatment. Multivariate
analysis indicated that treatment provided, and baseline radiographic depth of the defect signicantly inuenced the radiographic
bone ll 1 year after treatment. The percentage of resolution of the
defect was inuenced by the treatment, and the baseline plaque score.
CAL gain was inuenced by the treatment and the baseline PPD. The
baseline radiographic defect angle did not show a signicant impact
on the clinical and radiographic outcomes. The baseline defect angle
of an intrabony defect treated with GTR/deproteinized bovine bone
mineral failed to show a signicant impact in the observed changes in
clinical and radiographic outcomes 1 year after treatment.

Angular osseous defects: evaluation of the long-term

effectiveness of the periodontal treatment by using
subtraction radiography
A. Tsami*, E. Pepelassi and K. Tsiklakis et al.
University of Athens, Greece
Purpose: Explore the signicance of factors concerning the angular
defect morphology for the long-term periodontal treatment
eectiveness.
Methods: Sixty single rooted teeth in 60 patients severe proximal
angular osseous defects were studied. Treatment included phase I,
surgical pocket reduction (without osseous surgery), maintenance

care for 8 years with 75% mean compliance rate. Initial and nal
radiographic measurements (linear, area) were compared by the
EMAGO program. The correlation between factors concerning the
initial angular defect and osseous changes, imaged radiographically
at 8 years was studied.
Statistical analysis: Parametric students t-test, Wilcoxon test for
pair dierences, sign test, one way analysis of variance, nonparametric Spearman rank correlation coecient and logistic
regression analysis.
Results: The degree of osseous defect angle and the initial clinical
attachment level were signicantly correlated with linear (defect
base, osseous crest) and area osseous changes. The initial osseous
support was signicantly correlated with linear osseous defect base
changes. The interproximal distance was highly correlated with
linear osseous crest changes and area osseous changes. Patients
compliance with maintenance care program aected the linear
osseous changes. The ndings revealed that the severity and
morphology of the initial angular osseous defect aect the longterm periodontal treatment eectiveness, as assessed by osseous
changes.

The infrabony defect and its determinants

P. Eickholz*, C. H. Kim, T. S. Kim, S. H. Choi and J. Kaltschmitt
Perio, Frankfurt, Heidelberg, FRG, Yonsei, Korea
Aim: Assessment of the defect width of infrabony defects and
evaluation if the defect width is a function of defect depth.
Methods: Complete sets of intraoral radiographs of patients with
severe periodontitis that exhibited at least one infrabony defect
were digitised. The following parameters were measured: depth
(INFRA) and width (DW) of the infrabony defect, defect angle,
and width of the interdental spaces.
Results: Fifty one patients ranging from 21 to 73 years of age
(48.5 13.4) contributed a total of 1,272 teeth with 135 infrabony
defects (10.6%). 17 infrabony defects were located at sites without
a neighbouring tooth. Infrabony defects were statistically more
prevalent in the mandible (n = 82) than in the maxilla (P = 0.013)
as well as at mesial (n = 92) than at distal sites (P < 0.001). At
infrabony defects the width of interdental spaces at the most
coronal extension of the alveolar crest could be measured only at
sites with neighbouring tooth: 2.67 0.78 mm (1.195.70 mm).
Analysis failed to reveal a statistically signicant dierence between
DW at sites with (2.64 0.82 mm) or without (2.76 0.70 mm)
neighbouring tooth. Multilevel analysis revealed narrow defect
angles to be related to deep infrabony defects. Width of the
interdental space and distal location were related to wide defects.
Conclusions: The DW depended on INFRA and was not dierent
at sites with or without neighbouring tooth. Even in severe
periodontitis infrabony defects are found only at a minority of
teeth.

Oral session: Periodontal therapy

Quadrant root planing vs. same-day full-mouth root
planing with and without chlorhexidine
K. Swierkot*, C. Nonnemacher and L. Flores-de-Jacoby
Periodontology, Philipps-University, Marburg, FRG
The aim of study was to test the hypothesis that one-stage
full-mouth disinfection (FMD) resulted in greater improvement

compared to same-day full-mouth scaling and root planing (FMSRP) and quadrant scaling and root planing (Q-SRP). 28 patients
with chronic periodontitis were randomised into three groups. The
control group (Q-SRP) was scaled and root planed quadrant per
quadrant at one-week intervals for four consecutive sessions. The
two other groups received a one-stage full-mouth scaling and root
planing (within 24 h) with (FMD) and without (FM-SRP) the
adjunctive use of CHX. At baseline and after 1, 2, 4 and 8 months

35

Oral session: Periodontal therapy

clinical parameters were recorded and microbiological samples
were taken. The number of A.a.c, P.g, P.i., P.m., D.p., F.n., C.g
and C.r. and total bacteria were quantied with Real-time PCR.
The FM-SRP group showed signicant dierences in PD reduction
after 2 months compared to the Q-SRP group (P = 0.045). This
could also be shown for medium pockets (46 mm) of multi-rooted
teeth (P = 0.025). Signicant improvements in the other clinical
indices could not be revealed in any group. All three treatment
modalities resulted in signicant reduction of the total bacteria.
There were signicant reductions in P.i. in FM-SRP patients
compared to the other two groups (P 0.003). In conclusion,
FMD doesnt show advantages in comparison to the other groups.
All three treatment modalities revealed clinical improvements and
led to a signicant reduction of bacteria.

Clinical comparison of photodynamic therapy and its

effectiveness in initial periodontal therapy
R. Polansky*, M. Haas, G. Bertha and G. Wimmer
Parodontologie der Univ. Klinik fr ZMK Graz
Introduction: This randomized controlled clinical trial evaluates
the clinical ecacy of bactericidal potential and biostimulative
eect of Photodynamic therapy (PDT) in the treatment of
periodontitis.
Materials and methods: Fifty eight individuals with chronic
periodontitis, showing a minimum of at least three active
periodontal pockets 5 mm or deeper, bleeding on probing (BoP),
and the presence of Porphyromonas gingivalis (Pg) were included
to this trial. The patients were randomly assigned into two groups,
a control group receiving subgingival ultrasonic treatment and a
test group with additional photodynamic therapy. The initial
clinical values of PI, gingival index (GI), BoP, probing depth (PD),
and clinical attachment level (CAL) were registered and compared
to their changes at day 90. Clinical microbial sampling was
performed at baseline, on days 10, 42, and 90. Therefore Pg, Pi, Bf,
Td and Aa were quantied by polymerase chain reaction.
Results: After treatment test and control groups showed a
signicant reduction on all (clinical and microbial) values. When
comparing among both groups only BoP showed a signicant
dierence. All other (clinical and microbial) parameters did not
show any dierences.
Discussion: With the reduction of BoP, it seems that PDT has the
potential to reduce periodontal inammation. In terms of
eradicating bacterial growth PDT doesnt justify the additional
eort when compared to conventional treatment procedures.

Effects of non-surgical periodontal therapy on patient

perception of pain and quality of life a pilot randomized
controlled clinical trial
M. slund*, J. Suvan, D. R. Moles, F. D'Aiuto and M. Tonetti
Eastman Dental Institute, UK, Univ. Connecticut, USA
Aims: The aim of this study was to compare the patients
perception of the impact of subgingival instrumentation on pain
and quality of life.
Materials and methods: Fifty nine patients with periodontitis were
treated with a piezoceramic device (Group A n = 30) or hand
instrumentation (Group B n = 29). The impact of quality on life
was assessed using the16-item UK oral health related quality-of-life

36

measure (OHQoL-UK). Pain perception was assessed using the

short form McGill pain questionnaire (SF-MPQ) with visual
analogue scales (VAS). Questionnaires were completed at baseline,
treatment, 1, 4 and 8 weeks. Clinical parameters were assessed at
baseline and 8 weeks.
Results: No dierences in clinical outcomes were observed between
groups. VAS scores for sensitivity showed a small increase in group
B and decreased in group A at 8 weeks. Group dierences were
statistically signicant at 1, 4 and 8 weeks (P < 0.025) favouring
group A. OHQoL-UK function scores changed from oral health
having no eect to a level of positive eect. At 8 weeks function
scores were better for group A than group B (P = 0.038).
Conclusions: An improvement of quality of life perception was
observed in periodontitis patients following non-surgical
periodontal therapy delivered with a piezoceramic device.

The effect of Er:YAG laser on root coverage using

coronally positioned flap. A split-mouth study
B. Gaspirc* and U. Skaleric
Department of Oral Med and Perio, Fac. of Med., University of Lubijana
Slovenia
Background: The aim of present split-mouth study was to assess
the ecacy of Er:YAG laser to improve the results of a coronally
positioned ap (CPF) procedure.
Methods: Fifteen patients with 30 gingival recessions were
included. In each patient, one site was randomly assigned to the
test group and the contralateral site to the control group. In both
groups, a trapezoidal full- and partial-thickness ap was elevated,
coronally displaced, and sutured to cover the treated root surface.
Er:YAG laser was used in test group to modify the exposed root
surface and to prepare the connective tissue receptor site. Recession
(R), probing depth (PD), clinical attachment level (CAL) and
width of keratinized gingiva (KG) were recorded at baseline and at
3 and 6 months post-surgery.
Results: The average baseline R was 3.38 mm 0.84 mm
(mean SD) for the test group, and 3.26 mm 0.92 mm for
the control group. The mean root coverage after 6 months was
3.18 mm 0.55 mm for the test group and 2.71 mm 0.41 mm
for the control group. The mean CAL gain after 6 months was
3.47 mm 0.85 mm for the test group and 3.19 mm 0.69 for
the control group. Both dierences were statistically signicant
(P < 0.05). No changes of PD and KT were found.
Conclusions: This study suggests that Er:YAG laser seem to
improve the clinical outcomes of gingival recession treated by
means of CPF. Further studies with a larger number of teeth and
higher statistical power are needed to support this conclusion.

Non-surgical periodontal therapy of shallow gingival

recession defects: evaluation of the restorative
capacity of marginal gingiva after 12 months
M. Aimetti*, F. Romano and C. Debernardi
University of Torino, Italy
Background and Aim: No controlled clinical trials have evaluated
the capacity of non-surgical periodontal treatment to promote root
coverage. In the present study the restorative capacity of marginal
gingiva at shallow recession sites was explored after two dierent
non-surgical treatments.

Oral session: Periodontal therapy

Materials and methods: Twenty four pairs of Class I buccal
recessions, up to 2 mm deep, were selected in 24 patients (FMPS
and FMBS <20%). Using a split-mouth design, recessions were
randomly treated with scaling, root planing and polishing (test
group) or polishing alone (control group). Clinical treatment
outcome was evaluated 12 months postoperatively.
Results: Mean gingival thickness amounted to 1.00 0.34 mm in
the test group and to 0.97 0.31 mm in the control sites. Mean
recession depth decreased from 1.64 0.37 mm to 0.78
0.60 mm at test sites and from 1.43 0.42 mm to 1.34
0.45 mm in the control group over 12-month period. In the test
group 21 of 24 defects (87.5%) displayed coronal shift of gingival
margin and 6 (25%) achieved complete root coverage, whereas in
the control group most sites (62.5%) remained unchanged.
Dierence between two groups was signicant (P < 0.0001).
Conclusions: The removal of microbial toxins by polishing
prevents further progression of gingival recessions, the reduction
of root convexity by scaling and root planing promotes the coronal
migration of gingival margin. Gingival thickness would seem to
inuence the amount of root coverage.

positioned ap, connective tissue graft (CT) and application of an

enamel matrix protein derivative (EMD) and, (ii) to histologically
evaluate the treatment of Miller class I recession with coronally
positioned ap and application of EMD. A total of 52 teeth in 13
patients were treated with coronally positioned ap, CT and
application of EMD (Emdogain, Straumann, Switzerland). At
7 years following therapy, mean root coverage averaged 90%.
100% root coverage was achieved in 83% of the teeth. A 32 year
old female was referred for rootcoverage surgery prior to orthodontic therapy. The orthodontic treatment plan included bilateral
rst premolar extraction in the maxilla. Rootcoverage was
performed with a coronally positioned ap and application
EMD. 4 months after surgery the tooth was removed and
submitted to histologic analysis. The histological analysis demonstrated formation of new cementum, periodontal ligament and
bone on the previously denuded rootsurface. In conclusion, this
study has shown that: (i) the application of EMD in combination
with rootcoverage surgery can result in periodontal regeneration
and, (ii) treatment of Miller class I and II recessions with coronally
positioned ap, connective tissue graft (CT) and application of
EMD may result in an up to 7 years stable root coverage.

Ten-year longitudinal study of gingival recession in

dentists.
F. Matas Estany*, J. Sents and C. Mendieta
Facultat d'Odont, University of Barcelona, Spain
Aim: The aim of the present investigation was to assess the
prevalence and development/progression of gingival recession in a
population sample with a high standard of oral hygiene and wide
knowledge on the role of traumatic tooth-brushing in the aetiology
of gingival recession.
Methods: Forty dental students in their nal year course at the
University of Barcelona Dental School were examined for gingival
recession in 1994 and 10 years later by the same examiner. A
questionnaire collected information concerning tooth brushing
habits. Clinical parameters recorded on every recession were:
recession depth, probing depth, width of keratinized gingiva and
bleeding on probing. Full-mouth plaque index was recorded using
the modied Quigley and Hein index.
Results: A total of 210 recessions were found in the initial
examination and 299 in the second. One hundred and four
recessions detected in the initial examination disappeared
10 years later, 106 persisted and 193 new recessions appeared in
the second examination. Statistical dierences were found in
several clinical parameters between these groups of recessions.
All the subjects had a signicant increase in the plaque index in the
second examination despite very few changes in the oral hygiene
habits.
Conclusions: Some recessions can recover with time after
correction of traumatic tooth-brushing. Recessions that persisted
after 10 years showed more recession depth than the other groups
of recessions.

A clinical and histological study evaluating

rootcoverage in conjunction with an enamel matrix
protein derivative
G. De Quincey, R. Driessen*, R. Junker and A. Sculean
University of Nijmegen, Nijmegen, Netherlands
The purpose of this study was: (i) to clinically evaluate the
treatment of Miller class I and II recessions with a coronally

Comparative clinical study between two bilaminar

procedures for the treatment of gingival recessions: a
4-year study
M. Del Pizzo*, F. Modica and C. Debernardi et al.
Dental School, University of Turin, Italy
Aim: This prospective 4-year study compares two bilaminar
techniques: connective tissue graft (CTG) and coronally
advanced ap (CAF) with or without vertical releasing incisions
(V or nV) in achieving root coverage.
Materials and methods: Thirty non-smoking patients with a Miller
Class I or II gingival recession were selected for treatment using a
bilaminar technique. The patients were randomly assigned to two
groups of 15 patients each and treated by means of CTG + CAF/
V (group A) or CTG + CAF/nV (group B). The parameters
scored at baseline (T0), at 1 and 4 years postsurgery (T1 and T2)
were: recession depth (R), pocket depth, clinical attachment level
(CAL) and keratinised tissue width (KT). Aesthetic assessments
were made at T1 and T2 by a clinician and by the patients through
interviews.
Results: At T0 mean R-values were 3.87 mm (group A) and
3.67 mm (group B). Mean root coverage (MRC) went from 89.9%
(T1) to 87.7% (T2) in group A while MRC changed from 93.5%
(T1) to 94.8% (T2) in group B. From T0 toT1/T2 in both groups R
reduction, CAL gain and KT increase were statistically signicant
(P < 0.0001) without dierences between the groups. Aesthetic
results showed signicant dierences between the groups such as
better tissue blending (T1 P = 0.0008, T2 P = 0.0481) and
absence of scar formation (P < 0.0001) in group B.
Conclusions: Both techniques produced similar and stable clinical
results over a 4-year study time. However, aesthetic assessments
showed better outcomes in group B.

37

Oral session: Bacterial, genetic and other risk factors

Oral session: Bacterial, genetic and other risk

factors
Comparison study of prevalences and serologic profiles
of A. actinomycetemcomitans in patients with
periodontitis in Latin-America and Spain
J. Ferrs*, M. Sanz, R. Len and A. Jaramillo et al.
Universities of Madrid, Cali, and Santiago de Chile
Aim: To characterize and compare (serotypes), strains of
A. actinomycetemcomitans (Aa), isolated from dierent
countries, using culture and PCR technology.
Materials and methods: This was a cross-sectional epidemiological
microbiological study of a non-treated population, showing signs
of periodontitis in three countries (Chile, Colombia and Spain).
Three centres were involved, with a total 105 patients. Each study
subject was examined in one visit. Samples of selected patients were
both cultivated for 2 days and amplied using PCR technology for
serotyping. Taq-man probe and pairs of primer for serotypes a, b,
c, d, e and f of Aa were used. Groups were statistically compared by
anova and post-hoc test. Demographic data was compared by
means of chi-square test. Contingency tables were constructed to
compare PCR serotyping of Aa strains.
Results: Prevalence of Aa was of 19.4%, 17.1% and 22.2% in
Chilean, Colombian and Spanish patients respectively (P > 0.05).
Percentage of Aa on positive sites were 2.8%, 0.2% and 0.2% in
Chile, Colombia and Spain respectively (P = 0.74). For Chilean
patients positive for Aa, 7.7% were strain a, 38.5% b, 30.8% c and
23.1% strain e, no patient was positive for strains d or f. In the
Colombian group, 100% belonged to strain c. For Spanish positive
patients, 50% of Aa were type a, 25% b and 25% c.
Conclusion: No dierences were detected in prevalence of Aa
among the three populations, but evident dierences were found in
serotype distribution.

Prevalence of periodontal pathogens in Croatian

generalized chronic and aggressive periodontitis
patients
D. Bozic*, D. Plancak, A. Bonjak and J. Jukic
Department of Periodontology, University of Zagreb, Croatia
Aim: To investigate the prevalence of A. actinomycetemcomitans,
P. gingivalis, P. intermedia, T. forsythensis and T. denticola in
generalized chronic and aggressive periodontitis patients.
Materials and methods: Seventy-four patients were divided in two
groups: (i) generalized chronic periodontitis (CP, n = 39) and (ii)
generalized aggressive periodontitis (GAgP, n = 34). One
examiner (D.B.) using standard periodontal probe recorded at
four sites per tooth bleeding on probing (BOP), probing pocket
depth (PPD), and clinical attachment level (CAL) values. Four
subgingival plaque samples were collected from the deepest pockets
in each quadrant. Microbiological testing was done utilizing the
multiplex PCR of 16S rDNA followed by a simultaneous reverse
hybridization to identify ve periodontal pathogens in a single run.
Results: The average age for CP was 48.18 and for GAgP 32.97. At
sampling sites PPD for the CP group was 7.73 mm, CAL was 8.49,
for the GAgP group 7.74 mm and 8.36 mm, respectively. Our
results show that the isolation frequency of pathogens in the CP
group A.a 23%, P.g. 87.17%, P.i. 51.28%, T.f. 92.3% and T.d.

38

71.79%, and for the GAgP A.a 40%, P.g. 71.42%, P.i. 48.57%, T.f.
85.71% and T.d. 77.14%.
Conclusions: We could not nd any dierences between the groups
except for A.a. (40% in GAgP vs. 23% in CP). It seems that the
main pathogens in our population for the CP and GAgP groups
are the red complex bacteria with T.f. being the most frequent.

The role of the subgingival biofilm in pregnancy

gingivitis: microbiological patterns
A. Carrillo de Albornoz Sainz* and A. Bascones
Dental School, UCM, Madrid
Background: The increase in gingivitis in pregnant women
independent of a change in clinically detectable plaque has been
related to a rise in steroid hormone levels, however, there is some
dierence of opinion between authors. The aim of the study was to
asses the dierences in the microbiological patterns between
pregnant and non-pregnant women, specically focussing on
Prevotella intermedia, in relation to the clinical parameters.
Materials and methods: The study group consisted of 20 pregnant
women and 20 non-pregnant women who served as matched
controls. None of the subjects had periodontal disease. Clinical
examinations and microbiological samples were conducted in the
rst, second and third trimester and also 3 months post-partum in
the pregnant women, and twice in the non-pregnant women at a
6 month interval.
Results: Although the plaque levels remained unchanged, the
pregnant women exhibited higher levels of gingivitis than nongravidae. The pregnant subjects exhibited higher statistically
signicant proportions of Actinobacillus actinomycetencomitans
(Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi)
and total counts of colony forming units (CFU) in the rst and
second trimester, Aa and Pg in the third trimester and only Pi in the
post-partum samples.
Conclusions: The elevated hormonal levels characteristic of
pregnancy appear capable of inuencing the subgingival biolm
and increase the proportions of some periodontopathogens.

Effects of cigarette smoking on gingival inflammation

via inducible nitric oxide synthase pathway
B. aklc*,1, E. Bars 1, B. Tokman1 and N.
zmeri1
1
Gazi University, Ankara, Turkey
Periodontal disease pathogenesis is not fully understood yet and
has been associated with smoking. Previous in vitro data indicated
that nicotine enhanced inducible nitric oxide synthase (iNOS) gene
expression. We have previously shown increased iNOS levels in
periodontitis and signicant reduction after periodontal treatment.
Purpose of the study was to evaluate impact of smoking on iNOS
activity in gingivitis and to compare enzyme activity between
smokers and non-smokers.40 subjects were signed for the study.
Groups were consisted of smokers group with gingivitis, nonsmokers with gingivitis, periodontally healthy smokers and
periodontally healthy non-smokers (n = 10, for all groups). Fullmouth clinical indices were recorded and biopsies from papillary
regions were obtained. Immunohistochemical staining was performed for evaluating iNOS expression. The immunoreactive cells

Oral session: Bacterial, genetic and other risk factors

were semiquantitatively assessed. Inamed periodontal tissues
demonstrated strong iNOS expression in smokers with gingivitis
whereas immunostaining appeared weak in non-smokers with
gingivitis. Plasma cells, broblasts and macrophages within connective tissue displayed strong immunostaining. Immunostaining
decreased in endothelial cells and lymphocytes. iNOS expression
intensity and number of inammatory cells showing iNOS expression was found lower in healthy non-smokers group compared to
that in healthy smokers. Chronic smoking stimulates the expression
of iNOS in the periodontal tissues.

25.5% and 20% in CP and healthy group, respectively [OR = 0.8,

(95% CI = 0.41.89), P > 0.05]. RANTES -403A allele
frequencies were 31.9% and 28.7% in CP and healthy group,
respectively [OR = 1, (95% CI = 0.24.46), P > 0.05]. When we
were analysed genotype-phenotype relationship, no signicant
associations were observed between sex, age, smoking and
polymorphisms (P > 0.05).
Conclusions: These results show that a polymorphism in MCP-1
and RANTES gene is not associated with chronic periodontitis in
Turkish population.

Genetic variation in radiographic alveolar bone height.

A twin study

FC-mediated phagocytosis is enhanced in fccriia 131h/h

periodontitis patients

G. L. Torres de Heens* and B. G. Loos et al.

ACTA, NL and Sanquin Res. Inst., NL

E. Comandasu* and U. Van der Velden et al.

Academic Centre for Dentistry (ACTA), NL

Background: Previous studies suggested a heritable component in

periodontitis. The twin model enables the estimation of genetic
contribution to complex diseases like periodontitis.
Aim: To estimate the genetic variance for alveolar bone height in
periodontitis by means of the twin method.
Methods: European Caucasian descent adult twins participated.
Five monozygotics (MZ) and ve dizygotics (DZ) mean age 54 and
52 respectively. At least one individual of each pair was diagnosed
with periodontitis. Number of teeth was registered and the
percentage of sites 50% bone loss was assessed on periapical
radiographs. Genetic variance and heritability were estimated by
descriptive statistics (mean values and Kendalls correlation).
Results: Means of number of teeth and percentage of sites with
50% bone loss were 24.2 3.3 and 4.6 6.1 in MZ and
22.5 5.5 and 7.1 9.4 in DZ. Mean dierence in number of
teeth and bone loss within twin pairs were 3.2 2.3 and 6.4 5.9
in MZ and 5 4.4 and 4.2 1.5 in DZ. Number of teeth showed
positive correlation in MZ (r = 0.4) with 20% estimated
heritability (DZ r = 0.3). No positive correlation was found in
severity of disease for either group.
Conclusion: Approximately 20% of the variance in number of
teeth is genetically determined in this population. However, with
regard to periodontitis a larger sample with more severe
periodontal breakdown is needed to further explore the
biological and behavioural nature of periodontitis.

Background: Receptors for the Fc part of IgG (FccRIIa) on

polymorphonuclear leukocytes (PMNs) are important mediators of
phagocytosis. Of this receptor various genotypes are described, e.g.
131H/H, R/R and H/R. The FccRIIa-131H/H genotype is reported
to bind IgG opsonized antigens better than the R/R variant. Data
also shows that the H/H genotype is associated with a higher level
of periodontitis-associated bone loss than the R/R genotype.
Aim: In order to nd out whether the PMNs of the H/H patients
have a higher capacity of phagocytosis through the FccRIIa than
PMNs of R/R patients, we studied phagocytosis by PMNs of H/H
and R/R patients.
Methods: The PMNs from 7 H/H and 4 R/R patients were
incubated with whole [WS] or heat inactivated [HIS] serumopsonized
Actinobacillus
actinomycetemcomitans
(A.a).
Phagocytosis was measured by ow cytometry.
Results: The PMNs of H/H and R/R patients phagocytosed A.a
similarly when it was opsonized with WS (74% and 62% of the
PMNs showed phagocytosis respectively; P = 0.412). However,
when HIS was used for opsonization, twice as many of the H/H
PMNs showed phagocytosis compared the R/R PMNs (35% vs.
17% respectively; P = 0.038).
Conclusions: The results show that the polymorphism in the
FccRIIa gene has a functional consequence. We speculate that an
increased phagocytic activity of the H/H-PMNs may lead to a
higher release of granular enzymes which could result in a
more severe periodontal breakdown as seen in patients of this
genotype.

Are the MCP-1 -2518 G and RANTES -403 A alleles a

risk factor for periodontitis?

.
zaka*, N. Bak, A. Berdelli and T. Kse
Ege University, Izmir, Turkey
Objective: The goal of this study was to assess the possible
association between RANTES (Regulated on Activation, Normal
T cell Expressed and Secreted) and MCP-1 (Monocyte
Chemoattractant Protein-1) polymorphisms and susceptibility to
periodontitis in Turkish patients.
Materials and methods: The MCP-1 and RANTES gene
polymorphisms were investigated in samples of 51 with chronic
periodontitis (CP) and 48 periodontally healthy subjects. Genomic
DNA was analysed for polymorphisms in RANTES -403G/A and
MCP-1 -2518A/G by polymerase chain reaction amplication
followed by restriction enzyme digestion and gel electrophoresis,
taking into consideration age, gender and smoking status. Data
were analysed by chi square test, anova, and by calculating odds
ratio (OR) and 95% condence intervals (CI).
Results: The genotype distribution and allele frequencies in this
study were in Hardy-Weinberg equilibrium and were not dierent
in CP and healthy group. MCP-1 -2518G allele frequencies were

Effects of acute psychological stress on immune

response in chronic gingivitis
U. Weik*, V. Kolb-Bachofen, A. Herforth and R. Deinzer
University of Duesseldorf, Germany
Several studies haven shown psychological stress to be associated
with gingival immune response to plaque. In these studies immune
responses were measured in the context of an experimental
gingivitis design. Less is known about stress eects on immune
responses under conditions of chronic gingivitis. In the present
study we therefore analysed such eects. Seven male and six female
students volunteered for participation. All students suered from
clinically validated plaque-associated gingivitis at all sampling sites
when included into the study. They were observed for an additional
period of at least 5 weeks to conrm they suered from chronic
gingivitis. Afterwards they were either subjected to a standardized
psychological laboratory stressor (public speech) or to a control
condition on two consecutive days in a cross-over design. Gingival
crevicular uid (GCF) samples were taken at sites of inammation
prior to stress vs. control condition and 0, 45 and 90 min

39

Oral session: Clinical tips and cases aesthetics

afterwards. Acute stress induced a signicant increase of GCF
Interleukin-8. In contrast to results from experimental gingivitis
studies, however, no stress eects on Interleukin-1 were observed.
These results are the rst to show that psychological stress may

aect Interleukin-8 concentrations at chronic gingivitis sites. They

further indicate that psychological stress eects in experimental
and chronic gingivitis might dier at least with respect to
Interleukin-1.

Oral session: Clinical tips and cases

aesthetics
Causal relationship among factors in coronally
advanced flap. The Bayesian network analysis
R. Rotundo*, M. Nieri and G. Pini Prato et al.
Department of Periodontology, University of Florence, Italy
Aim: The aim of this study is to explore possible causal
relationship among patient-, tooth-, and site-related variables in
coronally advanced ap for root coverage procedure using the
Bayesian Network analysis.
Materials and methods: Sixty patients, 15 males and 45 females,
each showing maxillary buccal recessions (2 mm) identied as
Millers class I were consecutively enrolled. All the defects were
treated by coronally advanced ap procedure. From all patients,
age, gender, smoking habits were recorded. In addition, the
following clinical data were measured and calculated: recession
depth, width of keratinized tissue, probing depth, distance between
incisal margin and cemento-enamel junction (CEJ), root sensitivity,
distance between gingival margin and CEJ immediately after
surgery (GM1). A structural learning of Bayesian Networks was
performed.
Results: The main ndings reveal that GM1 was affected by the
baseline recession depth, deeper recessions being associated with
more apical GM1. Moreover, complete root coverage appeared to
be inuenced by GM1, more coronal GM1 levels being associated
with greater probability of complete root coverage.
Conclusion: The utilization of a structural learning of Bayesian
Networks seems to facilitate the understanding of the results and to
indicate further possible relationship between the considered
variables.

were recorded digitally using measuring software (Scion image).

We propose a new classication system based on the rst-look
aesthetic papillas aspect in a general smile descriptive assessment.
Our data suggest that interradicular distance may have a considerable role in terms of presence or absence of papilla and therefore
joint consideration of both variables must be advisable for
decision-making process of a combined prosthetic-periodontal
rehabilitation therapy in esthetic region. We also intended to give a
simple and repeatable protocol for therapy planning in such cases.

Decision-making in root coverage surgical techniques:

an evidence-based approach
J. M. Dersot*,1 and N. Moubarak2
Private Practice, Paris, 2F and Fujariah, UAE

Root recession is a regular concern of our patients, afraid of

loosing their teeth. In many cases, an aggressive brushing technique
is involved. In front of this periodontal defect, we need to control
or eliminate, if possible, the aetiology, often multiple. A modication of the brushing technique is usually needed. The level of the
attachment apparatus of the neighbouring teeth and the thickness
of the periodontal tissues will be considered in the surgical decision.
Theoretically, the aim of a root coverage is to regenerate all the
compounds of the periodontium. Clinically, for millers class i and
ii recession, the maximum of coverage will be researched, with the
gingival margin at the cemento-enamel junction, a ppd of 2 mm, no
bleeding on probing and the best cosmetic integration. Simple
decision-trees and meta-analysis of the scientic literature, based
on evidences, are a good help in choosing among several surgical
protocols.

Morph-metric study of interproximal unit in esthetic

region to correlate anatomical variables effecting the
aspect of soft-tissue embrasure space.

Autologous fibrin clot (platelet rich fibrin) for the

treatment of multiple class2 recession type defect

P. Martegani*, M. Silvestri and V. Cattaneo et al.

University of Pavia, Pavia, Italy

S. Aroca*, T. Keglevich, B. Barbieri, G. Istvan and D. Etienne

Paris VII, France, Semmelweis University, Hungary

Presence or absence of a normal papilla is crucial to avoid

unpleasant aesthetic defects of major concern to periodontists,
restorative dentists and to patients. In 1992 Tarnow rst proposed
a study to correlate a specic anatomical feature with the presence
or absence of the interproximal papilla. The aim of our study was
to correlate dierent anatomical variables inuencing the harmonical and eutrophic presence of the papilla in anterior region. We
analysed 120 interdental spaces among four anteriors of 40 patients
comparing data collected both clinically and radio-graphically
using a special metric device xed to a Rin centrator with a known
measure as reference value to detect the distance contact pointbone crest and the inter-radicular distance. The other two variables
were the papilla vestibular mesio-distal base length and the
distance contact point-tip of the papilla. All the measurements

The aim of this study is to determine the eciency of a coronally

advanced ap on multiple recessions root coverage with or without
the adjunction of an autologous brin clot. A controlled and
randomized split mouth study was performed on 20 patients with
multiple class I and II Millers recession defects in the maxilla. All
patients were in good general health and smokers were included.
Full mouth plaque index had to be <20%. Both surgeries (test and
control) were performed during the same session by one practitioner. The choice of the side of treatment was randomly
determined. A blood sample was taken just before anaesthesia.
Recession defects were scaled and no root conditioning was used.
Incisions and ap management were done according to the
Zucchelli et al. (2000) protocol. The ap gingival margin was
covering completely the recessions with or without the brin clot

40

Oral session: Clinical tips and cases aesthetics

and maintained in a coronal position with suspended sutures
around the contact point. Clinical parameters were obtained at
baseline, 1, 3 and 6 months after surgery. We will illustrate our
preliminary statistical data and clinical results at 3 months. One
month after surgery, root coverage was >95% in the control site
and from 50 to 60% on the test site, while gingiva thickness seemed
to be increased in the test site.

atraumatic removal of the residual roots and tissue-protecting

insertion of implants (Immediate Implant Placement) will allow the
prosthodontic reconstruction on an esthetical point of view. A
comparison of the results will demonstrate that osseodistraction is
not only an eective tool to gain vertical bone height but also for
the management of periodontal soft tissues, when residual roots
will be kept within the osteotomy segment during osseodistraction.
No surgery or further soft tissue management in necessary at the
level of the gingival margin when interproximal tissues can be
preserved after periodontal disease.

Register of labial transference (RLT) in the treatment of

gummy smile. Clinical protocol
M. Rocamora*, C. Garcia-soler, J. Figueras and A. Colomer
institut perio-implant, terrassa, spain
Background: When it comes to raise a treatment of a gummy smile,
three main facts need to be evaluated: the quantity of visible
gingiva on the preceding and back parts of the maxila, the length of
the clinical dental crown and the incisal and oclusal planes. All this,
settled on a context of labial dynamics, which should be transferred
to the study models, and will permit designing the gingival edge
and the clinical dental crown shape, aesthetically more appropriate
to the particular labial dynamics of each patient. The aim of this
communication is to present, throughout a series of cases, a clinical
protocol for the surgical treatment of a gummy smile, starting on a
RLT.
Methods: Three gummy smile cases are presented, with a clinical
coronal length inferior to 75% its wideness, in which incisal
abrasions that could justify the appearance of small teeth are not
evident. The cases are surgically solved, starting on the application
of RLT. The medical history, toxic habits, gingival index,
periodontal morphotype, periodontal sounding, bone sounding
and labial dynamics are evaluated.
Results: Clinical results manifest that the application of the clinical
protocol for the surgical treatment of a gummy smile starting on a
RLT, drives to a more natural and aesthetical relations between
gingiva and teeth, on a labial dynamics framework.
Conclusions: Register of labial transference permits predicting
pretreatment, on a reliable way, the nal aesthetic result obtained
throughout coronal enlargement procedures.

Osseodistraction after attachment loss in the esthetic

zone a case report
M. J. Hoffmann*
Private Office, Munich, Germany
The interproximal bone height determines esthetics in between
teeth and implants. When the inammation of periodontally
compromised upper incisors has been stopped, the alveolar process
in between both canines, together with residual teeth, will be raised
by osseodistraction. The soft tissues at the gingival margin will not
be reected. Thus further bone resorption, caused by surgical
procedures at the level of the bone crest can be avoided. Residual
papillae and microvascularisation will be preserved. New devices
for osseodistraction allow vertical and horizontal control of the
frontal segment of the alveolar process after osteotomy. By
increasing the height of the alveolar process, this special treatment
for Bone Augmentation at the basis of the alveolar process will also
shift the interproximal tissues coronally. There is even a gain of
attachment around adjacent teeth, next to the osteotomy line. An

Surgical reconstruction of the interdental papillae

O. Rodrguez Est vez*, R. Guillemin, F. Parahy and S. Miret
Private Practice, Zaragoza, Spain, UIC, Barcelona
The loss of interdental papillae can occur after periodontal
treatment or with the development of periodontal disease. In the
front teeth, the loss of papillae may cause an aesthetic disharmony
as well as phonetic and sensitivity problems. At this moment in
time the reconstruction of interdental papillae is still a challenge.
The aim of this communication is to present a technique to create
new papillae. This technique consists of a rst incision in the free
gingival margin to obtain small aps, a second incision to elevate a
full thickness ap. Then, after a meticulous cleansing of bone and
roots, we suture the ap lling the interdental spaces with the small
aps of the rst incision. Several clinical cases, the technique step
by step as well as literature review are presented in this paper.

The effect of using bone grafting materials in the

extraction socket to avoid ridge resorption (preliminary
results)
J. E. Corputty*1 and E. S. Tadjoedin2
1
University of Indonesia, Indonesia, 2ACTA Amsterdam, Netherlands
The aim of this study is to evaluate the ecacy of Demineralized
Freezed Dried Bone (Allobatan) and Deproteinized Bovine Bone
(Bio-Oss) in the extraction socket after tooth extraction to avoid
alveolar ridge resorption. A total of 12 patients undergo bone
augmentation in the extraction socket of the upper jaws using
either Allobatan or Bio-Oss particles and three patients as control
without having any of bone grafting materials. Clinically is
observed intra oral using a pocket probe directly after bone
augmentation, 3 and 5 months to measure the height (cervico
incisal) and width (buccolingual) of the alveolar ridges of each
socket. Radiograph has been made simultaneously and 3, 5 months
to measure the height using a caliper from the top of the ridge to
the demarcation line which is made through apexes of neighbouring teeth. Biopsies were taken after 3 months from buccal and
5 months from vertical for further histomorphometric. Radiographically shows radio-opacity in all areas grafted evidenced
calcication in those areas. Clinically demonstrates both height and
width of grafted areas are comparable with the adjacent teeth.
Biopsies taken 3 months after bone grafting reveal new bone
formation surrounding grafting materials and further examination
for evaluation. In summarizing, both bone grafting materials
augmented in the extraction sockets will be advantageous to avoid
ridge resorption for preservation the esthetic of alveolar process in
width and height.

41

Oral session: Periodontal connective tissues

Oral session: Periodontal connective tissues

Osteogenic effect of interleukin-11 and its synergism
with ascorbic acid in human periodontal ligament cells

results point out the potentiality of using HDFC or other

mesenchymal precursors as cementoblast progenitors, oering
new perspectives in periodontal regeneration.

E. Leon Pentzke*, K. Iwasaki, T. Kojima and I. Ishikawa

Period. Dept. Tokyo Med. and Dent. Univ., Japan
Background: The HPDL cells are the only able in the masticatory
apparatus to dierentiate into osteoblasts. Our aim was to
determine if IL-11 a cytokine with osteogenic ability, alone or in
combination with Ascorbic acid (A.A), essential for bone and
connective tissue formation, can stimulates osteoblastic
dierentiation of HPDL cells.
Materials and methods: Conuence HPDL cells stimulated with
concentrations of IL-11 alone or with A.A. in presence or absence
of inhibitor of collagen formation (ICF) were examined for the
expression of IL-11 receptor (IL-11r) and osteoblastic markers
(Runx2, OCN and BSP) using RT-PCR. Total protein (TP)
content, cell proliferation and Alkaline Phosphatase (ALP) activity
were measured with colorimetric assays and ALP staining.
Results: The IL-11r and osteoblastic markers were found in cells
stimulated with IL-11, together with A.A this expression was
enhanced as also happened with the ALP activity, moreover ALP
was upregulated by IL-11 + A.A in a similar level of its
downregulation by IFC. Furthermore we found an inverse
relation of IL-11 with cell proliferation and TP content.
Conclusion: The mechanism that IL-11 undergoes to induce the
osteogenic process is stimulating the cells in early maturation to
dierentiate into osteoblasts, decreasing proliferation and
increasing synthesis of collagen and ALP activity, which is
synergistically enhanced by A.A. IL-11 can be recognized as an
osteopromotive cytokine for bone regeneration after periodontal
therapy.

Differentiation of human dental follicle cells into

cementoblasts: inductive role of BMPS and EMD
S. Laurencin-dalicieux*, P. Kemoun and J. Rue et al.
UPS, France, UI 563, France
Tooth root development is regulated by epithelio-mesenchymal
interactions between Hertwigs epithelial root sheath (HERS),
dental papilla and dental follicle (DF) cells. HERS cells synthesize
Bone Morphogenetic Proteins (BMPs) and amelogenin which are
the main compounds of an Enamel Matrix Derivative (EMD).
Although previous data suggest that EMD and BMPs might induce
DF progenitors to dierentiate towards cementoblasts during
periodontal development, the mechanisms involved remain
unknown. We tested the eects of EMD, BMP-2 and -7 on the
proliferation and dierentiation of human dental follicle cells
(HDFC). HDFC were isolated from whole DF surrounding third
molars and stimulated by rhBMP-2 and -7 or EMD and/or
rhNoggin. Immunouorescence and immunohistochemistry were
used to localize Stro-1, BMP receptors and cementoblast markers.
Expression of Cementum Attachment Protein (CAP) was analysed
by Western-blot. HDFC submitted to EMD demonstrated
increased proliferation and dierentiation rates dependent on the
presence of BMP-2 and -7. EMD and BMP-2 and -7 signicantly
increased CAP expression, suggesting a specic eect of these
compounds to commit HDFC towards the cementoblast phenotype. RhNoggin partially inhibited the eects of EMD implying
that they also exert BMP-independent eects on HDFC. Our

42

Expression of S100A8 and S100A9 in human periodontal

ligament cells
T. Kojima*, K. Iwasaki, E. R. Leon and I. Ishikawa
Tokyo Medical and Dental University, Japan
Background: Previous reports showed that members of S100
calcium-binding protein family, S100A8 and S100A9, were
detected in gingival crevicular uid (GCF). Their heterodimer
with antimicrobial activity, calprotectin, was also detected in GCF
in accordance with local inammatory process. Human
periodontal ligament (HPDL) cells secreted S100A8 that acted as
an autocline chemotactic factor. The function of these S100
proteins in PDL is still unclear. The aim of the present study is to
clarify their function in periodontal tissue using cultured HPDL
cells.
Materials and methods: The HPDL cells were obtained from
healthy human teeth. The cells were cultured with or without
supplements inducing osteoblastic dierentiation. The cells were
also treated with LPS from E. coli. The expression of S100A8 and
S100A9 was detected by RT-PCR.
Results: The expression of S100A8 was found in HPDL cells,
whereas S100A9 was not. Its expression was down-regulated after
the induction of osteoblastic dierentiation. Inammatory stimulus
using LPS resulted in up-regulation of S100A8 expression.
Discussion/Conclusion: These results suggest that S100A8 is
expressed in PDL and works as an inhibitor against
mineralization. Such function may contribute to keep PDL
constant between alveolar bone and cementum. It is also
suggested that S100A8 in PDL is up-regulated in periodontal
inammation. The roles of S100A8 in pathogenesis of periodontitis
should be further investigated.

Effect of platelet-rich plasma (PRP) on gingival (GF)

and periodontal ligament fibroblast (PDL) repair in
an in vitro wound healing model
F. Arikan*, S. Cinar, S. Sonmez and I. Gurhan
Ege University, Izmir, Turkey
Platelet-rich plasma (PRP) contains several growth factors and is
widely used to promote healing. The aim of this study was to
evaluate the eect of PRP on GF and PDL cell healing on a special
wound model designed by the workgroup. A wound with a 5 mm
of diameter has been performed on PDL cells and GF cell cultures.
The cell wells were divided into ve groups. The control group
received only DMEM, where the test groups received 5% PRP with
1/3 thrombin; 1% PRP with 1/3 thrombin; 5% PRP with
thrombin and 1% PRP with thrombin respectively. All of the
groups were stained with erythrosine and basic fucsin on days 2, 5,
7, 9 and 11. Digital screenings were performed on each time stop
and a grid with 304 equal squares has been placed on each wound
circle. The squares occupied by the cells have been scored from 1 to
4 and all the sample pictures were evaluated by three observers.
The results were interpreted by means of % surface area. It has
been found out that 1% PRP with 1/3 thrombin group have closed
up the wound circle with a signicant dierence (P < 0.01) and

Oral session: Periodontal connective tissues

GF respond is better than PDL cell respond (P < 0.01). The
present data suggest the possibility that PRP might eectively
promote wound healing at sites of injury in periodontal disease and
the developed wound model may be utilized in future investigations
of the biological basis of periodontal wound healing.

A synthetic glycosaminoglycan mimetic (RGTA)

restructures the tissues destroyed by periodontitis in
hamsters
C. Lallam-Laroye*, J. L. Saffar and M. L. Colombier
Univ Paris Descartes, EA2496, Montrouge, France
A new class of candidate therapeutic agents, the RGTA family,
may have capacity to induce programs of tissues repair reminiscent
of developmental processes. We induced periodontitis in hamsters
and, starting eight weeks later, administered injections of RG 1503
(1.5 mg/kg/w) or saline for 8 weeks. Mandibles were processed for
immunohistochemistry and morphometry. Three dierent compartments of periodontitium were evaluated. The amount of
alveolar bone increased around the rst molar, and the interradicular bone was rebuilt. In the gingiva, the collagen network was
repaired in the treated group and the elastic network was rebuilt.
The continuity and the thickness of the basement membrane were
restored. Apoptotic cell numbers were decreased in the pocket
epithelium, and more so in the inltrated connective tissue. The
root cementum was thickened and the number of proliferating cells
in the periodontal ligament was increased close to the cementum.
RG1503 treatment induces potent anabolic reactions in all compartments of the periodontium. These eects may be related to the
already documented inhibition of proteolytic enzymes in the
gingiva and to the recruitment of progenitors that restructure
gingival tissues, cementum and rebuild lost bone. The specic
properties of RGTA observed in this model of periodontitis which
shares numerous similarities with the human disease, suggest that
RGTA may be an eective treatment for human periodontitis.

whereas experimental diabetes together with experimental

periodontitis up-regulated it. We suggest that diabetes mellitus
may contribute to tissue destruction in periodontitis by modulating
periodontal tissue quality.

Evaluation of telomerase activity in gingival fibroblasts

of cyclosporin a treated patients
C. Biray, N. Nizam* and C. Gndz et al.
Med Facul., Dent. Facul., Med Facul., Ege Univ, Izmir, Turkey
Gingival overgrowth (GO) is a common side-eect following
administration of cyclosporin A (CaA). Some case reports have
reported that squamous cell carcinomas could arise in GO induced
by CsA and phenytoin. It is also known that human telomerase is
activated in about 90% of cancers and it is mainly composed of
hTR, hTERT and TP1. The aim of this study was to investigate the
potential role of telomerase activity in the pathogenesis of CsAinduced gingival overgrowth. A total of nine patients medicated by
Cyclosporine-A, four with and ve without gingival overgrowth,
were included in the study. Gingival tissues were obtained during
gingivectomy or ap procedures and gingival broblasts were
cultured in Dulbeccos modied Eagles medium (DMEM) supplemented with 10 000 U/mL penicillin, 10 mg/mL streptomycin,
2 mM L-glutamine and 10% heat-inactivated fetal bovine serum at
37
C under a humidied 95% air 5% CO2 atmosphere. A
quantitative detection of hTERT mRNA was performed with the
commercially available LightCycler Telo TAGGG hTERT Quantication Kit using real-time online PCR. hTERT mRNA expression was found positive in one patient while hTERT mRNA
expression was negative for the others. Even the results indicate
that there could be a relationship between CsA induced GO and
positive telomerase activity, detailed studies should be performed
to clarify and conrm the present ndings.

The effect of age on the development of gingivitis.

histometrical and immunhistochemical findings
Apoptosis in healthy and diseased periodontal tissues
of experimentally induced diabetic rats
M. Tunali*1, T. Ataoglu2, I. Celik2, M. Ulker2 and A. Sengun2
1
Konya Military Hospital, Konya, 2Selcuk University, Konya, Turkey
Objectives: The aim of this study was to evaluate the apoptotic
behaviour of periodontal tissues in the presence or absence of
experimentally induced diseases; diabetes and periodontitis.
Methods: Sprague Dawley rats were used in this study.
Experimental periodontitis was created by placing silk ligature
around cervices of rst mandibular molars. Experimental diabetes
was induced by streptozotocin (STZ). Following the induction of
the both experimental diseases, the animals were divided into four
groups; (1) healthy group (H), (2) diabetes group (D), (3)
periodontitis group (P), (4) diabetes and periodontitis group
(DP). Apoptotic cells were determined by immunohistochemical
method.
Results: In the H, D, P and DP groups, the mean apoptotic index
scores were 1.00 0.47, 0.88 0.64, 2.09 1.14 and 3.14
1.07 for the periodontal ligament, whereas 1.70 0.95, 0.88
0.83, 2.73 1.10 and 3.29 0.49 for alveolar bone, respectively.
The dierences between the group P and group H, and between the
groups D and DP were statistically signicant (P < 0.05).
Conclusions: The results of this study showed that experimental
periodontitis alone up-regulated apoptosis in the periodontal
tissues, experimental diabetes alone suppressed apoptosis,

R. Mengel, D. Zschner* and L. Flores-de-Jacoby

Periodontology, Philipps-University, Marburg, FRG
The aim of the study was to evaluate the dierence in the
histometrical and immunhistochemical reaction of the gingiva in
experimental gingivitis of periodontally healthy young and aging
individuals. These persons were divided into two groups aged from
18 to 30 years (n = 11) and from 46 to 77 (n = 10). After
establishing a high level of oral hygiene, clinical data were recorded
and a biopsy was taken. After establishing an experimental
gingivitis the clinical examination was repeated and a new biopsy
was taken. All the biopsies were examined histometrically and
immunohistochemically. Antibodies were used to demonstrate the
existence of various cells in the connective tissue (CD 3, CD 4, CD
8, CD 20, CD 45 RA, CD 45 RO, CD 68, elastase, mast cells,
tryptase). In comparison of the two age groups, there was a greater
number in all cells examined in both the healthy and diseased tissue
of the younger group (except for helper-T-cells and mast cells). In
both groups, a large proportion of mast cells were detected in both
the healthy and the diseased tissue. In the connective tissue below
the epithelium in the older group, the number of suppressor-T-cells
(P = 0.048) and activated lymphocytes (P = 0.001) in the diseased tissue was signicantly smaller. In conclusion, the study
showed that there is a greater number of cells in both the healthy
and diseased tissue in the younger test persons. Both age groups
demonstrated a large proportion of mast cells in healthy and
diseased tissue.

43

Oral session: Implant therapy outcomes

Oral session: Implant therapy outcomes

The survival rate of endosseous dental implants
performed in previously failed implant sites
E. E. Machtei, D. Mahler*, K. Horwitz and O. Zuabi
Rambam Med Ctre & Technion Faculty Medicine, Israel
The survival rate of endosseous dental implants is considered high
(1st year survival exceeding 95% is common). However, some
systemic environmental and local factors might modify this rate.
Purpose: The purpose of this study is to examine the eect of
previously failed implant sites, on the success of new dental
implants placed in these same sites. 34 patients with 55 repeated
dental implants were included in this study. Age ranged between
2386 Year (mean 57 10.6). All implants were FDA approved,
with rough surfaces topography and either internal or external
connection. Patients were followed for a period of 960 months
(mean 27.0 1.9). Slightly more than half of these implants (53%)
were placed submerged, while 47% were non-submerged. Implants
length and diameter ranged between 1015 mm (mean 12.1 1.4)
and 3.255 mm (mean 4.0 0.5), respectively. Nine of these
implants failed during the rst year, while non have failed since,
which amounts to an overall survival rate of 83.6%. Implants that
were placed submerged had slightly lower survival rate (79.2%)
compared to these placed non-submerged (88.4%), however these
dierences were not statistically sig. (P > 0.05).
In conclusion: Dental implants placed in previously failed implant
sites have lower survival rate than previously reported for fresh
sites. This would tend to suggest that when replacing a failed
implant the use of an adjacent rather than the original implant site,
might increase the survival rate of these implants.

Implant failure predictors in the posterior maxilla: a

retrospective study of 274 consecutive implants
J. R. Friedberg, T. Vogiatzi and E. Ioannidou*
University of Connecticut Health Center, CT, USA
Objective: We aimed to assess the implant failure rate placed in the
posterior maxilla and to identify failure predictors at least
6 months after nal restoration.
Material and methods: We retrospectively collected data from all
subjects who underwent implant placement in the posterior maxilla.
The sinus elevation procedures that were used included: the 1-step
antrostomy, the 2-step antrostomy and the osteotome sinus oor
elevation. We dened implant failure as the presence of clinical
mobility, peri-implant radiographic radiolucency and the presence
of pain, infection and neuropathies. Multivariable logistic regression
was conducted with implant failure as the dependent variable.
Results: The overall implant failure rate in the posterior maxilla
was 4.9%. Multivariable logistic regression showed an eect of
smoking and surgical complications on implant failure. In the
covariate adjusted models we included gender, diabetes, smoking,
implant length and diameter, restoration design, membrane use,
sinus technique and complications. The odds ratio of implant
failure in smokers and subjects with surgical complications was 6.5
(P = 0.025) and 8.2 (P = 0.004) respectively. The use of sinus
elevation techniques was not associated with an increase in the risk
of implant failure (P = 0.702).
Conclusion: Implant failure in the posterior maxilla is more
common in smokers and subjects with surgical complications.
Sinus elevation procedures do not increase the risk of implant
failure.

44

Clinical comparison of implants placed in fresh sockets

and adjacent healed sites: preliminary results of a
prospective study in humans
P. Casentini*, F. Greco and M. Chiapasco
Dep. of Dentistry, Univ. of Milan, Italy
Aim of the study: To compare clinical performance of implants
placed in fresh sockets versus implants placed in adjacent healed
sites.
Materials and methods: Forty-six straumann implants were placed
in 17 patients: 25 implants (group 1) were inserted in extraction
sockets and 21 in adjacent healed sites (group 2). Seven patients (19
implants) received an immediate xed temporisation, while 10
patients (27 implants) were treated by traditional loading.
Evaluated parameters at 12 and 24 months were: (a) peri-implant
bone resorption and clinical parameters (PI, PD, BOP); (b) survival
and success rates of implants. Statistical analysis was conducted for
each parameter.
Results: A signicantly higher (P < 0.05) bone resorption was
recorded in group 2 at 12 months follow-up and a higher probing
depth was recorded for group 1 implants at 12 and 24 months.
Dierences in these parameters can be explained with deeper
positioning of immediate implants. Peri-implant tissues health was
considered very satisfactory and cumulative survival rate of
implants was 100% in both groups. No statistically signicant
dierences were recorded between implants with immediate
temporisation and implants with delayed loading.
Conclusion: Preliminary results suggest that immediate implants
and inserted in adjacent healed sites have very similar clinical and
radiographic performance allowing successful rehabilitation.
Immediate temporisation does not seem to aect implant survival
rate.

Variables affecting bone loss around internal and

external hex MIS implants. a long-term retrospective
analysis
M. Tandlich*, J. Eckstein, P. Reizman and L. Shapira
Hadassah Med Center, Israel, Priv. Clinic, Holland
Aim: A retrospective analysis was held to analyse the eect of
formerly documented variables on bone loss around MIS implants,
and to compare the bone loss around internal and external
abutment connections.
Materials and methods: Patients from two clinics who were treated
with either internal or external hex MIS implants were recalled for
a clinical and radiographic follow-up. Patients records with more
than 30 months of follow-up period were examined to include data
about their health condition, habits, implants and prosthetic
appliances. Bone loss was calculated out of obtained radiographs.
Results: Forty-ve patients with 180 internal hex, and 34 patients
with 74 external hex implants were examined, exhibiting an overall
95% and 97% success rate respectively. The mean bone loss
around the internal and the external hex implants was 3.01 1.57
and 2.35 0.87mm (P = 0.03), respectively, with a
corresponding mean number of exposed threads of 0.89 and 1.39
(P = 0.07). In the internal hex group, smoking, and in the external
hex group, type of prosthesis, were found to be signicantly
correlated with the bone loss. In both groups, neither time nor any
of the other suspected variables signicantly aected bone loss.

Oral session: Implant therapy outcomes

Conclusion: This study conrms that both types of MIS implants
exhibit success rate of more than 95%, and suggest that the
conguration of the implant neck, smoking habits and type of
prosthesis may inuence the amount of bone loss (Supported by
MIS).

10-year longitudinal study of patients treated for

generalized aggressive periodontitis and
osseointegrated implants
R. Mengel, M. Behle* and L. Flores-de-Jaocby
Periodontology, Philipps-University, Marburg, Germany
The aim of the study of patients with aggressive periodontal disease
and periodontally healthy patients was a comparison of teeth and
implants, and assessment of the implant success rate. 10 partially
edentulous patients provided with a total of 38 implants were
enrolled in the study. Oral rehabilitation was undertaken in ve
patients treated for generalized aggressive periodontitis (GAP) and
ve periodontally healthy patients. The examinations of the teeth
and implants were carried out within the framework of a 3-month
recall schedule over a 10-year period. At each session, clinical and
microbiological parameters were recorded. Additionally X-rays
were taken. At the implants and teeth, a slight increase in PD and a
continuous loss of AL was recorded in GAP patients. The
microorganisms reected healthy conditions throughout the observation period and revealed no signicant dierences between the
patient groups or between implants and teeth. The bone loss at
implants and teeth was signicant higher in GAP patients than in
periodontally healthy patients. The implant success rate was
96.77% in GAP patients and 100% in periodontally healthy
patients. In conclusion, the results showed that oral rehabilitation
can be performed with implants in GAP patients. However, slight
attachment loss and bone loss were registered at the implants and
teeth in the patients with aggressive periodontitis.

A prospective, 5-year study of tooth-implant and

implant-implant supported fixed partial dentures
K. Gotfredsen*
Faculty of Health Sciences, Univ. Copenhagen, DK
Aim: To evaluate the biological and technical outcome of implants
and teeth supporting tooth-implant (T-I) and implant-implant (I-I)
FPDs.
Material: Sixteen patients with a mean age of 62 years, a Kennedy
class I dentition and natural teeth or implants as antagonists were
treated with 47 Astra Tech Implants supporting FPDs. A
randomised split-mouth design was used. Each patient was
treated with one T-I and one I-I FPD. Thus, three groups were
obtained: The implants in the T-I FPDs (test-implants), the
implants in the I-I FPD (control implants) and the teeth in the
T-I FPDs (control teeth). All FPDs were followed for at least
5-years. Descriptive statistics and Wilcoxon paired test was used.
Results: Two of the sixteen T-I FPDs failed during the 5-years
follow-up period and none of the I-I FPDs. The median (range)
change in marginal bone level during the 5-years was: test implants
0.4 mm (03.2 mm); control implants 0.3 mm (04.3 mm) and
control teeth 0.2 mm (00.9 mm). No signicant dierence was
found between test and control implants, but signicantly more
bone was lost at the test implants compared to the control teeth.
Technical complications: loss transversal screw: 5%/yr, loss
occlusal screw/retention: 2.5 %/yr for implants and 1.25%/yr for
control teeth.
Conclusion: During a 5-year observation period more bone was
lost at implants than at the teeth supporting T-I FPDs. There was
no dierence in bone loss between implants supporting T-I FPDs
and I-I FPDs.

Changes in soft tissue dimensions following

second-stage surgery 1 year results
J. Tunkel*, L. de Stavola and F. Khoury
Priv. Clin. Schlo Schellenstein, Olsberg, Germany
Objective: The aim of this study was to compare the increase of
keratinized mucosa using three dierent techniques for secondstage-surgery.
Materials and methods: Thirty patients receiving prosthetic
rehabilitation of the maxilla with dental implants (18) were
selected for this study. The patients were divided into three
groups (10 patients each) based on preoperative anatomical
considerations. Second stage surgery was performed using either
the roll ap (group RF) or the apically repositioned ap (group
ARF) or an apically repositioned ap combined with a connective
tissue graft (group ARFCT). The height and thickness of the
keratinized mucosa was measured preoperatively, postoperatively,
at 2 weeks, 3 and 12 months after surgery.
Results: After 1 year the average gain of thickness and height of
keratinised mucosa was 1.2 mm and 4.8 mm in the ARF group,
2.5 mm and 1.2 mm in the RF group as well as 2.8 mm and
4.3 mm in the ARFCT group, respectively. ARF and ARFCT
increased the amount of keratinised mucosa signicantly more
compared to RF while gain of volume was signicantly increased
by RF and ARFCT compared to ARF.
Conclusion: From these results it can be concluded that in case of
missing volume a roll ap should be performed while a lack of
keratinized mucosa indicates the apically repositioned ap. When
there is the necessity to increase keratinised mucosa as well as
volume an apically repositioned ap combined with a free
connective tissue graft can be recommended.

Outcome of dental implants in immunosupressed

patients: a 10 years study
F. Novell Costa*, J. Novell and C. Ivorra
Centre Clinic Dental, Barcelona, Spain
Objective: To review the outcome of dental implants placed in
immunosupressed patients.
Material and methods: Between April 1995 and October 2005, 19
patients were treated with 86 dental implants. All they were
immunosupressed individuals: three patients with heart transplant,
three liver transplant, nine renal transplant and three with psoriatic
arthritis. Patients mean age was 50 years (3661), 12 women
(63.2%). Crestal bone was high enough to place implants without
bone surgery. No patients had evidence of organ rejection. Data
gathered included blood analysis, X-Ray, CT, operative reports,
complications and prosthesis. All patients were followed for a
mean time of 5.7 years (range 111).
Results: Charts were available for 17 patients (89.5%). Implants
were placed in ambulatory surgery; patients were discharged
without complications. A patient with psoriatic arthritis
presented severe pain in the implant zone the second week.
Patients exam was normal, the implant left in place and pain
disappeared in 2 weeks. Nine patients showed infectious gum
problems, four were solved medically and ve needed surgical
treatments. Two implants (2.3%) were lost in early
osseointegration period (6. 9 week). Prosthesis was loaded in a
mean time of 10 weeks (612). The mean treatment time was
107 days (35 m).
Conclusions: Immunosupressed patients show a higher morbidity
and mortality from infectious disease, despite that, implant
treatment doesnt have higher risk. Global success rate is similar
to the normal patients.

45

Oral session: Clinical tips & cases: Tissue regeneration

Oral session: Clinical tips & cases: Tissue

regeneration
Calcification of a novel collagen barrier in dogs
Y. Zubery*, E. Nir and A. Alves
Private Practice
Introduction: A novel glycation technique, mimicking a natural
collagen cross-linking, was used to produce a porcine type I
collagen barrier. The purpose of this study was to compare the
safety, ecacy and degradation of 2 porcine collagen barriers.
Materials and methods: Two months following extraction of
mandibular premolars in 10 beagle dogs, two buccal L-shape
defects were randomly assigned to four groups: Ossix-Plus + BioOss (OP + BO), Bio-Gide + Bio-Oss (BG + BO), Bio-Oss (BO)
or sham operated (ShO). Dogs were sacriced after 8, 16, and 24
weeks and the mandibles prepared for histomorphometric analysis.
Results: At 8, 16 and 24 weeks the amount of new bone and
restoration of original ridge morphology were OP + BO =
BG + BO > BO > ShO. Both membranes showed early
degradation at 8 weeks, and moderate to marked at 16 and
24 weeks respectively. One out of four BG barriers was completely
absent at 8 and 16 weeks. Increased calcication of OP and
augmentation of lingual bone volume were seen in all specimens
advancing with time into areas not in direct bone contact and was
completed at 24 weeks.
Conclusions: Both membranes exhibited barrier function with bone
formation and ridge restoration. OP was partially degraded at
6 months, whereas BG showed variation in degradation kinetics.
OP membrane calcication supporting bone augmentation was
observed in all specimens. This suggests that glycation technology
may produce an Osseo-conductive collagen matrix, in addition to
its degradable barrier function.

The totally submerged connective tissue graft. a

periodontal plastic surgical technique to prevent
exposure of non resorbable membranes at GBR
D. Gonz
lez*, G. Olmos, D. Calzavara and G. Cabello
Private practice
Introduction: Exposure of non-resorbable membranes during
healing is one of the most frequent complications of guided bone
regeneration procedures (GBR). When a non-resorbable
membrane is exposed, it is quickly colonized by bacteria, which
may produce an infection, jeopardizing the GBR.
Objective: To show a technique of periodontal plastic surgery that
prevents the exposure of non-resorbable membranes at GBR.
Material and methods: Description of the technique: When a nonresorbable membrane is positioned, covering a bone graft and the
alveolar ridge, a connective tissue (CT) graft obtained from the
contralateral side of the palate, is placed over the membrane, along
its supracrestal part. The CT graft must be partially submerged
under the palatal mucosa and sutured to the palatal ap. Then the
buccal ap is sutured to the palatal ap, leaving the CT graft
totally submerged. Care must be taken not to suture the graft to the
buccal ap, in such a way that if during healing, the buccal ap has
a recession or a dehiscence, the CT graft is exposed, isolating the
membrane from the oral environment.
Results: The surgical technique will be presented, as well as cases
treated successfully under this approach, showing that if this
technique were not used, membrane exposure would have occurred.
Conclusion: The totally submerged connective tissue graft is a
valuable approach to prevent exposure of non-resorbable membrane
when a guided bone regeneration procedure is carried out.

Vertical ridge augmentation around implants by e-PTFE

titanium-reinforced membrane and bovine bone matrix:
10 consecutive cases. 12 42 months study

Emdogain and autogenous bone graft in the treatment

of deep-wide intrabony defects

L. Canullo* and V. A. Malagnino

Univ. Chieti, Italy

D. Nisand* and M. Tuil

Dept. of Periodontology, Univ. Paris 7, France

This retrospective study evaluates the long-term survival (12

42 months) of 10 vertically augmented ridges in which 24 Defcon
implants were inserted. Deproteinized bovine bone (Bio-Oss) was
used as the only augmentation ller-material and was covered with
an titanium reinforced e-PTFE membrane (Gore-Tex). Clinical
evaluations showed defect heights between 9 and 2 mm (average
5.1 mm; SD = 2.1). Bone height gain was between +3 and
+9 mm (average 5.3 mm; SD = 1.7). Dierences were statistically
signicant for a mean value of > 4 mm (P < 0.005). For three
augmented areas bone samples were retrieved for histological and
histomorphometric examination. They show signicant new bone
formation, and remodelling of the deproteinized bovine bone
material. The histologies, the radiographic data, and the clinical
stability show that all implants were successfully osseointegrated.
In addition, the radiographic and clinical analysis indicates that the
generated bone crest levels are stable. This clinical study suggests
that vertical ridge augmentation with an e-PTFE membrane and
deproteinized bovine bone is predictable and can lead to long-term
success comparable to the results reported with autogenous bone.

Initial background: Potential limitations of EMD may be due to

their gel-like consistency. Thus, it has been suggested to combine
EMD and bone replacement grafts in the treatment of deep-wide
intrabony defects. However, the association of autogenous bone
graft and EMD has not been yet clinically evaluated in humans.
Aims of the report: The aim of this 6-months retrospective trial is
to evaluate the clinical eect of the association of autogenous bone
graft and EMD in the treatment of deep-wide intrabony defects.
Materials and methods: Five patients with severe chronic or
aggressive periodontitis were enrolled in the study for a total of
nine deep-wide intrabony defects. The criteria needed for inclusion
were: presence of at least one intrabony defect with a probing depth
>6 mm, on maxillary or mandibular molars, with a deep-wide, 1
or 2 wall intrabony components of 4 mm, and a radiographic
angle 30
.
Results: At baseline, the mean CAL is 9.78 1.3 mm and the
mean PD is 8.44 1.13 mm. At 6 months, the results of this pilot
study demonstrate a PD reduction of 5.33 1.11 mm, a 5.33
1.22 mm of CAG and the absence of gingival recessions.

46

Oral session: Clinical tips & cases: Tissue regeneration

Discussion and conclusions: This association may have lead to a
synergistic eect. The clinical results of this pilot study are
encouraging and need to be supported by a prospective clinical
study. The future direction in the development of EMD must be a
new carrier with supportive capacity.

Prospective study comparing 3 different crestal sinus

grafting techniques: 2-year results
N. Nader*, R. Younes, C. Makari and G. Jabbour
Scientific committee, Lebanese Dental Association
The aim of this prospective study was to compare three dierent
crestal sinus grafting techniques as a predictable solution to vertical
bone defects situations in the maxilla. All clinical cases were treated
using delayed implant placement. Seven months after sinus
grafting, 89 implants (Zimmer dental) were placed in 41 patients,
divided in three groups related to the grafting technique: group
A = 50 implants using particles of deproteinized bovine bone
material with a resorbable membrane, group B = 18 implants)
using Block bovine material associated with particles and membrane, and group C = 39 implants with a new innovative crestal
bone reecting trap (CBRT) technique associated with bone
particles. The decision criteria depend on residual ridge morphology. Rx control the same day, 3, 7, 12 and 24 months later enabled
us to analyse the bone loss, crestal and apical bone remodelling,
and implant survival rate. 2 years later, no statistically signicant
dierence in the three groups (cumulative implant survival rate
97.75%): peri-implant and apical bone loss from the group A and
C (14.6%) were similar and less for the group B (5.9%), despite a
signicant dierence concerning bone graft success rate:
A = 96%, B = 87.5%, C = 100%. Crestal approach is a successful solution to bone deciency situations. The CBRT technique
presents many advantages: preserving the crestal cortical bone,
playing the role of a biological membrane and protecting the
biomaterial inside the sinus cavity.

Parietal bone as a source for maxillary grafts in

implants rehabilitations (About 3 clinical cases)
A. Gaudin*, G. Brunel and E. Solyom
Univ. Toulouse, France
Bone augmentation for implant dentistry has become a necessary
procedure for a number of edentulous patients. The purpose of this
lecture is through three clinical cases, to describe the procedure for
harvesting the bone graft from the cranium, to present advantages
and disadvantages, to evaluate the histological results of the parietal
graft and nally to analyse and discuss the use in onlay or inlay bone
graft. Simultaneous or delayed implant placement can be performed.
Material and methods: A literature review with the main electronic
databases investigates on the stability of the reconstruction.
(Resorbtion, implants survival rates, type of graft: inlay or
onlay.) Biopsies of the augmented regions of the clinical cases
were performed after 6-month healing period (for the delayed
implantation). A survey was made to evaluate the postoperative
eects (pain, esthetic aspects at the donor site, fatigue) on 150
patients.
Results: The micro architecture of parietal bone and his cellular
properties explain his resistance to resorbtion (Tulasne 2005.)
histological and histomorphometric ndings demonstrates a living
bone that shows feature characteristic of mature and compact
osseous tissue. The side eects are very few. Nevertheless very rare
(11/13 000) neurological complications can happen (Kline and
Wolfe 1995).
Discuss: The parietal bone is reliable for onlay grafts in severe
atrophy of edentulous ridge but does not represent superiority to
other techniques for inlay grafts.

Data of 500 internal sinus lift procedures with different

grafting materials and the use of platelet rich plasma
H. Eymer* and F-E. Preusse
Praxis fr Zahnheilkunde Hamburg/Mlln, Germany
Introduction: PRP has an eect on bone enhancing procedures
with autologues bone. Non-invasive procedures in bone grafting
techniques try to reduce autologues bone harvesting and add
dierent grafting materials to enhance the volume of the graft. This
study analysis the eect of PRP to dierent grafting materials and
their mixtures in internal sinus lift procedures.
Materials and methods: Internal sinus lift procedures were
proceeded after measuring of dental ct-scans in residual bone
heights (six groups from 1 to 12.5 mm) Biogran, Cerasorb,
DFDBA, Bio Oss always mixed with 3040 vol% autologues
bone harvested as local bone chips and by the bone trap.
Results: Dierent concentrations of PRP have been achieved: 1200
blood bank, 573% labfuge, 450% PCCS System, 472% Smart
PReP. Additional bone heights in no 1 (res. bone 1 mm) were
11.8 mm to no 6 (res. bone 8 mm) 3.8 mm. The loading times had a
com spread of 11 weeks for DFDBA, 19 weeks for Biogran,
26 weeks for Cerasorb, 28 weeks for Bio Oss. Survival Rates:
98.2% in groups 36 (res. bone height 511 mm), 84% in group
2(34.5 mm), 79% in group1 (12.5 mm).
Conclusion: The internal sinus lift procedure seems to be a save
and predicable method to enhance bone management in the upper
posterior arch. The results of this study show an eect of PRP to
the dierent grafting materials in combination with autologous
bone. Grafting materials can be added to autologous bone in
combination with activated PRP to enhance bone-grafting
procedures.

Bone tissue engineering in periodontology a new

surgical approach by endoscopically assisted micro
surgery augmentation with DBM and RHBMP-2
K-H. Schuckert*, S. Jopp and U. Mueller
Indente, Inst. of Oral Surgery and Dentistry, Germany
Aims: In the past complications like infections of the wound
margins and recessions of the gingiva could be observed after
periodontal ap operations. A newly developed operation
technique is meant to minimize these complications.
Material and methods: This new technique protects the papillae
and enables the surgeon to move them coronally. Therefore the
gingiva has to be cut vertically followed by a bridge ap which is
detached from the bone and if necessary displaced coronally.
Endoscopically assisted the root surfaces and the bone are cleaned
and planed. Afterwards the bony defects can be treated with a
suitable augmentation material. Demineralized human bone graft
is used for bony defects with two and more walls while additionally
rhBMP-2 is inserted to create new bone growth in defects without
existing bone walls. The newly developed operation technique will
be demonstrated in a short video lm.
Results: Clinical results of this new operation technique are: no
recession of the papillae, no loss of attachment and seldom
supercial infection of the wound margin. In all cases of coronal
movement of the papillae a clear attachment gain with bony
underlay is recognizable.
Conclusion: The newly developed bridge ap technique in
comparison to the usual ap technique promises advantages in
wound healing and therefore better postoperative results.

47

Oral session: Bone regeneration

Oral session: Bone regeneration

The experimental use of a polymer of polylactic and
polyglycolic acid (fisiograft) in rabbit calvarial bone
defects for bone regeneration

augmentation are functional after a 12-months period of loading.

No bone loss associated with the grafts was observed.
Conclusions: Sinus augmentation technique using a composite
graft is a predictable technique with adequate long-term results.

F. Herrero*, F. Guerra and D. Calzavara et al.

Master Prog. of Period., U. Complutense, Madrid
Aim of the Study: The aim of the Study is to evaluate the inuence
of a polymer of polylactic and plyglycolic acid, Fisiograft (FG)
used as grafting material for bone regeneration.
Material and methods: Experimental animals: Thirty-six adult New
Zealand white rabbits were, divided in three groups of twelve
animals each to be sacriced in 7, 14, and 30 days for histological
evaluation.
Experimental modalities: Two round defects of 9 mm in diameter
were performed in the parietal bone. Four experimental modalities
were considered, and randomly assigned to the corresponding
defects: (a) FG sites (FGS) (b) FG and autogenous bone sites (FGABS) (c) Autogenous bone sites (ABS) (d) Untreated sites (US)
Tested material FG is a synthetic co-polymer of polylactic and
polyglycolic acid. For the present study, FG powder presentation
was used.
Results: Sixty-four samples were subjected to histological analysis.
In the 7, 14 and 30 days groups, the % of new bone formation
ranked 3.911.6, 2.04.4, and 3.212.4 for the US, 7.813.3, 1.4
4.2, and 5.216.9 for the FGS, 9.117.3, 12.919.2, and 13.429.2
for the FG-ABS, and 11.039.8, 8.726.6, 9.326.0 for the ABS.
Conclusions: The results suggest that the use of FG alone or in
combination autogenous bone in this animal model did not
promote a signicant new bone formation when compared to
autogenous bone alone.

Evaluation of two different composite bone graft

mixture for sinus augmentation
P. Galindo*, G. vila and F. Mesa et al.
School of Dentistry, Univ. Granada, Spain
Background: Placing of implants in the posterior maxilla often
poses a challenge to the clinician because of the bone loss caused by
tooth losses at these sites. Sinus lift is a highly suitable therapeutic
option to overcome this problem.
Objectives: The present study compares two graft materials used
for sinus augmentation to evaluate its clinical and biologic benets
Material & methods: Five patients, who underwent a bilateral
sinus augmentation, were recruited. Two dierent grafts per
patient were used in each sinus lift: Cortical bone overlying the
sinus membrane in combination with bovine bone (Bio-OssR) and
with synthetic resorbable bone substitute (NovaboneR). Biopsy
samples of the graft were taken 6 months later, at the time of
implant placement. 6 months later the xations were loaded with
FPD. Periimplant bone was evaluated 12 months after loading.
A comparative radiographic analysis was made using the program
Trophy 6.0.
Results: The histological study showed that the grafts present a
high biocompatibility, but demonstrated little growth in case of
Bio-Oss. Novabone samples revealed a better remodelation, with
some particles included in new normal bone with active osteoblasts
producing osteoid matrix. All implants placed after sinus

48

Histological evaluation of peri-implant bone

regeneration after application of calcium phosphate
bone cement to buccal dehiscence defects in dogs
C. Hayashi*, S. Oda and I. Ishikawa et al.
Tokyo Medical & Dental Univ., Japan
Background: The objective of this study was to evaluate
histologically the eects of calcium phosphate bone cement
applied in surgically created bone dehiscence defect on the xture
in six adult beagle dogs.
Methods: Bilateral all mandibular premolars were extracted in six
beagle dogs. After 12 weeks of healing, buccal dehiscence defects
were created on the buccal side of the drilled holes for implants,
then dental implants were implemented. Application of injectable
calcium phosphate cement (Norian PDC) in one side (test) or no
graft in the contralateral side (control) were performed. At
24 weeks postsurgery, the animals were sacriced and block
biopsies were prepared for histological section and analysis.
Results: In the experimental sites, Norian PDC remained intact
in the defect at 24 weeks. Newly formed bone was observed
between the implant and the residual Norian PDC. In the control
sites, a limited amount of bone was observed and the length of
osseointegration was always less than that seen in the experimental
site. In the histometric analysis, placement of Norian PDC
resulted in an approximate 3-fold increase in osseointegration
(P < 0.02), a 4-5 fold increase in bone area (P < 0.015), and a
2-fold increase in bone height.
Conclusions: The results indicate that Norian PDC would be
eective to improve peri-implant tissue healing, especially in case of
dehiscence defect adjacent to the dental implants.

Comparison between brushite set-cement granules and

Bio-Oss for bone augmentation in rabbit calvaria
F. Tamimi, J. Tores, I. Tresgeres*, L. Blanco and E. Cabarcos
Estomat.III & Phys.Chem.II, Univ.Complutense, Spain
Bio-Oss granulate has been extensively used in bone regeneration
as an osteoconductive graft. Nevertheless, its low resorption rate
compromises the quality of the regenerated bone on the long term.
Brushite is a biocompatible osteconductive calcium phosphate with
very good in vivo resorption rate. In this study we compare the use
of Bio-Oss with a novel granulate that consists of a brushite based
set-cement in a rabbit bone osteoconduction model. Defects were
prepared in the calvaria of 16 adult New Zealand rabbits and they
were implanted with: (1) Bio-Oss (2) brushite set-cement granulates
(3) left empty (negative control). After 4 weeks of the intervention,
the animals were sacriced, biopsies were taken, and the following
parameters were analysed: bone augmentation, bone mineral
density and graft resorption. Statistical analyses were performed
with students t test, with a signicance level of 5% for comparison
of data. Mean bone mineral densities of the experimental groups
(1, 2) were similar but higher than the negative controls (3) The
graft resorption and bone augmentation were signicantly higher

Oral session: Bone regeneration

in the defects treated with the brushite based set-cement (2) The
lowest bone augmentation was formed in the negative control
defects (3) In our study, the use of novel brushite set-cement
granules produces better results than Bio-Oss in bone augmentation procedures.

the grafted samples with no sings of immunological or inammatory reactions.

Adding PRP to Bio-Oss improves bone regeneration in

osteoporotic rabbits
Vertical ridge augmentation with xenogenous bone
blocks a histomorphometrical study in dogs

J. Torres*, I. Tresgeres, F. Tammi, E. Cabarcos and L. Blanco

Estom. III & Phys. Chem. II, Univ. Complutense, Spain

D. Rothamel*, M. Herten, F. Schwarz and J. Becker

Dept. of Oral Surgery, Univ. Duesseldorf, Germany

In periodontology and implantology, bone regeneration treatments are often needed in patients with reduced bone healing
capacity such as osteoporotic subjects. To correct an osseous
defect or to obtain greater bone thickness, biomaterials including
bone growth stimulating factors are often used. Among these
therapies the use of the platelet rich plasma (PRP) is common in
dentistry. The aim of the present study is to evaluate the
eectiveness of adding PRP to alloplastic hydroxyapatite (BioOss) in the vertical bone regeneration of osteoporotic rabbits. Two
groups of sixteen New Zealand white adult osteoportic rabbits
were included in this randomised, blind, prospective pilot study.
Two identical 10-mm-diameter groves were created in each rabbit
cranium with a trephine burr in order to x and stabilize a
titanium ring 4 mm high, and 10 mm diameter, creating a defect
limited by the cortical bone oor and the titanium rings walls.
Inside the defect only true vertical bone regeneration occurs
emerging from the defect oor. The defects were grafted with: (a)
a mixture of PRP with Bio-Oss (b) PRP alone (c) Bio-Oss alone
and (d) left empty for control. The rabbits were evaluated for
histological and histomorphometric analysis at 4 weeks of the
intervention. It was observed that the combination of PRP + BioOss achieved a signicant higher percentage of osseous regeneration than Bio-Oss alone.

The aim of the present study was to histologically evaluate healing

following vertical ridge augmentation using newly developed
xenogenous deproteinized bone blocks (XB) or autogeneous bone
blocks (AB) in dogs. Standardized vertical-typed jaw defects were
surgically created in edentulous ridges in the lower jaws of six
foxhounds. Two bone blocks (6 10 15 mm) were xed on each
mandibular side with both a titanium implant and a osteosynthetic
screw. Three groups were tested: [A] XB alone, [B] XB covered with
a chemically cross-linked collagen membrane (CM), and [C] AB in
inlay-technique, harvested from the opposite side. Three months
later, the screws replaced by secondary dental implants. After a
nal healing period the animals were sacriced. During the primary
healing period, three out of 12 jaw sides had to be excluded from
the study due to severe inammatory reactions (2 x B, 1 x C). In
general, histological analysis revealed that XB, used alone or in
combination with CM, exhibited osteoconductive properties on a
level equivalent to AB, resulting in a high grade of ossication of
the bone blocks. However, all specimens revealed obvious signs of
bone/graft resorption, which appeared to be more progressive on
the vestibular sides. Within the limits of the present study it was
concluded that I. XB revealed osteoconductive properties and graft
resorption on a level equivalent to AB, and II. The combination of
XB + CM did not seem to improve the outcome of therapy
additionally.

Vertical bone regeneration and graft resorption with a

novel brushite cement granulate
F. Tamimi*, J. Torres, I. Tresgeres, L. Blanc and E. Cabarcos
Estom. III & Phys. Chem. II, Univ. Complutense, Spain
Biocompatible Brushite (DCPD) based cement decomposes in
physiological environments and is resorbed by the body. The
regenerating potential of DCPD cements has been studied when
they are applied in the form of a setting paste, but recently, its use
as granules has gained interest. The preparation of granules at low
temperature allows the encapsulation of active agents added during
the setting reaction. Moreover, the high surface/volume ratio of the
granules can increase their resorption rate and is appropriate for
drug delivery applications. We have synthesized and characterized
a novel DCPD cement that sets using glycolic acid. The diametral
tensile strength of this cement was 2.9 0.7 MPa and the mineral
composition consisted of DCPD (83%) and beta-tricalcium phosphate (17%). Granules were made up from the set cement and used
as bone grafting material on seven New Zealand adult rabbits in a
pilot study. Bilateral circular cranial defects 10-mm-diameter
1 mm-deep, were prepared in each rabbit. The defects were
surrounded with titanium rings (4 mm high) allowing only true
vertical bone regeneration. Test defects were lled with the novel
material and the contralaterals were left empty as negative
controls. After 4 weeks of the implantation, a considerable
cement resorption and signicant improvement in the bone mineral
density (201%) and bone neoformation (327%) was observed in

Histomorphometric studies on bone regeneration using

PRP
V. Burlui1, M. Gelbart2, I. Baciu*,1 and C. Borta1
1
UMF IASI, Romania, 2New York, USA
Regenerative medicine techniques found a wide ground of application in oral implantology. The purpose of this study was to
observe the performance of an organic bone matrix coated with the
cell binding peptide P-15 (PepGen P-15) in combination with
DFDBA, PepGen P-15 Flow or PRP. A histomorphometric
analysis was performed on 12 patients for reconstruction of 15
maxillary sinuses.
Materials and method: The patient age range was 2365 and
smokers were included. Three mixtures were compared: mixture1:
50% PepGen P)15 + 50% DFDBA; mixture 2: PepGen
P)15 + PepGen P-15 Flow and mixture 3: PepGen P)15
s + PRP. In each mixture, 1015% autogenous bone was
included. A total of 15 crestal biopsies were taken after a 4 or
5 month healing time, stained with Stevenels blue and Van
Giesons picro fuchsin and analysed histomorphometrically.
Results: In all cases, the histology demonstrated that when
PepGen P-15 granules are mixed with DFDBA or PepGen P-15
Flow, the granules are interconnected by bridges of newly formed
vital bone. No inammatory or foreign body response was
observed. In contrast, interconnected bone bridges were not
observed in grafts containing PepGen P-l 5 plus PRP in the
absence of a spacer material.
Conclusions: Optimal bone formation requires PepGen P-15
combined with a spacer material (DFDBA or a hydro gel).
PepGen P-15 combined with PRP did not substantially speed the
bone formation process in the absence of a spacer material.

49

Oral session: Implant therapy

Oral session: Implant therapy

Registration of implant sites on a 3D CT image using a
novel tactile bone surface mapping and registration
technique

Conclusions The volume of a 4 10 implant is 1.25 cc. Bilateral

sinus augmentation requires approximately 5.00 cc of bone.
Plausibly, an average of 6.70 cc of bone, can be harvested from
mandibular symphysis and rami.

H. Tal*, M. Shohat and K. Schicho

Tel Aviv University, Hebrew University, Jerusalem
Three-dimensional visualization of a virtual implant and a
co-located jaw enables the selection of the most suitable implant
site, direction, and dimension. The study investigated a novel
computerized navigated implant system which is based on a
miniature intra-oral stent (ILS) that extracts tactile information,
maps the jaw surface, and performs registration onto a reconstructed 3D jaw image.
Materials and methods: CT scans were taken from six edentulous
fabricated human jaw replica models. A reference ILS frame was
rmly attached to the models. ILS tactile sensors comprised of a
micro-needle array were attached to the reference frame. Upon
activation, the needle beam was inserted into the mucosa until jaw
cortex was reached. Following sounding, a computerized surfacematching algorithm was applied to co-locate and register the CT
image and the measured jaw outline. Least squared estimation test
and Pearson chi-square test were used to analyse and validate
image registration accuracies and extract the cross-correlation
between those and the metric values respectively.
Results: Mean registration error for all measurements was
0.4 mm 0.2 mm. A signicant correlation was found between
metric values for post-convergence and registration accuracies
(Rv = 0.223, P < 0.004).
Conclusions: The ILS system can accurately map jaw surfaces by
performing tactile bone sounding. A corresponding computerized
surface matching procedure presents accurate and repeatable image
registration.

Computer-aided quantification of mandibular osseous

graft for sinus augmentation
F. Verdugo*, K. Simonian and R. S. Mac Donald et al.
Univ. of Southern California, CA, USA
Background: The quantity of intra-oral osseous transplants
necessary for sinus augmentation has not been determined. A
pre-surgical measurement methodology has not been established
Objective To quantify the osseous volume that can be harvested to
bilaterally augment a patients maxillary sinuses.
Methods Computerized axial tomography (CAT) scan images
from symphysis & rami (n = 40) were mapped by computeraided design software program (AutoCAD). Safety margins of
5 mm were outlined. After importing the CAT scan images into the
AutoCAD le, each 1 mm cut was mapped by a polyline. The
volume was calculated by adding the consecutive cuts. A 0.5 mL
graduated cylinder was used for intra-surgical measurements
(n = 12). Measurements of the augmented sinuses were made to
calculate the gain in volume at 6 months.
Results The mean symphysis volume excluding the lingual cortex
was 1.42 cc (SD = 0.56; range = 0.542.71). The mean ramus
volume was 0.79 cc (SD = 0.20; range = 0.421.22). Intrasurgically, the ramus volume averaged 2.30 cc per site (SD =
0.43; range = 1.803.00) and the symphysis 2.10 cc (SD = 0.38;
range = 1.702.80). This would yield a total of 4.60 cc (rami) +
2.10 cc (symphysis) = 6.70 cc. The osseous gain in sinus volume at
6 months averaged 1.88 cc (SD = 0.45; range = 1.312.60).

50

Histological evaluation of bovine-derived bone

xenograft in alveolar ridge augmentation prior to
implant placement
D. Murnane*, M. Toner, S. Renvert, D. Ryan and N. Claffey
Dublin Dental Hospital, Kristianstad University, Ireland
This study was designed to evaluate the histological changes at 8
and 12 months after the insertion of bovine bone xenografts (BioOss Geistlich, Pharma A G, Wolhusen, Switzerland) in future
implant sites of the anterior maxilla. A total of 14 sites in 13
patients were examined. Bone cores were trephined out at the time
of implant placement at 8 months and 3 mm punch biopsies were
taken of the grafted sites at 12 months during second stage implant
surgery. Ground sections were prepared from biopsies taken of the
grafted sites and examined histologically in order to assess new
bone growth as well as degradation of bovine bone xenografts. The
data were analysed using a Wilcoxon/ Kruskal-Wallis Rank Sums
test. The medians (interquartile ranges) of area measurements for
bovine bone xenografts in specimens as a percentage of the total
area of specimen were 13.93 mm2 (11.83) at 8 months and
8.37 mm2 (12.50) at 12 months (P 0.001). The median (interquartile range) for area of new bone in specimens at 8 months as a
percentage of total specimen area was 17.60 mm2 (22.65) compared
to 35.64 mm2 (30.74) at 12 months (P 0.001). The results of this
study suggest there was an increase in area of new bone in
specimens between 8 and 12 months and a decrease in graft
material over the same period. Although appreciable amounts of
graft material persisted at 12 months, all implants were integrated
and successfully restored.

Vertical ridge augmentation using composite bovine

bone mineral, fibrin sealer and collagen
membrane: clinical and histological findings
D. Cardaropoli*,1 and G. Cardaropoli2
1
Priv Practice, Torino, Italy 2Gotheborg Univ., Gothenborg, Sweden
The deciency of crestal bone height may result in the need for
supracrestal bone regeneration in order to have a proper threedimensional implant placement. In this study a protocol for the
treatment of reduced alveolar ridges was evaluated. In 16 patients,
24 endosseous implants presenting supracrestal bone defects were
placed. Vertical ridge augmentation was performed by the combination of a composite bovine xenograft (Bio-Oss Collagen)
stabilized with a brin seal (Tissucol) and covered by a porcine
collagen membrane (BioGide). After implant placement, the
mean height of supracrestal defects measured 3.06 1.70 mm.
Healing at the surgical zones was uneventful in all cases. Secondstage surgery was performed after 4 to 6 months. At the re-entry, a
hard bone-like tissue was detectable at the defect sites. Histologic
examination performed on one site conrmed the presence of newly
formed bone and revealed residual embedded particles of bovine
bone mineral. A nal mean gain of 2.58 1.79 mm in the vertical
defects was reported, corresponding to 83.96 24.59% of regenerated tissue. The present study reported the possibility of
obtaining supracrestal bone regeneration around osseointegrated

Oral session: Implant therapy

implants using a mixture of bovine bone mineral and brin glue
covered by a collagen membrane. The surgical procedure proposed
was able to stabilize the blood clot, maintaining the space for bone
regeneration and minimizing the risk for membrane exposure.

Ridge augmentation with periodontal regeneration

P. Windisch*, D. Sz-Kiss, A. Horvath, Z. Suba, I. Gera and A. Sculean
SE Dep. Maxillofac & Period. Hun & Nijmegen, The Netherlands
Background: Itrabony defects are treated by GTR. Horizontal
defects are the least predictable in regenerative treatment. Various
techniques exist to augment alveolar ridges before implant
placement. The aim of our study was to develop a one-step
surgical protocol for ridge augmentation and regeneration of
intrabony and horizontal defects of adjacent teeth.
Methods: Eight patients with inadequate alveolar ridge around
teeth presenting CAL 5 mm were included. Intrabony and
horizontal components of the defects were lled with natural
bone mineral (NBM) and covered with barrier membrane. Sub
epithelial connective tissue graft (SCTG) was sutured to the oral
ap. Core biopsies were retrieved 820 months later. Periodontal
probing depth (PPD), gingival recession (GR), clinical attachment
level (CAL), depth of intrabony defects (INTRA) and horizontal
bone loss (SUPRA) were measured at baseline and re-entry.
Results: Mean PPD reduction was 4.2 1.9 mm, mean CAL gain
was 4.8 2.0 mm. Intrabony components lled in all cases,
SUPRA levels were reduced by 3.2 1.8 mm, GR by 0.4
1.8 mm. The majority of NBM particles were surrounded by new
bone and osteoid tissue. Histomorphometry showed a mean new
bone formation of 23.6 7.1% and a mean graft area of
17.3 3.9%.
Conclusions: Our ndings indicate that grafting with
NBM + GTR + SCTG is a novel technique for simultaneous
ridge augmentation and periodontal regeneration of adjacent teeth.

Ribose-crosslinked collagen membranes are more

effective then ePTFE membranes in supporting bone
augmentation in humans: a morphometric study
S. Pitaru*,1, A. Friedmann2 and L. Meidan1 et al.
1
Tel Aviv Univ, Israel, 2Humboldt Univ, Berlin, Germany
The ecacy of absorbable collagen membranes in GBR depends
on their resistance to collagenolysis. Ribose is a novel non-toxic
agent for cross-linking collagen matrices and increasing their
resistance to degradation. This study was aimed to quantify the
capacity of ribose-crosslinked collagen membranes - Ossix to
support new bone formation in a lateral ridge augmentation
model in humans in comparison to that of ePTFE Gor-TexTM
membranes. 28 patients (14 in each group) were treated
randomly with either Ossix or Gor-Tex membranes. BioOssTM
served as a ller material. Impressions of preop and postop
alveolar ridges (AR) were obtained at an interval of 6 months.
These were cast in acrylic. An acrylic stent supported by the
residual dentition was glued to each cast. Reference marks on the
stent were used to obtain 1 mm thick bucco-lingual sections of
preop and postop casts at identical sites. The sections served to
determine changes in the AR height, width and volume. The
morphometric analysis indicated that: (1) the preop and postop
AR heights remained unchanged in both groups; (2) the mean
preop AR width did not dier between the 2 groups; (3) there
was a signicant increase in the postop AR width and bone
volume in the Ossix group compared to the preop AR in this
group and to the postop AR width in the Gor-Tex group
(P < 0.05). The results indicate for the rst time that the ribose-

crosslinked collagen membranes were more eective than ePTFE

ones in supporting GBR in humans.

The effect of platelet-rich plasma (PRP) on the bone

healing around cap coated and non-coated oral
implants in trabecular bone
D. Nikolidakis*, P. Stoelinga and J. Jansen et al.
Periodont, Oral-Max Surg, RUMC Nijmegen, The Netherlands
Platelet rich plasma (PRP), a autogenous volume of high platelet
concentration and a proven source of growth factors, has been
suggested for use in conjunction with dental implant placement.
The eect of local application of autologous PRP on bone healing
combined with titanium (Ti) implants with two dierent surface
congurations was investigated. PRP fractions were obtained from
venous blood sample of six goats and applied via gel preparation
and subsequent installation in the implant site, or via dipping of the
implant in PRP liquid before insertion. A total of 36 implants (18
non-coated and 18 CaP-coated) were placed into the goat femoral
condyles (trabecular bone). The animals were sacriced at 6 weeks
after implantation and implants with surrounding tissue were
processed for light microscopical evaluation. Besides histological
description, histomorphometrical variables were also evaluated
(the bone-implant contact and the bone mass adjacent to the
implant). Signicantly more interfacial bone contact was observed
for all the three groups of CaP-coated implants and the Ti/liquid
group (non-coated implant with PRP liquid) compared to the other
two non-coated Ti groups (with PRP gel or without PRP). The
additional use of PRP did not oer any signicant eect on the
bone response to the Ca-P coated implants, while PRP in a liquid
form showed a signicant eect on bone apposition to roughened
titanium implants during the early post-implantation healing
phase.

Trans-gingival implant design for immediate loading: a

prospective human study
E. E. Machtei, S. Frankental* and K. Horwitz
Rambam Med Ctre & Technion Faculty Medicine, Israel
Immediate loading of dental implants has gained considerable
attention. Two-piece implants designs were utilized for this purpose.
The aim of the present prospective study was to examine the ecacy
and success of transgingival implants design (3I Osseotite TG) in
an immediate loading protocol. 15 consecutively treated subjects
received 38 dental implants that were immediately restored (1SIL).
Solid abutments were connected and a prefabricated metal
reinforced acrylic restoration cemented. Implants survival rate,
radiographic bone loss (using computerized measuring software),
and implants stability (Periotest) were examined quarterly at
baseline until 12 months. Five implants failed during the healing
period, which amounts to an overall 86.8% survival rate. Mean
bone height (BC to implant) was 1.16 0.5 & 2.52 0.7 mm 0 &
12 M respectively (BL = 1.36 0.2 mm; P < 0.05). There was a
positive (r = 0.435) and sig. (P < 0.05) correlation between initial
bone height and eventual bone loss. To the contrary, we could not
nd any correlation between implants stability, length, diameter or
bone width and BL in the rst year. Pocket depth at 12 M, was sig.
shallower in single crown versus bridge restoration (2.17 0.1 vs.
3.2 0.2 mm; P = 0.01). Finally, the overall time for this
procedure was markedly reduced compared with previous experience with two-piece implants design.
In conclusion: A simplied 1SIL protocol using non-submerged
implant design was proven predictable and time consuming.

51

Oral session: Periodontal regeneration

Oral session: Periodontal regeneration

Orthodontic movement into infrabony defects
augmented with a composite bovine xenograft: clinical
and radiological results

performed either with EMD alone or EMD + BG resulted in

signicant clinical and radiographical improvements, but
combined treatment seems to enhance the results in the treatment
of wide intrabony defects.

D. Cardaropoli* et al.
Private Practice, Torino, Italy
Periodontal disease may create infrabony pockets adjacent to
pathologically migrated teeth. In these situations an interdisciplinary approach can be useful. Aim of the present work is to evaluate
the modications caused by orthodontic movement into infrabony
pockets lled with bone grafts. Ten adult periodontal patients,
presenting pathologic migration of a maxillary central incisor with
the presence of a bony defect, were treated. At baseline, PPD and
CAL were measured and, on standardized intraoral radiograms,
the vertical (RVBD) and the horizontal (RHBD) dimensions of the
infrabony defects were assessed. The aps were elevated according
to the modied papilla preservation technique and the defects were
lled with a composite bovine xenograft (BioOss Collagen). After
two weeks the orthodontic movement started in order to move the
teeth into the defects. 6 months after the end of the orthodontic
therapy the nal assessment of PPD, CAL, RVBD and RHBD was
recorded. At baseline mean PPD and CAL were 7.2 and 8.95 mm.
Mean nal PPD was 3.1 mm, with a CAL gain of 5.05 mm. The
radiological resolution of the original defects dimension was
72.63% in the vertical and 73.68% in the horizontal component.
Plaque control was optimal at all sites and no bleeding on probing
was reported. From a clinical and radiological point of view all
patients beneted from the treatment performed, obtaining pockets
closure and healthy periodontal conditions together with aesthetic
improvement.

Enamel matrix protein derivative alone or in

combination with a bioactive glass in the treatment of
wide intrabony periodontal defects
Arg`n, Ylmaz, Noyan and B. Kuru*
Yeditepe Un, Marmara Un, IST, Turkiye
This study aims to assess the clinical and radiographic outcome of
wide intrabony periodontal defects treated by EMD alone or in
combination with a bioactive glass (BG). Twenty-three patients
who received non-surgical periodontal therapy and had radiographical interproximal defects with an associated probing depth
(PD) of 6 and an intrabony component of 4 mm, were included
in this controlled parallel design study. Each of the patient was
treated with either EMD alone or EMD + BG. Clinical and
radiographic measurements for a total of 40 defects (20 in each
group) were performed at baseline and 8 months following
therapy. No adverse event related to the use of EMD was noted.
In both groups clinical and radiographical parameters were
improved at 8 months when compared with baseline
(P < 0.001). The groups EMD + BG and EMD alone, presented
a mean PD reduction of 5.55 mm and 4.98 mm, recession of
0.63 mm and 0.94 mm, attachment gain of 4.87 mm and 4.03 mm,
clinical bone gain of 2.48 mm and 2.13 mm and radiographic bone
gain of 2.68 mm and 2.15 mm, respectively. Intergroup comparison revealed also signicant dierences for all of the parameters,
yielding a more favourable outcome towards the combined
approach. Within the limits of the study, both treatments

52

Treatment of intrabony defects with emdogain alone,

emdogain + cerasorb and modified widman flap
surgery.comparison of 1-year outcomes
I. Bokan*, J. S. Bill and U. Schlagenhauf
Private period. practice; Univ. Wuerzburg, Germany
Aim: This controlled clinical trial was designed to compare
dierent treatments of deep intraosseous defects up to
12 months
follow-up: EMD alone, EMD + -tricalciumphosphate (Cerasorb), MWF surgery.
Materials and methods: Fifty-six patients were paralleled for
clinical parameters and randomly assigned to treatment. They
displayed one angular defect each with an intrabony component
3 mm, PPD and PAL 7 mm and PI < 1. Nineteen defects were
treated respectively with EMD + Cerasorb or EMD alone using
micro-surgical approach and 18 defects with MWF. PI, Gi, BOP,
PPD, PAL and REC were measured before and 12 months after
treatment.
Results: Signicant PPD decreases and PAL gains were proved in
all treatment-groups after 1 year. Combined treatment produced
4.1 1.2 mm mean PPD reduction and 4.0 1.0 mm PAL gain
(P < 0.001). Treatment using EMD alone yielded 3.9 1.3 mm
PPD decrease and 3.7 1.0 mm PAL gain (P < 0.001). Outcome
parameters were not signicantly dierent between the EMD
groups, recessions increased by 0.7 1.3 mm. Following MWF,
gained attachment was signicantly smaller (2.1 1.4 mm;
P < 0.001). PPD reduction was not signicantly dierent
(3.8 1.8 mm), while recessions increased by 1.5 0.7 mm
(P = 0.042 vs. EMD).
Conclusions: Limited to this study: Additional use of the bone
replacement graft material Cerasorb is not supported by our
results. The clinical use of EMD clearly appears to be a more
eective therapy modality than MWF surgery in the treatment of
intrabony defects.

Enamel matrix proteins combined with bone grafts in

smoker and non-smoker aggressive periodontitis
patients
D. Noyun*, Yilmaz, Kuru, Noyan, Ipci and Sculean
Yeditepe, Marmara Un, IST, Trkiye, Radboud Un, NL
The purpose of this study was to assess the eect of smoking on
regenerative periodontal treatment in generalized aggressive periodontitis (GAP) patients. A total of 20 GAP patients, 10 smokers
(S) and 10 non-smokers (NS) were included in this study. In every
patient, enamel matrix protein derivatives (EMD) and bovine
derived xenograft (BDX) (EMD + BDX) and EMD and bioactive glass (BG) (EMD + BG) combinations were used in either
maxilla or mandible. Prior to surgery and at 8 months, plaque and
sulcus bleeding indices, probing depth (PD), relative attachment
and probing bone levels were measured. At 8 months, the mean
PD reductions in S in the EMD+BDX and EMD+BG groups
were 3.17 1.07 mm and 3.16 1.30 mm (P < 0.05), whereas

Oral session: Periodontal regeneration

in NS these reductions were 3.69 1.18 mm and
3.45 0.96 mm (P < 0.01), respectively. The changes in relative
attachment levels in S in the EMD + BDX and EMD + BG
groups were 1.90 0.61 mm and 1.80 0.69 mm (P < 0.05),
whereas in NS these changes were 2.13 0.64 mm and
1.89 0.72 mm (P < 0.01), respectively. Evaluation of the hard
tissue ndings revealed that the mean clinical bone gain in S and
NS was 0.95 0.33 mm (P < 0.05) and 1.05 0.31 mm
(P < 0.01) in the EMD + BDX group whereas it was
0.92 0.31 mm (P < 0.05) and 1.07 0.25 mm (P < 0.01) in
the EMD + BG group. Intergroup dierences for all clinical
parameters were found to be insignicant in S and NS. Within the
limits of this study, similar clinical improvements were obtained in
both S and NS.

group F. Smoking, frequency of dental visits and plaque on the

treated site at the 1- and 6-year examination did not seem to
inuence the amount of PAL gain after 6 years or the occurrence
of PAL loss 1 mm or 2 mm from 1- to 6 years. In the three
GTR groups, 12 teeth lost 1 mm and 6 teeth lost 2 mm of the
PAL gain obtained after treatment, and three teeth were lost at
the 6-year examination. It can be concluded that the results of
GTR in combination with Bio-Oss are basically stable on a longterm basis.

Regenerative periodontal therapy with tutodent chips

and tutodent membrane
G. Chiantella*, M. Berakdar, R. Junker and A. Sculean
Univ. Nijmegen, NL, Univ. Mainz, GE

Regenerative periodontal surgery with enamel matrix

derivate. Baseline radiographic defect angle as a
prognostic indicator
S. Mrtu*, V. Burlui and I. Rudnic
University of Medicine, Iasi, Romania
Aims: The aim of this study was investigate whether an association
exists between baseline radiographic defect angle and treatment
autcome when enamel matrix derivate (EMD) is used in
periodontal regenerative surgery.
Materials and methods: The study was realized on 30 patients who
had pair test sites and control sites, with pockets 6 mm and infraosseous defects with depth 3 mm measured by probing and X-ray
evaluation radiographic defect angle was 22
than when it was
36
.
Results: The average values of the clinical attachment level (CAL)
in the test sites were 1.8 mm at 6 months and 2.1 mm after
12 months, for the group with EMDOGAIN, 1.1 mm at
6 months and 1.2 mm at 12 months for the control group. The
radiographic gain was ascertained after 12 months.
Conclusions: This study showed that there was a signicant
association between baseline radiographic defect angle and CAL
gain of 4 mm after regenerative surgery with EMD is used in
narrow ( 22
) intrabony defects suggests that the baseline
radiographic defect angle might be used as a prognostic
indicators of treatment outcome.

The purpose of the present study was to compare clinically the

treatment of intrabony defects with a combination of a bovine
derived xenograft (Tutodent Chips, Tutogen, Germany) and a
bioresorbable collagen membrane (Tutodent, Tutogen, Germany)
(test) to access ap surgery (control). 22 patients each of whom
displayed one intrabony defect received either the test or the
control therapy. The results were evaluated at 6 months following
therapy. Healing was uneventful in all patients. At 6 months after
therapy the test group showed a reduction in mean probing depth
(PD) from 8.5 1.4 mm to 2.7 1.5 mm (P < 0.001) and a
change in mean clinical attachment level (CAL) from
9.7 1.6 mm to 5.6 1.4 mm (P < 0.0001). In the control
group mean PD was reduced from 8.2 1.2 mm to 4.5 1.9 mm
(P < 0.001) and mean CAL changed from 9.8 1.8 mm to
8.0 1.9 mm (P < 0.01). The test treatment resulted in statistically higher PD reductions (P<0.05) and CAL gains (P < 0.001)
than the control one. It was concluded that the combination of a
bovine derived xenograft and a bioresorbable collagen membrane
appears to be a suitable alternative for treating intrabony periodontal defects.

Ostim for the treatment of intrabony periodontal

defects: a randomized controlled clinical study
B. Heinz*,1 and S. Jepsen2
1
Private Practice Hamburg, 2Univ. Bonn, Germany

Guided tissue regeneration in combination with

deproteinized bovine bone. 6-year results from a
randomized controlled clinical trial
A. Stavropoulos* and T. Karring
Dept. of Perio, Royal Dental College, Aarhus, DK
The present study reports the results of GTR in combination with
Bio-Oss in the treatment of human intrabony defects, 1- and
6 years after surgery. 60 patients with an intrabony defect with
PPD 7 mm and radiographic evidence of an intraosseous
component 4 mm were treated either with a bioabsorbable
membrane (M), or with a bioabsorbable membrane in combination with Bio-Oss impregnated either with sterile saline (BO-) or
with gentamicin sulphate 2% (BO+), or with ap surgery alone
(F). Statistically signicant clinical improvements were observed in
all four groups after 1 year, but treatment modality did not seem
to inuence the amount of residual PPD and PAL gain (M:
2.9 mm, BO-: 2.5 mm, BO+: 3.8 mm, F: 1.5 mm). These clinical
improvements remained basically stable in the 3 GTR groups, but
not in group F. At the 6-year examination (42 patients), PAL gain
was 2.4 mm, 2.3 mm, 4.1 mm in M, BO-, BO+ groups, respectively; a PAL loss of 1.2 mm compared to baseline was observed in

Objective: The aim of the present randomized controlled clinical

study was to compare the clinical outcomes of papilla preservation
ap surgery with or without the application of a novel
nanocrystalline hydroxyapatite bone substitute.
Material and methods: Twenty-four intrabony periodontal defects
in 12 adult patients with chronic periodontitis were included. In a
split-mouth design defects ( 4 mm) were randomly assigned to
receive Ostim (Heraeus Kulzer, Hanau, Germany) or open ap
debridement (OFD). At baseline and during surgery probing
pocket depths (PPD) and vertical bone level (BL) were measured
from a customized acrylic stent. Six months following surgery PPD
and BL (by vertical bone sounding) were assessed again.
Results: A statistical signicant improvement over time for PPD
and BL was detected in both groups. The test group (Ostim)
exhibited statistically signicant greater changes compared to the
control sites (OFD) in probing depth reduction: 8.3 + 1.2 to
4.0 1.1 mm vs. 7.9 1.2 to 5.1 1.2 mm (P < 0.05) and
vertical bone gain: 4.0 1.0 vs. 2.8 1.4 mm (P < 0.05).
Conclusions: Treatment
with
a
novel
nanocrystalline
hydroxyapatite compared to open ap debridement led to
signicant more favourable clinical improvements in intrabony
periodontal defects.

53

Posters: Aetiology and pathogenesis

POSTERS
Aetiology and pathogenesis
1
Salivary interleukin 6 and tumour necrosis factor alpha
in periodontal disease
V. Vucicevic-Boras2, V. Brailo*,1, D. Bozic3 and J. Lukac4
1
SchDentMed, Univ Zagreb, 2Clin Univ Hospital, Croatia
Periodontal disease is a chronic inammatory disease related
closely to the bacteria, host responses and genetics. However, its
clear ethiopathogenesis still remains unclear. Cytokines have been
known to have tremendous inuence on oral diseases as well as
periodontal disease. The aim of this study was to evaluate
salivary interleukin 6 and tumour necrosis factor a levels in
patients with periodontal disease as it is known that cytokines are
the key mediators of the host response to antigens. Study group
consisted of 27 participants (18 males and 9 females), age range
2862 yrs, mean 37.2 yrs. The control group consisted of 37
controls, age range 2765 yrs; mean 39.3 yrs. Enzyme-linked
immunoassay was used to determine the concentration of IL-6
and TNF-a in the whole saliva. Statistical analysis was done by
use of Student t test and values below 0.05 were considered as
signicant. Levels of salivary IL-6 were signicantly increased in
patients with periodontal disease when compared to the control
group (P = 0.041). Levels of salivary TNF-a did not dier
between patients and controls (P = 0.88). We might conclude
that salivary IL-6 plays more important role in periodontal
disease than TNF-a and their action is not synergistic as it was
previously taught.

2
Development of coronal periodontum in dental eruption
M. Naverac*, A. Caballero, F. Albalat, A. Carrasquer and F. Alpiste
Department of Periodontics. Univ. Valencia. Spain
The periodontum establishes a functional unit that experiences
modications with age. These modications are given in the
process of teeth eruption, until periodontum reaches the morphology and proper structure of the adult.
Aim: To examine the dimensional changes occur in dierent
structures of coronal periodontum, so much to level of soft as hard
tissues during the eruption of 1.1 teeth.
Material and methods: One hundred and four children (6 to
11 years) with the upper central incisor teeth permanent whole or
partially erupcionated. Variables: probing gingival sulcus, gingival
band width, clinical crown length, distance between CEJ and bone
crest, biologic width dimension, thickness of connective
attachment, gingival overlapping the enamel surface, and length
of anatomical crown using the parallel prole radiograph
technique (Alpiste, 1999).
Results: Depending on the age, is observed a statistically
signicant decrease of the dimension of the gingival band width
(P < 0.016), in the depth of the sulcus (P < 0.001) and in the
gingival overlapping the enamel surface (P < 0.001). It increases
in a statistically signicant way the dimension of the clinical crown
(P < 0.001). Statistically signicant changes perceive neither for

54

the biological space nor for the distance among CEJ and bone
crest.
Conclusions: Changes are produced in the level of soft tissues. The
dimension of the biological space does not show a clear trend to
change with the age and it might be determined before the tooth
begins the eruption.

3
IL-1b production in CD14-positive cells is affected by
FCG receptor genotype
K. Yamamoto*, T. Kobayashi, and N. Sugita et al.
Periodontology, Niigata Univ., Japan
Background: Functional
bi-allelic
polymorphism
of
immunoglobulin G (IgG) Fcc receptor IIa (FccRIIa-R/H131) has
been shown as a genetic risk factor for periodontitis. FccRIIa is
most expressed on mononuclear cells, and is also considered
important to regulate production of inammatory cytokine such as
IL-1b. The aim of this study is to examine whether IL-1b
production in mononuclear cell upon IgG-FccR cross-linking is
aected by FccRIIa genotypes.
Methods: Peripheral blood mononuclear cells (PBMCs) were
obtained from volunteers who had undergone the FccRIIa.
PBMCs were stimulated with heat aggregated human IgG1 and
IgG2, and then stained with phycoerythrin-conjugated anti-CD14
monoclonal antibodies. The expressions of CD32 on CD14 positive
cells and the intercellular expressions of IL-1b within CD14positive cells were assessed by ow cytometry.
Results: We found an increase in the percentage of IL-1b
producing CD14-positive cells in a dose dependent manner. The
percentage of IL-1b producing CD14-positive cells was increased
with an incubation time. CD32 expression level on CD14-positive
cells was not dierent among FccRIIa genotypes. There was a
dierence in levels of IL-1b producing-cells between the FccRIIaH/H131 and -R/H131, FccRIIa-H/H131 and -R/R131 genotypes.
Conclusions: These results support the concept that FccRIIa
genotype may aect IL-1b production in mononuclear cells,
possibly leading to inter-individual dierences in susceptibility to
periodontitis.

4
Actinobacillus actinomycetemcomitans,
porphyromonas and pigmented prevotella in
subgingival microflora of children with primary and
mixed dentition
N. Topcuoglu*, F. Keskin, S. Ciftci and G. Kulekci
Istanbul University, Turkey
Although associated with periodontal diseases in adults, little is
known about the presence of Actinobacillus actinomycetemcomitans, Porphyromonas and pigmented Prevotella species in children. The purpose of this study was to examine subgingival
microora of 100 children aged 311 years with primary (n = 50)

Posters: Aetiology and pathogenesis

and mixed dentition (n = 50) for the presence of these bacteria
determining their periodontal health. The subgingival samples
were investigated using continuous anaerobic culture techniques
and the bacteria identication has been veried by enzyme
proles and biochemical characteristics. Prevotella intermedia and
Prevotella nigrescens have been dierentiated by Polymerase
Chain Reaction (PCR) technique using species specic 16 S
rRNA primers. A. actinomycetemcomitans and Porphyromonas
species were not detected. The frequency of P. nigrescens was
increased with age (MannWhitney U-test, P < 0.05) and this
was statistically higher at mixed dentition then at the primary
dentition (Chi-square test, P < 0.05). Bleeding on probing,
associated with gingivitis, was correlated only with P. intermedia
among the other Prevotella species studied. Thus, we concluded
that P. intermedia, which is associated with periodontal diseases
in adults should be considered as indicator bacterium for
children, as well.
This study was supported by the Research Fund of the University
of Istanbul. Project number: T-1027/19022001.

5
Subgingival microbiota in aggressive and chronic
periodontitis Colombian subjects
A. Jaramillo, R. Arce, J. Botero, G. Lafaurie and A. Contreras*
University of Valle-University el Bosque-Colombia
Background: Control of microorganisms in dental biolm is one of
the goals of periodontal therapy, so it is important to establish the
subgingival microbiota of Colombian patients.
Methods: Subgingival samples of 128 Colombian subjects with
localized aggressive (LAP) (n = 20), generalized aggressive (GAP)
(n = 40) and chronic periodontitis (CP) (n = 68) were obtained,
and periodontopathic and some opportunistic organisms were
cultured and identied.
Results: Frequencies of most prevalent pathogens identied were:
Fusobacterium spp (75.8%), P.gingivalis (64.1%), P.intermedia/
nigrescens (53.9%), D.pneumosintes (34.4%), A.actinomycetemcomitans (32.8%) and Gram-negative enteric rods (32%). 42% of
patients with GAP, 30% with LAP and 28% with CP resulted
positive for A.actinomycetemcomitans. P.gingivalis was found in
85% of GAP patients, 50% of LAP and 55.9% of CP (P 0.05).
P. micros was recovered from 41% of CP patients, 35% of LAP
and 17% of GAP (P 0.05). Gram-negative enteric rods were
prevalent in all clinical periodontal conditions evaluated.
Conclusions: Microbial prole of Colombian LAP was found
dierent from North American and European reports that have
shown a high prevalence of A. actinomycetemcomitans. Ethnical
dierences may account in part to the diverse subgingival
microbial proles showed among Colombian subjects with
periodontitis. More studies of microbiology and prevalence of
aggressive and chronic periodontitis are needed in South
American populations.

6
Cyclosporin-induced gingival overgrowth reveals
elevated gene expression for MMP-1, MMP-10 and
TIMP-1
B. Dannewitz*, C. Edrich and P. Tomakidi et al.
Univ. Heidelberg, Univ. Frankfurt, Germany
Aims: In humans, it has been shown that treatment with the
immunosupressant drug cyclosporin A (CsA) leads to increased
levels of brillar extracellular matrix (ECM) type-1 collagen in the

connective tissue of CsA-induced gingival overgrowth (GO). CsA

also up-regulates gene expression of type-III collagen and
proteoglycans (PG). In this context it still remains unclear
whether this increase is associated with alter-ations of molecules
involved in the turnover of collagens and PG.
Material and methods: The present study explores the status of
MMP-1 and -10 and their tissue inhibitor TIMP-1 on the gene
expression as well as on the protein level on frozen sections derived
from GO and normal tissue.
Results: In situ hybridization (ISH) revealed elevated levels of
MMP-1 gene expression in the epithelial compartment of GO
compared with normal tissue. This elevation also applied to MMP10, while MMP-10 gene transcription appeared generally stronger,
rather than that observed for MMP-1. For TIMP-1, transcription
levels were week in normal and strong in GO tissue. These
dierences detected in ISH were corroborated by quantitative
RT-PCR. Detection of the protein by indirect immunouorescence
showed that normal gingival tissue was devoid of all three proteins,
while they were detectable in GO tissue, with emphasis on TIMP-1.
Conclusions: Analysis of our data indicates that in addition to
MMP-1 and-10, particularly TIMP-1 may contribute to the
pathogenesis of CsA-induced GO.

7
Effect of antimicrobial agents on early and mature
biofilm in vitro
H. Takinami*,1, Y. Takeuchi2, A. Filieri1, and P. Baehni1
1
Univ. Geneva, Austria 2Tokyo Medical and Dental Univ, Japan
The aim of the study was to assess the eect of antimicrobial agents
on an in vitro dental biolm model using culture and confocal laser
scanning microscopy (CLSM). Saliva-coated hydroxyapatite discs
were incubated with oral bacteria including A. naeslundii (OMZ
745), F. nucleatum (ATCC 25586), S. oralis (OMZ 607), and
V. dispar (OMZ 493) in modied uid medium (mFUM) in
anaerobic conditions for 12 h (early biolm) or 72.5 h (mature
biolm). Biolms were exposed for 1 min to 0.2% triclosan (TRI),
0.2% chlorhexidine (CHX), 0.1% isopropyl methylphenol (IPMP),
0.05% cetylpyridinium chloride (CPC), or 10% ethanol (control) at
various time intervals. Bacteria were harvested and the total
number of CFUs was determined by culture. Specimens were
observed by CLSM following live/dead uorescence staining. 3D
images were reconstructed using Imaris 4.2 software. For early
biolm, TRI (1.9 109 CFU/mL), CHX (1.2 109), and IPMP
(1.2 109) resulted in a signicant decrease in CFUs compared to
controls (4.7 109). For mature biolm, a signicant reduction
was also observed with TRI (3.9 1012) and CHX (3.2 1012)
compared to controls (9.7 1013) but to a lesser extend with IPMP
(9.1 1012). CPC had little eect on both, early and mature
biolms. The eect of antimicrobials on bacterial vitality was
conrmed by CLSM observations. 3D analysis revealed that killing
occurred mostly in the supercial layers and that live bacteria were
still present in the deepest parts of biolms.

8
Differences in MMP-1 and MMP-8 gene and protein
expression patterns between chronic and aggressive
periodontitis
E. Pepelassi*, X. Dereka and C. Markopoulou et al.
School of Dentistry, University of Athens, Greece
In periodontitis patients, an imbalance between activated matrix
metalloproteinases (MMPs) and their inhibitors leads to break-

55

Posters: Aetiology and pathogenesis

down of extracellular matrix. MMP-1 and MMP-8 are implicated
in the destruction of extracellular matrix in periodontal disease.
The purpose of this study was the exploration of the expression
patterns of MMP-1 and MMP-8 mRNA and mature protein
levels in human gingival tissues from patients with chronic and
aggressive periodontitis. Gingival samples were harvested from
nine subjects: three with healthy and intact periodontium (C)
requiring surgical crown lengthening, three with chronic (CP) and
three with aggressive periodontitis (AP). Patients initially were
subjected to phase-I periodontal therapy and periodontal surgery.
Gingival specimens were harvested during periodontal surgery.
Gene expression was determined by using reverse polymerase
chain reaction assay (RT-PCR). Expression of MMP-1 and
MMP-8 at mature protein level was revealed by using Western
blot-analysis. AP subjects presented signicantly higher MMP-1
and -8 mRNA and mature protein levels (Fishers
exact Pvalue = 0.036). MMP-1 and -8 mRNA and mature protein levels
in gingival specimens from CP or C patients were so low that they
were barely detectable. These results revealed that MMP-1 and -8
mRNA and mature protein levels remained high after phase-I
periodontal treatment only for the AP group. This nding might
indicate a dierent response of the AP cases to phase-I
periodontal treatment.

initiating the production of eicosanoid mediators, namely prostaglandins and leukotriens. SPLA2 may be secreted either
constitutionally or as an acute-phase reactant upon stimulation
by proinammatory cytokines (IL-1a, IL-1b, TNFa) and endotoxins (LPS). In this study we have investigated the SPLA2
activity in gingival crevicular uid (GCF) in periodontal patients.
GCF samples were harvested from 15 subjects with moderate to
severe adult periodontitis and 15 healthy volunteers. All participants were in good health and none of them had received any
periodontal treatment or antibiotic therapy in the previous
6 months. Clinical measurements were recorded after obtaining
GCF samples.sPLA2 activity was investigated using the Schadlich
et al method. It was found to be calcium dependent and was
estimated in patients fourfold higher. GCF was subject to
chromatographic separation (HPLC). The SDS electrophoresis
revealed two bands of 15.6 and 14 kDa. These results suggest that
the increased SPLA2 activity in the GCF of periodontal patients
and, therefore, the higher levels of inammatory mediators
(prostaglandins, leukotriens) in conjunction with the direct
action of SPLA2 as an acute phase protein, may aggravate the
periodontal tissue damage. The different SPLA2 activity bands
could represent two molecules with different roles in the
inammatory process.

9
Expression of high mobility group box 1 (HMGB1) in
gingival epithelial cells
Y. Morimoto*, K. Kawahara, I. Maruyama and Y. Izumi
Kagoshima Univ., Japan
Aims: High mobility group box 1 (HMGB1), originally described
as a DNA-binding protein, can also be released extracellularly and
functions as a late mediator of inammatory responses. However,
its role in the periodontal eld remains unknown. The purpose of
this study was to demonstrate HMGB1 expression in gingival
tissue of periodontitis, and to identify the role of HMGB1 in the
pathogenesis of periodontal disease progression.
Materials & methods: In gingival tissue of the patients with
periodontitis, the protein expressions of HMGB1 and its
receptor, RAGE, were assessed using immunohistochemical
staining. The human gingival carcinoma cell line (Ca9-22) was
exposed to TNFa and HMGB1. The level of HMGB1 in
supernatant
of Ca9-22 was
conrmed
by Western
immunoblotting. The signalling pathway involved in the release
of HMGB1 were examined using the specic and potent MAPKs
inhibitor. The levels of IL-8 and IL-6 were quantied by ELISA.
Results: Immunostaining revealed the expressions of HMGB1 and
RAGE in the gingival epithelial tissue with chronic periodontitis.
TNFa triggered the release of HMGB1 from Ca9-22 cells in a doseand time-course dependent manner. The specic inhibitor of p38
but not ERK1/2 or JNKs signicantly reduced HMGB1 release.
Moreover, HMGB1 increased the secretions of IL-8 and IL-6 from
Ca9-22.
Discussion/conclusion: These results suggest that extracellular
HMGB1 may be a key player in the chronic periodontitis.

10
Implication of secretory phospholipase A2 (SPLA2) in
periodontal disease
G. Baltas*, M. K. Koropouli, C. P. Markakis and H. Kotsifaki
Dept.of Exp.Physiology, Medical School of Athens, Greece
Secretory phospholipase A2 (SPLA2) participates in inammatory
conditions, as it catalyses the release of arachidonic acid,

56

11
Antioxidant capacity and periodontal condition in
pregnant women
E. Baltacoglu*,1, F. A. Akaln2 and A. Alver1
1
Univ Karadeniz Tech, 2Hacettepe, Turkey
Pregnancy is a physiological state of oxidative stress arising from
increased oxygen requirement and placental mitochondrial activity. Evidence suggests pregnancy-oxidative stress, periodontitispreterm birth, periodontitis-oxidative stress links. To analyse
antioxidant (AO) defence-periodontal status relation in pregnants,
serum and gingival crevicular uid (GCF) total antioxidant
capacity (TAOC) and superoxide dismutase (SOD) concentrations
were compared with those of non-pregnant chronic periodontitis
(CP) patients. 33 pregnants with CP who were followed in 1., 3.
trimesters (PCP1, PCP3), 18 pregnants with gingivitis (PG1,
PG3), 27 CP and 25 control women were studied. After
measuring probing depth, clinical attachment level, gingival
bleeding, gingival and plaque indices, and samplings (1., 3.
trimesters in pregnants), TAOC and SOD were measured by
automated and spectrophotometric tests. Clinical parameters were
higher in pregnant and CP groups than were in controls, in PCP3
than in CP group and increased from 1. to 3. trimester in
pregnants (except plaque index) (P < 0.05). Serum and GCF
TAOC and SOD were lower in pregnants, the lowest in PCP3,
and the highest in controls and reduced from 1. to 3. trimester in
pregnants (P < 0.05). The ndings showed reduced systemic and
local AO defence in CP, greater AO reduction and worse
periodontal status in pregnants, suggesting oxidative stress an
important pathogenic mechanism of periodontal problemspreterm birth link in pregnancy.

Posters: Aetiology and pathogenesis

12
Salivary detection of Actinobacillus
actinomycetemcomitans, Prevotella intermedia and
Porphyromonas gingivalis from Portuguese adolescents
with PCR

14
Evaluation of major cigarette smoke components
acrolein and acetaldehyde in saliva.

C. Coelho*, M. Relvas, M. J. Gonalves and C. Velazco

I.S.C.S.N, Portugal

Background: The aim of this research was to evaluate the

concentration of acrolein and acetaldehyde, major components of
cigarette smoke, in the saliva of subjects recruited according to age
and number of cigarettes smoked per day.
Materials and methods: Two saliva samples, one taken before and
one after cigarette smoking, were collected from 186 subjects
divided into groups according to age and number of cigarette
smoked. Samples were analysed by capillary electrophoresis.
Results: Base levels of acrolein and acetaldehyde were found to be
signicantly higher in the saliva of smokers of all age cohorts. In
addition, the concentration of these aldehydes in saliva was found to
increase with the number of cigarettes smoked per day and with age.
Discussion: The authors developed a capillary electrophoretic
technique, recently published in Electrophoresis. Some authors
suggest that the higher concentration of acetaldehyde in the saliva of
smokers is due to an increase in its production caused by a variation
in the oral bacterial microora. According to others, smoke may
inhibit the enzyme ALDH, and acrolein itself could be responsible
for this inhibition. The increase in concentrations of acrolein and
acetaldehyde in saliva with increasing age and number of cigarettes
smoked suggests that the antioxidant power and enzyme activity of
saliva are altered as a function of these factors. Smoke salivainteraction may deplete saliva ecacy in protecting oral tissues.

A number of forms of periodontitis aecting adolescents are likely

to be inuenced by periodontal microora and competency of the
host response with saliva as the principal way of transmission. The
aim of this study was to assess the salivary presence of Actinobacillus actinomycetemcomitans (A.a.), Prevotella intermedia (P.i.)
and Porphyromonas gingivalis (P.g.) from systemically health
12 years old adolescents, using Multiplex PCR. 169 adolescents,
107 (63.3%) females and 62 (36.7%) males, contributed with
10 mL of saliva stimulated by paran wax. Samples were sent to
the laboratory, vortexed at the maximal setting and 1 mL of each,
transferred to an eppendorf tube. After centrifugation, the supernatant was discarded and 50 lL of TE 1x (Tris-EDTA) were added
to resuspend the pellet. Samples were frozen at )20
C until PCR
analysis. Of the 169 adolescents, 51 (47.7%) and 83 (77.6%) of
females, harboured respectively A.a. and P. i. 36 (58.1%)of males
were colonized by A.a. and 48 (77.4%) by P. i. The simultaneous
occurrence of A.a. and P. i. was detected from 50(46.7%) of
females and 35 (56.4%) of males. P.g. was not found in any sample.
These results suggests a high percentage of colonization by A. a.
and P. i. among these adolescents which can represents a risk factor
for periodontitis development and demonstrated the absence of P.
g., a later colonizer.

13
Synergistic action of periodontal pathogens on the
production of interleukin-1a
J. Fernandez*, N. Bostanci, R. Allaker, F. J. Hughes and I. J. Mckay
Barts & The London School of Med & Dentistry, London, UK
Objectives: To investigate the interaction of periodontal pathogens
in stimulating IL-1a production by monocytes.
Methods: Bacterial supernatants from cultures of P gingivalis,
F nucleatum, C rectus, A actinomycetemcomitans, P intermedia and
T denticola were collected for cell stimulations. E coli LPS was used
at 100 ng/mL as a positive control. The single supernatants or
mixtures were added (diluted 1:250 in media) to Monomac-6 cell
cultures (1 106 cells per mL) and incubated for 6 hours at 37
C.
The production of IL-1a was quantied by enzyme-linked
immunoassays.
Results: Supernatants from four species, Aa, Fn, Cr and Pi,
produced marked up-regulation of IL-1a levels (e.g. controls
6.29 0.079 pg/mL, Aa 5.66 91.4 pg/mL). In contrast
P gingivalis induced only small increases in IL-1a and T denticola
had no eects when used on its own. However, T denticola had
signicant synergistic eects when used in combination with other
pathogens. In particular, there was a dramatic increase in IL-1a
production with T denticola mixed with P gingivalis or P intermedia
(e.g. Pg only 52.28 0.23 pg/mL; Pg + Td 579.8 164.1
pg/mL). When combined with other species T denticola induced
relatively small changes.
Conclusions: This study conrms that some periodontal pathogens
may act to signicantly enhance the immune response triggered by
other bacterial species. This serves to emphasize the complex
nature of periodontal disease as a disease with involving
polymicrobial infection.

V. Cattaneo1, C. Rota*,1, P. Martegani1 and S. Viglio2 et al.

1
Dept. Period Univ. Pavia, 2Dept. Biochem. Univ. Pavia, Italy

15
The effectiveness of TACE inhibitor; new option for
treating periodontal inflammation
M. Machigashira*, S. Tancharoen and Y. Izumi et al.
Dept. of Perio, Kagoshima Univ., Kagoshima, Japan
TUMOR NECROSIS FACTOR-alpha: TNF-a is a proinammatoty cytokine, plays a pivotal role in the inammatory reaction. Its
precursor is cleaved by a metalloprotease named TNF-a-converting
enzyme (TACE) to generate the mature TNF-a.
Objective: Currently, intense eort underway to regulate the
eective treatment of periodontitis remains challenging due to
the complexity of this disease. To achieve this goal, we aimed to
generate a potent inammatory drug, TACE inhibitor to overcome
this heterogenicity disease where TNF-a is thought to be
pathologically indicated.
Results: TACE-immunopositively localize mainly in macrophages
and gingival broblast in inamed-gingival tissues. By means of
immunouorescence assay, TACE immunolocalize on cultured
human gingival broblast (HGF) as well as on human monocytic
cell line (HL-60). The TACE inhibitor eliminates kinetics of LPSinduced TNF-a secretion beginning from 100-nanomolar
concentrations by ELISA. The inhibitor of TACE prevents the
cleavage of HGF-bound TNF-a in a dose-dependent manner with
an IC50 of 1.0x10-7 M.
Conclusion: TACE inhibitor may be eective to inhibit TNF-a
production on inamed gingival tissue. TACE inhibitor appears to
be an attractive target for treating human periodontitis.

16
Semiquantitative analysis of the tight junction
associated claudin 1, 4, 7 in healthy human gingiva
P. Valyi*, K. Bgi, G. Seprenyi and A. Fazekas
Univ. Szeged, Szeged, Hungary
Objectives: To quantity the expression of three identied Claudin
(CLDN) tight junction proteins in healthy gingival epithelium.

57

Posters: Aetiology and pathogenesis

Patients and methods: The expression of CLDN1, CLDN4 and
CLDN7 were analysed in histologically evaluated, healthy gingival
samples obtained from ve young patients prior to surgical
removal of impacted mandibular third molar. The expression of
Claudin tight junction protein was quantied in dierent epithelial
cell layers. The digital images captured from the stained samples
were optimized and converted by Adobe Photoshop software to
greyscale TIFF les. The semiquantitative analysis of Claudin
expression was performed by using ImageQuant software
(Molecular Dynamics). The background was eliminated by a
threshold set up. On the images, we set up ve randomly selected
polygonal areas with equal size in each cell layer. We determined
the baseline intensities of polygons and subtracted from the actual
pixels intensities obtained from specic staining. The statistical
signicance was determined by anova probe and Tukeys post-hoc
test.
Results: The expression of CLDN1, CLDN4 and CLDN7
signicantly elevated in spinous cell layer of gingival epithelium.
Conclusion: The multiple claudins family members play role in
paracellular transport in human epithelial tissues. Our results
suggesting that dierent claudins may play dierential role to
maintain epithelial integrity in human gingiva.

pattern in gingival tissues of CsA treated patients with chronic

periodontitis (CsA-CP) and compare this expression with that of
chronic periodontitis (CP) and periodontally healthy subjects.
Methods: In this pilot study, gingival tissue biopsies were obtained
from CsA-CP, CP and healthy subjects. Five subjects were included
in each group. mRNA levels of RANKL and OPG were quantied
by real time quantitative RT-PCR, and normalized against 18S
RNA.
Results: RANKL expression markedly increased in CsA-CP and
CP patients, which was very low in healthy subjects. OPG was
reduced by 99% in CP, and only 67% in CsA-CP patients
compared to healthy subjects (P < 0.05). The RANKL/OPG ratio
was also higher in CP and CsA-CP patients than that of healthy
subjects. CsA-CP patients had lower RANKL/OPG ratio
compared to CP patients (Ratios: CsA 0.05 0.027; CP
0.25 0.11).
Conclusion: This preliminary data suggests that CsA therapy
decreases the RANKL/OPG ratio in gingival tissues, by
enhancing OPG expression in CsA-CP patients.

17
Advanced glycation endproducts (age) in periodontal
disease

A. Wilensky*, Y. Houri, C. Genco, M. Curtis and L. Shapira

Hadassah, Israel; BU, USA, Queen Marys School, UK

W. Yu* and N. Hunter

Australia Inst. Dental Research, University of Sydney
Background: Advanced glycation endproducts (AGE), formed by
non-enzymatic glycation of protein, causes extensive tissue damage
through activation of inammatory processes and alteration of
protein structure. Although the pathology of diabetes-associated
periodontal disease has been attributed to AGE accumulation,
there exists a paucity of information. In this regard the aim of the
study was to investigate the role of AGE in the pathogenesis of
periodontal disease in diabetic versus non-diabetic patients.
Method: Gingival biopsies were obtained from nine untreated
chronic periodontitis patients (six diabetic; three non-diabetic
patients). Biopsies from four periodontally healthy patients were
obtained as controls. The biopsies were digested with collagenase
and AGE levels were quantied using the characteristic excitation:
emission uorescence spectra of 325/390 nm.
Results: Quantication of the uorescence emitted showed no
observable dierence between diabetic compared to non-diabetic
patients. Gingival biopsies from control patients, however,
demonstrated signicantly lower uorescence per microgram of
protein compared to chronic periodontitis patients (P < 0.02).
Conclusion: We have shown that gingival biopsies digested with
collagenase demonstrate a uorescent prole characteristic of
AGE. Further, our observations lead to the hypothesis that AGE is
a risk factor for periodontal disease that is not specically
associated with diabetes.

18
RANKL and OPG mRNA expression in cyclosporin a treated patients with chronic periodontitis
T. _Ilgenli*, N. Bostanci and B. Afacan et al.
University Ege, Turkey, University London, UK
Aim: The relative expression of the osteoclastogenesis inducing
factor RANKL (receptor activator of NF-kappa B ligand) and its
decoy receptor osteoprotegerin (OPG) is the main determinant of
bone resorption in health and disease. Cyclosporin-A (CsA) is
thought to regulate RANKL and OPG expression. The aim of this
study was to investigate RANKL and OPG gene expression

58

19
Recombinant Rgpa confirms protection against
P. gingivalis induced experimental periodontitis

Background: Gingipains, a group of cysteine proteases produced

by Porphyromonas gingivalis (P. gingivalis) are thought to be one of
the bacterias major virulence factors. As such, they are considered
to be candidate antigens for vaccine development.
Aims: To investigate the eect of RgpA and Kgp gingipains on
alveolar bone loss (ABL) and to evaluate the ecacy of
immunization with recombinant RgpA in preventing ABL.
Materials and methods: The mouse oral infection model (Baker et
al., 1994) was used. In order to test the eect of gingipains, ve
groups of Balb/c mice were infected with P.gingivalis wild-type,
RgpA-/-, Kgp-/-, RgpA-/-+Kgp-/- or vehicle. The ecacy of
immunization was investigated by immunization of orally
infected mice with 30 kd recombinant peptide derived from
RgpA, 60 kd recombinant RgpA, heat-killed P. gingivalis or none.
Results: The wild-type, as well as the Kgp-/- mutant bacteria,
induced signicant ABL compared to controls. However, the
RgpA-/- (and the double) mutant did not, and the ABL was not
dierent from non-infected mice. Both recombinant vaccine
preparations were able to signicantly reduce the ABL,
compared to the non-immunized group, and were as eective as
a whole-bacteria vaccine.
Conclusions: RgpA, but not Kgp, is a major virulent factor
aecting the mouse ABL after oral infection with P. gingivalis.
Immunization with recombinant peptides derivates from RgpA
may act as antigens for the prevention of periodontal disease.

20
Expression of e-selectine in gingival tissues in
agressive and chronic periodontitis before and after
phase I periodontal treatment
S. Bulut*, H. Uslu, N. Bal and F. Kayaselcuk
Depart. Perio, Depart. Patho. Univ. Baskent, Ankara, Turkey
Cell adhesion molecules (CAMs) are cell surface proteins involved
in the binding of cells, usually leukocytes, to each other, to
endothelial cells, or to extracellular matrix. Recent studies have
indicated that selectins (E, L, P) are implicated in cell tracking,
an important aspect of inammation related process. Either of
these selections can bind carbonhydrate molecules found on the
leukocyte, resulting in an increase in the time the leukocyte remains

Posters: Aetiology and pathogenesis

associated with the endothelium. This appears microscopically as
an increase in number of leukocytes attached to the lumenal
surface of the endothelium, or increased rolling. This study
compared e-selectine expression in gingival samples from Agressive
Periodontitis (AP) and Chronic Periodontitis (CP) to ndings in
controls. Gingival specimens were collected from individuals before
and after phase I periodontal treatment. Gingival tissue samples
were immunohistochemically analysed for e-selectine expression in
three groups. There was no signicant dierences among groups
and there was no signicant dierences between AP and CP groups
before and after phase I periodontal treatment. These ndings
suggested that inammation markers in periodontal disease can
help the prognosis and monitoring of periodontal illness. Specic
signals produced in response to wounding and infection control the
expression and activation of certain of this adhesion molecule.

21
Neutrophil functions before and after periodontal
treatment in generalized aggressive periodontitis

supra- and sub-gingival plaque were determined. Furthermore,

LDH activity and cytokine levels in culture supernatants of human
monocytic cells, THP-1, were measured when cultured with hLf
and LPS from E. coli for 24 h. Signicantly higher hLf and
endotoxin levels were detected in the area with calculus than
without. hLf levels were higher in the GCF than in the saliva. LDH
activity and TNF-a levels were increased following LPS stimulation; however, decreased when LPS and hLf were added together.
These ndings suggest that hLf released from neutrophils is bound
to LPS in periodontal pockets, which may aect cytokine releases
and chemotactic responses of monocytic cells.

23
Gingival crevicular fluid levels of IL-1B, TNF-A, IL-6
and IFN-G in patients with aggressive and chronic
periodontitis patients
M. Kafaoglu*, S. Yesil, G. Kasnak, N. Polat and E. Firatli
University of Istanbul, Turkey

The objective of this study was to evaluate clinical parameters,

phagocytosis and oxidative burst functions of neutrophils in
generalized aggressive periodontitis (GAP) and chronic periodontitis (CP) before and after initial periodontal therapy. 10 GAP, 10
CP patients and 10 healthy individuals were included. At 0 and
49 days peripheral blood analyses including phagocytosis and
oxidative burst functions have been performed by ow cytometric
method. At the same days plaque index, bleeding on probing,
probing depth and relative attachment level were measured.
Signicant clinical improvements were observed in two patient
groups (P < 0.01) compared to their respective baseline values
only with the exception of relative attachment level changes in CP.
Intergroup comparisons revealed no signicant dierences.
Regarding to the immunological evaluations % phagocytosis and
oxidative burst functions demonstrated no signicant dierences
between the three groups. The dierences between % phagocytosis
and oxidative burst functions in intergroup comparison did not
reveal statistical signicance. The mean uorescence intensity
considered as the degree of phagocytosis was found to be much
higher in GAP patients than in CP and healthy group before the
initial periodontal treatment but reached almost similar levels after
the treatment. It can be concluded that the investigated neutrophil
functions of GAP can be considered as in expected normal ranges.

Background: The cytokines Interleukin-1beta (IL-1b), Tumour

necrosis factor-alpha (TNF-a), Interleukin-6 (IL-6), Interferon
gamma (IFN-c) are inamation-related cytokines associated bone
resoption in periodontal disease. IL-1b, TNF-a, IL-6 and IFN-c
have regulatory eects on osteoclastogenesis and the most
aggressive forms of inammatory bone loss. The aims of this
study were to investigate the levels of IL-1b, TNF-a, IL-6, IFN-c in
gingival crevicular uid (GCF) samples from patients with chronic
periodontitis (CP) and aggressive periodontitis (AgP) and to clarify
the correlation of GCF levels of this markers with the severity of
periodontitis.
Methods: Ten patients with CP, 22 patients with AgP, 8 healthy
control (C) subjects were selected for the study. The GCF was
collected by using sterile lter papers. Assays for GCF IL-1b,
TNF-a, IL-6, IFN-c were carried out by an ELISA method. The
groups compared with each other by utilizing MannWhitney
U-test.
Results: The GCF level of TNF-a in GAgP group and C group
were statistically signicant higher than the LAgP group
(P < 0.05). A signicant increase of IL-6 was observed in GAgP
and LAgP groups compare to C group (P < 0.05).
Conclusions: These results suggest that IL-6 has a major eect on
progressive bone loss in aggressive forms of periodontitis. In
addition, the higher GCF level of IL-6 in GaP and LaP can be
demonstrate that IL-6 is associated with the severity and extention
of the soft and hard tissue destruction.

22
Distribution of human lactoferrin in the root,
GCF and saliva, and its roles in the pathogenesis
of periodontitis

24
Gingival crevicular fluid levels of IL-2, IL-5, IL-6, IL-10
and IL-12 in the patients with aggressive and chronic
periodontitis

Y. Yumoto*, K. Nakashima and Y. Furuichi et al.

Health Sciences, University of Hokkaido, Japan

S. Yesil*, G. Kasnak, M. Kafaoglu, N. Polat and E. Firatli

University of Istanbul, Turkey

Human lactoferrin (hLf) is a multifunctional glycoprotein, with

anti-inammatory and anti-tumour eects. hLf inhibits interaction
between LPS and CD14; thus, hLf released from neutrophils may
aect the inammatory responses. This study examined the
distribution of hLf in the root, GCF and saliva, and its roles in
the pathogenesis of periodontitis. 19 teeth not salvageable by
periodontal treatment were extracted with informed consent of the
patients. Five extracted teeth were incubated with anti-hLf and
Alexa 532-conjugated secondary antibody; subsequently, uorescence was measured. Grinded samples were obtained from
remaining 14 roots from the area with calculus and without, and
dissolved in PBS and hLf and endotoxin levels in the supernatant
were measured. Additionally, hLf levels in GCF, saliva, and

Background: The immune response to infection is regulated by the

balance between Th1 and Th2 cytokines. The aims of this study
were to investigate the expression of IL-2, IL-5, IL-6, IL-10 and
IL-12 in gingival crevicular uid (GCF) samples from patients with
chronic periodontitis (CP), and aggressive periodontitis (AgP) and
to examine the possible correlations between the GCF levels of
IL-2, IL-5, IL-6, IL-10 and IL-12.
Methods: Ten patients with chronic periodontitis (CP), 14
generalized aggressive periodontitis (GAgP), 8 patients with
localized aggressive periodontitis (LAgP) and 8 healthy control
(C) subjects were selected for the study. The GCF was collected by
using sterile lter papers. Assays for GCF IL-2, IL-5, IL-6, IL-10
and IL-12 were carried out by an enzyme-linked immunosorbent

H. Grsoy*, Noyan, Yilmaz, Demiralp and Kuru

Yeditepe Un, Marmara Un, Istanbul, Turkey

59

Posters: Aetiology and pathogenesis

assay (ELISA) method. The groups were compared with each other
by utilizing MannWhitney U-test.
Results: The GCF level of IL-6 in GAgP and LAgP groups was
statistically higher than in the C group. A signicant increase of
IL-6 level was observed in only AgP groups. The level of IL-10 in
control group was statistically higher than CP group.
Conclusions: These data suggest that the amount of IL-6 and IL-10
is associated with periodontal status. The expression of IL-6 may
reect inammation in gingival tissues and IL-6 may have a
profound eect on progressive bone resorption in AgP. The
absence or presence of IL-10 may play an important role in
identication of the diseased or healthy tissues.

25
Gingival crevicular fluid levels of VEGF in patients with
aggressive and chronic periodontitis
G. Kasnak*, M. Kafaoglu, S. Yesil, N. Polat and E. Firatli
University of Istanbul, Turkey
Background: Vascular endothelial growth factor (VEGF) is a
cytokine produced by gingival broblasts and responsible for
vascular hyperpermeability and angiogenesis in inammation and
wound healing. VEGF plays an important role in the pathogenesis
of periodontitis by causing the inammatory cells inltration,
edema and swelling. And VEGF promotes the progression of
periodontal disease. The aims of this study were to investigate the
level of VEGF in gingival crevicular uid (GCF) samples from
patients with chronic periodontitis (CP) and aggressive
periodontitis (AgP) and to compare the GCF levels of this
marker between periodontally healthy and diseased groups.
Methods: Ten patients with (CP), 14 patients with generalized
aggressive periodontitis (GAgP), eight patients with localized
aggressive periodontitis (LagP), and eight healthy control (C)
subjects were selected. The gingival crevicular uid was collected by
using sterile lter papers. Assay for VEGF was carried out by an
enzyme-linked immunosorbent assay (ELISA) method.
Results: The GCF level of VEGF in GAgP, LAgP and CP groups
was statistically higher than the C group. And VEGF level was
higher in the CP group than the AgP groups.
Conclusion: These datas suggest that VEGF could have an
important role in periodontal diseases. The higher level of VEGF
in CP group than the GAgP and LAgP groups may be related to
intermittent destruction in CP. VEGF might be associated with the
etiology of periodontitis in its early stages.

26
Effects of fibroblasts on BMP-induced osteoblastic
commitment
I. Tsiligkrou*, M. Al Masri and F. J. Hughes
Dept. of Periodontology, Royal London hosp., QMUL, UK
The aim of this study was to investigate the hypothesis that gingival
connective tissue might directly inhibit BMP-induced bone formation by production of soluble factors. Conditioned media derived
from rat periodontal ligament (PDL), skin and gingival broblast
cultures were tested for their ability to inhibit the BMP-induced
osteoblastic commitment of the C3H10T1/2 (10T1/2) mesenchymal
stem cell line. 10T1/2 cells were stimulated with conditioned media,
10)9 M of retinoic acid, and 100 ng/mL BMP-2, and tested for
induction of osteoblastic commitment as measured by alkaline
phosphatase activity (ALP) after 72 hours. Conditioned medium
from gingival and skin broblast cultures markedly inhibited
BMP-induced ALP expression (17.7 2.06% and 40.2 2.1%
reduction from controls respectively, P < 0.05). In contrast,
conditioned medium from PDL cells strongly enhanced the eects
of BMP-2 on ALP expression in 10T1/2 cells (274.4 0.75%

60

increase over controls, P < 0.05). These results demonstrate that

gingival and skin broblasts inhibited BMP induced osteoblast
commitment by release of soluble factors. However, PDL cells
potentiated BMP activity, consistent either with endogenous BMP
production in PDL cells, or due to other potentiating factors
present. Results from this pilot study are consistent with the
hypothesis that broblasts produce BMP-inhibitors such as
noggin, which may limit the potential for coronal bone growth
during regenerative therapies.

27
The relationship between apoptotic cell death and
gingival crevicular fluid neopterin levels in
periodontitis
A. Bodur*, A. Uraz, E. Ayhan and E. Gltekin et al.
Univ. Gazi, Ankara, Turkey
Neopterin is an early biomarker of cellular immunity and produced
by human macrophages after induction by interferon-gamma
(IFN-c). Apoptosis is activated by various signals, such as the
one caused by tumor necrosis factor (TNF). Combination of IFN-c
and TNF-a were found be related to the formation and release of
nitric oxide (NO). Neopterin was reported to be a possible
activator for inducible nitric oxide synthase enzyme (iNOS), thus
it has potential to direct apoptosis. The aim of this study was to
investigate the relationship between apoptotic cell death and
neopterin in patients with both aggressive (AgP) and chronic
(CP) periodontitis. Clinical indices were taken from 20 AgP, 15 CP
patients and 10 periodontally healthy (PH) subjects. Apoptosis in
tissue samples was determined in situ hybridization method. iNOS
and TNF-a were assessed by immunohistochemistry. The gingival
crevicular uid (GCF) neopterin levels were determined by ELISA.
Clinical parameters were found signicantly elevated in the AgP
and CP groups, compared to PH subjects. The dierence of GCF
neopterin levels was signicant between periodontitis and PH
groups. iNOS and apoptotic cell amount in the periodontitis
groups were found statistically greater than PH group. It may be
concluded that the neopterin-NOS-NO pathway and apoptosis
might be involved in the periodontal disease process.

28
Role of IL-17 in adult periodontitis
A. Beklen* and Y. T. Konttinen
Bogazici Turkey, Dep. of Medicine, Orton, Helsinki, Finland
Background: IL-17 is a proinammatory cytokine that modulates
the inammatory process in periodontitis. Our purpose is to
examine IL-17 distribution in the gingival tissues and analyse its
concentration in healthy and diseased human gingival crevicular
uid (GCF) samples.
Materials and methods: Gingival tissue and uid samples were
collected from ten healthy controls (age range 2037 years) and ten
adult periodontitis patients (age range 3145 years) from
periodontally aected sites (mean probing depth 5 mm). GCF
was collected using lter paper strips and enzyme-linked
immunoabsorbent assay (ELISA) was performed to determine
the concentration of IL-17. Localization of IL-17 in tissue
specimens was studied by immunohistochemistry.
Results: The intensity of IL-17 staining was stronger in
periodontitis and the number of IL-17 immunoreactive cells was
higher in periodontitis samples compared to healthy controls.
ELISA results showed that the cytokine concentration was higher
in periodontitis aected group than the controls (P < 0.01).
Conclusion: IL-17 was increased in periodontitis. Considering its
role to stimulate the production of tumour necrosis factor alpha
and interleukin 1 beta, it may play a key role in the
pathomechanism of the periodontitis.

Posters: Aetiology and pathogenesis

29
The relationship between p38 map kinase and gingival
crevicular fluid interleukin-1b levels in periodontitis
A. Uraz*, A. Bodur, E. Ayhan and B. Tokman et al.
Univ.Gazi, Ankara, Trkiye
p38 is a member of the mitogen-activated protein (MAP) kinase
family and is a critical enzyme in the proinammatory cytokine
pathway. Interleukin-1 (IL-1) is an important inammatory
mediator and plays a central role in the destruction of connective
tissue matrices in periodontal diseases. It is well established that
IL-1 activation of the MAP kinase pathway. The aim of this study
was to evaluate the relationship between p38 in gingival tissues and
gingival crevicular uid (GCF) IL-1b levels of patients with both
chronic (CP) and aggressive periodontitis (AgP). Clinical indices
were taken from 20 AgP, 15 CP patients and 10 periodontally
healthy (PH) subjects. The presence of p38 in gingival tissue
samples was determined by immunohistochemistry and the level of
IL-1 b in GCF was assessed by ELISA. Clinical parameters were
found signicantly elevated in the AgP and CP groups, compared
to PH subjects. The p38 amounts in the AgP and CP groups were
statistically greater than in PH group. The GCF IL-1b levels in
periodontitis groups were found statistically higher than PH group.
In AgP patients, a signicant correlation was detected between p38
and the GCF IL-1b levels. This is the rst report to evaluate the
involvement of p38 in AgP and CP and this might be considered of
value in understanding disease mechanisms.

30
The expression of proliferating cell nuclear antigen in
amlodipine induced gingival enlargements
S. E. Gltekin*, Y. Nacar, B. nsal and B. Sengven
Univ. Gazi, Ankara, Turkey
Gingival overgrowth is a common undesired side-eect in patients
taking calcium channel blockers. Amlodipine is a second generation calcium channel blocker used in the management of angina
and hypertension. Exact cause of induction of the hyperplasia is
unknown. The increase in the proliferation of gingival epithelial
cells and broblasts of lamina propria may have a role in the
development of gingival hyperplasia. The aim of study is to
investigate the expression and possible role in amlodipine induced
gingival enlargement of proliferating cell nuclear antigen (PCNA)
protein that stimulates cell cycle progression. A total of 40 gingival
samples were taken from 4 dierent patient groups;(1) inammatory gingival hyperplasia (10), (2) amlodipine induced gingival
hyperplasia (10), (3) amlodipine not induced gingival hyperplasia
(10), (4) gingivitis (10). All samples were immunohistochemically
studied for PCNA. The results showed that Proliferating index (PI)
of kerationcytes and broblasts was higher in inammatory
gingival hyperplasia group and the amlopidine induced hyperplasia
group than other two groups. The correlation was found between
PI and clinical parameters. The proliferation of kerationcytes and
broblasts have a role of development gingival hyperplasia which
may stimulated by both inammation and induction of drug.

a risk factor for periodontitis. In this study, we investigated the

expression of FccRIIb in peripheral blood leukocytes and gingiva
from periodontitis patients.
Methods: Peripheral blood leukocytes were obtained from 12
patients with periodontitis and 18 healthy volunteers with FccRIIa
H/H131 genotypes. FccRIIb expression was analysed with
owcytometry using the antibody 41H.16. The same antibody
was used for inamed gingiva obtained from seven patients.
Results: Intensity of FccRIIb expression was signicantly lower on
B lymphocytes from periodontitis patients compared with those
from healthy controls (MannWhitney U-test, P < 0.05). FccRIIb
expression was also conrmed in inamed gingiva with
periodontitis. Intense expression was observed on inltrated B
lymphocytes in the tissue section. Macrophages showed relatively
lower intensity.
Conclusions: Expression levels of FccRIIb on B lymphocytes were
lower in patients with periodontitis. This might be a cause of less
eective inhibition of overactivation of B lymphocytes in the
pathogenesis of periodontitis. Further studies are ongoing to
elucidate the genetic background of this observation and the eect
of cytokines on the expression of FccRIIb.

32
Interleukin-12 levels in gingival crevicular fluid in
periodontal disease

.
zer Ycel*,1, S. Gariboglu2 and E. Berker1
Dept of 1Periodontology and 2Immunology, Hacettepe Univ., Ankara,
Turkey
Background: Periodontitis is a chronic inammatory disease
resulting from a complex interaction between specic bacteria
and hosts immune response. Complex cytokine network which
mediates the immune response eects activation of macrophages
and dierentiation of CD4+ cells toward either Th1 or Th2
phenotypes. There is mounting evidence that an imbalance in Th1/
Th2 response is critical in periodontal destruction. Interleukin-12
(IL-12), produced by monocytes, macrophages and neutrophils, is
reported to play a major role in dierentiation of Th1 cells. The
aim of this study was to investigate IL-12 in GCF of periodontitis
patients.
Methods: A total of 40 patients including 13 chronic periodontitis
(CP), 14 gingivitis (G) and 14 healthy controls (C) were enrolled.
The clinical periodontal indices were recorded. GCF samples were
collected from six maxillary sites per patient and analysed for IL-12
by ELISA.
Results: Mean total amount of IL-12 in GCF was found to be
3.880 pg, 2.554 pg, and 2.228 pg for periodontitis, gingivitis and
healthy controls respectively. The dierence between CP and C
group was statistically signicant. (P = 0.0403 Kruskal-Wallis)
IL-12 levels showed a tendency to increase from periodontal health
to periodontal disease.
Conclusion: These ndings suggest that IL-12 stimulates Th1
response, and provides a link between innate and adaptive
immunity, may play an important role in periodontal destruction.

31
Expression of FccRIIB in human blood and gingiva with
periodontitis

33
Porphyromonas gingivalis dihydroceramides induced
apoptosis in huvec depends on caspase activation and
disturbed mitochondrial integrity

N. Sugita*, K. Kobayashi and J. Hanaoka et al.

Niigata Univ., Niigata, Japan

B. Riep*, J. Zahlten, F. Nichols and S. Hippenstiel et al.

Charit
Berlin, Germany, Univ. Connecticut, USA

Background: FccRIIb is one of IgG receptors and suppress the

activation of B lymphocytes through cross-linking with BCR via
immune-complex. FccRIIb is also has a critical role in antigen
presentation. Our previous study demonstrated FccRIIB gene to be

Porphyromonas gingivalis synthesizes complex lipids which are

found in extracts from calculus, diseased gingival tissue, and
atherosclerotic plaques. These lipids have been shown to promote
inammatory responses in gingival broblasts and peripheral

61

Posters: Aetiology and pathogenesis

blood monocytes. We could show that P. gingivalis lipids provoke
programmed cell death in human umbilical vein endothelial cells
(HUVEC). In this study we investigated the pathways of endothelial apoptosis induced by extracted P. gingivalis lipids. Freshly
isolated HUVEC were stimulated with 1 lg/mL P. gingivalis total
lipid extract and 0.1 lg/mL puried lipid fractions. The stimulated
cells were preincubated with dierent caspase inhibitors, forskolin
(Sigma-Aldrich) and RP-73401 (Roth), or N-acetylcysteine (NAC)
(Sigma-Aldrich). Cell death detection ELISA and Cytotoxicity
detection kit (Roche), Western Blot analysis of apoptosis inducing
factor (AIF), procaspases 3, 9 and caspase 6 were performed. The
P. gingivalis phosphorylated dihydroceramide lipid fraction
induced caspase dependent apoptosis in HUVEC. By measurement
of LDH in the supernatant necrosis was excluded. Apoptosis was
blocked by reducing oxidative stress with NAC as well as elevated
intracellular cAMP after preincubation with forskolin and
RP-73401 indicating mitochondrial involvement. Furthermore,
AIF was released. These data support the hypothesis that
P. gingivalis dihydroceramides may be important virulence factors
of P. gingivalis. Supported by DFG GRK 325.

aim of this study is to show the expression of certain growth factor

receptors (PDGF-a-R and bFGF-R) in gingival biopsies of
patients having CSA induced GO.
Methods: Specimens of both CSA induced GO and healthy gingiva
were obtained during periodontal treatment, either gingivoplasty
or crown-lengthening procedures. The samples were kept in
paran blocks until the immunohistochemical staining. After
paran sections were obtained, samples were stained with
antibodies against PDGF-a-Rs and bFGF-Rs.
Results: Epithelium was stained strongly for bFGF-R both in CSA
samples and in the control samples while PDGF-a-R staining was
strong in control group but not in CSA group. For the connective
tissue staining for both growth factors were strong in CSA patients
while less staining were observed in control samples.
Conclusion: From these results, it can be assumed that CSA use
increases the level of PDGF-a-R and bFGF-R in the connective
tissue but decreases in the epithelial layer of the gingiva causing the
thinning of the gingival epithelium resulting in, comparatively,
more edematous and reddish appearance among other GOs.

34
Prevalence of periodontopathogens in Romanian
population with periodontitis

36
The role of Th2 cytokines on nitric oxide and arginase
production in periodontal tissues of chronic
periodontitis patients

Doina Onisei*, D. Rusu, S. I. Stratul, A. Dinca and A. Benta

V. Babes Univ., Clinic Dr. Stratul, Timisoara, Romania

E. Ayhan*,1, N.
zmeri1 T. Aykan1 S. Elgn2A. Ylmaz1 and K. Balos 1

1
Gazi Univ., Ankara, Turkey, 2Ankara Univ., Ankara, Turkey

Background: Little recent information exists on periodontitisassociated subgingival microora of the Romanian population.
The occurrence, the interspecies relationships and the relationship
with the basic clinical parameters for a group of ve periodontal
bacteria were determined in a Romanian study population.
Methods: Subgingival microbial pool samples were obtained from
patients with localized (LagP = 18), generalized (GagP = 37)
and chronic periodontitis (CP = 41). PCR was used to
detect Actinobacillus actinomycetemcomitans, Porphyromonas
gingivalis, Tannerella forsythensis, Treponema denticola and
Prevotella intermedia. Chi-square and Kruskall-Wallis tests were
used to assess the dierences between the three diagnostic groups.
Results: In all germs, excepted Aa, the detection frequency did not
signicantly dier between the CP, LAgP and GAgP groups. The
detection frequency of Aa signicantly diers, continuously
increasing between the CP, LAgP and GAgP groups
(P = 0.0003). The mean proportions of Aa was higher in GAgP
and LAgP than in CP respectively (P = 0.0001). The mean
proportion of Td was higher in LAgP than in CP (P = 0.01).
Conclusions: Results demonstrate that the ve periodontal
pathogens analysed are strongly associated with Romanian
periodontitis. In particular, Aa and PG are more signicantly
associated with generalized aggressive periodontitis (P < 0.0001,
0.027 respectively), while Td are more signicantly associated with
localized aggressive periodontitis (P = 0.006).

The argininenitric oxide (NO) pathway in chronic periodontitis

has been shown in previous studies. The presence of NO release at
the periodontal tissues may have a role in selecting the type of T-cell
response. The aims of this study were:(i) to compare the salivary
and gingival tissue arginase and NO production between patients
with chronic periodontitis and healthy controls, (ii) to investigate
the role of Th2 cytokines on NO and arginase production. Our
study included 18 chronic periodontitis patients and 10 healthy
controls. Gingival biopsies and unstimulated saliva samples were
obtained at baseline, at ap surgery and 2 months postoperatively
from the same site. GCF samples were obtained from teeth where
gingival biopsies performed. ELISA was employed to determine the
amount of Th2 cytokines; IL-10 and IL-4 in GCF. The levels of NO
were determined with a nonenzymatic NO kit. Specic arginase
activity was determined spectrophotometrically. NO was measured
higher in saliva of chronic periodontitis patients compared with that
in gingival tissue. Similar amounts of arginase were observed in
both gingival tissue and saliva. Periodontal treatment did not have
an impact on salivary NO and arginase levels, however, tissue NO
levels elevated signicantly after therapy, whereas arginase levels
dropped dramatically. While IL-10 was observed to inhibit NO
production, IL-4 seemed not to down-regulate NO.Th2 cytokines
might have a role in NO-arginase involvement in periodontal
disease mechanisms.

35
Immunohistochemical localization of PDGF-alpha
receptors and basicFGF receptors in cyclosporin-a
induced gingival overgrowth
K. N. Kose*,1, L. Kuru1, S. Ylmaz2 and U. Noyan1 et al.
1
Marmara Uni., 2Yeditepe Uni., Istanbul, Turkey
Background: Cyclosporine A (CSA) is a potent immunosuppressive drug used to prevent organ transplant rejection. A
frequent side eect of CSA use is gingival overgrowth (GO). But,
the mechanisms of the GO are unknown although it has been
postulated that certain drugs play role in this pathology by
modulating levels of various mediators and their receptors. The

62

37
The effect of some sugar-free chewing-gums on
bacterial plaque formation. a comparative in vivo
investigation
G. Pizzo, M. E. Licata*, M. LaCara, R. Guiglia and I. Pizzo et al.
Dep. of Oral Sciences, University of Palermo, Italy
Background: The use of sugar-free chewing gums (SCs)
signicantly inhibits plaque formation on occlusal surfaces of the
teeth, whereas a similar eect cannot be found on smooth surfaces.
The aim of this comparative in vivo investigation was to assess
whether the SCs containing additives such as zinc gluconate, silicon
dioxide or lactoperoxidase and glucose-oxidase inhibit plaque
formation more eectively than the additive-free SCs.

Posters: Pre-clinical models

Materials and methods: The study was a double-masked,
randomized 4 4 Latin square cross-over design, involving 12
volunteers in a 4-day plaque regrowth model. On day 1, subjects
received professional prophylaxis, suspended oral hygiene
measures, and commenced chewing their allocated SCs. Gum
chewing was one piece chewed for 30 minutes 4 times per day. On
day 5, subjects were scored for plaque after disclosing from smooth
and occlusal surfaces.
Results: There were no signicant dierences in antiplaque activity
of the SCs tested, neither for the smooth, nor for the occlusal
surfaces (P = 0.83 and P = 0.42, respectively). Similar results
were obtained for the anterior and posterior sites of the smooth
surfaces (P > 0.05), and for the lower and upper sites of the
occlusal surfaces (P = 0.45 and P = 0.53, respectively).
Conclusions: The SCs containing additives has not shown a higher
antiplaque activity than the additive-free ones and should be
considered neither eective aids for gingivitis prevention nor useful
adjuncts to mechanical oral hygiene.

38
The effects of an amine fluoride/stannous fluoride and
an essential oil mouthrinse on supragingival plaque
regrowth
G. Pizzo, M. La Cara*, M. E. Licata, R. Guiglia and M. D'Angelo
Dep. of Oral Sciences, University of Palermo, Italy
Background: The problem associated with side eects of
chlorhexidine (CHX) has stimulated the search for alternative
antiplaque agents, such as amine uoride/stannous uoride (ASF)
and essential oils (EO). The aim of this study was to investigate the
plaque inhibitory eects of two commercially available
mouthrinses containing ASF and EO, respectively.
Materials and methods: The study was an observer-masked,
randomized 5 5 Latin square cross-over design, involving 15
volunteers in a 4-day plaque regrowth model. A 0.12% CHX rinse
and a saline solution served as positive and negative controls,
respectively. On day 1, subjects received professional prophylaxis,
suspended oral hygiene measures, and commenced rinsing with
their allocated rinses. On day 5, subjects were scored for disclosed

plaque. The ASF rinse was tested with two dosages: 10 mL and
20 mL (ASF-10 and ASF-20, respectively).
Results: The ASF and EO rinses showed a signicant inhibition of
plaque regrowth in comparison to saline (P < 0.0001), but the
lowest plaque indices were obtained with the CHX product
(P < 0.01). There were no signicant dierences among products
containing ASF-10, ASF-20, and EO (P > 0.05). There was no
correlation between the occurrence of side eects and the use of a
particular rinse product (P > 0.2).
Conclusions: The ASF- and EO-containing mouthrinses exerted
eective and quite similar plaque inhibition. The two regimens of
use tested for ASF rinse did not dier in antiplaque activity.

39
Serum IgG antibody to periodontopathogens and its
association with bacterial colonization
T. T. Ali*, K. Z. Abidin and W. Sosroseno
Univ. Malaya, Malaysia, Univ. Science, Malaysia
Objectives: To dene serum IgG antibody response to periodontal
diseased and healthy group and its relationship with bacterial
colonization.
Methods: Thirty subjects with advanced chronic periodontitis and
30 healthy controls who were ethically, gender and age-matched
were equally selected in numbers from each race. Serum IgG
antibody levels to Pg, Tf, Pi and Aa were assessed by enzymelinked immunosorbant assay (ELISA).
Results: Serum IgG antibody responses to all the four
periodontopathogens were found both in the diseased and healthy
subjects. Diseased group had signicantly higher antibody titer as
compared to healthy controls. Serum antibody responses to Pg, Tf
and Aa were higher in the presence of these bacteria.
Conclusions Multiple bacterial types may play a role in periodontal
disease destruction and a higher systemic antibody response exists
reective of subgingival colonization at diseased sites indicating
either predominance in colonization by certain pathogens or either
enhanced or poor response to their colonization.
Study supported by Vote F 0131/2003C.

Posters: Pre-clinical models

40
Effect of ibuprofen on bone proliferation
O. Garca-Martnez, R. Muoz*, L. Daz and C. Ruz
Dept. of Nursing and Stomatology, Granada, Spain
In dentistry, non-steroidal anti-inammatories (NSAIDs) as ibuprofen are usually used after a bone surgery because these drugs
exhibit favourable anti-inammatory, analgesic and antipyretic
properties. There is increasing evidence that NSAIDs drug like
ibuprofen, can adversely aect bone repair. Studies in vitro have
shown that NSAIDs inhibit osteoblast proliferation and stimulate
protein synthesis, but either animal tissues or cell lines. The
purpose of the present study was to obtain further insight into the
eect of ibuprofen on human osteoblast-like cells proliferation.
Methods: Osteoblasts were obtained from samples of human bone
sections obtained in the course of third molar surgery. Human
osteoblast lines were cultured with two dierent concentration of
ibuprofen (5 mM and 25 mM). Osteoblast proliferation was
examined by count of cell number after 24 and 48 hours.

Results: After 24 hours the experiments demonstrated a decrease

in cell proliferation in cultures incubated with 5 mM and 25 mM
concentrations of ibuprofen compared with controls (P = 0.001,
P = 0.002 respectively). The results werent statistically signicant
after 48 hours.
Conclusions: Our results suggest that ibuprofen reduces osteoblast
proliferation. So that in bone healing and alternative analgesic is
preferable where an increase in osteoblast number is important.
More studies are necessary to determine the eects of NSAIDs on
other cell parameters involved in osseointegration like cellular
adhesion.

41
The effect of diclofenac on MG-63 cells proliferation
L. Daz, O. Garca-Martnez, S. Ruiz* and C. Ruiz
Dept. of Nursing and Stomatology, Granada, Spain
Osteosarcoma is the most common primary malignant bone
tumour. MG-63 is a osteosarcoma cell line that expresses

63

Posters: Pre-clinical models

COX-2.COX-2 inhibitors exert antitumour activity via COX-2dependent and independent pathway. Meloxicam is a nonsteroidal
anti-inammatory drugs (NSAIDs) which acts as a COX-2
inhibitor. Meloxicam has inhibitory eects on osteosarcoma cell
growth and invasiveness. The aim of this study was to investigate
the in vitro eects of two dierent concentrations of diclofenac,
another NSAID with a selective COX-2 inhibition, on osteosarcoma cell line (MG-63) proliferation.
Methods: MG-63 line were incubated with diclofenac at dierent
concentrations: 1-10-100 lM. To study the proliferation included
the count of cell number for proliferation, after 24 and 48 hours of
treated.
Results: A statistically signicant dierence between test and
control cultures was observed after 24 hours of incubation; for
concentration 1 lM (P < 0.04) and for 10 lM (P < 0.02). Cells
number in culture incubated with diclofenac at 100 lM, declined
after 48 hours signicantly too (P < 0.01).
Conclusions: These results demonstrate that diclofenac reduces
osteosarcoma cell line proliferation. New experiments should be
realized in order to investigate the anti-carcinogenic potential of
diclofenac as is described with other NSAIDs as Meloxicam in
MG-63 and other tumoural cell lines. By other hand our results
suggest that, care should be taken when administering NSAIDs to
patients with skeletal problems.

42
Types I and III collagen distribution in healthy and
regenerated bone and periodontal ligament.
histomorphometric study in dogs.
S. Souza*, G. Macedo, A. Novaes Jr, M. Grisi and M. Taba Jr
School of Dentistry of Ribeiro Preto, USP, Brazil
This study evaluated the distribution of types I and III collagen in
healthy and regenerated bone and periodontal ligament. The lower
P3 and P4 of ve dogs, bilaterally, were used. Buccal furcation
lesions were surgically created and chronied. After that, full aps
were elevated and expanded polytetrauoroethylene membranes
were adapted, sutured and recovered by the aps. Two membranes
were removed 2 weeks and the other two 4 weeks after surgery.
The dogs were euthanized by 12 weeks following placement of the
membranes. P3 and P4, as well as P2 (health control teeth), and
their periodontal tissues were removed and histologically processed. The sections were stained with Picrosirius Red for Collagen
Quantication (COLQ), comparing, for both bone and periodontal
ligament, the native (nearby the regenerated area), the regenerated
(formed in the defect area) and the control (healthy) tissues. The
results of COLQ for bone showed that the amount of type III
collagen was higher (Tukeyss Multiple Comparison, P < 0.05) in
native bone, which was under higher functional demand during the
healing period. For periodontal ligament, COLQ for type I
collagen showed statistically signicant dierences between regenerated and control tissues. The membrane removal with 2 or
4 weeks postoperatively did not inuence the collagen composition
of bone or periodontal ligament. It was concluded that there are
dierences in collagen composition among the regenerated, native
and control tissues.

43
Effect of local antimicrobial agents on palatal wound
healing by secondary intention. a histomorphometric
study in rats
A. Kozlovsky*, Z. Artzi, H. Tubias and A. Hirshberg
School of Dental Medicine Tel-Aviv, Israel
Aim: Harvesting of gingival graft creates excisional wound
exposed to direct contact with the antimicrobial agents which

64

display both bactericidal activity and potential cytotoxicity. The

aim of the study was to assess the inuence of local antimicrobial
agents on wound healing by secondary intention.
Materials and methods: Excisional wounds, 5 mm in diameter were
made in the center of the palate of Wistard rats. In four
experimental groups, six rats each, chlorhexidine digluconate
(CHX) 0.1% solution, 1% CHX gel, phenolic compounds
solution and amine /stannous uoride solution and in control
group saline solution were applied daily. Wound diameter and
epithelialization rate were determined photographiclly and
histologically at 3,7,14, and 21 days postsurgery.
Results: The mean diameter of the circumscribed defects and the
area not covered by epithelium decreased signicantly and
positively by the time (P < 0.001) in experimental and control
groups. At day 14 the highest residual wound area was measured in
the saline group (70%) and the smallest in the 1% CHX gel group
(33%) with 20% of the specimens treated with 1%CHX gel
presenting complete epithelialization of the wound as compared to
none in the other tested and control groups.
Conclusions: The best epithelialization rate was achieved using 1%
CHX gel (P = 0.03). Each of the tested anti-plaque agents when
applied on excisional wound with epithelial and connective tissue
deciency does not aect negatively the wound closure.

44
Skeletal phenotype of lysyl oxidase knockout mice
N. Pischon*, P. Murawel and J. -P. Bernimoulin et al.
Dept. Perio, Berlin, Max Planck Inst., Boston University
Lysyl oxidase is essential for the accumulation of cross-linked and
insoluble collagen, which provides mechanical integrity, rigidity,
and strength in bone tissue. The role of lysyl oxidase in osteogenesis
is not well known. However, our previous data suggest a precise
regulation of lysyl oxidase in osteoblast dierentiation. The aim of
our study was to investigate the eects of lysyl oxidase deciency on
skeletal tissue and matrix mineralisation in vivo. We analysed E18.5
homozygous and heterozygous lysyl oxidase knockout mice as well
as wild type mice (C57 BL/6) by histological means, threedimensional reconstruction and Environmental Scanning Electronmicroscopy (ESEM). Our results demonstrated overall thinner,
more fragile craniofacial bones in the homozygous animals. Threedimensional reconstructions showed major morphological dierences in the bony mandible of the mutant mice compared to the
Wild type. Quantitative distance measurements showed longer
mandibles with thinner cranio-caudal dimensions and decreased
bone volumes up to 21%. ESEM analyses revealed in the upper and
lower jaws of the homozygous animals less trabeculae which were
more massive and with lower connectivity. In addition, thinner and
fragmented calvarial bony surfaces were noted. In conclusion, our
ndings indicate that lysyl oxidase may be crucial for the development of proper craniofacial bone morphology.

45
Dose-dependent effects of nicotine in human
osteoblastic cell cultures
M. L. Pereira* and M. H. Fernandes
Faculdade de Medicina Dentria da UP, Portugal
Introduction/Aims: Nicotine appears to play a signicant role in
the adverse eects of tobacco smoking in the bone tissue. This
work describes the eect of nicotine in the proliferation/
dierentiation behaviour of human osteoblastic bone marrow
cells in a concentration range representative of plasma and salivary
levels found in the average smoker.
Materials and methods: Human bone marrow cells were cultured,
for 28 days in the absence and in the presence of nicotine
10 ng/mL to 1 mg/mL, in experimental conditions that favour the

Posters: Pre-clinical models

proliferation and dierentiation of osteoblastic cells. Cultures were
characterised for cell morphology, cell proliferation/viability,
alkaline phosphatase (ALP) activity and matrix mineralization.
Results: The exposure to 10 ng/mL nicotine (plasmatic level) did
not signicantly aect the cell behaviour. The presence of salivary
levels, 0.05 to 1 mg/mL, caused dose-dependent eects: an increase
in the cell proliferation, ALP activity and matrix mineralization in
the range 0.05 to 0.2 mg/mL, an initial inhibitory eect followed by
a progressive recovery in the presence of 0.3 mg/mL and a dosedependent inhibitory eect for concentrations similar and higher
than 0.4 mg/mL. The presence of 1 mg/mL resulted in cell death
within few days.
Conclusions: Nicotine causes dose-dependent eects in the
proliferation/dierentiation of human osteoblastic cells. Plasma
levels do not signicantly aect cell behaviour. Salivary levels have
mixed eects.

46
The effect of cyclosporin-A on alveolar bone of rats
subjected to experimental periodontal disease
B. O. Cetinkaya*, G. Acikgoz, B. Ayas and G. C. Keles
Ondokuzmayis University, Samsun, Turkey
Backround: Cyclosporine-A (CsA), broadly used in organ
transplantation, may contribute to pathogenesis of osteoporosis.
The aim of this study was to investigate eects of CsA on alveolar
bone of rats subjected to experimental periodontal disease using
biochemical, radiographic, and histometric analysis.
Materials and methods: Forty Wistar rats were divided into four
equal groups: Group1 (Control), Group2 (CsA was injected
subcutaneously in a daily dose of 10 mg/kg), Group3 (Ligature
was placed around the mandibular molars), Group4
(Ligature + CsA). After 60 days; rats were decapitated, serum
alkaline phosphatase and calcium levels were measured.
Radiographic alveolar bone loss (ABL), histometric ABL, and
percentage of new alveolar bone formation (NABF%) were
determined on mandibular molars.
Results: Signicant increase in alkaline phosphatase (P < 0.001),
signicant decrease in calcium (P < 0.01) levels were observed in
ligated Group3 compared to Group1 whereas, no signicant
dierence was found between ligated and CsA-treated Group 4 and
Group 1 (P > 0.05). Radiographic and histometric ABL were
signicantly less (P < 0.001), NABF% was signicantly greater
(P < 0.05) in Group4 than in Group3. No signicant dierence in
any of the parameters between Group2 and Group1 was found.
Conclusions: The results showed that CsA therapy diminished
resorption and induced formation of alveolar bone. It can be
concluded that inhibition of immune system by CsA may decrease
the periodontal breakdown.

47
The morphometric analysis of cyclosporin A induced
gingival overgrowth in rats
N. O. Alptekin*, K. Ustun, E. Yaprak, M. C. Avunduk and T. Ataoglu
Selcuk University, Konya, Turkey
Aim: Cyclosporin A (CycA) induced gingival overgrowth depends
on dose, serum level and drug administration. The objective of this
investigation was to examine the eects of CycA on gingival tissue
in an 8-week period by using morphometric analysis.
Materials and methods: Eighty Sprague-Dawley rats were
randomly assigned into two groups of 40 animals each. The test
group animals were subcutaneously injected daily 10mg/kg body
weight of CycA. The control group animals were injected similarly
with saline (0.9%NaCl). In the 2nd, 4th, 6th and 8th weeks, 10
animals in each group were sacriced. Gingival thickness

measurements (mm) were obtained from the disto-buccal, midbuccal and mesio-buccal sites of second molar teeth by using
stereomicroscopy.
Results: In the 4th, 6th and 8th weeks, the test group gingival
thickness scores were signicantly higher than those in the control
group (P < 0.05). In the 2nd week, the dierence between groups
was not statistically signicant (P > 0.05).
Conclusion: The morphometric analysis results of this study
demonstrated that systemic administration of CycA for an
8-week period caused signicant gingival overgrowth and this
eect was parallel with the duration of medication.
This study was supported partly by Novartis Pharma AG and
Selcuk University Scientic Research Fund.

48
Effect of cyclosporin-A on Serum Calcium and Alkaline
Phosphatase levels in rats with experimental
periodontitis
N. O. Alptekin, K. Ustun, E. Yaprak, B. Serpek and T. Ataoglu*
Selcuk University, Konya, Turkey
Aim: The aim of this investigation was to evaluate the eect of
cyclosporin A (CycA) on serum Calcium (Ca) and Alkaline
Phosphatase (ALP) levels in rats with experimental periodontitis.
The data presented here were derived from an experimental study
in which the eect of CycA on the rat gingival tissue was examined.
Materials and methods: In 80 Sprague-Dawley-rats, experimental
periodontitis were induced by placing a silk suture around the
cervix of the mandibular rst molars. The animals were randomly
distributed into test and control groups of forty animals in each.
Test group animals were injected subcutaneously in a daily dose of
CycA 10 mg/kg body weight, while the controls received
subcutaneous saline injection throughout the study period. Serum
Ca (mg/dL) and ALP (UL/mL) levels were determined at the time
periods, 2, 4, 6 and 8 weeks, by using spectrophotometric analysis.
Results: Serum Ca levels in test group were signicantly lower than
in the control group at 4, 6 and 8 weeks (P < 0.05). However,
there were no statistically signicant dierences between the groups
in terms of the serum ALP levels (P > 0.05).
Conclusion: Within the limits of this study, we suggest that CycA
may have an eect to decrease the initial alveolar bone destruction
in rats.
This study was supported partly by Novartis Pharma AG and
Selcuk University Scientic Research Fund.

49
Stem cells in human periodontal ligament cultures
B. Moln
r*, K. K
d
r, P. Windisch, I. Gera and G. Varga
Dept of Oral Biology & Periodontol, Semmelweis University, Budapest,
Hungary
Objectives: Recently stem cells have been observed in human
dental tissues including PDL. Our objectives were to identify and
characterize postnatal stem cells in primary PDL cultures.
Methods: Cells were derived from PDL of human extracted third
molars. PDL tissue was separated from root surfaces using sterile
scalpels. PDL tissue was digested in a collagenase type I and
dispase containing solution. PDL cells were cultured using a-MEM
supplemented with FCS and incubated at 37
C in 5% CO2. Cell
viability of the PDL cultures was estimated by MTT-assay. To
measure colony-forming efciency, 14 day old cultures were xed
with 4% formalin, and then stained with 2% Giemsa.
Mesenchymal stem cell marker STRO-1 immunohistochemistry
and FACS analysis was performed on PDL cell cultures.
Results: Cell cultures were successfully established from PDL, then
cultivated for up to 25 passages. Cell cultures showed typical

65

Posters: Pre-clinical models

broblast-like morphology, demonstrating clonogenic activity. The
colony-forming eciency level of approximately 105 cells was 20
30 colonies. In the PDL cultures 810% of the cells showed STRO1 immunoreactivity.
Conclusions: We established primary cell cultures from human
PDL. The cultures contained cells capable of colony-formation.
STRO-1 immunoreactivity indicates the steady level of stem cells in
the primary cultures for up to 25 passages. These ndings open a
new avenue in our research aiming the application of PDL
originated stem cells in periodontal disease.

densitometrically. Cell proliferation was determined by BrdU

assay, with & without CTGF inhibitors. Western blot & RT-PCR
analysis demonstrated a dose- and time- dependent increase of
CTGF expression by EMD. In the presence of TGF- inhibitors,
CTGF expression of EMD-stimulated cells was signicantly
reduced, indicating a modulation of CTGF via TGF- pathway.
The BrdU assay revealed signicant increase of the cell proliferation exceeding 2.5-fold (P < 0.01) in EMD & TGF- stimulated
cells but no signicant eect when CTGF inhibitors were added.
We can conclude that EMD increases CTGF expression via TGF-
signaling pathway in osteoblasts.

50
Moxifloxacin as an alternative antibiotic in treatment
of Porphyromonas gingivalis-associated
periodontitis - conclusions from in vitro studies

52
Effect of experimental hemolytic anemia on
peri-implant bone tissue

W. Pfister*, K.-H. Schmidt and A. Schmitt et al.

Univ. Hosp. Jena, Germany

M. Fernandez*, A. Gorustovic, M. Giglio and M. Guglielmoti

Dep Oral Pathol, School of Dent, UBA, Argentina

Objectives: The aim was to evaluate experiments about the in vitro

activity of moxioxacin against Porphyromonas gingivalis (P.g.).
Methods: Minimal
Inhibitory
Concentration
(MIC)
of
moxioxacin against 16 strains of P.g. was determined by Etest.
The spontaneous mutation rate and the induction of resistant
strains by the 0.25fold MIC of the antibiotic were determined. To
nd the target of resistance the gyrA- and gyrB-genes were
sequenced. Finally the ecacy of moxioxacin to P. g. ATCC
33277 within biolms or within epithelial cells (KB cells) was
evaluated.
Results: Moxioxacin had very low MIC values (0.006
0.032 mg/L), but subinhibitory concentrations induced very fast
mutations. The spontaneous mutation rate was up to 5 10)8 after
the two-fold MIC and 1.2 10)8 after the eight-fold MIC. The
mutants exhibited a resistance up to 32 mg/L. All mutants bore
Ser-83Phe substitution in gyrA. The 5-fold MIC eliminated P.g.
ATCC 33277 within biolms after 24 h, and the 100-fold MIC was
able to kill all intracellular P.g.
Conclusions: Moxioxacin showed a very good activity against
planctonic P. g. and P.g. within biolms. In high concentrations it
was also ecient to intracellular bacteria. A rapid development of
resistance was observed under in vitro conditions. Moxioxacin
might be an alternative in the antibiotic treatment of P. gingivalisassociated periodontitis, but clinical studies should focus not only
on improvement of clinical parameters but also on occurrence of
resistant strains.

Anemia is a disease resulting from a decrease in the normal amount

of circulating hemoglobin (Hb). In previous studies we observed
that hemolytic anemia causes alterations in bone healing and
remodeling. The aim of the present study was to perform a
histological and histomorphometric evaluation of peri-implant
bone tissue under experimental hemolytic anemia. Male Wi rats
(60 7 g) were anesthetized and a laminar Ti implant was placed
in the tibiae. Animals were assigned to one of three groups: GI
(Control) (n:10); GII (Mild to Moderate Anemia, Hb1012 g/dL)
(n:15); GIII (Severe Anemia,Hb<10 g/dL) (n:15).On day 15, the
anemia groups were injected with phenylhydrazine every 48 h;control animals were injected with saline. Guidelines of the NIH were
observed. In all animals, body weight (b.w.), hematocrit (Hct), and
Hb were recorded every 48 h. Animals were killed 30 day after the
onset of the experiment. Tibiae were resected, xed, radiographed,
and embedded in methylmethacrylate. Ground sections were
stained with toluidine blue. Animals of GII and GIII exhibited a
reduction in b.w. (20% and 39%), Hct (20% and 43%), Hb (31%
and 51%) respectively as compared to control. Histomorphometric
evaluation revealed a statistically signicant reduction in periimplant bone volume (71% and 82%) and percentage of bone to
implant contact (66% and 87%)in GII and GIII respectively.
Hemolytic anemia and/or associated factors cause qualitative and
quantitative alterations in the peri-implant bone tissue. CONICET
PIP 6042 UBA O020.

51
The effects on enamel matrix derivatives (EMD) on
connective tissue growth factor (CTGF) expression via
TGF- signaling pathway in osteoblastic cells
N. Heng*, B. M. Kleber, J. P. Bernimoulin and N. Pischon
Dept. Perio; Graduate College, Charit
, Berlin
Enamel matrix proteins (EMD) stimulate the production & release
of growth factors such as TGF-.CTGF is a downstream mediator
of TGF- & mediates cell growth stimulatory actions of TGF-.
Interactions between EMD and TGF- on osteoblastic cell growth
& bone formation have been described but whether EMD is
aecting CTGF expression is still unknown. Our study investigates
the eects of EMD on CTGF expression in osteoblasts & whether
EMD-induced CTGF expression is modulated by TGF- signaling
pathway. We also examine if CTGF plays a role in EMD-induced
cell proliferation in osteoblasts. Human osteoblasts (SaOS-2) were
treated with 25100 lg/mL EMD, with & without TGF-
inhibitors. TGF--treated cells served as positive control. CTGF
steady-state mRNA expression was detected by RT-PCR. CTGF
protein levels were assayed by Western Blot & quantitated

66

53
Experimental bony defect models in rats: which are
critical-size defects? a histologic study
M. Nagata, F. Furlaneto, J. Almeida and S. Fucini*
So Paulo State Univ., Brazil; Priv. Practice, USA
A variety of biomaterials have been placed in bony defects in order
to facilitate and/or promote bone regeneration. A critical-size
defect (CSD) is the ideal model with which to evaluate their
regenerative potential. However, studies have reported conicting
results regarding the size of CSDs in dierent experimental models
in rats. The purpose of this study was to histologically analyse bone
healing in surgically created defects in rat calvaria, tibia and
mandibular angles. 48 rats were divided into three groups: Group 1
- a 5 mm diameter calvarial defect was made; Group 2 - a 4 mm
diameter tibial defect was made; Group 3 - a 5 mm diameter
mandibular angle defect was made. Each group was subdivided
(n = 8) for euthanasia at either 30 or 90 days post-operative.
Histometric and histologic analyses were performed. Newly formed
bone area (NFBA) was calculated as percentage of total area of
original defect. Data were statistically analysed (anova, Tukey,
P < 0.05). In Groups 1 and 3, no defect completely regenerated

Posters: Pre-clinical models

with bone at either 30 or 90 days post-op. In Group 2, complete
bone regeneration was seen in ve animals (n = 8) at 30 days and
four animals (n = 5) at 90 days post-op. three animals were lost
due to tibial fractures. Group 2 had signicantly more bone
formation than Groups 1 and 3 at both periods of analysis. It can
be concluded that a 5 mm diameter calvarial or mandibular angle
defect is a CSD, while a 4 mm diameter tibial defect is not.

Conclusion: The Type B I/A connection morphology show

improved resistance to lateral force compared to the type A and C.

54
Three-dimensional type I collagen cell culture system
for the study of periodontal ligament cell differentiation

U. S. Yavuz*, E. Yuzbasioglu, G. Acikgoz and T. Turk et al.

Faculty of Dentistry, Ondokuz Mayis Univ, Turkey

X. E. Dereka*, C. E. Markopoulou and A. Mamalis et al.

School of Dentistry, University of Athens, Greece
Three-dimensional (3-D) type I collagen cell culture systems
composed of reconstituted collagen bers are able to support
short- and long- growth of various cell types, including endothelial
cells, osteoblasts and broblasts and to sustain or even enhance
cell dierentiation, in vitro. The aim of this study was to investigate
phenotypic dierences arised when periodontal ligament (PDL)
cells populations were cultured in both mono-layer and 3-D type I
collagen cell culture systems. PDL cells were isolated from the midroot of three maxillary premolars extracted for orthodontic
reasons. Freshly isolated collagen bers depleted of telopeptides
and proteoglycans containing endogenous and exogenous collagen
cross-links were used to form collagen gels. PDL cells were allowed
to grow in collagen gels and in mono-layer cultures for 4 to 7 days.
Immunohistochemical analysis of the expression prole of Vimentin (indicator of mesenchymal origin) and a-Smooth Muscle Actin
(a-SMA, indicator of broblastic dierentiation) was used to
assess phenotypic variations in the dierent culture media. Monolayer cells cultures were found to express a-SMA and vimentin
while cells cultured in the 3-D collagen system expressed only
vimentin. In the 3-D type I collagen system, PDL cells dierentiate
in a dierent manner than in mono-layer cell cultures. Such a
culture system may act as an important experimental tool to
elucidate mechanisms of growth and dierentiation of PDL
tissues.

56
Evaluation of dental implants used as orthodontic
anchors: a comparison of histomorphometric and finite
element analysis results

Aim: The aim of this study was evaluation of dental implant used
as orthodontic anchors by means of comparison of
histomorphometric and nite element analysis results.
Materials and methods: Eight SLA implants with a 4.1 mm
diameter and length of 10 mm were placed in the maxilla and
mandible 8 dogs after 12-week healing period after extraction.
Superelastic nickel-titanium coil springs were activated between
implants and the canines, producing a force of 200 g (2 N). Two
unloaded implants served as controls. A two-dimensional nite
element analyses of the implant-abutment complex are carried out
using FEA software.
Results: Histologic analysis showed a corticalization of bone
trabeculae, thicker at the loaded than at the unloaded implants.
New bone formation at the level of the crest was slightly superior in
the test implants. A dierence between the tension and
compression areas could not be observed in the test implants.
The mean bone-implant contact values of the test implants for the
maxilla and mandible were 40.23% and 49.33%. In the control
implants, the bone-implant contact value was 67.91% for the
maxilla and 49.23% for the mandible. The nite element analysis
results indicated that the maximum stresses located around the
neck of the implant, in cortical bone.
Discussion/Conclusion: According to histomorphometric and nite
element analysis results stress areas should be preserved clinically
in order to maintain bone-implant interface structurally and
functionally.

55
Resistance of the implant/abutment morphology to
lateral force

57
Periodontal wound healing following regenerative
procedures in furcation degree III
defects: histomorhpometric outcomes

B. Simoncic, U. Covani, A. Barone and S. Marconcini* et al.

Dep. Bio. Med. Dent. Sch., University Genoa, Italy

N. Gkranias*, F. Graziani, A. Sculean and N. Donos

UCL EDI, London, UK, Radboud University Nijmegen, The Netherlands

Aim: The aim of in vitro study was to evaluate the inuence of

dierent implant - abutment connection (I/A) morphology
resistance to lateral force. Three Types of I/A connection were
evaluated. Type A: external hexagon in implant; Type B: internal
conical surface; Type C: internal hexagon.
Method: Ten I/A pcs. of each Type were evaluated. The implants
were rmly screwed in to testing device. The tip of the machine
was pressed on the abutment from lateral side at the level of
I/A connection. The force was increasing from 0 N, trough
the irreversible plastic deformation, till breaking the abutment
screw.
Result: The average breaking force for the Type A was 650.6 N
(SD = 85.7), for the Type B 814.7 N (SD = 72.7), for the Type C
658.7 N (SD = 49.2). The mean plastic deformation of the screw
before breaking for Type A was 2.09 mm (SD = 0.44), for Type B
2.16 mm (SD = 0.26), for Type C 1.19 mm (SD = 0.09). The
Type B I/A show signicant (P = 0.01) higher breaking force for
the abutment screw than the Type A and Type C. The irreversible
deformation of the abutment screw of Type A and Type B I/A
morphology show signicant higher rate (P = 0.01) as the Type C.

Objectives: To describe the periodontal healing following dierent

regenerative modalities in degree III furcation defects.
Materials and Methods: Degree III furcation defects were
surgically created at teeth 36, 37, 46 and 47 in three monkeys.
Spontaneous healing of the defects was prevented by placing
impression material into the defects. After 6 weeks, four treatment
modalities were performed: (i) Emdogain (EMD), (ii) GTR (iii)
EMD and GTR (iv) coronally repositioned ap (control). In all
groups root surfaces were conditioned with 24% EDTA gel. After
5 months of healing, 3 central sections 100 lm apart, were used for
histomorphometric analysis. Measurements were performed at six
zones on each tooth. Zones 14 were within the furcation area. (1):
At the level apically to the notch (2): At the level of the notch (3):
At the most coronal level of regenerated bone between the notch
and the fornix (4): At the level of the fornix. Zones 56 were on the
pristine external surface of the root. (5): on the level of the fornix.
(6): on the level of the notch.
Results: In all specimens, new cementum 3060 lm wide, with
inserting collagen bres was formed. Its linear extension within the
defects varies according to the treatment modality. Regeneration

67

Posters: Pre-clinical models

extending in the furcation fornix was observed only in the GTR or
EMD and GTR treated speciments.
Conclusion: The predictability of regeneration in furcation degree
III defects depends mainly on the presence or absence of barrier
membranes (GTR).

pressure should be incorporated in the new in vitro
studies of

CDS to simulate more accurately in vivo conditions.
Conclusion: Positive pressure signicantly aects the rate of
dentinal perfusion.

58
Effect of chlorhexidine/thymol and fluoride varnishes
on dental biofilm formation in vitro

60
Comparison of naturally occurring and ligature induced
peri-implantitis bone defects in humans and dogs

Y. Takeuchi*, B. Guggenheim, A. Filieri, and P. Baehni

University Geneva, University Zurich, Switzerland, Tokyo Med & Dent
University Japan

A. Hakimi*, F. Schwarz, M. Herten and J. Becker

Heinrich Heine University, Dsseldorf, Germany

The aim of the present study was to evaluate the eect of two
varnishes containing either chlorhexidine/thymol (CHX/T) or
uoride (F) on a biolm model in vitro. Hydroxyapatite discs
were coated with varnish and exposed for various times up to 20 h
to a bacterial suspension containing A. naeslundii, F. nucleatum,
S. oralis, and V. dispar. Uncoated discs served as controls. In some
experiments discs were immersed in saline for 0, 3, 7 or 14 days
before incubation with bacteria. Bacterial growth and biolm
development were monitored by culture and by scanning electron
microscopy (SEM). Bacterial vitality was examined by live/dead
uorescence staining. In the CHX/T-treated group, the total
number of bacteria was signicantly lower than in controls at
each observation time. SEM observations showed that bacterial
colonization was delayed compared to control discs. In the Ftreated group, the total number of bacteria did not dier from
control discs although the number of S. oralis was lower compared
to controls. Bacterial vitality in the CHX/T (86.8 %) and the F
(78.6%) group did not dier from that in controls (74.9%). Total
numbers of bacteria on CHX/T-treated discs immersed into saline
for 3, 5 and 14 days were signicantly higher than non-immersed
discs. Bacterial attachment and subsequent biolm development
were inhibited on CHX/T varnish-coated discs but not F-treated
discs. The eect of CHX/T varnish decreased following immersion
of varnish-coated discs in saline.

59
In vitro effect of positive and negative pressure on the
permeability of a self-etch adhesive used to treat
dentinal sensitivity
P. de Grado*, A. Fygueroa, F. Gil, A. Pascual and F. Alpiste.
Department of Peridontics. Univ. Valencia, Spain
Based on the hydrodynamic theory, adhesive systems have been
used to treat dentinal sensitivity (CDS). In vitro studies show
successful results while clinical studies not. The aim of study is to
compare the eect of positive pressure on the permeability of a selfetch adhesive (AdheSE) proposed for treatment of CDS.
Materials and methods: Sixty dentin discs obtained from molars
were divided into two groups: G1 (positive pressure) and G2
(negative pressure). Discs were mounted in a perfusion device
based on the Pashleys system. Our device allows control pressure of
perfusion uid during the whole process.1 disk of each perfusion
was studied under scanning electron microscopy to check acid etch
opened dentine tubules. In G1 AdheSE was applied keeping a
positive pressure of perfusion uid during the whole process. In G2
no pressure of the perfusion uid was allowed until it was applied.
Permeability was measured after 1 and 2 hours. Chi Square Test
and t-test statically analysed the results.
Results: G2 showed signicant lower dentinal perfusion rates and
a greater amount of tubular occlusion than G1 in all cases.
Discussion: Recently studies have used a tubular positive pressure
and found the presence of Water Tree
that can justify the
postoperative sensitivity. These results indicate that positive

68

The aim of the present study was to compare naturally occuring

and ligature induced peri-implantitis bone defects in humans and
dogs. Twenty-four patients undergoing bone augmentation procedures due to advanced peri-implantitis were included in this study
(n = 40 implants). Furthermore, peri-implantitis was induced by
ligature placement and plaque accumulation in ve beagle dogs
(n = 15 implants). The ligatures were removed when about 30% of
the initial bone was lost. During open ap surgery, conguration
and defect characteristics of the peri-implant bone loss were
recorded in both humans and dogs. Open ap surgery generally
revealed two dierent classes of peri-implant bone defects. While
Class I defects featured well-dened intrabony components, Class
II defects were characterized by consistent horizontal bone loss.
The allocation of intrabony components of Class I defects
regarding the implant body allowed a subdivision of ve dierent
congurations (Classes Ia-e). In particular, human defects were
most frequently Class Ie (55.3%), followed by Ib (15.8%), Ic
(13.3%), Id (10.2%), and Ia (5.4%). Similarly, bone defects in dogs
were also most frequently Class Ie (86.6%), while merely two out of
15 defects were Classes Ia and Ic (6.7%, respectively). Within the
limits of the present study, it might be concluded that congurations and sizes of ligature-induced peri-implantitis bone defects in
dogs seemed to resemble naturally occurring lesions in humans.

61
Effects of bisphosphonate and doxycycline on alveolar
bone resorption in rats with experimental periodontitis
H. Kooglu, B. nsal*, A. Uraz, B. Tokman and E. Bars
University Gazi, Ankara, Turkey
Disodium chlodronate, a bisphosphonate that is a potent inhibitor
of osteoclast-mediated bone resorption is clinically used in the
treatment of metabolic bone diseases associated with bone resorption. Doxycycline has been widely used in periodontal treatment
for its antimicrobial and anti-enzymatic eects. The aim of this
study was to compare the eects of doxycycline and bisphosphonates to bone loss from prophylactic and curative aspects in an
experimental periodontitis. Thirty-six Wistar rats were used.
Maxillar left molars ligated with silk suture to induce periodontitis.
The contralateral side served as a control group. The rats were
divided into six groups: (1) prophylactic chlodronate, (2) prophylactic doxycycline, (3) prophylactic control, (4) curative chlodronate, (5) curative doxycyline, (6) curative control. In prophylactic
groups, drugs were injected for 7 days, starting at day 0 and until
day 7, while in curative groups the drugs were injected from day 5
until day 11. At designates times, histological evaluations were
accomplished. The results showed that bone loss in the doxycycline
and chlodronate groups were statistically less than control group.
Prophylactic groups were most eective in reducing bone loss. No
detectable statistically signicant dierences between the doxycycline and chlodronate groups. This study suggests that local
application of doxycyline and chlodronate can be used as a adjunct
in periodontal therapy for reducing bone resorption.

Posters: Pre-clinical models

62
Characterization of ofloxacin encapsulated chitosan
microspheres for periodontal applications
G. Cakar*, Sezer, Kuru, Yilmaz, Cevher and Akbuga
Yeditepe Unversity, Marmara University, Istanbul University, Istanbul,
Turkey
The objectives of this study were to prepare ooxacin (OFL)
encapsulated chitosan microspheres and to investigate the eect of
the formulation parameters on the properties of the prepared
microspheres. In vitro and in vivo release proles from periodontal
pockets in aggressive periodontits patients were further compared.
OFL encapsulated chitosan microspheres were prepared by precipitation method. The eect of chitosan, drug and cross-linking
agent concentrations on particle size, encapsulation capacity and
release properties of the microspheres were the investigated
parameters. In vitro OFL release from microspheres was performed
in PBS (pH 7.4) at 37 0.1
C and the released amount of OFL
was analysed at 1, 3, 5 hours and 1, 3 and 5 days spectrophotometrically. Microspheres were applied into 4 periodontal pockets
( 5 mm and + bleeding) in each of six patients. Gingival
crevicular uid samples were taken at 1, 3 and 5 hours and at 1, 3
and 5 days and the samples were evaluated with HPLC. The
encapsulation ecacy of the microspheres, with the size range of
1.05 and 2.08 lm, changed between 48.8 and 89.2 %. All
formulation parameters aected the particle size, encapsulation
capacity and release proles of the microspheres. The cumulative in
vitro release of OFL from the particles was found similar with OFL
levels in the GCF samples. It can be concluded that OFL
encapsulated microspheres might be a potential delivery system
for periodontal applications.

63
The effect of Nd: YAG laser irradiation on human
cultured cells derived from the periodontal tissue and
MC3T3-E1
E. Murakashi*, T. Tachibana, H. Takeuchi and Y. Numabe et al.
The Nippon Dental University, Japan, The jikei University, Japan
Background and objective: Nd: YAG lasers (laser) have been
widely used for various dental treatment procedures. However, the
biological eects of laser irradiation on cultured cells derived from
periodontal tissue have not been determined. The growth rate, and
the morphological and biological responses of cultured cells
derived from periodontal tissue and subjected to laser irradiation
were investigated in this study.
Materials and methods: PDL cell and HGF were isolated from
human periodontal ligament and gingiva attached to permanent
rst premolars extracted during orthodontic therapy performed in
subjects with a clinically healthy periodontium. MC3T3-E1 used in
place of Osteoblast derived from human periodontal tissue. A total
of 1500 cells were cultured in each 96-well plate, and laser
irradiation was performed. The variable parameters were pulse
energy (100~400 mJ), pulse rate (20~100 Hz). The cell proliferation
activity after irradiation was assessed using the modied MTT
method, and cytomorphology was observed under a phase-contrast
microscope. TGF-beta1 expression after irradiation was measured
using an ELISA.
Results and conclusion: The proliferation and size of PDL cell,
HGF and MC3T3-E1 increased laser irradiation (PDL cell:
100250 mJ, HGF: 100~400 mJ, MC3T3-E1: 100~200 mJ).
Furthermore, the production of TGF-beta1 also increased in
each cell type. Thus, laser irradiation may be useful for
regenerating periodontal tissue in vitro.

64
Implications of oxidant/antioxidant interactions of
nicotine, coenzyme Q10, pycnogenol and
phytoestrogens on healing in fibroblasts and
osteoblasts
E. Figuero*,1, M. Soory2and A. Bascones1
1
University Complu, Madrid, Spain, 2King's College, London, UK
Background: There is a growing awareness that oxidative stress
may play a role in periodontal disease. The aim of this investigation
was to investigate potential oxidant/antioxidant interactions of
nicotine with antioxidants (Coenzyme Q10 (CoQ), Pycnogenol)
and phytoestrogens in a cell culture model.
Methods: Duplicate incubations of human periosteal broblasts
and osteoblasts were performed with 14C-testosterone as substrate,
in the presence or absence of CoQ (20 lg/ml), Pycnogenol
(150 lg/ml) and phytoestrogens (10 and 40 lg/ml), alone and in
combination with nicotine (250 lg/ml). At the end of a 24-hour
incubation period, the medium was solvent extracted with ethyl
acetate, and testosterone metabolites were separated by thin-layer
chromatography and quantied using a radioisotope scanner.
Results: The incubations of broblasts and osteoblasts with CoQ,
Pycnogenol or phytoestrogens stimulated the synthesis of the
physiologically active androgen DHT, while the yields of DHT
were signicantly reduced in response to nicotine compared to
control values (P < 0.001 for phytoestrogens). The combination
of nicotine with CoQ, Pycnogenol or phytoestrogens increased the
yields of DHT compared with incubation with nicotine alone in
both cell types (P < 0.005 for the association of nicotine with
phytoestrogens).
Conclusion: This investigation suggests that the catabolic eects of
nicotine could be reversed by the addition of antioxidants such as
CoQ or Pycnogenol and phytoestrogens.

65
Anorganic bovine-derived hydroxyapatite matrix
coupled with a synthetic cell-binding peptide
(PepGen P-15) for bone regeneration
N. Mardas*, A. Stavropoulos and T. Karring
Royal Dental College, Univ. Aarhus, DK
The aim of the study was to evaluate the eect of PepGen P-15
implantation on the healing of craniectomy defects. Sixteen,
4-month old rats were used in the study. A 5.0 mm round, full
thickness defect was created in each parietal bone of the animals. In
each animal, one defect was loosely lled out with the graft (test),
while the defect in the other side was left empty (control). Groups
of 8 animals were sacriced after 2 and 4 months and undecalcied
sections approx. 10 lm thick were produced. The most central
section from each defect was selected for histometric analysis.
Histological examination showed limited bone formation in both
tests and controls. Complete bone bridging of the defect was never
observed. In test sites, the defect was basically occupied by graft
particles embedded in loose brous connective tissue and new bone
had formed only at the margins of the defect. In the controls,
minimal new bone formation was observed again only at the
periphery of the defect, while a rather narrow band of brous
connective tissue bridged its margins. After two months of healing,
the residual defect was 94.6% and 90.6% (P=0.06) of the original
defect size in control and test sites, respectively. After four months,
the corresponding values were 89.9% and 85.0% (P = 0.33).
Although somewhat more new bone formation was observed in the
grafted defects, PepGen P-15 does not seem to enhance bone
formation since the vast portion of the grafted defects did not heal
with bone.

69

Posters: Pre-clinical models

66
Systemic administration of TTC delays degradation of 3
different collagen membranes in the rat
O. Moses*, A. Shemesh, M. Weinreb and C. Nemcovsky et al.
Dent Med. School, Tel Aviv Uni, Ramat-Aviv, Israel
Background: Degradation of bioabsorbable collagen membranes
(BCM) can be altered by enhancing their structural integrity or by
delaying the degradation process using matrix metalloproteinase
(MMP) inhibitors. We have previously shown that immersing
BCMs in Tetracycline (TTC) solution before implantation delays
their degradation in-vitro and in-vivo. This study evaluated the
eect of systemic TTC administration on the degradation of three
dierent BCMs in the rat calvaria.
Methods: Three dierent BCM disks (Biomend, Biogide, Ossix),
5 mm in diameter, were labeled with biotin and implanted in
similarly sized, surgically created intra-bony defects in rat calvaria.
IP injections of either Deoxytetracycline (60 mg/kg) or saline
(control group) were administered every three days. Specimens
were harvested on day 14 or 28. After histological processing and
staining with HRP-Streptavidin complex, BCM degradation was
measured by image-analysis and analysed using anova and paired ttest.
Results: In the control group, Ossix membrane degraded by 5%
after 14 days and by 10% after 28 days. Degradation of Biogide
membrane was more pronounced - 10% and 40% respectively, and
that of Biomend was the greatest - 30% and 60% respectively.
Systemic TTC administration signicantly reduced signicantly the
degradation of all three membranes at 14 days and that of Ossix
and Biomend also at 28 days.
Conclusion: Systemic TTC administration is eective in reducing
collagen membrane degradation in-vivo.

67
Vertical ridge augmentation with guided bone
regeneration in association with dental implants in the
canine model
I. Rocchietta*, C. Dahlin, T. Karring and M. Simion et al.
Dep. Periodontology, Univ.Milan, Italy
Aim: To evaluate the eect of guided bone regeneration with a
titanium reinforced e-PTFE membrane in alveolar bone defects
with titanium implants.
Materials and methods: Following extraction of three mandibular
premolars and a molar in both sides of the jaw in three dogs,
alveolar bone defects (depth: 57 mm) were produced. At
4 months three implants were inserted per defect to a depth of
5 mm, so that the coronal portion protruded about 5 mm. Four
sides in the dogs were assigned to a test group and two sides to a
control group. 12 test implants were covered with a reinforced
e-PTFE membrane. The space under the membrane was lled with
peripheral venous blood from the animal and aps were sutured
over the membrane. Six control implants received no membrane.
Animals were sacriced at 6 months.
Results: Histologic and histomorphometric analyses revealed a
signicantly (P = 0.08) larger bone ll in the test group
(52.77%, 62.07%)than in the controls (13.78%, 9.51%), and
clinical evaluation of one test site showed the implants were
completely covered with tissue resembling bone. In most of the
specimens, bone had grown in height close to, or in direct
contact with the membrane. However, the new bone generally
was not in direct contact with the implants. A zone of dense
connective tissue was interposed between the implants and the
newly formed bone.
Conclusion: Formation of even considerable amounts of bone
following vertical ridge augmentation with GBR and implants

70

was not accompanied by predictable osseointegration of the

implants.

68
The effect of platelet-rich plasma on the proliferation of
human periodontal ligament cells, alone or in
combination with a bone allograft
A. L.Pantou*, C. E. Markopoulou, A. Mamalis and I. A. Vrotsos
Dep. Periodontol, Dental School, Univ. Athens, Greece
Objectives: A novel therapeutic technique for periodontal
regeneration is the application of platelet-rich plasma (PRP).
PRP is a blood component and is considered to be a rich source of
growth factors. The purpose of this study was to investigate the
mitogenic eect of homologous PRP on human PDL cell lines
in vitro.
Material and methods: Human PDL cultures were derived from the
mid-root of three maxillary premolars extracted for orthodontic
reasons. PRP obtained from three donors was prepared from
plasma by centrifugation. Each PRP preparation (5% v/v) was
added in all cell lines, in the absence or presence of 10 mg/mL of a
demineralized freeze-dried allograft (DFBA). Cells were also
treated with 25 ng/mL bFGF (positive control). Consequently,
cells were incubated for 24 hours at 37 oC, in humied atmosphere
of 5% CO2, 95% air. After the 24-hour treatment, cell proliferation
was determined using Trypan Blue Exclusion Assay.
Results: The results of this study suggested that all PRPs as well as
bFGF signicantly (P < 0.001) induced cell proliferation in all cell
lines, in contrast to DFBA. When the allograft was combined with
all PRPs, cell proliferation was signicantly induced. Furthermore,
PRP preparations alone exhibited an advantage over bFGF.
Conclusion: PRP alone or in combination with DFBA exhibits an
important mitogenic eect on periodontal ligament cells, providing
a signicant biological approach in the periodontal regeneration
in vivo.

69
How valid is the experimental gingivitis model?
R. Deinzer*, U. Weik, V. Kolb-Bachofen and A. Herforth
University of Duesseldorf, Germany
Experimental gingivitis (EG) is often used as a model to study the
eects of plaque accumulation on clinical and immunological
parameters. However, it is not clear whether eects seen after up to
28 days of EG mirror eects of more prolonged periods of plaque
accumulation and gingivitis. In the present randomised controlled
trial we thus compared EG with chronic gingivitis (CG). 24
students without periodontitis volunteered for participation. When
included in the study they all suered from gingivitis at least ve of
six papillae of the posterior teeth of the maxilla. They were
randomly assigned either to the EG condition or to the CG
condition. After professional tooth cleaning and a period of
excellent and professionally controlled oral hygiene to achieve
perfect gingival health EG subjects refrained from any oral hygiene
for a period of 28 days. CG subjects received no professional tooth
cleaning and were instructed just to continue their regular oral
hygiene procedures. Plaque and bleeding on probing were assessed
twice a week, while gingival crevicular uid samples were taken
weekly from the six papillae and analysed for Interleukin-1 and
Interleukin-8. After 28 days groups did not dier with respect to
clinical parameters. They did, however, dier signicantly with
respect to interleukins. These data indicate that at least from an
immunological point of view experimental gingivitis might not be a
valid model for more chronic stages of gingivitis.

Posters: Pre-clinical models

70
Comparative study of the antibacterial effect of the
second (k=532 nm) and third (k=355 nm) harmonics of a
Nd: YAG laser on a dental biofilm

72
Bone healing in critical-size-defects treated with
platelet rich plasma. A histologic and histometric study
in rat calvaria

C. Gmez, A. Herrero*, A. I. Garca and A. Costela et al.

CSIC, Dental School UCM, Madrid, Spain

M. Nagata*, M. Messora, R. Dornelles and S. Bomfim

So Paulo State University, Brazil

Background/aims: To establish an in vitro biolm model which

allows the standardized formation of dental plaque and to evaluate
and compare the antibacterial eect of two dierent wavelengths of
irradiation on the accumulated biolm.
Materials and methods: An acetate splint was designed to maintain
four sterile disks of hydroxyapatite in contact with the teeth of the
maxillary arch of a patient. The disks were used to accumulate
dental plaque during 12 h. Immediately after the acetate splint was
removed, the disks were irradiated with a Q-switchet Nd: YAG
laser (Spectron SL282G) operating at the second (k = 532 nm)
and third harmonic (k = 355 nm). Next, the microbiological
analysis of the disks and the bacterial count by means of CFU/
mL were carried out by culture. A double blind study was carried
out with 22 cases and 28 controls.
Results: The design employed allowed the accumulation of dental
plaque without any type of manipulation and its immediate
examination. Both irradiation wavelengths successfully reduced the
biolm from the disks. anova and KRUSKAL-WALLIS statistical
analysis conrmed a signicant reduction of aerobic and anaerobic
microorganisms with the dierent wavelengths employed
(P < 0.05). Biolm absorptivity at the dierent wavelengths
appears to be the most important parameter for explaining the
dierences in the bactericidal eect between irradiation at 355 nm
and 532 nm.
Conclusions: The UV radiation at 355 nm showed a greater
bactericidal potential.

Platelet Rich Plasma (PRP) has been used either alone or in

combination with bone grafts in order to enhance bone healing.
There are only a few histologic studies evaluating the healing of
bone defects treated with PRP alone. The purpose of this study was
to histologically analyse the inuence of PRP on bone healing in
surgically created critical-size-defects (CSD) in rat calvaria. 32 rats
were divided into 2 groups: C (control) and PRP (Platelet Rich
Plasma). An 8 mm diameter CSD was created in the calvarium of
each animal. In Group C the defect was lled by blood clot only. In
Group PRP it was lled with Platelet Rich Plasma. Both groups
were divided into subgroups (n = 8) and euthanized at either 4 or
12 weeks post-operative. Histometric, using image analysis software, and histologic analyses were performed. Amount of new
bone was calculated as percentage of total area of original defect.
Percentage data were transformed into arccosine for statistical
analysis (anova, Tukey, P < 0.05). No defect completely regenerated with bone. Group PRP had a statistically greater amount of
bone formation than Group C at both 4 (17.68% and 7.20%,
respectively) and 12 weeks (24.69% and 11.65%, respectively)
post-operative. Within the limits of this study, it can be concluded
that PRP signicantly enhanced bone healing in critical-size-defects
in rat calvaria.

71
Histological and immunohistochemical analysis of
early periimplant tissue reactions to chemically
modified SLA titanium implants in dogs
F. Schwarz*, M. Herten, D. Rothamel and J. Becker
Heinrich Heine University, Dsseldorf, Germany
The aim of the present pilot study was to investigate early tissue
reactions to modied (mod) and conventional sandblasted/acidetched (SLA) titanium implants. Implantation of modSLA and
SLA implants was performed bilaterally in both the mandible and
maxilla of dogs. The animals were sacriced after healing periods
of 1, 4, 7, and 14 days. Non-decalcied tissue sections were
evaluated using conventional histology (H) and immunohistochemistry (IH) using monoclonal antibodies to transglutaminase II
(TG) (angiogenesis - AG) and osteocalcin (OC). Bone density and
bone to implant contact (BIC) were assessed morphometrically. IH
analysis at day 1 revealed an early TG antigen reactivity in the
provisional brin matrix adjacent to both implant surfaces. Day 4
was characterized by the formation of a collagen-rich connective
tissue, which revealed rst signs of OC synthesis adjacent to
modSLA surfaces. IH staining for TG revealed a direct correlation
between AG and new bone formation (BF). BF was clearly
identiable after 7 days by means of H, as well as a positive OC
and TG staining. After 14 days, mod SLA surfaces seemed to be
surrounded by a rmly attached mature, parallel-bered woven
bone. Within the limits of the present study, it might be concluded
that the combination of immunohistochemical and conventional
histological stainings at non-decalcied tissue sections is a valuable
technique to evaluate early stages of wound healing around
endosseous titanium implants.

73
Inhibitory effects of green tea polyphenol
(-)-epigallocatechin gallate (EGCG) on the osteoclast
survival in vitro
J. H. Yun, C. S. Kim, K. S. Cho, J. K. Chai, C. K. Kim* and S. H. Choi
Dept. Dent. Kwandong University; Dept. Perio, Yonsei University, Korea
Background: Alveolar bone resorption involves removal of
mineral and organic constituents of bone matrix. Osteoclasts
are principally responsible for this process. Recently,
(-)-epigallocatechin gallate (EGCG) has been shown to induce
apoptotic cell death of osteoclasts and modulate caspase
activation. In the present study, we investigated inhibitory eect
of EGCG on osteoclast survival and examined if EGCG mediates
osteoclast apoptosis via caspase pathway.
Materials and methods: Eect of EGCG on osteoclast survival was
examined by TRAP staining in osteoclasts dierentiated from
RAW264.7 cells. In addition, we evaluated apoptosis of osteoclasts
by EGCG using DNA fragmentation analysis. Involvement of
caspase in EGCG-mediated osteoclast apoptosis was evaluated by
examining eect of EGCG on activity of caspase-3, which was
assessed by western blotting and colorimetric activity assay.
Results: EGCG signicantly inhibited survival of osteoclasts
dierentiated from RAW264.7 cells. It was conrmed by DNA
fragmentation pattern that this inhibitory eect was mediated by
apoptosis. Moreover, EGCG stimulated activity of caspase-3.
Conclusions: From these ndings, we could suggest that EGCG
might prevent alveolar bone resorption by inhibiting osteoclast
survival through the caspase-mediated apoptosis. This study was
supported by a grant from the Korea Health 21 R&D Project,
Ministry of Health and Welfare, Republic of Korea (03-PJ1-PG1CH08-0001).

71

Posters: Biomaterials and surfaces

74
Evaluation of ablation of naturally grown biofilm by
laserfluorescence
U. Stosch*, C. Schwahn, K. Scholz and T. Kocher
Dept. of Periodontology, Univ. Greifswald, Germany
Aim: With laser devices it may be possible to remove selectively
calculus. It is unknown if a low power laser irradiation removes
completely biolm without ablating root cementum. The purpose
of the present study was to evaluate the ablation of biolm and the
removal of root cementum with a KEY-laser-III with dierent
power settings.
Methods: Fifty extracted teeth were treated with a KEYlaser-III
and water-spray in the former pocket region. Biolm was stained
with toluidine-blue. Each tooth and a handpiece were xed at a
computer-assisted-bench, which allowed a standardized treatment
eld (3 1.65 mm/min). The glass tip was applied perpendicular to
the root. On each root surface a control eld was irradiated with
160 mJ. The treatment was performed either with 120 mJ, 100 mJ
or 80 mJ. Afterwards digital images were taken to evaluate the
biolm ablation. To assess the amount of tooth substance removal
the roots were cut into 200 lm thick slices (3 slices per tooth). The
Wilcoxon-test was used to compare 160 mJ with 120 mJ, 100 mJ or
80 mJ. MannWhitney U-test was used for comparisons among
120 mJ, 100 mJ or 80 mJ.
Results: Root substance removal was 243.7 lm 159 lm
(median IQR) with 160 mJ, 59.3 lm 116.7 lm at 120 mJ,
55.9 lm 121.3 lm, at 100 mJ and constant 0 lm with 80 mJ.
(P < 0.001 for all comparisons) Biolm was ablated to 100% at
100160 mJ and at 80 mJ to 63%.
Conclusion: It has to be evaluated which setting between 80
100 mJ will remove biolm completely without ablating tooth
substance.

75
The effect of deer antler growth factor on the viability
and proliferation of human osteoblast cells in vitro
M. Laky*, Z. Qu, C. Ulm, M. Matejka and X. Rausch-Fan
Bernhard Gottlieb Univ. Clinic, Vienna, Austria
Deer Antler Growth Factor (DAGF) is a product which is
extracted from deer antler. In Traditional Chinese Medicine
DAGF is used for the treatment of osteoporosis and fracture
healing. This study examined the inuence of dierent DAGF
concentrations on the viability and proliferation of osteoblast cells.
Material and methods: Primary human osteoblast cells were used
in the experiments. The cells were cultured in Dulbeccos modied
Eagles medium (DMEM), supplemented with 10% calf serum, 1%

streptomycin at a humied air atmosphere of 5% CO2. The cells

were exposed to various concentrations of DAGF (0 lg/mL,
12.5 lg/mL, 25 lg/mL, 50 lg/mL, 100 lg/mL, 250 lg/mL). After
an exposure period of 48 hours, cellular viability and proliferation
were evaluated with a cell counting kit and a MTT cell
proliferation assay.
Results: The cell number and the cell viability of human osteoblast
cells increased by concentration of DAGF, the results are
signicant (a < 0.05).
Conclusions: The results demonstrate that DAGF increases the
proliferation of human osteoblasts in vitro. Further research is
indicated to understand the interaction of DAGF with osteoblasts
and to assess the potential of DAGF for bone regeneration and
improved fracture healing.

76
Implant stability in relation to osseointegration. An
experimental study in the Labrador dog
I. Abrahamsson*, T. Berglundh, N. P. Lang and J. Lindhe
Gteborg Univ. Sweden and Univ. Berne Switzerland
Background: Resonance frequency analysis (RFA) is frequently
used to determine implant stability and the time interval at which
loading can be initiated. The correlation between RFA values and
degree of osseointegration is unclear.
Aim: The objective of the present experiment was to study RFA in
relation to early phases of osseointegration.
Material and methods: All mandibular premolars in 20 Labrador
dogs were extracted. 3 months later, four implants were placed in
each premolar region. The implants were designed with either a
turned (TS) or a SLA surface (SLA). The animals were divided into
four groups and each group represented two dierent healing
times. Hence, the healing following implant installation could be
examined after 2 hours, 4 days, 1 week, 2 weeks, 4 weeks, 6 weeks,
8 weeks and 12 weeks. RFA assessments were performed at the
time of implant placement and at each biopsy interval. Block
biopsies from each implant site were processed for histological
analysis.
Results: The histological analysis revealed that the degree of
osseointegration (BIC%) increased from 1 to 4 weeks, while
changes from 4 weeks to 12 weeks were small. The BIC% was
signicantly higher at SLA than at TS implants at all healing
periods examined. The changes of the RFA values during the
course of healing were small and no dierences were observed
between the 2 types of implants.
Conclusion: The RF analysis did not correlate with BIC% changes
assessed in specimens representing the various implant sites.

Posters: Biomaterials and surfaces

77
Load capability of root canal treated teeth restored
with adhesively cemented fibre reinforced posts
depends on bone support
M. Naumann*, M. Rosentritt, A. Preu and T. Dietrich
Charit
, Berlin, Regensburg, Germany, Boston University, USA
Aim: It was aim of the present investigation to study the inuence
of a reduced bone support on fracture resistance of endodontically
treated teeth (ETT) restored by glass bre-reinforced posts (FRC).

72

Methods: Forty caries-free maxillary central incisors were divided

into four groups (n = 10). Endodontic treatment was performed.
Teeth were attened 2 mm above the cemento-enamel junction.
Group I (control) simulated a clinical situation without
horizontal bone loss. In group II a horizontal bone loss of
25%, in group III of 50% and in group IV of 75% was
simulated. All specimens received FRC and composite core
restorations. All-ceramic crowns were adhesively cemented.
Specimens were exposed to chewing simulation (TCML) and
nally statically loaded until failure. For statistical analysis, the

Posters: Biomaterials and surfaces

Kruskal-Wallis test was applied followed by the MannWhitney
test as post hoc testing.
Results: The median fracture load values (min. / max.) were: group
I=501 (326 / 561), group II=422 (323 / 495); group III=352 (266 /
406). Two specimens each of group II and III and all specimens of
group IV failed during TCML. Statistical analysis revealed
statistically signicant dierences between all test groups
regarding maximum fracture load.
Conclusions: The fracture resistance of ETT restored adhesively
with a FRC, composite core, and all-ceramic crown restoration
dependent on the level of surrounding supporting periodontal
bone. The level of fracture decreases as the level of bone moved
apical.

78
Bone microstructure and mineral density in two
different interimplant distances. A dog study
T. Traini*, A. Novaes, A. Piattelli and V. Papalexiou et al.
Dental Schools of Chieti and So Paulo
Background: The peri-implant bone level will aect the position of
gingival soft tissues, and have a signicant impact on the aesthetic
outcome of the implant therapy.
Aim: The aim of this study was to evaluate the inuence of two
dierent interimplant distances on crestal bone microstructure and
mineral density level.
Materials and methods: Forty-eight implants (DENTSPLYFRIADENT, Mannheim, Germany) were placed in the
mandibular bone of six dogs. Each animal received eight
implants. The implants were divided into two groups: in group A
the interimplant distance was 2 mm, while in group B the distance
was 3 mm. The implants received after 12 weeks, temporary
prostheses than, 4 weeks later, metallic crowns. The animals were
killed after four additional weeks.
Results: For groups A and B, respectively, the interimplant area
was 29.813 6.421 pixels and 23.574 4.238 pixels. The area
covered by bone was 15.988 4.322 pixels and 11.843 4.528
pixels. In group A the marrow spaces represented 99%, while in the
group B they represented 86.4%. In group A, 44.5% of the bone
area was highly mineralized while 35.7% showed a low mineral
density. In group B, 41.2% of the bone area appeared highly
mineralized while 22.4% showed a low mineral density. No
statistically signicant dierences were obtained.
Conclusions: The distances of 2 and 3 mm between implants did
not result in statistically signicant dierences in the bone
microstructure characteristics and mineral density.

79
Finite element analysis of dental implants placed at
varying mesio-distal angulations and connected by
3-unit bridges
A. Zampelis* and L. Heijl
Dental School, University of Gothenburg, Sweden
Objectives: Proximity of the maxillary sinus to the alveolar ridge
sometimes prohibits implant therapy in the posterior maxilla.
Placement of one or more implants at an angle to avoid the sinus
has been proposed, but so far clinical evidence is very limited. The
aim of this study is to test for stresses generated by dierent
implant mesio-distal angulations, at and around implants
supporting 3-unit bridges.
Method: Two-dimensional models were created of 3 unit bridges
supported by implants (13 mm length, 4 mm wide) placed at 0, 10
or 20 degrees to the vertical axis, embedded in bone blocks.
Material properties were taken from the literature. Finite element
models were constructed and forces applied on the angulated

implants via the bridges. The stress distribution on the bridges,

implants and alveolar bone was evaluated for every model and then
cross-compared.
Results: The numerical results showed little or no dierence in
stress distribution between the models.
Conclusions: Within the limitations of nite element analysis, it
was demonstrated that the constructed models were not
compromised by the implant angulation.

80
Surface microstructure and fibrin clot extension on
titanium laser sintered specimens
G. Iezzi*,1, T. Traini1, C. Mangano1 and A. Piattelli1
1
Dental School, Univ. Of Chieti, Chieti, Italy
Background: Fibrin seems to be an important factor in the early
healing processes at the interface with dental implants. The aim of
the present study was a quantitative evaluation of the in vitro brin
clot extension on a new implant surface obtained throughout laser
powder sintering.
Materials and Methods: Ten disk-shaped of Ti6Al4V sintered
titanium alloy were used in the present study. The specimens were
covered by 0.2 mL of human whole blood drawn during implant
placement. The blood was immediately dropped onto the surface of
each specimen. Contact time was 5 minutes at room temperature.
After processing, all the specimens were observed under SEM and
Confocal Laser Scanning Microscopy (CLSM).
Results: Quantitative analysis performed under CLSM on a mean
of 12.543 mm2 , showed that a 33% (4.144 mm2 ) of the surface
was 40 lm deep, 36.6% (4.597 mm2) was 20 lm deep and 17.8%
(2.237 mm2) was 5 lm deep. The analysis of the brin clot
extension on a total of 786432 42.386 of the investigated
surface showed a 78807 41.027 pixels of metal surface free from
the brin network. The 90% of the surface resulted covered by
brin clot while only a 10% of the metal surface remained
uncovered. There was a statistically signicant correlation between
the quantity of brin and surface roughness (P < 0.05).
Conclusions: The results of this in vitro study indicated that there
was a correlation between implant surface roughness and brin clot
extension.

81
Proliferation and differentiation of osteoblast like cells
cultured on different bone graft materials: an in vitro
investigation
E. Conserva*, M. Manca, M. Rosa and P. Pera
Dept. of Implant Prosth. Genova University, Italy
Aim of this study was to investigate the biological activity of eight
bone graft materials analysing their inductive potential of osteoblast proliferation and dierentiation. The materials were classied
as: Synthetic materials: Sintbone, Fisiograft and Ostim Animal
derived materials: BioGen, Bio-Oss, and Osteograft Mixed materials: Biostite and Pep Gen P-15 The bone graft materials have been
tested by the MTT Test using osteoblasts SaOS-2, coming from
human osteosarcoma. Afterwards the ALP enzymatic assay was
performed. Both tests were repeated three times for each specimen
at three, four and ve days. After the cellular growth evaluation by
MTT test we quantied the absorbance value for each sample using
a spectrophotometer at 405 nm and we calculated the ALP/MTT
ratio. Data were statistically analysed (anova one way and post-hoc
Schee` test) The mean values of MTT (proliferation test) and ALP
enzymatic activity (dierentiation test) at three, four and ve days
were dierent between tested materials. Within the limits of the in
vitro studies it can be concluded that: Tested bone graft materials
induced dierent amounts of osteoblast proliferation Biostite

73

Posters: Biomaterials and surfaces

(mixed material) shown the lowest proliferation and dierentiation
values at three, four and at ve days (this bone graft material has a
cytotoxic eect) Others tested bone graft materials induced a good
osteoblast dierentiation At ve days Pep-Gen, Bio-Oss and
Osteograf showed the highest ALP activity values.

84
Effects of gamma radiation sterilization on morphology,
mechanical properties, and biocompatibility of ostrich
eggshell membranes
M. A. Torres-Quintana*, N. Brierley and P. Smith et al.
Dental Fac. and INTA, University of Chile, Stgo, Chile

82
Histological evaluation of using bio-gide membrane
with or without deproteinized bovine bone mineral
(DBBM) in healing of bony defects in rabbit
S. A. Miremadi*, A. A. Khoshkhoonejad, A. Rokn and H. Kalbasi
Univ. Tehran, Iran
Guided Bone Regeneration (GBR) doesnt always produce consistent results and bone lling within the space provided by
membrane can be incomplete. The aim of this animal study was
to evaluate the eect of using a collagen membrane (Bio-Gide) in
combination with or without deproteinized bovine bone mineral
(DBBM) on healing of calvarial defects. 12 New Zealand white
rabbits were used in this randomized blind prospective study. In all
animals, four equal defects were created on the calvarium. Four
defects per rabbit were randomly assigned to one of the following
treatments: 1-no treatment (control) 2-Bio-Gide 3- DBBM 4-BioGide + DBBM. The results showed no signicant dierences
between control group and the group with Bio-Gide. There was
a signicant dierence between the group with DBBM and
the group with DBBM + Bio-Gide in comparison with the control
group. The dierence between the group with Bio-Gide and the
group with DBBM + Bio-Gide was insignicant at 1 and
2 months intervals. Within the limits of this study no additional
benets were seen with regard to use of collagen membrane.

83
Clinical evaluation of treatment of intrabony
periodontal lesions using autogenous bone graft and
ostim
S. A. Miremadi*, M. Moosavi, M. Bamadi and S. R. Miremadi
Tehran University, Iran
The ultimate goal of periodontal treatments is restoring the lost
periodontium. In spite of the autogenous bone graft being the gold
standard material for reconstructive methods, in some cases with
not enough source, using a bone substitute material can be helpful.
This study evaluates the treatment of intrabony periodontal defects
using the autogenous bone graft and a bone grafting material
(Ostim). In this clinical trial study, 12 patients aged 2340, who had
bilateral intrabony defects, were treated with Ostim and ABG. In
each patient, one side was treated with Ostim and the other side
with ABG randomly. Clinical attachment levels (CAL) and
probing pocket depths (PPD) were recorded before the operation
and 6-months post-operation. Radiovisiography was also carried
out at the same intervals. The results of this study showed no
signicant dierences between Ostim and ABG. The mean reduction of PPD after 6-months was 3.92 mm for ABG and 3.02 mm
for Ostim and the mean attachment gain was 3.79 mm for Ostim
and 4.18 mm for ABG. The mean bone ll was 2.29 mm for Ostim
and 2.77 mm for ABG. Due to the above results, Ostim can be
considered as a safe and appropriate bio-material for treatment of
intrabony periodontal defects, especially in cases with not a
suitable source of ABG. Histological evaluation of the regenerative
potential of this bio-material is also recommended.

74

Eggshell membrane has been introduced as resorbable biological

membranes for guided tissue regeneration technique but the results
have demonstrated that chicken egg collagen membrane failed to
promote bone healing probably due to its lack of rigidity and the
structural characteristics of collagen. This study aimed to evaluate
the morphology, mechanical properties, and the biocompatibility
of a more rigid ostrich eggshell membrane (OEM). Specimens were
performed for microscopic analyses and for tensile test. In vitro cell
proliferation and adhesion tests was performed using broblasts
obtained of healthy gingival explants and MTT spectrofotometrical detection, after cultivate by 10 and 20 minutes in a 98 wells
culture plates blocked with BSA, with gamma radiation OEM
sterilized and a control membrane. The dierences were analysed
by unpaired t-test with P < 0.05. The gamma radiation process
did not aect morphology and tensile strength. The cells cultivated
in the presence of OEM showed greater optical density values. The
mean of OD increased progressively with the time of incubation in
both control and OEM culture, but the cellular adhesion was
signicantly greater in OEM (P = 0.000). The ostrich eggshell
membrane sterilized by gamma radiation, has good mechanical
properties and is biocompatible with gingival human broblasts,
and it shown characteristics that allow a full cellular adhesion
mediated by integrins and the conservation of cellular vitality.

85
Efficacy of tetracycline adsorbed xenogenic bone
substitute for periodontal therapy
A. Dashti*, D. Ready, S. N. Nazhat and N. Donos
UCL, Eastman Dental Institute, London, UK
Objectives: (1) To investigate the in vitro release of tetracycline
hydrochloride (TCH) onto deproteinised bovine bone minerals
(Bio-Oss) (DBBM) (2) to evaluate its antimicrobial ecacy.
Material and methods: DBBM granules were incubated in TCH
solutions of dierent concentrations (0.1, 0.5, 1 mg/mL) and
adsorption of TCH onto DBBM was followed for 216 hours (h).
The TCH release from the DBBM particles was carried in phosphate
buered saline for 96 h. The adsorption and release of dierent
concentrations of TCH from DBBM were determined using UV
spectroscopy. The eect of TCH adsorbed onto DBBM was tested
on Actinobacillus actinomycetemcomitans (A.a), Porphyromonas
gingivalis (P.g), and Staphylococcus aureus (S. aureus). The
bacterial growth was determined by the total viable colony count
(TVC) of the bacteria in agar cultured plates and was followed for
96 h in the presence of DBBM with or without TCH.
Results: Most of TCH adsorption onto DBBM took place during
the rst 73 h. The highest concentration of TCH resulted in
increased adsorption onto DBBM granules. The TCH release
prole was fast during the rst 10 h, and was reduced gradually
over time. The TCH adsorbed DBBM showed reduction in growth
of A.a, P.g, and S. aureus for all TCH concentrations. High
concentration of TCH adsorbed onto DBBM resulted in increased
reduction in the growth of all bacteria.
Conclusions: DBBM granules are able to adsorb and release TCH.
This eect might provide clinical utilisation.

Posters: Biomaterials and surfaces

86
The bone regenerative effects of tetracycline blended
chitosan membranes on the calvarial critical size
defect in sprague-dawley rats

88
Microvessel density (MVD) and vascular endothelial
growth factor (VEGF) expression in sinus lifting
procedures using anorganic bovine bone (Bio-Oss)

G. J.Chae*, J. S.Lee, U. W. Jung, C. S. Kim and S. H. Choi et al.

Dept. of Perio. Dent. Hosp, Yonsei University, Korea

V. Perrotti*, M. Degidi, L. Artese, C. Rubini and A. Piattelli

University of Chieti-Pescara, Italy, University of Ancona, Italy

The aim of this study is to evaluate the osteogenesis of

tetracycline blended chitosan membranes on the calvarial critical
size defect in Sprague Dawley rats. An 8 mm surgical defect was
produced with a trephine bur in the area of the midsagittal
suture. The rats were divided into ve groups: Untreated control
group versus four experimental groups. Four types of membranes
were made and comparative study was been done. Two types of
non-woven membranes were made by immersing non-woven
chitosan into either the tetracycline solution or chitosan-tetracycline solution. Other two types of sponge membranes were
fabricated by immersing chitosan sponge into the tetracycline
solution, and subsequent freeze-drying. The animals were sacriced at 2 and 8 weeks after surgical procedure. The specimens
were examined by histologic analyses. The results are as follows:
(1) Clinically the use of tetracycline blended chitosan membrane
showed great healing capacity. (2) The new bone formations of all
the experimental group, non-woven and sponge type membranes
were greater than those of control group. But, there was no
signicant dierence between the experimental groups. (3)
Resorption of chitosan membranes were not shown in any
groups at 2 weeks and 8 weeks. These results suggest that the use
of tetracycline blended chitosan membrane on the calvarial
defects in rats has signicant eect on the regeneration of bone
tissue in itself.

Aim: The aim of this study was to conduct a comparative

immunohistochemical evaluation of microvessel density (MVD)
and Vascular Endothelial Growth Factor (VEGF) expression in
sinus augmentation procedures using anorganic bovine bone (BioOss) after 3 and 6 months.
Material and methods: Twenty patients participated in this study.
The sinuses were lled with 100% Bio-Oss. Implants were inserted
after 3 months in Group A, and 6 months in Group B. As control,
the pre-existing subantral bone was used.
Results: The mean MVD in control bone was 23.6 1.8, while in
the sites augmented with Bio-Oss, at 3 months, the MVD was
23.3 2.1, and at 6 months the MVD was 29.5 2.4. The
dierence in MVD between control bone and Group A was not
statistically signicant. The dierence between the control bone
and Group B was statistically signicant (P-value < 0.05).
Moreover the dierence in MVD between Group A and Group
B was statistically signicant (P-value < 0.05).
Discussion and conclusions: Bio-Oss seemed to induce an increase
in the MVD that reached a higher value after 6 months. VEGF
decreased from Group A (85% of vessels stained) to Group B
(65% of vessels stained). Our data could point to a close spatial
relationship between angiogenesis and osteogenesi due to an higher
percentage of vessel and stromal cells positive to VEGF and higher
MVD values in the front of osteoconduction compared to the
center of bone maturation.

87
Histopathologycal evaluation of the effects of alveolar
bone and bone marrow originated cell on healing
around various root surfaces
D. K. Erguven*, A. Dogan, A. Ozdemir, I. Saygun and T. Oygur
Gazi University, Turkey, G.A.T.A., Ankara, Turkey
Periodontium contains various mesenchimal cell populations with
specic dierentiation potential capacity of those cells for tissue
formation still remains unclear. Sementoblast precursors within
periodontium reported to found on endosteal surfaces of alveolar
bone. The aim of this study is evaluation of the eects of alveolar
bone and bone marrow originated cell on healing around various
root surfaces. According to this purpose, cortical layer of the
alveolar bone was removed by 3 3 1 mm (width, length,
height) dimensions at the level of maxillar and mandibular molars
level in ve pigs for preparations of bone defects. Furthermore,
those defects were covered with 3 3 mm root particle caps with
cement, dentin and bronectin coated dentin surfaces and
Atrisorb membranes were plated over those root particle caps.
After the operations, pigs were sacriced at 15th and 45th days
and histopathological examination of the samples were performed
by light microscope. Results of those observation showed that the
cells originated from endosteal gaps of the alveolar bone has
regenerative potential not towards sementoid formation. In
conclusion, the results showed that periodontal ligament cells
has regenerative potential.

89
Attachment and spreading of human fibroblasts on
suprathel - membranes
D. Schneider*, R. Hierlemann and J. Meyle et al..
University Giessen, Germany, ITV, Denkendorf, Germany
Human broblasts adhere to surfaces with integrins and show a
typical morphology. Attachment and spreading of cells can be
classied into dierent stages described by Rajaraman et al. (1974).
The aim of this study was to examine cell spreading of human
broblasts on two material surfaces at dierent incubation times.
For the experiments human periodontal ligament cells (PDL) and
gingival broblasts (HGF) were used. The materials, cover slip and
resorbable Suprathel membrane, were tested for cell compatibility. Cells were seeded in duplicates for 3, 6, 18 and 24 hours on
cover slips and membranes. PDL and HGF were analysed by light
and scanning electron microscope (SEM). SEM photographs were
used for cell counting and dening stages of spreading. Mann
Whitney U-Test (P < 0.05) was used to analyse the dierences
between the stages on the various materials. Early cell spreading
events could be observed after 3 hours on both materials.
Signicant dierences between the stages 1, 2 and 3 were shown
for cover slip and Suprathel after 3 and 6 hours (P < 0.05). After
18 hours incubation there were signicant dierences between
stages 1, 2 and 4 (P < 0.05) for both materials. After 24 hours
only a low number of cells was completely attached to Suprathel.
For the rst 24 hours the results showed a well attachment and
spreading of HGF and PDL on Suprathel compared with cover
slip. Incubation times over 24 hours indicate lower attachment
because of membrane degeneration.

75

Posters: Biomaterials and surfaces

90
Microvessel density (MVD) in sinus augmentation
procedures using anorganic bovine bone (Bio-Oss)
and autologous bone: 3 months results

92
Experimental evaluation in rabbits of the effects of
thread concavities in bone formation with different
titanium implant surfaces

L. Artese*, M. Degidi, C. Rubini and A. Piattelli

Dept. of Stomat and Oral Science, Chieti, Italy

A. Scarano*, M. Degidi, G. Iezzi, V. Perrotti and A. Piattelli

University of Chieti-Pescara, Italy

Bio-Oss is a xenogeneic bone graft material of bovine origin that

has been demonstrated to be biocompatible and osteoconductive.
Angiogenesis plays a key role in bone formation and maintenance.
Aim of the present study was an immunohistochemical evaluation
of microvessel density (MVD) in sinus augmentation with autologous bone and Bio-Oss. Twenty-four patients participated in
this study. Twelve sinus augmentation procedures were performed
with 100% autologous bone, with in the other twelve patients
100% Bio-Oss was used. Endosseous implants were inserted after
a mean period of 3 months. As control, the portions of pre-existing
subantral bone were used. The mean value of the MVD in control
bone was 23.4 1.3. The mean value of the MVD in the sinuses
augmented with autologous bone was 29.0 2.4. The mean value
of the MVD in the sinuses augmented with Bio-Oss was
23.8 2.2. The statistical analysis showed that the dierences of
the MVD between control bone and sinuses augmented with BioOss were not statistically signicant (P = 0.52), while the
dierence of the MVD between sinuses augmented with autologous
bone and Bio-Oss was statistically signicant (P = 0.0008). This
fact can, probably, be explained with the hypothesis that autologous bone may act not only as a passive lling material in bone
defects but also through the release of osteogenic growth factors
and that the particles of autologous bone seem to contain vital
osteoprogenitor cells.

Aim of the present study was an evaluation of the osseous response

in machined implants (M), in implants blasted with apatitic
calcium phosphate (TCP/HA blend) particles (Resorbable Blast
Texturing, RBT), and in implants coated with HA (HA). Threaded
M, RBT and HA coating commercially pure titanium screw shaped
implants (BioHorizonsR, Birmingham, AL, USA) were used in this
study. Twelve New Zealand white mature male rabbits were used
for this study. The implants were inserted into the tibia. Each
rabbit received four implants, two in the left tibia and two in the
right tibia. A total of 48 implants (16 M, 16 RBT and 16 HA) were
inserted. Three animals were killed, with an overdose of intravenous pentobarbital, respectively after 1, 2, 4, and 8 weeks. A total of
48 implants were retrieved. The specimens were processed to obtain
thin ground sections with the Precise 1 Automated System (Assing,
Rome, Italy). Higher and highly statistically signicant dierences
were found in the percentages of bone that had formed in the
concavities rather than the convexities of the implants in the
specimens retrieved after 1 (P = 0.000), 2 (P = 0.000), and
4 weeks (P = 0.004). No statistically signicant dierences were
found in the percentages of bone that had formed in the concavities
rather than the convexities of the implants in the specimens
retrieved after 8 weeks (P = 0.703).

91
Peri-implant bone evaluation combining confocal laser
scanning microscopy and scanning electron
microscopy backscattered electrons imaging

93
Evaluation of abm/p-15 hydrogel in a rabbit cranial
bone model

A. Piattelli*,1, T. Traini1M. Degidi1 and S. Caputi1

1
Dental School, Univ. Of Chieti, Chieti, Italy

S. Matos*,1, F. Guerra1, J. Marcelino1and M. Sanz2

1
Fac. Med., University Coimbra, Portugal, 2University Madrid, Spain

Background: Aim of this report was to present a new investigative

approach of the peri-implant tissues based on the correlation of the
qualitative and quantitative details by overlapping dierent images
obtained on the same specimen through dierent investigative
techniques.
Materials and methods: Unloaded titanium dental implants (3
XiVE plus and 2 Frialit2, DENTSPLY-Friadent, Mannheim,
Germany), retrieved from the mandibles of four patients after a
mean period of 6 months period, were used in the present study.
Samples of resin-embedded peri-implant tissues were evaluated
under SEM using a Backscattered Electrons (BSE) signal, Confocal
Laser Scanning Microscopy (CLSM), Circularly Polarized Light
(CPL) and Light Microscopy (LM).
Results: The SEM BSE images were used to identify the mineral
density around the implants. The CLSM images was used to
provide information about cells and bone marrow spaces. The CPL
images gave the collagen bers orientation in the peri-implant
bone, while; LM images were used as controls. To overlap the
images we used a program based on a linear transformation matrix;
the overlapping was made by calculating three corresponding
points in the BSE and CLSM gures.
Conclusions: The combination by overlapping of two images of the
same section of the same specimen made possible to have, in the
same image, a complete evaluation of both the peri-implant bone
tissue and of the cellular elements, the not yet mineralized osteoid
matrix, the newly-formed bone.

Background: ABM/P-15 is a combination of anorganic bovinederived HA bone matrix (ABM) with a synthetic cell-binding
peptide (P-15). An evolution of this biomaterial was achieved
through the combination with a hydrogel carrier to optimize its
clinical handling and ecacy. The aim of this study is to compare
the standard ABM/P-15 particulate with the ABM/P-15 hydrogel
in a preliminary bone defect animal model.
Materials and methods: Twelve male adult rabbits were used.
Cranial bilateral full thickness circular 8 mm defects were created.
Defects randomly received either the ABM/P-15 particulate or the
ABM/P-15 suspended in a hydrogel composed by glycerol and
carboxymethylcellulose, or remained empty as controls. At time
periods of 2 and 4 weeks post surgery, six animals from each group
were sacriced. Skulls were harvested en bloc and prepared for
histological processing of undecalcied specimens for
histomorphometric evaluation.
Results: Control defects healed with connective brous tissue.
None of the graft materials showed adverse tissue reactions. ABM/
P-15 particulate promoted signicantly the formation of new bone
when compared to control defects. The hydrogel produced an
unexpected increased migration of particles, determining a poor
ecacy on bone regeneration.
Conclusions: The ABM/P-15 particulate enhances new bone
formation. Nevertheless, the hydrogel vehicle does not seem
suitable to be applied in non-contained bone defects as a carrier
for bone graft substitutes.

76

Posters: Biomaterials and surfaces

94
Evaluation of p-15 in a new hydrogel bone graft in a
rabbit cancellous bone model

96
BGP-15, a new type insulin sensitizer is protective in
rat experimental periodontitis

S. Matos1, F. Guerra*,1, J. Marcelino1 and M. Sanz2

1
Fac. Med., University Coimbra, Portugal, 2University Madrid, Spain

Z. Lohinai*, Zahonyi, Kolonics, Literati-Nagy and Tory

Semmelweis University and N-Gene Res Lab, Budapest, Hungary

Background: Coating anorganic bone mineral (ABM) with the cellbinding small peptide P-15 (ABM/P-15) simulates the ligand role of
native collagen, which can have the potential to enhance osseous
regeneration. The purpose of this study is to evaluate the ecacy of
the synthetic peptide by comparing the ABM matrix with and
without the P-15 in an inert hydrogel carrier in a cancellous bone
defect model.
Materials and methods: Twelve male adult rabbits were used.
Rabbits randomly received either the ABM or the ABM/P-15
suspended in a hyaluronic acid hydrogel, and as controls, only the
hydrogel and empty defects. Four cylindrical defects (4 mm
diameter by 10 mm depth) were created per rabbit in the distal
femur and medial tibia. At time periods of 1, 2, 4 and 8 weeks post
surgery, ve animals from each group were sacriced. Bones were
harvested en bloc and individual specimens xed for
histomorphometric evaluation.
Results: All the rabbits recovered with no negative response to the
surgical procedure or graft material. Sections receiving no graft
material or hydrogel carrier showed minimal bone ingrowths. At
1 week, bone formation was comparable but, with increasing time,
histological sections at 2, 4 and 8 weeks showed greater bone
formation with ABM/P-15 hydrogel.
Conclusions: The signicant results of this study were attributed to
the P-15, which provides a biomaterial with an ability to stimulate
cells interaction with their extracellular matrix, mimicking the role
of collagen.

Previously our group identied a hydroxilamine derivative, BGP15 with insulin sensitizer activity. BGP-15 inhibits poly (ADPribose) polymerase, stimulates the expression/function of heat
shock proteins and constitutive nitric oxide synthases (NOS), and
through these mechanisms it improves mitochondrial biogenesis/
function. Considering that diabetes is a major risk factor of
periodontitis, furthermore some of the observed biochemical
activities of BGP-15 might be benecial in periodontitis even in
the lack of diabetes, the potential therapeutic ecacy of BGP-15
was tested in periodontitis model. Periodontitis was produced by a
silk ligature placed around the cervix of the lower left 1st molar in
the rat. Animals were gavaged with 20 or 50 mg/kg BGP-15 or
vehicle once a day for 7 days. On Day 8, the gingivomucosal tissues
encircling the mandibular 1st molars were harvested and the level
of inammation in the tissue was evaluated by Evans blue
extravasation technique. The heat shock, NOS, and COX-IV
protein contents were determined by Western blot, and the alveolar
bone loss by videomicroscopy. Ligation-induced periodontitis
resulted in marked inammation in the gingivomucosal tissue
and led to alveolar bone destruction. Both of the applied doses of
BGP-15 signicantly reduced gingival inammation. The insulin
sensitizer and cytoprotective BGP-15 is active in experimental
periodontitis and it represents a new drug candidate in the
treatment of periodontal disease.

95
Morphological, structural and chemical
characterization of bone graft substitutes
,1

J. Henriques* , Figueiredo , Figueiredo and Guerra

1
Fac. Med., University Coimbra, 2FCTUC, Coimbra, Portugal
Aims: The purpose of this study is to characterize bone graft
substitutes with dierent origins using techniques currently
available.
Materials and methods: Five materials (DFDBA, Bio-Oss,
PepGen P-15TM , Osteogenos and Biocoral) were characterized
with respect to their physical and chemical properties. The samples
were observed by light and scanning electron microscopy to
qualitatively evaluate morphological aspects. Size was
characterized by laser diraction spectrometry and image
analysis. Sample porosity was quantied by mercury intrusion
porosimetry. Density was determined by gas pycnometry. Physical
characterization was complemented by X ray diraction, for
crystalline phase identication, and by FTIR, to qualitatively
assess samples functional groups. Ash content was determined by
incineration.
Results: It was detected organic material in the allograft and
animal xenografts. The materials kept the microscopic
organization typical of bone tissue, however pores size
distribution curves revealed that the majority of the particle
pores have submicron sizes not suitable to cellular colonization.
Conclusions: These results suggest that, rst, some of the
manufacturing techniques are not able to completely eliminate
organic components and, second, interparticle spaces play an
important role in the nal performance of these materials.
Therefore attention should be paid not only to the particles
properties but also to the processing methods and packing
characteristics.

97
Ultrastructural features of regenerated bone in
maxillary sinus augmentation using a porous
porcine-derived allograft
R. Strocchi*, G. Orsini and A. Scarano et al.
Univ. of Chieti-Pescara, Italy
Natural anorganic porcine-derived hydroxyapatite matrix in form
of 0.121 mm granules (Apatos, Tecnoss, Turin, Italy) has been
used in this study. Aim of the present study was to report the light
microscopy and transmission electron microscopy results in 12
specimens retrieved 5 months after a sinus augmentation procedure
using this biomaterial. Each specimen was cut in half and one part
was xed in formalin and treated to be observed under light
microscopy; the other part was xed in glutaraldehyde and
paraformaldehyde, decalcied and treated to be observed under a
transmission electron microscope. Light microscopy showed that
most of the particles were surrounded by newly formed bone. In
some areas osteoid matrix was present. In transmission electron
microscopy, all phases of bone formation (osteoid matrix, woven
bone, lamellar bone) were observed around the biomaterial
particles. Some reactive connective tissue was present and a few
inammatory cells were identied. Bone-biomaterial interface
showed a close contact between the partially demineralized porcine
bone particles and the bone tissue that had mainly features of
mature bone with numerous osteocytes. This is, according to our
knowledge, the rst study presenting data on transmission electron
microscopy of porcine-derived hydroxyapatite used in a sinus
augmentation procedure in man. Our data, in conclusion, show, at
an ultrastructural level, the high biocompatibility and eectiveness
of this biomaterial.

77

Posters: Biomaterials and surfaces

98
Proliferation and differentiation of human gingival
fibroblasts on titanium implant surfaces
L. Ramaglia, G. Di Spigna, R. Saviano*, G. Capece and L. Postiglione
Dip Sc Odont, Biol Pat CM, University Napoli Federico II, Naples, Italy
Surface characteristics of dental implants seem to modulate the
cellular phenotypic expression and metabolic activity thus aecting
perimplant tissues healing. In order to investigate in vitro the eects
of surface topography on the biological behaviour of broblasts,
human gingival broblast cells from primary cultures were cultured
in DMEM with 10%FCS at 37
C in 5%CO2 on c.p. titanium disks
with two dierent surface topographies: machined, smooth(S) and
dual acid-etched, Osseotite(O)(3i-Biomax,Italy).Cell adhesion and
DNA synthesis were tested by means of 3H-thymidine incorporation while production of extracellular matrix(ECM) proteins was
assessed by indirect enzyme-linked immunoassay in situ and
immunoblotting using specic monoclonal antibodies. The adhesion of gingival broblasts measured after 3h of culture and cell
proliferation up to 14 days of culture did not show any statistically
signicant dierence between the surfaces. The ECM proteins
collagenI(CoI), bronectin(FN) and tenascin(TN) were progressively produced between 1 and 14 days of cloture on both surfaces
with a greater expression of CoI and FN on the surface O. The
preliminary results indicate that in vitro both the smooth and the
Osseotite surfaces show a favourable interaction with human
gingival broblasts supporting cell proliferation and dierentiation
and suggest that the microtopography of a dual acid-etched surface
may not modify in vivo the biological behaviour of human gingival
broblasts.

99
Emdogain improves the proliferation and differentiation
of osteoblasts on the surface of titanium implants
X. Rausch-Fan*, Z. Qu, C. Ulm and M. Matejka et al.
Dept Periodontology, Dental School, Vienna, Austria
Background: Enamel matrix derivative (EMD) supports
periodontal tissue regeneration of cementum, periodontal
ligament (PDL) and alveolar bone. The purpose of this study
was to study the eect of EMD on osteogenesis and behaviour of
osteoblasts on the surface of titanium implants.
Material and methods: Human osteoblast-like MG-63 cells were
incubated on the surface of sand-blasted and acid-etched (SLA)
titanium discs (Straumann Co) in culture medium containing EMD
(50 and 100 lg/mL). After 48 hours the supernatants were
collected and osteoprotegerin (OPG) and TGF- were
determined by ELISA Kits, alkaline phosphatase (AP) activity
with an enzyme assay. Cells were stained with cell tracker orange
and monitored under time-lapse microscopy for 6 days.
Results: Treatment with EMD resulted in higher levels of OPG
and TGF- that were produced from cells growing either on
titanium surface or on the culture surface, compared to control
groups in the absence of EMD (P < 0.01). AP activity was
enhanced by EMD (P < 0.01). Cytouorescence staining showed
increased density of cells on the titanium surface in the presence of
EMD in 3-day-old cultures and mineralized nodule formation after
5 days.
Conclusion: Our results demonstrated that EMD stimulates
osteoblast-like cells on titanium surfaces to induce OPG, TGF-
and AP activity. This study gives evidence that EMD may
positively participate in osseointegration and bone formation on
the surface of titanium implants.

78

100
Bone healing around resorbable ceramic/autologous
platelet lysate constructs: the role of anatomical site
and of thrombin
E. Soffer*,2, J. P. Ouhayoun1and F. Anagnostou1
1
Period. Univ Paris 7 and 2B OA UMR-CNRS 7052 Paris
The eects of autologous platelet lysates (APL) on the resorption
of calcium carbonate ceramic particles (CP) and on new bone
formation were investigated in an animal (rabbit) model at two
critical-size defects: calvaria and femur. PL for autologous use was
prepared according to published methods for human PL. Defects
were lled with CP, CP plus APL, and CP plus APL with or
without thrombin (THR). Bone formation and CP resorption were
determined histomorphometrically after 6 weeks of implantation.
Resorption of CP occurred under all conditions tested. Compared
to respective CP alone, addition of APL resulted in signicantly
(P < 0.01) higher CP resorption at both defect sites. The presence
of THR prevented reduction of both CP diameter and number in
the femoral sites. Addition of APL to the CP resulted in a
signicant (P < 0.03) two-fold decrease in new bone area at the
calvarial, but not at the femoral sites; moreover, when THR was
added to the CP plus APL constructs, bone formation in was
signicantly (P < 0.05) reduced. The results of this study provided
evidence that APL aects bone healing when used with a
resorbable ceramic material; the dierences observed in CP
resorption and bone formation between the two sites tested may
be due to the dierences in the respective cellular environment and
mechanical loading. These results provide new information on the
conditions needed to ensure the success of platelet concentrates
used with biomaterials for bone reconstruction.

101
Different titanium surface treatment influences initial
adhesion and proliferation of human osteoblast-like
cells (MG-63). an in vitro study.
A. Mamalis*, K. Markopoulou, S. Silvestros and I. Vrotsos
Dental School, University of Athens, Greece
Surface characteristics play a prominent role in determining bone
tissue response to dental implants and entirely to clinical outcome.
The major objective of the present study was to determine the eect
of four commercially available titanium surfaces: smoothmachined, osseotite, sand-blasted/acid-etched (SLA) and hydroxyapatite coated (HA) to initial cell attachment and proliferation. Six
implants of each surface morphology were obtained from commercially available sources. Implants were incubated in semiconuent cultures of human osteoblast-like cells (MG-63) for 1, 3, 7,
12 days. At the end of each period, implants were removed from
culture media. Viable MG-63 cells attached to implant surface were
calculated using the Trypan Blue Exclusion Assay. A Poisson
regression analysis statistical model was employed to determine
signicant variations in attachment and proliferation rates for
dierent surfaces and time intervals (P < 0.001). Initial attachment for MG-63 cells (day 1) was signicantly higher in HA
surfaces (P < 0.001). MG-63 cells proliferate on each dierent
surface in a time dependent manner (P < 0.001). For days 3, 7, 12
MG-63 cells proliferate in a signicant higher rate on the SLA
surface when compared to other surfaces (P < 0.001). Although
cells grown on all surfaces exhibited good adhesion and proliferation potential, a clear early adhesion prole was exhibited by the
HA surface. Moreover, SLA surface revealed a unique long-term
proliferation capability.

Posters: Biomaterials and surfaces

102
Randomized comparison of periodontal indices for
HA- or TPF-coated IMZ implants in 313 partially
edentulous mandibles followed up for 5 years
M. Yong* and J. Mau for SPPI Study Group
Inst.Statistics in Medicine, Univ. Dsseldorf, Germany
Background: The clinical eectiveness of bioactive coating of
implants remains controversial, evidence from randomized
controlled trial to compare the surfaces of implants is required.
Materials and methods: Hydroxyapatite (HA) and titaniumplasma-ame (TPF) coated intramobile cylinder (IMZ) implants
have been compared in 313 partially edentulous mandibles in a
randomized controlled trial. The patients had been followed up for
at least 3 (average 5) years after placement of prostheses. Plaquefree, inammation-free, and mobility-free intervals are compared
between the implants and the abutment teeth as well. Kaplan
Meier survival curve and log-rank test are used for the analyses.
Results: Two year cumulative survival rates for HA and TPF
implants are 29% (95% CI: 1938%) and 46% (95% CI: 3656%),
respectively, for plaque-free interval, 49% (95% CI: 3859%) and
50% (95% CI: 4061%), respectively, for inammation-free
interval, and 99% (95% CI: 96100%) and 97% (95% CI: 93
100%), respectively, for mobility-free interval. HA had a
statistically signicantly shorter plaque-free interval than TPF
(P = 0.04). No other statistically signicant dierence in terms of
periodontal indices has been suggested between two coatings.
Conclusion: In restoration of partially edentulous mandibles, HA
coated implants seem to attract plaque more easily than TPFcoated ones, while there are no dierences with respect to the
survival time of mobility and inammation.

103
Development of an injectable composite for periodontal
regeneration
S. Herberg1, U. Wikesj, C. K. Kim2and M. Siedler*,1 et al.
1
Scil Technology; Temple Univ, USA, 2Yonsei Univ, SK
Aim: Various biomaterials have been used to facilitate periodontal
regeneration. Because several tissues constitute the periodontium it
is challenging to nd a single biomaterial that may full basic
requirements including biocompatibility, porosity, mechanical
properties, and resorption rate to in concert support regeneration
of alveolar bone, cementum, and the periodontal ligament. Ideally,
the biomaterial is combined with suitable growth factor(s) that will
orchestrate and accelerate regeneration of all relevant tissues. The
present study describes the development of a novel injectable,
in-situ setting composite combined with rhGDF-5 for regeneration
of periodontal defects.
Materials and methods: Dierent composites consisting of
bioresorbable poly (lactic-co-glycolic acids) (PLGA) and inorg.
llers were characterized in terms of porosity, mech. stability,
degradation prole, and injectability. The stability of rhGDF-5
within the formulation and its release kinetics from the carrier were
determined using RP-HPLC, SEC, and ELISA.
Results: Injectable, in-situ setting composites based on PLGA and
inorg. llers can be combined with rhGDF-5 to achieve a ready-touse formulation that shows high porosity after application and
degrades in an appropriate time to allow a maximum regeneration
rate.
Conclusion: The results suggest that the formulation may have
ideal properties to allow regeneration of all relevant tissues in
periodontal defects.

104
Osteoblast functions on functionalized PMMA-based
polymers exhibiting S. aureus adhesion inhibition
F. Anagnostou*,1,2, A. Debet2, V. Migonney2 et al.
1
Periodont Univ Paris 7, 2UMR-CNRS 7052 Paris
The eect of ionic composition on functionalized poly (methyl
methacrylate) PMMA-based terpolymers on both S aureus adhesion and osteoblast select functions were investigated, in order to
identify biomaterial surface modications which inhibit bacteria
adhesion but do not interfere with osteoblast functions pertinent to
new bone formation. Terpolymers bearing randomly distributed
carboxylate and sulfonate groups were synthesized by radical
polymerization, characterized by nuclear resonance spectroscopy
and classied by the ratio R = [COO-/COO- + SO3-] in the range
0.50.8. S aureus adhesion and select functions of rat calvaria
osteoblasts were examined using established methods. Compared
with results obtained on PMMA, adhesion of S. aureus on the
functionalized terpolymers was highly (more than 90%) inhibited.
In contrast, and compared to results obtained on PMMA, 4-hour
adhesion of osteoblasts onto these terpolymers was decreased only
by 20%. However, only osteoblast cultured on the PMMA-based
terpolymers with R equal to 0.7 and 0.8 exhibited proliferation,
alkaline phosphatase activity and calcium accumulation similar to
that observed onto non-functionalized PMMA. The results provide
evidence that since functionalized PMMA-based terpolymers with
a ratio R of 0.7 and 0.8 simultaneously inhibit bacteria adhesion
and support osteoblast functions, they could be used as coating of
dental implants to render them both bone compatible and less
vulnerable to bacterial infection.

105
Bioactive implants: first clinical experience with a
fluoridized surface
Helmut G. Steveling* and K. Merkle
Department of Oral and Maxillofacial Surgery, University of Heidelberg,
Heidelberg, Germany
The successful integration of enossal implants depends on several
factors like, e.g., material, design and surface characteristics of the
implant. An Astra Tech implant system with a uoridized surface
has been available since 2004. By means of this modied surface an
improved osseous integration is rapidly achieved even in structurally weak osseous beds. This type of implant was applied in 17
patients at the Heidelberg University department of oral and
maxillofacial surgery in 2003 within the scope of an international
multicenter survey and before launch onto the market. Of a total of
53 implants, 12 were inserted into the mandible and 41 into the
maxilla. All implants healed in transgingivally. Six weeks later the
abutments were mounted, according to the manufacturers instructions, with a force of 25 Ncm and provided with cemented
superconstructions within two weeks. One implant, inserted into
the mandible, with a length of 8 mm, was lost during the healing
phase. All other implants remain in function. After one year in
function they show the same clinical and radiological results as the
Astra Tech implants with the traditional healing protocol, applied
at the department of oral and maxillofacial surgery since 1992. The
uoridized implant surface allows an improved osseous integration
in best time and even in structurally weak osseous areas.

79

Posters: Diagnosis and risk factors

Posters: Diagnosis and risk factors

106
Amlodipine and nifedipine used with cyclosporin a
induce different effects on gingival overgrowth

Conclusion: Salivary HGF concentration may be a novel,

promising and the cause and eect-oriented marker of advanced
periodontal disease.

R. M. Lpez-Pintor*, G. Hern
ndez and L. Arriba et al.
Univ. Complutense. Madrid, Spain

108
Evaluation of sampling methods for subgingival
bacteria by real-time PCR

Gingival overgrowth (GO) is a side eect associated with administration of Cyclosporin A (CsA) and calcium channel blockers (CCB).
This study aimed to determine and compare GO prevalence and
severity in three groups of renal transplant recipients (RTR) who had
been medicated with CsA, CsA-nifedipine and CsA-amlodipine.
Methods: A cohort of 93 RTR was selected. Thirty-one RTR had
been medicated with CsA, 31 with CsA-nifedipine and 31 with
CsA-amlodipine. Drug, demographic data and presence and
severity of GO for each subject were recorded and photographs
of the anterior buccal gingiva were taken.
Results: There were no signicant dierences for age, gender
distribution, and CsA dose among the three groups. There were
signicant dierences for GO prevalence and GO severity among
the three groups. A higher proportion (90.3%) of the CsA
nifedipine group were categorized as having GO compared with
CsAamlodipine group (58.1%) and CsA group (51.6%). A greater
percentage of subjects in the CsAnifedipine group expressed
severe GO (22.6%) when compared to the CsA group (0%) and
CsAamlodipine group (16.1%).
Conclusion: Prevalence and severity of GO in RTR maintained on
CsA-nifedipine is signicantly greater than those treated with CsAamlodipine and CsA. The GO prevalence and severity is greater in
CsA-amlodipine group than CsA group. This fact should lead the
clinicians to avoid the use of these drugs together with CsA or to
choose amlodipine instead of nifedipine.

107
Hepatoctye growth factor in saliva is a novel marker of
advanced periodontal disease
M. Wilczynska-Borawska*, J. Borawski and W. Stokowska
Medical University, Bialystok, Poland
Background: Hepatocyte growth factor (HGF) a pluripotential
reparative cytokine is a new factor in the pathogenesis and
progression of periodontal disease (PD), due to the excessive
stimulation of gingival epithelial cell growth and impaired
regeneration of deep collagenous structures.
Aims: To compare for the rst time: (i) HGF levels in unstimulated
whole mixed saliva from PD patients vs. that from healthy subjects,
and (ii) to test relationships between the salivary HGF levels and
clinical indices in PD patients.
Methods and results: Immunoreactive HGF levels were determined
in 26 patients with PD, and in 20 healthy subjects. Salivary HGF
was detected in all PD patients and was 0.065.38 ng/mL (a mean
of 1.87 1.32 ng/mL). In healthy subjects, HGF level was
0.68 ng/mL (full range: 07.33 ng/mL), and almost 3-fold lower
as compared with that in PD patients (MannWhitney
P < 0.0001). Periodontal parameters in the patients were as
follows: gingival index (GI) 2.0 (02.8), papillary bleeding index
(PBI) 2.2 (03.2), plaque index (PI) 2.0 (03.0), and the loss of
clinical attachment level (CAL) 4.7 (1.110.6) mm. Direct and
logarithmic Spearman correlations between salivary HGF and GI
(P = 0.004), PBI (P = 0.046) and PI (P = 0.001), but not
between HGF and the loss of CAL (P = 0.172), teeth number
(P = 0.279) and patients age (P = 0.362) were found.

80

P. Jerve-Storm*,1, H. AlAhdab1 and R. Fimmers2 et al.

Depts of 1Periodontology, and 2Med. Biometry, University of Bonn,
Germany
Objective: To compare curette and paper point sampling of
subgingival bacteria by quantitative Real-Time PCR.
Materials and methods: Twenty patients with chronic periodontitis
( 1 maxillary incisor with PPD 6 mm) were randomised into
groups A & B. Before scaling and root planning (SRP) and after
10 weeks samples in group A were taken rst with a paper point
then with a curette at the same site. In group B samples were taken
in
opposite
sequence.
Samples
were
analysed
for
A. actinomycetemcomitans (A.a.), F. nucleatum ssp. (F.n.),
P. gingivalis, P. intermedia, T. denticola, T. forsythia (T.f.) and
total bacterial count (TBC) by quantitative Real Time - PCR
(meridol Perio Diagnostics, GABA Int., CH).
Results: Curette samples yielded higher TBCs than paper points.
The proportions of T.f. (group A: 3.56.5%; group B: 3.14.4%),
and F.n. (group A: 1.83.8%; group B: 2.43.7%) were comparable
with both methods, with only limited eects of SRP. A.a. was much
higher before (4.69.9%; except PP group A) than after SRP (0.0
0.7%).
Conclusion: Within the limitations of the experimental design, we
found a relatively good agreement between two sampling methods
of subgingival bacteria as evaluated by the novel method of
quantitative Real Time-PCR.

109
Completely unerupted wisdom teeth increase the risk
for periodontitis
B. W. Sigusch*, T. Nietzsch, R. Zschenderlein and W. Pfister
Faculty of Medicine, University of Jena, Germany
This study investigated the relation between the clinical and
microbiological ndings on the distal surfaces of 2nd molars (zone
of contact to completely unerupted 3rd molars), and 1st molars and
lower incisors (reference teeth). 202 subjects aged 13 to 65 years were
examined clinically and microbiologically. The test group consisted
of 144 subjects with a mean PD of > 3.5 mm, whereas the control
group was comprised of 56 subjects with a mean PD of < 3.5 mm at
the reference teeth. The subgingival samples were taken from the
distal sites of 2nd molars and the mesiobuccal sites of 1st molars.
Two samples were taken from the lower incisors. PCR was employed
to detect F.n., A.a., P.g., T.f., T.d., and P.i. Compared to the control
group, the subjects of the test group had a signicantly greater
number of periodontopathogenic species in both regions (test group
1.12 vs. controls 0.18). The risk for harbouring P. gingivalis in the
reference sites is higher by a factor of 14.2 if these species occur on
the distal site of the second molar (CI 95% 5.238.7).
Furthermore the risk for a periodontitis at the reference teeth is six
times higher if at least one of the species is found on the distal site
of a 2nd molar (CI 95% 2.514.4). The results of this study suggest
that completely unerupted wisdom teeth could be associated with
increased numbers of periodontopathogenic species and increased
pocket depths at rst molars and lower incisors.

Posters: Diagnosis and risk factors

110
Evidence based diagnosis of dysfunction in periodontal
patients
V. Burlui, S. Mrtu, M. Br nz* and C. Dascalu
University of Medicine and Pharmacy, Iasi, Romania
Aim: The aim of the study was to investigate the possible
correlation between dysfunctional syndrome of stomatognatic
system and periodontal diseases.
Materials and methods: The research was realized on 87
individuals, with ages between 1872 years old, diagnosed with
periodontal disease and one or more sign and symptoms of
stomatognatic dysfunction. The diagnosis of oral dysfunction and
periodontal disease is based on correlation between clinic and
complementary exams (EMG, KMG, gnathosonic and radiological
exam).
Results: The study showed a signicant statistical relevance
between periodontal disease and dierent degrees of malfunction
of muscles, TMJ and occlusion.
Conclusion: Periodontal disease can be the consequence of TMD,
but in the same time can be the etiologic factor for dysfunctional
syndrome of stomatognatic system.

111
Dental health and periodontal disease in pregnancy
R. Muza and M. Galarce*
Dental Service, Hospital Rancagua, Chile
Background: It is very important to know the oral status of
pregnant women in order to recommend eective preventive
measures.
Aim: To determine the prevalence of dental caries, gingivitis,
periodontal disease and tooth loss from mothers who recently
delivered live-born infants.
Material and methods: In the period from May to July 2005, a
cross-sectional study was carried out at the Hospital Rancagua
(Chile) among 610 pregnant women who recently delivered liveborn infants. Following variables were recorded: age, number of
children, the Decayed, Missing and Filled Teeth Index, the
Gingivitis, Plaque, periodontal disease, and dental treatment
during pregnancy. Examination and questions were designed to
obtain information from mothers who recently delivered live-born
infants.
Results: Prevalence of gingivitis was (66.0%), periodontal diseases
was 93.2%. The number of tooth loss was upper jaw (833) and
lower jaw (809). D.M.F. index was 10.39. Dental care use during
pregnancy was 33.9%. Among mothers reporting a dental
problem, 42 were treated for extractions and 142 for restorative
treatment. Mothers age was 29.5% (15 to 20 years old); 26 % ( 21
to 25 years old); 21.8 % ( 26 to 30 years old); 12 % ( 31 to 35 years
old); 10.7 % (36 to 40 years old).
Conclusions: Pregnancy was shown to be associated with a higher
prevalence of gingivitis, and periodontal disease. Poor oral healths
represent strong reasons for activation of dental health care in this
period.

112
Assay of the total antioxidant capacity (TAC) of
crevicular fluid in healthy subjects and in
periodontopathic patients
C. Littarru*, F. Galeazzi, G. Vittorini O. and G. Deli
Catholic University, Rome, Italy
Oxidative stress is involved in the pathogenesis of numerous
diseases, many of which of an inammatory type, such as
periodontal disease. Several studies have highlighted the inuence

of free radicals and reactive oxygen species (ROS) on the

pathogenesis of tissue damage in the course of inammation. The
aim of this study was to determine the total antioxidant capacity of
gingival crevicular uid (GCF) in a group of healthy subjects and
to compare the ndings with those from a group of periodontopathic patients. We enrolled 18 patients 6 m 12 f with clinically
healthy gums and 15 patients suering from moderate periodontitis, 7 m 8 f. GCF samples were collected using Periocol strips
inserted in the sulcus and then placed in an Eppendorf test tube
containing 10 lL of a solution of PBS Tween 20 at pH 7.4 diluted
at 0.05%. The test tubes were vortexed and stored at 80
C until
analysis, which was carried out by a spectrophotometric method.
GCF did not show high TAC as measured by the LAG phase,
either in healthy or periodontopathic subjects. Some technical
problems are likely related to diculties in assaying the GCF
protein content, to which results should be referred. This could be
due to the binding anity between paper and proteins, and by the
fact that the strips are designed to measure the GCF volume of the
sample and they may not completely release the absorbed material.

113
The relationship between cotinine and periodontal
disease in smokers and non-smokers
N. Leow*, G. Tofler, M. Morel-Kopp, M. Woodward and B. Taylor
SydneyDental, RoyalNShoreHosps, GeorgeInst, Australia
Background: Tobacco smoking is an established risk factor for
periodontitis but self-reported smoking status may be inaccurate.
Cotinine (Cot), a major metabolite of nicotine is a stable
biochemical marker of smoking status. The relationship between
Cot and periodontitis is unclear.
Aim: To clarify the relationship between Cot and mean probing
pocket depth (PPD), loss of attachment (CAL), and recession.
Methods: We studied 135 adults (age 55.4 12 years) with
moderate-advanced periodontitis. Plasma Cot concentration was
measured using ELISA. Cumulative exposure to smoking was
represented by cotinine years (CotY) where CotY = Cot
number of years smoked. Associations were assessed using
Pearson correlations.
Results: Smokers, when compared with non-smokers, were
younger (mean age 49.7 10.8 vs. 60.2 11.4 years,
P < 0.0001) and had higher levels of plasma Cot (249.6 149
vs. 2.7 7 ng/mL, P < 0.0001). CotY was signicantly related to
mean recession (r = 0.31, P = 0.02) and a trend toward greater
CAL (r = 0.24, P = 0.06) but not associated with PPD. No
signicant relationship was found between Cot concentration and
the periodontal markers.
Conclusion: In this population, cumulative exposure (cotinine
years) was associated with recession and a trend towards greater
CAL although no signicant relationship was seen with plasma
Cot. Smokers had comparable periodontal disease at a younger age
than non-smokers.

114
Untreated periodontitis in diabetes adult patients in
Lithuania- a pilot study
A. Puriene*, J. Aleksejuniene and I. Balciuniene
Univ. Vilnius, LT, Univ. British Columbia, CA, USA
Aim: Natural course of periodontitis disease not interfered by
complex periodontal treatment was studied in diabetes patients in
Lithuania.
Materials and methods: Periodontitis was evaluated in a sample of
50 diabetes patients from Vilnius area. One calibrated examiner
performed clinical recordings with a Florida Probe. Clinical
parameters were oral hygiene index, by individual numbers of:

81

Posters: Diagnosis and risk factors

sites with bleeding on probing, pockets 5.5 mm or more, teeth with
furcation involvement and number of mobile teeth. Non-clinical
variables were smoking and satisfaction with oral health. Bivariate
associations were assessed by means of Spearmans correlation.
Results: The number of deep pockets was statistically signicantly
correlated to oral hygiene index (0.509), number of bleeding on
probing sites (0.587), number of teeth with furcation involvement
(0.605) and to the number of mobile teeth (0.725). Smoking was
signicantly related only to oral hygiene index (0.280). The
satisfaction with oral health was correlated to the individual
number of teeth with furcation involvement. The mean number of
pockets 5 mm or more was higher, although non-signicant in a
current smokers group compared to a group of ex-smokers and
never smoked group.
Conclusion: A few clinical indicators related to periodontal disease
experience were frequently observed in Lithuanian diabetes
patients. The high level of untreated periodontitis in diabetes
patients indicates that this group of patients is a risk group.

smoking exposure, clinical periodontal and endodontic evaluation.

The subject intensity and quality of the pain on periodontal
probing was assessed using a Visual Analogue Scale (VAS).
Results: At site level statistical analysis revealed in both groups
that pain responses to periodontal probing were statistically
signicant higher in older group (>50 years), in females and in
teeth with higher probing pocket depth, with higher percentage of
sites with bleeding upon probing (P < 0.001) and in vital teeth
(P < 0.05). Results indicated that approximal sulci of all teeth
were the most pain sensitive (P < 0.05).
Conclusions: These data suggest that pain on periodontal probing
depends on several variables as age, gender, tooth type, site type,
probing pocket depth, bleeding on probing, tooth vitality.

115
Oral bacteraemia caused by chewing in patients with
periodontal disease

N. Efthimiadis*, R. Teles, T. Slini and A. Konstantinidis

Aristotle University Thes, Germany, Forsyth Res. Inst., USA

A. Murphy*, C. Daly, D. Mitchell and B. Curtis et al.

Univ Sydney, ICPMR Westmead Hospital, Australia
Background: Transient bacteraemia caused by chewing is
considered a risk factor for infective endocarditis (IE) in at-risk
patients. Previous chewing studies have shown conicting results in
bacteraemia incidence (0%55%) and have not classied the
periodontal status of subjects. Most failed to obtain pre-chewing
blood samples.
Aim: To determine if chewing in patients with untreated chronic
periodontitis (CP) or plaque-induced gingivitis (GV) causes
bacteraemia.
Method: 21 CP (3275 year old) and 19 GV (2654 year old)
patients chewed a standard wax medium for 4 min. Blood samples
were drawn before, during and 5 min post-chewing. Aerobic and
anaerobic BACTEC system culturing was performed for 21 days
and positive bottles subcultured and isolates identied to genus
level. Following sampling, full periodontal analysis was performed
(PPD, CAL, BOP, PI, GI, mobility). Radiographs were assessed
for alveolar bone loss.
Results: No bacteraemia of oral origin was detected in
any patients. Skin contaminants (Staphylococcus epidermis,
Propionibacterium spp) were detected in three patients (2 CP, 1
GV). Mean CAL for CP was 4.4 mm 0.9 mm and GV was
2.5 mm 0.3 mm; BOP (CP 46% 14%, GV 19% 11%); PI
(CP 1.9 0.4, GV 1.2 0.5); GI (1.9 0.2, GV 1.1 0.4).
Total number of mobile teeth> Grade I was GV = 0, CP = 134.
Conclusion: Chewing did not cause bacteraemia in CP or GV
patients and may not be a risk factor for IE, even in severe CP.
(Grants from AustPerioResFndt, AustDentResFndt).

116
Analysis of pain experienced during periodontal
probing in smokers
A. L. Dumitrescu*
University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania
Background: The aim of this study was to investigate the factors
that can aect the pain responses to periodontal probing and to
establish whether smoking will cause dierent periodontal pain
levels and discomfort.
Methods: The study population consisted of 40 patients 2065
years old, with a negative medical history and with absence of
current analgesic therapy. The following data were collected: the

82

117
Porphyromonas gingivalis and Actinobacillus
actinomycetemcomitans in periodontitis patients of
Greek origin

Background: Dierent distribution for Porphyromonas gingivalis

(Pg) and Actinobacillus actinomycetemcomitans (Aa) might exist
in various geographic locations.
Aim: To evaluate the levels of these pathogens in chronic and
aggressive periodontitis patients of Greek origin.
Materials and methods: Data from 78 patients with chronic
periodontitis (mean age 53.6 7.4) and 44 patients with
aggressive periodontitis (mean age 35.23 6.81) never treated
previously were included in the present study. Pg and Aa were
quantied in 485 subgingival samples from chronic periodontitis
patients and 394 subgingival samples from aggressive periodontitis
patients previously analysed using the checkerboard
DNA-DNA
hybridization. Quantication was performed using image analysis
software (Total Lab 100, Nonlinear Dynamics).
Results: The sites from chronic periodontitis patients had mean
probing depth 4.78 0.83 mm and the sites from aggressive
periodontitis patients had mean probing depth 5.39 1.17 mm.
Chronic periodontitis patients displayed mean and SEM of
2.72 105 4.1 104 bacterial cells of Pg and 1.19 105
2.1 104 of Aa, while the respective values for aggressive
periodontitis
patients
were
2.7 105 0.27 104
and
0.87 105 0.2 104. Counts for the two species did not dier
between the two groups (MannWhitney test P > 0.05).
Discussion/Conclusions: Subgingival samples from chronic and
aggressive periodontitis patients of Greek origin displayed high
counts of Pg and Aa.

118
Subgingival calculus detection employing IR-laser
fluorescence and a led-based optical probe in vitro
F. Krause*, A. Braun, S. Ehrentraud and M. Frentzen
Dep. Periodontology, University Bonn, Germany
Objective subgingival calculus detection techniques are desirable
for systematical periodontal treatment procedures. Therefore, the
aim of the present study was to compare two systems for detecting
subgingival calculus evaluating both sensitivity and specicity. 20
freshly extracted human teeth with calculus on the root surface
were xed in an articial pocket model. Measurements on the root
surfaces were performed with the DetectarTM -system (DE) and the
DiagnodentTM -system (DI) using a novel periodontal tip. Each
tooth was scanned in increments of 1 mm with an angulation of
0
10
between the tip of the optical ber and the root surface. The
values of the blindly examined root surfaces were compared to the
clinical ndings. Clinically apparent calculus on the root surface

Posters: Diagnosis and risk factors

was detected by both systems (P < 0.05). Regarding the exact
position of mineralized deposits, sensitivity for calculus detection
of 30% (DE) and 46% (DI) and a specicity of 99% (DE) and 95%
(DI) were observed. However, irrespective of the exact localisation
of calculus, sensitivity was 61% (DE) and 78% (DI), values for
specicity was 95% and 80% respectively. The present study
indicates that the systems do not appear to allow a reliable
assessment of the exact localisation of mineralized deposits.
However, both systems oer the possibility of subgingival calculus
detection and may, therefore, be suited to determine the endpoint
of root surface instrumentation during non-surgical periodontal
therapy.

119
Relationship between unstimulated and stimulated
whole saliva, DMFT and CPI in young adults
M. Girotto*, V. V. Boras, A. Bosnjak, S. Srdjak and K. Srdjak
Sch. Med. Rijeka, Sch. Dent. Med. Zagreb, Croatia
Aim: Saliva is considered to be an important factor in oral health.
Few studies have investigated the correlation between salivary
function, periodontal health and caries. There is no conclusive data
on gender dierences in salivary ow, and the correlation to
periodontal disease and caries.
Material and methods: It was the goal of this study to evaluate
possible dierences between genders in unstimulated and
stimulated salivary ow rate, periodontal status (by means of
Community Periodontal Index, CPI), and caries (by means of
Diseased, Missing and Filled Teeth index, DMFT), in a young
population (mean age 23.8 1.1).
Results: Males show more increase in salivary ow rate after
stimulation, but there is inconclusive data concerning salivary ow
rate and CPI and DMFT values. It seems that subjects with healthy
periodontium have lower DMFT values.
Conclusion: Saliva represents an important mechanism of
periodontal and dental health. Although there were no
statistically signicant dierences between genders, it is believed
that males are not so prone to regular dental check-ups, but there is
a drive to encourage gum chewing, as the values of sugarless gum
chewing stimulated salivary ow rate is 50% greater than ascorbate
stimulated salivary ow rates.

120
Association between labial frenum insertion and
mucogingival problems
T. Vives*, A. Pascual, M. Vicario and A. Santos et al.
Universitat Internacional de Catalunya, Spain
Introduction: The labial frenum is a brous band of connective
tissue, muscular or both, which joins the lip with the alveolar
mucosa or gingiva. It can be related with periodontal, prosthetic,
orthodontic or phonetic problems. Placek presented a classication
of the labial frenum, depending on whether its insertion was on
mucosa, attached gingiva, interdental papilla or papillapenetrating.
Aim: The purpose of this study is to analyse if there are signicant
dierences related to clinical attachment level, height of attached
gingiva, or gingival width, of the adjacent teeth, depending on the
type of labial frenum insertion.
Material and methods: An examination of subjects from the
Universitat International de Catalunya was made and prevalence
of the labial frenum attachment was determined. The following
measurements were examined in each subject: type of the frenum
attachment as mentioned above, probing depth, attachment level,
height and width of attached and queratinized gingiva.

Results: Means were obtained for each type of labial frenum and
repeated measures analysis of variance (anova) was used to
determine if the dierent periodontal parameters were correlated
with labial frenum classication.
Discussion: An extent periodontal exploration should consider the
type of the frenum attachment and its relation with the periodontal
tissues. This simple consideration should help us to detect future
mucogingival problems.

121
Comparison of the qualitative PCR technique results
from two independent laboratories
J. Calvo Zuluaga* and A. Santos Alemany
Universitat Internacional Catalunya, Spain
Introduction: An accurate diagnosis is of utmost importance in
order to give patients the best treatment in each case. Then, the
development of molecular techniques to detect the main specic
microorganisms that are found in periodontal diseases has meant a
great advance as a possible diagnostic tool.
Aim: The aim of this study is to set the validity and usefulness of
the qualitative PCR technique as a good and reliable diagnostic
tool.
Material and methods: Thirty patients from the school of dentistry
were evaluated. Samples from the same localization and taken at
the same time were sent to two independent laboratories in order to
detect specic periodontal pathogens using a qualitative PCR
technique.
Results: The provisional results show only few cases where the
results provided from the two laboratories were similar.
Discussion and conclusion: With the limitations of the study, we
question severely the usefulness and validity of the qualitative PCR
technique as a good and reliable diagnostic tool.

122
The analysis of the relationship between smoking and
periodontal disease according to serum cotinine levels
D. Yaman* and K. Demirel
Dep. Periodontology, Univ. Istanbul, Turkey
The aim of the study was to evaluate the relationship between
chronic periodontal disease and smoking in regard to serum
cotinine levels (SCL) and to analyse the eect of co-existence of
these two situations on the biochemical parameters that reect
systemic health. In the clinical part of the study, plaque index (PI),
gingival index (GI), probing pocket depth (PPD), bleeding on
probing (BOP), clinic attachment level (CAL), gingival recession
(GR), calculus index (CI), have been examined in order to
determine the periodontal situation of patients with chronic
periodontitis. In the laboratory part of the study, SCL, taken
from subjects have been analysed. Triglyceride, HDL-C, LDL-C,
VLDL-C values have been analysed to determine cholesterol level
and haematological analyses have been investigated. Results
derived indicate that SCL of the patients was signicantly
associated with daily tobacco consumption (DTC). Although
no association of smoking with PI and CI observed, its inverse
association with GI and BOP levels, and signicant positive
association with PPD, CAL and GR have been found. SCL was
also signicantly associated with CAL and PPD, and this result has
displayed the relationship between smoking and periodontal
destruction on a biochemical basis. SCL was signicantly inversely
related to systemic HDL-C, and signicantly positively related to
WBC and eosinophil amount. DTC was also signicantly associated with haemoglobin, hematocrite, MCH and leucocyte number.

83

Posters: Diagnosis and risk factors

123
Prevalence of gingival stippling in children
J.-H. Phark*, C. H. Finke and B.-M. Kleber
Charit
Universittsmedizin Berlin, Germany
Aim: In this cross-sectional study prevalence and characteristics
(morphometric data, distribution on gingiva, relation to oral
hygiene and gingival inammation) of gingival stippling in children
were determined.
Material and method: Two hundred and seventy four children (#
148, $ 126) aged 0 to 10 years (mean age 4.98) were examined. API,
PBI, dmft/DMFT and race were obtained. Stippling, documented
by photo camera or replica (Anis light), was scanned and
analysed regarding density, height and width of the stipples with
the software analysis 3.0. For statistical analysis v2-Test
(P < 0.05) was used (SPSS 12.0).
Result: Stippling was found in 68.2% of the children and was
evident from an age of 1 year. There was no relation between
stippling and sex, race, caries, oral hygiene or gingival
inammation. It was more frequently in mixed dentition and in
anterior region as well as in upper jaw. It was mainly localized to
the attached gingiva (interradicular> radicular>subpapillar area).
Morphometric data showed a density of 2.54 stipples/mm2, a
height of 0.10 mm and a width of 0.09 mm. Older children had a
higher density. Height and width were not inuenced by sex or by
age.
Conclusion: Stippling is a normal characteristic of healthy
keratinized gingiva. In our study it appeared at an age of 1 year
and increased with age. But it cannot be used as a major criterion
in clinical assessment of gingival or periodontal inammation,
because missing stippling does not always coincide with presence of
inammation.

124
Microbiological testing: changing the target. Exploring
antibiotic resistances in a sample of periodontal
patients in Spain
A. Pordomingo*, I. Arregui and A. Pordomingo Jr et al.
Centro de Periodoncia e Implantes, Burgos, Spain
Initial background: The adjunctive use of certain antibiotics
(Amoxicillin + Metronidazole) in the treatment of periodontitis,
especially in the most aggressive forms, has shown to be eective
especially when certain putative periodontal pathogens
(P. Gingivalis) are present. But some patients do not benet from
this treatment, maybe because of the absence of these specic
periodontal pathogens. One of the virulence factors of the bacteria
is the quantity. Based on this, we consider our target the most
common bacteria in the sub gingival plaque of our patients and we
wanted to know its sensitivity to the commonly used antibiotics.
Materials and method: We took sub gingival plaque samples of 234
consecutive periodontal patients. We search for the most common
bacteria of the sample. Antibiotic sensitivity test was carried out in
each of the cases. Clinical parameters were also recorded at the
time of the rst visit (baseline) and at the end of the periodontal
treatment.
Results: The result showed 44 dierent bacteria, almost equally
distributed along the sample, and a very high incidence of
resistance for the most commonly used antibiotics, especially
Metronidazole (89.3%).
Discussion/conclusion: Due to the high incidence of resistance to
certain antibiotics in our sample we consider microbiological
testing and antibiogram desirable, especially if we want to use
antibiotics as an adjunctive treatment in our periodontal patients.

84

125
Periodontal status of patients receiving hemodyalisis
at Rancagua hospital, chile
Ricardo Muza*
Dental Service, Hospital Rancagua, Chile
Background: The number of patients on dialysis is growing. Good
dental hygiene reduces the risk of oral infections. Healthy dentition
becomes increasingly important when a patient is a candidate for
renal transplantation. The incidence of periodontal disease seems
greater among dialysis patients.
Aim: The aim of this study was to examine the levels of
periodontal status of patients on hemodialysis at Rancagua
hospital.
Method: Completion of a questionnaire and a non-invasive oral
examination was obtained from all hemodialysis patients at
Rancagua hospital, between March 1 and June 30 of 2005. A
total of 36 patients, were examined for gingivitis, gingival index
(GI), the periodontal index (CPITN), Oral Hygiene and DMFT
index. Information gathered from the medical chart included the
patients age, sex, duration of dialysis, dialysis modality and so on.
Results: The mean age of dentate patients was 49.9 and 64 year in
edentulous. Mean dialysis duration (months) was 28.5. Most
hemodialysis patients have complex medical conditions, including
hypertension and diabetes and polycystic kidney disease. The GI
revealed 2.29 scored, CPI of 2.34, and almost all (90%) had
gingivitis. Dental hygiene and frequency of dental control found
was regular to bad. 72.2% of dental visit was for pain and only
27.8% or prevention. The group DMFT index mean was 16.8.
Conclusion: Gingival and periodontal diseases are prevalent in this
patients studied. They need more dental prevention.

126
The potential impact of the sampling site on the resting
volume of gingival crevice fluid
H. Hatipoglu, N. Yamalik* and A. Berberoglu et al.
Dept. Periodontology, Univ Hacettepe, Turkey
Background & aim: Volumetric features of gingival crevice uid
are inuenced by a vast majority of factors, including various
sampling variables. As attempts to standardize such factors may
enable a more precise methodology, the possible impact of the
clinical periodontal status and the distinct location of sampling site
on uid volume was analysed.
Materials & methods: Clinical parameters were recorded and uid
samples were obtained from 931 maxillary sites. The potential sitespecic volumetric dierences among healthy, gingivitis and
periodontitis sites and between multi-rooted or single-rooted
teeth and mesio-buccal or disto-buccal sampling sites, and the
correlations between volume and clinical measures were
statistically analysed.
Results: Although volume increased in a disease-related pattern
(healthy < gingivitis < periodontitis) (P < 0.05), the distribution
range of volume was wide with prominent overlaps between
dierent clinical periodontal conditions. Multi-rooted teeth
presented more uid volume, and even mesio-buccal or distobuccal sites exhibited volumetric dierences (P < 0.05). Constant
correlations between uid volume and clinical parameters could
only be observed at gingivitis sites (P < 0.05).
Discussion/conclusion: These ndings support the disease-related
spectrum values of uid volume and the clear impact of the unique
dimensional features of dierent teeth groups and the distinct
sampling site on the volumetric features of this biologic uid.

Posters: Diagnosis and risk factors

127
Correlation of five gene polymorphisms with
periodontal conditions in a Greek population

129
Risk indicators of aggressive periodontitis in Syrian
adolescents

D. Sakellari, M. Georgiadou* and V. Katsares et al.

Aristotle Univ. Thessaloniki, Greece

M. Kazem* and J. M. Albandar

Damascus Un., Syria; Temple Un., Philadelphia, USA

Background: Various studies have examined possible correlations

between a number of cytokine gene polymorphisms and
periodontal disease in populations of dierent origins. This study
sought the correlation between four Single Nucleotide
Polymorphisms (IL-1A + 3954, IL-1B + 4845, TNF-A -308,
COL1A1 Sp1) and a Variable Number of Tandem Repeats
Polymorphism (IL-1RN intron 2) and periodontal conditions in
subjects of Greek origin.
Methods: One hundred and ninety two healthy subjects
representing four periodontally distinct conditions (healthy,
gingivitis, chronic and aggressive periodontitis) participated in
the present study. Genotyping was performed by PCR based
techniques using primers and conditions described in the literature.
The frequencies of genotypes and alleles between study groups
were compared using Genepop genetic software. Neis genetic
distances were calculated using GeneAlex genetic software. Data
were also analysed with subjects stratied as smokers or nonsmokers.
Results: No dierences were observed among the four groups
concerning the distributions of alleles, genotypes and haplotypes
under investigation, regardless of smoking status.
Conclusions: Carriage rates of the polymorphisms under
investigation in healthy Greek subjects are within the range
reported for Caucasians but these polymorphisms cannot
discriminate between four distinct periodontal conditions. Our
ndings do not support the incorporation of testing for these
polymorphisms in clinical practice.

Background: Little is known about the etiological factors and risk

indicators of aggressive periodontitis (AgP) in developing
countries. We assessed the occurrence and characteristics of this
disease among a representative group of youths in Syria.
Material and methods: 1,795 subjects 1118 years of age in 27
public schools were randomly selected from four districts in Syria,
and were clinically examined to assess the attachment loss at six
sites on all permanent teeth. Subgingival dental plaque at six
deepest pockets was collected using sterile paper points from cases
and controls, and the presence of the putative pathogens
Actinobacillus actinomycetemcomitans (Aa), Porphyromonas
gingivalis (Pg), Prevotella intermedia (Pi), Tanerella forsythensis
(Tf), and Treponema denticola (Td) was assessed. Epithelial cells
were collected by buccal swab, and the occurrence of
IL-1b + 3953, IL-1b + 511, and IL-1a-889 polymorphisms were
investigated.
Results: Forty-nine (2.7%) subjects had clinical features of
aggressive periodontitis. The disease was more prevalent among
females (3.4%) than males (2%) (P = 0.07), and in subjects with a
large family size (P = 0.01) and poor education (P = 0.02). Only
Td showed signicant association with AgP. A signicantly higher
frequency of IL-1b + 511 allele 2 polymorphism was found in
cases than controls (P < 0.05).
Conclusion: The ndings suggest signicant association of AgP
with socio-economic factors and polymorphism of IL-1b + 511
allele 2.

128
Screening for pre-diabetic and diabetic patients using
a capillary blood glucose meter in a specialist
periodontal practice

130
Actinobacillus actinomycetemcomitans as indicator for
aggressive periodontitis

K. M. Gale*
School of Dentistry, Univ. of Western Australia
Diabetics who are undiagnosed or uncontrolled can suer severe
periodontal disease. This study aimed to detect type II pre-diabetic
or diabetic patients using an Accu-chek Advantage blood glucose
meter in 280 consecutive new patients referred to a specialist
periodontal practice. Patients were asked if they were high risk for
type II diabetes based on the following criteria: >55 years old;
>45 years with high blood pressure; >45 years, overweight and/
or elevated blood fats; >45 years and an immediate family
member with diabetes; has/had heart disease or a heart attack;
has/had high blood sugar during pregnancy; has/had borderline
blood glucose levels; has polycystic ovary syndrome and overweight; >35 years old and Aboriginal, a Torres Strait Islander,
from the Pacic Islands, Indian subcontinent or of Chinese origin.
From 159 patients who admitted to being high risk 116 (73%)
agreed to be screened. The maximum probing depth was recorded
for each patient (mean = 7.3 mm). Diabetes had already been
diagnosed in 14 patients (4 = type I; 10 = type II). Blood glucose
levels 5.7 mmol/L were detected in 54 patients (46%) signifying
possible impaired fasting glucose, impaired glucose tolerance or
diabetes (>11 mmol/L). Thirteen patients (11%) had readings
between 7 and 18.9 mmol/L. Patients with >5.7 mmol/L were
referred to their medical practitioner for further testing. Capillary
blood glucose screening helped identify potential and unstable
diabetic patients in a specialist practice.

M. Wohlfeil*, F. Baron, M. Roberg and P. Eickholz et al.

Department of Periodontol, University of Frankfurt, Frankfurt, Germany
Objective: Comparison of the subgingival microora in aggressive
and generalized severe chronic periodontitis.
Methods: In 41 patients (22 female) suering from untreated
aggressive (AgP: 17) or generalized severe chronic (ChP: 24)
periodontitis subgingival plaque samples were obtained from the 4
pockets with the deepest probing depths. Two sterile paper points
were inserted simultaneously in the periodontal pockets. One paper
point from each pocket was put in a separate transport-vial, the
second was pooled with the three other paper points of a respective
patient in a transport-vial. The content of each vial was analysed
separately for Actinobacillus actinomycetemcomitans (AA),
T. forsythensis, P. gingivalis, and T. denticola.
Results: Using the separate analysis the detection rate of AA was
statistically signicant higher in AgP than in ChP (P = 0.012).
Further, log-transformed numbers of AA were lower for ChP than
AgP (P = 0.067). Detection of AA as a diagnostic test for AgP
had a sensitivity and positive predictive value of 65%. For all other
tested pathogens with neither sampling strategy the analysis failed
to detect statistically signicant dierences between AgP and ChP
regarding log-transformed bacteria numbers and detection
frequency.
Conclusion: The AA was detected in higher numbers and
frequency in AgP than in ChP. Detection of AA may conrm the
clinical diagnosis and inuence choice of therapy. To be used as a
diagnostic test alone its sensitivity was to low.

85

Posters: Diagnosis and risk factors

131
CARD15 gene variants in aggressive periodontitis
patients

133
Lip piercing: periodontal complications and etiologic
factors

B. Noack*, H. Grgens, H. K. Schackert and T. Hoffmann

Med. Faculty, Dresden University of Technology, Germany

I. Kapferer, N. Gregoric* and T. Benesch et al.

Department of Periodont., Med.Statistics, University of Vienna, Austria

Background: The CARD15 protein acts as an intracellular receptor

of bacterial products. CARD15 gene variants have been shown to
be associated with Crohns disease (CD), an inammatory bowel
disease.
Aim: The study aimed to investigate the association of the three
most common mutations of the CARD15 gene (R702W, G908R,
and L1007fsX1008) with aggressive periodontitis (AgP).
Methods: Eighty six patients with AgP as well as 67 periodontal
healthy controls were genotyped for the three main mutations in
the CARD15 gene. The carrier and allele frequencies were
compared between the study groups.
Results: The carrier and allele frequencies of the three variants in
the groups were not statistically signicant dierent. All study
subjects were further classied into carriers and non-carriers of at
least one of the three mutations. No signicant dierence was
found between the groups. Additionally, a logistic regression
analysis adjusted for gender and smoking showed no association
between carriers of any of the studied variants and periodontal
status.
Conclusion: Since similar pathogenic mechanisms may be involved
in both CD and periodontitis, a common genetic background may
be inferred. However, our results reject the hypothesis that the
major CARD15 gene mutations are involved in generalized AgP
susceptibility. Our data nd support on two recent studies that
could not show an association between CARD15 gene mutations
and chronic periodontitis (Folwaczny et al. 2004, Laine et al. 2004).

Background: There are only limited studies assessing the

prevalence of periodontal complications in association with
lower-lip studs. This clinical controlled trial investigated the
prevalence of periodontal complications of mandibular incisors
and their possible etiologic factors in association with lower-lip
studs.
Methods: The study involved 88 females and 12 males (mean age
21.76 2.66). The test group (n = 50) included subjects with a
lower-lip stud, controls (n = 50) were matched according to sex,
age and smoking status. Patients with a prior diagnosis of
periodontitis, need of antibiotic prophylaxis, pregnant or
lactating women were excluded. Clinical examination included
plaque indices, bleeding on probing, probing depth, recession,
attachment level, width of keratinized gingiva, gingival biotype,
insertion of the frenulum, evaluation of the hard tissues, trauma of
occlusion, characteristics of the stud, radiographs and
photographs.
Results: Recessions of the test group were noted in 68% as
compared to 4% in controls (P = 0.001). Localized periodontal
disease limited to the mandibular incisors was noted in 4% of the
test group (n = 2). Stud-closures positioned on the CEJ, and time
of wear showed a signicant association to gingival recessions.
Conclusion: The prevalence and severity of gingival recessions is
strongly associated with labial piercing. The position of the
intraoral disc and time of wear might be a signicant predictor
for the development of recessions.

132
Association between genotype and microbacterial
profile of patients with periodontitis an introductory
report
J. Kowalski*, R. Grska, M. Dragan and I. Kozak
Department of Periodontology, Med. University, Warsaw, Poland
Polymorphism of IL-1 seems to have an inuence on the
progression of periodontal disease. Oral mouth microora can
also have an eect on the disease process. The aim of the work was
to evaluate the association of microbacterial pathogens in the
periodontal pockets of patients with positive and negative genotype
with their clinical status. Study group comprised of 16 patients,
aged 2550 years. Only patients with severe generalized form of
chronic periodontititis were included into the study. After clinical
examination patients were subjected to the IL-1 genotype evaluation (Genotype PST, Hain Lifescience GmBH, Germany) and
PCR examination of selected bacteria pathological for periodontium (Perio-Analyse, Pierre Fabre Medicament, France). 7 out of
16 individuals were diagnosed as genotype positive. No association
is observed between clinical parameters and the genotype of the
patients. Total count of bacteria from so called red complex

(P. gingivalis, T. forsythensis, T. denticola), and orange complex

(F. nucleatum, P. micros, P. intermedia, C. rectus) were respectively
2, 4-fold and 1, 3-fold higher in group with positive genotype,
despite the fact that group was smaller (7 vs. 9 persons with
negative genotype). Number of bacteria seems to correlate with
plaque and bleeding indices and percentage of pockets deeper than
4 mm. Observed association may have an inuence on increased
severity of periodontal disease in patients with positive genotype.

86

134
Factors associated with oral hygiene and gingival
health in flemish pre-school children
R. Leroy*, M. J. Garca-Zattera, A. Jara and D. Declerck
Catholic University Leuven, Belgium
Objectives: The study aimed to identify factors associated with
dental plaque accumulation and gingival health in young children.
Methods: Cross-sectional data from 1250 3-year old and 1283
5-year old children from four geographical areas in Flanders
(Belgium) were analysed. Children were examined at school
by eight trained dentist-examiners, using standard criteria and
calibrated examination methodology. Buccal plaque accumulation
and gingival health were assessed on six index teeth. Data on oral
hygiene and dietary habits, oral health behaviour and sociodemographic variables were obtained through structured
questionnaires, completed by the parents.
Results: Roughly, 31% of 3-year-olds and 37% of 5-year-olds
presented with visible plaque accumulation. In both age groups,
only 3 to 4% of children presented with signs of gingival
inammation. Multivariable logistic regression models revealed
that brushing frequency had a signicant impact on plaque
accumulation in both age groups; in 3-year-olds, other signicant
covariates were age, educational level of the mother and frequent
consumption of drinks. With gingival health as dependent variable,
multivariable logistic regression analysis revealed that plaque
accumulation as well as the age at start brushing had a
signicant eect in 5-year-old children.
Conclusion: Parents should be motivated to start brushing the
dentition at an early age and brush frequently in order to maintain
good oral health in their o-spring.

Posters: Diagnosis and risk factors

135
Proximal caries in localized aggressive periodontitis
Moroccan patients
N. khlil*, M. Baite and J. kissa
Dental school, Casablanca, Morocco
A number of studies have made an eort to demonstrate an
association between caries and periodontal disease. Some studies
have found no association while others have found a positive
association between the two diseases. In order to determine if an
inverse relationship (Fine and coll, 1984) exists between periodontal disease and proximal caries in a group of Localized aggressive
periodontitis (LAP) patients as compared to a group of control
patients (CP), 55 subjects (1426 years old) were examined in the
Dental Health Centre of the university of Casablanca.33were LAP
aected and 25 were periodontally healthy. In these patients the
plaque Index (PI) (silness and loe, 1964), the gingival index (GI)
(loe and silness, 1963) and the number of decayed, missing and
lled teeth were assessed. Carious lesions were assessed using
radiographic evaluation (bite wing) (Marthaler and German,
1970). Concerning the mean value of PI, it appears that there is
no dierence between the LAP and control. Concerning the
periodontal status, the GI revealed no signicant dierence
between LAP and control. Concerning the dental status, no
statistically signicant dierence occurred when the total number
of decayed missing and lled teeth was compared in the two
groups. In the opposite, results indicated that LAP patients had
signicantly less proximal decay than the control group.

136
Effects of zinc-deficiency on oral tissues and
periodontal diseases in rats

Prevotella intermedia (Pi) in subgingival plaque of three ethnic

groups of Malaysia (Malays, Chinese, Indians) with Advanced
Chronic Periodontitis and to correlate these ndings with their
periodontal status.
Methods: Thirty diseased adults were age, sex and ethnically
matched with 30 healthy individuals. Clinical parameters were
assessed for all. Subgingival plaque samples were collected from
each subject for identication of Pg and Tf (on only 44 subjects)
and Aa and Pi using PCR (Polymerase chain reaction).
Results: Prevalence for Pi was (83.3%); Pg (59%); Tf (54.5%) and
Aa (6.7%) in the total subject population. Pg, Tf, Pi and Aa were
more prevalent in diseased (87.5%, 81.9%, 86.7%, 10%
respectively) than in healthy (30.5%, 26.4%, 80%, 3.33%
respectively) subjects. There was a signicant association between
Pg (OR = 21.5) and Tf (OR = 11.1) with diseased status. Among
the ethnic groups, only presence of Pg was signicantly associated
with Indian subjects. When tested by General linear model
analysis, Pg had a signicant causal eect on PPD (P < 0.01,
Observed power = 0.99) and CAL (P < 0.01, Observed
power = 0.99) while Aa had a moderately signicant causal
eect on CAL (P < 0.05, Observed power = 0.68).
Conclusion: Porphyromonas gingivalis was signicantly associated
with the Indian subjects. Pg had a signicant causal eect on PPD
and CAL while Aa had a moderately signicant causal eect on
CAL.

138
Microbiological pattern and periodontal pathogens
resistance to metronidazole in patients needing
prosthetic treatment

R. Orbak, C. Kara*, E.
zbek, A. Tezel and T. Demir

Atatrk University of Erzurum, Turkey

A. Quaranta, M. A. Di Leo* and M. De Luca et al.

University of La Sapienza, Rome, Italy

The aim of this study was to investigate the alterations of the oral
tissues in zinc-decient rats and to compare these results with those
of control rats. The study was carried out on 14 Sprague-Dawley
rats, cessation of lactation on 24th day of birth. Rats were randomly
divided into two groups. Group I rats were fed with a Zn-decient
diet, and Group II rats with a Zn-containing diet. At the end of the
fourth week on experimental diets, alterations of the oral tissues in
both groups were recorded and oral tissue samples were investigated
by light microscopy. Then, the blood samples were taken and serum
Zn levels were measured by atomic absorption spectrophotometry.
The zinc-decient ndings were observed at the 1016 days in rats.
Although body weight, body length and tail length were retarded in
zinc-decient rats, they were advanced in rats fed with a
Zn-containing diet. Although, the mean PI and GI for Group II
was lower than that for Group I (P < 0.001), there was not a
signicant dierence as regards the PPD between two groups of
rats. According to histological ndings, there was no any dierence
related with the epithelial keratinization of the hard palate between
the two groups. However, hyperkeratosis was found on the dorsal
surface of the tongue in zinc-decient rats. The ndings indicated
that oral health was better in Group II rats than that in Group I
rats. We suggest that Zinc-deciency can be a potential risk factor
for oral and periodontal diseases.

Aim: Evaluating the microbiological pattern, antibiotic sensitivity

and resistance with culture methods in a group of 14 adult patients
aected by aggressive periodontitis requesting prosthetic
treatment. Supragingival debridment was performed with curettes
and sonic devices, sterile paper points were inserted in two pockets,
removed after 40 sec, inserted in test tubes, in a vial of anaerobic
media and brought to a microbiological laboratory. Culturing
assed the main periodontal pathogens. Susceptibility to the
following antibiotics was tested: Penicillin G, Ampicillin,
Amoxicillin, Amoxicillin/Clavulanate, Metronidazole, Clindamycin,
Cloramfenicole, Imipenem, Cefotetan, Cefoxitine, Piperacilline.
Among the bacteria identied 12 were Tf, 14 were Pg, 2 Aa, 12 Td,
and 2 Pi. 11 out 14 patients showed the red complex
(Tf, Pg and
Td), in two cases presenting also Pi. All the bacteria showed
normal susceptibility to all the drugs except for metronidazole.
Regarding the red complex
in 10 out 11 cases Tf showed resistance
to metronidazole, in another one Pg was resistant. In one patient
with the only Pg this bacteria was also resistant and in one patient
with Aa and Td Aa was resistant to metronidazole. There was a
dramatic and clinically relevant antimicrobial resistance to
metronidazole in most of patients that did not allow to use the
combination amoxocilline and metronidazole together

137
Identification of four periodontopathogens in adults
with advanced chronic periodontitis

139
Characterization of progressive periodontal lesions in
chronic periodontitis patients

R. D. Vaithilingam*, L. Younis and T. B. Taiyeb-Ali et al.

University of Malaya, Malaysia

R. Vernal*, M. Hern
ndez and N. Dutzan et al.
Periodontal Biology Laboratory, University of Chile, Chile, USA

Objectives: To identify Porphyromonas gingivalis (Pg), Tannarella

forsythensis (Tf), Actinobacillus actinomycetemcomitans (Aa) and

Aim: The aim of this work was to determine the quimiokines,

cytokines, MMP-13, periodontal pathogens and inammatory cells

87

Posters: Diagnosis and risk factors

levels in periodontal sites characterized by active periodontal
connective tissue destruction.
Materials and methods: Periodontitis was characterized by at least
six sites with probing depth 35 mm , clinical attachment level
33 mm, and radiographic bone loss. Selected patients had not
previous periodontal therapy, antibiotic treatment during last
6 month, any systemic disease, and pregnant. Periodontitis
progression was determined by tolerance method. Samples of
gingival crevicular uid, subgingival plaque and a gingival biopsy
according to surgical requirements were obtained from active sites.
RANKL, MPC-1, TNFa, IL-1b, MMP-13, A. a, P. g, and
inammatory cells levels were determined. Data were expressed
as mean SD and t-test and chi-square test were used.
Results: Twenty one active sites were detected. Higher
quimiokines, cytokines and MMP-13 levels were observed in
active sites vs. inactive sites (P < 0.05). Although statically nonsignicant, not only Actinomycetemcomitans and P. gingivalis but
also lymphocytes and macrophages levels were higher in active
than inactive sites.
Conclusion: In an active periodontal site, which is characterized by
attachment loss 32 mm after 2 month clinic following, there are
cellular and molecular markers that are characteristics and
dierent to inactive sites.
This work was nanced by Fondecyt 1050518 project.

titis. 32 postmenopausal chronic periodontitis (PMCP), 31 premenopausal chronic periodontitis (CP) patients, 25 periodontally
healthy postmenopausal controls (PMPH), 26 premenopausal
controls (PH) were studied. After clinical measurements and
samplings, TAOC and SOD were measured by automated and
spectrophotometric tests respectively. Clinical parameters were
higher in periodontitis groups. There was no signicant dierence
between PMCP and CP groups. TAOC and SOD were the lowest
in PMCP and the highest in PH groups (P < 0.05). The values
were lower in postmenopausal women than in periodontally
matched premenopausal women, in periodontitis than in controls
(P < 0.05). Moderate correlations were found between clinical
parameters and AO values (P < 0.05). TAOC and SOD were
signicantly reduced in both menopause and periodontitis. Menopause seemed more related with AO reduction in serum while
periodontitis seemed more eective in GCF. The ndings showed a
clear reduction in systemic and local AO defense in menopause and
periodontitis. The lowest values in PMCP group suggest menopause a risk factor for periodontitis.

142
The correlation of gingival crevicular fluid matrix
metalloproteinase-8 and prostaglandin E2 levels with
each other and clinical parameters

140
New perspective on gingival overgrowth

C. Basegmez*, G. Isik, K. Demirel and F. Yalcin et al.

Department of Periodontology, Istanbul University, Istanbul, Turkey

P. Augustin*, A. Fassmann and L. Izakovicova et al.

Dental clinic, St. Ann's Teaching Hospital

Background: Chronic periodontitis arises from the interaction

between bacterial factors and the host response. Perpetuation of
this immunoinammatory response in susceptible host disrupts
homeostatic mechanisms. In return inammatory mediators such
as matrix metalloproteinase-8 (MMP-8) and prostaglandin E2
(PGE2) are released. Since levels of both mediators are shown to be
higher in active and lower in inactive periodontal sites, they can be
implicated as useful parameters in the assessment of disease
activity. The purpose of this study is to further assess the
relationship between GCF MMP-8 and PGE2 levels and clinical
parameters.
Methods: GCF samples were obtained from 640 interproximal
sites with at least 4 mm pocket depth in 40 chronic periodontitis
patients. Plaque index, sulcus bleeding index and probing pocket
depth were recorded. Half of the samples were used for MMP-8
and the remaining were analysed for PGE2 detection with enzyme
immunoassay method. The correlations of MMP-8 and PGE2
levels with each other and with the corresponding clinical
recordings were evaluated using Linear Regression Analysis.
Results: GCF MMP-8 and PGE2 levels exhibited positive
correlations with clinical parameters (Rsq = 0.79 and Rsq =
0.76 respectively) (P < 0.05) and with each other (Rsq = 0.86)
(P < 0.01).
Conclusion: The assessment of GCF MMP-8 and PGE2 levels may
reect disease severity. Periodontal sites with elevated levels of
MMP-8 may also be expected to have higher levels of PGE2.

Gingival Overgrowth (GO), mainly medicamentously induced, is

still problem of nowadays. GO occurs during immunosuppressive
(Cyclosporin A, Azathioprin, Mycophenolate), antihypertensive
(Calcium Channel Blockers, e.g. nifedipine) and anticonvulsive
therapy (Phenytoin). It is very complicated status, where many
factors play important role, e.g. sex, duration of treatment, parallel
medication, hormones, genetic.
Aim1: We decided to establish new classication of GO. Our scale
has four stages: 0-without any lesion, 1-lobulation localized on
interdental papilla, 2-GO to 1/3 of clinical crown, 3-GO to 2/3 of
clinical crown, 4-GO to incisal (occlusal) line.
Results1: We evaluated CPITN, PBI, GO and X-ray index in 40
patients. There were some correlations in the data (sex, time after
transplantation).
Aim2: Not only proliferation of the cells has eect on GO. On the
other side there should be the key for controlling proliferation/
apoptosis. The other our view was focusing on apoptosis (Caspace
molecules).
Results: We found some dierences in the groups of patients
(antihypertensive,
immunosuppressive
and
anticonvulsive
therapy).
Conclusion: It can be guidance for the treatment induct with
focusing on interdisciplinar coordination between doctors and
periodontists.

141
Reduced antioxidant defense in serum and gingival
crevicular fluid in menopause and chronic periodontitis
F. A. Akaln*,1,2 and A. Alver2
1
University 2Karadeniz Tech, Turkey
Recent evidence suggests menopause-oxidative stress, menopauseperiodontal destruction links and increased reactive oxygen species
generation and oxidative stress in periodontitis. Serum and gingival
crevicular uid (GCF) total antioxidant capacity (TAOC)
and superoxide dismutase (SOD) concentrations were compared
between pre- and postmenopausal women with chronic periodon-

88

143
Correlation between inflammatory mediators in GCF
and clinical signs of periodontal disease in a Greek
population
D. Sakellari*, R. Teles, A. Haffajee and S. Socransky
The Forsyth Institute, USA, Thessaloniki University, Greece
Objectives: To compare the levels of IL-1b, IL-8, and MMP-8 in
GCF samples from patients with periodontitis and healthy controls
and correlate their levels to clinical signs of periodontal disease.
Methods: Nineteen periodontitis patients and 19 periodontally
healthy subjects were studied. After the clinical exam, 30-second

Posters: Diagnosis and risk factors

GCF samples were collected from the mesial aspect of each tooth
using periopaper (882 samples). Samples were stored at )70
C and
after elution, analysed for their content of IL-1b, IL-8, and MMP-8
using checkerboard immunoblotting. The MannWhitney test was
used to determine dierences between the two clinical groups.
Correlations between the three biomarkers and clinical parameters
were sought using the Spearman correlation coecient.
Results: There were signicant dierences between the two groups
for PD, AL, % of sites with BOP and GCF volume (P < 0.001).
The mean levels of IL-1b (P < 0.001), IL-8 (P < 0.001) and
MMP-8 (P < 0.05), were higher in the periodontitis vs. control
group. There were signicant correlations between all three pairs of
biomarkers and signicant correlations between all three mediators
and PD, AL and % of sites with BOP. When only healthy sites
from both groups were compared; there were still signicant
dierences between the groups for all biomarkers.
Conclusions: There is an association between levels of IL-1b, IL-8,
and MMP-8 and the traditional clinical measures of periodontal
disease.
Supported by NIDCR grants DE14242 and DE12108.

144
Effects of self-ligating and conventional bracket
systems on gingival crevicular interleukin-6 levels
A. Gokcelik, S. Unal* and E. E. Alaaddinoglu et al.
Baskent University, Baskent, Turkey
Fixed orthodontic appliances induce accumulation and retention
of bacterial plaque, which constitute a risk of white spot lesions
and periodontal disease development during orthodontic treatment. Interleukin-6 (IL-6) plays an important role in the local
regulation of bone remodelling and in the acute inammation
found at the onset of orthodontic tooth movement. The aim of
this study was to investigate and compare the eects of two
bracket systems, with dierent ligation type, on gingival crevicular
uid (GCF) IL-6 levels. 30 patients between the ages of 1218 with
Angle Class I, II and III anomalies were selected to participate the
study. Subjects were divided in two groups: group I included
patients treated with roth brackets and group II; subjects treated
with in-ovation brackets. Quigley-Hein plaque index (QPI),
gingival index and probing depths were recorded. GCF was
collected before orthodontic treatment and after 3 months of force
application from the upper six anterior teeth. The results were
compared with T and Wilcoxon Signed Rank Tests. At baseline
and 3rd month no signicant dierences were found for GCF IL-6
levels between groups. At 3rd month, group I demonstrated higher
QPI and GI than group II (P < 0.001, P < 0.05). Although no
signicant dierences could be detected during the 1st month of
the study, the group with self-ligating brackets improved better
oral hygiene at 3rd month correlating with the decrease of GCF
IL-6 levels.

145
Periodontal damage of impacted third molar:
prevalence of lower third molar impaction in
orthodontic patients treated nonextraction and with
extraction
D. Gallego*, Torres, Gonz
lez, Cabezas and Llamas et al.
Oral Surgery Department, University of Seville, Seville, Spain
The periodontal damage in the second molar caused by an
impacted lower third molar or by its surgery is poorly documented
in the literature. With this in mind, three orthodontic cases groups
have been studied in order to analyze lower third molar impaction:
lower rst molar extraction cases, lower rst bicuspid and non
extraction cases. Eruption space for the wisdom lower molar has

been established, through dierent values: distance to the anterior

border of the ramus and inclination of the third molar crown.
Results of the study show a better eruption pattern in the lower
rst molar extraction cases, and a more favourable uprighting of
the wisdom molar in the bicuspid extraction cases. Both values
results show a bad eruption pattern in the non extraction cases.
Therefore, we will have a lower potential periodontal damage of
the lower third molar working with extractions groups than non
extraction group.

146
The importance of psychologic factors on periodontal
disease
A. Forabosco, M. Malavasi* and T. Grandi
University of Modena-Reggio Emilia, Italy
Background/Aim: Clinical observations and epidemiological
studies suggest that psychosocial stress and adverse psychological
conditions may represent risk factors for periodontal disease. The
purpose of the present study was to verify the inuence of some
psychosocial factors on periodontal disease.
Materials and methods: One hundred and two subjects were
examined: 51 cases and 51 controls. Plaque index, gingival index,
Decayed Missing Filled Surfaces index (DMFS) and Periodontal
Screening and Recording index (PSR) were registered for all
patients. Life Stress Events by Holmes and Rahe, the Coping
Humor Scale and 10 couples of semantic dierentials to be
associated once to ones own teeth and once to ones own gums
were used to investigate the psychosocial aspects.
Results: A statistically signicant correlation (P < 0.01) between
stress and gravity of periodontal disease was observed. Coping
Humor Scale was not correlated to stress and periodontal disease.
In the semantic dierentials, a statistically signicant dierence
(P < 0.05) between perception of ones own teeth and ones own
gums between the group of cases and the one of controls was
detected.
Conclusions: Stress did not act modifying aetiological factors of
periodontal disease, but it can be assumed, through complicated
mechanisms like biohumoral factors which act on target organs. As
to the semantic dierential, the distinction of teeth and gums in the
cases and in the controls bolsters the theory of target organs.

147
Comparison of the periodontal screening index (PSI)
and radiographic (OPG) findings a double blind study
D. Ziebolz*, I. Szabadi, E. Hornecker and R. F. Mausberg
ZMK, University of Goettingen, Germany
The PSI indicating reliable assertion of the periodontal situation is
an integral part of the dental check-up. The x-ray completes the
initial diagnostic nding by showing the bone level approximately.
The aim of this study was to examine if both diagnostic tools
generate similar results relating to the periodontal situation. The
clinical examination was performed by one investigator and
includes the following parameters: PSI, DMF-T and QHI. The
category no periodontitis
was dened up to PSI score 2; PSI score
3 and 4 indicated periodontitis
. Separated by location and time,
two other investigators evaluated the radiographs (OPG) in
agreement. The classication followed according to the two
categories above. 112 males aged 1858 years (: 37.7 8 years)
without any previous periodontal treatment participated. The
mean QHI was 2.4 1.3, the mean DMF-T 14.6 4.9. With
regard to the PSI 17 patients had no periodontitis
and 95 patients
had periodontitis
; according to the radiographic evaluation 42
patients revealed no periodontitis
and 70 patients periodontitis
.
Correspondingly, the result of both diagnostic methods was no

89

Posters: Diagnosis and risk factors

periodontitis
in 17 patients and periodontitis
in 42 patients.
However, in 53 cases the result was dierent. Statistics showed
signicant dierences between both methods (P = 0.00;
kappa = 0.194). The results show that both diagnostic methods
have dierent outcomes. In addition, there is a dierence in the
informative value of both ndings.

148
Interleukin-1 gene polymorphism and periodontal
status in a Spanish population
G. J. Valderrama Mateos*, A. Puyet, P. A. Garrido and A. Bascones
Facultad de Odontologa UCM, Madrid, Spain.
Background: Find a possible association between presence of
polymorphisms in IL-1A (+4845) and/or IL-1B (+3954)
genotypes and the initiation and progression of chronical
periodontal disease (CPD). On the other hand, correlate the
[IL-1b] in the gingival crevicular uid (GCF) with the disease
activity and with the presence of genetic polymorphisms.
Materials and methods: The study extended to 50 patients, 25
healthy and other 25 patients with active (CPD). Two samples of
GCF were taken from every patient and [IL-1b] was determined
using (ELISA). Besides that, 10 ml of blood were taken in order to
determine their ADN and to detect possible polymorphisms in
IL-1A (+4845) and IL-1B (+3954) genotypes.
Results: The [IL-1b] in GCF of patients with active (CPD) was
higher [4.161 + 2.845 (pg/lL)] than control group [2.304 + 1.459
(pg/lL)]. (P = 0.016). No statistically signicant dierences were
found (SE) between the [IL-1b] in GCF and the presence of
polymorphisms in any genotype. With respect to polymorphisms
prevalence, no dierences (SE) were found between both groups.
Conclusions: Our results show that [IL-1b] is higher in patients
with (CPD), almost double than in healthy patients. On the other
hand, the presence of polymorphisms in IL-1A (+4845) and/or
IL-1B (+3954) genotypes, does not implicate an overproduction of
[IL-1b] in GCF. And nally, the presence of polymorphisms in
those genotypes, do not represent a risk factor to suer chronical
periodontal disease.

149
Comparison of two different microbiological assays to
characterize the subgingival microflora
I. Wegener*, H. Schuster and T. Kim
Sect. of Periodontol, University of Heidelberg, Heidelberg, Germany
Aims: Sensitivity of clinical assays for detection of microorganisms
can show signicant dierences. The goal of this study was to nd
out if a new assay for quantitative detection of Actinobacillus
actinomycetemcomitans (A.a.) in samples of subgingival plaque
(Meridol real time PCR) exhibits a dierent sensitivity when
compared with an established assay (IAI Pado Test).
Methods: Fourteen patients that suered either from aggressive
Periodontitis (AP) or severe chronic Periodontitis (sCP)
participated in the study. Inclusion criterium was a negative test
result for A.a. with the IAI Pado test. Subgingival plaque samples
were drawn according to the manufacturers instruction of the IAI
Pado and the Meridol real time assay.
Results: With the IAI Pado test, none of the 14 patients was tested
positive for A.a. In contrast, the meridol real time PCR could
detect A.a. in subgingival plaque samples of 5 out of 14 patients
(35.7%).
Conclusion: If A.a. concentrations in samples of subgingival
plaque are close to the lower detection threshold, selection of a
certain microbiological assay can decide if a patient is A.a. positive
of not. Since the detection of A.a. can have therapeutic

90

consequences in patients with sCP and AP, it should be

recommended to choose an assay with a maximum sensitivity.

150
Composition of supra- and subgingival biofilm of
subjects with health and diseased implants
J. Shibli*, L. Melo, L. Figueiredo and M. Feres
Guarulhos University, Guarulhos, SP, Brazil.
Forty four subjects (mean age 48.9 13.51 years) with at least
one implant restored and in function for at least 1 year were splited
in two groups: peri-implantitis (n = 22) subjects presenting periimplant sites with radiographical defects 3 mm, bleeding on
probing and/or suppurating; and control (n = 22) subjects with
healthy implants. The clinical parameters evaluated were gingival
redness, plaque index, bleeding on probing, suppuration, probing
depth and clinical attachment level. Supra- and subgingival biolm
samples were taken from the deepest sites of each implant and
analysed for the presence of 38 microorganisms by Checkerboard
DNA-DNA Hybridization. All clinical parameters were statistically higher in the diseased implants, except for plaque index. The
species evaluated were found supragingivally and subgingivally in
the two groups. The total counts of red complex species (Porphyromonas gingivalis, Treponema denticola, and Tanerella forsythia)
were higher in the peri-implantitis group for both supra- and
subgingival plaque (P < 0.001). The presence or absence of
P. gingivalis and P. intermedia in supragingival biolm showed
high correlation with the presence or absence of the same species in
the subgingival plaque. The main dierences between supra- and
subgingival biolm, as well as between healthy and diseased
implants were in the proportions and counts of orange and red
complex species.

151
Oral condition in patients undergoing dialysis due to
chronic renal failure
B. Kesek, M. Chomyszyn-Gajewska* and D. Darczuk
Jagiell. University, Coll. Med., Dent Inst., Cracow, Poland
Aim: Clinical assessment of oral condition and cytology of the oral
buccal mucosa in patients on hemodialysis due to chronic renal
failure compared to patients on peritoneal dialysis and healthy
controls.
Materials and methods: One hundred and twenty patients have
been examined in three groups: I 40 patients on hemodialysis. II
40 patients on peritoneal dialysis. III 40 healthy controls. Dental
conditions were assessed using the DMF, CPITN and OHI indexes.
Cytological assessment of the oral mucosa specimen included the
following indicators: cell maturation, acidophilia and
karyopycnosis. Statistical analysis was carried out by means of
the Statistical package (P < 0.05).
Results: The results showed hard tissues of the teeth of the patients
on dialysis to be more susceptible to caries. The patients
oral
hygiene was poor and changes in periodontal tissues were found to
be more frequent. High levels of urea in the blood of the patients
on dialysis caused pathological changes in oral mucosa. The
cytology of the mucosa was also found to deviate from the norm.
The above disorders were most often observed in patients on
hemodialysis due to chronic renal failure.
Conclusions: The collaboration between nephrologists and dentists
is indispensable to prepare the patients properly and to avoid
complications due to the primary and secondary sources of
infection inside the mouth.

Posters: Diagnosis and risk factors

152
A decision support system for determining prognosis
and survival time in periodontics (an innovation)

154
Assessment of preoperative bone loss with different
X-ray techniques

M. Sh. Dowlatshahi*, M. Kiani and A. Saki

University of Ahwaz, Iran, University of Shahid Chamran, Iran

C. Geenen*, C. Obst and T. Kim

Sect. of Periodontol, University of Heidelberg, Heidelberg, Germany

Background: In traditional methods prognosis is determined based

on number of current clinical parameters without considering risk
ratios of each parameter and especially on self implications of
clinicians which often lead to false conclusions.
Aim: The aim of this project is construction and evaluation of
computer software (Decision Support System) for determining
primary prognosis to decrease cited problems.
Materials and methods: First, project algorithms based on risk
ratios of most important clinical factors with mathematical and
statistical calculation designed. Next, among 30 periodontal
patients, 61 teeth were selected as case and information form for
each of cases was given to three experienced periodontists and they
determined prognosis (clinical prognosis). Afterward, algorithm
prognosis was determined for each case. Finally, a computer
software (DSS) was written based on designed algorithms and
accuracy calculated.
Results: The DSS result was same as gold standard (algorithmic
prognosis) and to conclude Accuracy was 100%. Moreover, there
was a signicant dierence between three clinical prognosis and
also between clinical prognosis and algorithmic prognosis (DSS)
which was the main rationale to doing this study.
Conclusion: With regard to including most important clinical
parameters with risk ratios of each parameter which is not
performed by mankind accurately, we can conclude that this
DSS is reliable and useful.

Aims: The aim of this study was to nd out if the amount of bone
loss that can be diagnosed in patients suering from aggressive
Periodontitis (AgP) or severe chronic Periodontitis (CP) depends
on the applied X-ray-techniques.
Method: A total of 65 patients (33 female, 32 male) with AgP
(n = 37) or severe CP (n = 28) were included. Panoramic X-rays
(OPTG) and intraoral radiographs (IO) were analysed for each
patient: (i) computer assisted (software: Friacom) (ii) manually
with the Schei-straightedge. Distances Cemento-enamel-junction
(CEJ)- Alveolar Crest (AC), CEJ- deepest point of Bony defect
(BD) and CEJ-Apex were measured.
Results: Comparative analysis showed a higher percentage of bone
loss using Friacom vs. the Schei-straightedge. The amount of
dierence depended on I) the examined location (maxillary molars:
18.6% dierence between Friacom and Schei-straightedge,
mandibular incisors 2.6%) as well as on chosen reference points
(BD distal: 13.8% dierence between Friacom and Scheistraightedge, LA mesial )0.9%). Not measurable sites were
mostly found in the maxillary premolar region. Intraoral
radiographs showed better contrast between AC and BD than
OPTG.
Conclusion: With panoramic radiographs, a pre-orientation
concerning the expected bone loss is possible. The computerassisted analysis of single intraoral lms provides larger diagnostic
potential concerning the estimation of the defect localization
compared to the conventional Schei-straightedge.

153
Real-time polymerase chain reaction quantification of
the periodontal pathogens variations after occlusal
therapy
A. Forabosco, T. Grandi* and R. Vivoli
University of Modena-Reggio Emilia, Italy
Background: The relationship between occlusal forces and the
initiation or progression of periodontal disease has been
controversial for over a century.
Aim: The present study was performed to assess the inuence of
occlusal therapy on periodontopathic ora.
Method: One hundred and seventy two patients with advanced
destructive periodontitis were recruited. The participants met the
following inclusion criteria: (i) probing pocket depth of 5 mm at
3 teeth in the upper anterior group and dental mobility (value 1 or
2 on Millers scale) at the same teeth; (ii) non-smokers. Permanent
splinting of teeth was performed in 110 patients. In the remaining
62 patients, a prosthetic solution was adopted that involved
applying a provisional resin bridge. Occlusal therapy was not
preceded or followed by topical or systemic drug treatment or by
surgical or non-surgical treatment of the aected periodontal
tissues. Clinical parameters (probing depth, bleeding on probing,
presence of pus) were measured and the subgingival ora was
detected by real-time PCR before treatment, after 20 days and
lastly after 60 days for each patient.
Results: At each follow up visit and for each patient a statistically
signicant improvement of clinical parameters towards baseline
was recorded. After 60 days of treatment, a statistically signicant
reduction of periodontal pathogens was recorded in all patients.
Conclusions: Removal of the occlusal trauma brings about a
reduction in pathogenic subgingival microora levels.

155
Influence of biopsy localization on diagnosis of
gingivitis desquamativa
K. Bieling*, F. Schwarz, M. Megahed and J. Becker
Heinrich Heine University, Dsseldorf, Germany
Direct immunouorescence (DIF) has increasingly been used to
determine the disease causing desquamative gingivitis. However, in
some cases there are still diagnostic diculties concerning the
localization of biopsy where immunoreactive deposits can be
observed. Therefore, the aim of the present study was to evaluate
and compare the inuence of biopsy localization on the reliability
of DIF diagnosis of gingivitis desquamativa. A total of 14 patients
(mean age 61 11 years) suering from non specied gingivitis
desquamativa (GD) were included. Three incisional biopsies were
taken from each patient including (i) aected (2x lesional), and (ii)
non-aected (1x non-lesional) oral sites and prepared for histopathological (HP) (lesional) and DIF (lesional and non-lesional)
examinations. Additionally, patients sera were taken and analysed
for indirect immunouorescence (IIF). In nine patients, DIF of
lesional biopsies exhibited autoimmune reactions to basement
membrane proteins (i.e. IgG: eight patients; IgG and IgA: one
patient), while respective non-lesional biopsies were negative. In
ve patients, both lesional and non-lesional biopsies were negative
for DIF. However, IIF was positive in all patients. The combination of lesional DIF, IIF and HP examinations classied GD as
mucous membrane pemphigoid in all patients. Within the limits of
the present study, it might be suggested that a combination of
lesional DIF, IIF and HP diagnosis seems to be appropriate in
order to specify GD.

91

Posters: Diagnosis and risk factors

156
Rapid detection of periodontopatogenic species from
subgingival paper points samples with a commercial
PCR based method

158
Association of the IL10 gene polymorphism at
position -1082 with generalized aggressive
periodontitis in an Iranian Khorasanian population

L. Lpez Cerero*, S. Ballesta, D. Torres Lagares et al.

Microbiology Department, University of Seville, Seville, Spain

H. Arab*, J. Tavakol, M. Radvar and A. Moeintaghavi

Mashhad University, Iran, Booali Res. Inst., Iran

A poor treatment response in adults with periodontitis has been

related to the persistence of periodontopathogenics species. Periodontitis patients may benet from molecular testing to identify
the presence of periodontopathogenics after periodontal treatment
in order to consider further therapy.
Objective: To assess a commercial PCR method (MicroDent) for
control testing of adult periodontitis after active treatment.
Subgingival plaque was sampled by inserting paper points in the
deepest periodontal pockets from several teeth (45) from 22 adult
patients with periodontitis following actual periodontal treatment.
DNA extraction was carried out with DNeasy Spin Columns kit
(Quiagen) whithin 48 h after sampling. The amplication was
realized by multiplex-PCR of 16S rDNA (MicroDent). The
detection of periodontopatogenics was realized by hybridation
with species-specic probes. The mean age of patients 37.4 years,
being 82% female, 18% male and 36% were active smokers. A
positive hybridation result for peridontopathogenics yielded in
86% patients. DNA from T. forsythia (95%) was mostly detected
as well as T. denticola (79%), and P. intermedia (63%). In 11 cases
P. gingivalis was still found and only in two patients
A. actinomycetemcomitans remained. The molecular MicroDent
assay has been shown a rapid and reliable procedure in clinical
practice to evaluate incomplete removal of subgingival pathogens,
without the problems during sample collection and transport.

Aims: Polymorphisms in cytokine genes have recently been

described in susceptibility to periodontitis. IL-10 is a multifunctional cytokine thought to play a role in periodontitis by
down-regulating the production of pro-inammatory cytokines.
The aim of this study was to investigate the association of the
1082(G/A)
polymorphism
with
generalized
aggressive
periodontitis.
Materials and methods: This study included 37 Iranian
Khorasanian subjects suering from generalized aggressive
periodontitis (GAP) referred to periodontology department of
Mashhad dental school. They were compared to 43 healthy
controls of the same race. The DNA was isolated from
peripheral blood cells and genotyping was performed by means
of ARMS-PCR method. Data was analysed using chi-square test.
Results: There was a marked dierence in allele frequencies
between controls and GAP patients. The G allele carriage was
signicantly more prevalent among the GAP subjects, while the A
allele was signicantly associated with healthy periodontal status
(P = 0.040). Moreover, the proportion of subjects, which showed
the AA genotype in comparison to subjects exhibiting a genotype
other than AA, was signicantly larger in the control group
(P = 0.040).
Conclusion: We concluded that the polymorphic nucleotide A at
position )1082 of the IL-10 gene protects against GAP. This may
help us to investigate the role of genetic variations among
individuals in susceptibility to periodontal disease.

157
The influence of oral hygiene practices on the
inflammatory periodontal diseases in the adult
population of Riyadh, Saudi Arabia

159
Microbiological profile of subgingival plaque in
patients with aggressive and severe chronic
periodontitis

S. K. Al-Salehi*, O. S. Al-Hokail and T. F. Walsh

University of Sheffield, Sheffield, UK

H. Schuster*, C. Geenen, D. Krigar, P. Eickholz and T. Kim

Sect. of Periodontol, University of Heidelberg, Heidelberg, Germany

Aim: This study investigated the inuence of oral hygiene practices

on the prevalence and severity of inammatory periodontal
diseases in the adult population of Riyadh.
Methods: Using a two stage stratied random sampling method a
sample size of 1053 subjects was selected for the study. The
subjects, aged 1669 years, composed of 538 females and 515
males. The methods of oral hygiene employed were one or a
mixture of the following: tooth cleaning by miswak
(a brous
substance made from the roots of Arak Tree), tooth brushing and
interdental cleaning. The study was carried out in two parts;
clinical examination and questionnaire interview.
Results: The eect of each of the oral hygiene methods on
inammatory periodontal disease and gingivitis was assessed by
the measurement of CPITN and Bleeding Indices. Chi-square test
was used to test the correlation between oral hygiene practices and
inammatory periodontal disease status. Logistic regression was
used to determine the eect of each method on the prevalence of
both gingivitis and periodontal inammatory disease when the
inuence of age and gender was controlled. A 5% level of
signicance was employed.
Conclusions: The results indicate that all the methods of oral
hygiene signicantly reduced the prevalence and severity of
gingivitis and inammatory periodontal disease. Toothbrushing
was shown to have the greatest impact on inammatory
periodontal diseases as measured by the indices used.

Aims: The goal of this study was to nd out the prevalence of

Actinobacillus actinomycetemcomitans (A. a.), Tannerella
forsythensis (T. f.), Porphyromonas gingivalis (P. g.) and
Treponema denticola (T. d.) in samples of subgingival plaque
obtained from patients with aggressive (AgP) and severe chronic
periodontitis (CP).
Methods: Eighty eight patients with either AgP (n = 26) or sCP
(n = 62) participated in the study (inclusion criteria). After
removal of the supragingival plaque, papertips were applied into
the deepest periodontal pockets of four dierent teeth to obtain
subgingival plaque. Microbiological analysis of pooled samples
was performed with a 16s-RNS-gene probe test (IAI-Pado-Test).
Results: There were no dierences between AgP and sCP at the
beginning of the study, regarding oral hygiene (PCR),
inammation (GBI, BOP), mean pocket probing depths and
clinical attachment levels. There were only small dierences in
the percentages of patients tested positive for A. a. (57.7 vs.
40.3%), T. f. (88.0 vs. 96.8%), P. g. (69.2 vs. 83.9%) and T. d. (88.5
vs. 95.2%) when comparing AgP and sCP Patients. Medians for
dierent bacteria species in the AgP and sCP group were 3.0 x 105
and 0.1 x 104 (A. a.), 9.6 x 106 and 3.7 x 106 (T. f.), 15.5 x 106 and
4.4 x 106 (P. g.), 4.7 x 106 and 1.8 x 106 (T. d.).
Conclusions: In patients with the clinical diagnoses AgP and sCP
there are no signicant dierences concerning the microbiological
prole of the analysed periodontal pathogens.

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Posters: Diagnosis and risk factors

160
Two subgingival plaque sampling strategies used with
RNA-probes
D. Krigar* and P. Eickholz et al.
Sec. of Perio., Heidelberg, Sec. of Perio., Frankfurt, Germany
In 158 patients suering from aggressive or generalized severe
chronic periodontitis clinical examinations were obtained before
(n = 82) or after (n = 76) combined mechanical and antibiotic
antiinfectious periodontal therapy. Subgingival plaque samples
were obtained from the three pockets with the deepest probing
depths. Two sterile paper points were inserted simultaneously in the
periodontal pockets. One paper point from each pocket was put in a
separate transport-vial, the second was pooled (MT3) with the two
other paper points of a respective patient in a transport-vial. The
content of each vial was analysed separately for A. a., T. f., P. g. and
T. d. with a commercially available RNA-probe test. The logtransformed number of bacteria was higher in pooled samples than
the mean value of the results of the separate samples for all tested
pathogens (P < 0.001). However, for all four pathogens analysis
failed to detect statistically signicant dierences between the single
samples and the MT3 regarding the detection frequency. These
ndings were observed over all samples as well as after evaluation of
samples before and after therapy separately. Pooling of subgingival
plaque samples increased the bacterial counts per analysis compared
to separate samples and thus may increase the probability to detect
existing pathogens. This observation had no statistically signicant
eect on the detection frequency of the tested pathogens.

161
Periodontal alterations in users of marijuana and
cocaine
E. Carvalho*, L. Damis and R. Carneiro
College of Dentistry of the Federal University of Bahia, Bahia, Brazil
A patient is characterized as special when it presents some shunts of
the normality standards, which need dierentiated cares, then, the
inclusion of narcotics users is justied in this group. The illicit
psychoactive drugs have right eect on the structures of the mouth
(mucous, tooth, tongue), and the caries and the periodontal illness
happen more frequently with druggeds, particularly, of marijuana
and cocaine. This study evaluated the periodontal alterations in forty
patients of mental illness and mannering upheaval, all male, attended
in the Dental Sector of the Juliano Moreira Hospital. The sample was
divided in twenty using patients of marijuana and cocaine and twenty
patients that are not using. The gotten data had been compared and
submitted to statistics analysis. The periodontal diagnosis was made
by only one examiner duly calibrated, in intention to evaluate the
depth the level of clinical insertion, for this, it was used the
periodontal probe Williams by Hy-Friedy. The epidemiologist index
of Silness Loe and Ainano Iday was applied to evaluate the indices of
biolm and gingival bleeding. The data were registered in clinical
handbook especially created for this study. A high prevalence of the
inammatory periodontal illness in the drugged patients was
observed, what it conrms the hypothesis of this study.

Materials and methods: This study was carried out on 30 pairs of

twins between 1235 years old including 12 pairs of monozygotic
and 18 pairs of dizygotic twins in Mashhad. Periodontal
parameters studied, consisted of: Probing Pocket Depth (PPD),
Clinical Attachment Level (CAL), and Bleeding on Probing
(BOP).Moreover factors such as age, sex, education, dental
hygiene and inheritance index was studied.
Results: (i) PPD and CAL were signicantly dierent between MZ
and DZ, while no signicant dierences in BOP was observed
between two groups. (ii) CAL and PPD were signicantly dierent
according to sex in dz group. This dierence was not signicant in
MZ. (iii) PPD, CAL and BOP were signicantly dierent according
to age in DZ. This dierence was not signicant in MZ. (iv) with
improvement in dental hygiene, BOP decreased signicantly in
both groups, but PPD and CAL were not related to dental hygiene.
(v) study of inheritance index showed that BOP could be aected
by environmental factors (0.41) while CAL and PPD aected by
genetic factors ()0.70, -0.61) respectively.
Conclusion: In twins, PPD and CAL are aected by genetic
factors, while BOP is aected by environmental factors.

163
Single nucleotide polymorphisms of
osteoclastogenesis-related genes in aggressive
periodontitis
N. Soedarsono*, H. Kamei, A. Yamaguchi and T. Kojima
RIKEN, Yokohama, Tokyo Medical and Dental University, Japan
Background: Aggressive periodontitis (AgP) is characterized by
rapid attachment loss and bone destruction. While attempting to
identify genetic polymorphisms associated with AgP, we focused
more on single nucleotide polymorphisms (SNPs) in the key
mediators of osteoclast dierentiation and activation, which
involve receptor activator of nuclear factor -kB (RANK), RANK
ligand (RANKL) and osteoprotegrin (OPG) in the Japanese
population. The aim of this study was to evaluate the association
of RANK/RANKL/OPG gene polymorphisms with AgP in the
Japanese population.
Materials and methods: We examined 99 Japanese patients with
AgP and 89 controls to explore the possibility of RANK/RANKL/
OPG loci as candidate regions associated with the disease. These
three candidate genes were amplied by PCR, followed by direct
sequencing, and polymorphisms were identied by comparing the
sequences obtained from 48 subjects.
Results: We identied 27 SNPs in RANK including 10 novel
SNPs, and 7 SNPs each in both RANKL and OPG. A pairwise
linkage disequilibrium analysis using the r2 statistic showed that
some SNP pairs from the three loci are in tight linkage
disequilibrium. An association analysis with allelotypes showed
that SNPs identied in the RANK/RANKL/OPG genes have no
signicant association with AgP in the Japanese population. The
study will be continued by further functional analysis of some
SNPs that might have important roles in the genetic molecular
mechanism of aggressive periodontitis.

162
Comparative evaluation of periodontal statues in
Khorasan twins

164
The association of tissue plasminogen activator and
plasminogen activator inhibitor-1 gene polymorphisms
in patients with chronic periodontitis

K. Fatemi*, S. A. Bnihashem, Ghodsik

Department of Perio, Mashhad dental school, Mashhad, Iran

G. Emingil, A.Grkan* and G. Atilla et al.

Ege University, Izmir, Turkey

Background: Study on the twins has helped us to know about the

roles of genetic and environmental factors in periodontal diseases.
The purpose of this study was the evaluation of periodontal
condition in twins.

Aim: Tissue plasminogen activator (t-PA) and plasminogen

activator inhibitor type 1 (PAI-1) may be involved in the
pathogenesis of periodontitis by controlling proteolytic events in
the extracellular matrix. This study was designed to investigate the

93

Posters: Diagnosis and risk factors

association of t-PA and PAI-1 genes with chronic periodontitis
(CP).
Methods: A total of 163 subjects were included. Genomic DNA
was obtained from peripheral blood of 66 CP and 83 periodontally
healthy subjects. We used polymerase chain reaction and
endonuclease digestion to genotype for 4G/5G polmorphism in
the promoter region of the PAI-1 gene and the Alu-repeat
insertion/deletion (I/D) polymorphism in intron 8 of t-PA gene.
Results: The genotype distributions and allele frequencies of t-PA
gene did not dier between CP and healthy subjects (I/I 27.7%, I/D
47.7%, D/D 24.6%and 34.7% I/I, 36.0% I/D, 29.3% D/D,
respectively) (P > 0.05). t-PA I and D allele frequencies were
51.5% and 48.5% in CP and 52.7%and 47.3% in healthy subjects,
respectively. PAI-1 genotype distribution was also similar between
CP (18.5% 4G/4G, 44.6% 4G/5G, and 36.9% 5G/5G) and healthy
subjects (24.4% 4G/4G, 54.9% 4G/5G, and 20.7% 5G/5G,
respectively) (P > 0.05). 4G and 5G allele frequencies were not
dierent between groups (40.8% and 59.2% in CP and 51.8% and
48.2% in healthy subjects, respectively).
Conclusion: These ndings suggest that t-PA or PAI-1 gene
polymorphisms are not associated with susceptibility to CP in
Turkish population.

165
Evaluation of papillary blood flow using laser Doppler
flowmetry
H. Develioglu, V. Bostanc, H. Ozdemir* and G.
zcan
Department of Periodontology, University of Cumhuriyet, Sivas, Turkey
Objective: Previous investigations have shown that there is an
interaction between gingival blood ow and gingival health. The
purpose of this study was to compare the papillary blood ow at
sites treated with bridge the blood ow at untreated sites.
Design: Twenty persons with resin faced, xed partial dentures
were enrolled in the study. The contralateral natural teeth of the
site symmetrical to that of the restorations were used as controls.
The blood ow was measured from the middle point of the papilla
from both from test and control sites by laser Doppler owmetry
(LDF). The plaque index, papillary bleeding index, and probing
depth measurements were recorded.
Results: There was a statistically signicant dierence between the
test and control groups in papillary blood ow measurements
(P < 0.05). In contrast, no signicant dierence between two sites

clinical indices was found (P > 0.05).
Conclusions: It should be emphasized that there is an important
relationship between resin-faced, xed partial dentures and
papillary blood ow. Blood ow measurements provide
information about the microcirculation of the tissues. It seems
that it is necessary to evaluate, in detail, the eects of xed bridges
on proximal periodontal health conditions.
Key words: xed partial dentures, papillary blood ow, laser
Doppler owmetry.

166
Clinical and microbiological monitoring from
Portuguese subjects group with and without
periodontal diseases
F. Salazar*,1, J. J. Pacheco1, M. Vias2 and C. Velazco
1
I.S.C.S.N, Portugal, 2U.B. Spain
The infectious nature of periodontal disease has been demonstrated
in many studies, with specic bacterial, such as Actinobacillus
actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.),
Prevotella intermedia (P.i.) and Tannerella forsythia (T.f.). The
subject of this study was to evaluate the presence of these putative
periodontal pathogens from patients with and without periodontal
diseases. 57 patients were selected based on clinical diagnostic: 33

94

chronic periodontitis, 4 aggressive periodontitis, 12 gingivitis and 8

periodontally healthy. Clinical examination included conventional
periodontal measurements. These bacteria were determined by
culture and presumptive identication was obtained by colonial
and microscopic morphology, pigment formation, U.V. uorescence, C.A.A.M, M.U.G and catalase. From the periodontitis
patients, 26 (70.2%), were positive for at least one of the tested
bacteria. The simultaneous occurrence of A. a., P. i., P. g. and T. f.
were observed in 3 (75%) with aggressive periodontitis. The
presence exclusive of A. a. was detected from 2 (6%) with chronic
periodontitis, 1 (25%) with aggressive periodontitis and 3 (25%)
with gingivitis. From chronic periodontitis patients, the simultaneous presence of P. g/A. a, occurred in two cases and P. g/A. a in
11, P. i or T. f. were detected in 18 cases. The obtained results
suggest some consistency between clinical diagnosis and microbiological data, particularly in respect to aggressive periodontitis.

167
FCaRI and FCcRIIB gene polymorphisms in Caucasian
periodontitis patients
J. Gonzales*, T. Kobayashi and J. Meyle et al.
University of Giessen, Giessen, Germany, Niigata University, Niigata,
Japan
The IgA and IgG Fc receptors have been implicated in the
pathogenesis of periodontitis, because increased levels are features
of this inammatory disease. The FccRIIB T (+695)-C single
nucleotide polymorphism (SNP) in exon 5 (Ile 232 Thr) and the
novel SNP FcaRI A (+324)-G in exon 3 have been associated with
aggressive periodontitis (AGP) in Japanese. To determine whether
an association with periodontitis susceptibility in Caucasians exists,
FcaRI and FccRIIB SNPs were examined in patients with AGP
(n = 45) and chronic periodontitis (CP, n = 78), and in two groups
of age-matched healthy controls, <35 years (CY, n = 45) and
>55 years (CO, n = 21). Clinical parameters were assessed, blood
samples were taken and DNA was isolated. Genotypes were
determined by means of allele-specic PCR, as previously described
(Yasuda et al. 2003, Kaneko et al. 2004). The frequency of the
genotypes between groups was analysed (Fishers exact test). A
signicant dierence was observed in the distribution of the
polymorphic allele C of the FccRIIB-232 I/T allele (exon 5) between
the groups (P 0.03), whereas the higher frequency (37.3%) was
detected in the CP group and the lowest frequency (11.4%) in the
CY group. No signicant dierence in the distribution of the FcaRI
A (+324)-G SNP between the groups was present. This is the rst
report of these Fc receptor SNPs in Caucasians with periodontitis.
These results document a possible association of the FccRIIB-232 I/
T with chronic periodontitis in Caucasians.

168
Distribution of HLA class I antigens in a group of
Spanish subjects with chronic or aggressive
periodontitis
M. Rioboo*,1, P. Baehni2 and A. Bascones1
1
University of Complutense, Madrid, Spain, 2University of Geneva,
Geneva, Switzerland
The aim of this study was to investigate the distribution of HLA-A
and HLA-B antigens in a group of Spanish patients with chronic
periodontitis (CP) or aggressive periodontitis (AgP) and to
compare the frequency distribution of the dierent alleles between
both groups. Subjects included in the study were recruited among
patients who were treated at the Complutense University, Madrid.
Based on clinical diagnosis using standard criteria patients were
divided into two groups, CP (n = 17) or AgP (n = 37). Twenty
mL blood samples were obtained from each patient and typed for

Posters: Diagnosis and risk factors

HLA class I antigens. HLA-A and HLA-B loci were determined by
a lymphocytotoxicity test (One Lambda Inc, Canoga Park, CA).
Patient prole of both groups was similar for age, sex, and tobacco.
Distribution of HLA type I antigens was similar to the one
observed in the Spanish population. HLA-A2 allele was the most
frequently found with 72.9% in the CP group and 58.8% in the
AgP. The HLA-B44 and -B35 allele were detected in 37.8% and
21.6% respectively in the CP group and 41.2% and 29.4%
respectively in the AgP group. No statistical signicant dierence
was found in alleles frequencies between both groups. Discrepancies between the data of the present investigation and previous
studies may be explained by dierences in patient selection criteria,
ethnic and geographical origin as well confounding factors like age,
sex and tobacco.

Results: P-glycoprotein is expressed in the endothelial layers of

blood vessels obtained from healthy or inamed gingiva. Subjects
treated with calcium antagonists had signicantly deeper gingival
pockets than their drug-free counterparts (P < 0.0001). This drugrelated eect was associated with the MDR1 2677 G/G-G/TA
genotypes (P < 0.001) but not with the variants T/TA. The eect
was proved by regression analysis adjusting for the risk factors of
periodontitis age, sex, smoking, and education (P < 0.0001) and
was associated with elevated C-reactive protein. The association
was also conrmed in a matched-pair analysis comprising 93
subjects using calcium antagonists and 186 without (P < 0.0001).
Conclusion: Calcium antagonists lead to increased pocket depth
which is associated with the MDR1 G2677 polymorphism. The
genotype may modify the inammatory response to the drugs.

169
Mannose-binding lectin (MBL) gene polymorphisms in
relation to periodontitis

171
Clinical characteristics associated with the presence
of A. actinomycetemcomitans p. gingivalis

A. Louropoulou* and U. vd Velden et al.

ACTA, Netherlands, VUMC, Netherlands

F. Duffau* and P. Baehni

University of Geneva, Switzerland

Background: Mannose-binding lectin (MBL) is an important

component of the innate immunity, activating the complement
system. Plasma levels are inuenced by polymorphisms in the MBL
gene.
Objectives: To investigate polymorphisms in the MBL gene in
relation to periodontitis.
Methods: Ninety four periodontitis patients (mean age
44 10 years) and 69 controls (mean age 40 13 years) of
Caucasian origin participated in the study. MBL plasma levels
were available and smoking status was recorded. Genotyping was
performed by allelic discrimination analysis after PCR.
Results: To date polymorphisms at loci )550(H/L) and )221(X/Y)
were determined. The prevalence of H/H, H/L, L/L genotypes was
52%, 32%, 16% for patients compared to 36%, 53%, 11% for
controls respectively (P = 0.033). The L allele carriage among
patients was 48% vs. 64% among controls (P = 0.053). MBL
plasma levels were signicantly lower in subjects carrying allele H
compared to subjects carrying allele L (P = 0.012). The prevalence
of X/X, X/Y, Y/Y genotypes was 61%, 32%, 7% for patients and
71%, 26%, 3% for controls respectively(P = 0.271). The Y allele
carriage among patients was 39% vs. 29% in controls (P = 0.187).
Conclusions: At least one polymorphism in the MBL gene is
associated with susceptibility for periodontitis; H/H genotype was
more prevalent in patients and was associated with lower MBL
plasma levels. Thus, possibly, in periodontitis MBL genetic
variation may lead to a reduced function of the MBL-induced
complement pathway.

The aim of the study was to evaluate the clinical characteristics

associated with the presence of A. actinomycetemcomitans
P. gingivalis at the patient and site level. The investigation was
based on the databank of a commercial laboratory that provides
microbial analysis services (IAI, Zuchwill, Switzerland). Subgingival plaque samples were collected in patients with various
periodontal conditions. A. a. and P. g. levels were determined
using oligonucleotide probes. A total of 33 259 samples from
10 946 patients were included in the analysis. The database was
stratied according to bacterial levels using three thresholds, e.g.
below detection, < median, median, and then analysed for
frequency distribution. A. a. P. g. was not detected in 28.2% of
the samples whereas 12.7% of the samples were positive for both
species (values < median, median). High level of both A. a.
P. g. (values median) was detected in only 3.0% of the samples, in
patients with a mean age 47.1 11.4 years and in sites with
probing depth 7.6 2.0 mm. Distribution of these samples
increased with probing depth and patient age. When exploring
the eect of A. a. or P. g. levels on the distribution of samples
according to age and probing depth, results showed that A. a. levels
did not inuence the distribution of samples with high P. g. In
contrast, distribution of samples with high A. a. was dependent on
P. g. levels. Results suggest that characteristics of sites with high
A. a. P. g or high P. g. alone are similar.

170
Role of transporter P-glycoprotein gene polymorphism
in drug-induced gingival hyperplasia
P. Meisel*, Ch. Schwahn and Th. Kocher
Department of Pharmacology, University of Greifswald, Germany
Background: Gingival overgrowth is a common side eect of
calcium antagonists. Several lines of evidence point to a
modulation of inammatory processes. Since the calcium
antagonists act as inhibitors of P-glycoprotein (Pgp), the gene
product of MDR1, and inammation may modify Pgp expression,
we analysed the MDR1 polymorphisms as risk factors for gingival
overgrowth.
Methods: Periodontal, laboratory and anamnestic data and use of
calcium antagonists were assessed in a cross-sectional
epidemiological investigation (n = 1.484). MDR1 polymorphism
in exon 21-G2677T/A was determined and Pgp expression detected.

172
The influence of traumatic occlusion on progression of
marginal periodontitis
N. Luksic-Dolenc* and J. Leusic
Dental Polyclinic Zagreb, Croatia
The aim of this study was to conrm the direct correlation between
traumatic occlusion and progression of periodontitis. In order to
clarify the role of traumatic occlusion in etiology of periodontal
disease 54 patients were observed. Clinical examination revealed
periodontitis (inammation, gingival recession, periodontal pockets) and traumatic occlusion caused by high crowns or restorations
on particular teeth (pain, periodontal abscess, increased mobility).
The radiographic signs conrm clinical observation: horizontal bone
destruction and vertical destruction on a particular tooth. The
following clinical parameters were pooled for analysis: the mean
infrabony defects depth (IBD), horizontal bone destruction, gingival
recession, loss of attachment (LA), found traumatic occlusion (IBD/
S) and duration of traumatic occlusion. Depending on duration (3,
6, 12, 24 months) of traumatic occlusion on single tooth the IBD was

95

Posters: Diagnosis and risk factors

4, 5, 6 and 8 mm, respectively (P < 0.001 for trend) which was also
the case for LA on single tooth (7, 9, 10, 12 mm; respectively;
P < 0.001 for trend). Persistent traumatic occlusion is an important
factor in the etiology of periodontal disease.

173
The effects of hormonal changes on periodontal tissues
and gingival crevicular fluid prostaglandine E2 levels
during pregnancy and post-partum
E. Dinar*, U. Onan, C. Zeren and F. Yalcn.
Department of Periodontology, Istanbul University, Istanbul, Turkey
In a previous clinical trial we demonstrated the necessity of
periodontal therapy in pregnancy. The present study was designed
to analyse the inammatory changes in gingival tissues on a group
of pregnant subjects during pregnancy and post-partum with a
control group of non-pregnant subjects. A total of 40 females with
gingivitis were included in the study. The test group was made up
of 20 pregnant subjects in their rst trimesters of pregnancy; while
control group was formed 20 non-pregnant subjects. Initial
periodontal therapy was repeated 3 months intervally, both in
control and test groups. Clinical measurements including PI, SBI,
PPD and CAL were recorded and GCF samples were obtained at
baseline and 3, 6, 9 months after therapy. Following the collection
of samples GCF levels of propstaglandine E2 were evaluated using
enzyme immunoassay technique. Statistical evaluation was performed by MannWhitney U-test and Wilcoxon signed rank test.
Signicant improvements were noted in both clinical and biochemical parameters following initial periodontal therapy in
control group while no improvement achieved in the test group.
However, all clinical and biochemical scores were decreased
signicantly after the end of pregnancy. So it can be concluded
that there is a strong hormonal factor concerning pregnancy;
enabled us to achieve the expected improvement in clinical and
biochemical parameters. Also, levels of PGE2 in GCF might be
used as a marker of gingival inammation.

174
The lack of association of tolllike receptor 2 and 4
gene polymorphisms with generalized aggressive
periodontitis
G. Emingil, A. Berdeli, H. Baylas* and B. Han et al.
_
Ege University, Izmir,
Turkey
Aim: Toll-like receptors (TLRs) recognize exogenenous ligands
such as lypopolysaccaride and bacterial lypoprotein during
immune response to pathogens. The aim of the present study was
to investigate whether TLR2 and TLR4 gene polymorphisms are
related to susceptibility to generalized aggressive periodontitis
(G-AgP).
Methods: A total of 162 subjects were included in the present
study. Genomic DNA was obtained from the peripheral blood of
79 patients G-AgP, and 83 periodontally healthy subjects. The
TLR2 gene Arg753Gly polymorphism and TLR4 gene Asp299Gly
and Thr399Ile polymorphisms were genotyped by polymerase
chain reaction-restriction fragment length polymorphism (PCRRFLP) method.
Results: There was no signicant dierence in the distribution of
TLR2 and TLR4 genotypes and allele frequencies between G-AgP
patients and healthy subjects (P > 0.05). The 753Gly allele was
found in 3.8% of the G-AgP patients as compared to 3.6% in the
healthy group. The frequency of 299Gly and 399Ile allele was 2.5%
and 1.3% in G-AgP patients. For the healthy subjects, the allele

96

frequency was 1.8% for 299Gly and 0.6% for 399Ile allele. The
G-AgP patients and healthy subjects did not show homozygosity
for the TLR2 and TLR4 mutant alleles.
Conclusion: These results show that TLR2 and TLR4 gene
polymorphisms are not related to susceptibility to generalized
aggressive periodontitis in Turkish subjects.

175
Gene polymorphisms of tissue plasminogen activator
and plasminogen activator inhibitor-1 in patients with
generalized aggressive periodontitis
G. Emingil, A. Grkan, A. Berdeli*, B. Han and T. Kse et al.
_
Ege University, Izmir,
Turkey
Aim: Tissue plasminogen activator (t-PA) and plasminogen
activator inhibitor-1 (PAI-1) are major regulators of plasmin
generation. The aim of this study was to investigate t-PA and PAI1 gene polymorphisms in relation to susceptibility to generalized
aggressive periodontitis (G-AgP).
Methods: The study population consisted of 162 subjects. Genomic
DNA was obtained from peripheral blood of 79 G-AgP patients
and 83 periodontally healthy subjects. 4G/5G polymorphism in the
promoter region of PAI-1 gene and Alu-repeat insertion/deletion
(I/D) polymorphism in intron 8 of t-PA gene were genotyped by
polymerase chain reaction and endonuclease digestion.
Results: The genotype distributions and allele frequencies of t-PA
and PAI-1 genes were similar between G-AgP and healthy subjects
(P > 0.05). The distribution of t-PA genotypes in G-AgP patients
was 30.0% D/D, 47.1% I/D, and 22.9% I/I, and was 29.9%, D/D,
36.0% I/D, and 34.7% I/I in healthy subjects. The I allele was found
in 46.4% of G-AgP patients and in 52.7% of healthy subjects, while
D allele was 53.6% in G-AgP and 47.3% in healthy subjects. PAI-1
genotype distribution in G-AgP was 27.0% 4G/4G, 45.9% 4G/5G,
and 27.0% 5G/5G, while 24.4% 4G/4G, 54.9% 4G/5G, and 20.7%
5G/5G in healthy subjects. 4G and 5G allele frequencies in G-AgP
were 50.0% and 50.0%, and 51.8% and 48.2% in healthy subjects.
Conclusion: These data suggest that tPA and PAI-1 gene
polymorphisms are not related to susceptibility to G-AgP in
Turkish subjects.

176
Polymorphisms in the CD14 and IL-6 genes and
increased extent of periodontal disease
T. Tervonen, T. Raunio, R. Karttunen and M. Knuuttila*
University of Oulu, Oulu, Finland, Health Centre, Oulu, Finland
The aim of the study was to examine whether genetic polymorphism in certain cytokine and receptor molecule genes is associated
with periodontal disease. Patients with periodontitis (n = 51, age
range 2261 years) were recruited to the study. Probing pocket
depth (pd), attachment loss (al) and alveolar bone loss (bl) were
recorded. The following cytokine and receptor gene polymorphisms were studied using PCR technique: CD14, IL-6, TNF-a,
IL-10, IL-1a, IL-1b and TLR-4. The frequencies of various
genotypes in the periodontitis patients were compared to the
frequencies in a reference population (n = 178). The polymorphism data were related to the periodontal parameters. No statistically signicant dierences could be found in the frequencies of
the genotypes between the periodontitis and the reference groups.
The extent of periodontal disease was increased in subjects with
the T containing genotype of the CD14)159 and, GG genotype of
the IL-6)174. The extent of advanced periodontal disease was
highest among carriers of a combination composed of the T

Posters: Periodontal therapy

containing genotype of the CD14)159 and the GG genotype of the
CD14)159 with signicant dierences in the percentages of sites
with pd 6 mm, (P = 0.015), al 6 mm (P = 0.009) and
bl 8 mm (P = 0.042) in this specic combination genotype

when compared to the rest of the periodontitis group. We

conclude that the T containing genotype of the CD14)159 and
the GG genotype of the IL-6)174 are associated with higher extent
of periodontal disease.

Posters: Periodontal therapy

177
Analgesic efficacy of diclofenac vs. ibuprofen after
periodontal resective surgery

179
Oral health status and the evaluation of tooth brushing
skill in students with mental disability

B. Monfort Len*, M. Savoini and A. Santos

Universitat Internacional de Catalunya, Spain

F. Dogan and K. Nazarov*

University of Istanbul, Istanbul, Turkey

Objective: This study examined the eect of the diclofenac 50 mg

as a postoperative analgesic vs. ibuprofen 600 mg on periodontal
resective surgery.
Materials and methods: Thirty patients suering chronic
periodontal disease were enrolled in a randomised clinical
double-bind controlled single-centre study. The baseline
examination recorded probing depth, attachment level, mobility,
PI, BI, and furcal involvement. After S/RP all periodontal sites
that exhibited signs of periodontal disease were submitted to
periodontal resective surgery of similar characteristic. There were
performed at least two surgeries per subject. The recorded variables
were: pain intensity and the need for rescue medication during
1 week. Magnitude of port-surgery pain was assessed using a VAS
questionnaire. The results will be presented and statistically
analysed.

The aim of this study was to determine dental caries and gingival
status and to maintain more eective tooth brushing skill in
children and young adults with mental disability by using electrical
toothbrush.
Methods: The target population included trainable
subjects with
IQ level between 2545 who attended a special education and
practise school. 49 students, aged between 917 years, were
examined and their caries and gingival status were determined.
Then, 10 students were chosen in order to practice a training
programme about tooth brushing by electrical toothbrush for four
times. In this group the tooth brushing success was determined by
using a tooth discoloration method, before and after training
procedure. A data collection from to include only buccal surfaces
of 12 teeth from dierent quadrants of the mouth. Data were
analysed using Wilcoxon non-parametric method.
Results: At the end of the examinations the ndings were
following: DMF/T = 4.67, DF/S = 6.47, GI = 0.42, the
prevalence of calculus = 12%. The number of coloured surfaces
was no changed before and after toothbrush training (P 0.05).
Most of the students did not have the ability to brush all tooth
surfaces by themselves and they were not able to brush the
postdental area. To conclude, in mentally retarded individuals, it
was thought that regularly maintaining tooth brushing practices
under observation and getting support of the family and teachers
would play an important role in improving tooth health.

178
Long-term follow-up clinical trial of the efficacy of a
sonic powered toothbrush in periodontal patients
E. Lowden*, S. K. Hellwig and M. Hellmich et al.
Center of Dent. Med., Univ. Cologne, Germany
Aim: The aim of the follow-up study was to determine the longterm safety and plaque removal ecacy of a manual (Oral B 35)
and a sonic powered toothbrush (Sonicare Elite Pro) in
periodontal maintenance patients.
Methods: A previous randomised, single blind, crossover clinical
study showed the superior ecacy of the sonic powered toothbrush
over the manual toothbrush (0.76; 0.501.03, P < 0.001). Eighteen
months after completion of this previous study, 34 out of 37
patients took part in an examiner-blinded follow-up exam. The
full-mouth plaque scores (PI; Silness and Loe, 1973), the gingival
index (GI; Loe and Silness, 1963), the sulcus uid ow rate (SFFR,
Periotron 6000) were recorded. The intraoral soft-tissue exam was
documented.
Results: All 34 patients completed the study. Patients continuously
using the sonic powered toothbrush (26) reported stable superior
results over the manual toothbrush users (8) in reducing plaque
(PI) and inammation (GI) (P < 0.05). No changes in SFFR were
detected. No evidence of soft tissue trauma was seen in both
groups.
Conclusion: Based on the ndings of this long-term follow-up
clinical trial, the action of the sonic powered toothbrush is more
eective in plaque removal and inammation reduction. The sonic
powered toothbrush is an eective tool for maintaining an
acceptable level of oral healthcare in periodontal patients.

180
Periodontal status of Behet's disease patients in
comparison with healthy individuals
C. Akyol, A. Boyvat, C. A. Gurgan and H. S. Bostanci*
Ankara University, Ankara, Turkey
Objective: The presence of painful oral ulcers in Behcets Disease
(BD) is a signicant risk factor for an increase in plaque
accumulation because of the limitation of oral hygiene
applications. The aim of our study was to investigate the oral
health and systemic conditions of BD patients compared to healthy
individuals.
Materials and methods: The material of study was consisted of 201
BD patients diagnosed according to the International Study Group
for Behcets Disease criteria, and 200 healthy controls. Plaque
index (PI), pocket depth (PD), clinical attachment level (CAL) and
bleeding on probing (BOP) measurements for the clinical
periodontal status, and C-reactive protein (CRP) measurements
for the systemic condition were obtained. The dierence between
BD and healthy individuals were tested with t-test analysis.
Results: The mean values for PI, PD, CAL and BOP for control
group were 1.46 0.68, 2.31 0.33, 1.79 0.54, 15.52 13.95,
respectively. The same values for the BD group were 1.52 0.56,

97

Posters: Periodontal therapy

2.51 0.41, 1.81 0.75 and 25.39 20.1, respectively. The
mean CRP values for the control and BD patients were 0.413
0.64 and 8.91 16.27, respectively. There were signicant
dierences for PD (P < 0.001), BOP (P < 0.001) and CRP
(P < 0.001) values between BD and control groups.
Conclusion: According to the results of our study, the periodontal
status was observed to be impaired in patients with BD compared
to healthy individuals.

181
Epidemiological study on the periodontal status and
treatment need in a Romanian population sample

relationship between gingival overgrowth and Phy and Nif

concentrations in GCF.

183
The evaluation of alveolar bone fractures taking
together out with the tooth in during extraction
(a histological study)
A. Tezel*, R. Orbak, F. Kavrut, T. Sahin and M. Zihni
Faculty of Dentistry, Ataturk University of Erzurum, Turkey

Aim: Evaluation of the periodontal status and the treatment need

in a national patient sample.
Materials and methods: The sample consisted in 8145 patients
(4020 men, 4125 women), utilizing: CPI, according to WHO
methodology.
Results: Results obtained are resumed as follows: (i) at 1525 years
old group theres 25%, periodontal impairment, gingival
inammation being prevalent; (ii) at 2635 years old group
theres 40% ( CPI1 22%, CPI2 17%), (iii) between 36
45 years of age theres 46% prevalence of the periodontal disease,
calculus and mild periodontitis (CPI2 22.5%, CPI3 3%); (iv)
for the 4665 years age group the prevalence of the periodontal
disease is in average of 57% with moderate periodontitis (CPI2
24%, CPI3 5%); (v) for the group of 65 years and above theres
severe periodontitis in 62% of the patients and edentation (12.5%
out sextant). When assessing the treatment needs, there is a great
dierence between rural (43%) and urban patients (36%).
Conclusions: In order to obtain periodontal health it is necessary to
adapt the national, regional and local programs to the WHO
objectives according to the local particularities.

The purpose of this study was to evaluate periodontal structures in

the fractures of alveolar bone taking together out with the tooth
during extraction, and whether there was any ankylosis or the role
of iatrogenic factors in these fractures. This study was carried out
on the extracted teeth together with alveolar fractures obtained
from 134 individuals not having a systemic disorder. The collected
samples were blocked in order to histological investigate. In
histologic sections obtained from 134 samples, while ankylosis was
observed in 14.8% of the samples, periodontal area was found
normal 44.8% of samples. Ankylosis was found upper jaw (80.0%)
rather than lower jaw (20.0%). The ankylosis was generally found
between the cemento-enamel-junction (CEJ) and 1/3 crown of the
root length (90.0%).According to obtained data, only 11.5% of
individuals were found gingival recession. Plaque (93.3%) and
gingivitis (88.5%) at the highest rate were determined. The
occurrence probing depths of 4 mm or more was low (n = 15,
11.5%). Also, relationship between sex and periodontal pocket was
not statistically signicant (P > 0.05). The fact that alveolar
fractures were seen in periodontium having normal structure makes
us think that there was an iatrogenic factor in extractions. When
we consider the problems lost bone caused and for its treatment
required time and money, one should not forget how much
important a peace of alveolar bone is.

182
Drug concentrations in gingival crevicular fluid as a
risk factor for gingival overgrowth in patients
medicated with phenytoin or nifedipine

184
The 18-months effect of an oscillating-rotating power
toothbrush on recession

G. N. Gnc*, F. aglayan, A. Dinel, A. Bozkurt and F.
zmen

Hacettepe University, Turkey

C. E. Drfer*, D. Jr, P. Rau and D. Wolff

Conservative Dentistry, University of Heidelberg, Germany

Gingival overgrowth is a known side eect of phenytoin (Phy) and

nifedipine(Nif) use. However pathogenesis of this side eect is
unclear. This study was conducted to determine whether there is an
association between Phy and Nif concentrations in gingival
crevicular uid (GCF) and the degree of gingival overgrowth in
patients using these drugs. 18 patients medicated with Phy and 18
patients medicated with Nif took part in the study. Vertical and
horizontal gingival overgrowth, plaque, gingival and bleeding
indices were recorded on each patient. Blood and GCF samples
were also collected. Plasma and GCF drug concentrations were
determined by high performance liquid chromatography. Nine of
the Phy using patients and nine of the Nif using patients
demonstrated clinically signicant overgrowth and were thus
designated responders. In both groups, no signicant dierence
was seen between responders and nonresponders with regard to
GCF drug concentration, plaque index, gingival index and
bleeding index. There was a signicant correlation between
plasma Phy concentrations and gingival overgrowth; and also
signicant correlation between GCF Phy concentration and
gingival overgrowth. In Nif group, signicant correlations were
detected between gingival index and horizontal gingival overgrowth; and between bleeding index and vertical gingival overgrowth. The results of this study suggest that, there is no apparent

Objective: To observe the recession changes after 12 months

clinical use of an oscillating-rotating power toothbrush and the
ADA reference manual toothbrush.
Methods: Healthy subjects were appointed to either brushing with
the power toothbrush (D17U, Oral-B Laboratories, n = 55) or the
ADA reference toothbrush (n = 54) according to a prospective
randomised, controlled, single-blind, parallel design. Participants
were asked to brush their teeth twice daily for 2 min each with
standard uoride toothpaste. Attachment loss [mm] and probing
pocket depths [mm] were measured at six sites per tooth to the
nearest mm by one calibrated examiner at baseline, after 6, 12 and
18 months. Recessions were calculated as dierences between CAL
and PPD at every site.
Results: On buccal surfaces, recessions were statistically signicant
reduced from 1.58 0.65 mm to 0.68 0.76 mm in the
oscillating-rotating toothbrush group (P < 0.001, paired t-test)
and from 1.28 0.43 mm to 0.54 0.62 mm in the manual
toothbrush group (P < 0.001). This related to a recession decrease
of 0.89 0.91 mm in the oscillating-rotating toothbrush group
and of 0.73 0.73 mm in the manual toothbrush group (n.s.,
t-test).
Conclusions: Both toothbrushes signicantly reduced recessions on
buccal surfaces. This study was supported by Oral-B Laboratories.

S. Mrtu*, V. Burlui and V. Nicolaescu

University of Medicine, OMS, Iasi, Romania

98

Posters: Periodontal therapy

185
All that glistens is not gold: quantitative and qualitative
analysis of systematic reviews in periodontology

187
Survival of furcation-involved molars after resective
treatment

J. Plack* and J. C. Trp

Department Prosth., University of Freiburg, Germany, and Basel,
Switzerland

I. Simon* and T. Kim

Sect. of Periodontol, University of Heidelberg, Germany

Aim: The aim of this study was to identify all published systematic
reviews and meta-analyses in periodontology, and to make a
qualitative assessment of their level of evidence.
Materials and methods: A systematic search was performed in the
following electronic databases: Cochrane Library, PubMed,
Embase, Medpilot (www.medpilot.de), the dental journals of the
Deutsche Arzte-Verlag (www.dzz.de) and those of the QuintessenzVerlag (www.quintessenz.de). Additionally, two independent
reviewers handsearched selected German-language journals:
Schweizer
monatszeitschrift
fur
zahnmedizin,
Deutsche
zahnarztliche
zeitschrift,
Stomatologie,
Zahnmedizinische
mitteilungen and Quintessenz parodontologie. All identied
systematic reviews were analysed according to a modied version
of the QUORUM statement. The modication, which was made in
collaboration with the German Cochrane Centre, involved (i) the
specication of the eight given questions to dental aspects, and (ii)
the introduction of a point system for each of the specied
questions. Every review could yield 024 points (03 points for
each question). Reviews with 1824 points were rated as having
high quality (713 points: acceptable quality; 06 points: poor
quality).
Result and Conclusion: Eighty-three systematic reviews were
identied: three were of high, 66 of acceptable, and 14 of poor
quality. Thus, periodontologists should be aware of the fact that
high-quality systematic reviews are scarce.

Aims: To enhance the prognosis of teeth with advanced furcation

involvement, resective treatment options like root resection or
hemisection can be indicated. The goal of this study was to describe
the clinical outcome of furcation involved teeth that underwent
resective therapy.
Methods: In 11 patients, 15 teeth (1 upper premolar, 12 upper
molars and 2 lower molars) with advanced furcation involvement
(grade II and III) were treated with resective techniques (1
trisection, 2 hemisections and 12 root resections) and
consequently restored with llings (2), single crowns (7) or
double crowns (6). All patients agreed to participate in a regular
recall system.
Results: During the follow-up period (minimum: 20 months,
maximum: 132 months), 2 out of 15 resected teeth (13.3%) had
to be extracted because of fractures of the remaining roots. The
remaining 13 teeth showed a stable clinical outcome without signs
of gingival or periodontal -inammation.
Conclusion: If furcation involvement has advanced to grade II or
III, resective treatment options should be considered as possible
therapeutic strategies. Regular periodontal maintenance and a
sucient coronal restoration of the root resected teeth are
important preconditions for long-term survival.

186
Choice of antibiotic after sampling by culture and real
time PCR

188
The use of b tricalcium phosphate vs. bovine bone
matrix in the treatment of deep intra osseous defects

C. Verner*,1, A. Daniel1 and M. Sixou2 et al.

1
Faculty of dentistry, Nantes, France 2Toulouse, France

O. Zelic, B. Dimitrijevic, N. Lukovic* and S. Cakic

Perio Department, School of Dentistry, University of Belgrade,
Belgrade, Serbia

Objectives: This study compare the choice of antibiotics according

to the two samplings protocols on the same patients: Real Time
PCR which refers to the literature and the bacterial culture which
makes possible to realize an antibiotics sensitivity test.
Materials and methods: Seventy two samplings from 18 patients
suering of aggressive periodontitis have been studied. Sampling
has been done at same time and into the same pocket. Comparison
of data of the two methods, according to the quality and quantity
of pathogens found, has been carried out. An analysis by an
antibiotics susceptibility testing was done for the culture.
Results: For the quality and quantity of pathogens found, the real
time PCR technic presents results closed to the bacterial culture.
But there is an agreement of the choice of antibiotic only for 11%
of the cases and 5% an intermediate sensitivity was found. If we
mix two antibiotics, a correlation was obtained in 44% of the cases
and an intermediate sensitivity in 34%. However the cultures show
a resistance in 83% to the metronidazole and 33% an intermediate
resistance to the spiramicine.
Discussion: The variation of sensitivity is important for aggressive
periodontitis.
Conclusion: There is an important dierence between the two
methods and in particular for the metronidazole few for other
antibiotics. Real time PCR cannot substitute an analysis by an
antibiotics susceptibility testing. We have to choose one of these
methods according to our clinical objectives.

The aim of this study was to evaluate the eectiveness of pure b

phase tricalcium phosphate (p TCP, Cerasorb, Curasan, Germany) as compared to bovine bone matrix (Bio-oss Geistlich
Pharma, Switzerland) in the surgical treatment of periodontal
osseous defects. Patients with paired intrabony defects and probing
depths measuring 5 mm who have been treated for chronic
periodontitis were selected. A splitmouth design was utilized.
Sixteen intrabony defects were treated with b pTCP (experimental)
and compared with 16 contralateral defects treated with bovine
bone matrix (control). Pocket probing depth (PPD), epithelial
attachment level (EAL), width of attached gingiva (WAG) were
recorded at the baseline, 3 and 6 months after surgery. In the
experimental group, PPD amounted to 5.73 1.07 mm before
surgery, and decreased to 2.50 0.42 mm 6 months following
surgery, while in the control group PPD decreased from
5.45 0.94 mm pre-surgery to 2.45 0.46 mm post-surgery.
Six months following surgery the average gain in EAL was
recorded 1.64 0.68 mm for the experimental group and
1.50 0.80 mm was found for the control group. Dierences
between groups (in favour to experimental group) were also found,
but they didnt reach statistical signicance (P > 0.05). The
present study concluded that the use of bTCP (Cerasorb) or
bovine bone matrix is equally eective in the treatment of deep
periodontal defects.

99

Posters: Periodontal therapy

189
Randomized split-mouth study on non-surgical therapy
with the chlorhexidine xanthan-based gel chlosite

191
Plaque inhibition with 0.12% chlorhexidine spray in
comparison to 0.2% spray and 0.2% mouthwash

A. Dinca*, M. Mesaros, D. Onisei, A. Bacila and S. Stratul

Clinic Dr. Stratul, V. Babes University, Timisoara, Romania

J. E Stoeken* and G. A. Van der Weijden et al.

ACTA, The Netherlands

Objectives: To compare eects of a xanthan-based chlorhexidinegel delivered into periodontal pockets during initial therapy with
the xanthan placebo.
Methods: Twenty patients with periodontitis underwent
examination at baseline and after 6 weeks: PI, BOP, PD, CAL at
6 sites/tooth. Maximal-values/quadrant and mean-overall-values of
PD and CAL were considered. Patients received One-Stage-FullMouth-Disinfection. Each quadrant of same arch received single
subgingival application of chlorhexidine-xanthan-gel (Chlosite,
Ghimas, Italy) (CHL) or the xanthan placebo (XP).Patients used
CHX 0.2% mouthwashes 6 weeks. Wilcoxon test was used.
Results: Both therapies resulted in signicant improvements. In
max-values/quadrant
of CHL, PD changed from 8.60 2.08 to
5.50 2.13, CAL changed from 9.42 2.38 to 6.62 2.12,
while in the XP group PD changed from 8.90 2.63 to
5.55 2.37, CAL changed from 9.57 2.56 to 6.77 2.45. In
the max-values/quadrant
of XP, treatment resulted in no CAL
gains and slight PD reductions than CHL (ns).In mean-overallvalues of CHL, PD changed from 4.61 0.83 to 3.10 0.58 and
CAL changed from 5.07 0.85 to 3.81 0.70, while in XVgroup
PD changed from 4.85 1.05 to 3.26 0.74 and CAL changed
from 5.31 1.12 to 4.17 0.90 (all dierences signicant at
P < 0.0001). In the mean-overall-values
, CHL resulted in slightly
higher CAL gains (ns) and PD reductions (ns) than XP.
Conclusions: Following both approaches, there were no signicant
clinical improvements in terms of PD reductions and CAL gain.

Aim: To test whether 0.12% chlorhexidine (CHX) spray is as

eective as 0.2% CHX spray and 0.2% CHX mouthwash in a
3-day de novo
plaque formation model.
Materials and methods: The study had a single blind, randomized
3-group parallel study design. 90 volunteers were enrolled in the
study and received a thorough dental prophylaxis at the beginning
of the test period. Subjects were randomly divided into three equal
groups. They were instructed to use their assigned product only
and requested to refrain from all forms of mechanical oral hygiene
during the 3 day experimental period. After 3 days the plaque
growth was assessed according the Quigley and Hein plaque index
(PI) at 6 sites per tooth.
Results: After 3 days the CHX mouthwash group had a mean
whole PI of 1.17 (SD 0.38) compared with a mean PI of 1.41 for
the 0.2% CHX spray (SD 0.33) and a PI of 1.49 (SD 0.42) for the
0.12% CHX spray. The dierence between the mouthwash and the
two sprays was statistically signicant. The two sprays did not
dier signicantly from each other.
Conclusion: Within the limitations of this study, the twice daily
applications of CHX spray both in concentrations of 0.2% and
0.12% inhibits the novo
plaque formation, although not to the
level of 0.2% CHX chlorhexidine mouthwash.

190
Gingival crevicular fluid-free oxygen radicals level in
patients with generalized aggressive periodontitis
before and after initial therapy
E. Efeoglu*,
. Ugurlu, A.
gn, G. Haklar and S. Yaln
_
Marmara University, Istanbul,
Turkey
Polymorphonuclear leukocytes become activated at the presence of
inammation and release free oxygen radicals (FR) which results in
the oxidative destruction of cellular membranes and responsible for
serious tissue damage. The aim of this preliminary study was to
investigate the change between pre- and post-therapy level of FR in
gingival crevicular uid (GCF) in patients with generalized
aggressive periodontitis (GAgP). Fourteen GAgP patients and 10
healthy individuals were participated. At least one single rooted
tooth at each quadrant with a probing pocket depth (PPD) 35 mm
and bone loss was selected for the patient group. Plaque index (PI),
sulcus bleeding index (SBI), PPD and relative attachment level
(RAL) were measured before and 12 weeks after initial therapy.
GCF samples were obtained at same time points and FR levels
were further analysed by luminol-enhanced chemiluminescence
assay. Reductions in PI, SBI, PPD and gain in RAL were
statistically signicant compared to their baseline values
(P < 0.0001). The level of GCF-FR in the GAgP group was
signicantly decreased from 355.6 82.4 Auc to 320.6 62.6
Auc (P < 0.01) while the level in the control group was
114.2 18.5 Auc. Our ndings suggest that initial periodontal
therapy caused reduction of GCF-FR levels in GAgP patients,
although healthy control levels could not be achieved. Further
studies with adjunctive antibiotics/antioxidants are needed to
clarify the change in FR levels.

100

192
Evaluation at 6 months of the healing of intrabony
defects following treatment with collagen composite
matrix. A controlled clinical study
D. Onisei*, M. Mesaro, D. Rus, A. Dinca, A. Benta and S. Stratul
V. Babes University, Clinic Dr. Stratul, Timisoara, Romania
Purpose: To compare clinically treatment of deep intrabony
defects with collagen composite matrix (CCM) to access ap
(AF) surgery, in early evaluation 6 months after therapy.
Methods: Thirty one patients with chronic periodontitis, with 58
intrabony defects in total, were randomly treated either with CCM
(PONETI, Bucharest, Romania) (test) or with AF surgery
(control).Gingival parameters, soft tissue measurements were
made at baseline and 6 months after therapy.
Results: No dierences in investigated parameters were observed
at baseline between groups. Healing was uneventful in all
patients.6 months after, test group showed a reduction in mean
probing depth (PD) from 8.00 1.76 to 4.70 1.80 mm
(P < 0.0001)and a change in mean clinical attachment level
(CAL) from 10.07 3.60 to 7.67 4.10 mm (P < 0.0001). In
control group, mean PD was reduced from 8.61 1.31 to
5.86 1.94 mm (P < 0.0001)and mean CAL changed from
10.32 2.07 to 8.32 2.79 mm (P < 0.0001). The test
treatment resulted in higher PD reduction (P = 0.03) and CAL
gains (ns) than the control one. In the test group and in the control
group, 14 and 11 of sites respectively gained at least 3 mm of CAL.
In control group, a CAL gain of 6 mm was measured in 1 defect.
Conclusions: Within the limits of the present study, it can be
concluded that: at 6 months after surgery both therapies resulted in
signicant PD reductions and CAL gains; evaluation at 6 months
of the treatment with CCM resulted in statistically higher PD
reductions but non-signicant CAL gains than treatment with AF.

Posters: Periodontal therapy

193
Six months and one year results following treatment of
intrabony defects with oily calcium hydroxide
suspension and enamel matrix proteins
S. Stratul*, M. Mesaro, D. Rus, B. Willershausen and A. Sculean
V. Babes University, Timisoara, St. Radboud University, Nijmegen, The
Netherlands
Background: Treatment with enamel matrix proteins (EMD) or
oily Calcium hydroxide suspension (OCHS) has been shown to
enhance periodontal regeneration. However, until now there are
limited data on the medium-term results following these treatment
modalities.
Aim: Aim of the present clinical study was to present the 6-months
and 1-year results following treatment of intrabony defects with
EMD and OCHS.
Materials and methods: Twelve patients with a total of 22
intrabony defects of a probing depth of at least 6 mm, were
randomly treated with one of the treatments. Following parameters
were evaluated prior to surgery, at 6 months and at 1 year after:
plaque index, gingival index, bleeding on probing, probing pocket
depth (PPD), gingival recession (GR), and clinical attachment level
(CAL). No statistically signicant dierences in any of the
parameters were observed at baseline between the two groups.
Results: The sites treated with OCHS demonstrated a mean CAL
gain of 4.57 1.65 mm (P < 0.001) and of 4.14 1.79 mm
(P < 0.001) at 6 months and at 1 year respectively. Sites treated
with EMD showed a mean CAL gain of 4.62 2.77 mm
(P = 0.01) at 6 months and of 4.75 2.49 mm (P = 0.01). At
6 months and 1 year, no statistical signicant dierences between
the two treatments were found in terms of PPD and CAL.
Conclusion: Within the limits of the present study, it may be
concluded that short-term clinical results following treatment with
OCHS and EMD can be maintained over a period of 1 year.

194
The application of bovine pericardium for treatment of
gingival recessions

195
Effectiveness of vector in supportive periodontal
therapy
M. Berakdar*, N. Arweiler and A. Sculean
University of Mainz, University of Freiburg, Germany University of
Nijmegen, The Netherlands
The aim of the present study was to evaluate the eectiveness of the
Vector ultrasonic device in supportive periodontal therapy. 41
periodontal maintenance patients were treated in a split-mouth
design with either Vector ultrasonic device (Durr Dental, Bietigheim-Bissingen/Germany) (test) or scaling and root planing (SRP)
using hand instruments (Gracey curettes, Hu-Friedy, Chicago,
USA). Treatment was performed without local anaesthesia. Following parameters were evaluated at baseline and at 6 months:
Plaque index (PI), gingival index (GI), probing depth (PD) and
clinical attachment level (CAL). Patients pain sensibility was
measured using a numerical analogue scale registered from 1-10.
Mean PD decreased in the test group from 6.13 0.81 mm to
4.08 0.72 mm (P 0.001) and in the control group from 6.06
0.69 mm to 3.96 0.76 mm (P 0.001). Mean CAL decreased in
the test group from 7.56 1.16 mm to 6.04 1.06 mm (P
0.001) and in the control group from 7.45 0.93 mm to
6.00 1.17 mm (P 0.001). No signicant dierences between
the two groups were found at 6 months. A statistically signicant
pain sensibility reduction was found when Vector was compared to
hand instruments (P 0.001). It was concluded that: (i) both
therapies led to signicant clinical improvements and, (ii) without
local anaesthesia, treatment with Vector seems to be more
acceptable for patients than treatment with hand instruments.

196
Effectiveness of tetracycline impregnated bone graft
combined with membrane

M. Schlee*
Private Practice

E. Efeoglu1, G. akar2, A. Seyedresuli*,1 and T. Kadir1

1
_
_
Marmara University, Istanbul,
Turkey, 2Yeditepe University, Istanbul,
Turkey

Gingival recessions were treated by various approaches. The aim of

these procedures was not only the coverage of exposed roots but
also the enhancement of gingival thickness. Thickness is assumed
to be one of the factors for long term stability. Several authors used
connective tissue grafts gained from the palate as an autogenous
transplant. Recent approaches used acellular freeze dried human
dermis as a homologue transplant to avoid a second site surgery.
Beside the width of keratinized gingiva similar results could be
obtained. In this presentation a new method of increasing gingival
thickness by implantation of acellular deproteinised soluble
degraded bovine pericardium (Tutoplast) will be shown. The
special preparation of this material maintains collagen in its
original 3-D structure. 21 patients (15 female, 6 male), all
nonsmokers, with 93 Miller class I or II recessions where treated
with a coronal positioned split thickness ap with the bovine
material underneath. Recession, CAL where documented at
baseline, after 3 and 6 months Clinical results will show this
materials ability to achieve the coverage of gingival recessions, to
improve thickness and beside this to regenerate aesthetics. Histological and immunohistologic results demonstrate the increase of
tissue thickness and the replacement by connective tissue over time.
The membrane seems to act as a scaold. Further investigations
will have to compare the outcome of this method to usual
techniques.

Infection of guided tissue regeneration and bone graft treated sites

has been one of the common complications which can compromise
healing. The aim of this study was to evaluate clinical and
microbiological eect of XT-Resolut membrane (XT-RM) in
combination with tetracycline HCL impregnated PepGen P-15
bone graft (ABM-P15). Eleven defects with probing pocket depth
(PPD) 36 mm and intrabony defect depth 34 mm was included.
All patients were prescribed systemic tetracycline HCL for 2 weeks.
Plaque index (PI), sulcus bleeding index (SBI) and microbiological
samples were taken at baseline and 2, 4, 8, 12, 24 weeks and other
clinical parameters were recorded at 0 and 24 weeks postsurgery.
Reduction in PI and SBI at 2 and 4 weeks postoperatively and
gingival recession (1.63 1.02), reduction in PPD (3.72 1.36),
gain in relative attachment level (2.09 1.30) were all statistically
signicant compared to their baseline values (P < 0.01) The mean
number of total viable counts also decreased at 2 and 4 weeks
followed by a slight increase at 8, 12 and 24 weeks, but did not
return to baseline level. The proportions of obligate anaerobes
decreased from a baseline value of 25.77% to 3.23% at week 2, to
10.13% at week 4 (P < 0.001), to 16.8% at week 8 (P < 0.05) and
increased at week 24 (29.05%). These results suggest that clinical
improvements could be obtained and periodontopathogens could
be controlled during initial phase of healing, however this eect
was of short duration.

101

Posters: Periodontal therapy

197
Non-surgical periodontal therapy with adjunctive use
of photodynamic therapy

199
Desensitizing effect of lasers with and without sodium
fluoride varnish

N. Christodoulides*, D. Nikolidakis, R. Junker and A. Sculean

Periodont. and Biomat, Radboud University, Nijmegen M.C., Netherland

S. Ipci*, Kuru, Noyan, Cakar and Yilmaz

Yeditepe Un, Marmara Un, Istanbul, Turkey

This single-blind, controlled clinical trial evaluated the adjunctive

use of Helbo Photodynamic Therapy (PDT) in periodontitis
patients during initial periodontal therapy. 24 patients were
randomly distributed to a test and control group. Full mouth
plaque scores (FMPS), bleeding on probing (BOP), probing pocket
depth (PPD), clinical attachment level (CAL) were evaluated and
microbial sampling was performed at baseline and 3 months.
A. actinomycetemcomitans, P. gingivalis, P. intermedia, T. forsythensis and T. denticola were analysed by PCR technique. All
patients received conventional initial periodontal therapy and the
test group received additionally a session of PDT. No dierences
were observed at baseline between groups. At moderately deep sites
(PD 46 mm) mean CAL changed from 5.6 1.2 mm to
4.8 1.4 mm in control group and from 5.8 1.4 mm to
4.8 1.3 mm in the test group. At deep sites (PD 7 mm) mean
CAL changed from 7.6 0.9 mm to 6.6 1.3 mm in the control
group and from 8.8 0.9 mm to 6.5 1.5 mm in the test group.
At 3 months, all parameters improved signicantly (P < 0.05)
compared to baseline, but no statistically signicant dierences
were observed between groups. A slight tendency for additional
CAL gain was observed at deep sites in the test group. The
microbiological analysis revealed that PDT facilitates further
bacterial reduction. These preliminary results suggest that PDT
might have a potential to improve the outcome of non-surgical
periodontal therapy.

The aim of the study was to evaluate and compare the ecacy of
CO2 and Er:YAG lasers alone and in combination with topical
ouride gel in the management of dentin hypersensitivity. The
study was conducted on 50 patients divided into ve groups who
had clinically elicitable hypersensitivity in the upper anterior
region. Following the pretreatment assessment of hypersensitivity,
the selected teeth (94 teeth in each group) in all groups received
CO2 laser (1 W, CW, 15 sec), Er:YAG laser (30 Hz, 60 mJ, 15 sec),
CO2 or Er:YAG laser plus topical uoride gel (F) (CO2 + F)
(Er:YAG + F) or F alone application. Recordings were assessed
before treatment and 1 week, 1 month, 6 months after treatment.
Within each test group there was a signicant reduction in
hypersensitivity before and 1 week, 1 month and 6 months after
treatment (P < 0.001). All the groups showed signicant reduction
in hypersensitivity at each follow-up examination when compared
to the F group. This signicance was higher in the CO2 and
CO2 + F groups (P < 0.001) especially at the 1st week compared
to the Er:YAG (P < 0.05) and Er:YAG + F (P < 0.01) groups.
The combination of CO2 and Er:YAG lasers with uoride gel seem
to show an impressive efcacy, when compared to uoride gel
alone, in treating dentin hypersensitivity. However, no superiority
was found in terms of desensitization between CO2, Er:YAG,
CO2 + F and Er:YAG + F groups.

198
The long-term effect of periodontal treatment
cooperated with staff of rehabilitation facilities in
adults with intellectual disability
M. Oido-Mori*, S. Kato, K. Nakashima and Y. Furuichi
Health Sciences University of Hokkaido, Japan
The purpose of this study was to evaluate the eects of supportive
periodontal therapy (SPT) for patients with intellectual disability
performed for 22 years. The study population consisted of 27
patients (14 males and 13 females, average 33.1 years old at the rst
visit) who lived in the rehabilitation facility for persons with
intellectual disabilities. At rst, sta members were educated the
importance of plaque control and toothbrushing techniques by
periodontists. Then the sta instructed the persons with intellectual
disability in toothbrushing techniques as daily training. After
having received initial preparation for 2 years, the patients visited
the dental clinic for SPT on average of every 6 months during
22 years. SPT included repeated oral hygiene instruction and
debridements. Clinical examination and measurements of gingival
index (GI), periodontal pocket rate (PoR), plaque control record
(PCR) and number of missing teeth were evaluated at the baseline,
the termination of initial treatment and each SPT visit. A
signicant improvement was observed in GI, PoR and PCR
following the initial treatment. During the 22 years of follow-up,
all three measurements; GI, PoR, and PCR; were lower than those
at the baseline. The average of missing teeth during 22 years was
0.96 per patient. The 51.8% of the patients did not lose any teeth
during 22 years of follow-up. These results suggested that SPT was
eective to maintain oral health of the study group.

102

200
Comparison of galvano-ceramic and metal-ceramic
crowns on clinical periodontal parameters: evaluation
after 24 months, preliminary data
P. Murawel*,1, Lange2, Bernimoulin1 and Hgewald1 et al.
Department of 1Periodont, University of Berlin, Berlin, Germany
2
Prosthet, University of Berlin, Berlin, Germany
Galvano-ceramic crowns (GCC) are considered as biocompatible,
stable and esthetic prosthetic restorations. Few data are available
on their clinical eects on periodontal tissues.
Objectives: To test the impact of two crown systems on clinical and
inammatory responses of periodontal tissues.
Methods: In a prospective, blinded randomised clinical trial, GCC
(AGC, Wieland, Germany) and metal-ceramic crowns (CMC,
Degunorm, Degudent, Germany) were compared in 64
periodontally healthy patients (split-mouth design). This
preliminary report presents the rst 24-months data for 21
patients. Clinical parameters (GI, PLI, PPD) were taken from 6
sites/tooth by one blinded examiner. Gingival crevicular uid ow
rate (GCF) was determined by Periotron 6000 (Harco, USA).
Non parametric Wilcoxon test was used for statistical analyses.
Results: Obvious clinical inammation was only rarely observed.
PLI (0.29 vs. 0.14, P = 0.01) and GI (0.59 vs. 0.33, P < 0.01) were
statistically signicant lower at GCC sites after 24 months. PPD
were not dierent and gingival recessions were not observed. GCF
was statistically lower at GCC sites at 6 months (P = 0.02) after
insertion.
Conclusion: After 24-months, periodontal tissues adjacent to GCC
show signicant better clinical parameters. However, the
dierences were small in absolute numbers. GCC may contribute
to the maintenance of gingival health at prosthetic sites.
Supported in part by DFG grant 325/3 and Wieland, Germany.

Posters: Periodontal therapy

201
Effects of 0.2% chlorhexidine gluconate to the plaque
accumulation on silk suture materials in oral mucosa: a
scanning electron microscope study

203
Preliminary evaluation of the efficacy of a topical
anaesthetic on pain and unpleasantness during
periodontal treatment

E. O. Erdemir*, U. S. Tekin, A. Erdemir and S. Akturk.

University of Kirikkale, Turkey

J. Demoersman*, Le Guiffant, A. Daniel and A. Soueidan

UFR d'Odontologie de Nantes, Nantes, France

Aim: To evaluate the eect of chlorhexidine gluconate (CHX) to

the plaque accumulation on silk sutures by scanning electron
microscope (SEM).
Method: After ap operation of mandibular posterior teeth, 14
patients were randomly divided into two groups. 0.2% CHX was
used in the test group and saline for the control group. The sutures
were removed after 7 days and kept in 70% alcohol and processed
for SEM. The material was critical-point dried using dry ice
method and observed in a eld emission SEM. The contamination
of the suture surfaces was scored and the MannWhitney U-test
was used for statistical analysis.
Results: Scanning electron microscope observations showed that
all of the silk sutures were encrusted with plaque accumulation on
the surface and in the inter-lamental spaces. The surface of silk
sutures in the control group was completely contaminated by
debris along the surface. Signicant dierences were found between
the test and the control groups (P < 0.01). The amount of the
contamination was signicantly lower in the test group. Higher
magnication of SEM showed numerous microorganisms which
were predominantly rod-shaped bacteria and this debris to be
composed mainly of clusters of spherical organisms with some
lamentous structures.
Conclusion: The results of this study suggested that the CHX
group had less contaminated surface area than the control group.
SEM observations strongly indicated the eect of CHX in the
reduction of plaque accumulation on silk sutures.

Periodontitis is the result of complex interrelationships between

infectious agents and host factors. Their treatment consists of
elimination of the bacterial biolm and supra and subgingival
calculus. The main goals are to reduce the inammatory and to
obtain a biocompatible surface of the tooth. The patient could feel
pain during probing or scaling and root planning, which requires
the use or of the anaesthesia by injection. This injection with the
insertion of the needle in soft tissues can be painful and produce
anxiety for the patient. Its duration of action can be also too long.
Furthermore, the patient can have unpleasant feelings and numbness. The recent projections into galenic made it possible to develop
a eutectic mixture containing priloca ne and lidoca ne (Oraqix).
The rheological properties of this mixture confer to him a liquid
state at low temperature - what makes it possible to condition it in
the form of carpule, before use - and in the viscous gel form in the
periodontal pocket. In this preliminary study we tested Oraqix on
40 patients. We evaluate it in term of facility of use, eectiveness,
time of action, the duration of the anaesthesia obtained, and
eventual side eects. Application of Oraqix reduced both pain
intensity and unpleasantness. Generally, the patients accepted the
anaesthetic procedure well. Oraqix may be recommended as a
simple pharmacologic strategy to reduce pain and unpleasantness
during periodontal treatments.

202
Microbiological and clinical effects of chitosan
mouthrinses on plaque formation: a pilot study
A. Uraz1, D. Boynuegri*,1, D. U1, S.Senel2, N.Sultan1 and G.
zcan1
1
Gazi university, Ankara, Turkey, 2Hacettepe university, Ankara, Turkey
Various antiseptic substances have been assorted in mouthrinses
and dentifrice preparations to improve outcome of mechanical oral
hygiene procedure. Chitosan (Ch) is a derivative of chitin, a natural
biopolymer, which is biologically safe, biodegradable, non-toxic
and can be formulated in a variety of forms in dentistry. The aims
of this study were to evaluate the microbiological and clinical
eects on plaque inhibition of Ch mouthrinses and to compare
with 0.2% chlorhexidine (CHX). 36 gingivitis patients were
recruited. Following clinical examination and recorded PI, GI,
PD measures, the volunteers were given oral hygiene instructions,
scaling and professional mechanical tooth cleaning. After the nal
PTC, volunteers were allocated to 1 of 3 treatment groups. Group
A: rinsed twice daily for 60 sec each time with Ch solution, group
B: rinsed twice daily for 60 sec each time with 0.2% CHX,
group C: rinsed twice daily for 60 sec each time with Ch + 0.2%
CHX. Subgingival plaque samples were collected from each subject
on Day 0 and after 1, 2 and 4 days. And this sample assayed for
S. mutans, C. albicans and enterococci.After 4 days of nonbrushing, there was no signicant dierences in plaque accumulation between groups. No signicant dierences were seen in
S. mutans and enterococci levels among the groups; however
C. albicans levels were statistically signicant between all groups. It
was concluded that Ch mouthrinses may be recommended in
reducing and delaying the bacterial accumulation.

204
Coverage of gingival recessions with connective tissue
grafts and platelet rich plasma
B. E. Yesilbek and F. Unlu*
_
Ege University Dishekimligi Fak., Izmir,
Turkey
Connective tissue grafts (CTG) are accepted as golden standard for
coverage of gingival recessions. However, new procedures are
developed to overcome problems like a second surgical site and
graft size. Platelet rich plasma (PRP) obtained from patients blood
is an autologous source of several growth factors. PRP improves
bone and periodontal regeneration. The purpose of the present
study was to compare the ecacy of CTG and collagen sponges
soaked with PRP in root coverage procedures. 24 patients were
enrolled to the study. Test group was treated with PRP activated
by calcium and blood obtained from operation eld as a source of
thrombin. PRP soaked collagen sponges were placed under full
thickness aps. The control group was treated by CTG combined
with partial thickness ap. After 6 months clinical parameters were
compared to baseline values. Postoperative healing at PRP sites
was uneventful and results were esthetically pleasing Root coverage
was 84% with PRP and 85% with CTG at 6th month. Statistically
signicant dierence was not observed between the groups. CTG
sites had a signicant increase in keratinised tissue width as
opposed to PRP sites. The results of this study demonstrated that
PRP which does not possess cross infection or antigenity concerns
can be prepared at required size and used for treatment of gingival
recessions.

103

Posters: Periodontal therapy

205
Antimicrobial susceptibility of three periodontal
pathogens recovered from a chronic periodontitis
sample with a high intake of antibiotics

207
The effects of a 0.1% chlorhexidine mouthwash on
plaque and gingival indices in patients with gingivitis:
a 3-month study

C. Serrano*, N. Torres, M. Barrera and M. Cabrales

University of Javeriana, Colombia

S. Morante*, S. M. P.Correa, D. M.Vargas, D. Herrera and M. Sanz

Department of Periodontics, University of Complutense, Madrid, Spain

The aim was to determine the antimicrobial susceptibility of

Fusobacterium nucleatum, Prevotella intermedia and Porphyromona gingivalis isolated from periodontitis patients. Twenty-ve
patients diagnosed with generalized moderate-advanced chronic
periodontitis were recruited according to specic criteria. All
patients lled out a questionnaire about antibiotic intake. The
deepest pocket in each quadrant was sampled. Pooled samples were
mixed, diluted and plated on enriched brucella agar plates.
Identication of the bacteria was performed based on: colony
morphology, gram staining, aero-tolerance and biochemical reactions (RapidAna II, Remel). The bacteria were subjected to
antimicrobial testing using: amoxicilin, tetracycline, doxycicline,
azithromicin and metronidazole (E-test, ABBiodisk). The minimal
inhibitory concentrations obtained were compared to crevicular
uid concentrations to determine resistance. Amoxicilin-resistant
species were tested for b-lactamase production. Forty-four percent
of the patients used antibiotics without any medical prescription.
The presence of eleven species could be conrmed: four F.
nucleatum, ve P. intermedia and two P. gingivalis. All strains
were resistant to metronidazole, ve were resistant to tetracycline
and azithromicin, two were resistant to amoxicilin and doxycicline.
The strains resistant to amoxicilin were positive for b-lactamase.
Antimicrobial resistance was a common phenomenon for the
bacterial samples analysed.

Aim: To compare the clinical ecacy and tolerability of a 0.1%

chlorhexidine (CHX) mouthrinse during a 3-month trial using a
placebo and a 0.2% CHX solutions as controls.
Materials and methods: A prospective, parallel, randomised
clinical trial was designed to evaluate the clinical eects of the
test mouthrinse. 37 patients were assessed at baseline, and days 7,
14, 28 and 84. Clinical parameters were assessed by full mouth
modied gingival index, plaque index, discoloration index and
bleeding on probing. Data was analysed using the Dunnetts,
Fisher and t-Student tests.
Results: The 0.1% CHX and 0.2% CHX groups showed higher
reductions in Plaque Index after 7, 14, 28 and 84 days (P < 0.05;
excepted 0.1% CHX after 84 days, P = 0.06), as compared with
the placebo group. The same was true for the modied Gingival
Index (P < 0.05; excepted 0.1% CHX after 28 days and after
84 days, P = 0.11). The discoloration index demonstrated a
signicant higher level of staining for the 0.2% CHX group after
84 days, as compared with placebo, while no signicant dierences
were found between the 0.1% CHX and the placebo group.
Conclusions: The 0.1% chlorhexidine solution can be use as an
adjunctive treatment for gingivitis. The test solution was more
acceptable for patients because of its lower discoloration of teeth
and taste alteration.
Supported by Pierre-Fabre.

206
A retrospective longitudinal study on early onset
periodontitis

208
The clinical impact of PRP and TCP in the treatment of
infrabony defects

B. Sjdin* and E. Wennerstrand

Department of Periodontology, rebro, Sweden

Z. Aleksic* and S. Jankovic

University of Belgrade, Serbia and Montenegro

The aim of the study was to examine the long-term result of

periodontal treatment in EOP patients.
Materials and methods: Twenty nine EOP patients were
re-examined 1315 years after end of treatment. The patients
were re-examined and retrospective data were recorded from the
les. The number of appointments for periodontal treatment
during the maintenance care was registered. In 16 of the patients
the presence of Actinobacillus actinomycetemcomitans (A.a) were
monitored at the appointment for re-examination.
Result: PII, GI, the number of deep pockets and boneloss sites
were signicantly reduced during periodontal treatment. At the
time for re-examination the periodontal status were still better
compared to the primary status, but compared to the status at the
beginning of the period of maintenance care it showed a higher
mean number of pockets and a higher mean number of bone loss
sites. The individuals with deteriorated status had had signicantly
fewer appointments of maintenance care compared to the
individuals with unchanged or improved periodontal status. 8 of
16 patients harboured (A. a) in their deepest pockets at the time of
re-examination. The occurrence of A. a was not associated with
progression of the disease.
Conclusion: The periodontal health for this group remained better
than before treatment. For the individual patient the present
periodontal health is associated with the number of yearly
maintenance care.

It is conceivable that concentrated growing factors within platelet

rich plasma PRP up-regulates cellular activity and subsequently
promotes periodontal regeneration in vivo. In combination with
TCP (RTR) activated cytokine cocktail from PRP should
extensively enhance periodontal tissue regeneration. The objective
of this study was to compare the clinical eectiveness of two
regenerative procedures for intrabony defects: a combination of
PRP/TCP/GTR vs. a combination of PRP/TCP.15 patients took
part in the study. Interproximal bony defects were surgically
treated with a combination of PRP/TCP/GTR or PRP/TCP.
The primary outcomes of the study included changes in probing
depth, attachment level, and defect ll as revealed by re-entry
surgeries at 6 months post-treatment. 6 months after surgery both
treatment modalities resulted in signicant probing depth reduction and clinical attachment gain compared to baseline values.
Clinical attachment level improvement was 3.55 2.52 mm for
the PRP/TCP group and 3.68 2.35 mm for the PRP/TCP/
GTR group. Re-entry surgeries evaluated similar defect ll for
both treatment groups (PRP/TCP group: 3.88 2.55 mm, PRP/
TCP/GTR group: 4.05 2.33 mm).Dierences between clinical
results obtained in the two treatment groups showed no statistically
signicance. Surgical procedure of this study resulted in highly
eective and clinically equivalent changes with no statistically
signicance when comparisons were made between test and control
group.

104

Posters: Periodontal therapy

209
A 980 nm diode laser effect on clinical and microbial
parameters of aggressive periodontitis
J. J. Kamma*, G. E. Romanos and V. Vasdekis
Private Clinic, Greece, New York University, USA, Athens University
Econom Bus, Greece
The aim was to compare the eect of scaling and root planing
(SRP) to SRP plus diode laser treatment (SRP + LAS), to LAS or
to no treatment (CRL) on clinical and bacterial parameters of
aggressive periodontitis (AgP). 30 AgP patients were assessed for
PD, CAL and BOP. Four subgingival plaque samples were
randomly obtained from each individual, one in each quadrant.
Following baseline (BL) sampling, each quadrant randomly
received SRP, SRP + LAS, LAS, CRL. A 980 nm diode laser
(SmilePro980TM, Biolitec) was used in a continuous mode and a
2 W power setting. Plaque samples were collected from the same
site in each quadrant 6 weeks (R1), 12 weeks (R2) and 6 months
(R3) post treatment. Clinical parameters were recorded at the same
time intervals. The level of P. g, B. f, A. a, T. d as well as total
bacterial load (TBL) was evaluated using DNA probes (IAI Pado
Test). Bacterial counts, PD, CAL and BOP were signicantly
decreased following SRP, SRP + LAS, LAS and didnt reach BL
levels at R3. SRP + LAS showed lower bacterial levels compared
to SRP or LAS at R1, R2 and R3. P. g, B. f, T. d. and TBL
exhibited a signicant time by treatment interaction eect
(P < 0.001) showing that each treatment had a dierent performance on time. SRP + LAS mean levels of all bacteria at R3 were
never higher than the corresponding levels of SRP or LAS at R1.
In conclusion, SRP + LAS seem to have a superior eect on both
clinical and bacterial parameters of AgP over the 6-month
monitoring period.

210
Effects of platelet riched plasma (PRP) on soft tissue
wound healing
N. Nikolic-Jakoba*, B. Dimitrijevic and S. Jankovic
University of Belgrade, Serbia and Montenegro
The main purpose of this study was to evaluate the eects of PRP
(platelet riched plasma) on clinical eects of soft tissue wound
healing in early healing period. In this split-mouth study 16
patients were enrolled. Ten patients with bilateral areas of
insucient attached gingiva in lower jaw were included. Free
gingival graft (FGG) was placed on control site, while the other
(experimental) site was treated with FGG in combination with
PRP. Six patients, each contributing a pair of Miller Class I or II
buccal gingival recessions, were treated. In each patient one
randomly chosen defect received connective tissue graft (CTG)
with coronally advanced ap, while the contralateral defect
received a CTG in combination with PRP. Clinical eects were
evaluated on the 7th, 14th and 21st day post surgery by early
healing index(EHI). Mean EHI values recorded on the 7th day
were 2.8 in FGG group, 3.9 in FGG + PRP group and 2.9 in CTG
group and 4.1 in CTG + PRP group. Results achieved on the 14th
day were 3.5 in FGG group, 4.8 in FGG + PRP group and 3.4 in
CTG group and 4.7 in CTG + PRP group, while the results
detected on 21st day were 4.5 in FGG group, 4.9 in FGG + PRP
group and 4.4 in CTG group and 4.9 in CTG + PRP group.
According to the results of this study, we can conclude that use of
PRP stimulate and provides superior wound healing response in
early healing period(rst 2 weeks post surgery).After this period,
there are no signicant clinical eects on wound healing process
and treatment outcomes.

211
Treatment efficacy of palatal connective tissue graft vs.
allogenic freeze-dried dermis graft applied for root
coverage in buccal gingival recessions
A. S. Jan*, T. Griffin and P. Damoulis
Tufts University, Boston, USA
Background: The subepithelial connective tissue graft (SCTG) is
currently the golden standard in the treatment of gingival recession
when the objective is root coverage. Recently, the use of allogenic
freeze-dried dermis (AFDD) has been proposed as an alternative
grafting material, but data on its ecacy are still limited. The
objective of this study was to compare the SCTG and AFDD
procedures in the treatment of gingival recessions as it relates to
clinical soft tissue coverage, post-operative pain and esthetic
outcome.
Materials and methods: Forty Miller class I or II bilateral
symmetrical areas of gingival recession were treated in 11
patients. All clinical measurements were performed for the
selected teeth 2 weeks after initial therapy (baseline) and again 6,
12 and 20 weeks after surgery. Clinical photographs were taken at
the same visits. Patients were asked to evaluate post-operative
discomfort separately on each side one week after the procedure.
Results: Both procedures gave comparable results in terms of
clinical root coverage (both vertically and horizontally), increase in
keratinized gingiva, as well as matching adjacent tissue colour and
consistency, However, the use of the AFDD resulted in reduced
postoperative pain and generally fewer postoperative
complications.
Conclusions: Our study demonstrated that the AFDD could serve
as a good alternative to SCTG for root coverage procedures with
the added advantage of fewer post-operative complications.

212
Access flap vs. papilla preservation technique (PPT)
combined with emdogain-TS
A. Miliauskaite*, D. Selimovic and M. Hannig
Clinic Op. Dent., Perio., Saarland University, Germany
The aim of the present study was to present the 1 year results
following treatment of intrabony defects with Access Flap vs. PPT
combined with Emdogain-TS (EMD-TS). Twenty-ve patients
with a total of 70 intrabony defects were treated by Access Flap (35
defects) and PPT (35 defects) combined with EMD-TS. The
following clinical parameters were evaluated at the baseline and at
1 years after treatment: probing depth (PD), gingival recession
(GR), and clinical attachment level (CAL). The primary outcome
variable was CAL. The measurements were made at 6 sites per
tooth: mesiobuccal (mv), buccal (v), distobuccal (db), mesiolingual
(ml), lingual (l) and distolingual (dl). The cemento-enamel junction
(CEJ) was used as reference point. In case the CEJ was not visible,
a restoration margin was used for these measurements. The sites
treated with papilla preservation technique combined with EMDTS demonstrated mean CAL decrease from 7.9 1.1 mm to
4.0 0.8 mm (P < 0.001) at 1 years. The sites treated with
Access Flap combined with EMD-TS demonstrated mean CAL
decrease from 8.5 2.5 mm to 4.8 2.0 mm (P < 0.002) at
1 years. It can be concluded that the treatment of intrabony
defects with papilla preservation technique combined with EMDTS as well as Access Flap combined with EMD-TS results in
signicant improvement of the investigated clinical parameters. As
our results show there was no signicant dierence between the
data of both investigated groups.

105

Posters: Periodontal therapy

213
Moxifloxacin as an adjunctive antibiotic in treatment of
severe chronic periodontitis a pilot study

215
Levels of platelet activating factor in gingival tissue
following periodontal surgical therapy

S. Eick*, O. Brunner, H. Jentsch and W. Pfister

University Hospital, Jena, Germany, University of Leipzig, Leipzig,
Germany

G. C. Keles*, B. O. Cetinkaya and B. Ayas et al.

Ondokuzmayis University, Samsun, Turkey

Objectives: The aim was to perform a pilot study using

moxioxacin in treatment of severe periodontitis.
Materials and methods: The randomised study included 35 patients
with severe chronic periodontitis. All the patients underwent a
systematic periodontal therapy (oral hygiene, deep scaling and root
planing, supportive therapy), but in 17 randomly selected patients
additionally 400 mg moxioxacin / d over 7 d were applied.
Clinical parameters, the microora, IL-8 and the activity of
granulocyte elastase were determined in sites with an attachment
loss >5 mm immediately before periodontal therapy as well as 3
and 9 months later.
Results: The clinical outcome in both groups was similar. In both
groups a reduction of IL-8 in crevicular uid was observed; the
decrease of granulocyte elastase activity was higher in the
moxioxacin group (80% reduction) than without antibiotics
(55%). After treatment less T. denticola and T. forsythia were
found, but only in the moxioxacin group a signicant reduction of
P. gingivalis (>105 before treatment in 40.9% of the samples,
9 months
later
in
7.2%)
and
leukotoxin-positive
A. actinomycetemcomitans (>105 before treatment in 12.4% of
the samples, 9 months later in 2.4%) was detected.
Conclusions: The results of the study indicate the necessity of a
larger clinical trial to evaluate moxioxacin as adjunctive antibiotic
in treatment of periodontitis.

Background: The role of platelet activating factor (PAF), a potent

inammatory phospholipid mediator, on healing after periodontal
surgery remains unclear. The aim of this study was to determine
levels of PAF in gingival tissues collected from sites that have
undergone guided tissue regeneration (GTR) and ap surgery.
Materials and methods: Using split mouth design, 20 intrabony
defects were randomly assigned treatments with GTR (test) or ap
surgery (control). Gingival tissue samples were obtained at surgery
(baseline) and 6 month follow-up evaluation visit. One half of each
sample was used for histomorphometric analysis that included the
measurements of number and diameter of blood vessel proles
(BVP), the other half of sample was used for analysis of PAF levels
by high performance liquid chromatographic method.
Results: Platelet activating factor levels and diameter of blood
vessel proles were signicantly decreased (P < 0.001), number of
BVP was signicantly increased (P < 0.05) in both treatment
modalities compared to baseline values. Postoperative number of
BVP were signicantly higher in test group (P < 0.001), whereas
there was no signicant dierence in postoperative PAF levels
between the two groups (P > 0.05). A statistically signicant
negative correlation was found between PAF levels and the number
of BVP (P < 0.001).
Conclusion: Decrease in PAF levels and increase in the number of
blood vessels might be indicators of resolution of inammation,
and periodontal repair and regeneration.

216
The effect of periodontitis on biting abilities
214
Comparison of epithelial proliferative activity following
surgical therapy with bioactive glass and flap surgery
B. O. Cetinkaya, G. C. Keles and B. Simsek* et al.
Ondokuzmayis University, Samsun, Turkey
Background: Bioactive glass (BG) graft material has been
suggested as having an ability to enhance regenerative type of
healing of periodontal lesions. The aim of this study was to
compare proliferative activity of epithelium following surgical
therapy with BG and ap surgery.
Materials and methods: Ten chronic periodontitis patients (mean
age: 41.9 2.34) with paired intrabony defects were randomly
assigned surgical therapy with BG (test) or ap surgery (control).
Gingival biopsies were taken at surgery (baseline) and 8 week
follow-up evaluation visit. After histological processing,
proliferating cell nuclear antigen (PCNA) expression was
determined in immunohistochemically-stained sections and
epithelial thickness was measured in hematoxylin and eosinstained sections.
Results: At postoperative 8 week, PCNA expression and epithelial
thickness were signicantly increased in both treatment groups
compared to the baseline values (P < 0.05). There was no
signicant dierence between baseline values of two groups
(P > 0.05) while at 8 weeks, increase in PCNA expression of
control group was signicantly greater than that of test group
(P < 0.05).
Conclusions: The results of this study revealed that proliferative
activity of epithelium increased in both treatment modalities.
Within the limits of this study, it was suggested that healing by long
junctional epithelium might be more prominent following ap
surgery compared to surgical therapy with BG.

106

A. Alkan*, I. Keskiner, S. Arici and S. Sato

Ondokuz Mayis University, Turkey, Tohoku University, Japan
Periodontitis is a destructive disease which causes the loss of toothsupporting tissues. The loss of bone may aect the biting abilities
(bite force, occlusal contact area). The aim of this study is to
evaluate the biting abilities in periodontitis patients and in healthy
control group. The study group consisted of 20 chronic periodontitis patients in whom the mean probing pocket depth and probing
attachment level was 3.21 mm and 4.16 mm, respectively. The
periodontitis patients had 7 sites with 5 mm probing depths.
Bone loss observed in periapical radiographs taken with parallel
technique conrmed clinical diagnosis. Twenty subjects with
healthy periodontium served as control. Biting abilities were
measured with a pressure sensitive sheet and analysed with an
image scanner following initial periodontal treatment (scaling and
root planning). Independent samples t-test showed statistically
signicant dierences between the groups for bite force (P = 0.006)
and occlusalcontact area (P = 0.033) measurements at the 95%
condence level. In the light of these ndings, this study suggests
that the loss of bone support may cause a decrease in bite force and
occlusal contact area. Therefore, using regenerative techniques to
regain lost periodontium may help to improve biting abilities.

217
Comparative study of salivary chlorhexidine
concentrations after oral application of different
pharmaceutical forms
A. B. Legaz Mellado*, A. S
nchez, G. Garca-Teresa and M. Alc
zar
University of Murcia, Spain
Introduction and Aims: Chlorhexidine concentration in the mouth
may vary according to the pharmaceutical form involved. The

Posters: Periodontal therapy

present study compares the salivary chlorhexidine concentration
after the application of three dierent pharmaceutical forms.
Materials and methods: Forty healthy subjects over 18 years old
were included in a randomized, cross-over, comparative study to
analyze the evolution of salivary chlorhexidine concentration after
a single oral application of three dierent pharma. Salivary
samples were collected at baseline and 5 min and 1, 2, 6, 12, 24,
36 and 48 h after application. Study variables: mean chlorhexidine
concentration at each control time point, maximum concentration,
clearance rate and area under the concentration-time curve. The
study was authorized by the Clinical Research Ethics Committee of
Virgen de la Arrixaca Hospital.
Results: Chlorhexidine was still detected in saliva at the last
control (48 h) with all three products. The mouthrinse and
bioadhesive gel aorded signicantly higher chlorhexidine
concentrations than the spray formulation (P = 0.005 and
P = 0.001, respectively). In the case of the gel, the initial
concentrations decreased faster than when the mouthrinse was
used (P = 0.004 after 1 h and P = 0.012 after 2 h).
Conclusions: Forty-eight hours after a single application of
chlorhexidine, the drug is still detectable in saliva, although the
evolution of chlorhexidine concentration varies according to the
pharmaceutical form used.

Methods: Thirty eight patients (19/19) each with one deep

intrabony defect were treated with a b TCP (Cerasorb) +
PRP + e-PTFE (test) or b -TCP + e-PTFE (control). PPD and
CAL were recorded at baseline and at 6 months. Membranes were
removed after 56 weeks and microbiological examination
performed. The presence of 6 selected periopathogenic species:
A. actinomycetemcomitans (A. a.), P. gingivalis (P. g),
P. intermedia (P. i.), F. nucleatum (F. n.)., Actinomyces spp
(A. spp)., P. micros (P. m.) were identied by cultures.
Results: In the test group P. g. was not detected. The number of
pathogenic isolates cultured from the retrieved membranes was: A.
a. 3 (16%), P. i. 6 (31%), F. n. 5 (26%), A. spp. 6 (31%), P. m. 12
(63%). The CAL gains measured at 6 months. In the presence of
periodontal pathogens were: A. a. 54%, P. i. 56%, F. n. 62%, A.
spp., 62%, P. m. 53%. In the control group P. i. was not detected
and was positive for 1 A. a. (5.3%), 2 P. g. (12%), 10 F. n. (53%),
5 A. spp. (26%), 13 P. m. (68%). The CAL gains obtained at 6
months in the presence of periodontal pathogens were: A. a. 50%,
F. n. 52%, P. g. 60%, A. spp., 55%, P. m. 54%.
Conclusion: Mean CAL gain was higher in the test group even in
the presence of A. a., P. i., F. n. although the CAL gain showed
marked individual variations.

218
Repeated subgingival chlorhexidine varnish
administration in persistent periodontal pockets

220
Clinical evaluation of platelet rich plasma and a
synthetic bone graft material in the treatment of
intrabony defects

J. Cosyn*, I. Wyn and M. M. Sabzevar

VUB, Department of Periodontology, Belgium

B. Demir, A. Berberoglu* and D. Sengn

Department of Periodontology, University of Hacettepe, Ankara, Turkey

Background: Studies have indicated that the outcome of scaling

and root planing (SRP) may benet from the adjunctive
subgingival application of a chlorhexidine (CHX) varnish. The
aim of this study was to investigate the clinical impact of the latter
at persistent pockets.
Materials and methods: Fifteen chronic periodontitis patients
having completed root debridement phase at least 3 months prior
to the study, participated in this intra-subject parallel study. Per
patient at least four persistent non-adjacent bleeding pockets
5 mm were selected and randomized at split mouth level to one of
two strategies. Control sites were scaled and root planed. If pockets
remained deeper than 3 mm, SRP was repeated at 1 and 3 months.
Test sites received the same treatment; yet, they were additionally
disinfected using a CHX varnish. Clinical response parameters
were recorded at baseline, after 1, 3 and 6 months. A site-based
analysis was performed by means of repeated measures anova.
Results: Both strategies were eective at improving the clinical
status. At one month, test sites expressed a signicant additive
pocket reduction of 0.39 mm (P = 0.035) and a trend towards a
higher clinical attachment gain (P = 0.074). However, benecial
eects were not maintained.
Conclusions: The application of a CHX varnish as an adjunct to
SRP in persistent pockets can be considered; yet, when patients are
well-compliant following an intensive supportive care program,
this agent does not provide a lasting benet.

The purpose of this study was to evaluate the eect of bioactive

glass graft material (BGGM) with and without PRP on clinical
healing of intrabony defects in humans. Twenty nine intrabony
defects were randomly treated with either PRP/BGGM (n = 15)
or BGGM (n = 14) alone. Nine months after surgery, signicant
reductions were observed on plaque index (PI), gingival index (GI),
bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), the distance between cementoenamel junction
(CEJ) and base of the defect (ESJ-BD) and intrabony defect depth
(IDD) in both groups. The values of gingival recession (GR) and
the distance between CEJ crest of the defect (ESC-CD) were not
statistically signicant. PD reduction was 3.60 mm in the PRP/
BGGM group and 3.29 1.68 mm in BGGM group. Clinical
attachment gain was 3.13 1.77 mm in the PRP/BGGM and
2.86 1.56 mm in BGGM group. IDD was reduced 3.47
0.53 mm and 3.36 0.55 mm in the test and control groups,
respectively. None of the dierences between two treatment
modalities were statistically signicant. The results of this study
suggest that both PRP/BGGM combination and BGGM alone are
eective in the regenerative treatment of intrabony defects in
patients with severe periodontitis. The results also showed that
using PRP with BGGM has no additional benet in the reduction
of pocket depth, clinical attachment gain and defect ll.

219
Bacterial contamination of e-PTFE membranes
following regenerative periodontal therapy with a
synthetic bone-graft and PRP
F. Dri, Z. Barna*, M. Fzi, I. Gera and A. Sculean
SE Period, BJ. Epidem. Ranboud U. Hung, The Netherlands
Objective: The objective of this study was to assess the inuence of
the bacterial contamination of e-PTFE barriers used in GTRtherapy of intrabony defects on the healing.

221
Clinical and microbiological effects of different
antimicrobials on generalized aggressive periodontitis
C. Xajigeorgiou, D. Sakellari and A. Baka* et al.
Aristotle University, Thessaloniki, Greece
Aim: To evaluate and compare the eects of adjunctive
metronidazole plus amoxicillin, doxycycline and metronidazole
on clinical and microbiological parameters in patients with
generalized aggressive periodontitis.
Materials and methods: Forty three patients participated in this
Randomized Clinical Trial divided into four groups. Six weeks

107

Posters: Periodontal therapy

after scaling and root planning (SRP), groups 1, 2 and 3 received
adjunctive metronidazole plus amoxicillin, doxycycline and
metronidazole respectively and group 4 acted as controls.
Clinical recordings concerning probing depth, probing
attachment level and bleeding on probing were performed at
baseline, 6 weeks after SRP and 6 months from baseline.
Subgingival samples were analysed using the checkerboard

DNA-DNA hybridization for Porphyromonas gingivalis,
Actinobacillus actinomycetemcomitans, Tannerella forsythensis and
Treponema denticola.
Results: All treatments resulted in improvement of clinical
parameters (anova P > 0.05). Systemic administration of
metronidazole plus amoxicillin or metronidazole resulted in
statistically signicant greater reduction of the proportion of sites
>6 mm than scaling root-planing (z-test, P < 0.05). These
antimicrobials yielded a signicant eect on levels of important
periodontal pathogens for 6 months.
Conclusions: Adjunctive metronidazole plus amoxicillin or
metronidazole alone (when A. actinomycetemcomitans is not
involved) is eective in deep pockets of aggressive periodontitis
patients.

study was planned to evaluate the adjunctive ecacy of systemic

doxycycline clinically and biochemically.
Methods: Twenty chronic periodontitis patients were placed in two
groups. The control group received initial periodontal therapy,
while the test group additionally received systemic doxycycline for
2 weeks. PI, SBI, probing pocket depth (PPD) and relative
attachment level (RAL) recordings and GCF samples were
obtained initially and at 1st, 3rd and 6th months after therapy.
GCF levels of MMP-8 and PGE2 were evaluated by enzyme
immunoassay. MannWhitney U and Wilcoxon signed rank tests
were used for statistical analysis.
Results: Both groups showed signicant improvements in all
parameters (P < 0.05). Initially the mean PI value was higher in
the control group (P < 0.05) but the intergroup dierences were
not signicant ever after (P > 0.05). There were no signicant
intergroup dierences regarding mean SBI scores and mean
decrease in PPD, RAL, MMP-8 and PGE2 level (P > 0.05).
Conclusion: The use of systemic doxycycline demonstrated no
clinical or biochemical benecial eect. Standard mechanical
procedures are sucient for the successful therapy of chronic
periodontitis.

222
Comparative clinical study of guided tissue
regeneration and subepithelial connective tissue graft
in the treatment of gingival recession

224
Clinical and biochemical efficacy of short-term
systemic ibuprofen in non-surgical periodontal therapy
of chronic periodontitis

B. Ors Orug, B. Kurtis*, D. Cetiner and K. Balos

Gazi University, Department of Periodontology, Ankara, Turkey

C. Basegmez, G. Isik*, K. Demirel and F. Yalcin et al.

Department of Periodontology, Istanbul University, Istanbul, Turkey

The aim of this study was to compare the clinical ecacy of two
surgical approaches in the treatment of the recession type defects
and to determine the inuence of smoking on the outcome of these
techniques. Seventeen pairs of Miller Class I and II defects were
selected in 17 patients (11 non-smokers, 6 smokers). The defects
were randomly assigned to the test (GTR using a bioabsorbable
membrane) or control (SCTG combined with a coronally positioned ap). Recession depth (RD), probing depth (PD), clinical
attachment level (CAL), recession width (RW), width of keratinized tissue (KT) were assessed at baseline and 6, 9, 12 months
postsurgery. Both techniques yielded signicant improvements in
terms of RD and RW decrease, CAL and KT gain compared to
baseline values. There were no signicant dierences between the
two groups in RD, CAL, RW either at baseline or postoperative
evaluations. The percentage of root coverage (RC) achieved
80.04% for GTR and 89.82% for SCTG on the 1 year postsurgery
(P = 0.212). Smokers showed signicantly less percentage of RC
compared to non-smokers in GTR group (45.26% vs. 87.67%,
respectively; P = 0.018). However, in SCTG group, smoking was
not associated with a statistically signicant decrease in percentage
of RC (80.66% for smoking, 95.83% for nonsmoking; P = 0.750).
The results indicate that both surgical approaches are eective in
addressing root coverage. Treatment outcomes following GTR in
gingival recession defects are impaired in smokers.

Background: Ideal periodontal therapy must simultaneously target

periodontopathogens and the destructive host response. Therefore,
management of the disease may require additional interventions
such as the use of nonsteroidal anti-inammatory drugs that may
modulate the host response. The present study was designed to
evaluate the adjunctive ecacy of systemic ibuprofen clinically and
biochemically.
Methods: Twenty chronic periodontitis patients were randomly
assigned to two groups. The control group received initial
periodontal therapy, while the test group additionally received
systemic ibuprofen for 2 weeks. PI, SBI, probing pocket depth
(PPD) and relative attachment level (RAL) recordings and GCF
samples were obtained at the beginning and at 1st, 3rd and 6th
months following therapy. GCF levels of MMP-8 and PGE2 were
evaluated with enzyme immunoassay. Results were analysed by
Wilcoxon signed rank test for treatment modalities and Mann
Whitney U-test for intergroup changes.
Results: Both groups showed signicant improvements in all
parameters after therapy (P < 0.05). Neither mean PI scores, nor
the improvements in SBI, PPD, RAL, GCF MMP-8 and PGE2 levels
demonstrated statistical signicance between groups (P > 0.05).
Conclusion: The use of systemic ibuprofen demonstrated no
benecial eect on the clinical or biochemical outcome of
periodontal therapy. Standard mechanical periodontal procedures
are sucient for the successful treatment of chronic periodontitis.

223
Clinical and biochemical evaluation of systemic
doxycycline as an adjunct to non-surgical periodontal
therapy of chronic periodontitis
C. Basegmez, G. Isik, K. Demirel and F. Yalcin* et al.
Department of Periodontology, Istanbul University, Istanbul, Turkey
Background: Periodontal breakdown is a consequence of the
action of bacterial and host derived proteinases and mediators.
Ideal therapy must address both components by applying standard
mechanical procedures and systemic pharmacotherapeutics as
bacteria reducing and host modulating adjuncts. The present

108

225
Root coverage with enamel matrix derivatives with and
without connective tissue graft a modified surgical
technique: 1-, 2- and 6-year-results
H. Gnay*,1 and S. Dogan2
1
Medical University, Hannover, Germany, 2University of Washington,
USA
Recently, the enamel matrix derivatives (EMD) in combination
with or without connective tissue graft (CTG) were applied more
frequently in the therapy of gingival recession with dierent

Posters: Periodontal therapy

surgical techniques as a consequence of better clinical and
histological results in case of periodontal regeneration. Aim of
this clinical study was to evaluate the coverage of gingival recession
defects with EMD with or without CTG.
Methods: Twenty ve patients (16 f, 9 m) from 16 to 58 years of
age with 92 gingival recessions (Miller classes I, II) and with at least
4.0 mm of clinical attachment loss were treated with a modied
surgical technique for the root coverage by CTG with EMD
(n = 45) and only EMD (n = 47). Vertical recession defect,
probing depth, clinical attachment level, dehiscence depth, the
keratinized gingiva and recession coverage were recorded before
surgery and at 1, 2 and 6 years.
Results: The average pre-surgical recession depths were 4.4 mm
(1.3) (EMD + CTG) vs. 3.2 mm (1.1) (EMD). Both
treatment modalities led to a signicant decrease in recession and
to an attachment gain. Mean root coverage 1-year postoperatively
was 92.7% (EMD + CTG) vs. 96.3% (EMD) and 2-year
postoperatively was 92.1% vs. 94.3% as well as 6-year
postoperatively was 88.4% vs. 85.7%.
Conclusion: The results of this study demonstrate that the applied
modied surgical techniques are safe without any postoperative
complications and predictable with better clinical outcomes at the
donor and recipient sites.

determine whether correlations exist between dierent gingivitis

parameters in distinctive populations.
Methods: Three populations were selected depending on the oral
hygiene level of the participants (excellent vs. modest). Population
A (excellent) consisted of 39 dental students, B (modest) of 38
participants from a local population, and C was a mixed
population (A + B, n = 77). During the experimental gingivitis
study the participants rinsed with either a placebo or 0.2%
chlorhexidine (CHX). After 21 days, Gingival Index (GI),
Modied Gingival Index (MGI), Bleeding on Probing (BOP),
gingival crevicular uid (GCF), and colony forming units (CFU)
were assessed. The association between the parameters was tested
using the Pearson correlation coecients.
Results: Statistically signicant correlations were observed
between GI and MGI in all groups and populations. GI and
BOP as well as MGI and BOP correlated in group C. GI and GCF
correlated only in group A after rinsing with CHX as did MGI and
GCF. No correlations were found between GI and CFU.
Conclusion: Gingival Index and MGI are the most reliable
parameters regardless of the composition of the study
population. For the use of BOP during experimental gingivitis,
however, a mixed population is preferred.
Supported by GABA International AG.

226
Evaluation of a non-staining chlorhexidine mouthwash.
A short-term clinical trial

228
Effects of co-administration of azithromycin during
periodontal treatment for early onset periodontitis

A. Crea*, L. Dassatti, A. Giacinti and G. Deli

Catholic University, Rome, Italy

T. Fujii*, P-L. Wang, P. Baehni and S. Shirai et al.

Health Sciences University, Matsumoto University, University of Geneva

Background: Chlorhexidine (CHX) is known for its antiseptic and

antiplaque properties in the treatment on periodontal diseases. It
induces stain formation on tooth surfaces as local side-eect. Aim
of the present study was to evaluate the potential reduction of
staining formation of a mouthwash containing CHX and Anti
Discoloration System (ADS), in non-surgical periodontal therapy.
Materials and methods: Sixty patients in general good health
conditions and suering from moderate chronic i were enrolled.
Full Mouth Bleeding Score (FMBS), Full Mouth Plaque Score
(FMPS) and Full Mouth Staining Score (FMSS) were registered at
baseline. All subjects received oral hygiene instructions and
underwent scaling and root planing in 24 appointments. All the
patients were randomly divided into two groups, test and control,
and were prescribed to rinse for 1 min twice a day for three weeks
with 0.2% CHX mouthwash respectively containing and noncontaining an Anti Discoloration System. FMBS, FMPS and FMSS
were again registered after 21 days and compared to baseline data.
Results: At the term of the analysis, CHX with and without ADS
system showed similar eectiveness in term of inammation
inhibition (FMBS reduction) and antiplaque property (FMPS).
FMSS was statistically less in test group compared with control
group.
Conclusion: The CHX + ADS seemed to be more eective in
inhibiting stain formation on tooth surfaces than CHX alone,
maintaining similar antiseptic activity.

Purpose: We examined the clinical usefulness of azithromycin

(AZM) that is potentially eective in eliminating biolm during
basic periodontal therapy in patients with early onset periodontitis
(EOP).
Materials and methods: Five patients were clinically diagnosed as
having EOP, and gave consent to participate in co-administration
of AZM were recruited in the study. AZM was administered
(500 mg/day, three days) during the period of basic periodontal
therapy. Tests were conducted at presentation and also at the
completion of basic therapy, and the changes were compared and
analysed. The test items were; (i) periodontal pocket (PD); (ii)
bleeding on probing (BOP) and (iii) pathological periodontal
pocket rate proportion of periodontal pockets of 4 mm or above
(PoR).
Results and Conclusion: Co-administration of AZM signicantly
(P < 0.05) increased the improvement rates of PD, BOP and PoR.
Signicant improvement of clinical symptoms was observed within
a short treatment period. Multiple regression analysis conrmed
signicant improvement of PD and BOP by AZM
co-administration, but the improvement of PoR did not reach
statistical signicance. These results probably reect improvement
of gingival swelling as a result of regression of inammation, and
suggest the necessity of approaching deep pockets such as
infrabony pockets. These results indicate that co-administration
of AZM augments the therapeutic eects of basic periodontal
therapy on EOP patients.

227
Reliability of clinical and paraclinical parameters in
different study populations during an experimental
gingivitis study
K. Lorenz*, G. Bruhn, M. Brecxm and C. Heumann et al.
University of Dresden, University of Munich, Germany
Objectives: In designing a CCT to assess the ecacy of oral
antiseptics the selection of parameters and participants is a basic
principle. The aim of this experimental gingivitis study was to

229
The effect of coronally advanced flap and allogenic
acellular dermal matrix with and without enamel
matrix proteins on gingival recession defects
R. Poorabbas*, E. Kosarieh and F. Motaghian
Faculty of Dentistry, Tabriz Medical Science University, Tabriz, Iran
Aims: This study was aimed to compare the clinical outcomes of
root coverage procedures, using a Coronally Advanced Flap

109

Posters: Periodontal therapy

(CAF) in combination with Acellular Dermal Matrix (ADM) with
and without the application of Enamel Matrix Derivatives (EMD).
Material and methods: A total of 22 recession defects (Cl I or II
Miller) in eight patients were selected and randomly allocated to
test and control groups. In the test group a combination of CAF,
ADM and EMD was used whilst the control defects were treated
only by CAF and ADM. Recession depth (RD), recession width
(RW), width of keratinized tissue (KT), clinical attachment level
(CAL) and the position of muccogingival junction (MGJ) were
measured at the base line, 2 and 4 months after the treatments. The
data were analysed by student t-test and one-way anova.
Results: Both of the treatments led to a signicant root coverage in
the recession sites (P < 0.001). However there was no signicant
dierence in any of the parameters between the study groups. Two
months after the surgeries, mean root coverage for
CAF + ADM + EMD and CAF + ADM was 82.75 22%
and 88.89 22% respectively. However 4 months after surgery,
these values were changed to 80.89 22% and 90.00 21%
respectively.
Conclusion: Using EMD does not improve the clinical ecacy of
CAF + ADM in root coverage. However, histological studies
recommended to reveal any benet that may arise by application of
EMD in combination with ADM and CAF in this procedures.

Aim: To investigate the analgesic ecacy and tolerability of

ibuprofen arginine in patients with periodontitis during and after
professional dental hygiene.
Methods: In this randomized, triple-blind, placebo-controlled,
parallel-group trial, 64 patients with chronic periodontitis
received either 800 mg ibuprofen arginine or placebo 30 min
before treatment. Numeric pain and electronic visual analog scales
ranging from 0 to 100 were employed.
Results: Average pain levels during treatment were lower following
ibuprofen arginine (quartiles: 0.5, 4.5, 11) compared to placebo (4,
16, 26), corresponding to a percentage reduction in median pain of
72% (P = 0.023). The median maximum pain was 28
(interquartile range 1050) following placebo and 10 (431)
following ibuprofen arginine (P = 0.065).
Conclusions: In patients with mild to moderate chronic
periodontitis, ibuprofen arginine was safe and superior to
placebo for alleviating pain during non-surgical periodontal
treatment. Its painless administration and rapid onset of action
make it well suitable for pain management in a general dental
oce.

232
The application of photodynamic therapy in the
periodontology
230
Vertical strip gingival graft: a new technique for
gingival augmentation, a pilot study
A. A. Khoshkhoonejad* and S. A. Miremadi
Tehran University, Tehran, Iran
There are numerous methods for widening keratinized attached
gingiva. This study is to present Vertical Strip Gingival Graft
Technique
as an attempt to improve methods of gingival
augmentation. After bed preparation of 12 patients with no
attached gingiva more than 0.5 mm, free gingival graft was divided
in two pieces and each part was xed in one end of the bed. In this
method, an area between two grafts was remained uncovered.
Clinical Parameters were measured before surgery, 6 and 12 weeks
after operation. Results showed signicant increase in the width of
attached gingiva (P < 0.01). The mean distance of stent to
mucogingival line between baseline and six weeks data; and
baseline and 12 weeks also showed signicant changes
(P = 0.001). With respect to the limitation of this study, by
application of this technique wider recipient site with less donor
tissue can gain keratinized coverage.

231
Ibuprofen arginine (SPEDIFEN) for pain control during
scaling & root planning a randomized, triple-blind,
placebo-controlled, parallel-group trial
D. A. Ettlin*, A. Ettlin and K. Bless et al.
Clinic for Masticatory Disorders, Zurich, CH
Background: Fear of pain often keeps patients from complying
with a periodontal maintenance program. Anti-inammatory
agents have proven eective for alleviating postsurgical dental
pain, but clinical trials testing their ecacy for managing pain
associated with non-surgical periodontal treatment are lacking.

110

J. Fanghnel*, M. Rothenburg and T. Kocher et al.

School of Dentistry, University of Greifswald, Germany
The goal of this double-blind randomized trial was to examine
whether the Photodynamic Therapy (PDT) leads to a clinical
healing, which is comparable with the mechanical root debridement in patients with persistent periodontal pockets in the
supportive periodontal therapy (SPT).
Methods: Sixty-seven chronic periodontitis patients, who were
enrolled at least 1 year in SPT and with at least three teeth with
probing depth (PD) 5 mm, were randomized in two treatment
groups. One group (29) has been treated with ultrasonic device
(US) and the other group (25) with PDT. We measured the probing
depth (PD), loss of attachment and the bleeding on probing (BOP)
on teeth with periodontal at six sites with an electronic probe. The
samples in the PDT-group were lased with PDT agent 0.5 min per
site. The activation of the agent was carried out by application of
photo sensor in the pocket. The control teeth were debrided with
US.
Results: Both treatment methods were successful in reduction of
pocket depth from 5.27 mm to 4.49 mm by using US (P < 0.001)
and from 5.33 mm to 4.73 mm by using PDT respectively
(P < 0.001) for the baseline pockets >4 mm. There were no
statistically signicant dierences between both groups in the
reduction of the PD for baseline pockets >4 mm (P = 0.203), for
all pockets (P = 0.717), nor for attachment loss of baseline
pockets >4 mm (P = 0.517) or for all pockets (P = 0.627).
Hence, PDT may oer a meaningful alterative treatment approach
for conventional root surface debridement.

233
Reconstruction of periodontal defects using a
bovine-derived xenograft
C. Tietmann* and F. Brseler
Praxis fr Parodontologie, Aachen, Germany
Initial Background: For a long time the gold standard in GTR of
severe periodontal defects has been a two-step procedure using

Posters: Periodontal therapy

titanium reinforced membranes. Biodegradable barriers had been
only used for small defects. The presentation describes a series of
more than 900 regeneratively treated periodontal defects.
Materials and Methods: A bovine-derived xenograft has been used
for defect reconstruction in combination with a collagen membrane
or autogenous tissues alone for coverage depending on the defect
morphology. In a retrospective study more than 900 regeneratively
treated infrabony defects had been followed-up. One, 2 and 3 years
postoperative data (PPD, CAL-gain, tooth mobility) have been
surveyed.
Results: The overview of a 5-year period between 2000 and 2005
demonstrates that a successful outcome revealing PPD reduction,
CAL gain and reduction of tooth mobility can be achieved in more
than 96%.
Conclusion: A one-stage procedure using a xenograft provides the
advantage of avoiding surgical intervention in any donor sites for
the patients comfort depending on the defect morphology, less
recession and esthetic predictability. It can be shown that a onestage procedure using deproteinized bovine derived xenograft is an
option to get predictable long-term results in the treatment of
severe periodontal defects following the guidelines of the surgical
protocol.

Aim: Aim of the present study was to investigate the eects of

Periochip as an adjunct to mechanical treatment of chronic
periodontitis.
Materials and methods: Fifty chronic periodontitis patients were
randomized in two groups. The test group (n = 25) received
scaling-root planning and adjunctive Periochip in four pockets
>5 mm. The control group (n = 25) received scaling-root
planning only. Clinical indices (PD, CAL, BOP and PI) were
assessed at bsl, 3 and 6 months after completion of treatment.
Subgingival samples from preselected pockets were analysed at bsl,
3 weeks, 3 and 6 months after treatment for presence and levels of
10 bacterial species using DNA-DNA checkerboard

hybridization.
Results: Data were analysed with both the patient and the site as
the observational unit (MannWhitney and Wilcoxon tests,
P 0.05). Both treatments resulted in improvement of clinical
indices and non statistically signicant dierences were observed
between the two groups at any timepoint. No major dierences
were observed between the two groups concerning levels of key
periodontal pathogens.
Discussion/conclusion: Data from the present study suggest that
Periochip as an adjunctive treatment does not enhance clinical
and microbiological eects of scaling-root planning at the initial
treatment phase of chronic periodontitis patients.

234
Adjunctive effect of a systemic biphosphonate in
non-surgical therapy of advanced generalized
chronic periodontitis: a randomized clinical trial
F. Graziani*,1, S. Cei1 and A. Guerrero2
1
University of Pisa, Pisa, Italy; 2Private Practice, Malaga, Spain
Aim of the study was to assess the adjunctive clinical eect of
systemic neridronate in non-surgical treatment (PT) of advanced
generalized chronic periodontitis (GCP). Sixty GCP patients were
randomly assigned to two treatment groups. Thirty subjects in test
group (TG) received PT with adjunctive neridronate (12.5 i.m. per
week/3 months). Control group (CG) received PT only. Clinical
parameters were evaluated by a calibrated masked examiner at
baseline and 3-months and a masked therapist performed PT.
Groups were balanced at baseline and all clinical parameters
improved at 3 months in both groups. None of the patients in the
TG showed oral necrotic lesions. No dierences were noted in
terms of bleeding score between the groups (P = 0.933). In
moderate pockets (46 mm) no dierences were noticed between
groups (95%CI: -0.40.2; P = 0.646). In deep pockets (7 mm),
PPD reduction was 3.0 mm (2.43.4) in CG and 2.7 mm (2.03.4)
in TG ()0.51.2; P = 0.414). Mean clinical attachment level
(CAL) gain in PPD 7 mm was 2.8 (2.23.4) in CG and 2.2 (1.5
2.9) in TG ()0.31.4; P = 0.210). CAL gains 2 mm at 25% of
sites in test patients compared with 19% in placebo (P = 0.25).
PPD reductions 2 mm were observed in 25% of sites in TG and
24% in CG. A total of 76% of pockets with PPD 5 mm at
baseline were 4 mm at 6 months in TG. This compared with 70%
in the CG (P = 0.4). Adjunctive use of systemic neridronate did
not result in additional improvements of periodontal clinical
conditions in GCP patients, 3 months after PT.

235
The effect of locally delivered chlorhexidine
(PERIOCHIP) on chronic periodontitis patients
I. Ioannidis*, M. Antoniadou and D. Sakellari et al.
Aristotle University of Thessaloniki, Thessaloniki, Greece
Background: The impact of locally delivered chlorhexidine on
clinical and microbiological parameters of chronic periodontitis
requires further documentation.

236
Effect of full-mouth disinfection in the treatment of
drug-induced gingival overgrowth
J. Krieger*, D. Krigar, P. Eickholz and B. Dannewitz
University of Heidelberg, Heidelberg, Germany, University of Frankfurt,
Frankfurt, Germany
Aim: Retrospective evaluation of the clinical eect of non-surgical
periodontal therapy according the concept of full-mouth
disinfection (FMD) in patients with drug-induced gingival
overgrowth (GO).
Material and Method: Ten patients (seven female, 3273 years of
age) medicated with cyclosporine and/or calcium channel blocker
received oral hygiene instruction, professional tooth cleaning
followed by scaling and root planning of all four quadrants
within 24 h. Patients rinsed with 0.12% CHX solution and brushed
with 1% CHX gel for the next 2 weeks. The clinical situation was
re-evaluated approximately 4 months after FMD. After
completion of FMD eight patients were assigned to supportive
periodontal therapy (SPT) and monitored for a mean of
24 months. Plaque control record (PCR), gingival bleeding index
(GBI), pocket depth (PD) were recorded at baseline, re-evaluation
and the last SPT visit. PD sites were stratied as follows: 4 mm,
56 mm and 7 mm.
Results: The number of sites with PD 4 mm was increased
signicantly after FMD (56.597.4%). Concomitantly sites with
56 mm and 7 mm decreased in the same interval (27.12.2%,
16.40.4% respectively). PCR and GBI also declined
signicantly compared to baseline. All clinical variables
remained stable over SPT. Further surgical therapy was
required only in one case.
Conclusions: FMD and regular SPT were eective in resolving
inammation and reducing the need for surgical treatment in
patients with drug-induced GO.

111

Posters: Periodontal therapy

237
Increasing the effectiveness of periodontal supportive
therapy by chlorhexidine or hydrogen-peroxide gel
applied in night guard splints
A. Mukics*, L. Pt, V. Tth
1
University of P
cs School of Dentistry, Hungary
Introduction: The aim of the supportive therapy is to maintain
long-term benecial periodontal therapeutic eects. The
maintenance of high-level of oral hygiene requires a highly
motivated patient. In cases of decreased patient collaboration the
use of local chemical plaque control can still have an adjuvant
eect. The nature of the chemical agents, the patients compliance,
the cost and the time span of the treatment without side eects are
all subjects that need to be considered.
Materials and methods: Changes in plaque and gingival indices
were followed at non-smoking patients, who were enrolled in
periodontal supportive therapy after scaling and root planning
(SRP) treatment. Patients were divided into three groups of ten. In
Group I SRP was followed with no adjuvant therapy. In Groups II
and III 1% chlorhexidine or a 3% hydrogen-peroxide gel was given
in a custom made foil-based plastic night guard splint. Night
guards were in function for 30 min once a day for 21 consecutive
days. Dierences between the treatment results were analysed using
the Wilcoxon signed-rank test.
Results: In Groups II and III the plaque and gingival indices
signicantly decreased after 3 weeks but not at the Group I.
Discussion: These antiseptic agents applied in the foil-based plastic
night guard splint could be used eectively in gingivitis and plaque
control during the short-term supportive therapy.

238
A dental ultrasonic scaler augmented with a smart
surface recognition feature in vivo application
G. Meissner*, B. Oehme, J. Strackeljan and T. Kocher
University of Greifswald, University of Magdeburg, Germany
Background: We recently introduced a surface detection system
based on a conventional dental ultrasonic scaler designed to
discriminate cementum and dental calculus, which is the
prerequisite for complete and thorough calculus removal. After
successful in vitro testing, the results of the rst in vivo application
will be presented in this study.
Methods: The root surfaces of 63 periodontally involved teeth
were systematically scanned with the detection scaler in vivo. All
positions of the supragingival portion of the insert and the
corresponding results of the detection system were synchronously
saved as separate video or data stream les on a computer disk.
After extraction, size and prevalence of calculus of all scanned
root surfaces were evaluated and the instruments tip was
repositioned onto the then extracted teeth for detection
accuracy evaluation.
Results: The calculus surface prevalence of 22.3% corresponded to
43 individual regions, out of which 39 were correctly classied.
According to the mean size of the calculus spots, the non-calculus
surface was virtually assorted to 152 individual regions
, out of
which 123 were correctly classied. Thus, calculus and cementum
were discriminated with a sensitivity of 90% and a specicity of
80%.
Conclusion: We show the possibility to classify subgingival calculus
under in vivo conditions with a smart dental piezoceramic scaler.
This device may help to nd the optimal time point to stop scaling
during a treatment procedure.

112

239
Factors for tooth loss in periodontal treated patients
(long-term results 10 years after periodontal therapy)
B. Pretzl* and P. Eickholz
Section of Periodontology, Heidelberg, Section of Periodontology,
Frankfurt, Germany
Objectives: Assessment of factors contributing to tooth loss
10 years after initiation of periodontal treatment.
Methods: Ninety-three adult patients were recruited for the study.
Inclusion criteria were full-mouth radiographs from beginning of
therapy and completion of anti-infective therapy. Clinical
examinations including probing parameters, Plaque and Gingival
Index, samples for interleukin-1 haplotype (IL-1) test, and a
detailed questionnaire on e.g. smoking habits were obtained by the
same examiner. Periodontal conditions were surveyed according to
the criteria of the Swiss Dental Association. Medical les were
searched for initial diagnosis, frequent supportive periodontal
therapy (SPT) and prognosis index.
Results: The following means of tooth loss per patient within
the 10 years of observation were observed: gender (male/
female): 1.5 3.5/1.7 3.9; smoking (no/yes): 1.1 1.8/3.1
6.5; prognosis (A/B, C): 1.4 2.4/2.7 4.9; initial diagnosis
(moderate/severe chronic, aggressive periodontitis): 0.6 1.4/
2.0 4.2; regular maintenance (yes/no): 0.45 0.8/3.1 5.1;
IL-1 (no/yes): 0.95 4.7/2.1 1.3. Stepwise linear regression
analysis identied irregular SPT and IL-1 haplotype to be
associated with an increased rate of tooth loss (P < 0.005).
Conclusions: Some criteria seem to interact with tooth loss whereas
only regular SPT and absence of IL-1 haplotype could be proven to
be statistically signicant in prevention of tooth loss.

240
Adjunctive low-dose doxycycline in severe chronic
periodontitis: effect on clinical parameters and
crevicular fluid transforming growth factor-b1
A. Grkan1, G. Emingil1, S. Cinarcik*,1 and A. Berdeli2
1
School of Dentistry, 2School of Medicine, Ege University, Turkey
Objectives: Present study evaluated the eect of adjunctive
low-dose doxycycline (LDD) on clinical parameters and
gingival crevicular uid (GCF) transforming growth factorbeta1 (TGF-b1) levels in severe chronic periodontitis over
12-month period.
Methods: Thirty-ve patients with severe periodontitis and 11
healthy subjects were included. Following rst session of nonsurgical therapy at baseline patients randomized to take either
LDD bid or placebo bid for 3 months. Recording of probing depth
(PD), clinical attachment level, papilla bleeding index and plaque
index and GCF sampling were performed at baseline, 3, 6, 9 and
12 months. TGF-b1 was analysed by ELISA. Signicant changes
over time and between groups were assessed by Friedman,
Wilcoxon and MannWhitney tests.
Results: Thirteen patients in both groups completed the trial.
Clinical parameters signicantly improved following both
therapies (P < 0.01). Adjunctive LDD was more eective in
reducing PD of initially deep pockets (7 mm) by 3 mm at 6 and
9 months and by 4 mm at 6 months than adjunctive placebo
(P < 0.05). Sites with moderate PD (46 mm) at baseline had
lower PD in LDD group at 9-month compared to placebo group
(P < 0.05). GCF TGF-b1 levels of LDD group was signicantly
higher than baseline (P < 0.01) and placebo group (P < 0.017)
at 3 months.

Posters: Periodontal therapy

Conclusion: These data ensures further data for benecial eects of
non-surgical therapy supplemented with LDD in the long-term
management of severe chronic periodontitis.

241
Reliability of plaque and gingivitis parameters in
different study populations an experimental gingivitis
study
G. Bruhn*, K. Lorenz and Th. Hoffmann et al.
University of Technology, Dresden, Germany
Objectives: Several indices are recognized as reliable for scoring
plaque and gingivitis during evaluation of antiplaque procedures.
The aim of this study was to determine whether correlations exist
between plaque parameters as well as between plaque- and
gingivitis-parameters in distinctive populations.
Methods: Three study populations were selected depending on the
oral hygiene level of the participants. Pop. A (excellent) consisted
of 39 dental students; B (modest) of 38 participants from a local
population and C was a mixed pop. (A + B). During a 21-day
experimental gingivitis study using parallel group design the
participants rinsed with either a placebo or 0.2% chlorhexidine
(CHX). After 21 days, two dierent plaque indices (PlI, QHI) were
evaluated. Furthermore the Gingival Index by Loe (GI), and the
Mod.Gingival Index by Lobene (MGI) were assessed. For
statistical analysis the Pearson correlation coecient was used.
Results: Statistical signicant correlations were observed between
PlI and QHI in all groups and populations. A correlation between
plaque indices and gingivitis parameters was only shown for
population A, and for the CHX-groups in population B and C.
Conclusions: For assessment of plaque accumulation PlI and QHI
are the most reliable parameters regardless of the composition of
the study population. For associations between plaque
accumulation and inammation, population with excellent oral
hygiene are advisable.

242
Use of platelet-rich plasma in periodontal surgery
a prospective randomised double blind clinical trial
J. Meyle, I. Kurtulus* and J. Gonzales et al.
Department of Periodontology, University of Giessen, Giessen,
Germany
Platelet rich plasma (PRP) has been used in the treatment of
intrabony defects. Studies have examined the signicance of purephase b-tricalcium phosphate (b-TCP) as bone substitute material
with good results. The aim of this prospective controlled randomized trial was to evaluate the eect of PRP in bone regeneration.
Twenty-two patients with periodontitis showing contralateral
intrabony defects were included. Defects were randomized to
b-TCP (Cerasorb) in combination with PRP (test) or alone
(control). PPD, CAL, and relative attachment level (RAL) were
assessed before and after surgery. Defect dimensions were recorded
at surgery and during re-entry at 6 months, with the vertical depth
of the defect as primary outcome variable. An early healing index
(EHI) was assessed 3 days, 1, 2 and 4 weeks after surgery. Both
treatments led to clinical improvements. The median reductions of
PPD and CAL at test sites were 0.8 mm and 0.28 mm, and at
control sites 0.4 mm and 0.13 mm, respectively. The median
reduction of open vertical depth was 1.9 mm (interquartile
intervals: 0.75 mm, 2.5 mm) at test sites, compared with 2.6 mm
(1.8 mm, 3.5 mm) at control sites. The EHI showed a reduction

from grade 3 after 3 days to grade 1 after 4 weeks. No signicant

dierences between test and control sites were found (P = 0.8,
Wilcoxon). PRP + TCP had no additional eect. b-TCP (Cerasorb) is a satisfactory graft material in periodontal surgery even
without PRP.
Acknowledgement: This study was supported by curasan AG,
Germany.

243
Impact of non-surgical periodontal treatment on oral
malodor in a Turkish children population with gingival
inflammation
C. Kara*, A. Tezel, R. Orbak, N. Beldz and H. Yagiz
Atatrk University, Erzurum, Turkey
Oral malodor aects a large proportion of population and may
cause a signicant social or psychological handicap to those
suering from it. Oral malodor has a positive correlation with the
accumulation of bacterial plaque in the oral cavity. The aim of the
present study was to two hold; rstly to determine whether oral
malodor and periodontal disease parameters are associated with
one another in 150 Turk subjects (mean age 9.1 2.7; ages
ranging from 7 to 12); secondly to investigate the impacts of nonsurgical periodontal treatment on oral malodor. Parameters
measured included whole mouth odor judge scoring, Halimeter,
saliva pH scores, gingival index, plaque index and probing depth
before and after the treatment procedures. Odor judge scores were
signicantly associated with Halimeter. However, gingival index,
plaque index, probing depth was signicantly associated with odor
judge scores or Halimeter scores. The statistical analysis revealed
that periodontal treatments presented a signicant reduction
(P < 0.001) in VSC formation. Results suggest that in the
population studied, periodontal health and oral malodor are
associated with one another.

244
Ultrasonic vs. curette scaling in transcanine region: a
comparison of clinical and microbiological outcome
B. Simoncic*, K. Seme and E. Sodja
Simed, MF University, Ljubljana, Slovenia
Aim: This study evaluates the clinical and microbiological ndings
during mechanical scaling with ultrasonic scalers or hand curetts.
The eect of diode laser on periodontal microora was evaluated.
Methods: Voluntary 40 subjects where participated in this
randomised split-mouth designed study where one side was
treated with ultrasonic scaler (SG ultrasonic group) and the
other side with hand curette (CG curette group). Measurements
of PD, BOP, GI and PI at t = 0, 6 and 12 months were recorded.
Microbiological samples were taken at baseline, during the surgery
and 1 month after and were analysed by cultivation and molecular
micro-IDent assay (Hain Life science, Nehren, Germany).
Periodontal tissue was treated by the diode laser at half of all
periodontal open ap surgery.
Results: Clinical parameters of PD, BOP, GI and PI signicantly
decreased within both groups with no dierences comparing the
SG and CG. At baseline B. forsythus was detected in 93.3%,
P. gingivalis and T. denticola in 66.7%, A. actinomycetemcomitans
in 60% and P. intermedia in 33.3% of all patients. The presence of
pathogens were signicantly reduced in samples taken during
surgery as well as 1 month after. In addition the samples of sites
treated with diode laser show signicant reduction of pathogens
comparing to non laser treated sites.

113

Posters: Periodontal therapy

Conclusions: The clinical and microbiological outcome of SG show
no signicant dierences compare to CG in transcanine region.

245
Evaluation of free gingival grafts for augmentation of
keratinized gingival
H. Varnica*, A. Bosnjak, K. Srdjak and D. Bozic
School of Dental Medicine, Zagreb, Croatia
Aim: Aim of this study was to assess free gingival graft (FGG) as
means for long-term augmentation of gingiva and possibly root
coverage in a specialized clinic setting.
Material and methods: Totally 71 teeth in 17 patients (15 female,
two male, mean age 27.1 7.5 years) were treated by means of
FGG during a three-year specialist training. All patients had
gingival recession (GR) on at least one tooth, were non-smokers,
otherwise healthy, with good oral hygiene, all of them signing
written consent. Measured parameters included: initial gingival
recession (iGR), postoperative (pGR), initial width of keratinized
gingiva (iKG), postoperative width of keratinized gingiva (pKG),
and thickness of FGG. Since all FGGs were placed in areas
previously included in mucosal tissue, the initial thickness of
keratinized gingiva was considered zero. Operating resident
performed all preoperative measurements, while residents not
aware of investigations, during recall session, recorded
postoperative values.
Results: Mean iGR was 2.49 1.41 (range 06 mm), mean iKG
was 2.35 0.85 mm (range 05 mm). Statistical analysis included
Pearsons correlation and Spearman correlation coecient (/),
which was for GR 0,72 (P < 0.01), and for KG 0,33 (P < 0.01).
There was statistically signicant reduction of GR, as well as
augmentation of KG.
Conclusion: FGG is a predictable, simple procedure for
augmentation of keratinized gingiva with long-standing results,
and, in a smaller extent, for root coverage.

246
Comparison of new and 3-month-old brush heads for
plaque removal using a powered toothbrush
L. Hogan*, C. Daly and B. Curtis
Sydney Dental, WestmeadHosps, University of Sydney, Sydney,
Australia
Background: It is recommended that powered toothbrush (PTB)
heads should be replaced every 3 months.
Aim: Compare eectiveness of new and 3-month-old brush heads
in plaque removal using a counter rotational PTB and assess eect
of bristle wear on plaque removal.
Method: Single examiner blind, randomized study in which 33
adults attended the clinic on two occasions following 48 h periods
of no oral hygiene. Following plaque scoring, subjects brushed for
2 min with a new brush head at one visit and a brush they had used
for 3 month at the other visit (random allocation). Plaque was
re-scored and percent reductions in plaque scores calculated.
Bristle wear of the 3-month-old brushes was determined by
measuring brush surface areas (BSA).
Results: Mean plaque score (SD)% reductions with new brush
heads were not signicantly dierent from those achieved with the
3-month-old brushes for total plaque (new = 37.6 18.2;
3-month-old = 36.7 18.8); (P = 0.8, Paired t-test) and
proximal
plaque
(new = 30.9 19.2;
3-monthold = 0.5 18.9) (P = 0.9). BSA ranged from 0135% (mean
26.9%; SD 31.4%). Compared with new brushes in the same
subjects, no signicant dierences were found for plaque score
reductions for 3-month-old brushes with minor (BSA 010%,

114

n = 14, P = 0.74), moderate (BSA 1140%, n = 11, P = 0.57)

or marked wear (BSA 41135%, n = 8, P = 0.14).
Conclusion: Conter rotational PTBs with 3-month-old brush
heads exhibiting various degrees of wear were as eective as new
brushes in plaque removal. (NSW Dental Board Grant).

247
Treatment of mandibular class II furcations with
enamel matrix proteins and bone grafts
Ibrahimoglu*, Kuru, Noyan, Ipci, Yilmaz
Yeditepe Un, Marmara Un, IST, Turkiye
The aim of this study was to evaluate the clinical and radiographic
outcome of combined application of enamel matrix proteins
(EMD) with bovine derived xenograft (BDX)(EMD + BDX) or
bioactive glass (BG)(EMD + BG) in mandibular Class II furcations. Fourteen chronic periodontitis patients presenting a total of
44 buccal mandibular Class II furcation involvements were
included in this split mouth study. Prior to surgery and at
10 months plaque and sulcus bleeding indices, probing depth (PD),
marginal soft tissue, relative attachment, probing and radiographic
bone levels in vertical direction were measured. Probing bone level
was also measured in horizontal direction. Both treatment modalities resulted in statistically signicant clinical improvements,
with no signicant dierences between the groups. Considering the
vertical
measurements,
in
the
EMD + BDX
group
2.71 0.32 mm of PD reduction, 2.19 0.26 mm of attachment
gain, 0.39 0.99 mm of recession were obtained whereas in the
EMD + BG group 2.58 0.45 mm of PD reduction,
2.05 0.34 mm of attachment gain, 0.32 0.97 mm of recession
were found. The mean vertical clinical and radiographic bone gain
was 1.70 0.65 mm and 1.66 0.48 mm in the EMD + BDX
group whereas in the EMD + BG group, these values were
1.95 0.36 mm and 1.48 0.40 mm respectively. The mean
horizontal bone gain was 3.78 0.46 mm and 3.76 0.42 mm
in the EMD + BDX and EMD + BG groups respectively. Both
combination therapies resulted in similar promising improvements.

248
Effect of periodontal treatment on clinical symptoms of
Behet's disease
C. Akyol*, A. Boyvat, C. A. Grgan and H. S. Bostanci
Ankara University, Ankara, Turkey
Objective: Recurrent painful oral ulceration in the mouth of a
Behcets disease (BD) is a major restriction upon regular oral
hygiene habits. It was reported that plaque, bleeding and
periodontal indices were found higher in active Behcets disease
patients compared to the control group. The aim of our study was
to evaluate the eect of alterations in the periodontal status of BD
patients on the clinical symptoms of BD with and without
periodontal treatment.
Materials and methods: The study material was consisted of 29
periodontally treated and 31 untreated BD patients. The plaque
(PI), bleeding on probing (BOP), probing depth (PD) and clinical
attachment levels (CAL) values, and the frequency of occurrence
and the healing time of oral ulcers before and 3 months after
periodontal treatment were recorded. The dierences between the
groups were tested by using t-test and Wilcoxon Signed Rank tests.
Results: The mean values for the frequency of occurrence of oral
ulcer at the beginning and 3 months after for treated and untreated
groups were 7.42 7.5 and 7 7.89, and 7.93 5.81 and
4.1 3.44, respectively (P < 0.01). The mean values for the
healing time for treated and untreated groups were 6.26 4.22
and 6.75 4.18, and 7.06 2.96 and 5.58 2.64, respectively
(P < 0.001).

Posters: Periodontal therapy

Conclusion: Within the limits of our study, signicant contribution
of the periodontal treatment on the frequency of occurrence and
healing time of oral ulcer was observed in BD patients.

249
Autogenous cortical bone particles and enamel matrix
derivative in the treatment of deep intraosseous
defects: a 12-month case series
L. Guida1, M. Annunziata*,1, R. Farina2 and L. Trombelli2
1
Second University, Naples, Italy; 2University of Ferrara, Ferrara, Italy
The aim of the present study was to investigate the eectiveness of
a regenerative procedure based on supracrestal soft tissue preservation in association with combined autogenous cortical bone
particles (ACBP)/enamel matrix derivative (EMD) application in
the treatment of non-self supporting periodontal intraosseous
defects. Thirteen consecutively-treated patients, seven females and
six males, aged 3065 years, two smokers, were included. A total of
14 deep, 12 wall intraosseous defects were selected. Pocket
probing depth (PPD), clinical attachment level (CAL), and gingival
recession (REC), at baseline and 12 months after surgery, were
recorded. PPD amounted to 9.1 1.6 mm before surgery, and
decreased to 4.0 1.4 mm post-surgery (PPD reduction: 5.1
1.7 mm, P < 0.0000). CAL varied from 10.3 1.5 mm presurgery to 5.4 1.7 mm post-surgery, with a CAL gain of
4.9 1.8 mm (P < 0.0000). REC shifted from 1.1 0.9 mm at
baseline to 1.4 1.1 mm after surgery, REC change being
0.3 0.8 mm (P > 0.05). Our results supported the eectiveness
of a regenerative procedure based on supracrestal soft tissue
preservation combined with ACBP/EMD in clinically and statistically improving soft tissue conditions of non-self supporting
periodontal intraosseous defects.

250
Free gingival grafting and gingival margin over 7 years
D. Groselj, K. Rener-Sitar and A. Razem*
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Aims: (i) To assess whether the areas with small amounts of
attached gingiva are more prone to gingival recession and loss of
clinical attachment level (CAL) than areas with gingival grafting to
increase the width of attached gingival and (ii) whether gingival
grafting prevents recession and loss of CAL.
Patients and methods: Twenty females and six males, mean age
33 years at baseline (BL), with midvestibular singular or multiple
gingival recessions in the mandible had undergone 28 free gingival
grafting from palatal donor sites to increase the width of attached
gingiva. A group treated by gingival grafts consisted of 98 teeth at
BL and 35 teeth after 7 years. A control group was composed of 35
teeth at BL and also 7 years later. Using periodontal probe we
assessed the following parameters: probing depth (PD), CAL,
gingival margin regarding cementoenamel junction, width of
keratinized gingiva and bleeding on probing (BOP). The
statistical analysis of dierences in each parameter between the
7 years and BL was performed using Wilcoxon signed-rank test
and for BOP using McNemars test.
Results/Conclusion: We found out: (i) statistically signicant gain
of CAL and reduction of recession on test group (P < 0.05); (ii)
signicant reduction of PD (P < 0.05) and non signicant BOP on
both groups. The areas with small amount of attached gingiva
seems to be more prone to gingival recession in spite of non
signicant change of CAL.

251
Effect of adjunctive local or systemic metronidazole on
mmp-8 and timp-1 levels in gingival crevice fluid in
chronic periodontitis patients
_
L. Kuru*, . Noyan, B. Kuru, G. akar, S. Ipi
and S Ylmaz
Marmara University, Yeditepe University, Istanbul, Turkey
The aim of this study was to evaluate the eects of initial
periodontal treatment combined with local/systemic use of metronidazole on clinical parameters and gingival crevice uid (GCF)
levels of matrix metalloproteinase-8 (MMP-8) and tissue inhibitor
of metalloproteinase-1 (TIMP-1) in chronic periodontitis patients.
Out of 30 subjects, 10 received scaling and root planning (SRP), 10
adjunctive local metronidazole (SRP + LM) at 0 to 7 days and 10
adjunctive systemic metronidazole for 10 days (SRP + SM).
Plaque index (PI), sulcus bleeding index (SBI), probing depth
(PD) and relative attachment level (RAL) were recorded, GCF
samples were collected before and 49 days after treatments. MMP8 and TIMP-1 were assessed by enzyme linked immunosorbent
assay. Signicant improvements in PI, SBI, PD were observed in all
groups (P < 0.01), only SRP + LM group showed signicant
attachment gain (P < 0.05). The dierence in attachment gain
between the SRP and SRP + LM groups was signicant
(P < 0.05). Marked decrease in MMP-8 level and increase in
TIMP-1 level were detected in all groups while the SRP-LM group
only showed a signicant change in the TIMP-1 (P < 0.05). The
results indicate that initial periodontal treatment with and without
use of local/systemic metronidazole improved clinical parameters
and GCF levels of MMP-8 and TIMP-1 in chronic periodontitis
patients. Furthermore, local administration of metronidazole may
have an additional eect on attachment gain and TIMP-1 level
change.

252
Surgical and non-surgical treatment of periodontal
diseases: two modalities of treatment
S. de Loureno*, P. Obeid, W. D'Hoore and P. Bercy
Department of Periodontology, UCL University, Brussels, Belgium
Aim: A clinical trial was performed to compare the outcomes of
non surgical and surgical therapies in subjects with a recurrent
periodontal disease.
Material and methods: As basic therapy, 32 patients included in
this trial had previously been treated by a non surgical root
planning (RP). At active therapy, remaining inammatory pockets
were treated by a split mouth design and each quadrant was
randomly assigned to one of both therapies: surgical modied
Widman ap (SU) and RP. After active therapy all subjects were
provided with supportive periodontal therapy (SPT) every
3 months, for 2 years. The clinical parameters evaluated were:
reduction in probing pockets depth (rPPD) with an electronic
Florida probe, gain in clinical attachment level (gCAL), bleeding
on probing index EASTMAN (BoPI) and plaque index OLeary
(PI).
Results: Both therapies were found eective for the treatment of
periodontitis in deep (7 mm) and moderate pockets (56 mm); in
smokers (S), formerly smokers (FS) and non smokers (NS). At
deep pockets, SU seemed to be more eective than RP in terms of
gCAL and rPPD. At moderate pockets, gCAL seemed to be more
eective with RP. The S group showed less marked results. The FS
and NS groups showed the same results. PI and BoPI were
signicantly reduced with both therapies.
Conclusion: Both SU and RP therapies seem to be eective
methods for the treatment of recurrent periodontitis. In the
treatment of deep pockets, SU therapy resulted in greater rPPD
and gCAL.

115

Posters: Periodontal therapy

253
Does emdogain improve the result of coronally
advanced flap in the treatment of multiple gingival
recessions? a prospective split mouth study
L. Cordaro, V. Mirisola*, F. Torsello and C. Rossini
Department of Periodontics, Eastman Dental Hospital, Roma, Italy
Background: The eectiveness of coronally advanced ap (CAF) in
the treatment of gingival recessions has been largely demonstrated
in literature. Some studies have already tested the use of
Emdogain (EMD) in combination with various surgical
techniques for achieving root coverage.
Objectives: The aim of this study was to assess the ecacy of EMD
in improving the results of CAF in the treatment of multiple
gingival recessions.
Methods: This intra-individual test has been performed on 10
patients that presented at least two bilateral and comparable
recession-type defects (Miller Class I and II) aecting adjacent
teeth. Surgical root coverage was performed as a bilateral
simultaneous CAF procedure, with the adjunct of EMD for the
test site and without EMD in the control site, in accordance with
the randomization procedure. Clinical parameters were recorded at
baseline and 6 months after surgery by a blinded examiner and
included: recession length and width, keratinized tissue, probing
depth and papilla height.
Results: At the 6 months evaluation, according to follow-up data
available for eight of 10 cases, the test group showed better results
in term of recession length reduction and tissue appearance. Both
treatment procedures displayed good results with signicant root
coverage gain (7080%).
Conclusions: According to these data, the use of EMD seems to
improve the ecacy of the CAF procedure for root coverage in
multiple recession treatment.

255
Evaluation of the benefits of using a power toothbrush
during initial phase of periodontal therapy
P. Gugerli*, G. Secci and A. Mombelli
School of Dental Medicine, University of Geneva, Geneva, Switzerland
Background: Studies evaluating the ecacy of oral hygiene
procedures typically focus on either prevention, or maintenance
after periodontal therapy. Little is known about the specic benet
of a power toothbrush during therapy.
Objective: To evaluate the clinical ecacy of power as compared
to manual toothbrushing in patients undergoing the initial phase of
periodontal therapy.
Materials and methods: This was an examiner masked, randomized
two-arm parallel study involving 70 adults (age 2381), with
untreated periodontitis. After an initial supragingival debridement,
subjects were assigned to tooth brushing with either a manual (M)
or a power toothbrush (P). Subjects returned after 7, 14 (D14) and
28 (D28) days.
Results: In the subjects of group P the mean Plaque Index (PlI) was
signicantly lower at D28 than in those of group M (P: 0.23, M:
0.41, P = 0.006). These subjects also had a signicantly lower
mean number of sites remaining with a PlI > 1 (D14: P: 3.9, M:
11.3, P=0.018; D28: P: 5.8, M: 13.4, P = 0.005), and a
signicantly lower mean BOP (D14: P: 0.29, M: 0.38, P = 0.017;
D28: P: 0.30, M: 0.37, P = 0.034). Dierences in the mean
Gingival Index, the number of sites with a GI > 1, mean recession,
mean pocket probing depth and the number of pockets >4 mm
were not signicant.
Conclusion: Subjects using a power toothbrush during initial
treatment reduced supragingival plaque to lower levels than
subjects using a manual brush.
Acknowledgement: Supported by Oral-B Laboratories.

254
Local periodontal therapy with subgingival controlled
release of chlorhexidine microbiological effects
L. Harnack*, J. Gonzales and J. Meyle et al.
Department of Periodontology, Department of Microbiology, University
of Giessen, Giessen, Germany
Studies on controlled release of chlorhexidine (PerioChip) in
periodontal pockets have shown an eect on microbiota before
treatment. The aim of this randomized, prospective, doubleblinded, placebo-controlled study was to analyse the eect of the
local periodontal therapy with the adjunctive use of PerioChip on
microbiota before, during and after active treatment. 24 adults with
severe chronic periodontitis (12 teeth with PPD 5 mm) were
randomized in two groups (n = 12). After a prophylaxis phase, in
the test group (PC) PerioChips and in the control group (PL)
placebo chips were inserted in pockets with PPD 5 mm. After
10 days, SRP was done and new chips were placed. Plaque samples
were taken from the deepest pocket of each quadrant at baseline
(T0), before SRP (T1a) and 1 month after SRP (T2). Bacterial
counts of A. a., P. g., P. i., T. f. and T. d. were assessed by
RT-PCR. In the PC group, a reduction of bacterial counts of T. f.
and T. d. was found between T0 and T1a (mean: 1.4 105 bacteria/
10 ll for T. f. and 7.3 103 for T. d.). In the PL group, an increase
of T. f. and T. d. was found for the same time (mean: 2.1 105 for
T. f. and 7.4 103 for T. d.). The dierence between groups was
signicant (P < 0.01, U test, a level: P < 0.05). Similar results
were shown for T. d. between T0 and T2 (P < 0.02). These results
demonstrate that PerioChip reduces periodontal pathogens
before and after subgingival mechanical treatment.
Acknowledgement: This
study
was
supported
by
DEXCELPHARMA, GmbH, Germany.

116

256
Success of tunnel preparations in molars with class III
furcation involvement
J. Kaltschmitt*,1, M. Radek1, B. Dannewitz1 and P. Eickholz2
1
University of Heidelberg, Heidelberg, Germany; 2University of
Frankfurt am Main, Frankfurt, Germany
Objective: Retrospective evaluation of success after tunnel
preparation of class III furcation molars.
Methods: In 41 patients (29 female, mean age 54.8 10.8 years)
tunnel preparations were rendered to a total of 56 molars from
19922000. Before and 113 years after therapy examinations took
place. A multilevel regression analysis was used to identify factors
inuencing the survival time of tunnel preparations: sex, jaw
(maxilla/mandible), molar type (1st/2nd molar), smoking,
participation in supportive periodontal therapy (SPT).
Results: Six tunnel preparations were performed in the maxilla, 50
in the mandible. Forty tunnel preparations were done at 1st, 15 at
2nd, and 1 at 3rd molars. Eight tunnel preparations were lost
during the observation period: seven in the mandible. For the lost
tunnel preparations a mean survival time of 40.8 18.6 months
was observed. For those tunnel preparations that were still in
function a mean survival time of 53.1 22.9 months was
calculated. Multilevel regression analysis identied frequent SPT
as positive (P = 0.08) and smoking (P = 0.08) as negative
prognostic factors for tunnel survival.
Conclusion: After an observation period of 50.7 22.6 months 48
of 56 tunnel preparations were still in function (86%).

Posters: Periodontal therapy

257
Adjunctive systemic amoxicillin and metronidazole
with scaling and root planning for treatment of severe
chronic periodontitis
A. Moeintaghavi*, M. Talebi, A. Haerian and H. Zandi
Mashhad University, Mashhad, Iran; Yazd University, Yazd, Iran
Objectives: The aim was to study the eect of systemic
metronidazole and amoxicillin as an adjunct to mechanical
therapy in patients with chronic periodontitis.
Methods: Altogether 50 adult patients with untreated periodontitis
were randomly assigned to receive full-mouth scaling and root
planning with systemic metronidazole plus amoxicillin (T-group)
or scaling and root planning with placebo (P-group). Clinical
measurements including probing depth (PD), clinical attachment
level (CAL), plaque index (PI) and bleeding index (BI) were taken
at baseline and 6 to 8 weeks after therapy. The deepest pocket was
selected for microbiological testing. Patients received coded study
medication of either 500 mg amoxicillin in combination with
250 mg metronidazole or similar appearance placebo, every 8 h for
the following 7 days.
Results: There was a signicant change in PD, CAL, PI and BI in
the T-group as compared to the P-group after therapy. Parallel to
the clinical changes, treatment reduced the number of A. a, P. g
and P. i compared with baseline in the T-group. This reduction was
signicant, but in P-group only p. i colony count reduced
signicantly. After therapy there was a signicant dierence
between the T-and P-group in the number of patients negative
for A. a, P. g and P. i.
Conclusions: The signicant dierences between T-and P-groups
support the considerable adjunctive benets to SRP of amoxicillin
and metronidazole combined in the treatment of chronic
periodontitis.

258
Repeated subgingival scaling versus combined
subgingival scaling/surgery in young adults with
generalized advanced periodontitis a prospective
study
J. Knig*, C. Schwahn and J. Fanghnel et al.
Department of Periodontology, University of Greifswald, Greifswald,
Germany
Objective: Current literature supports a concept of non-surgical/
antibiotic periodontal therapy. Our prospective split-mouth study
compared the clinical results of surgery vs. repeated subgingival
scaling without antibiotics in 3040 years old adults with
generalized advanced periodontitis.
Material and method: Twenty-six patients (37 3 years) were
treated: Initial exam (1), subgingival scaling, baseline exam (2),
randomly assigned 2nd subgingival scaling (control) and periodontal
surgery (test), nal exam (3) 6 months p. o.. Mean pocket depth (PD)
and attachment level (AL) were analysed (SUDAAN).
Results: PD decreased from 4.1 0.2 mm (1) to 3.1 0.1 mm
(2) and 2.9 0.1 mm (3) for control and from 4.5 0.2 mm (1)
to 3.5 0.1 mm (2) and 3.1 0.1 mm (3) for test sites. The
decrease 13 was highly sign. (P < 0.001) for both therapies, PD
reduction 23 only sign. (P = 0.001) for test sites with a sign.
(P = 0.010) dierence between test and control. AL increased
0.2 0.1 mm (2) plus 0.3 0.1 mm (3) for control, and
0.2 0.1 mm (2) plus 0.2 0.1 mm (3) for test sites. Total
AL-gain was signicant for control (P = 0.008) and test (0.012).
AL-gain 23 was only sign. (P = 0.022) for control sites with no
signicant. dierence between both therapies.
Conclusion: Both treatments reduced PD, gained AL. A 2nd
subgingival scaling did not further reduce PD but gain AL.

Changes in PD, AL are in line with results for patients with

generalized chronic periodontitis and dont support a general use
of antibiotics.

259
Root surface assessment after treatment with two
ultrasonic micro inserts: topographic features
S. Cohere*, Guerin, Leray, Cathelineau and G. Gagnot
Umr Cnrs, 6511 Rennes University, France
Aim: Comparison of eects on the root surface of two micro insert
designs, one curette shape (MIC: H4* R and L) the other with a
round section (MIR: TK2 R and L* 5)., (Satelec Bordeaux,
France).
Methods: Forty single human rooted teeth were treated in vivo on
their proximal surfaces by the same clinician, the same generator at
low power using the two inserts. The choice of the insert was
randomized. After extraction the teeth were prepared and observed
with SEM. Secondary electron was used to qualify the cementum
topography. On four areas on each surface the appearance of
scratches, alterations, and the cementum appearance (smooth,
altered, crackled or dappled) were scored from 0 (no sign) to 3.
Results: A total of 320 zones were analysed by statistical
generalized model (GENMOD). When MIC were used, all the
surfaces appear smoother than when MIR were used. Using MIC,
cervical zones appear smoother, less dappled and less crackled than
in apical (P < 0.05) when on distal we have observed more
alterations. No signicant dierences were observed with MIR.
Conclusion: The dierent micro inserts were eective in the
treatment of the root surfaces. Few scratches and alterations
appear after ultrasonic debridement. Generally, the surface appears
smoother in cervical when treated with MIC. The dierences noted
on distal and apical reveals that the MIC needs to be use by a
trained clinician. This study must be combined with the previous
studies, which has shown MIC less aggressive than Gracey.

260
Clinical and microbiological evaluation of effectivity of
a 0.12% chlorehexidine toothpaste
F. Chiarelli, F. Faraco, W. Sendyk and A. Feitosa* et al.
Unisa, Ufes, Usp, Brazil
Chlorhexidine has been known as an eective antimicrobial agent
to inhibit supragingival dental biolm formation. The purpose of
this study is to evaluate the eects of a 0.12% chlorhexidine
toothpaste on plaque control, gingival inammation and microbial
composition of supragingival biolm. Eighteen consenting volunteers were divided into two groups (test and control) and used the
toothpastes containing chlorhexidine 0.12%, stannous uoride and
a placebo with stannous uoride only, for 4-week period. Measures
of Plaque and Gingival Index, clinical attachment level, clinical
probing depth and supragingival plaque samples were collected on
days 0, 7, 14 and 21. Polymerase Chain Reaction (PCR) will be
used to identify the bacterium periodontopathogen: Porphyromonas
gingivalis. Our results demonstrated signicant statistical associations between Gingival bleeding Index and the test toothpaste, and
the positivity of the P.gingivalis with gingival bleeding.

261
Bacterial interference in periodontal therapy: a proof of
principle?
W. Teughels*, A. D. Haffajee, M. Pauwels et al.
KUL, Belgium;Forsyth Institute, US;UG, The Netherlands;UCLA, US
Aims: The level by which periodontopathogens are re-established
subgingivally after root planning is correlated with clinical

117

Posters: Implant therapy

improvement and the risk for relapse. Because of the importance of
the establishment of a benecial subgingival microbiota, the aim of
his study was to assess quantitative changes in the subgingival
microora after root planning when benecial bacteria were
applied adjunctively.
Methods: Streptococcus mitis, S. sanguinis and S. salivarius were
selected on their ability to interfere with adhesion of
periodontopathogens in in vitro studies. These species were
applied after root planning adjunctively in a split mouth beagle
dog model. Clinical and microbiological parameters (culture,
checkerboard hybridization) were monitored during 12 weeks.
Results: Bacterial culturing revealed that adjunctive application of
benecial bacteria after root planning resulted in a signicant lower
recolonization rate of anaerobic bacteria, Porphyromonas
gingivalis and Prevotella intermedia. The checkerboard analysis
conrmed an interference with subgingival recolonization. The
interference appeared to be benecial strain, pathogen and
frequency of application depended.
Conclusions: This study gives a prove of principle for the
hypothesis that a subgingival application of benecial species
after mechanical debridement can prolong the benecial microbial
shift towards a less pathogenic microbiota.
Acknowledgement: Supported by NIDCR grant 1 R21 DE015360
01.

262
The effect of a mouthwash containing extracts of
Calendula officinalis on plaque and gingivitis
S. Yusoff* and S. Kamin
Dental Division, MOH, Dental Faculty, University of Malaya, Malaysia
Aims: To evaluate eects of mouthwash (mw) containing extracts
of Calendula ofcinalis (Plandula) on prevention of dental plaque
formation & subsequent development of gingivitis in young adults.
Materials and Methods: Test product; herbal mw containing
0.64% Calendula ofcinalis in 2.56% Plandula mw. Clinical trial;
placebo controlled, double blind, crossover design, consisting of
two 14-day test periods, separated by 4 weeks washout period.
Participants continued on regular non-supervised, self-performed
oral hygiene measures, without ossing. Rinsed with 15 ml mw
twice daily for 30 s after brushing. On day1, new toothbrush &
toothpaste provided. 34 screened subjects aged 1923 years
randomly assigned into two groups. Gp1 started with placebo
(distilled water) for 2 weeks followed by 4 weeks washout period &
switched to Plandula for 2 weeks. Gp2 started with Plandula.
Scores recorded at baseline & after 2 weeks: Plaque Index (PI)

(Silness & Loe, 1964) records presence/absence of plaque,

Gingival Index (GI) (Loe & Silness, 1963) determines presence/
absence of gingival bleeding. Full mouth prophylaxis carried out
after each measurement.
Results: On plaque; statistically signicant PI score dierence in
means of 23.9% compared to placebo. On gingivitis; statistically
signicant reduction of 62.3% in mean GI scores compared to
placebo.
Conclusions: Plandula might have potential of inhibiting plaque
accumulation & eective in reducing gingivitis, seemed more
eective in reducing gingivitis.

263
Comparison of ten instruments for subgingival removal
of artificial calculus
P. Schmage*, Y. Schultz, U. Platzer and I. Nergiz
Operative Dentistry, University of Hamburg, Hamburg, Germany
This in vitro study evaluated the cleaning ecacies of four
ultrasonic and two sonic tips, two rotating instruments, the
Vector and the manual curette at dierent areas of the root. The
roots of 50 molars were totally covered with articial calculus.
Teeth were xed in silicone in order to imitate periodontal
pockets. All roots were cleaned (maximum 5 min) with each of
the following instruments (n = 5): DesmoClean, PerioSet, CavitronJet, PiezonMaster, SonicFlex with smooth (SFS)/diamond
tips (SFD), SuprassonP-Max with smooth (SMS)/ diamond tips
(SMD), VectorSystem and GraceyCurettes. Photographs were
taken before and after cleaning from 4 sides. The remaining
calculus in relation to the respective surface area was determined.
Statistical analysis was carried out (anova, Bonferroni,
P < 0.05). Cleaning ecacies for buccal or oral surfaces were
found to be approx. 80% for PM and SFS, 70% for DC, CJ,
SFD, SMS, SMD, GC and 50% for PS and VS. Signicant
dierences (P < 0.05) were obtained between PS and GC, DC,
CJ, PM, SFS, SFD as well as between VS-PM and VS-SFS. The
ecacies for approximal surfaces amounted to between approximately 80% for PM and 50% for PS and VS and did not dier
signicantly from GC (70%). Signicantly more calculus
remained using PS compared to DC, PM, SFS, SFD and
using VS compared to PM (P < 0.01). Regardless of their
working methods, most instruments achieved about 70% ecacy,
except for PS and VS. Furthermore, their ecacies were not sitespecic.

Posters: Implant therapy

1
Hyaluronic acid in peri-implant maintenance of
immediate function implants. A comparative study with
chlorhexidine
M. Nobre* and N. Cintra
Mal Clinic; Lisbon, Portugal
Background: The maintenance phase of the prosthetic
rehabilitations with immediate function implants, assumes a role
as important as the surgical phase, representing a main factor

118

inuencing the success rate. The aim of this prospective clinical

trial was to compare the survival and healing of immediate
function implants, inside a maintenance protocol using hialuronic
acid (HA) and chlorhexidine (CHX) gels.
Materials and Methods: Thirty patients, with four immediate
function implants (All-on-Four concept) placed in the mandible
(total of 120 implants), were included in two groups (HA and CHX)
using only these two chemicals in their daily implant self-care. Both
groups were followed for 4 months, with clinical observations on
the 10th day, 2 months and 4 months post-surgically.

Posters: Implant therapy

Results: The implant survival rate at 4 months was 100% in both
groups. The HA and the CHX produced good results on the
maintenance of complete rehabilitations of the edentulous
mandible with immediate function implants. Statistically
signicant dierences were found in favour of the HA group in
the Modied bleeding index on the 2nd observation (P = 0.003).
The dierence was located mainly in the axial implants placed in
the 5th sextant (P = 0.05).
Discussion/Conclusion: The ndings point out that the importance
of the maintenance protocol in implantology, and that both
chemicals are valid tools for implant maintenance.

2
The question of implant-crown relation
L. Gallardo-Lop z*, D. Gonzales-H and H.G. Steveling
University of Heidelberg, Heidelberg, Germany
Introduction: Traditional standard protocols have to be considered
especially in cases of periodontal-compromised situations. The
purpose of this article is to report the outcome and verify the
possible negative consequences on long-term-result, with special
focus on bone loss or loss of implant in cases of divergent protocols
(the length of the crown should not be longer than the length of the
implant).
Material and method: Twelve patients (4180 years) received 80
Astra Tech implants (4.5 and 3.5 diameter; 811 length) The
patient were followed up 28 years following the prosteric
restoration.(length of the crown > length of the implant).
Results: During the observation period of 28 years after
prosthetic restoration no signicant bone resortion could be
recorded. No implant was lost during the observation period no
inammation surrounding the soft tissue was found.
Discussion: We considered that the Conical Seal Desing brings
increased mechanical strength to the implant-abutment interface,
the stress at this point is signicantly reduced.
Conclusions: If we want bone to be retained although a
compromised situation exist, dental implants should have an
intimate relationship between bone loading and bone structure
(biological-biomechanical-stimulation) as example in case of
ASTRA TECH implant system (Conical Seal Desing and the
Micro Thead). The protocol regarding crown-implant relation
should be redened according to this criteria.

3
Three years clinical experience with the new direct
abutment
L. Gallardo-Lop z*, A. Arab Oghli and H.G. Steveling
Catholic University, Honduras
Purpose: This study reports the clinical and radiographs result,
following the use of the commercially pre-prepared Direct
Abutment of the Astra Tech implant system.
Material and Method: Twenty patient with one or more missing
teeth received a total of 60 Astra Tech 4.5 and 3.5 diameter.
Implant were placed according to the recommended surgical
protocol of the manufacturer. After haling period, the abutment
were connected (using a force of 15 Ncm) followed by the standard
impression, registration, and laboratory techniques for a
ceramometal or allceramic restaurations. Radiographs were taken
using a long cone technique on crown cementation and annually
thereafter. Pateint were followed up every 6 months to determine
clinical stability of the crown and the tissue health.
Result: After 3 years, the success rate was 100%. No Implants had
been lost, and all restoration remained in function. We found no
detectable mobility of the restoration and no loosening or

fracturing of the abutment. Mean distance for the marginal bone

loss was 0.2 mm. Excellent soft tissue health was maintained
around all the implants.
Conclusion: The Direct Abutment of Astra Tech implants system
was simple to use and there were no complications. The
rectorative and laboratory procedure time and cost was
reduced of to 40%. All patient were satised with the esthetic
outcome.

4
RANKL OPG concentration in crevicular fluid of
patients with and without peri-implantitis
G. Monov*, G. Strbac, G. Watzek and R. Gruber et al.
MD DDS
Peri-implantitis is associated with progressive bone resorption that
may lead to implant failure. Receptor activator of NF-kappaB
ligand (RANKL) is a member of the TNF-superfamily required for
the formation, activation, and survival of osteoclasts. A functional
relationship between RANKL expression and peri-implant bone
resorption was therefore reasonable to suggest. Here we determined the concentration of soluble RANKL, not bound to its
antagonist osteoprotegerin, in crevicular uid of dental implants.
Thirteen patients with symptoms of peri-implantitis and ten
patients with fully osseointegrated implants were included in the
study. In eight patients with peri-implantitis and seven patients
with osseointegrated implants, soluble RANKL was detectable by
immunoassay, with a calculated mean value of 288 nM and
427 nM in the crevicular uid, respectively. Concentration of
soluble RANKL did not correlate with the clinical parameters
probing depth, bleeding index, and plaque index. These results
indicate that peak concentrations of soluble RANKL in crevicular
uid of osseointegrated implants are similar to those observed in
peri-implantitis. Local concentration of soluble RANKL may
therefore not solely account responsible for progressive bone
resorption in peri-implantitis.

5
A clinical study of the peri-implantitis in a long term
maintenance after implantation
A. Iida*, N. Imamura, R. Suda and H. Miyashita
Department of Periodontology, Showa University, Tokyo, Japan
Recently, oral implants were evaluated functionally and esthetically as clinical value for oral denture. Still, there are only a few
study on the maintenance therapy after treatment. The aim of this
study was to evaluate the conditions of peri-implantitis in long
terms maintenance. We analysed 93 patients (mean age 48.5 years
old, total 455 implants) who have being treated therapy over
3 years. This program started from 1990 to 2004. The patients
were regularly measured pocket depth (PD) around implants in
four sites about third month. 192 implants (42.2%) were
diagnosed peri-implantitis. There was a large number of the
deepest pocket of implant in medial and distal side. In the other
hand, most shallow pockets were in buccal side. According to
these peri-implantitis possibility been within 4.3 years (SD = 2.9),
and at that moment PD was 5.05 mm (SD = 1.80 mm). The
means PD and starting PD of peri-implantitis were signicantly
greater than healthy surrounding implant tissue. There were many
peri-implantitis in maxilla than mandibular, and no signicantly
dierence between incisor and moler. In conclusion, the results
showed that the establishment of peri-implantitis has high
possibility about 4 years after implantation and the prevalent
was higher in maxilla.

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Posters: Implant therapy

6
Tactile sensibility of single tooth implants, a clinical,
single-blinded, randomised, split-mouth study
N. Enkling, S. Heussner*, R. Mericske-Stern and K.-H. Utz
University of Bonn, University of Bern, Germany
In the present study the active tactile sensibility of a single-tooth
implant was compared with the remaining natural tooth of the
contralateral side. The experiment was performed with anaesthesia of the antagonistic natural teeth on both sides. The aim of
the study was to get more information about the neurophysiological mechanisms of osseoperzeption and the meaning of
periodontal mechanoreceptors for oral tactile sensibility. Testing
the 50% values of tactile sensibility and the equivalence from
implant and tooth represented the primary endpoint
of the
study. The results showed a mean tactile sensibility of
16 9 lm for the pairs of natural teeth (controls) and
20 11 lm for the implant region; the intraindividual dierence
was 3.5 7 lm. At thresholds of 8 lm, chosen according to
the thickness of the thinnest occlusal foil used which also is
8 lm, the statistical evaluation resulted in an equivalence of the
active tactile sensibility when comparing single-tooth implants
occluding against natural antagonists with the remaining natural
dentition (P < 0.01, Power > 80%). Comparing the results with
other publications, anaesthesia of the antagonists did not impair
the tactile sensibility of the implants. The periodontal receptors
of the antagonistic teeth do not have that important role for the
capacity of oral implants to transmit tactile sensibility. This
study conrms the theoretical considerations about osseoperception.

7
Short vs. long implants in augmented and nonaugmented mandibular and maxillary sites: a
systematic review of 22 prospective studies (11 222
implants)
B. Pommer*, G. Tepper, A. Marczell and G. Watzek
Department of Oral Surgery, University of Vienna, Vienna, Austria
Twenty-two prospective clinical trails including 11 multicenter
studies were systematically reviewed to evaluate the survival of
short and long implants in augmented and non-augmented
mandibular and maxillary sites. A total of 11 222 implants in
3647 patients were placed in 38 implant centers in 15 countries all
over Europe and the USA. Implants of six dierent manufactures
with ve dierent surfaces were followed up over a period of
5.3 4.7 years. Implant length reached from 5 to 20 mm. A total
of 83% of the implants were retained in original jawbone while the
remainder were placed in areas previously augmented using onlay
graft or sinus lift techniques. Implants placed in non-augmented
mandibular bone showed the highest success rate (98.7%),
followed by implants in the non-augmented anterior maxilla
(98.0%). A 97.6% success rate was calculated for implants in the
non-augmented posterior maxilla as well as in augmented mandibular bone. A signicantly lower implant survival rate was
recorded in augmented posterior (93.8%) and anterior (91.0%)
maxillary sites. In original jawbone short and long mandibular
implants showed similar survival rates, while a signicantly higher
failure rate of maxillary implants shorter than 8 mm could be
observed. In augmented sites mandibular implants shorter than
8 mm and maxillary implants shorter than 10 mm showed signicantly lower survival rates. It can be concluded that the survival
of short implants is impaired in the maxilla as well as in augmented
bone.

120

8
New protocol for implant surgery: low speed without
irrigation bone drilling: in vivo study concerning 40
implants
Y. Reingewirtz* et al. and N. Reingewirtz
Department of Periodontology, Dental Faculty of Strasbourg,
Strasbourg, France
In a previous in vitro study*, low heat elevation was shown after
cortical bone drilling, with a low drilling speed without irrigation.
The aim of this study is to evaluate this protocol in vivo in dental
implantology.
Material and methods: Forty implants (standard Straumann
implant, 4.1 mm) were set up for 15 patients (seven female,
eight male). Every type of bone was concerned: upper jaw, molar
area (5), premolar area (11), canine (3), incisive (4); lower jaw,
molar area (9), premolar (3). Every drilling step (predrilling, and
then 2.2, 2.8 and 3.5 mm diameter drills) was performed with low
speed (450 rpm) without irrigation. Standard X-rays were
performed after placement of the implants, and then after
6 months and 1-year visit check up.
Results: After an average time of 18 months of loading, osseous
integration following Albreksson success criterions (Int JOMI,
1986) was recorded for all implants. X-rays measurements did not
show either craterisation or abnormal osseous lost around
implants.
Conclusion: In the limit of this study, it can be concluded that
implant socket can be performed with success at low drilling speed
(450 rpm) without irrigation. This technical approach can provide
an easier legibility of the laser marks of the drills, especially in the
molar areas whose access is dicult; a step-by-step control of the
axe and depth of the drills, and the possibility of easily recovering
the whole part of the drilled bone.
*Reingewirtz et coll, Clin Oral Impl Res, 1997.

9
Clinical evaluation of br
nemark TI-unite implant and
ITI SLA implant in the post maxillary area with sinus
elevation technique
S. B. Hong, G. J. Chae, J. S. Lee, U. W. Jung and S. H. Choi* et al.
Department of Periodontology, Dental Hospital, Yonsei University,
Korea
Aim of this study was to evaluate the ecacy of Branemark
Ti-Unite implant system and ITI SLA implant system placed in the
atrophic posterior maxilla with sinus oor elevation procedure.
Eighty patients received placement of Branemark Ti-Unite
implants (195 implants) in their atrophic posterior Maxilla with
sinus oor elevation procedure (153 osteotome sinus oor elevation
technique and 42 window opening procedure). Fifty patients
received placement of ITI SLA implants (83 implants) in their
atrophic posterior Maxilla with sinus oor elevation procedure (77
osteotome sinus oor elevation technique and six window opening
procedure). Chart review were taken from each patient. The total
failed implants were seven and the total implant survival rate was
96.4% in Branemark Ti-Unite system. The total failed implants
were one and the total implant survival rate was 98.8% in ITI SLA
system. The implant survival rate with osteotome technique was
96% and 97.6% with window opening in Branemark Ti-Unite
system. The implant survival rate with osteotome technique was
98.7% and 100% with window opening. The implant survival rate
with osteotome technique was 96% and 97.6% with window
opening in ITI SLA system. The results of this evaluation show
that the placement of Branemark Ti-Unite system as well as ITI

Posters: Implant therapy

SLA system is a reasonable treatment option for patients with the
atrophic posterior maxillary area.

10
Treatment of peri-implantar gingivites in patients with
and without history of rheumatoid arthritis: a pilot study
F. Oliveira, M. Vale and E. Antunes
State University of Campinas, Brazil
Aim: The aim of this study was to treat peri-implantar gingivitis
(PIG) in patients with and without Rheumatoid Arthritis (RA) and
to analyse if there were dierences between them.
Material and Method: Eighteen patients were selected and divided
in two groups: Group (1): Ten patients with no history of RA (ve
men: age 55.1 10.92 and ve women: age 54.6 9.87) and
Group (2): eight patients (four men: age 58 and four woman: age
56.8). All had, at least, three implants unitary (Straumann) and one
or two sites with PIG. Patients of Group (2) were under medical
treatment, taking a non-steroid anti-inammatory COX-2
selective, and both groups were submitted to a prophylactic
scaling (monthly) and chlorhexidine gel (0.5%) topic, 1 x day,
during 6 months. All patients were examined 2, 4, 6 and 12 months
after study for evaluation of clinical parameters Plaque Index (PI)
and bleeding on probing (BoP). Qui-square and Fisher Exact tests
were used to analyse the statistical results between groups.
Results: The statistical analyse in 2 and 4 months showed similar
PI and BoP scores on both groups, however, there were dierences
statistically signicant between 4, 6 and 12 months on BoP
(P < 0.001) in Group 2.
Conclusion: The results shows that patients with RA need shorter
intervals between dental recalls for supportive therapy, moreover,
biolms upon prosthetic surfaces cause an inammation of periimplantar tissues due to an excessive production of proinammatory cytokines from subjacent connective tissue.

11
Radiographic changes in immediately restored dental
implants in periodontally susceptible patients, 2 year
results.
J. Horwitz, O. Zuabi* and E. Machtei
Department of Oral and Dent Med, Rambam Health Care Campus
Objectives: Radiographic bone changes (CB) of immediately
restored implants (R) was compared to non submerged non
restored (NR) and submerged implants (S).
Materials & Methods: Treated chronic periodontitis patients
received implant therapy. A provisional restoration was
immediately provided for R implants. The rest either received
healing abutments (NR) or were submerged, 2nd stage surgery
performed 6 months later and restored thereafter (S). Two year
radiographic bone level changes were compared between the three
groups. Results are reported between insertion, 6, 12 and
24 months expressed in mm as mean change SE.
Results: A total of 89 implants were inserted in 18 patients, of
which 41 in extraction sites. Thirteen implants failed and were
excluded from the analysis. Mean CB change was 0.845 0.092,
1.263 0.121, 1.47 0.122 and 0.113 0.083 between 06, 0
12, 024 and 1224 months, respectively. 06-month CB changes
of R and NR (0.957 0.12, 0.654 0.199 respectively) and 612month CB changes of S (0.792 0.13) were not signicantly
dierent (anova). 1224-month CB changes in R, S and NR
(0.188 0.132, 0.07 0.122 and 0.007 0.239 respectively)
were not dierent between groups (P = 0.7197). No dierence

was found between R and NR groups for BC in any of the time

intervals. No dierence was found between extraction and non
extraction sites either.
Conclusions: (i) BC of immediately restored implants do not dier
from non restored implants and (ii) BC of immediately restored
implants is within the literature range.

12
Results of cover screw loosening following surgical
placement of implants: a retrospective cohort study in a
private office setting.
S. S. Baloul*, T. J. Griffin, W. Cheung and H. Moroi
School of Dental Medicine, Tufts University, USA
The purpose was to assess the sequlae of implant cover screw
loosening (CSL) found at the second stage of implant surgery in a
private periodontal practice. The prevention and treatment of CSL,
and its clinical impact on implant placement will be discussed.
Methods: The study included total of 157 implants (115 TiUnite
and 42 Osseotite). All implants were placed by one investigator and
positioned ush with the crestal bone. Measurements were done on
digitized periapical radiographs taken at Stage II surgery prior to
placement of the healing abutment. Bone loss around implants
with both CSL and non-CSL on the mesial and distal aspects and
the distance of the microgap caused by CSL were measured. The
distortion factor was calculated to compensate for nonstandardized radiographs.
Results: The relationship between CSL and early implant exposure
was statistically signicant. The relationship between CSL and
radiographic crestal bone loss was statistically signicant. No
correlation found between the distance of microgap and crestal
bone loss. No signicant relationship between CSL and the
following: patients ability to wear prosthesis following Stage I,
age, gender, systemic diseases, bone augmentation, use of
membrane, implant conguration, implant diameter, and presurgical steroids.
Conclusions: The ndings of this study led to the recommendation
of increasing the post-operative visits to identify and treat CSL
and/or exposure to limit crestal bone loss.

13
Prosthetic complications in implant borne
reconstructions after an observation period of at least
40 months
A. De Boever*, K. Keersmaekers and G. Theuniers et al.
Private Practice, Belgium, University of Cologne, Germany, University
Gent, Belgium
Aim of the study: To evaluate the prevalence and type of
complications in xed implant borne reconstructions.
Material and Methods: In 105 patients, 172 FPDs (317 prosthetic
units) were made on 283 ITI implants (eighty crowns, 92 dierent
types of xed bridges). Mean evaluation time was
62.5 25.3 months. In 45 cases the reconstruction was screw
retained and in 127 cases cemented (Harvard or Improv).
Results: Complications occurred after a minimum period of
2 months and a maximum period of 100 months (mean:
35.9 21.4 months). Fifty-ve prosthetic interventions were
needed on 44 reconstructions (25%) of which 88% were in the
premolar and molar region. The lowest percentage occurred in
crowns (25%), the highest in 34 units FPDs (P < 0.048). Screw
retained reconstructions had signicantly more complications than
cemented (P < 0.001). More complications occurred in patients

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Posters: Implant therapy

with bruxing habits than in the non-bruxing group (P < 0.001). Of
the clinical interventions, 14% were classied as minor (e.g.
polishing), 71% as moderate (1060 min of chair time but no
laboratory costs), 14% as major interventions (more than 1 h chair
time and additional laboratory costs). Type and duration of
necessary interventions were not dierent between the bruxing and
non-bruxing group. Additional laboratory costs ranged from
28 Euro to 840 Euro.
Conclusion: Complication rate was 17% on the prosthetic unit
level, 25% on the reconstruction level.

was detectable by immunoassay, with a calculated mean value of

288 nM and 427 nM in the crevicular uid, respectively.
Concentration of soluble RANKL showed no correlation with
the clinical parameters probing depth, bleeding index, and plaque
index.
Conclusion: These results indicate that peak concentrations of
soluble RANKL in crevicular uid of osseointegrated implants are
similar to those observed in peri-implantitis. Local concentration
of soluble RANKL may therefore not solely account responsible
for progressive bone resorption in peri-implantitis.

14
Perforation of cover screws leads to irreversible
marginal bone loss

16
Evaluation of immediate loading success rate on
peri implant tissues in patients with posterior fixed
implant-supported prosthesis

N. Van Assche*, B. Collaert and M. Quirynen

Catholic University, Leuven, Belgium; Private practice, Leuven, Belgium
Background: Reports show that bone remodelling around onestage implants is similar to around two-stage implants, however an
unintentional soft tissue perforation above the cover screw of a
two-stage implant appears to cause an inammatory reaction
resulting in marginal bone destruction.
Aim: This study aimed to determine the consequence of early cover
screw exposure on marginal bone.
Materials and methods: Sixty AstraTech implants installed in
partially edentulous jaws were compared: 20 implants were placed
following a two-stage protocol but showed an early exposure, 20
implants were placed following a two-stage protocol and were
exposed after a normal subgingival healing time (36 months), and
20 implants were placed following a one-stage surgery. Digital
radiographs were taken at implant placement, and after abutment
surgery for the two-stage exposed and two-stage submerged group
or after 3 months for the one-stage group. Bone loss mesially and
distally was measured by an on screen cursor after calibration.
Results: Mean bone remodelling was 1.96 mm (range: 0.23.2 mm)
around two-stage exposed implants, 0.01 mm (range: 0.00.3 mm)
around two-stage submerged implants and 0.14 mm (range: 0.0
1.2 mm) around one-stage implants.
Discussion and conclusion: The unintentional perforation with twostage implants leads to signicant bone destruction, probably
caused by the creation of biological width. An intentional
perforation (one-stage) is acceptable because the ap design
respects the biological width.

15
Soluble rankl in crevicular fluid of dental implants
G. Monov*, G. Strbac, B. Kandler and Gruber PhD
Department of Oral Surgery, Vienna, Austria
Background: Peri-implantitis is associated with progressive bone
resorption that may lead to implant failure. Receptor activator of
NF-kappaB ligand (RANKL) is a local produced member of the
TNF-superfamily required for the formation, activation, and
survival of osteoclasts. A functional relationship between
RANKL expression and peri-implant bone resorption was
therefore reasonable to suggest.
Objective: Here we determined the concentration of soluble
RANKL, not bound to its antagonist osteoprotegerin, in
crevicular uid of dental implants.
Methods & Results: Thirteen patients with symptoms of periimplantitis and ten patients with fully osseointegrated implants
were included in the study. In eight patients with peri-implantitis
and seven patients with osseointegrated implants, soluble RANKL

122

M. E. Rahmani*, S. Rokni* and D. Jazebi

Dental Research Center, Mashhad, Iran
Introduction: The aim of this study was to evaluate the clinical
response and success rate of immediately loaded implants
compared with delay loaded implants.
Materials & Methods: Twelve patients were enrolled in this study.
A total of 28 Xive implants were placed in these patients and
randomly divided into two groups (14 implants in test group and
14 implants in control group). Test group implants were
immediately loaded within 24 h after surgical placement with an
temporary acrylic resin restoration. Control group implants were
left to heal submerged for 34 months and then were loaded with
FRC restorations. Implants were evaluated at the time of surgery
and every 2 months, considering the following parameters: Plaque
index, bleeding index, probing depth, mobility, pain and bone
resorption. Peri-implant bone resorption was evaluated on
periapical radiographs with standardized parallel technique.
Results: Survival rates in test and control groups were 87% and
100% respectively. No signicant statistical dierence was
observed between the two groups in PI and PD. No pain, BOP
or mobility was observed in all recalls. Mean bone resorption of
peri-implant bone height was 0.26 mm (0.32) in test group and
0.98 mm (0.59) in control group. The dierence was signicant
(P = 0.011).
Conclusion: Peri-implant bone resorption in immediate loading
implants was signicantly lower than that of delay loading ones.

17
Periodontal and peri-implant health in patients with
poor compliance
N. Bolukbasi*, S. Yesil, F. Beck and B. Leblebicioglu
Istanbul University, Istanbul, Turkey; The Ohio State University, Ohio,
OH, USA
Background: Compliance with maintenance program (MP) has
been reported as an important factor for periodontal health. The
purpose of this study was to determine changes observed in
periodontal and peri-implant parameters in a re-established MP for
patients with poor compliance.
Materials and Methods: Twenty-seven poor compliant patients (13
males, 14 females, 47 12 years old) and 95 implants (six single,
21 xed partial restorations, 2.4 1.6 years in function) were
included. Initial oral health was evaluated with modied Dental
Index.3 months rigid MP was applied for 1 year and gingival
health status was evaluated by using plaque index, gingival index
(GI), bleeding on probing (BOP), clinical attachment level (CAL)
and simplied oral hygiene index (sOHI). Periodontal (PS) and

Posters: Implant therapy

peri-implant sites (PIS) were compared by using Wilcoxon
matched-pairs and step-down Bonferroni method.
Results: Initial CAL was approximately 3 mm for both PIS and
PS, and remained stable. Plaque accumulation was statistically
lower at PIS compared to PS at each appointment (P < 0.05).
Although not signicant, BOP was higher at PIS compared to PS
and a slight improvement was observed in sOHI by last
appointment (P > 0.05). This did not aect GI values.
Conclusion: The results suggest that tissue response against plaque
accumulation may be dierent for PIS and PS. Also, despite a
re-established MP, changes observed in home care practice are
minimal in patients with poor compliance.

18
Alveolar ridge augmentation using collagen membrane
and DFDB in combination with PRP
S. Jankovic*, B. Dimitrijevic and M. Dordjevic
Periodontology Department, Faculty of Stomatology, Beograd
Background: The purpose of this study is to evaluate a surgical
procedure for vertical and horizontal alveolar-ridge reconstruction
in the maxilla using demineralized freeze-dried bone (DFDB) graft
mixed with platelet-rich plasma PRP associated with a collagen
membrane prior the implant placement.
Methods: A group of 30 single tooth missing patients, presenting
the need for vertical and horizontal bone augmentation of at least
3 mm, were treated before implant placement. For the period of
the rst surgery, in the group of 15 patients (experimental group),
DFDB graft was mixed with activated PRP and placed in wanted
position in the region of bone defect, covered with collagen
membrane secured with titanium pins. After 4 months, pins were
removed and 15 ITI implants were successfully placed. In the
Second group of 15 patients (control group) augmentation
procedure was preformed with DFDB only, prior 15 ITI implant
placement.
Results: The signicant bone level increase was reached in all
patients of experimental group. Bone augmentation achieved in
control group was on statistically lower level. Abutment
connection was obtained 3 months after implant placement.
Clinical parameters after prosthetic restoration, conrmed the
presence of a healthy peri-implant mucosa.
Conclusion: Surgical technique preformed in experimental group in
combination with ITI implant placement provides supreme
functional
and
aesthetics
outcomes
in
alveolar-ridge
augmentation and prosthetic rehabilitation.

19
Microflora formation around one-stage dental implants
a preliminary report
S. De Angelo*, P. Kumar, D. Tatakis and B. Leblebicioglu
The Ohio State University, Ohio, USA
Background: Limited information is available on initial bacterial
colonization of dental implants. This study aims to determine the
characteristics of newly forming microora around one-stage
implants.
Materials and Methods: Eleven periodontally healthy patients
(seven males, four females, 48 16 years old) needing single
implant were included. Exclusion criteria were antibiotic uptake
within 3 months or simultaneous guided bone regeneration.
Subgingival plaque samples were obtained around adjacent teeth
and implant prior to and at 2, 4, 8, 12 weeks post implant
placement. Polymerase chain reaction was used to detect specic
microorganisms. Clinical evaluation included probing depth,

bleeding on probing and, width and thickness of keratinized

gingiva.
Results: No early healing complications were noted. Fusobacterium
nucleatum was initially present in nine patients and continued to be
part of tooth ora during 12 weeks. Four patients had
Fusobacterium nucleatum around implant by week 2 and six by
week 12. Detection of Porphyromonas gingivalis, Provetella
intermedia, Tanerella forsythia and Treponema denticola was rare.
Bacteria were not detected in internal part of implant body.
Conclusion: The rate of specic bacterial growth around implants
is slower than around teeth. Further studies are necessary to better
establish the rationale for post-operative care of one-stage
implants.

20
Clinical parameters analyses in implants placed nearly
to retained roots
F. Oliveira, M. Vale and V. Dourado
School of Technology and Sciences, FTC, Brazil
Aim: The aim of this study was to evaluate clinical and
radiographic parameters on implants in function and positioned
adjacent to roots intentionally retained.
Materials and Methods: Eight patients were selected to receive
implants (Straumann Implants) in inferior molars with divergent
roots, which, at least, one root had extraction indication. After
3 months of healing period, the implants were placed (single-stage
surgical protocol in conjunction with controlled immediate
loading) on six patients and the clinical parameters (attachment
level and probing depth) were analysed at each 90 days, during
1 year, including instructions of oral hygiene and radiographs as
control. Nevertheless, in the other two patients the implants were
maintained submerged and radiographs were taken as control.
Results: All implants succeeded and during the whole study it was
not observed any kind of alterations on those clinical parameters
analysed, as well as any radiographic alteration on those implants
intentionally retained.
Conclusion: Implants placed nearly to roots intentionally retained
with their prosthesis showed similar aspects, attachment level and
probing depth, on mesial and distal sites.

21
Single tooth replacement in the aesthetic zone with
nobel perfect immediate placement and
provisionalization
M. Pinto*, M. Resende and E. Santiago
Periodontics Department, Faculty of Medicine, Dentria U. Porto,
Portugal
In the aesthetic zone maintaining the existant and providing
stability to the hard and soft tissue architecture of the failing tooth
may be important goals of implant therapy. The purpose of this
study was to evaluate some clinical outcomes of Nobel Perfect
dental implants placed in fresh extraction sockets with immediate
provisionalization.
Materials and methods: Six patients, 3558 years, were treated.
Implants were inserted in the extraction sites of upper incisors
using a method described by A. Rocci, J. Gottlow, with the
exceptions: (i) No attempt was made to ll the gaps between the
implant and the alveolae and (ii) The peak of the implant was not
always aligned towards the centre of the interproximal contact
areas. All implants were placed above the bone crest and received
straight abutments and temporary crowns immediately. Clinical

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Posters: Implant therapy

evaluation were made at implant placement and provisionalization
and 12 month later. The following variables were recorded:
implant success/failure, radiographic osseous change and
photographic gingival level.
Results: No implants were lost during the 12 months follow-up.
Most papilla lled the available interproximal space and minor
change at radiographic osseous and photographic gingival levels
were observed.
Discussions/Conclusions: This technique seems to allow excellent
clinical results. With the method there is freedom to avoid deeply
submerged implants and apparently demonstrate the potential for
preserving the existant osseous and the gingival architecture.

22
Fixation screws resistance to cuspid distalization
A. Torre, M. de la Rosa, D. Espinosa* and M. de la Rosa
Universidad Autnoma de Nuevo Len, M
xico
Mini-implants, miniplates and xation screws have been used as
alternatives for orthodontic anchorage. The purpose of this study
was to determine the resistance of xation screws to cuspid
distalization. Thirty 10 mm by 1.4 mm xation screws (Osseox,
3i) were placed in 15 patients with no periodontal disease referred
for orthodontic treatment. Each patient received two screws, one in
the maxilla and one in the mandible. A screw was placed 1 month
and the other 2 weeks before the application of forces. A Nance
button was used as control on the opposite maxilla. A force of
200 grams was applied weekly for a period of 4 months. Statistical
analysis was made with a one way of analysis variance (anova) and
a chi square test. At the end of the 4 months, nine screws were lost
due to plaque accumulation. All 10 screws placed 1 month before
distalization resisted the movement. Of the 11 screws placed
2 weeks before distalization, seven resisted the movement and four
did not (two in the mandible and two in the maxilla). No
dierences were found between test and control, or regarding time
of placement or whether screws were placed on cortical or
cancellous bone. The xation screws provide an excellent alternative method for orthodontic anchorage. They are cheaper and easy
to install and to remove. Although no statistical dierence was
found, based on the observations, it is recommended that the
orthodontic forces be applied 1 month after placement of the
screws.

23
Postmenopausal females, medication, osteoporosis and
implant integration first cases of a prospective
clinical study
A. Friedmann*, M. Friedrichs and D. Felsenberg et al.
Institute of Periodontology, CBMR, Charit
, Berlin
Data on Osseointegration of dental implants in osteoporotic
patients are missing and the inuence of oral Bisphosphonates (BP)
remains unknown. This prospective controlled clinical study tests
implant integration and function under load in mandibles of
postmenopausal osteoporotic (Tests) vs. age-matched healthy
females (Controls) and analyses possible morphological dierences
in bony structures by Micro-CT. Clinical parameters for plaque
(PI), bleeding (BoP), peri-implant crevicular uid (PCF), probing
depth (PD), and attachment level (AL) are obtained at 1 and
3 weeks and 3, 6, 9 months after implant installation. In the test
group either BP (Alendronate) or Placebo were randomly administered starting 1 month prior to implantation; in addition,
everybody in this group received Ca-VitD substitution. Bone
cores were obtained during implant surgery, undecalcied embedded and analysed (Micro-CT). Implant healing lasted for 3 months
before loading. This preliminary report presents two exemplary

124

cases (Test/Control). From the Tests the case with the lowest Bone/
Tissue Volume (BV/TV) ratio was chosen, from Controls the one
with the highest. Clinical parameters were related to Micro-CT
data. Despite approximately 50% dierence in BV/TV ratio
between Test and Control, an uneventful integration and stability
of implants were observed. Three months after insertion PCF value
was 44 (for Test) vs. 105 (for Control) Periotron-Units and AL was
at 3.5 vs. 3.75 mm, respectively.

24
Platelet rich plasma in regenerative treatment of
infrabony defects around immediate implants in the
anterior maxilla
Z. Berkman*, O. Tuncer, T. Subasioglu and A. Kantarci
University of Istanbul, Istanbul, Turkey; Boston University, Boston, USA
Platelet rich plasma (PRP) delivers enriched growth factors that
could enhance wound healing in intraoral bone defects.
Objective: The aim was to evaluate PRP-mediated bone
regeneration in immediate oral implantation in conjunction with
bone grafts.
Methods: Following extraction of teeth in anterior maxilla, 14
implants (Branemark, MK III TiUnite, 3.75) in seven patients
were immediately placed. The rst group received PRP with betatricalcium phosphate (b-TCP) while the second group was treated
with b-TCP alone. Guides were used as referral points to
standardize the measurements taken at baseline and after
9 months.
Results: All areas showed complete hard tissue ll and none of the
implants demonstrated any loss of stability. Bone grafts healed well
without any infection. Hard tissue ll was signicantly higher in
PRP + b-TCP group compared to graft alone (25%; P < 0.05).
The histological results showed that new bone was formed among
particles of b-TCP in both groups, but in PRP + b-TCP group,
new bone was denser and presented mature woven bone, more new
bone was formed into the micropores of the particles. In addition,
there were less b-TCP particles observed conned within new bone.
Conclusions: PRP signicantly enhances the clinical eects of the
bone graft in regenerative treatment of anterior peri-implant
defects leading to a denser and mature bone formation.
Acknowledgement: Supported by the Research Fund of Istanbul
University. Project No 1734/15082001.

25
Influence of various surface treatments on
reosseointegration around contaminated implants
A. Parlar*,1, B. nsal1, D. etiner1 and C. Hayta2 et al.
1
University of Gazi, Ankara, Turkey 2University of ukur, Adana, Turkey
The similarity of periodontitis and peri-implantitis demands for the
utilization of similar principles for the treatment. Dierent
decontamination methods were available cleaning of implant
surfaces contaminated with bacteria. The aim of the present
study was to evaluate the eects of various decontamination
methods on reosseointegration on contaminated implants. Six
mongrel dogs were used. The mandibular 1st molars and all
premolars were removed bilaterally. Three months later, experimental implants with dierent surface characters were installed in
each sides of the mandible. The implant consisted of two parts; the
implant body and an exchangeable intraosseous implant cylinder.
After osseointegration, experimental peri-implantitis was induced
by cotton ligatures until the bone loss reached the junction of the
two segments of the implant. After debridement of the bone
defects, three treatment models were performed; (i) contaminated
cylinders were removed, pristine cylinders were placed; (ii)
contaminated cylinders were cleaned in situ with saline and (iii)

Posters: Implant therapy

contaminated cylinders was removed, cleaned with saline, sterilized
by autoclaving. All implants were covered with membranes. After
3 months, histological evaluations were accomplished. The results
indicated that in situ saline therapy demonstrated a signicant
dierence at SLA surfaces in bone-implant-contact. Treatment of
contaminated implants in situ with saline resulted in resolution of
peri-implantitis and bone ll in defects.

26
Histological evaluation of wound healing following
simulated immediate implant placement
A. Parlar, D. etiner*, B. nsal, E. Gltekin et al.
University of Gazi, Ankara, Turkey
The gap occurred following immediate implantation around the
coronal portion of the implant is expected to be lled by newly
regenerated bone tissue. A rich blood supply was an essential
requirement to promote rapid and uncomplicated postoperative
healing. The purpose of this study was to evaluate the reaction of
peri-implant tissue to immediately placed implants into simulated
extraction sites following guided bone regeneration. Nine mongrel
dogs were used. The premolar teeth on both sides were extracted.
After 90 days, four holes were prepared in bone for each
edentulous quadrant. Then the coronal part of these holes was
enlarged to 4 mm diameter until 3 mm depth. Experimental
implants with three dierent surface characters were placed into
three of the holes. One cavity was left empty as control. Total of 54
stable experimental implants were covered by membranes. The
dogs were sacriced at 3, 7, 21, 28, 35, and 49 days after implant
surgery. At 3 and 7 days, abundant newly formed blood vessels
and immature bone were seen on SLA and TPS implant surfaces.
At 21, 28, 36 and 49 days no vascular network was detected and
the surface of the bone was a mixture of immature and mature
tissue. Within the limits of this study, the results demonstrated that
osseointegration occurs around immediately placed titanium
implants in simulated extraction sites and the use of barrier
membranes will heal in a predictable way.

27
Function and patient satisfaction in implant therapy
C. Koyuncuoglu*, A. Aral, S. Yaln and
. Tuncer
University of Istanbul, Istanbul, Turkey
Objective: The aim of our study was to evaluate the function and
patient satisfaction in implant therapy including the surgical steps.
Methods: In total, 19 patients that received two-step implant
therapy with various prosthetic constructions were evaluated by a
questionnaire of 26 questions. Out of 26 questions, four were about
the comfort, duration, and patient compliance during the surgical
phase, 10 questions were related to the patient satisfaction with
completed prosthesis, and 12 questions were focused on the
situation before implant therapy, comparison between
conventional and implant-supported prosthesis. Data was
evaluated by chi-square analysis.
Results: All patients reported full satisfaction due to implant
therapy as the treatment of choice in restoring partial or full
edentulism (P < 0.05). Restoring function and aesthetics were
observed as the main expectancy. No patients reported any periand post-surgical pain while 89% of patients reported no
discomfort during the surgery. Seven patients had minor postoperative complaints but they reported that these minor issues did
not aect their overall satisfaction of the outcome of the therapy.
After the completion of prosthetic restorations, 63% of patients
felt their implant-supported prosthesis were similar to their natural
dentition (P < 0.05).

Conclusion: The duration of the implant therapy was the major

concern and this nding suggests that immediate loading in
implant therapy should be chosen when possible.

28
A 10-year follow-up with astra tech implants
C. Schulda* and H. Steveling
University of Heidelberg, Heidelberg, Germany
The present retrospective long-term trial statistically evaluates 1999
Astra Tech implants placed in 607 patients following the Kaplan
Meier procedure. Additionally, proximal and distal bone apposition and resorption in 40 patients with implants in situ since for
least 10 years were examined radiologically, digitalized using
Friacom-Dental Oce Software, and subsequently evaluated. In
order to verify bone level alterations, the distance between
referencing point and marginal bone level was measured. The
median observation period was 50.6 months. The survival rate
after 5 years, remaining unchanged till the end of the observation
period (>10 years), was 97%. The radiological examination of the
marginal bone level of 40 patients (163 implants) with implants
in situ for at least 10 years showed a mean bone loss of 0.4 mm (SD
0.7 mm). The outcome of the present study conrms very good
long-term results with the Astra Tech implant system in terms of
implant survival rate and marginal bone level. Furthermore, the
marginal bone level with a median bone resorption rate of 0.4 mm,
observed over a 10-year period, represents a special clinical success
with a very good esthetic outcome.

29
Immediate and early load on zygoma implants: initial
results of a 3-year prospective study
R. Muela*, S. Lundgren, W. Ouazzani and C. Aparicio
Clnica Aparicio, Barcelona, Spain
Background: The atrophic maxilla presents specic problems for
implant placement. Often these patients are candidate for
rehabilitation on zygoma implants. Recent publications have
demonstrated the predictability of immediate loading of implants
in dierent oral locations. The aim of this study is to report on the
use of immediately loaded zygoma implants to rehabilitate severely
atrophic maxillae.
Materials and methods: The inclusion criteria were the same used
for the original two-stage surgery. Forty-six zygoma and 127
regular implants on the residual bone crest were placed in 25
consecutive patients. Then, straight and angulated abutments were
placed and oclusal registers as well as impressions were taken
during the surgery. A screw retained full arch restoration was
selected in 23 patients, two patients received partial cemented
rehabilitations. Six patients were rehabilitated using an early,
5 days, load protocol. Nineteen patients followed an immediate,
24 h, loading protocol. The patients were instructed for a soft diet
during 4 months. Follow-up controls were performed at 1, 4 and
12 months, thereafter annually.
Results: After 7 to 38 months follow-up (mean 16.2 months) the
CSR of both zygoma and regular anterior implants, was 100%.
CSR of the prostheses was 100%. No complications were observed
during the study.
Conclusions: Within the limits of this study it is possible to
predictably splint zygoma implants with conventional implants
utilizing an immediate load protocol.

125

Posters: Implant therapy

30
Guided surgery and immediate screw retained
prostheses: 1-year prospective study

32
Radiographic changes of graft materials after sinus
floor elevation

M. Codesal*, X. Ar valo, L. Sennerby and C. Aparicio

Clnica Aparicio, Barcelona, Spain

S. H. Cho1,2, O. S. Kim*,1 and Y. K. Kim1

1
Department of Periodontology, CNU; 2Mir dental Hospital, Gwangju,
Korea

Background: Computers have been used to plan implant surgery.

Today, through a specic radiological examination and a new
computer software, the number, size, depth and position of the
implant needed for the restauration, can be planned on a 3D
reproduction basis. The system makes apless surgery possible as
well as the fabrication of an screwed prosthesis before surgery. The
aim of this study is to illustrate the clinical outcome of the rst
patients rehabilitated with the above mentioned system.
Material and Methods: Fifteen consecutive patients; 14 maxillae
and four mandibles, including the learning curve, were
rehabilitated by means of 18 full arch screwed prostheses
supported by a total of 127 implants. Inclusion criteria were:
edentulous of at least one arch, bone enough to place six implants
of a minimum length of 10 mm. After a virtual planning using a
Procera O` software, implants were placed according to the
positions marked by an specically produced surgical guide. No
mucoperiosteal ap was raised. All the prostheses were screwed
immediately after the surgery.
Results: Eight implants failed in one smoker and bruxist patient
3 months after the surgery. The CSR of implants and prostheses
was 93.8% and 94.9% respectively. Minimum pain or discomfort
was experienced.
Conclusions: The method enhances accuracy and precision of the
surgical procedure, minimises postoperative morbidity. Patient
selection is important to insure the success of the procedure.

31
An up to 5-year prospective clinical study on implants
in the zygomatic arch for prosthetic rehabilitation of the
atrophic edentulous maxilla
Fortes*, Lundgren, Sennerby, Ouazzani and Aparicio
Clnica Aparicio, Barcelona, Spain
Background: Prosthetic rehabilitation with implant-supported
prostheses in the atrophic maxilla usually requires bone
augmentation procedures to enable implant placement. However,
a rigid anchorage can be achieved by using so called zygomatic
implants placed in the zygomatic arch in combination with routine
implants placed in residual bone areas. The aim of the present
study was to long-term report on the clinical outcome of zygomatic
and regular implants for the rehabilitation of the severely atrophic
maxilla.
Materials and methods: Sixty-nine consecutive patients with severe
maxillary atrophy were, during a 5-year period, rehabilitated with a
total of 69 xed full-arch prostheses anchored on 435 implants (131
zygomatic). Fifty-seven bridges were screw-retained and 12
cemented. The patients had been followed for at least 6 months
and up to 5 years in loading.
Results: CSR of zygoma and regular implants was 100% and 98%
respectively. Periotest measurements of zygomatic and regular
implants showed a decrease of the PTV value with time. Loosening
of prosthetic gold screws was recorded in nine patients. Fracture of
one gold screw as well as the prosthesis occurred twice in one
patient. Fracture of anterior prosthetic teeth was experienced in 12
patients.
Conclusions: The results from the present study show that the use
of zygomatic and routine implants represents a predictable
alternative to bone grafting in the rehabilitation of the atrophic
edentulous maxilla.

126

The aim of this study was radiographically to evaluate the change

of the graft materials after Mx sinus oor elevation and the
inuence by the graft material type on graft height. A total of 59
patients (28 in LA and 31 in CA) who underwent sinus oor
elevation composed of lateral (LA) and crestal approach (CA) were
radiographically followed for up to about 48 months. Changes in
graft height were calculated with respect to implant length (IL) and
grafted sinus height (BL). From BL/IL, we evaluated change of the
grafted height according to function time, the time of implant
placement in LA and inuence of the type of graft materials to
change of the graft height and the height change of the grafted
sinus oor relative to the implant apex. To assess graft remodelling,
a novel index (SGRI) was used. Sinus graft height decreased
signicantly in both approaches in 12 months (P < 0.01).
Signicant dierence was not observed between staged and
simultaneous approach in graft height change according to time
in LA. However, staged approach had more height loss to
simultaneous approach in all observed time. In LA, there was
signicant dierence in BL/IL change according to graft type
(P < 0.05). Autogenous bone had maximum height reduction and
MBCPTM had minimum height reduction. SGRI was increased
statistically signicantly from baseline to 3 months and 3
(P < 0.05) to 12 months (P < 0.01) in both approaches.

33
Evaluation of clinical performance of Swissplus
dental implants in partially edentulous patients: a
retrospective analysis
E. Yuzbasioglu, U. S. Yavuz, E. Konas and G. Acikgoz* et al.
Faculty of Dentistry, Ondokuz Mayis University, Turkey
Aim: The aim of this study was to evaluate clinical performance of
Swissplus Dental Implant System.
Materials and methods: A total of 105 implants which were
inserted in 30 patients (16 male, 14 female), between 35 and
66 years of age. A one-stage surgical protocol with delayed loading
was used. Abutment connection was performed 36 months after
implant installation. The patients were followed for at least 1 year
after loading. The survival rates were evaluated according to
location, diameter and length.
Results: Three implants were lost during the 1 year of follow-up.
The overall survival rate at 1 year was 98.09%. The corresponding
survival rate was 96.07% for straight implants and 98.14 % for
tapered implants. The survival rates of anterior and posterior
regions of maxilla were 92.8% and 100%, respectively. For
anterior and posterior mandible survival rates were 80% and
98.1%, respectively. The mean loss of marginal bone at the
implants during the rst year in function was 0.33 mm.
Discussion/Conclusion: These favourable results showed that
SwissPlus Implant System can be used safely in partially
edentulous patients. Larger numbers of implants followed for
longer periods of time are needed for further investigation. Good
bone quality, primer stability adequate loading are important
factors for long term maintaining of bone-implant interface
structurally and functionally.

Posters: Implant therapy

34
Integration and function of dental implants in
postmenopausal women with osteoporosis compared
to healthy females of matched age. preliminary results
M. Friedrichs*, A. Friedmann and D. Felsenberg et al.
Institute of Periodontology, CBMR, Charit
, Berlin
Postmenopausal osteoporosis is the most common form of this
skeletal disease. Prospective studies evaluating the relationship
between osteoporosis, medication and integration of dental
implants are lacking. This controlled, prospective study in
postmenopausal women compares integration and function of
dental implants in patients with diagnosis of untreated osteoporosis (tests) to that in age-matched healthy controls. Implants
installed in lateral areas of mandibles are allowed to heal for
3 months prior to loading. Clinical parameters for plaque (PI),
bleeding (SBI, BoP), peri-implant crevicular uid (PCF), probing
depths (PD), attachment level (AL) and keratinized gingiva (KG)
are assessed and analysed at week 1, 3 and 3, 6, 9 months after
implant insertion. All members of the test group receive Ca-VitD
substitution and according to a random assignment Bisphosphonates (Alendronate) or Placebo. Continuous healing tendency is
indicated in both groups by decreasing PCF levels. In control
group PCF is signicantly higher at 1 week than in other samples
(P = 0.008; 0.001; 0.014; 0.046, respectively); same trend is
observed in the test group. No signicant changes in mean values
from month 3 to month 6 are detected for PD, AL and KG in both
groups. At 3-month evaluation dierences between tests and
controls regarding PCF, PD, AL and KG values are statistically
none-signicant. At 6 months PCF levels correlated with PD in
controls (P = 0.041), and with KG levels in tests (P = 0.01).

35
Function and patient satisfaction in implant therapy
C. Koyuncuoglu*, A. Aral, S. Yalcn and O. Tuncer
University of Istanbul, Istanbul, Turkey
Objective: The aim of our study was to evaluate the function and
patient satisfaction in implant therapy including the surgical steps.
Methods: In total, 19 patients that received two-step implant
therapy with various prosthetic constructions were evaluated by a
questionnaire of 26 questions. Out of 26 questions, four were about
the comfort, duration, and patient compliance during the surgical
phase, 10 questions were related to the patient satisfaction with
completed prosthesis, and 12 questions were focused on the
situation before implant therapy, comparison between
conventional and implant-supported prosthesis. Data was
evaluated by chi-square analysis.
Results: All patients reported full satisfaction due to implant
therapy as the treatment of choice in restoring partial or full
edentulism (P < 0.05). Restoring function and aesthetics were
observed as the main expectancy. No patients reported any periand post-surgical pain while 89% of patients reported no
discomfort during the surgery. Seven patients had minor postoperative complaints but they reported that these minor issues did
not aect their overall satisfaction of the outcome of the therapy.
After the completion of prosthetic restorations, 63% of patients
felt their implant-supported prosthesis were similar to their natural
dentition (P < 0.05).
Conclusion: The duration of the implant therapy was the major
concern and this nding suggests that immediate loading in
implant therapy should be chosen when possible.

36
Incidence of fracture in endosseous osseintegrated
implants
A. Jornet*, A. S
nchez, J. M. Montoya and V. Jornet
Periodontology Unit, University of Murcia, Spain
Introduction: The fracture of dental implants osseointegrated is an
infrequent complication within the dental treatment. In spite of his
low prevalence, it is a clinical situation that bears importance for
the diculty of his treatment.
Objective: The objective of our work is to quantify the risk of
fractures of implants and knowing the prevalence that we can nd
this complication at the daily clinic with.
Materials and Methods: A bibliographic quest in medical seekers
like PubMed and ScienceDirect have been realized. Likewise, we
have looked up the bibliographic bottoms of Murcias University.
Results: The incidence of the fractures of implants is very low. In
the realized meta-analysis we have found inferior values to the
0.5%.
Discussion: It proves to be important to dierentiate several types
of designs, in terms of his mechanical resistance. Finally, the
incidence found for solid threaded implants comes from
approximately one fracture for each 220 implants.

37
Influence of implant surface topography on early
osseointegration. A histological study in human jaws.
S. Grassi*, G. Iezzi, A. Piattelli and J. Shibli
Guarulhos University, Guarulhos, SP, Brazil
This study evaluated the inuence of anodized surface on bone-toimplant contact (BIC%), the bone density in e threads area (BA%)
as well as bone density outside of the threads area (BD%) in
human jaws after 2 months of unloaded healing. Thirteen subjects
(mean age 42.61 + 6.15 years) received two micro-implants
(2.5 mm in diameter and 6 mm in length) each during conventional
implant surgery either in mandible or maxilla. The micro-implants
with commercially pure titanium surfaces (machined) and anodized
surfaces served as control and test surfaces, respectively. After
2 months, the micro-implants and the surrounding tissue were
removed and prepared for histomorphometric analysis. All microimplants except for two machined and one oxidized micro-implant
surfaces were found to be clinically stable after healing period.
Histometric evaluation indicated that the mean of BIC% was
21.71 + 13.11% and 39.04 + 15.75% to machined and oxidized
micro-implant surfaces (P < 0.05), respectively. The BD% was
higher for the oxidized surface, although there was no dierence
between maxilla and mandible (P = 0.99). The anodized surface
presented inuence on BA% in the type IV bone. Data suggest that
the anodized surface presented a higher percentage of bone-toimplant contact when compared to machined surfaces under
unloaded conditions after a healing period of 2 months.

38
Tilted implants. A 5-year retrospective clinical,
radiological and periotest study
T. Fayos*, W. Ouazzani, L. Sennerby and C. Aparicio
Clinica Aparicio, BCN, SP; www.clinicaaparicio.com
Background: Tilted implants have been described as alternative to
the sinus elevation in patients with severe atrophy of the posterior
maxillae. However, few studies provide long-term controlled data
on the behaviour of those implants.
Objective: To report the long-term clinical outcome of tilted
implants compared to axial implants in dierent oral situations and
locations.

127

Posters: Implant therapy

Material and methods: A total of 161 patients were rehabilitated
with 172-implant-supported prosthesis. A total of 828 Branemark
System implants were placed. Out of them, 320 were tilted
implants and 508 were placed axially to the oclusal plane. The
average follow-up period was 78 months. The radiographic
controls included one initial radiograph at the moment of
prostheses connection and a nal control radiograph. The
marginal bone loss between both radiographs was measured.
Implant stability was evaluated using the Periotest device.
Results: The 5-year CSR was 100% and 98% for tilted and axial
implants, respectively. The CSR of the prosthesis was 100%. The
mean annual marginal bone loss was 0.22 mm and 0.18 mm for
tilted and axial implants respectively. No signicant dierences
between both groups were found.
Conclusions: Within the limits of this sample it is concluded that
the tilted implant is a predictable technique.

39
Zigomatic implants: a new surgical approach
Ouazzani*, Ar valo, Sennerby, Lundgren and Aparicio
Clinica Aparicio, BCN, SP; www.clinicaaparicio.com
Background: Current literature describes zygoma implant as
intrasinus surgical approach, ideally maintaining the sinus
membrane intact while gaining access to the zygomatic bone. An
anatomical limitation of the technique comes from the presence of
a pronounced concavity of the anterior maxillary wall. This forces
to move the implant head from the crest to a more palatal position.
The aim of this study was to report our experience with zygoma
implants utilizing a new surgical approach.
Materials and methods: Twenty consecutive patients showing
extreme concavities of the maxillary anterior wall were treated
with 87 regular and 41 zygoma implants inserted with an extrasinusal surgical approach that allows the placement of the implant
head close to the residual crest. Implants were followed for 6 to
18 months after oclusal loading, mean follow up of 12 months.
Inclusion criteria were the same used for zygoma implant
placement and the presence of an anterior maxillary concavity
precluding the placement of the implant head on the palatal bone
closer to 10 mm to the centre of the residual bone crest.
Results: CSR of zygoma and regular implants was of 100%. No
pain, discomfort or complications related to the extrasinusal path
were recorded.
Conclusions: Within the connes of this study, the extra-sinusal
surgical approach represents a predictable alternative to the intra
sinus approach for the rehabilitation of the atrophic edentulous
maxilla.

40
Influence of the diagnostic value of 3D cone-beam
tomograms
L. Ritter*, T. Dreiseidler and J. Neugebauer et al.
Caesar, Surg. Sys., Uni. Kln, CMF-Surgery, Germany
Cone beam volume tomograms are more and more accepted for
oral diagnosis. A total of 38 digital volume scans were evaluated by
ve investigators with the score between 1 and 5 for diagnostic
ndings of anatomical structures. Structures evaluated were canalis
mandibularis, foramen mentale, foramen incisivum, nasal and
sinus oor and TMJ. The age, the body-mass-index (BMI), amount
of metal llings, superstructures and implants were documented for
each patient. The scans were performed by a new 3d radiological
device (Sirona, Bensheim, Germany) with a voltage of 90 kV and
an energy dose of 28 mAs. BMI and amount of metal material in
the oral cavity have no signicant inuence on visualization of
evaluated anatomical structures. A stronger correlation could be

128

found for the age. The median for all anatomic structures were very
good (1) or good (2). The three-dimensional imaging is an
appropriate imaging technique even for elder patients to evaluate
anatomic structures for implant prosthetic planning.

41
Peri-implant condition in toothless patients carrying
mandibular implant overdentures on bar
anchorages ITI system
E. Canet*, J. Faus-Lpez, E. Palomero and J. P. Firmino
Periodontology, University of Cardenal Herrera, CEU, Valencia
Aim: Analyse advantages of using two ITI implants with bar
anchorages for retention of inferior overdentures and importance
of motivating and instructing patient in oral hygiene. Use plaque
index Silness & Loe and calculus index, modied for this treatment.
Monitoring 10 years 50 patients treated.
Material and Methods: Fifty patients; 28 women, 22 men; 50
82 years, 100 implant, position 3233 and 4243. Was evaluated:
stability of prosthesis, strength distribution, maintenance of
biological support, implant splint, and dierent index of oral
hygiene.
Results: Stabilization, implant splint, xation of prosthesis against
horizontal translation forces, was obtained. 22.5% of subjects
showed plaque score 0, result of oral hygiene instructions. 90%
dont exhibited sulcus bleeding indicating health of peri-implant
soft tissues. One patient shown plaque and subgingival calculus,
oedema, reddening, bleeding and radiographical bone loss not
exceed 2 mm.
Conclusion: In patients followed 10 years all conditions of
retention, stability and function take place with smaller number
of implants that necessary for xed implant rehabilitation. This is
the best treatment when high degree of bony atrophy appears and
is impossible to place implants in back sector. In cases of poor
hygiene, presence of plaque and calculus on abutments and on bar
causes bone loss around implants, being able to cause the failure of
this technique.

42
Immediate occlusal loading of implants in 24
consecutive full-arch cases in the maxilla:
6- to 38-month results
A. Simonpieri*, J. Choukroun, D. Dohan and A. Diss
Private Practice, Nice, France.
Purpose: The purpose of this study is to evaluate prospectively
survival and success rates of implants placed in the complete
edentulous maxilla and immediately loaded with a full-arch
restoration.
Materials and methods: Four male and 20 female patients, aged
between 48 and 81 years (mean age 65.7 year), were treated with
289 implants placed in edentulous maxillary bone or extraction
sites (mean 12.04 implants per patient). Seventy-two hours after
implant placement, a metal-reinforced provisional prosthesis was
fabricated and 266 implants were rigidly connected and
immediately loaded. Twenty-three implants, which had
unsatisfactory primary stability, were maintained unloaded.
Success rate of implants was evaluated clinically and
radiographically.
Results: A total of 289 implants were followed up from a minimum
of 6 months to a maximum of 38 months. Of 289 implants placed,
23 implants were not immediately loaded. Three of these unloaded
implants in two dierent patients were removed owing to loss of
osseointegration. Of 266 immediately loaded implants, 10 implants,
although still osseointegrated, did not full success criteria.
Therefore, the absolute success and survival rates were 95.5%

Posters: Implant therapy

and 98.9%, respectively. Concerning immediate loaded implants,
success and survival rates were 96.2% and 100% respectively.
Conclusion: A high success rate can be achieved when screw-type
osseointegrated implants are immediately loaded with xed fullarch restorations in the maxilla.

45
Peri-implant health on epi-crestal placed implants with
grid-blasted and low or high temperature etched
surfaces
J. Neugebauer*, V. Karapetian, M. Scheer and J Zller
University of Cologne, Department for CMF-Surgery, Germany

43
Papillae height and its relation with osseous crest in
single unit rehabilitations with oral implants. A
retrospective study
Ar valo*, Restrepo, Franch. Sennerby and Aparicio
Clnica Aparicio, Barcelona, Spain
Background: The presence of the papilla can determine the success
of the treatment. Parameters such as the distance from the contact
point to the crestal bone have been related with the presence of
papillae. Yet, in between presence or absence, several anatomical
levels of papillae can be found. The aim of this study is to correlate
the dierent levels of papillae, in the single unit implant
rehabilitation, with bone related parameters.
Materials and methods: A systematic selection of 259 clinical
histories, including at least one single unit implant restoration, was
performed. Out of them, 59 patients and 64 implants complied with
the following inclusion criteria: single unit implant restoration, the
crown having uni- or bi-lateral contact areas, and patient
acceptance for participation in this study. The following data
were retrieved: implant location; abutment type; oral radiographs;
distance of implant-abutment junction (IAJ) to marginal bone crest
and to the contact point; distance of the marginal bone crest to
contact point; horizontal distance from the implant to the adjacent
tooth at IAJ level. Papillae were classied following the Jemt index.
Results: Type 2 papillae were present in 45%, followed by type 3 in
32%. Mean distances from contact point to osseous crest in type 2
and 3 papillae were 9 and 6 mm respectively.
Conclusions: Within the limits of this study, the results do not
show a direct relationship between marginal bone level and papillae
height.

44
Survival rates of implants with a rough surface
geometry in the posterior maxilla and mandible
J. M. Navarro*, N. Elian, S. C. Cho, S. Froum, D. P. Tarnow
Department of Periodontology and Implant Dent., NYU, USA
Introduction: The predictability of endosseous implants for
prosthetic restoration of missing teeth has been well documented.
High rates of clinical success have been reported with implants
placed in both the maxilla and mandible. However, the survival
rate of short implants has been shown to be lower than that of
standard size implants. (10 mm in length). Implants with rough
surfaces have been shown to have a high survival rate when placed
in various areas of the mandible and maxilla. The purpose of this
retrospective study was to determine the survival rate of short
implants (<10 mm in length) with dierent rough surfaces in the
posterior maxilla and mandible.
Material and methods: The Department of Periodontology and
Implant Dentistry at the New York University Kriser Dental
Center database of rough surfaced implants has been kept up to
date by forms reporting implant status at stage I, II and postloading. Analysing this database we were able to report on 223
short implants placed with a total of six failures.
Results: The overall survival rate was of 97.8%.
Conclusion: The results of the present research indicate that short
implants with a rough surface geometry show survival rates
comparable to implants of standard lengths.

Modern implant surfaces show a high quality of osseointegration

with a high bone to implant contact. The formation of the crestal
implant design is under research to maintain the peri-implant bone
and soft tissue. This study compares the crestal bone level on
implants with grid blasting surface and two types of etching
procedures in hip grafting and radiation patients. The high
temperature etched surface shows a much deeper micro-morphology then the low temperature etched surface. The roughness of
both surfaces is about Ra = 2.6 lm. Two groups of 25 patients
each received a total of 221 implants. A total of 112 implants were
placed with the low temperature etched surface with a smooth
collar of 1.1 mm and 109 implants were placed with high
temperature etched surface with a smooth collar of 0.4 mm. The
radiological bone level after 1 year of prosthetic loading was
2.1 mm below the implant shoulder in the low temperature etched
group and 0.9 mm in the high temperature etched group. The
prevalence of peri-implantitis with bleeding on probing was low
with 4.5% of the implants in both groups. These results demonstrate that the reduced machined collar and the solely high
temperature etched implant collar stabilize the peri-implant bone
formation. Even in cases with higher bone loss the high temperature etched surface showed no increased signs of peri-implantitis or
plaque accumulation on the micro-structured surface.

46
Would hazards of unloaded and loaded implants differ?
J. Mau*, M. Yong and T. Kvitkina
Heinrich Heine University Hospital, Dusseldorf, Germany
Background and Aims: Implant life times are commonly stated as
time since placement of either the implant or the prosthetic
superstructure. Because of its relative shortness in longer followup, the functionally unloaded pre-prosthetic phase is typically
not analysed separately. Pre- and post-prosthetic risks of implant
loss and associated risk factors are compared in the Dusseldorf
Implant Registry Cohort Studies (DIR-CS).
Material and methods: In three cohorts of single-tooth replacement/
abutment supplement (n = 278), partial edentulism (n = 388), and
edentulous maxilla/mandible (n = 214), patients had been followed
for up to 8 years. Risk factors including patient and implant
characteristics were assessed with Cox regression for life tables.
Results: Annual loss rates in these cohorts were 20.1%, 13.6%,
and 19.4%, respectively, for unloaded, and 3.5%, 1.6%, and 2.5%,
respectively, for loaded implants. All risk factors, even the wellknown higher loss rate of ceramic implants, were demonstrated to
depend on whether implants were functionally loaded or not.
Conclusion: By their distinct magnitudes of risk and their dierent
risk factors, implant service times before and after placement of
prosthesis deserve separate analyses more systematically.

47
Can melatonine and growth hormone reverse the
effects of aging in bone?
Luis Ortiz Camarero* and Isabel Fernandez Tresguerres
Od. Department, Universidad Rey J. Carlos, Madrid, Spain.
Purpose: The aim of this study was to investigate the eect of
Melatonin and GH on Bone metabolism and density in rats.
Material and Methods: Forty female rats were used: eight young and
32 old. The young and eight old were used as control. The remaining

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was randomly divided into three groups: eight treated with melatonin
(1 mg/kg/day), eight with GH (2 mg/kg/day), and eight with
Melatonin plus GH. Rats were killed and blood for an assay of
osteocalcin was collected and Tibiae dissected. Osteocalcin levels,
morphometric and densitometric parameters mean SD of each
group were calculated. The groups were tested by the analysis of
variance (anova) elaborated with the Statgraphics 5.0 statistical
software package. Signicance for the analysis was set for P < 0.05.
Results: The plasmatic Osteocalcin levels were increased in the GH
(267 ng/ml), melatonin (186 ng/ml) and GH-Melatonin Groups
(205 ng/ml) when compared with the old control; group (80 ng/
ml), with statistically signicant dierences. The morphometric
evaluation showed statistically signicant more bone area in the
melatonin (5.97 mm2), Gh (6.23 mm2) and melatonin-Gh groups
(5.8 mm2) when compared with the old control group (4.4 mm2).
The densitometric analysis showed a statistically signicant more
BMD in melatonin (0.136 g/cm2), GH (0.14 g/cm2), and
melatonin-gh groups (0.135 g/cm2) when compared with the old
control group (0.125 g/cm2).
Conclusion: GH and Melatonin seem to exert benecial eects
against age-induced changes in bone mass, metabolism and density
in rats.

the replacement of lost teeth. This Tissue Engineering (TE)

solution consists of PDL cells growing around a titanium pin.
This ligament will liaise the pin to the jawbone, mimicking natural
PDL. Here we report for the rst time the preliminary results of a
clinical trial in humans of such an implant, so called-ligaplant.
PDL cells were extracted and amplied in vitro. Bioactivated
titanium conical pins were seeded with autologous cells, cultured
for eight weeks, and implanted into corresponding patients.
Periodontal regeneration was followed by clinical and radiological
evaluation. Three of nine ligaplants were present and functional
after 22 months. Mechanical tests by twisting and pulling revealed
a maximal coronal mobility of ligaplant less then 1 mm above that
of the control teeth, and no ankylosis. The felt resistance could be
discussed as a ligament connection to the bone. Radiological
evaluation revealed bone reformation. Around a ligaplant persisted
a radio translucent space showing the presence of a non-mineralized layer. This structure resembling the PDL around a natural
root might be formed by the tissue engineered ligament. This
observation was in agreement with the mechanical tests. Our study
shows that TE PDL covered implants could be an alternative to
osseointegration, and would ease tooth replacement in defective or
growing bone.

48
Clinical and radiographic analysis of SLA ITI dental
implants placed in the posterior maxilla with the
osteotome technique. A prospective study

50
The use of narrow neck implants in the replacement of
single or multiple missing mandibular incisors:
functional and aesthetic outcomes.

B. Mateos*, M. Herrero, P. L
zaro and A. Herrero et al.
Master of Periodontology, UCM, Spain

L. Cordaro*, F. Torsello and V. Mirisola di Torresanto

Department of Periodontics, Eastman Dental Hospital, Roma, Italy

Maxillary sinus oor elevation using osteotomes has been successfully used for implant placement when a limited vertical height is
available at posterior maxilla.
Objectives: (i) To evaluate the clinical outcomes of SLA ITI dental
implants placed in the posterior maxilla using the osteotome
technique; (ii) to radiographically assess the vertical displacement
of the maxillary sinus oor and long-term changes in sinus graft
height with this technique.
Material and methods: Twenty-two patients with a total placement
of 54 implants. Sinus oor elevation was performed with bone
chips and tricalcium phosphate as bone ll material. Presurgically
and postsurgically at 3 and 12 months digital panoramic
radiographies were analysed and clinical outcomes assessed.
Implant stability assessment using resonance frequency analysis
was recorded at baseline and 3 months.
Results: The success rate was 94.2%. The mean preoperative
distance between the sinus oor and the crest was 6.4 mm. The
mean vertical bone gain assessed radiographically at the centre of
the implant was 4.1 mm at surgery but was reduced signicantly
(P < 0.05) to 3.6 mm at 3 months. Implant stability assessment at
surgery ranged between 28 and 77 ISQ with a mean value of 62.2
ISQ at 3 months.
Conclusions: The osteotome technique provides a way to increase
the amount of available bone but the grafted area apical to the
implants undergoes remodelling and sinus graft height decreases
signicantly at 12 months.

There are no studies that focus on mid or long-term results of

mandibular incisors replacement with narrow diameter implants in
partially edentulous patients. The authors have retrospectively
evaluated 31 patients treated for single or multiple lower incisor
replacement with narrow neck implants with a mean follow-up of
23 months. The patients were divided in three groups: single tooth
(ST), multiple unit restoration (MU) and restorations on adjacent
implants (AI). Survival and success rates and soft tissue parameters
such as modied Plaque Index (mPI), Peri-implant Probing Depth
(PPD), Bleeding on Probing (BOP) and the Papilla Index were
analysed. Patients and clinicians on Visual Analogue Scales
performed subjective evaluation. The implants and prostheses
showed a survival rate of 100% and an overall success rate of 94%.
The distribution of mPI index outcomes showed better results for
the ST group. The AI group showed a statistically signicant
increase in PPD and in BOP index. The Papilla Index showed a
better outcome distribution in ST and MU group. The professional
subjective evaluation showed good outcomes for the ST and MU
groups and signicantly poorer results in the AI group. It may be
concluded that the replacement of lower incisors with narrow neck
implants leads to favourable functional and aesthetic results in
cases of single-tooth or multiple-unit replacement. Worse results
are achieved if two adjacent mandibular incisors are replaced with
adjacent implants.

49
Tissue engineering for tooth replacement : preliminary
results of a clinical trial with a tissue engineered
periodondal ligament covered implant.
P. Gault*, F. Thillou and A. Black et al.
Private Practice, Orl
ans, France; Natural Implant, France
The periodontal ligament (PDL) exerts strong regenerative capacity and could remove clinical limitations of current solution for

130

51
Aesthetic outcome of immediate vs. delayed anterior
implant placement associated with immediate
temporization
R. Younes*, C. Makari, N. Nader and R. Abi Nassif
St. Joseph University, Beirut, Lebanon
The aim of our prospective study was to compare gingival aspect
(papilla and buccal contour) and peri-implant bone remodelling of
immediate vs. delayed anterior maxillary implant placement. Sixtynine Screw-Vent implants (Zimmer dental) were placed in the

Posters: Implant therapy

anterior region in 57 patients. Thirty-four implants (group A) with
immediate placement and 35 implants (group B) with delayed
placement (3 months). A temporary crown was immediately placed
in all cases. Clinical evaluation and radiographic control (post-op.,
1, 3, 6, 12 months) enabled us to analyse gingival variation and
bone modication. Implant survival rate at 1 year was similar
(A = 97.05; B = 97.14). Despite a progressive alveolar bone loss
in the delayed placement compared to the immediate uncontrolled
bone resorption, interproximal bone loss was similar after 1 year
(A = 0.67 mm, B = 0.7 mm). The overlying papilla preservation
was slightly better in the immediate placement (80% vs. 60%).
Regarding the buccal aspect, immediate placement showed more
contour modication during the rst 6 months, as a result of tissue
remodelling. In the delayed placement, a better aesthetic buccal
contour was obtained due to the possibility of soft and hard tissue
management during implant surgery. In conclusion, despite the
multiple advantages of immediate placement (papilla preservation,
time saving, patient comfort), tissue variation in immediate
placement is less predictable, without a second chance to enhance
the aesthetic result by tissue management.

52
Immediate loading in total edentulous patients: 2-year
prospective clinical study
C. C. Alves* and M. Neves
Clinica Med. Dent. Manuel Neves, Porto, Portugal
Background/Aim: In edentulous patients, the literature supports
immediate placement and immediate load in the mandible/maxilla
using cross-arch stabilization of the implants and a xed passivetting prosthesis on multiple implants having veriable primary
stabilization upon placement. The aim of this study was to evaluate
the implant and prostheses survival for immediate loading total
edentulous patient.
Materials and Methods: In 23 consecutive patients, 12 females and
11 males, between 39 and 74 years old, four smokers and 19 nonsmokers, were placed 168 implants (83 maximum and 85 mand.) to
support 26 full immediate xed provisional prostheses. Only 159 of
the 168 presented ISQm values 70 and these were loaded at least
in the rst 48 h after implant placement. All 23 patients were
rehabilitated with ceramic fused-metal xed prostheses 4 month
after implants placement. Clinical/radiographic parameters were
evaluated at 6, 12,18 and 24 months after implant loading.
Results: Two of the 159 immediate loaded implants did not
osseointegrate (98.74% implant success rate). The cumulative
success rate was 100% for the 26 provisional and denitive
prostheses. No other implant was lost during the 2-year follow-up
period. 100% prostheses success rate at 2-year follow-up.
Discussion/Conclusion: Immediate loading in total edentulous
patients seems, for the 26 clinical cases of the study, a
predictable technique with 98.74% implant success rate and
100% prosthetic success rate.

53
Infrared laser-assisted peri-implantitis treatment.
Clinical and radiological experience on 27 cases
G. E. Romanos*,1,2 and G. H. Nentwig2
1
Perio/Impl, NYU, USA; 2University of Frankfurt, Frankfurt, Germany
The incidence of peri-implantitis is relatively low (Klinge et al.,
2002). However, deep peri-implant bony defects may negatively
inuence the implant prognosis. The main problem in the
treatment is the optimal decontamination of the implant surface
before augmentation of the defect. The aim of these case series was
to show the long-term prognosis of failing implants, which were
decontaminated with a laser immediately before augmentation.

Based on the previous experience using thermocouples, microbiological as well as morphological studies of implant surfaces after
the laser decontamination we were able to successfully treat 27
peri-implant defects and to improve the implant prognosis without
the changing of the implant restoration in cases of restored
implants. Nineteen defects were decontaminated with the CO2 laser
and eight defects were treated with the diode (980 nm) laser using
power settings of 2 Watt in a cont. wave and defocused beam for
implant decontamination. The augmentation was performed with
autogenous bone or BioOss and a Biogide collagen membrane
coverage. Based on the radiological evaluation after at least 2 years
post augmentation we showed a bone gain independent on the used
laser or the implant surface. In some cases, with the use of
autogenous bone grafts some resorption of the augmentation
material was observed. The data presented in this report showed
that these infrared lasers might be useful for the ecient decontamination of deep peri-implant bony defects.

54
Histomorphometric study of bone density in augmented
alveolar ridges
Z. Suba, D. Sz-Kiss, B. Molnar*, I. Gera, A. Sculean and P. Windisch
SE Department of Maxillofac & Period. Hun & Nijmegen NE
Objective: Measurement of the bone density is an appropriate
method for evaluation of the load bearing capacity of the bony bed
prior to implant insertion. Sinus oor has an excellent bone
forming capacity compared with the destructed alveolar crest.
Methods: Vertical augmentation (VA) of the alveolar ridge defect
was surgically performed by Bio-Oss grafting combined with
guided tissue regeneration in 20 cases. In 10 of them, sinus oor
elevation (SFE) was simultaneously performed. After 68 months,
tissue samples were taken from the grafted area and implants were
inserted. Histomorphometric measurements were performed on
decalcied, paran embedded sections by a computerized
technique. Densities of the newly formed bone and of the bone
substitute material were determined as a percentage of the total
biopsy area.
Results: In the alveolar ridges new bone and graft densities were
measured both in the group of patients with AV, and in the cases
with combined AV and SFE surgery. The mean bone density of the
10 AV cases was lower (18.4 3.6%) compared with that of the
AV + SE group (22.3 5.4%). Graft densities were similar in
the two groups; 28.8 10.1 and 29.6 13.2%, respectively.
Conclusions: Bone density of the Bio-Oss grafted alveolar ridge can
be enhanced by simultaneous sinus oor elevation.

55
Regenerative therapy of peri-implantitis intrabony
defects
E. Nuesry*, F. Schwarz, K. Bieling and J. Becker
Heinrich Heine University, Dsseldorf, Germany
The aim of the present clinical study was to evaluate healing of
peri-implantitis intrabony defects following application of a
nanocrystalline hydroxyapatite (Ostim) or a bovine-derived xenograft combined with a collagen membrane (BDX + BG). Twentyfour patients suering from advanced peri-implantitis (n = 24
defects), were randomly treated with (i) access ap surgery (AFS)
and the application of Ostim (n = 12 implants test), or with AFS
and the application of BDX + BG (n = 12 implants control).
The bone defects and implant surfaces were cleaned with plastic
curets + cotton pellets soaked in saline. Clinical parameters
(probing depth PD, clinical attachment level CAL) were
recorded at baseline and after 6 months of non-submerged healing.

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Postoperative wound healing revealed that Ostim seemed to
compromise initial adhesion of the mucoperiosteal aps in all
patients. At 6 months after therapy, the test group showed a
reduction in mean PD from 7.2 0.8 to 5.0 0.8 mm and a
change in mean CAL from 7.7 1.1 to 5.8 1.1 mm. In the
control group, the mean PD was reduced from 7.1 0.8 to
4.6 0.7 mm and the mean CAL changed from 7.5 1.0 to
5.2 0.7 mm. The dierences between both groups were statistically non-signicant. Within the limits of the present study, it can
be concluded that at 6 months after surgery both therapies resulted
in statistically signicant PD reductions and CAL gains. However,
postoperative wound healing seemed to be ameliorated following
application of BDX + BG.

to canine) and 346 in the posterior regions. After 3 months in the

mandible and 5 months in the maxilla, osseointegration was
evaluated clinically and radiographically for the possible early
failures prior to prosthetic loading.
Results: From all 421 implants placed, 12 were lost as early failures
comprising 2.85%. Implant failure rate in the mandible was 1.78%
(four implants lost from 224) while in maxilla it was 4.06% (eight
from 197). Anterior segments had 5.33 % of failures (three from
75), while posterior regions exhibited 2.6% implant loss (nine from
346).
Discussion and conclusion: With the limitations of this retrospective
study it can be concluded, that high success rate of non-submerged
two-piece implant placement can be achieved.

56
Full arch immediate functional loading of maxilla
implants with cemented prosthesis in post-extractive
sites. A prospective clinical study

58
Diabetes and dental implants: a comprehensive and
critical review of the literature

M. Silvestri*,1, L. Passaler3, P. Martegani2 and V. Cattaneo1 et al.

1
University of Pavia, Italy; 2Private practice, Varese; 3Private practice,
Milano, Italy
Aim of this study is to present a protocol for complete rehabilitation of the upper jaw, using immediately loaded post-extractive
implants and analyse the outcomes at 18 months. Passed the entry
criteria, patients underwent a diagnostic process. Once diagnosis
was established and decision to remove all natural teeth was taken,
feasibility of full arch-rehabilitation with implant and cemented
prosthesis was assessed. At the time of surgery measurements were
recorded: number, length, diameter of implants; number of postextractive implants, gap between bone crest and implant, torque,
number of immediately. loaded implants. Follow up measurements
were registered: FMPS, FMBS, PD and BOP (six measures per
implant), implant failure, implant suering, aesthetic evaluation
throughout time. The same operator treated eight patients; 67
implants were placed (XiveFriadentO`); 51 implants were immediately loaded with a provisional arch (torque 35 N/cm2) and 44
were placed in post-extractive sites. Six months later a metalceramic prosthesis was done. Average implant length was
11.84 1.18; average diameter was 4.31 0.57. Eighteen
months after surgery, patients were re-evaluated and showed an
average PD of 2.77 0.62; BOP was 14.28%; survival rate was
100%; implants suering rate was 1.49%. Papilla presence rate
between post-extractive implants was 78.23%. On this data
immediate functional loading is a reliable surgical-prosthetic
procedure with a good predictability of aesthetic maintenance in
multiple post-extractive implants.

57
Analysis of early failures of two-piece non-submerged
implants

S. Kotsovilis*, I. Karoussis and I. Fourmousis et al.

Department of Periodontology, University of Athens, Greece
Background: A comprehensive review of implant placement in
diabetic subjects has not been published.
Aim: The aim of the present study was to perform a comprehensive
and critical review of experimental and clinical studies, regarding
implant placement in diabetic subjects and to draw evidence-based
conclusions on its eectiveness and predictability.
Material and methods: Search for articles up to and including
March 2005 was performed by using The National Library of
Medicine and Cochrane databases. The references of identied
articles, workshops and hand-searched journals were also used. At
the rst phase of selection the titles and abstracts and at the second
phase full papers were screened independently by three reviewers
(S.K., I.K.K., I.F.). Any disagreement was resolved by discussion.
Results: The search provided 227 titles and abstracts. After the rst
phase of evaluation, 28 papers, including 11 experimental studies
and 16 clinical studies (one clinical study corresponded to two
papers), were selected. After the second phase, 11 experimental and
eight clinical studies were accepted.
Conclusion: Experimental studies seem to reveal an impaired bone
healing response to implant placement in diabetic animals
compared to non-diabetic controls. Most clinical studies indicate
that controlled diabetes is no contraindication for implant
placement. However, guidelines with objective criteria (e.g. type,
duration of diabetes, glucosylated haemoglobin levels) need to be
established.

59
Transtomography for implant placement guidance in
non invasive surgical procedures: presentation of
surgical protocol, interest and applications

A. Puisys*, S. Grybauskas and T. Linkevicius

Vilnius Implantology Center, Vilnius, Lithuania

F. Bousquet*, P. Bousquet, L. Vasquez and P. Gibert

Implantology, University of Montpelier, France; University of Geneva,
Switzerland

Background: Non-submerged placement of two-piece implants is

well documented as a predictable and ecacious treatment, but its
use in a daily practice is not very common.
Aim: The aim of the study was to evaluate the success rate of nonsubmerged two-piece implants prior to prosthetic loading.
Materials and methods: A total of 421 two-piece Biohorizons
(Birmingham, Alabama, USA) implants were installed in 189
patients, 70 male and 119 female, partially dentate and edentulous.
Immediately after implant placement-healing abutments were
connected and peri-implant mucosa was sutured. In the maxilla
197 implants were placed, while mandible received 224 implants.
Seventy-ve implants were placed in anterior segment (from canine

Transtomography use X-rays narrow beam and a digital detector

to perform tomograms. Image appears instantly. So intraoperative
tomograms may be done for implant placement guidance during
non invasive surgical procedures. The aims of the report is to
present this new surgical protocol, its interest and results of
experimentation. Clinical cases illustrate applications of the technique.
Materials and methods: Cross-sectional and longitudinal
transtomogram is done after a rst pilot drill through the
mucosa and the bone as planned preoperatively (rst pilot drill is
2 mm section and shorter than the distance to critical zones). A
radiographic reference guide (2 mm section) is then inserted in the

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bone. This titanium guide closes all the drilled zone during
radiographic control. Patients move a few meters from the surgery
table to the panoramic machine installed in the surgery room. The
guide is securely sutured to the adjacent tooth or to the
surrounding mucosa.
Results: Position of the guide on the tomographic images allow to
control the planned surgical drilling trajectory in the three
dimensions. The axis of the drill can be corrected accordingly
when needed. Full pilot drill and enlargement are then performed.
Conclusion: Intraoperative transtomograms during noninvasive
surgeries may minimize the risk of damaging critical anatomic
structures and bone wall perforation. This protocol enables to
extend noninvasive techniques to patients with a narrow alveolar
bone ridge.

60
The retrograde peri-implantitis: about five clinical
cases and review of the literature
F. Parahy*, S. Miret, E. Parahy and O. Rodriguez Estevez
Private Practice, Zaragoza, Spain;UIC, Barcelona
The use of dental implants as an integral part of rehabilitation
therapy increased in recent years. Long-term studies have conrmed their predictability in restauring partially and completely
edentulous patients. The failure of osseointegrated dental implants
primarily occurs as a result of peri-implantitis and occlusal
overload. Even if less frequently, reported failures had been
attributed to retrograde peri-implantitis or implant periapical
lesion. The aetiology and management of such lesion have been
speculated throughout the literature. Five cases reports under
diagnosis of retrograde peri-implantitis are presented with a
successful treatment: apicoectomy of the implant. This communication discusses possible aetiologies and treatment for retrograde
peri-implantitis based on the existing literature and ve cases
reports.

61
Sinus floor elevation using osteotomes: a systematic
review and meta-analysis
D. Emmerich*, W. Att and C. Stappert
Department of Oral Max, Faculty of Surg & Prosth, University of
Freiburg, Germany
Background: Various techniques of sinus oor elevation (SFE) are
described. The elevation with osteotomes (OSFE) from a crestal
approach is a relatively new technique. The aim of this systematic
review and meta-analysis was to evaluate the clinical outcome of
implants placed with an OSFE technique.
Methods: A systematic online and manual review of the literature
identied articles dealing with OSFE. Applying rigid inclusion
criteria, screening and data abstraction were performed
independently by two reviewers. The follow-up of loaded
implants had to be at least 6 months. The identied articles were
analysed in regards to implant outcome and dened surgical
aspects. Survival and success rates were estimated by Kaplan-Meier
curves.
Results: Eight out of 44 articles dealing with OSFE met the
inclusion criteria. Five of the eight selected studies met established
success criteria. The survival and success rates were 95.7% and
96.0% after 24 and 36 months, respectively. The median and mean
follow-up periods were 24 and 18.73 months for the survival rate
and 24 and 19.7 months for the success rate. Due to a multivariate
database, no statistical analysis could be performed on surgical
parameters.
Conclusions: Short-term clinical success/survival (up to 3 years) of
implants placed with an OSFE technique seems to be similar to

that of implants conventionally placed in the partially edentulous

maxilla. Controlled prospective clinical long term studies are
needed.

62
Immediate provisionalization of maxillary single
premolars: a 2-year prospective study
O. Henry-Savajol*, J. K. Y. Kan and K. Rungcharassaeng
Oral Implant Center, Loma Linda University, USA
Purpose: This 2-year prospective study evaluated the implant
success rate and marginal bone changes of immediately provisionalized maxillary premolar single implants in edentulous ridges.
Materials and Methods: Ten patients (three men, seven women)
with a mean age of 51 years (range 4082) were included in this
study. Ten threaded and tapered implants with a porous surface
were placed and provisionalized immediately with a temporary
screw-retained acrylic resin crown. The denitive restoration was
placed 6 months later. The patients were evaluated clinically and
radiographically at implant placement and at 6, 12, 18 and
24 months after implant placement.
Results: At 2 years, all implants remained osseointegrated. The
mean marginal bone change from the time of implant placement to
24 months was )1.01 mm and presented a statistically signicant
dierence (anova, p 0.05).
Discussion: Although marginal changes were statistically
signicant from implant placement to 2 years of follow-up, they
were well within clinical expectations and appeared to be similar to
ndings of previous studies regarding the delayed loading protocol.
Conclusion: The results of this study suggest that favourable
implant success rates and marginal bone changes can be achieved
with immediately provisionalized maxillary premolar single
implants in edentulous ridges.

63
Long-term retrospective analysis of marginal bone loss
and implant failure of MIS external HEX implants
J. Ekstein*, M. Tandlich and L. Shapira
Hadassah Medical Center, Jerusalem, Israel
Objectives: The aim of the study was to retrospectively evaluate
bone loss and success rate of external hex implants (MIS) and to
construct a multivariate correlation model between implant
variables (time, smoking habits, xed/removable prosthesis,
implant dimensions) and bone loss.
Methods: Patients that had completed at least 30 months of
follow-up were recalled for clinical and radiographic
examination. The radiographic bone loss was measured, and used
to calculate the actual bone loss.
Results: Thirty-four out of 52 patients were available, with total of
74 implants. Follow-up time range was 3084 months (mean 45.8).
Two patients were smokers, and in seven patients the procedure
involved bone augmentation. Two implants failed at the rst
healing phase (3% early loss), and none were lost through time of
function, exhibiting an overall success rate of 97%. The average
number of exposed threads was found to be 1.4 0.93 (03.5) and
the average radiographic bone loss was 2.35 0.87 mm (0.74.4).
No correlation was found between the time of service and crestal
bone loss. From the all tested variables, only removable prosthesis
was found to be positively correlate with bone loss (P = 0.002).
Conclusions: The results of the present study conrm that MIS
external hex implants exhibited an overall success rate of 97% in a
long-term follow-up period. Except for the prosthesis type, none of
the other suspected variables were found to inuence crestal bone
loss.
Acknowledgement: Supported by MIS Implants.

133

Posters: Implant therapy

64
Crest expander-the use of distraction osteogenesis as
an alternative technique to bone augmentation

66
Stabilizing of the extraction clot to promote alveoler
ridge resorption

Z. Laster*, A. Rachmiel and O. T. Jensen

Tiberias, Israel; Haifa, Israel; Denver, USA

A. Arab Oghli*, L. Gallardo, E. Patellis and H. Steveling

University of Heidelberg, Deutschland, Germany

Aim: To introduce a new device and technique to widen a narrow

alveolar crest prior to implantation.
Materials and methods: A new distractor was used to widen
a narrow alveolar crest. Under local anaesthesia, three
mucoperiosteal incisions were performed. One along the crestal
ridge and two vertical incisions at the anterior and posterior buccal
aspects. Through these incisions, bone cuts were made without
stripping the mucoperiosteum. The bone transport was fractured
by an osteotome and the distractor was inserted into the crestal
bone cut. Distraction started 7 days post-op and was stopped when
adequate width was achieved. Consolidation period was 1 week
and then removed under local anaesthesia. Implants inserted at the
same session.
Results: Study group consisted of 19 patients who suered from a
narrow alveolar crest. Crest widening ranged from 46 mm.
Distraction periods ranged from 1016 days. Latency period was
7 days. Total of 57 implants were inserted. No complications were
observed. No complications were observed 1830 months after
prosthetic treatment.
Conclusions: Crest widening by distraction may be a better
alternative to bone augmentation in cases of narrow crest with
sucient height. The advantages of the new technique are: early
implant placement, simple procedure, no painful donor site, no
post-op bone resorption, the technique can be easily performed in
the private oce. A long-term and multi center trial is needed.

The stabilization of the extraction clot is becoming more important

to promote ridge preservation after tooth extraction. The aim of
this study was to evaluate whether alveolar ridge resorption
following tooth extraction could be reduced using absorbable
collagen matrix impregnated with gentamicin and sealed with an
autogenous soft tissue to stabilize the extraction clot, compared to
the natural healing by using a classic extraction technique. 110
extraction sites were including. Three Groups were compared:
classic technique (Group A, n = 50), atraumatic extraction sealing
the socket with autogenous soft tissue graft (Group B, n = 33),
and atraumatic extraction with gent-coll plug and soft tissue
sealing (Group C, n = 27). Casts were used to measure the width
of the alveolar bone at the extraction area. The clinical measurement before and 3-month after the extraction revealed a loss of
bone weight of 2 1.48 mm in Group A, a loss of 0.34
0.18 mm in the group B and a loss of 0.16 0.066 mm in the
group C. The bone loss in group B und C was signicantly less than
that in Group A (P < 0.05). After 10 days, all grafts from group C
and 20 from group B were vital. Based on the present observations,
connective tissue grafts sealing fresh extraction sites signicantly
reduced ridge resorption following tooth extraction and created an
increased width of keratinized tissue and the local application of
gentamicin stimulated more vascular in-growth in the granulation
tissue beneath the graft.

65
Prospective evaluation of hard- and soft-tissue
remodelling after ridge preservation with and
without primary wound closure
D. Engler-Hamm*, T. Griffin, W. Cheung and A. Yen
Department of Periodontics, Tufts University, Boston, USA
Background: A signicant problem of ridge preservation
procedures is the loss of attached keratinized tissue on the buccal
side due to ap advancement when primary closure of the
extraction socket is attempted. The present RCT investigates
hard-, and soft-tissue changes after ridge preservation using
PepGen, DFDBA and ADAPT with and without primary wound
closure.
Materials and methods: Twenty patients are enrolled in this clinical
prospective randomized controlled trial that compares the guided
membrane exposure
(test) method with the ap advancement
method
in a split mouth design. The changes of keratinized tissue,
bone width and height and postoperative discomfort are evaluated
over a period of 6 months.
Results: By the time of the presentation approximately 15 patients
will have had bilateral ridge preservation. Several cases will be
presented and the evidence and applicability of ridge preservation
will be explained. The surgical method and the signicant
dierence in postoperative discomfort and swelling will be
presented for each site. The initial clinical results will be
presented together with obtained histological sections.
Discussion: It seems that the guided membrane exposure
method
has signicant advantages in regards to preserving the keratinized
tissue and decreasing postoperative discomfort and swelling
without having a negative impact on the amount of preserved
bone volume.

134

67
Preliminary clinical results with zirconium oxide
dental implants in humans
J. Oliva*, X. Oliva and J. Oliva
Clinica Oliva, Spain
There is extensive literature in prosthetic dentistry showing the
optimal biocompatibility, aesthetics and long term results with
zirconium oxide. However there is little literature about zirconium
oxide in implant dentistry. The aim of this communication is to
present the preliminary clinical results of a zirconium oxide dental
implant. Also to analyse the initial in vitro and animal investigations made with this implant. The zirconium oxide implants used in
these in vitro and animal investigations, as well as the clinical tests,
were specially designed and made for this purpose. The composition, design and surface characteristics will be presented. The
preliminary results in the clinical test have shown an optimal
gingival health without inammation or bleeding on proving, no
implant mobility, and no pain on percussion. Also the x-rays have
shown no loss of bone around the implants. The aesthetic results
have been considered very well. The in vitro investigations have
shown a good biocompatibility of the material, and a good fatigue
resistance of the implants. The animal investigations have proven a
good osseointegration and no foreign body reaction or encapsulation of this zirconium oxide implant. From all the results of the in
vitro, animal and clinical tests we can conclude that this zirconium
oxide implants are a good alternative to conventional titanium
implants, especially in patients with metal allergies or when there is
an important aesthetic component.

Posters: Implant therapy

68
Preliminary results on the syncrystallization technique
for fixed provisionalization of immediately loaded
implants: a twelve months follow-up
M. Degidi*, P. Gehrke, A. Spanel and A. Piattelli
Private Practice, Bologna, Italy
Aim: The objective of this article was to evaluate a prosthetic
concept for an accelerated rigid splinting of multiple implants for
same-day immediate loading with metal-reinforced provisional
restorations using a novel technique of welding temporary implant
abutments with a pre-fabricated titanium bar directly in the oral
cavity (Syncrystallization).
Materials and Methods: Immediate loading of threaded implants
with a metalreinforced, acrylic resin provisional restoration at stage
one surgery was evaluated in 40 consecutive patients. A total of 192
implants were placed in selected edentulous or partially edentulous
patients using the Syncrystallization technique. Once the titanium
bar was welded intraorally to the abutments, opaque was applied and
the provisional restoration was relined and screw-retained the same
day. In addition, a comparison of deformations and stress distributions in implant-supported, metal-reinforced and non-metal-reinforced resin provisional restorations were analysed in the edentulous
mandible by a three-dimensional nite element model (FEM).
Results: All of the 192 rigidly temporized immediately loaded
implants osseointegrated. An implant success rate of 100% was
achieved over a period of 6 months post placement. Compared to
mere acrylic superstructures, a signicant reduction of deformation
and strain within metal-reinforced provisional restorations was
detected by FEM analysis.

69
Using a space maintaining biodegradable membrane
for guided bone regeneration a novel method for ridge
augmentation
Z. Mazor D.M.D
Private Practice, Ra'anana, Israel
Reconstruction of the decient alveolar ridge requires using a
space-maintaining barrier to promote osseous regeneration.
Guided bone regeneration using a space-maintaining E-PTFE
membrane had been successfully incorporated into the dental
practice with predictable long-term results. One of the disadvantages reported with using this membrane is premature exposure
followed by infection and graft resorption. A new biodegradable
PLGA\TMC copolymer membrane with a space maintaining
physical properties and a lasting barrier function of 12 weeks is
reported. Fifteen patients requiring lateral and vertical bone
regeneration were treated with the new membrane. Exposure of
the treated sites 36 months post operatively revealed new bone
formation in the regenerated defects as shown in histological bone
cores taken. One-year follow-up of the regenerated sites with dental
implant placement showed no signs of crestal bone resorption.
Within the limits of this study it can be concluded that using a
biodegradable space maintaining membrane should be considered
as an alternative treatment option to the nonresorbable barriers.

70
A 5-year life table analysis from a prospective study on
the treatment of edentulism in the posterior region by
short (68 mm) SLA ITI implants
P. Filippini* and A. Fanti
Private Practice
The aim of this prospective study is to report a private practice
experience on the use, as an alternative to advanced surgical

techniques, of short (68 mm) SLA ITI implants placed in the

posterior region and loaded for at least 1 year. Starting from
January 2000, 36.6 mm, and 76.8 mm implants were placed in the
molar and premolar area in 68 patients, following a standard
surgical procedure. The purpose was to replace single or multiple
missing teeth. The prosthetic procedures started after 6 weeks and
the functional load with acrylic prosthesis was applied after about
8 weeks. After at least 3 months of progressive load, metal-ceramic
crowns or bridges were placed on implants. Six millimetre implants
were never used for single replacement and were always connected
to longer implants (8 mm or more). When two or three implants
were placed in the same area, a rigid prosthetic connection was
always used, as well during the period of progressive load. Implanttooth connection and cantilevers were avoided. Bone level was
recorded, through peri-apical radiographs, at the time of surgery,
before prosthetic load and after every year. At the present no
implants were lost; two implants (4.1 8 mm) dont satisfy
Albrektsson criteria, with a cumulative success rate of 98.2%
(100% for 6 mm and 94.7% for 8 mm). The present study shows
that, within the condition described, the use of short SLA ITI
implants in the treatment of posterior edentulism is successful in a
medium-term period.

71
Histomorphometric analysis of bone formation after
maxillary sinus floor augmentation using a ground
cortical bone allograft
R. Kolerman*, H. Tal and O. Moses
Department of Periodontology, Tel Aviv University, Israel
Background: Grafting of the maxillary sinus oor has become a
common procedure for increasing alveolar bone height.
Demineralized freeze-dried bone allograft (DFDBA) has limited
eectiveness for such procedures. (AO sinus graft consensus
conference 1996).
Aims: To evaluate clinically, histologically and histomorphometrically the eciency of a Freeze Dried Bone Allograft
(FDBA) in sinus lift procedures.
Materials and methods: The lateral antrostomy technique with
FDBA (Oragraft Life-Net) allograft and collagen membrane was
used. A double (internal-external) collagen membrane was used in
16 cases. Core biopsies were harvested 9 months after sinus oor
augmentation. Biopsies were stained with H&E and Mallory.
Histomorphometrical measurements were made using the pointcounting procedure. Each section was examined using a projection
microscope (Visopan). The percentage fraction of each of the
following tissues: newly formed bone, residual graft material, bone
marrow and connective tissue) was calculated for each section.
Results: Graft particles were observed in all specimens surrounded
by newly formed bone in direct connection or by soft tissue
marrow. The histometrical analysis of the sections showed an
average new bone formation of 37%, residual graft particles of
18% and connective tissue of 45%.
Conclusion: FDBA (Oragraft) is comparable to DFDBA
Allografts or Deproteinized Bovine Bone Mineral Xenograft for
sinus lift augmentation procedure.

72
Papillon-lefvre syndrome: a case report of the 12-year
boy treated by tissue engineering method
J. Slapnicka*, A. Fassmann, L. Holla and P. Augustin
Masaryk University, Brno, Czech Republic
A case is reported of periodontal 12-year-old patient diagnosed with
Papillon-Lefe`vre Syndrome. Papillon-Lefe`vre syndrome is a very
rare autosomal recessive condition characterised by pronounced
palmoplantar hyperkeratosis and severe early onset periodontitis,

135

Posters: Epidemiology and delivery of care

leading to early loss of teeth. Our patient presented with palmoplantar hyperkeratosis, intraoral examination revealed parodontitis
with generalized recession, periodontal pocketing and severe mobility aecting most of the teeth. Panoramic radiograph conrmed the
presence of generalized destruction of the alveolar bone around the
permanent dentition with maximal manifestation in regions of
incisors and 1st molars. Among the possible treatment modalities,
we decided for surgical approach by tissue engineering with
concomitant systemic antibiotic therapy. For reconstruction of
alveolar bone and the periodontium we used an organic bovine bone
(Bio-Oss) mixed with autologous platelet rich plasma (PRP), which
was activated by tissucol. Today, PRP remains the sole growth factor
preparation for tissue engineering available for clinical practice.
Periodontal tissue engineering by means of an organic bovine bone
and PRP is one of the best alternatives in the treatment of
periodontal destruction associated with Papillon-Lefe`vre syndrome.

73
A 210 years study of 527 implants placed directly into
extraction sockets
T. Eccellente, M. Piombino, A. Rossi and S. Capasso*
Private Practice, Grumo Nevano (NA), Italy
Aim: To determine the long-term survival rate of 527 dental
implants placed into extraction sockets.

Methods: Between 01/94 and 11/02, 309 immediate implants and

218 delayed implants were placed in 247 patients. Three dierent
Implant System were used (42 Branemark Implants; 207
Straumann Implants and 278 Ankylos Implants). Bone
augmentation procedures were combined with implant
placement. After conventional healing period all implants
were osseo-integrated from clinical and radiographic point of
view and xed restorations were inserted. In dierent time
intervals mPlI, mSBI, standardized peri-apical radiographs,
technical complications and patients
satisfaction have been
registered.
Results: Twelve patients with a total of 19 implants were not
present to recall. During a total observation period of 4.7 years
(range 210 years), 20 implants were lost and the cumulative
survival rate was 96%. The majority part of implants presented
healthy peri-implant soft tissue conditions (mPlI > 1, mSBI < 1)
and stable peri-implant bone level. Twenty-one patients reported
technical complications. Fourteen patients were not satised with
the aesthetic result.
Conclusion: Immediate implants positioning is a predictable
method to restore missing teeth with high survival rate. Technical
complications can have a negative inuence on the patients
comfort. The internal-tapered implant-abutment connection can
have a positive inuence on the healing and long-term stability of
peri-implant tissues.

Posters: Epidemiology and delivery of care

74
An investigation of localized aggressive periodontitis
prevalence among 1119 years. students in mashhad
city, Iran
H. Ghanbari* and M. Radvar
MUMS University, Mashhad, Iran
Background: The aim of this study was to evaluate the prevalence
of localized aggressive periodontitis (LAP) among an Iranian
population.
Materials and methods: From a total of 15 237 junior high-school,
and high school of six educational districts of Mashhad City,
cluster sample comprising of 3909 1119 years. Subjects including
1726 female and 2183 male students were clinically examined. Fullmouth periapical radiographs were taken for putative LAP subjects
before a denitive diagnosis of LAP was established.
Results: Nine subjects were diagnosed as LAP. The overall
prevalence of LAP was 0.23%. The female to male ratio was 3.5 : 1.
Conclusion: The prevalence of LAP in Iran population
corroborates with previous reports on other ethnic/racial groups.

75
Changes of the oral hygiene habits, knowledge and
attitudes of the patients after active periodontal therapy
M.
zer*, T. Kse and G. Atilla
University of Ege, Turkey
Aim: The aim was to assess the changes about oral hygiene habits,
knowledge and attitudes of patients after active periodontal
therapy.
Methods: One hundred patients from middle/lower socioeconomic class, 1472 years old, were recruited from patient pool
of Ege University Dental School. During periodontal therapy, all

136

patients were given oral hygiene instruction. Their toothbrushing

and interdental cleaning attitudes were observed 6 months after
therapy. Patients answered to structured questionnaire including
information about social-demographics, oral hygiene knowledge
and attitudes, and dental visiting habits. Chi square or Fisher exact
test was used to analyse the relation between questionnaire data
and oral hygiene attitudes.
Results: Majority of patients (94%) never visited a dentist unless
they have dental problem. All patients reported to brush their
teeth, but only 76% were brushing with proper technique twice a
day. Seventy-two percent of patients reported to use interdental
hygiene aids, however 57% were using them properly. Patients who
were performing adequate interdental cleaning were also brushing
their teeth properly.
Conclusion: It appears that classical intervention based on
information and training about oral hygiene techniques is not
enough for the long-term eectiveness of this intervention. Other
than knowledge and training could play a role in oral hygiene
attitudes. We suggest that educational intervention needs to be
improved perfectly in periodontal patients.

76
Prevalence of osseous defects on a population of
patients undergoing periodontal surgery
J. Delgado*, M. Vicario, A. Pascual and A. Santos
Universidad internacional de Catalua, Spain
Introduction: Periodontitis causes osseous destruction resulting in
architectural changes in the alveolar supporting bone, reducing
stability and dental support. Those osseous changes or defects can
be found in very dierent ways, as their morphology and
aggressiveness can vary from one tooth to another, or between
surfaces of the same tooth.

Posters: Epidemiology and delivery of care

Aim: The aim of the study is to know the prevalence and
distribution of osseous defects, in patients from the periodontics
area of the universidad internacional de cataluna dental clinic, who
undergo periodontal surgery.
Materials and methods: The study includes 130 patients above
18 years, with periodontal surgery done, excluding those with
systemic illness that could aect alveolar bone such as
osteoporosis. Probing depth is registered previously and during
surgery, and defects are classied by direct vision using various
classications.
Results: In 130 surgeries, 248 defects have been found. Most
prevalent defects are intraosseous, and from these, the crater or
two wall defects are the most prevalent (88). Maxillary defects are
more frequent than mandibular and most of the patients with
osseous defect were smokers.
Discussion and conclusion: We observed a great prevalence of two
wall-defects, which means that most of these defects wouldnt have
been detected unless a surgical therapy was performed.

77
The evaluation of patient profile and satisfaction
(a pilot study)
M. Kucukcoskun*, U. Baser, G. Aykol et al.
University of Istanbul, Istanbul, Turkey
The satisfaction of the patient and the quality of the treatment are
accepted to be related. A detailed assessment of patient satisfaction
plays a major role in revealing the quality of the treatment. In this
study, the relation between the patient satisfaction and the social
and medical prole a group of Turkish patients are evaluated. To
assess the patient prole and patient satisfaction two separate
questionnaires were used. The rst one used for evaluating the
prole of the patient and it is divided into two sections: social
prole and medical prole. The second questionnaire used for
evaluating the patient satisfaction. Subjects were chosen from
Istanbul University School of Dentistry Periodontology Department (From Periodontal Surgery Clinic 31, student Clinic 70
patients). Sixty-seven percent of the patients were chronic periodontitis, 25% gingivitis, 3% aggressive periodontitis and 5% have
mucogingival problems. As a result, 56% of the patients mentioned
that they were very satised with the attitude of the dentist. In this
group, the graduation from high school and university was 56%.
Six percent of the patients mentioned that they had too much pain,
also it is found that sex is not related with pain. In this study
population, it seems that a general satisfaction of the patient group
have obtained from the treatment that they received.

Perception of oral health is at a higher level because more of 80%

of them think oral hygiene is necessary and believe they practice it
properly. Motivation to keep the natural teeth is also at higher level
but although 82% would seek conservative treatment instead of
extraction when toothache occurs, still the toothache is the main
reason for dental visits (53%) instead of check-ups. Knowledge,
habits and motivation positively correlate with clinical status of
oral health. Only 20% of population did not need any dental
treatment.
Conclusions: Although perception of oral health and motivation
are at higher level, low-level perception of oral diseases must be
improved by educational public dental program.

79
Survey of members of the French society of
periodontology on bone grafts and implant materials
H. Tenenbaum* and S. Bronner
Department of Periodontology, Dental Faculty, Strasbourg, France
Objective: The aim of the present survey through questionnaires to
members of the French Society of Periodontology (SFPIO) was to
determine the use of bone grafts and implant materials in
periodontal and implant indications.
Materials and methods: An anonymous questionnaire has been
send to the 800 members of the SFPIO registered in 2003. The data
were collected between May and October 2004.
Results and Discussion: A total of 307 exploitable questionnaires
were returned to give a 38% response rate. The results show a great
implication of university institution in periodontal post-graduate
training, which contrast with a lack of university-based
implantology training. Autogenous bone graft is still the gold
standard both in periodontology and implantology. Of the wide
range of implant materials, Perioglas (in periodontal indications)
and Bio-Oss (both in periodontal and implant indications) are by
far the most frequently used. On the other hand, in contrast with
some Anglo-Saxon countries, the use of allogenic grafts is
insignicant in France. The most frequent indications of bone
grafts and implant materials use are three-wall periodontal lesions
and pre- or per-implant placement. It is comforting to notice that
the choice of the clinicians is mainly inuenced by research
publications and very few by the eects of marketing by
companies. The use of bone grafts and implant materials is fully
part of the treatment facilities oered by a large majority of
members of the SFPIO.

78
Knowledge, motivation and habits in oral hygiene in
relation to oral health of young people in Croatia

80
Compliance with supportive periodontal therapy in
patients with periodontal disease at university of
Valencia

S. Spalj, D. Plancak*, H. Juric and S. Srdjak et al.

School of Dental Medicine, University of Zagreb, Croatia

A. Pujol*, F. Gil, V. Fuenmayor, P. Buitrago and F Alpiste

Department of Periodontics, University of Valencia, Spain

Aims: The main condition for establishment and maintenance of

oral health is patient who is educated and motivated in oral
hygiene. The aim of this study was to assess the knowledge,
motivation and habits in oral hygiene of young people in relation
to dental status.
Materials and methods: The assessment was conducted in
the sample of 750 individuals aged 1828 in Croatia using the
questionnaire and clinical examination according to the
recommendation of the WHO.
Results: Oral health habits of Croatian young men do not satisfy
because only 57% of them brushed their teeth twice a day, only
10% used auxiliary devices and less then half went to dental checkups. Oral health knowledge is limited especially in periodontology.

Introduction: Professional maintenance care is important in

preventing further periodontal breakdown. In these visits the
clinical parameters are controlled, as well as risk factors. The
knowledge of the prole of the patient and degree of compliance of
supportive periodontal visits will help us in the daily practice.
Aim: To know the variables that inuence the compliance of
patients treated at Department of Periodontics at University of
Valencia.
Materials and methods: Data were obtained from 400 records of
patients seen over 12-year period. All of the patients had received
hygienic treatment and had been informed about the importance of
realizing periodic supportive periodontal visits. Analysis was made
to correlate the degree of compliance with gender, age, level of

137

Posters: Epidemiology and delivery of care

studies, distance university-residence, origin of the patient, care
seeking, periodontal disease diagnosed, severity of periodontal
disease, type of treatment received, systemic diseases and smoking
habits. Descriptive and statistical analysis of the population is
realized.
Results: 25.4% were found to be complete compliers, 11.1% were
erratic compliers, 33.3% never initiated maintenance visits and
30.2% have initiated it but later they dropped out. The statistically
signicant variable with compliance of maintenance periodontal is
severity of periodontal disease.
Conclusions: We will have to be aware in insisting the importance
of supportive periodontal treatment in those patients with early
periodontal disease.

81
Oral hygiene aids: which are used by persons before a
group prophylaxis? results of a questionnaire
S. Mattysek*, D. Ziebolz, E. Hornecker and R. F. Mausberg
ZMK, University of Goettingen, Germany
In preventive dentistry oral health education increasingly gains in
importance. One aspect is giving competent and customized
information on oral health aids. As a stock-taking we investigated
which aids are used by persons before receiving corresponding
advice. Oral health behaviour was assessed with a standardized
questionnaire before starting a group prophylaxis. A total of 196
persons aged 1157 years (25.9 years) participated: 65 pupils,
students, trainees; 71 university students; 60 employees. 92 were
males and 104 females. Tooth brush: 54% of the students and
trainees used a standard head, a short head was used by half of the
university students and to the employees this item did not matter
(55%). The results were signicant (P < 0.001). The females as a
whole preferred using a short head brush. Relating to the brushing
prole this item did not matter to the students and trainees (53%),
half of the university students stated using a brush with a jagged
prole. The employees used to 43% at and to 45% jagged proles.
Some of the dierences were signicant (P < 0.05). Dental oss:
74% of the students and trainees, 42% of the university students
and 73% of the employees never ever performed ossing, whereas
35% of the university students used dental oss, mainly unwaxed
oss. The results show that competent information on oral health
aids should mainly focus on the use of dental oss and further aids
for interdental cleaning.

82
Oral hygiene aids: which are preferred by dental
professionals? results of a questionnaire
G. Gressmann*, D. Ziebolz, E. Hornecker and R Mausberg
ZMK, University of Goettingen, Germany
In preventive dentistry oral health education increasingly gains in
importance. One aspect is giving information on oral health aids.
This responsibility applies to the dental professionals. Therefore we
investigated which aids they use and if there are dierences between
the occupational categories. Oral health behaviour was assessed
with a standardized questionnaire during a dental meeting on
prevention. A total of 160 dental professionals including 55
advanced dental students participated (79 dentists, 26 dentists
assistants). Tooth brush: The size of the head was important for the
majority of the interviewees (88%), whereas most of them preferred
a short head (78%) and 10% a standard head. The dierences
between the occupational categories showed a slight signicant
tendency (P = 0.055). Relating to the brushing prole one third
preferred a at prole, another third a jagged and for the last third
this item did not matter. The dierences between the occupational
categories were not signicant (P = 0.55). Dental oss: 84% of the

138

dental professionals performed ossing, mainly with unwaxed oss

(52%). The dentists assistants used signicant more waxed oss
than dentists (P = 0.03) and students (P = 0.01). Tongue cleaner:
13% of the participants stated using this aid, half of them were
dentists. The results show that most of the interviewed dental
professionals choose their own oral hygiene aids carefully. This
result meets good requirements for reliability in oral health
education.

83
Oral malodor in children
A. T. Karaman, E. nsal* and C. Grgan
Ankara University, Department of Periodontology, Turkey
Objective: Oral malodor is a problem both for adults and children.
The purpose of this study is to determine the relationship between
oral malodor, tongue coating and periodontal parameters in
children.
Materials and Methods: The study included 620 children (306 girls
and 314 boys) aged between 8 and 12 years. Malodor related
parameters included volatile sulphur compounds (VSC) measured
with a portable sulphide monitor (Halimeter). Periodontal related
parameters included periodontal screening and recording (PSR)
and tongue coating index. (TCI). The relation between VSC, PSR
and TCI were tested with Spearmans Correlation Analysis.
Results: The VSC scores for girls was 203.54 91.45 ppb and
203.56 93.84 ppb for the boys. The average PSR values for girls
and boys were 0.66 0.75 and 0.69 0.74 respectively. For all
evaluated parameters there was no signicant dierence between
the genders. The tongue coating index was 1.73 0.84 and
1.67 0.89. According to the results of the correlation analysis,
there was a signicant relation between VSC, PSR (r = 0.329,
P 0.001) and tongue coating (r = 0.606, P 0.001).
Conclusion: Our data suggested that as in adults, oral malodor in
children is associated with tongue coating. Particular emphasis
must be placed on cleaning the tongue surface for the treatment of
malodor in children.

84
Prevalence of periodontal diseases in the Belgian army
B. Dombret* and M. Moradi Sabzevar
Belgian Armed Forces; Free University of Brussels, Belgium
The aim of the study was to assess the periodontal status of the
Belgian military population. The survey was conducted using the
Community Periodontal Index of Treatment Needs (CPITN). A
total of 484 military personnel belonging to the 10th Tactical Wing,
on recall for a routine Annual Dental Inspection, participated in
the study. Lifetime of the participants ranged between 21 and
56 years. 14.5% of the population presented pockets at least 6 mm
deep (CPITN 4); 40.2% showed pockets ranging between 4 and
5 mm (CPITN 3); 45.2% showed no pockets exceeding 4 mm
(CPITN 0, 1 and 2). Calculus or plaque retaining factors with no
pockets exceeding 4mm (CPITN 2) could be detected among
41.5% of the population. When analysing CPITN scores according
to age, CPITN 4 could be detected in 1.8% of the people 21
29 years old, in 10.6% of the people 3039 years old and in 22.9%
of the people 4056 years old. These results are at variance with an
epidemiological survey conducted in Belgium among hospital sta
members (Bercy et al., 2002) where a CPITN 4 was detected among
29.7% of the population 3544 years old, among 39.7% of the
population 4555 years old and among 55.9% of the population
aged 55 years or more. The lower prevalence of CPITN 4 cases in
the Belgian Army compared to a non-military Belgian population
could be explained by the regular dental recalls to which Belgian

Posters: Epidemiology and delivery of care

military patients are submitted, resulting in a better on time
treatment of periodontal diseases.

85
Oral health status in elderly institutionalized adults in
arcos de valdevez district, Portugal
J. Frias-Bulhosa*, A. M. Matias, S. Gavinha, P. Melo and R. F. Almeida
Faculty Health Sciences, University Fernando Pessoa, Portugal
The main purpose of this study was to investigate the periodontal
status and oral hygiene, in 503 old adults (76.6% was women),
institutionalized in 10 community hospitals in Arcos de Valdevez
district in Portugal. All examinations were carried out within the
PASOP
(Ambulatory Project of Oral & Public Health) of the
University Fernando Pessoa (UFP) and were conducted according
to WHO criteria for oral health surveys. The Periodontal status
was assessed by the CPI index and the oral hygiene habits through
a questionnaire. All data was analysed by SPSS 12.0. The results
indicate that 39.4% of the sample was edentulous and the tooth
mortality rate was 70.2%; 71.8% of the individuals have an
inappropriate method of teeth and prostheses hygiene. In 95.6% of
the individuals has gingival bleeding: 82.1% had presence of
calculus, in 68.2% had shallow periodontal pockets and 40.2% had
deep periodontal pockets. The daily oral hygiene habits occur in
only 73.4% of the individuals. The OCDE perspectives about the
demographic evolution of the elderly people (>60 years) in
Portugal for the next 50 years, with an estimated increase of
37%, and take attention that the oral hygiene habits and the assess
to oral health consultation in Portugal are desadequated to adults
needs and indicates that it is necessary a change of strategies in
planning and organising the dental services attending the particular
attention need for the elderly persons.

86
Significance of dentist-patient-communication in
dentist's education and work
P. Ratka-Krger*, D. Deimling and B. Schacher et al.
Department of Periodontology, University of Freiburg and Frankfurt,
Germany
Aims: The aim of our investigation was to survey the signicance
of dentist-patient-communication particularly with regard to
integrating communicative topics into dental education.
Materials and methods: Patients, dentists and students were
questioned on communicative issues using questionnaires. After
the students had been given a 45-min lecture on a didactic training
program in patient management, they were again asked to ll in a
second questionnaire.
Results: A total of 730 questionnaires were available for evaluation
(233 dentists, 185 patients, 312 students). Eighty-six percent of the
patients and 87% of the dentists supported an integration of
communicative issues into dental university education. Following
the lecture 85% of the students judged an extension of their
education to include communicative topics as important or very
important. Only 15% had no preference or considered it as of low
or very low importance. On a licert-scale (scaled from 1 to 5)
dentists found the friendliness of the oce sta (1.5) as important
as the professional competence (1.5), followed by detailed
informative talk (1.7) and modern instruments (2.6). Eighty
percent of the dentists and 51% of the patients attached vital
importance to the dentist-patient-relationship concerning therapy
outcome.
Conclusions: Since patients, dentists and students of dentistry all
agreed on the importance of the dentist-patient-communication,
this topic should become part of the dental curriculum.

87
The prevalence and severity of dental fluorosis and
periodontal disease in an above optimal and optimal
fluoride area of Sudan
AbdelRahman M. A. I. Ramadan*, A. Ibrahim and A. Ghandour
Khartoum College of Medical Sciences, Sudan
Objectives: Dental uorosis is a public health problem in many
part of the Sudan. A cross sectional study to determine the
prevalence of dental uorosis and to study the eect of uoride in
potable water on periodontal disease in an above optimal (Um
Duwanban) and optimal uoride area (Tiraat El-Bijah).
Materials and methods: A sample of 400 adults aged 1565 years
were randomly selected from life long residents of Um Duwanban
and Tiraat El-Bijah. The Modied Deans index was used to record
the dental uorosis on the two most aected teeth. The periodontal
status of the participants was determined using the gingival and
plaque indices. The probing pocket depth and loss attachment were
also measured.
Results: The mean uoride concentration in Um Duwanban was
1.36 mg/L and in Tiraat El-Bijah was 0.45 mg/L. The prevalence of
dental uorosis was 70% in Um Duwanban and in Tiraat El-Bijah
was 42.5%. All the periodontal parameters increased with age in
both communities. Except for the attachment level all the
periodontal parameters were statistical signicance (P < 0.05).
Conclusions: Findings suggest that there is a need for continued
monitoring of dental uorosis and further investigation into the
uoride intake from all sources in Sudan. There is a need to change
the drinking water supplies in the Um Duwanban area. The
uoride level in the potable water has no inuence of clinical
signicance on the periodontal parameters.

88
Baseline periodontal status, oral hygiene and smoking
habits in head and neck cancer patients
D. MacCarthy*, B. Glass and M. O'Regan
Trinity College, Dublin 2, Ireland
Periodontally diseased sites are a high risk for osteoradio-necrosis
following cancer therapy, especially furcation involved sites.
Aim: To assess the periodontal status and smoking habits of head
and neck cancer patients scheduled for radiotherapy.
Material and methods: Initial records for 287 patients were
reviewed.
Results: There were 64 females and 223 males with 61% in the 46
65 age group. The cancer diagnosis was squamous cell carcinoma
in 80% of cases. Forty-nine percent had never smoked cigarettes or
had quit long-term, 51% had stopped in the previous 12 months or
currently smoked. Sixty-nine percent of subjects had more than 16
teeth, 44% had a plaque score of >81% and 4% had a bleeding
score >81%. The highest CPITN score was 0
in 1% of subjects,
1
in 5%, 2
in 23%, 3
in 39% and 4
in 31%. Associated
periodontal factors were gingival recession (39% of subjects),
furcation involvement (32%), mobility (2%) and gingival
hyperplasia (0.7%). Pre-radiation dental extractions were advised
for periodontal reasons in 43% of cases.
Discussion: A highest CPITN score of 4 was recorded in 31% of
individuals and 32% had furcation involvement. These clinical
ndings will have an impact on decisions regarding pre-radiation
extraction if aected teeth are in the eld of radiation.
Conclusion: Dental consultation and treatment prior to radiation
therapy to the head and neck are an important part of care of the
head and neck cancer patient.

139

Posters: Epidemiology and delivery of care

89
Epidemiological study of periodontal diseases
holistic approach
V. Burlui, S. Mrtu, A. Apostu* and M. Crusu
University of Medicine, Iasi, Romania
The aim: The research establishes the interrelations between
periodontal and systemic diseases (as possible risk factors).
Materials and methods: The epidemiological study was realized on
18 932 individuals, clinically investigated in collaboration with
WHO Collaborating Center for Oral Health Systems in Transition,
Iasi, as a national research for Romania, in 20022005 period.
Results: The values showed chronic periodontal diseases in 39.41%
cases, calculus index >1 in 14.41%, gingival hyper-growth in
9.98%, gingival recession in 21.49% associated with a cardiac,
metabolic and other chronic systemic diseases.
Conclusion: Systemic diseases have a direct inuence on
periodontal health status.

90
Oral health status and dental treatment needs among
non-institutionalized psychiatric patients
R. Dababneh* and F. Sayegh
King Hussain Medical Center, Amman, Jordan
Objective: To describe oral health status among noninstitutionalized psychiatric patients receiving long-term antipsychotic and anti-depressant drugs.
Method: Forty psychiatric outpatients were selected as a study
group on the basis of having chronic psychotic illness and on
neuroleptic medications for at least 2 years. The control group
consisted of 40 healthy patients who were selected to match the
study group by age and gender. Demographic characteristics,
smoking and brushing habits in addition to dental examination
including DMF-T, plaque index and CPITN were recorded for
each patient in both groups.
Results: Psychiatric diagnosis revealed that 57% were having
schizophrenia and 43% mood disorders; the mean duration of
illness was 11 years. Dry mouth was the chief complaint among
40% of the psychiatric patients. The mean indices for the study vs.
control groups were as follows, (9.07 vs. 8.65) for the DMF-T,
(1.96 vs. 1.55) for the plaque index and (2.3 vs. 1.97) for the
periodontal treatment needs. Filled teeth and plaque index score-0
were signicantly greater in the control group, while plaque index
score-3 and periodontal treatment need score-1 were signicantly
greater in the study group.
Conclusion: Oral health status of chronic psychiatric outpatients
seems to be worse than that of the mentally healthy population.
Mental health professionals should pay more attention to dental
care of outpatients.

91
Evaluation of the relationship between cholestorol and
triglyceride blood values and periodontal parameters in
patients of mashhad health center
S.A Banihashemrad* and A. Rafighdoost
Mashhad Dental school, Periodontal department, Mashhad, Iran
Although the causal link between peroidontitis and cardiovascular
disease is supported by some research and seems biologically
plausible, it remains a contraversial topic. Now the evidence
suggests that periodontitis once established, possibly provides a
biological burden of endotoxin and inammatory cytokines, which
serve to initiate and exacerbate atherogenesis and thromboembolic
events. The aim of this study was to evaluate the relationship
between periodontitis and blood level cholesterol and triglyceride

140

changes. Seventy-one patients took part in this study. For each

patient, a blood sample was taken and the level of the blood total
cholesterol, triglyceride and glucose was measured and a periodontal examination including of probing depth and bleeding on
probing was carried out. Statistical analysis of results suggested
that with increasing the level of total blood cholesterol, average
probing depth and percent of pockets more than 4 mm increased.
Although there were direct correlation between periodontal and the
measured biochemical parameters, none of these correlations
turned out to be a signicant. More research is needed to draw
any conclusion on the relationship between periodontitis and
hypercholestrolemia and hyper triglyceridemia.

92
Dental anxiety among patients referred for periodontal
treatments in hospital Rancagua, Chile
Alfredo Cueto* and Ricardo Muza
Universidad de Valparaiso de Chile
Background: Dental anxiety is an important component of distress
to patients in the dental treatments. Avoidance of dental treatment
due to anxiety is very common and may be associated with
deterioration of dental health.
Objective: To register specic anxieties by patients referred for
specialist periodontal treatment.
Materials and methods: The study was carried out among 176 new
patients referred for periodontal therapy at dental service, Hospital
Rancagua, during the moth of July and August 2005. Prior to
periodontal procedures by specialist completed an anxiety
questionnaire. All patients were included in the study, and their
levels of anxiety were assessed. Dental anxiety was evaluated by the
administration of a questionnaire based on the Corahs Dental
Anxiety Scale (DAS). Dentally anxious individuals were dened as
those with a DAS score 13 or more.
Results: Females recorded higher total DAS scores than males
(9.49 and 9.16 respectively). Patients in the 2434 years age group
showed the highest total DAS scores (9.25) followed by <24, 35
49, and >50 year age groups in descending order. The total DAS
scores for age groups 3539 and >50 years dier signicantly from
those of age groups <24 and 2434 years, but the 24 to 34-year
and <24 year age groups did not dier signicantly.
Conclusion: The periodontal patients referrals had moderate levels
of anxiety. In Chile a large percentage of the population avoids
dental treatment except when their feel severe pain.

93
An assessment of oral self-care among Romanian
dental students using the Hiroshima university dental
behavioural inventory
A. L. Dumitrescu, M. Kawamura and H. Sasahara*
UMF Carol Davila
, Hiroshima University Hospital
Objective: To determine the dierences in oral self-care levels
between 322 Romanian dental students.
Design: Cross-sectional survey of dental students. Setting:
Romania.
Participants and methods: The examination was based upon
responses to a questionnaire titled Hiroshima University
Dental Behavioural Inventory (HU-DBI)
and three additional
questions.
Results: Statistical signicant dierences of the mean HU-DBI
scores were observed between Years 1 & 2 (level of basic science
course) and Years 5 & 6 (level of clinical course) and between
genders (P < 0.001). Statistical signicant dierences were notable
in 10 items out of 20 between three levels of dental education
(basic, preclinical and clinical levels). The most striking results were

Posters: Periodontal systemic interactions

that Years 5 & 6 students were less likely to use a toothbrush which
has hard bristles (P < 0.001), and less likely to worry about the
colour of their teeth (P < 0.01). While 20% of Years 1 & 2
students reported daily ossing, almost 46% was reported in Year
5 & 6 students (P < 0.001). A signicant dierence was also
observed on ossing behaviour between genders (P < 0.001). A
total of 176 of 205 Years 14 students (85.9%) and 177 of 193
female students (91.7%) were correctly predicted by the models.
Conclusions: There were considerable dierences in dental health
attitudes/behaviour between the three levels of dental education
and between genders.

94
Periodontal destruction and oral health-related quality
of life among adolescents
R. Lopez* and V. Baelum
Faculty of Health Sciences, University of Aarhus, Denmark
Background: The need for appraisal of oral health related quality
of life (OH QoL) has been increasingly recognized over the last
decades. Our aim was to assess the association between periodontal
outcomes and the OH QoL in adolescents considering selected
socio-demographic correlates.
Methods: The data originated in a study conducted among high
school students from Santiago, Chile. The participants were
sampled using a multistage random cluster procedure yielding
9203 students. Clinical examinations comprised direct recordings
of clinical attachment levels and the presence of necrotizing
ulcerative gingival lesions. The students answered a Spanish
version of the Oral Health Impact Prole (OHIP-Sp), and the
headmasters of the schools provided information on monthly
tuitions and annuals fees for each school. The dichotomous
outcomes presence of attachment lost 3 mm
; and presence of
necrotizing gingival lesions
were computed and two multivariable
linear regression models for the OHIP-Sp total score were obtained
using the covariates age; gender; and annual education expenses.

Results: A total of 9155 students lled the OHIP-Sp. The

coecients of the linear regression models revealed that students
with attachment lost 3 mm (3.5) or necrotizing gingival lesions
(2.4); as well as older students (2.1); girls (2.0); and students from
schools with lower tuitions and fees (3.5) were more likely to have
higher scores for OHIP-Sp and consequently poorer OHQoL.

95
The new European credit system (ECTS): determinants
in dental students to acquire the periodontics
competencies to achieve the degree in dentistry
C. Machuca*, C. Suarez, L. Lpez, L. Chandler and P. Bulln
Dental School, University of Sevilla; University of Puerto Rico
The purpose of this innovative educational research project has
been to determine the total workload of students (TWS) needed to
acquire the competencies in the subject of Periodontics to obtain
the DMD degree. Eleven students developed an agenda o schedule
to establish the work time need to study the Periodontic subject.
Also the students classied and quantied the work performed for
the Periodontic subject course.
Results: The mean VTT of the student to acquire the competencies
was 19 377 (mean of presence hours 78 and 115.7 h not present at
class). The student employed a mean of 18.15 h for each week. The
student prole was studying alone, use of notes, highlighting,
performing schemes, no summaries, no use of books, and
performed reviews.
Conclusion: The equivalent number of European credits for the
Periodontic subject was 28.1 h of work for student by credit. The
mean grades about knowledge were not related to number of hours
dedicated to self-study neither to total workload of students. The
present study techniques used by dentals students need a change in
order to enhance performance in the new European credit
academic system (ECTS).
Acknowledgement: Supported by Educational Science Institution
(ICE).

Posters: Periodontal systemic interactions

96
Inflammatory cytokine production propensity of the
main inflammatory cells before and after periodontal
treatment
V. Tth*, T. Berki and A. Mukics
Department of Dentistry, et Department of Immunology, University of
P
cs, Hungary
In the case of a chronic periodontal destruction, the amount of
cytokines produced in the local tissues could be little worth to elicit
systemic damage. But it seems to be worth to determine the
interleukin production propensity of the main inammatory cell
lines, rather than the current sera interleukin level.
Aim of the study: Detection of IL1-b, IL6, IL8, IL-10, IL-12p70
and TNF-a production of Monocytes and Lymphocytes by BCA
method at patients with periodontitis gravis. Two assays were
carried out: rst before the beginning of the periodontal treatment
and then 6 weeks after the completion of treatment. The further
periodontal indexes were recorded: bleeding on probing (BOP),
periodontal pocket depth (PPD), gum recession (R), tooth mobility
(M), and furcation involvement (F).

Results: A slight but not remarkable increase of cytokine

production was detected with BCA method in the case of
periodontal patients. IL-6 production propensity showed the
most remarkable decrease 6 weeks after the periodontal
treatment completion. The production of other cytokines
decreased almost in all cases after the therapy but showed not a
coherent rather a diverse pattern.
Conclusions: Some consequent elevation in the macrophage
cytokine production at periodontitis patients was demonstrated
by the present study. This increased cytokine production
propensity could be present through the whole disease process.

97
Periodontal changes during pregnancy and post-partum
M. Latva-aho*, R. Pajukanta, T. Sorsa and E. Knnen
KTL and University of Helsinki, Helsinki, Finland
Aim: It is unclear whether pregnancy gingivitis exposes an
individual to periodontitis. Our aim was to examine
longitudinally the severity of periodontal changes during
pregnancy and post-partum.

141

Posters: Periodontal systemic interactions

Methods: Twenty-eight healthy women (age 2435 years) with
three visits during pregnancy (I: at 1214 weeks, II: at 25
27 weeks, and III: at 3438 weeks), and two visits post-partum
(IV: after delivery, and V: after lactation) were included in this
study. At each visit, visible plaque index (VPI), bleeding on
probing (BOP), probing pocket depth (PPD), and clinical
attachment level (CAL) were measured from six sites/tooth.
Results: VPI scores (mean SD) were 25.3 12.76% at visit I,
20.8 11.3% at visit II, 18.2 10.2% at visit III, 17.96
11.6% at visit IV, and 14.1 7.8% at visit V. The corresponding
percentage for BOP were 24.97 16.36%, 34.7 13.2%,
28.0 13.38%, 17.6 12.26%, and 7.9 3.53%, all changes
in BOP being statistically signicant. The increase in BOP between
the 1st and 2nd trimester (P = 0.0009) was not associated with
plaque. The mean number of pockets >3 mm increased from
0.18 0.78 at visit I to 12.1 10.99 at visit II (P < 0.0001) but
decreased to 8.24 9.54 at visit III (P < 0.05) and 2.3 4.42 at
visit IV (P < 0.05) and, further to 0.14 0.47 at visit V
(P < 0.05). No PPD >4 mm nor changes in CAL were detected.
Conclusion: Major changes in clinical parameters occur during the
2nd trimester. Pregnancy gingivitis develops regardless of the
amount of plaque, and pocket formation occurs transiently due to
gingival swelling.

98
Non-surgical periodontal therapy and lipid levels in a
population of Singaporean diabetics
H. K. Chee*, L. P. Lim, F. Tay, A. C. Thai and C. F. Sum
National Dental Centre, NUH, AH, Singapore
Diabetes mellitus is a known risk factor for periodontal disease.
Poor metabolic control of diabetes is associated with increased risk
for coronary heart disease (CHD). Periodontitis has also been
associated with CHD and a signicant association between
periodontitis and low HDL-C levels has recently been shown.
Aim: To determine the eects of non-surgical periodontal
treatment on serum lipid levels, as measured by HDL-C levels, in
diabetic patients.
Methods: In a randomized, clinical controlled trial, 84 diabetic
patients were examined at baseline and randomly subdivided into
three dierent groups of intervention [Group 1 scaling & root
planning plus oral hygiene instructions (OHI); Group 2 OHI
alone; Group 3 a control group without treatment or any OHI]
and then re-examined at 3 & 9 months later. Full mouth plaque
and gingival bleeding scores, serum lipid panel, serum HbA1c and
CRP levels were taken at all three visits. The total cholesterol:
HDL-C ratio and HDL-C levels were compared to baseline.
Results: A signicant and sustained improvement in periodontal
parameters was seen in groups 1 & 2 while group 3 only showed
minor improvement in percentage plaque. Group 1 also showed
some increase in HDL-C levels as compared to Groups 2 & 3.
Conclusion: Within the limits of this study, there were no marked
changes in the HDL-C levels for all the three groups at the review
visits. The improvement of oral health status is attributed mainly to
the modality of treatment rendered.

evaluated the impact of the duration of diabetes on periodontal

health and related systemic factors.
Aim: The aim of this paper is to assess the periodontal status of a
cohort of patients with diabetes of dierent duration.
Materials & Method: A total of 191 patients with diabetes were
recruited from two Diabetic centres. Subjects were examined for
plaque, bleeding, calculus and probing depths. Blood serum was
collected for analysis of HbA1c, Cholesterol and HsCRP (High
sensitivity C Reactive Protein). Subjects were categorised into two
groups (<10 years, 10 years and more) based upon the duration of
diabetes since diagnosis.
Results: A total of 117 subjects had diabetes for 10 years or less.
For these patients, the HbA1c values were lower and the number of
teeth present were higher than those who had the condition for
more than 10 years (P < 0.05). Only marginal dierences were
found for the other periodontal parameters. Similarly, there was no
marked dierence for the HsCRP and cholesterol levels.
Conclusion: The results of the study showed that although the
duration of diabetes have no direct impact on the periodontal
status, the importance of glycaemic control remains a major target
in the management of patients with diabetes and periodontal
disease.
Acknowledgement: Supported by NUS FRC Grant 222000017
112.

100
Bernard soulier syndrome with prolonged gingival
bleeding
I. Duran, S. Enhos*, K. Ustun, U. Caliskan and S. S. Hakki
Selcuk University, Konya, Turkey
Bernard Soulier Syndrome (BSS) is a rare autosomal recessive
disease, which is characterized by prolonged bleeding time,
thrombocytopenia, and extremely large platelets. A 21-year-old
female presented with a complaint of prolonged gingival bleeding
for 3 months. The case was diagnosed as BSS in Department of
Paediatric Haematology at the age of three. She was the second
child of the consanguineous healthy parents. Her younger female
sibling has also BSS and achondroplasia. In order to prevent
prolonged menstrual and/or spontaneous bleeding, hormonal
therapy, coagulant agents were prescribed. In intra-oral examination, the gingiva was oedematous and spontaneous gingival
bleeding was noted around the prosthesis in both maxillary and
mandibular posterior regions. The amount of plaque was not
consistent with the severity of gingival inammation. Haemoglobin, haematocrit level and the number of platelets were signicantly
low (Hgb: 6.1 g/dl Hct: 19.9% PLT: 76.000) when compared to
normal range values. Since the systemic condition of case was not
stable, thrombocyte transfusion and iron supplementation was
performed and concomitantly professional dental care including
scaling and polishing and daily irrigation with Chlorohexidine
gluconate was carried out for 1 week. To maintain gingival health,
monthly recall and additional oral irrigation device was suggested
to control plaque accumulation and gingival bleeding. Any
spontaneous bleeding was not observed at third month visit.

99
Duration of diabetes on periodontal status and serum
markers

101
Comparison of gingival crevicular fluid interleukin-8
levels in chronic periodontitis patients with or without
type 2 diabetes mellitus

F. B. K. Tay*, L. P. Lim, C. F. Sum and A. C. Thai

Dent Alex Hosp & NUH; Med, Alex Hosp & NUH, Singapore

B. F. Oduncuoglu*, S. Bulut and E. Alaaddinoglu et al.

Baskent University; Hacettepe University, Ankara, Turkey

Background: Diabetes has been recognized as a risk factor in

periodontal disease. While periodontal disease severity has been
found to be related to glycaemic control, few studies have

Chronic periodontitis (CP) is accepted as a complication of

diabetes mellitus (DM). Defects that can be seen in functions and
chemotaxis of neutrophils are reported to be related with the

142

Posters: Periodontal systemic interactions

severity of periodontal disease in diabetic patients. IL-8 has an
important role in restricting the destructive eects of plaque
bacteria by its chemotaxis eect on neutrophils. This study aimed
to determine IL-8 levels in gingival crevicular uid (GCF) of CP
patients (n = 15) which had been shown to have type 2 DM, CP
patients (n = 15) which were systematically healthy and patients
which were periodontally and systematically healthy (control
n = 24). Full mouth periodontal clinical parameters and GCF
sampling was done before and after Phase I therapy. ELISA was
used to determine the levels of IL-8. No signicant dierences were
seen between CP and DM groups regarding to GCF parameters at
baseline and after therapy. However, mean GCF volume was
found to be signicantly lower, and mean IL-8 concentration was
found to be signicantly higher in control group. A general
reduction in GCF parameters of CP and DM groups were seen
after therapy. The marked reduction of cytokines in GCF
following treatment observed in the present study suggests a
relationship between disease and cytokine production.

102
Periodontitis and markers of platelet activation
D. Papapanagiotou* and U. vd Velden et al.
ACTA, Netherlands; AMC, Netherlands
Background: Chronic inammation may result in increased platelet
activation, an important factor in atherosclerosis. Periodontitis is
epidemiologically associated with atherosclerosis.
Objective: To explore whether two markers of platelet activation
are increased in periodontitis.
Materials and methods: Plasma levels of sCD40 ligand (sCD154)
and sP-selectin (sCD62) from 62 moderate and 43 severe
periodontitis patients and 46 controls were determined. Age,
gender, race, smoking, cholesterol, BMI and education were
recorded.
Results: No signicant association between plasma levels of
sCD154 and periodontitis was found (P = 0.452). sCD62 was
modestly elevated in periodontitis; controls, moderate and severe
periodontitis patients showed median values of 52, 67 and 82 ng/ml
respectively (P = 0.006). Patients more frequently had plasma
levels of sCD62 above the 75th percentile value (84 ng/ml) of the
controls (34% and 49% for moderate and severe periodontitis
respectively, P = 0.014). In a regression model, cholesterol (P =
0.002), periodontitis (P = 0.024) and education (P = 0.030) were
explanatory variables for sCD62 levels.
Conclusions: sCD62 levels were related to the presence and severity
of periodontitis, therefore platelet activation may occur in patients.
However, the association found was not independent.
Furthermore, it cannot be excluded that the observed raise in
sCD62 is partially originating from endothelial cells, since sCD154
was not elevated in periodontitis.

103
Relation between periodontitis and rheumatoid arthritis
E. Odevoglu and M. Gursel*
Selcuk University, Konya, Turkey
Rheumatoid arthritis (RA) is a chronic destructive inammatory
disease characterized by the accumulation and persistence of an
inammatory inltrate in the synovial membrane that leads to
synovitis and the destruction of the joint architecture. Periodontitis
has a remarkably similar pathobiology to RA. The aim of present
study was to investigate a relationship between RA and periodontitis. Two groups, RA and control, were compared with regard to
medical and dental status. The study population was comprised of
73 individuals. RA group was comprised of 33 patients with proven
RA (nine males and 24 females) and control group was comprised
of 40 random patients, matched for sex and age (11 male and 29

females). All individuals had at least 12 teeth. The study subjects

were clinically examined by full-mouth probing depth, gingival
index, clinical attachment loss and plaque index. Also the number
of remaining teeth was recorded. The amount of alveolar bone loss
was measured by means of Shei ruler on panoramic radiographs
and dened as percentage. Statistical analysis of data revealed all of
the clinical parameters were signicantly higher in RA than control
group (P < 0.05). However the number of remaining teeth was
signicantly lower in RA group (P < 0.05). In conclusion, this
study highlights a potential relationship between two of the most
common and debilitating chronic inammatory conditions aecting humans. However, further analyses were needed to conrm this
relationship.

104
Study of the dental and periodontal health of children
suffering from leukaemia in northern Turkey
E. Esen*, A. Alkan and I Cengiz
Ondokuz Mayis University, Samsun, Turkey
Background: The relation between leukaemia and oral
manifestations has been the topic of many investigations.
Aim: The aim of this study was to evaluate the dental and
periodontal health status of 39 children suering from acute
lymphoblastic leukaemia (ALL) in Northern Turkey.
Materials and Methods: The female to male ratio in the study
population was 22/17 and mean age was 7.7, ranging between
4 months-2 years old. All the patients were under remissioninduction therapy. Periodontal examination was performed using
plaque and CPITN indices. Dental status was evaluated by using
dmf-t and DMF-T indices. Presence of oral lesions was also noted
in the routine intraoral examinations.
Results: Three patients had mucositis and another three had
localized gingival hyperplasia. The mean plaque index score was
1.42. CPITN scores revealed that 29% of the patients had healthy
gingiva; 63% of the patients had plaque who needed only oral
hygiene instruction and 7.9% of the patients had calculus who
needed scaling and oral hygiene instruction. The results of dmf-t
and DMF-T indices showed that 32 patients had decayed teeth
(n : 119), 13 had missing teeth (n : 28) and only four had lled teeth
(n : 5).
Conclusion: It may be concluded that, most of these hospitalized
leukaemic children had poor oral hygiene and dental status. They
needed proper oral hygiene instructions as well as decay treatment.
Since, presence of bacterial plaque and caries lesions might be lifethreatening.

105
Periodontal disease, preterm birth and low weight
children: a cross-sectional study
R. Fenoll*, M. Savoini and A. Santos
Universitat Internacional de Catalunya, Spain
Introduction: Several studies in medical literature report risk
factors related to preterm birth and low weight birth. Also
several reports and studies have been done in order to relate
periodontitis as a possible risk factor in preterm birth and low birth
weight.
Aims: The purpose of this trial is to establish a possible
relationship between periodontal status in 88 pregnant women
and the results of their pregnancy.
Material and methods: The sample was 88 pregnant women aged
between 16 and 38. Measurements recorded were: Age, race, height
(cm), weight (kg), number of children, number of pregnancies,
number of medical controls during pregnancy, and the mothers
periodontal status. Ramfjords Index Teeth (#16, #21, #24, #36,

143

Posters: Periodontal systemic interactions

#41, #44) were taken to record the grade of bleeding on probing,
mobility, probing depth and clinical attachment loss, in six
dierent points at each tooth. Once the child was born,
gestational time (weeks), child weight (g), length (cm) and type of
birth were recorded.
Results: Means of probing depth, clinical attachment loss, mobility
and grade of bleeding on probing, are evaluated in order to relate
them to preterm birth and low weight birth and analysed with the
analysis of variance anova.
Conclusions: It seems to be that low weight birth and low weight
infants are related to periodontal disease, but further investigation
would be necessary in order to relate the mothers periodontal
status with the pregnancy results.

106
Relations between periodontal disease, cytokine gene
polymorphisms, preterm birth and the intra-uterine
growth restriction in postpartum women
N. A. Cagli*, N. O. Alptekin and M. E. Erdal
Oral Dental Hospital, Mersin and Selcuk University, Turkey
Aim: The aim of this study was to evaluate the relations between
periodontal disease, cytokine gene polymorphisms; preterm birth
(PB) and intra-uterine growth restriction (IUGR) in postpartum
woman.
Materials and Methods: Out of 156 subjects, 64 subjects with
normal birth (NB), 45 subjects with PB and 47 subjects with IUGR
ranging in age from 18 to 34 years were included in this study.
Dental plaque, probing depth, bleeding on probing and clinical
attachment level was recorded and three groups were made:
healthy group (n = 46), mild group (n = 7) and periodontitis
group (n = 103). Polymorphisms of IL-1A (IL-1a+4845), IL-1B
(IL-1b+3954) and IL-1RN (IL-1ra) genes were determined with
polymerase chain reaction (PCR) and restriction fragment length
polymorphism (RFLP) analysis.
Results: As regards to the genotype frequencies of IL-1A and
IL-1B, no dierences were found between NB, PB and IUGR
groups (P > 0.05). In this study, we found that IL-1RN allel
2+
property was closely related with PB and IUGR (P < 0.05). There
was no relationship between IL-1A, IL-1B, IL-RN polymorphisms
and periodontal disease.
Conclusions: This data provide evidence that IL-1RN allel
2+
property and periodontal disease characterized with CAL are
associated with PB and IUGR.

107
Initial periodontal therapy on IL-1b levels in patients
with type II diabetes mellitus
F. M. Tun*, L. Kuru, B. Kuru, S. Ylmaz and . Noyan
Marmara University, Yeditepe University, Istanbul, Turkey
The aim of this study is to investigate the eect of initial
periodontal therapy (IPT) plus systemic doxycycline (DOC) on
clinical parameters and gingival crevicular uid (GCF) interleukin1 beta (IL-1b) levels in chronic periodontitis (CP) patients with
diabetes mellitus (DM) type II. Twenty patients and 10 medically
and periodontally healthy subjects were included. DM patients
were divided into two groups: Group 1 received IPT and DOC;
Group 2 received IPT only. At baseline and 7 weeks post-therapy,
plaque index, probing depth (PD), bleeding on probing and relative
attachment level were recorded, GCF samples were collected from
sites with initial PD 5 mm and IL-1b levels were further
determined by enzyme-linked immunosorbent assay. Both treatments provided signicant clinical improvements 7 weeks after
therapy (P < 0.01). However, no signicant dierences were
observed between G1 and G2. Although levels of HbA1c decreased

144

markedly in both groups, intra- and inter-group comparisons

revealed no statistically signicant differences. While total amounts
of IL-1b in GCF were reduced in both G1 and G2 (P < 0.05), the
dierence between the groups was not signicant. IPT provided
clinical improvement together with reduction in IL-1b levels.
Although not signicant, periodontal therapy improved glycaemic
control in these patients. However, within the limits of this study,
the use of systemic DOC did not provide additional eect to IPT
alone.

108
Effect of periodontal therapy on glycaemic control and
gingival tissue lipid peroxidation and glutathione
levels in type 2 diabetes mellitus
Tun, Yarat, Tunal, Kuru, Ylmaz, Kuru and . Noyan*
Marmara University, Yeditepe University, Istanbul, Turkey
The eects of initial periodontal therapy (IPT) and plus systemic
doxycycline (DOC) administration on clinical parameters, glycaemic control and gingival tissue lipid peroxidation (LPO) and
glutathione (GSH) levels were investigated in chronic periodontitis
(CP) patients with type II diabetes mellitus (DM). Twenty patients
and 10 medically and periodontal healthy subjects were included.
DM patients were divided into 2 groups: Group 1 received IPT and
DOC; Group 2 received IPT only. Plaque index, bleeding on
probing, probing depth (PD), relative attachment level (RAL) and
HbA1c were measured at 0 and 49 days. Gingival tissues were
collected from the selected sites. Levels of malondialdehyde and
GSH were measured by biochemical methods. Clinical evaluation
revealed statistically signicant improvements in all clinical
parameters of both treatment groups (P < 0.01), however intergroup dierences were not signicant (P > 0.05). No signicant
dierences were observed at in the HbA1c levels. Gingival tissue
LPO and GSH levels showed signicant changes in both treatment
groups after therapy (P < 0.01). There was no signicant
dierence between the groups (P > 0.05). Clinical and laboratory
results of this study demonstrated no superior eect of systemic
DOC usage combined with IPT in comparison with IPT alone in
CP + DM patients. Clinical and laboratory parameters of study
groups after periodontal therapy were comparable with those of
healthy group.

109
Anti-TNFa biological agents and periodontal
conditions: a pilot study
P. Xatzisavvas*, A. Sarantopoulos and A. Baka et al.
Aristotle University, Thessaloniki, Greece
Background: Periodontitis and rheumatoid arthritis share a
number of similarities concerning the pathogenic mechanisms of
disease initiation and progression. Proinammatory cytokines and
matrix metalloproteinases are common features of both diseases.
Modulation of host inammatory activity with anti-TNFa agents is
a new approach in the treatment of rheumatoid arthritis and has
shown promising results in experimental periodontitis.
Aim: Aim of the present study is to investigate the eects of antiTNFa agents, on clinical and radiographic parameters of
periodontal conditions.
Materials and methods: Ten patients with severe RA (Disease
Activity Score DAS28 > 5.1), were scheduled to initiate antiTNFa treatment. On entry and after 6 months of treatment,
patients were evaluated concerning Probing Depth, Probing
Attachment Level, Bleeding on Probing and Presence of Plaque.
Full-mouth radiographs were taken. Changes in bone-crest height

Posters: Periodontal systemic interactions

were assessed with the Emago digital radiographs analysis
programme vs. 3.4.
Results: Non statistically signicant changes were observed in
clinical or radiographic parameters (Wilcoxon test, P > 0.05) with
the patient as observational statistical unit.
Conclusions: Despite poor oral hygiene of these patients, antiTNFa treatment did not cause deterioration of periodontal
conditions. Findings from this pilot study suggest that the
possible anti-inammatory eects of anti-TNFa agents on
periodontal conditions require further investigation.

110
The effects of menopause on periodontal condition by
means of clinical and hormonal parameters
A. Cekici*, G. Isik, S. Akhan, et al.
Istanbul University, Istanbul, Turkey
Menopause should not be accepted as a negative experience in
women life. Post-menopausal women suer from hot ushes,
atrophic changes, osteoporosis, tooth loss, etc. Periodontitis is also
a complex disease, which its progression is inuenced by modifying
factors such as systemic diseases and age. Some of the risk factors
are the same in menopause and periodontitis. There is limited data
trying to correlate hormone therapy, hormonal parameters and
periodontal condition. The aim of this study is evaluating the
eects of menopause on periodontal condition by correlating
clinical and hormonal parameters and. A total of 24 women were
included in the study. Eight of them are menopausal and receiving
hormone therapy, eight of them are menopausal and not receiving
any therapy and eight of them are not menopausal. Clinical
parameters were; Plaque index (PI), sulcus bleeding index (SBI),
relative clinical attachment levels (RCAL) and probing depth (PD).
Oestrogen levels were collected from each patient. The clinical and
hormonal correlation between the groups was performed by the
Mann Whitney U test. Non-menopausal group had statistically
higher oestrogen levels and statistically lower RCAL. As conclusion, in the post-menopausal period, women have a greater risk of
RCAL loss. A adequate periodontal recall programme might
reduce this risk.

111
The effect of behet's disease on the clinical
periodontal status and amount of gingival crevicular
fluid
I. Duran*, M. Ozdemir, N. Okudan and S. S. Hakki
Selcuk University. Konya, Turkey
The aim of this study was to evaluate the eects of BD on
periodontal clinical parameters and volume of the gingival crevicular uid (GCF). Test group of this study is consisted of 16
volunteers (female: 12 and male: 4, aged 2065 years, mean age:
3506 10.66), patients with Behcets disease and who referred to
Dermatology department of University of Selcuk, Meram Medicine Faculty and control group is consisted of randomly selected 16
volunteer (female: 12 and male: 4) patients with aged 2355 years
(mean age: 39.81 7.36), and who referred to the Periodontology
department of University of Selcuk, School of Dentistry. In all
patients, Probing Depth, Clinical Attachment Level, Gingival
Index and Plaque Index were recorded and GCF sampling was
performed. No statistically signicant dierences were observed for
all clinical parameters and amount of GCF between groups
(P > 0.05). Data obtained from this study suggest that Behcets
disease is not directly a risk factor for periodontal diseases.

112
Serum antibodies in Porphyromonas gingivalis induced
bacteraemia after scaling and root planning in
periodontitis patients
G. Lafaurie*, D. Gualtero, J. DeAvila and L. Rodriguez et al.
University El Bosque, Colombia
Background: It is little known the role, kinetic and protective value
of anti-Porphyromonas gingivalis antibodies during bacteraemia
induced by scaling and root planning in periodontitis patients.
Materials and methods: Thirty-nine patients diagnosed with
periodontitis participated in the study: 15 with Generalized
Aggressive Periodontitis (GAP) and 24 with Generalized Severe
Chronic Periodontitis (GSCP). P. g was isolated in each one of the
patients in subgingival plaque before scaling and root planning.
Four blood samples from the ante-cubital vein were taken at
dierent times: (i) Before the scaling and root planning; (ii)
Immediately after treatment; (iii) 15 min after treatment and (iv)
30 min after treatment, in order to identify by culture P g. in blood.
Samples of serum pre- and 1 h after-treatment were processed to
evaluate IgG and IgM antibodies specic to P. g. and its LPS using
an ELISA.
Results: Bacteraemia associated to P. g. was detected in 28.2%
patients (11/39), no signicant dierences were found in
bacteraemia between GAP and GSCP patients (P > 0.05). There
was no dierence between IgG and IgM pretreatment levels
comparing patients with or without P. g. in blood induced by
scaling (P > 0.05). The sample taken one hour after the procedure
showed a signicant increase of anti-P. g. and anti-LPS specic
IgG in GSCP patients (P < 0.05). These results show evidence of
immune activation during bacteraemia, but do not evidence a
protective value in its early phase.

113
Evidence-based dentistry: a systematic review to
evaluate antibiotic therapy for gingival overgrowth
induced by assumption of cyclosporine A
G. Vittorini*, O. M. Clementini, A. Crea and G. Deli
Catholic University, Rome, Italy
Background: Gingival overgrowth (GO) is a common nding in
periodontal patients under pharmacological treatment with
Cyclosporine A (CsA). A systematic review was conducted to
evaluate the ecacy of azithromycin (AZM) in patients with GO
induced by assumption of CsA.
Materials and methods: Using an ideal key-word to search the
online database MEDLINE, EMBASE and Cochrane Central of
Register Controlled Trials (CENTRAL), we found 21 articles, only
four of which were Randomized Controlled Trials (RCTs)
published in English, thus meeting the inclusion criteria. The
great heterogeneity between proposed treatments and nal data did
not allow to conduct a meta-analysis.
Results: A systemic antibiotic therapy without plaque and calculus
removal does not reduce GO. A 5-day course of AZM with Scaling
and Root Planning reduces the degree of GO, while a 7-day course
of metronidazole is only eective on concomitant bacterial overinfection.
Conclusions: The great heterogeneity of diagnostic data and results
found is due to the lack of precise diagnostic methods and
protocols about GO. The pathogenesis of GO as well as the
mechanism of action of AZM still remains unclear. In literature
there are few RCTs on the ecacy of systemic antibiotic therapy in
case of GO; that is mainly due to the absence of precise diagnostic
methods and tools and of an adequate classication aimed to
determine a correct prognosis and an appropriate therapy for GO.

145

Posters: Periodontal systemic interactions

114
Periodontal disease and angiographic demonstrated
coronary heart disease

116
Comparison of the periodontal condition in Down
syndrome and other mental retarded children

M. Pachn, M. Gonz
lez-Jaranay*, J. Moreu, J. Gijn and G. Moreu
Hospital V de la Salud, University of Granada, Toledo, Spain

M. Motallebnejad*, N. Jenabian and G. H. Kermanizadeh

University of Babol, Iran

Background: Many epidemiological studies reported an

association between periodontal (PD) and cardiovascular disease,
another ones found no association. In most of these studies,
Coronary heart disease (CHD) diagnostic was clinical instead of
angiography. The aim of the study was to investigate the
association between periodontal health and angiographic
demonstrated CHD.
Materials and methods: Forty patients with coronary
catheterization were included in this study. Twenty-three with
coronary disease (A group) and 17 without disease (B group).
Conventional cardiovascular risk factors were not statistically
signicant between groups. Missing teeth, plaque index (PI),
probing depth (PD) and gingival index (GI) were recorded.
Blood samples were taken for measurements of serum total
cholesterol (TC), triglycerides (TG), high-density lipoprotein
cholesterol (HDL-CL) low density lipoprotein cholesterol (LDLCL), and (PCR).
Results: The mean PD between A (2.52 0.70 mm) and B
(2.06 0.74 mm) groups was nearly signicant (P = 0.06),
percentage of sites with probing depth>3 mm, and GI were not
statistically signicant. We also found blood PCR higher levels in
group A (15.43 29) vs. B (4.81 4.90) (P > 0.02).
Conclusions: The results indicate that PD may be associated with
angiographic demonstrated CHD. We are carrying out a
prospective randomized study to determine whether PD is a risk
factor of CHD and a possible clinically meaningful reduction in
heart disease from the prevention or treatment of PD.

Objectives: The aim of this case-control analytic study was the

evaluation of periodontal condition in Down Syndrome (DS)
children in compare with other mental retarded (MR) children.
Patients and Methods: Twenty-ve DS (611 years) children as
case group and 25 MR age-matched children as control group were
studied. Plaque Index, Gingival Index, Probing Pocket Depth and
Periodontal Disease Index were measured in both groups and the
data were analysed by paired t test.
Results: GI in DS was 2.51 0.63 compared with 2.43 0.55 in
MR, PI in DS was 2.35 0.15 compared with 2.31 0.31 in
MR, PDI in DS was 4.4 0.51 compared with MR 4.38 0.45,
PPD in DS was 4.90 0.54 compared with 5.8 0.71 in MR.
Clinical indices of periodontal condition were higher in DS but
were not statistically signicant (P > 0.05).
Conclusion: Down syndrome children dont display dierent
periodontal condition compared with age-matched other mental
retarded children.

115
Investigation of periodontal status in acromegalic
patients
D. L. F. Lima*, D. M. Rego, R. M. Montenegro Jr and M. S. Albano
PPGCSA- UFRN; Unifor; UFC
Acromegaly is a chronic metabolic disorder caused by the presence
of an increased growth hormone secretion due to an adenoma of
the pituitary gland in nearly every case. It occurs after normal
growth of the skeleton and other organs is complete. Acromegaly
has an estimated prevalence of 4060 cases per million. Patients
with acromegaly may exhibit insulin resistance. The greatest
anomaly is seen in the mandible, with greater enlargement of the
ascending ramus. The most common oral features of acromegaly
are a prognatic mandible, interdental spaces, macroglossy, and
everted swollen lips. Periodontal status is not described in the
literature. We investigated sixteen individuals, eight males and
eight females, with mean age of 41.5 10.5 years. Periodontal
probing was performed and gingival bleeding index (GBI) was
calculated, followed by an assessment of gingival overgrowth,
tooth mobility and gingival recession. All patients exhibited tooth
mobility, mainly in the lower anterior teeth, seven patients
presented with recession areas and no gingival growth was
observed. No site with probing depth over 4 mm was found and
mean GBI was 0.35 0.2. The most interesting result was the
complete absence of periodontal pockets. It is suggested that the
presence of mobility and recession is caused by dental trauma
resulting from the malocclusion caused by mandibular prognatism.
The absence of periodontal pockets was not determined although
growth hormone is anabolic for bone tissue.

146

117
Relationship of HBA1c level and smoking to
periodontal status in a cohort of Croatian patients
with insulin-dependent diabetes mellitus
I. Bago, A. Bosnjak*, D. Plancak and D. Bozic
School of Dental Medicine, Zagreb, Croatia
Background: There is rmly established correlation between
periodontitis and diabetes mellitus (DM), but it is still unknown
how does the duration of DM inuence the periodontal status of
individuals.
Aim: The aim of the study was to investigate the eect of DM
duration and HbA1c level on periodontal status of patients with
insulin-dependent DM, as well as the combined eect of smoking
and HbA1c level on periodontal status.
Materials and methods: Subjects were randomly selected from the
patients with insulin-dependent DM that are treated at the
Department of Endocrinology in the hospital Sveti Duh. Data
was gathered by means of an interview, clinical periodontal
investigation and patients
charts from the department. Sites with
probing depth of 5 mm and greater were selected as sites with
periodontitis. By means of Poisson regression model a relative risk
with 95% condence interval was computed, corrected for age of
the subjects.
Results: Relative risk for attachment loss in smokers was 12.805
and for probing depth in smokers 7.99. Relative risk of the HbA1c
level >8.5 in smokers were 10.681 (P = 0.002), and 8.214
(P = 0.006) for HbA1c level 8.5. Relative risk for attachment
loss in nonsmokers was 4.891 (P = 0.031).
Conclusion: It was concluded that insulin-dependent smokers with
poor glycaemic control have the greatest risk for development and
progression of periodontal disease.

118
The relationship between periodontitis and
hyperlipidaemia
N. Jenabian*, M. Pour Amir, M. Abbasi and K. Zabiani
Periodontology Department, Biochemistry Department, Babol medical
University, Iran
Objectives: The aim of this study is to evaluate the relationship
between chronic periodontitis and hyperlipidaemia.

Posters: Periodontal systemic interactions

Material and methods: In this case-control study 50 patients with
chronic periodontitis (case) and 50 patients with normal
periodontium (control) were examined through Probing Pocket
Depth (PPD) and periodontal indices including: Plaque Index
(PLI), Bleeding Index (BI) and Periodontal Disease Index (PDI).
Also Triglyceride (TG), Cholesterol (Chol), LDL-C and HDL-C
levels were measured for all patients.
Results: The mean serum levels of TG (169.18 74 mg/dL), Chol
(206.06 56 mg/dL) and LDL-C (143.19 58 mg/dL) were
signicantly higher and HDL-C (46.70 11 mg/dL) was lower
in case group in compare with control which their TG levels were
129.36 69 mg/dL, and the levels of Chol, HDL-C and LDL-C
were respectively 180.94 51, 52.36 13 and 105.30 46 mg/
dL (P < 0.05). There were a signicant relationship between PPD
and increase of TG (P = 0.00), Chol (P = 0.00) and LDL-C
(P = 0.03). Also hyperlipidaemia showed a signicant relationship
with BI and PDI (P = 0.00).
Conclusion: There is a signicant correlation between periodontitis
and hyperlipidaemia.

119
Long-term clinical outcomes of S/RP with SPT of HIVseropositive patients taking highly active antiretroviral
therapy
A. R. Jordan*, H. P. Joehren and P. Gangler
Dental Faculty, Witten/Herdecke University, Germany
The aim of this controlled study was to assess the treatment
outcomes of S/RP with subsequent SPT in generalized, chronic
periodontitis of HIV-seropositive patients undergoing highly active
antiretroviral therapy (HAART). Twenty-two patients divided into
test and control group, who were similar in age, sex and smoking
behaviour, were treated by S/RP followed by a 15-month lasting
SPT. The data collected in both groups were recorded before
therapy as well as at the end of the study. The results were
evaluated between the two dates of the survey and among the
groups of trial subjects. The haemato-immunological marker
values of the test group showed a stable phase of immunity
reconstitution over the whole period of survey. The index BOP
improved with all patients (P < 0.002). The average PPD was
reduced in the test group by 0.9 mm (P < 0.001) and in the control
group by 1.0 mm (P < 0.001). The number of teeth classied as
exhibiting from periodontal disease to teeth without clinical
ndings was reduced in both study groups (P = 0.001). A
so-called healing rate showed for the test group 84%, for the
control group 87%; the comparison of the groups was not
signicantly dierent in terms of statistics (P = 0.4). In conclusion
there was no statistically signicant dierence concerning the
clinical outcomes between both study groups. The conservative
periodontal treatment by S/RP and strictly organized SPT in HIVseropositive patients undergoing HAART is an eective and safe
treatment concept.

120
The effects of anabolic androgenic steroid abuse on
gingival
O. Ozcelik* and M. C. Haytac
Cukurova University, Turkey
Background: Anabolic androgenic steroid (AAS) is the familiar
name for synthetic derivatives of the male sex hormone,
testosterone. A large number of young adults abuse AAS to
enhance performance and physical appearance. The aim of this
study was to evaluate the eects of AAS abuse on the gingival
tissues in a group of bodybuilders and weight lifters.

Methods: The test group was composed of 24 athletes who have

been using AAS for more than 1 year. All subjects were clinically
examined for plaque levels (plaque index), gingival inammation
(gingival index), and gingival hyperplasia. The results were
compared with a control group of 20 bodybuilders who had
never used AAS drugs.
Results: Although there were no statistical dierences between the
plaque index (P > 0.05) and gingival index (P > 0.05) scores of
the study group and the control group, the AAS abusers had
statistically higher scores of gingival thickness, extent of gingival
encroachment and total gingival overgrowth scores (P < 0.001
each) when compared to non-users.
Conclusions: The results of this study have revealed that the
prolonged use of AAS is closely associated with signicant levels of
gingival hyperplasia. Since recreational abuse and abuse in noncompetitive sports are out of control and seems to increase despite
legislation, dentists and periodontists should be familiar with the
adverse eects of these synthetic derivatives of testosterone on the
gingival tissues.

121
Presence of respiratory pathogens in the oral biofilm of
patients with nosocomial pneumonia
L. C. B. S. Oliveira*, R. G. Fischer and E. M. B. Tinoco
University Est. do Rio de Janeiro, Brazil
Hospitalized patients receiving treatment at Intensive Care Units
may have the oral cavity colonized by respiratory pathogens,
increasing the risk for nosocomial pneumonia.
Aim: The aim of this study was to investigate the presence of
respiratory pathogens in the oral cavity of hospitalized patients at
Intensive Care Units.
Material and methods: Thirty patients from Hospital R. Serta, NF,
Brazil, with nosocomial pneumonia, were included in the study,
and tracheal aspirate samples were cultured to identify the causing
microorganisms. Microbiological samples from supragingival
dental plaque, tongue and respiratory tube were cultured for a
panel of respiratory pathogens.
Results: The most frequently found bacteria in the tracheal
aspirate were S. pneumoniae 23.3% (7), P. aeruginosa 20% (6), S.
aureus 13.3% (4), K. pneumoniae 13.3% (4), C. albicans 6.6% (2), ahaemolytic streptococcus 6.6% (2), Staphylococcus sp. 6.6% (2), A.
calcoaceticus 3.3% (1), E. coli 3.3% (1) and E. cloacae 3.3% (1).
70.0% (21) of these microorganisms were found in the dental
biolm, 63.33% (19) in tongue samples; 73.33% (22) in the
respiratory tube and 43.33% (13) in all sampling sites
simultaneously. No dierences in proportions could be observed
between the sampling sites (P > 0.05).
Conclusion: The results of this study show that respiratory
pathogens associated with nosocomial pneumonia are present in
the oral biolm of hospitalized patients, which may serve as a
reservoir for these microorganisms.

122
Periodontal status of asthma patients
Z. Cvoriscec*, D. Plancak, M. Samarzija and A. Stipic et al.
School of Dental Medicine, Medical school, University of Zagreb,
Croatia
Aims: Periodontal status investigated in 59 asthmatic patients and
83 healthy controls (mean age 48.9 years).
Materials and methods: We are using API, PBI and probing depth
and results were compared according to age, gender, smoking and
asthma intensity in both groups.
Results: API was signicantly higher in patients with asthma than
in controls (P < 0.001). PBI was also signicantly dierent
compared to the controls (59% : 41%).All patients with asthma

147

Posters: Periodontal systemic interactions

had all four stages of gingival inammation, while only four
controls had inammation stage III and none had stage IV.
Analysis of probing depth showed a signicant dierence between
patients with asthma and the controls in three teeth in maxillar
(third sextant) and nine teeth (fourth and the sixth sextant) in
mandibular jaw.
Conclusions: Results showed poorer periodontal status in
asthmatic patients compared to healthy controls. Mean probing
depth was 0.2 mm deeper in asthmatic patients than in controls
(P = 0.022). The percentage of API increased in patients with
moderate and severe asthma. This trend of enhanced frequency was
also visible in PBI in all three stages of persistent asthma compared
to intermittent asthma. Tendency of increased probing depth
almost reached statistical signicance (P = 0.052) in patients with
persistent asthma, as compared with controls. API and PBI indices,
probing depth and the number of extracted teeth showed no
dierence in both groups according to gender, age and smoking
habits.

123
Relationship between periodontitis and preterm birth:
case-control study
P. Santos* and R. Almeida
University of Fernando Pessoa; Maternity Daniel de Matos
The introduction of Periodontal Medicine took doctors and
dentists to face with a big heterogeneity of data, which suggest
that periodontitis can contribute to the morbidity and mortality of
individuals with some systemic conditions and to the preterm birth.
The aim of this study was to determine whether maternal
periodontitis could be associated with preterm birth.
Materials and methods: The case group (n = 22) was dened as
postpartum women with spontaneous preterm labour (gestational
age <37 weeks) as a result of premature labour or premature
rupture of membranes. The control group (n = 24) included
postpartum women with term birth (gestational age 37 weeks).
Known risk factors for preterm birth and the periodontal status
were recorded. Only postpartum women without any systemic
disease were included. The patients were only enrolled into the
study after giving informed written consent.
Results: The mean birth weight and the gestational age were both
lower within postpartum women with periodontitis comparing to
the group with gingivitis. The dierence is signicant (P = 0.002
and P = 0.008, respectively). A signicant association was found
between periodontitis and preterm birth. The odds ratio was 2.9 at
the 95% condence interval.
Conclusions: The obtained data in this population revealed an
association between the presence of maternal periodontitis and
preterm birth. Further studies are needed to clarify this association
and to determine whether this relation is causal.

124
Periodontal and metabolic status after conversion to
wholesome nutrition in adults
R. Purschwitz*, F. Rassoul and H. Jentsch et al.
University of Leipzig, Germany
The aim of the study was to examine the eect of the conversion
from western style nutrition to wholesome nutrition on periodontal
and metabolic health in adults. Twenty-three female subjects, mean
age 51.9 years, were followed-up over 12 months during nutritional conversion. Attachment level (AL), probing depth (PD),
bleeding on probing (BOP), gingival index (GI), interproximal
plaque index (API) and serum variables (cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoproteins A-I and B,
C-reactive protein, leukocytes, glucose, uric acid, creatinine,

148

homocysteine, folic acid, vitamin B12, vitamin E) were determined

at baseline (0), after 2 weeks as well as after 3, 6 and 12 months.
Friedman/Wilcoxon tests were used for statistical analysis. The
results of the periodontal variables were as follows (12 months vs.
0): AL 2.7 vs. 2.9 mm (P = 0.024), PD 2.2/2.4 mm (P = 0.001),
BOP 40/50% (n.s.), GI 0.9/1.1 (P = 0.014), API 77/74% (n.s.). No
signicant changes were found for variables of lipoprotein metabolism (lipids, lipoproteins, apolipoproteins). CRP and leukocytes
were unchanged. There was no signicant change of folic acid
(16.0/14.9 nmol/L) and vitamin B 12 276/259 pmol/L). Interestingly, for vitamin E a signicant increase of serum concentration
was observed (51.7/36.9 mmol/L, P = 0.001). The results demonstrate a benecial eect of the conversion to wholesome nutrition
on periodontal variables after 1 year, especially on attachment
level, probing depth and gingivitis.

125
Effects of periodontal treatment and antioxidant usage
in type II diabetes mellitus patients with chronic
periodontitis

zcengiz*, Akbay, Kuru, Yarat, Kuru, Ylmaz and Noyan
Marmara University, Yeditepe University, Istanbul, Turkey
The aim of this study is to assess eects of initial periodontal
therapy with and without antioxidants on metabolic control and
gingival glutathione (GSH) and malonaldehyde (MDA) levels in
type II diabetes mellitus (DM) patients with chronic periodontitis
(CP). Ten DM + CP patients received scaling and root planning
(SRP) combined with systemic antioxidants (Vitamin C 1 g/day,
Vitamin E 400 IU/day) for 2 months (SRP + A). Ten DM + CP
patients received SRP. Ten systemically and periodontally healthy
subjects undergoing crown-lengthening operation served as the
healthy control group (H). HbA1c levels and plaque, sulcus
bleeding indices (SBI), probing depths (PD) and relative attachment levels were assessed at baseline and gingival tissue samples
from periodontal sites of DM patients with a PD 5 mm. All
assessments were repeated 2 months after therapy. Gingival GSH
and MDA levels were determined by Ellman and Thiobarbituric
acid methods respectively. There were signicant reductions in
clinical parameters and HbA1c levels in SRP + A and SRP
groups (P < 0.01), whereas GSH levels increased signicantly
(P < 0.01). MDA level reduced signicantly only in the
SRP + A group (P < 0.05), there were no signicant dierences
between the two groups. Biochemical parameters of both DM
groups after periodontal therapy were comparable with the H
group. Within the limits of this study the ecacy of antioxidants
in conjunction with initial therapy on MDA levels warrants
further detailed studies.

126
Effect of diabetes on salivary antioxidant activity
P. Meri*, N. Buduneli and S. etinkalp et al.
Ege University, Turkey; Louisville University, USA
Aims: Exact mechanisms of interactions between diabetes and
periodontal disease remain unclear. This study was conducted to
compare clinical periodontal measurements and salivary
glutathione, Vitamin C, and total antioxidant capacity between
diabetic and non-diabetic patients.
Methods: Forty-one diabetic patients and 24 otherwise healthy
control subjects matched with the diabetic group according to
periodontal health status were included in the study. Whole saliva
samples were obtained and full mouth clinical periodontal
measurements were recorded at six sites/tooth. Saliva ow rate,
salivary levels of glutathione, Vitamin C and total antioxidant

Posters: Periodontal systemic interactions

capacity were determined. Data were tested statistically by nonparametric tests.
Results: Diabetic group exhibited signicantly less number of teeth
present (P = 0.01), reduced saliva ow rate (P = 0.001). Clinical
periodontal measurements and salivary glutathione, Vitamin C,
and total antioxidant capacity values did not show signicant
dierences between the groups (P > 0.05). In diabetic group
salivary glutathione level was signicantly correlated with probing
depths (P = 0.001), and total antioxidant capacity correlated with
saliva ow rate and Vitamin C level (P < 0.01).
Conclusion: Within the limits of the present study, salivary
glutathione, Vitamin C and total antioxidant capacity values do
not seem to play a role among mechanisms by which diabetes
aects periodontal tissues.

127
The relationship between periodontal disease and
indices of atheroscrelosis
T. Naito*, K. Miyaki, M. Naito, T. Nakayama and T. Hirofuji
Fukuoka Dental College, Keio, Nagoya and Kyoto University, Japan
Background: Epidemiological studies have shown that periodontal
disease may be associated with an increased risk of progression of
cardiovascular and cerebrovascular disease. Endothelial
dysfunction would be present in patients with periodontal disease.
The purpose of the present study was to examine the relationship
between periodontal infection and endothelial dysfunction.
Methods: The study design was a cross-sectional study. Male
subjects (average 47.2 11.2-year-old, range 2463) from same
workplace with slight periodontitis (n = 38), severe (n = 19) and
control (n = 41) were enrolled for this study. Severity of
periodontitis were classied with having at least one site of
probing pocket depth more than 4 mm (slight), having more than
6 mm (severe), or control. For the indices of atherosclerosis,
Brachial-Ankle Pulse Wave Velocity (baPWV) and the ankle
branchial index that reect the development of atherosclerosis were
measured. Other indices known as risk factors for atherosclerosis,
such as blood pressure and serum cholesterol were also measured.
The anova and post-hoc Schee test was used for statistical
analysis.
Results: The baPWV were also higher (P < 0.05) in slight
periodontitis (1475 237) and in severe periodontitis
(1507 195) than in control (1346 251). After adjustment for
age, a weak relationship was found between periodontitis and these
indices of atherosclerosis. Periodontitis has the possibility of
showing a relationship with atherosclerosis.

128
Association of periodontal diseases with C reactive
protein
N. Sargolzaie*, A. Moeintaghavi, H. Arab and M. Sanatkhani
Mashhad Dental Research Center, Mashhad University, Iran
Introduction: C reactive protein is one of the acute phase proteins
that its levels elevate during infectious diseases. The aim of this
study was to elevate the relationship between periodontal diseases
and C reactive protein level.
Materials and methods: Fifteen patients (seven male, eight female,
mean age 34 11.6) with chronic periodontitis and 15 ages and
sex matched (seven male, eight female, and mean age 29 10.4)
periodontally healthy subjects recruited from the patients referred
to the department of periodontics, Mashhad faculty of dentistry.
Periodontal probing depths of Ramfjord teeth were recorded for
both groups. Peripheral blood samples were collected and sent to
the laboratory to determine the amount of CRP using
semiquatetive method.

Results: The amount of CRP in the test group was 4.1 mg/L. In
the control group it was 0.18 mg/L CRP in the test group was
signicantly higher than the control group (P = 0.008). There was
no signicant correlation between the mean pocket depth and the
CRP levels. Sex and age did not aect the amount of plasma CRP.
Conclusion: Periodontal diseases can increase the amount of
plasma CRP. This might be due to the infective nature of
periodontal diseases.

129
The effect of phase I periodontal therapy on blood lipid
and CRP levels: a pilot study
F. Y. Bozkurt*, Z. Y. Ay and N. Delibas et al.
SDU, Isparta, Turkey; AKU, Afyon, Turkey.
Background: Recently, it has been suggested that there is a link
between the periodontal disease and blood lipid proles and CRP
levels. The aim of this study was to evaluate the eect of phase I
periodontal therapy on blood lipid and CRP levels in gingivitis and
periodontitis patients.
Material and Methods: Systemically healthy 46 subjects older than
30 years included in this study. The patients were divided into three
groups according to their clinical recordings: gingivitis (n = 12),
the periodontitis (n = 17) and control (n = 17). Before and after
6 weeks of the phase I periodontal therapy, the clinical recording
and blood sampling were obtained. Triglyceride (TRG), cholesterol
(Chol), high-density lipoprotein (HDL), very low-density
lipoprotein (VLDL), low-density lipoprotein (LDL), and
C-reactive protein (CRP) levels were determined in the blood
samples.
Results: After phase I periodontal therapy, all of the clinical
parameters in both groups have improved. The levels of the blood
lipids and CRP were not statistically signicantly dierent, when
compared in the groups and between the groups, before and after
phase I periodontal therapy (P > 0.01). No signicant correlations
were found between the clinical and blood parameters after therapy
(P > 0.01).
Conclusion: Within the limitations of this study, improvement in
gingivitis and moderate periodontitis by phase I periodontal
therapy did not aected the blood lipid levels and CRP levels in
short term.

130
Oestrogen receptor genotypes and alveolar bone loss
in postmenopausal Malay women
H. Taib*, D. Swaminathan and A. Rehman et al.
University of Malaya; University of Sains Malaysia, Malaysia
The polymorphisms of the oestrogen receptor gene (ERG) have
been reported to be associated with systemic bone loss, which may
also aect oral bone particularly mandibular bone resorption in
postmenopausal women.
Objectives: To
detect
the
association
between
ERG
polymorphisms with alveolar bone loss and tooth loss in
postmenopausal Malay women (PMW).
Methods: Sixty-four PMW (mean age 57.06 4.69) were
recruited from Out Patient Dental Clinic, Hospital University
Sains Malaysia, Kelantan. Oral panoramic radiographs were taken
for dental assessment and measurement of alveolar bone loss using
the technique as described by Wical and Swoope (1974).
Genotyping was done through the restriction cleavage of
polymerase chain reaction-amplied genomic DNA with the two
restriction enzymes, PvuII and XbaI. Oestrogen receptor genotypes
were represented as P or p (PvuII) and X or x (XbaI) with the lower
case letters signifying the presence of the restriction site.

149

Posters: Periodontal systemic interactions

Results: High frequency of heterozygous allelic variants (53% for
Pp and 86% for Xx) was observed. There was no signicant
association between ERG polymorphisms with alveolar bone loss
and tooth loss in PMW.
Conclusion: ERG polymorphisms may not be a genetic marker for
alveolar bone loss in postmenopausal Malay women.
Acknowledgement: This study supported by USM Short Term
Grant, 301 PPSG 6131300.

131
A comparative evaluation in pregnant women of the
periodontal condition and low birth delivery incidence
H. E. Sueri and I. Devrim*
University of Ondokuz Mays, Samsun, Turkey
The objective of this study was the evaluation of periodontal
condition in pregnant women, the eect of the treatment of
periodontal disease upon low birth weight. A total of 269 women in
their rst trimester were included in this study. Their ages ranged
from 1835 years, their height was above 150 cm and they have no
history of any systemic disease. At the end of each trimester these
measurements were performed: attachment level, probing depth,
gingival index, plaque index, and bleeding on probing. According
to the periodontal diagnosis the research population was divided
into three groups: periodontally healthy women; periodontally
diseased women, however rejection of treatment; periodontally
diseased women, however acceptance of treatment. When parameters such as number of pregnancies, previous low birth weight,
prenatal care, genital tract infection, use of antibiotics, smoking,
tooth brushing habit were evaluated it was concluded that only the
brushing habit was statistically signicant (P < 0.001). When such
parameters as infant birth weight, gestational age, type of delivery
and sex were evaluated, it was found that only the birth weight was
statistically signicant (P < 0.001). The evaluation of the risk
factors concerning low birth weight, prenatal care, irregular
brushing and periodontitis found to be statistically independent
risk factors. In this study one-way anova, chi-square, conditional
logistic regression analyses were used.

132
The prevalence of systemic diseases in Turkish urban
population
M.
ztrk*,1, Y. Bozkurt1, Z. Yetkin Ay1 and R. Demirel2
1
SDU, Isparta, TR; 2AKU., Afyon, TR
Background and Aims: In Turkish population; hypertension,
hypercholesterolemia, cardiovascular diseases (CVD) and
diabetes are common diseases because of the traditional dietary
habits. The aims of this study were to determine the prevalence of
systemic diseases in patients with gingivitis and periodontitis and to
explore the eects of periodontal disease in risk of systemic disease
occurrence.
Material and methods: The study design was a retrospective
recording review. The recordings were belonging to the period of
20012002. The study population included 2737 patients. The
patients self-reported systemic condition, age, gender, educational
level, oral hygiene, smoking status were evaluated and periodontal
status and the number of missing teeth were recorded.
Results: A total of 1887 patients were diagnosed as periodontitis
while 850 patients were gingivitis. Periodontitis was frequently seen
in male patients and patients older than 30 years. A total of 773/
2737 subjects have reported their systemic diseases. A total of 331
patients have CVD, 196 have endocrine disorders, 79 have lung
disease and 234 individuals are using regularly various drugs. Age,
gender, presence of periodontitis, smoking, tooth loss and the

150

usage of prosthetic appliances were determined as risk factors for

the presence of systemic diseases in this population.
Conclusion: Within the limitations of this study, systemic diseases
were observed more frequently in patients diagnosed as
periodontitis than gingivitis patients.

133
Coincidence between periodontal disease and
coronary heart disease verification of bacterial
and cytokine's theories
M. Czerniuk*, M. Zaremba, R. Grska and K. Filipiak
Medical University, Warsaw, Poland
The aim of the study was to evaluate the inuence of periodontal
disease on the inammatory response in ACS and to evaluate
incidence of selected anaerobic bacteria in subgingival and atherosclerotic plaques in patients treated surgically because of coronary
vessels
obliteration. The study involved 50 patients with an initial
diagnosis of acute coronary insuciency, with diagnosed advanced
chronic periodontitis (ACP) and 20 individuals with ACP, where
subgingival plaque was collected from periodontal pockets, DNA
test was used for marking eight pathogens responsible for periodontal tissues destruction. In the same patients material from
atherosclerotic plaque was collected during by-pass implantation
procedure, and identical DNA testing occurred. This material was
used to ascertain the mean serum levels of CRP and TNF-a. The
high mean values of clinical parameters measured attest the presence
of active periodontal disease, which may aect the incidence of
cardiovascular disease. Patients with ACS and with more advanced
periodontal disease were characterized by higher mean values of
serum concentrations of cytokine CRP in the acute phase of ACS
and in the long term and of TNF-a in the long term. In DNA-tested
group, in 13 of 20 patients pathogens most frequent in severe
chronic periodontitis were found in coronary vessels. In 10 cases
those bacteria were also present in atherosclerotic plaque.

134
Is preterm birth predictable in the case of pregnant
women with early periodontitis?
M. Radnai*, I. Gorz, E. Urb
n, T. Nov
k and A. P
l
Faculty of Medicine, University Szeged, Hungary
The aim of our study was to examine if there was an association
between early periodontitis of pregnant women and preterm birth
in the South-East Hungary.
Material and Methods: In total 161 healthy women were included
in this case-control study. Preterm birth was dened if the patient
had a threatening premature labour during pregnancy, preterm
rupture of membranes, or spontaneous preterm labour, and/or if
the weight of the newborn was <2500 g. In the control group
women had delivery after 37th gestational week and the newborns
weight was 2500 g. Early periodontitis was dened, if the patient
had 4 mm probing depth at least at one site and bleeding on
probing occurred at 50% of her teeth.
Results: A signicant association was found between the weight of
the newborns and the periodontitis of the mother. Deep pockets or
gingival bleeding alone did not correlate with preterm birth, but
having at least one 4 mm probing depth and BOP at 50% of the
teeth at, had a strong correlation with preterm birth (P = 0.000).
Mean weight of the newborns was 2834.5 g in the periodontitis and
3180.3 g in the control group the dierence was signicant
(P = 0.004). Mothers with early periodontitis had 3.32 x greater
odds of preterm delivery or low birth weight, than did women
without periodontitis.
Conclusion: The results of the study showed, that the early
periodontitis of the pregnant woman could be an independent
risk factor for preterm birth.

Posters: Periodontal systemic interactions

135
Occurrence of self-reported systemic medical
conditions in patients with periodontal disease

137
Prevalence and severity of periodontitis in individuals
with metabolic syndrome

A. L. Dumitrescu, M. Gociu*, A. Turea and L. Galie

University of Medicine and Pharmacy, Carol Davila

P. Cachapuz*, R. Cachapuz, K. Matilla and E. Tinoco

Unigranrio, UERJ, Petrobras, Brazil

Objectives: The objective of this retrospective study was to

investigate the occurrence of self-reported systemic disorders in
patients referred to a specialist clinic for periodontal treatment.
Materials and methods: The study design was a case-controlled,
retrospective chart review. Patient charts (n = 1044) were selected
from Department of Periodontology, University of Medicine and
Pharmacy Carol Davila
. Two examiners collected the data.
Results: The most frequent disorders in patients with gingivitis
were high blood pressure (35.85%), followed by coronary artery
disease (15.741%), kidney and urinary tract disorders (15.71%)
and allergic reactions (14.28%). Eighty percent of patients with
gingivitis had at least one of these disorders. The most frequent
disorders in patients with periodontitis were high blood pressure
(29.51%) followed by digestive disorders (18.92%), coronary artery
disease (16.54%), kidney and urinary tract disorders (16.24%),
endocrine disorders (10.58%), and rheumatoid arthritis/
rheumatism (9.68%). 81.96% of patients with periodontitis had
at least one of these disorders. However, only rheumatoid arthritis
was found to be more prevalent in periodontitis patients comparing
with gingivitis aected individuals (P < 0.05). Multiple
correlations were found between the independent variables.
Conclusions: These ndings support the results from previous
investigators that a number of systemic conditions are closely
associated with periodontal disease.

Metabolic Syndrome (MS) represents a complex disease with

several components from degenerative chronic diseases, like
diabetes. These components include: high blood pressure (130/
85 mmHg); fasting blood glucose 110 mg/dL; abdominal circumference 102 cm (men); triglycerides 150 mg/dL; HDL
40 mg/dL (men). Some of those factors have been associated
with periodontal disease.
Aim: The aim of this study was to describe the prevalence of
periodontitis in a sample of individuals with MS.
Materials & Methods: Twenty-ve males with MS, with mean age
49.6 (SD 6.2), all non-smoking, were examined for Clinical
Attachment Level (CAL) and bone level using panoramic
radiographs. Severe periodontitis was classied as 10% of sites
with CAL 5 mm or bone loss 2/3 of the root length, and
moderate periodontitis as 10% of sites with CAL > 2 < 5 mm
or bone loss between 1/3 and 2/3 of the root length.
Results: Seventy-two percent (18) of the individuals with MS
showed signs of destructive periodontal disease 36% (9) severe
periodontitis and 36% (9) moderate periodontitis. Within the
individuals with periodontitis, 83.3% (15) showed high
triglycerides levels; 66.7% (12) showed high blood glucose levels;
66.7% (12) showed high abdominal circumference; and 55.5% (10)
showed low HDL levels. No statistical dierences could be
observed in this small sample.
Conclusion: A rather high prevalence of periodontitis in
individuals with MS was observed in this sample.

136
Effects of simple periodontal therapy on periodontal
status and glycaemic control in patients with diabetes
W. C. Tan*, F. B. K. Tay, A. C. Thai, C. G. Koh, C. F. Sum and L. P. Lim
National Dental Centre; Alex. Hospital, National University of
Singapore, Singapore
Periodontal status of diabetic subjects has been shown to be
aected by glycaemic control. Few studies have examined the eect
of periodontal therapy on glycaemic control. The aims of the study
were to compare the eects of dierent treatment modalities on
periodontal parameters and glycaemic control in diabetic patients
and to examine the eect of glycaemic control on treatment
response. Ninety-eight adult subjects were randomly assigned to
one of three groups: simple non-surgical periodontal therapy and
oral hygiene (T; n = 36), oral hygiene alone (OH; n = 32) and no
treatment (C; n = 30). Blinded examiners carried out full mouth
periodontal charting and blood samples at baseline, 3 and
9 months after therapy.
Results: Mean plaque scores were reduced at 9 months within T &
OH (P < 0.05). For bleeding scores, only T showed signicant
reduction at 3 and 9 months compared to baseline (P < 0.05). At
9 months, T (19.4 19.6%) showed signicantly better reduction
in bleeding scores when compared to OH (7.1 14.3%) & C
(3.8 18.2%). HbA1c levels were not signicantly aected over
time. Subjects with poorer glycaemic control (HbA1c > 8%) had
poorer periodontal status. At 9 months, T & OH subjects with
HbA1c > 8% showed signicant reduction in bleeding scores
compared to subjects with HbA1c 8%. In this study, simple
periodontal therapy improved the periodontal health of diabetic
subjects, with little eect on their glycaemic control. Subjects with
poorer glycaemic control beneted from some intervention.

138
Periodontal and serum lipid changes in diabetics
following non-surgical periodontal therapy
C. C. Tan*, F Tay, C. F. Sum, A. C. Thai and L. P. Lim
National Dental Centre; Alex. Hospital; National University of
Singapore, Singapore
Background: Diabetics tend to have higher prevalence, more severe
forms of periodontal disease and reduced treatment outcomes.
Periodontitis is also associated with elevated blood lipid levels.
Aim: To determine the inuence of glycaemic control and/or
periodontal therapy on serum lipid levels.
Materials and methods: A total of 102 subjects were recruited from
two diabetic centres, divided into well- and poorly-controlled
diabetics and then randomly subdivided into test and control
groups. Test group received oral hygiene instructions and scaling
and/or root planning. Control group received no treatment. All
subjects were examined at baseline, 3 and 9 months. Each
examination included an assessment of HbA1c, serum lipid (total
cholesterol TC, triglyceride TG and LDL) levels and full mouth
periodontal assessment.
Results: Poor glycaemic control was associated with poorer
periodontal condition and higher TC/TG/LDL at baseline. All
except the control group with poor glycaemic control showed
signicant improvement in mean plaque score and BOP (P < 0.04).
Poorly-controlled diabetics who received periodontal treatment also
showed signicant improvement in LDL levels (P = 0.001).
Conclusion: This study shows the benecial eects of simple
periodontal therapy in improving the periodontal health of
diabetics. The relative improvement appears more marked in
patients with poor glycaemic control. Diabetics with poor
glycaemic control also showed signicant improvement in LDL
levels following non-surgical periodontal therapy.

151

Posters: Periodontal systemic interactions

139
The evaluation of the oral and systemic parameters in
diabetic patients: a pilot study
Z. YetkinAy*,1, M.
ztrk1, Y. Bozkurt1 and R. Demirel2
1
SDU, Isparta, TR; 2AKU, Afyonkarahisar, TR
Background and aims: The eects of diabetes on periodontal health
are known. The aim of this study is to investigate the inammatory
and periodontal status of the diabetic and healthy individuals with
the equal PD values and to determine the correlations between
periodontal and systemic parameters in diabetic patients.
Material and methods: The study population was consisted of 32
diabetic (DM) and 17 healthy (C) individuals. The clinical
parameters (gingival index-GI, plaque index-PI, gingival bleeding
time index-GBTI, probing depth-PD and clinical attachment lossCAL) and systemic parameters (total cholesterol, TG, HDL, LDL,
cre and HBA1c) were obtained. The DM group was investigated
about the presence of neuropathy, nephropathy, cerebrovascular
stroke (CVS), chronic lung diseases (CLD) and retinopathy.
Results: All of the clinical parameters (except PD) and systemic
parameters (except TG) were found signicantly dierent between
the groups (P < 0.05). 9.4% of DM had grade 1, 18.8% grade 2,
12.5% grade 3, 3.1% grade 4 nephropathy. 3.1% of DM had
neuropathy, 6.3% CLD, 34.4% retinopathy. The correlations
between cre and PD and CAL were found signicant in diabetic
patients.
Conclusion: The signicant dierences between the groups in
inammatory markers and periodontal status have supported the
relationship between the diabetes and periodontal diseases. Larger
diabetic population is needed to determine the correlations between
the clinical parameters and diabetic major complications.

140
Association between periodontal health and
hyperlipidaemia
O. Fentoglu1, P. Tasdelen1, G. Oz2 and Y. Aykac*,1
1
Ankara University; 2Hacettepe University, Ankara, Turkey
Recent studies have shown an association between increased
plasma lipid levels and periodontal disease. The aim of this study
was to determine whether a metabolic disorder such as hyperlipidaemia might be a risk indicator for periodontal disease. In this
study body-mass index, plasma lipid levels, fasting blood glucose
and C-reactive protein of 55 male and female patients aged 34
62 years who have evident hyperlipidaemia were measured and the
results for 55 age-and sex-matched healthy controls
measurements
were compared. For periodontal assessment, plaque index (PI),
gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) measurements
were evaluated. Hyperlipidaemic patients showed statistically
signicant increase in PI, GI, PPD, CAL and BOP values when
compared to healthy controls (P < 0.05). In conclusion, impaired
lipid metabolism seems to be a risk indicator for periodontal
disease.

141
Systemic C-reactive protein and GCF IL-1 profiles in
periodontitis
S. D. Aspriello*, M. Piemontese and F. Bambini et al.
University Polytechnic of Marche, Marche, Italy
Background: Elevated CRP levels in periodontal patients have
been reported by several groups. Levels of IL-1beta in GCF are
dependent upon a genetic inuence and the clinical parameters at
the site of collection. In this study, we examined whether CRP

152

plasma levels are in relation to levels of IL-1 in GCF evaluated

from patients with varying degrees of periodontal disease.
Methods: Serum CRP (by radial immunodiusion assay) and
FCG-IL-1b (by ELISA) levels were assessed in 72 subjects, 24 with
moderate mean clinical attachment loss (AL) (2.45 0.32 mm)
and 24 with height Al (4.27 0.68 mm) as compared to 24
periodontally healthy controls (AL, 1.79 0.24).
Results: At baseline CRP plasma levels were correlated with IL-1b
levels for each group. Statistical signicant increases in CRP levels
and in IL-1b levels were observed in subjects with periodontal
disease when compared to healthy control. Subjects with high levels
of mean clinical attachment loss had signicantly higher mean
CRP and IL-1beta levels (3.95 5.17 mg/L and 109.8 96.6)
than control (1.82 2.01 mg/L and 38.6 45.3).
Conclusion: These data suggest that the levels of FCG-IL-1b and
plasma CRP are closely associated with periodontal status. At
baseline the extent of increase in CRP and IL-1b levels in
periodontal groups depends on the severity of the disease after
adjusting for age, smoking, cholesterol, etc. These markers
expression can in part a host trait, and not strictly a function of
clinical parameters.

142
Are high-density lipoproteins associated with a lower
risk of periodontitis?
J. Pereira*, N. Lunet, D. Carvalho, M. Pinto and J. Medina
Faculty of Medical Dentistry and Faculty of Medicine, Porto, Portugal
Aim: This study was performed to estimate the independent
association between periodontitis and sociodemographic,
overweight, high-density lipoproteins cholesterol and glycated
haemoglobin (A1c) in diabetic and in non-diabetic subjects.
Materials and methods: We evaluated 158 subjects, 59 had type 2
and 20 had type 1 diabetes, and 79 were non-diabetic. For each
participant we obtained information on pocket depth, clinical
adherence level, blooding on probing; age, sex, education, body
mass index (BMI); analytical values: fasting glycaemia, low-density
lipoproteins, high-density lipoproteins (HDL) cholesterol,
triglyceride and A1c. Periodontitis with systemic repercussions
was considered to be present when more than 50% of sites with
PD 4 mm. To estimate the association between periodontitis and
each of the evaluated variables we computed Odds Ratios and
respective Condence Intervals through multivariate logistic
regression models.
Results: In a model including sex, age, smoke, prosthesis,
education, BMI, HDL, A1c compared to non-diabetics the OR
for type 1 diabetics was 2.00 (95%CI: 0.312.4), and 3.4 (95%CI:
1.39.2) for type 2 diabetes. Among non-diabetic subjects, the OR
was 3.0 (95%CI: 0.424.3) when the BMI 25, and the OR was 0.1
(95%CI: 0.010.8) when HDL 50. Among the diabetic
individuals the OR was 0.3 (95%CI: 0.11.2) when HDL 50.
Conclusions: Regardless of the diabetic status, HDL values above
50 mg/dL are associated with a lower risk of periodontitis.

143
Lipid profile in periodontal patients
L. Chandler*, M. Battino, M. Machuca and P. Bullon et al.
Dental School, University of Sevilla; University of Granada; University
of Ancona, Spain
Cardiovascular disease and periodontal disease are some of the
most common illnesses. They produce serious damage with high
social and economic impact. Some papers have been published
showing the epidemiological relationships between these processes.
Atheroma is the main lesion of cardiovascular disease related with
disordered lipid metabolism. Our objective was to the quantitative

Posters: Periodontal systemic interactions

plasma lipid prole, measured by gas chromatography, in a group
of patients with periodontitis (PG) compared with non-periodontitis (NPG). Fifty-seven patients over 35 years, without systemic
health problem were recruited for the study, previously approved
by our Local Ethical Committee. Probing pocket depth (PD) and
clinical attachment level (CAL) were recorded and blood and
plasma were obtained. Periodontitis was dened on the presence of
CAL 3 6 mm in two or more teeth and one or more sites with PD 3
5 mm (Machtei criteria). Total cholesterol: 195.04 (NPG), 217.67
(PG) (P = 0.04); triglycerides: 92.93 (NPG), 144.63 (PG)
(P = 0.005); very-low-density lipoprotein-cholesterol (VLDL-C):
18.42 (NPG), 28.36 (PG) (P = 0.006); total cholesterol/HDL: 3.56
(NPG), 4.58 (PG) (P = 0.01); total saturated fatty acid: 80.51
(NPG), 109.12 (PG) (P = 0.0002); total polyunsaturated fatty
acid: 112.93 (NPG), 130.64 (PG) (P = 0.02). Our data showed
impairment in the lipid metabolism, with higher levels of plasma
fatty acids, cholesterol and triglycerides. These alterations represent an increased risk for the development of cardiovascular
disease.

144
Ten year longitudinal study of the relationship between
periodontal status and coronary heart disease
G. Machuca*, G. Jim nez, J. R. Lacalle and P. Bulln
Faculty of Odontology, University of Seville, Spain
Background: To investigate: (i) the changes in periodontal
evolution after etiological periodontal treatment and (ii) the
inuence of periodontal status in the evolution of cardiac health
over ten years.
Materials and methods: Fifty-ve patients (44 nished the study),
two groups: Healthy Group (HG) n = 9 and Cardiac Group (CG)
n = 35, subdivided into Angor Pectoris Group (AG) n = 5, Acute
Myocardial Infarction Group (AMIG) n = 22 and Exitus Letalis
Group (EG) n = 8. Gingival level (GL), probing depth (PD),
clinical attachment level (CAL), plaque index (PI) and bleeding on
probing (BOP) were measured to compare the periodontal status in
both groups. The patients were examined and periodontal
treatment was performed. They were examined at the end of 1
and 10 years. Statistical method: One way-anova and MR-anova
were established (P < 0.05).
Results: The CG patients showed a worse evolution of periodontal
indices at the end of one years periodontal treatment (PD
P < 0.041, PI P < 0.043, BOP P < 0.007). EG had the worst
evolution (P < 0.008). At ten years
treatment, it could be seen
that although the CG continued increasing CAL on the second visit
(P < 0.0385), dierences in PI (P < 0.023) and BOP (P < 0.012)
were established at the end of 10 years.
Discussion/Conclusion: The coronary cardiopathy aected patients
showed a worse evolution of periodontal indices than healthy ones.
The patients with worse evolution of coronary cardiopathy showed
the worst evolution of the aforementioned indexes.

145
Periodontal conditions in patients with coronary heart
disease
C. Starkhammar*, A. Richter and N. Ravald et al.
Central Oral Rehab., Department of Card., Linkping, Sweden
Aim: The aim of this study was to examine the periodontal
conditions of a group of patients with severe coronary heart disease.
Methods: The study group comprised 161 patients aged 40
75 years recruited from University Hospital, Linkoping. All
patients had undergone percutaneous coronary intervention.
Patients with diabetes were excluded. The control group
comprised 162 subjects with no history of coronary heart disease.

Periodontal conditions were examined clinically and in full-mouth

radiographs. Periodontal disease experience was classied into ve
groups according to Hugoson and Jordan (1982).
Results: Severe periodontitis (periodontal experience groups 4 and
5) was more prevalent in the test group, 25% vs. 8%. The patients
had a mean bone level of 3.0 1.0 mm and the controls
2.6 0.8 mm. Mean tooth loss was 5.3 in the test and 3.4 in the
control group. Periodontal pockets with a PPD 46 mm were more
prevalent among heart patients. We found a signicant association
between coronary artery disease and the variables periodontal
disease experience groups 4 and 5 and smoking. When controlling
for smoking and a wide condential interval, the odds ratio for
having coronary heart disease when severe periodontal disease is
present (periodontal disease experience group 4 or 5) was 2.4.
Conclusion: Severe periodontal disease seems to be more prevalent
in individuals with severe coronary heart disease than among
controls.

146
C-reactive protein, erythrocyte sedimentation rate and
ferritin levels in humans with periodontitis
D. Deimling*, Ch. Koch and P. Ratka-Krger et al.
Department of Periodontology, University of Freiburg, Germany
Introduction: Periodontitis is frequently considered as a local
inammation. However, epidemiological studies have indicated
that this disease may have a systemic eect.
Aims: The aims of this study were to determine if periodontitis
eects inammatory markers in the blood and if non-surgical
periodontal therapy inuences these markers.
Material and methods: C-reactive protein (CRP), erythrocyte
sedimentation rate after 1 h and after 2 h (ESR) and ferritin
(FER) were analysed in 35 generally healthy patients with
periodontitis (test group) before treatment (baseline) and in 18 of
those after non-surgical periodontal therapy. As control we
recruited 22 periodontally and generally healthy adults and
collected blood samples twice within fortnight.
Results: The comparison of the four parameters at baseline
between control and test group showed no statistical signicance
except for ESR/2 h [P-value (Mann Whitney test): CRP = 0.2580;
FER = 0.7121; ESR/1 h = 0.1538; ESR/2 h = 0.0378]. The
dierences within the test group before and after treatment were
not statistically signicant for any marker [P-value (Wilcoxon
signed ranks test): CRP = 0.1477, FER = 0.6475; ESR/
1 h = 0.3942; ESR/2 h = 0.7983]. Performing condence
interval for a single prediction using the two blood samples of
the control group revealed that the reason for these results is based
on the distinct intra-individual uctuations within a person.
Conclusion: In our study the determined markers did not show
statistical signicance.

147
Genetic associations between rheumatoid arthritis and
periodontitis
T. Kobayashi*, S. Ito, T. Kuroda and H. Yoshie et al.
Niigata University of Medicine and Dentistry, Tsukuba University,
Japan
Fc receptors for immunoglobulin G (FcgR) and interleukin 1 (IL1) play a major role in the pathogenesis of rheumatoid arthritis
(RA) and periodontitis. Both diseases are partly inuenced by
genetic component. The aim of this study was thus to evaluate
whether FcgR and IL-1 genotypes could be a risk factor for
periodontitis in RA. The study subject consisted of 46 RA patients,
83 periodontitis patients, and 104 healthy controls. RA patients
fullled the American Rheumatism Association 1987 Revised

153

Posters: Periodontal systemic interactions

Criteria. Periodontitis patients were identied as having more than
one diseased site with more than 4 mm in probing depth. Genomic
DNA was isolated from peripheral blood, and FcgR and IL-1
genotypes were determined by the Invader method. The prevalence
of periodontitis was found to be 76.1% in RA patients. No
dierence was observed in the FcgRIIA, FcgRIIIA, and FcgRIIIB
genotype distributions among the subject groups. However,
IL-1B + 3954 genotype distributions in RA patients were dierent
from those in periodontitis patients and controls (P = 0.013 and
P = 0.04), and also proved dierent between RA patients with and
without periodontitis although this failed to reach statistical
signicance. These results document IL-1B polymorphism to be
possibly associated with risk of periodontitis in RA patients.

148
Gingival crevicular fluid levels of PGE2, IL-1, T-PA and
PAI-2 in type 2 diabetic patients with periodontal
disease
L. Kardes ler*, N. Buduneli and B. Bykoglu et al.
_
School of Dentistry, School of Medicine, Ege University, Izmir,
Turkey
Aims: This study was conducted to evaluate gingival crevicular
uid (GCF) levels of prostaglandin E2 (PGE2), interleukin-1beta
(IL-1b), tissue-type plasminogen activator (t-PA), and plasminogen
activator inhibitor-2 (PAI-2) in type 2 diabetic patients with
periodontal disease.
Methods: Seventeen type 2 diabetic patients with periodontal
disease (DM), 17 otherwise healthy periodontally diseased patients
(PD) and 17 systemically and periodontally healthy control
subjects (H) were enrolled in the study. GCF samples were
obtained from two randomly selected single rooted teeth and fullmouth clinical periodontal measurements were recorded at six
sites/tooth. GCF levels of PGE2, IL-1b, t-PA and PAI-2were
analysed by appropriate ELISA kits. Data were tested statistically
by anova and Dunnett C test.
Results: GCF volume was signicantly greater in DM group than
PD and H groups (P < 0.05). DM and PD groups showed
signicantly higher PGE2 and t-PA levels than group H
(P < 0.05). DM group revealed signicantly higher IL-1b levels
than PD and H groups (P < 0.01). PAI-2 level was signicantly
higher in DM group than H group (P < 0.05).
Conclusion: Within the limits of this study, DM may be suggested
to aect GCF levels of some major inammatory mediators and to
modify host response and eventually clinical periodontal situation.
Further studies are required to better clarify mechanisms of
interactions between DM and PD.

149
Ligneous periodontitis-a destructive membranous
disease
I. Kurtulus*, A. Gokbuget and S. Cintan et al.
Department of Periodontology, Istanbul University, Turkey
Ligneous conjunctivitis is a rare form of chronic conjunctivitis
characterized by the development of rm brin-rich, woody-like
pseudomembranous lesions mainly on the tarsal conjunctivae. Less
frequently, similar lesions may occur on other mucous membranes
of the body (in the mouth its been termed ligneous periodontitis),
indicating that these manifestations are part of a systemic disease.
Actually, systemic plasminogen deciency has been linked to
ligneous conjunctivitis in humans and mice. Histopathological
ndings from aected humans indicate that wound healing, mainly
of injured mucosal tissue, is impaired and shows a thinned or
eroded epithelium with supercial or subepithelial deposits of
amorphous hyaline-like eosinophilic material and foci of persisting
granulation tissue with accompanying inammatory cells, mainly

154

lymphocytes, plasma cells, and granulocytes. The amorphous

hyaline-like eosinophilic material of the pseudomembranes, which
resembles amyloid, but is negative for Congo red stain, has been
shown to contain mainly clotted brin (ogen), and other plasma
proteins such as albumin and immunoglobulins (mainly IgG). This
research is dealing with a short description of plasminogen
activation and deciencies, diagnosis and clinical characteristics
of ligneous lesions mainly in the mouth, histological abnormalities
and electron microscopical study of pseudomembranous lesions on
some cases and current treatment approaches.

150
Comparison of periodontal status in HIV-positive
patients and controls: relationship with the
immunological and virological parameters
M. Perea*, J. Campo, V. Hernando, J. Del Romero and A. Bascones
Department of Periodontics, University of Complutense, Madrid, Spain
Objectives: To determine the periodontal status in HIV+ patients
vs. a control group of HIV- patients, in relation with their
immunological and /or virological state.
Material and methods: A group of individuals with HIV (n = 32)
and a control group of HIV (n = 16) were analysed. A health
history was completed by each subject. Periodontal measurements
included Ramfjord teeth (16, 21, 24, 36, 41, and 44) and we
recorded: locations with probing depths >3 mm (LPD > 3),
locations with loss of attachment >3 mm (LAL), gingival index
(GI), the bleeding index (BI) and plaque index (PI). CD4 and CD8
lymphocyte counts and percentages and viral load (VL) were also
recorded. The frequency of oral hygiene and visits to the dentist
were noted. Statistical analysis was made by Kruskal Wallis test.
Results: There were no statistically signicant dierences in
periodontal measurements between HIV+ patients and controls:
PI (34.3% vs. 27.7%); BI (18.2% vs.15.9%); GI (3.7 vs. 3.2);
LPD> 3 mm (2.9 vs. 2.9); LAL >3 mm (7.5 vs. 5.3). The average
VL was 17596 copies/mL and the media of CD4 count was 537.6
cel/mm3; the CD4 percentage was 25.1%, and the CD8 count was
1123 cel/mm3, and the CD8 percentage was 50.3%.
Conclusions: The immunological and virological parameters
showed a clinical HIV asymptomatic state. The high GI and PI
were not related neither the immunological nor virological state but
there may be concomitants factors, as poor oral hygiene, that could
explain this matter.

151
Influence of cardiovascular risk factors and glycaemic
control on periodontal health in diabetes
L. P. Lim*, F. B. K. Tay, C. F. Sum and A. C. Thai
Dent, NUS & Alex Hosp; Med, Alex Hosp & NUS., Singapore
Background: There has been emerging evidence on the impact of
cardiovascular risk factors on periodontal health. Patients with
diabetes have been shown to be at increased risk to cardiovascular
and periodontal disease. Few studies have been reported on the
cumulative eects of cardiovascular risks and diabetes on
periodontal health.
Aim: To investigate the eects of cardiovascular risks and diabetes
on the periodontal status of a cohort of patients with diabetes.
Materials and methods: A total of 185 patients were recruited from
two diabetic centres. All subjects had a full mouth assessment for
plaque, bleeding on probing (BOP), calculus and probing depths.
Blood serum analysis was also carried out for HbA1c, HsCRP and
lipids. Subjects were divided into various risk categories based
upon a combination of three serum risk prole targets. The
acceptable targets for were: HbA1c < 8%, HsCRP < 2 mg/L and
CholesterolHDL ratio <4.5%.

Posters: Periodontal systemic interactions

Results: More than one third of the patients had at least 2 of the
risks above the target level. When the periodontal parameters were
compared; subjects with lower systemic risks had lower BOP and
probing depths as compared with those who had higher risk
proles (anova P < 0.05). Some dierences were found between
the racial groups.
Conclusion: The results highlight a need to consider the impact of
systemic risks as well as demographic factors in risk analysis and
control of periodontal disease in diabetes.
Acknowledgement:
The study is supported by NUS FRC Grant 222-000-017-112.

152
Gingival bleeding in childhood: an update
Vera Hubkova*, Radovan Slezak and Eva Parizkova
Department of Dentistry, Hr. Kralove, Charles University, Czech
Republic
Gingival bleeding in childhood is not only a sign of the plaqueinduced gingivitis. According to various age periods it occurs in
association with dierent local and systemic diseases with periodontal involvement. In deciduous dentition, gingival bleeding with
teeth mobility and pocketing may represent periodontal manifestation of congenital, mostly hereditary systemic diseases leading to
periodontal tissue damage because of immunodeciency, enzymatic disturbances or tumourous destruction. Sudden gingival bleeding
in children and adolescents associated with acute stomatitis and/or
pharyngitis, cervical lymphadenopathy and fever may be a sign of
primary herpetic gingivostomatitis and acute myeloid leukaemia.
More often, gingival bleeding occurs as a clinical manifestation
of plaque-related gingivitis, juvenile hyperplastic gingivitis and of
early stages of aggressive or chronic periodontitis in periods of
mixed and permanent dentition. Gingival bleeding associated with
extremely painful necroses and inadequate oral hygiene in adolescence are typical signs of the necrotizing periodontal disease
predominantly aecting immunocompromised individuals. Acute
traumatic, chronic granulomatous and desquamative gingivitis are
less common causes of gingival bleeding in childhood. The authors
believe dental practitioners should be able to distinguish local and
systemic diseases with gingival manifestations including bleeding
and manage it.
Acknowledgement:
Supported by Research Project MZO 001 79906.

153
Short-term effects of periodontal therapy on serum lipid
levels in patients with hyperlipidaemia
O. Fentoglu*,1, G. Oz2 and Y. Aykac1
1
Ankara University; 2Hacettepe University, Ankara, Turkey
The literature suggests that there is a relationship between
periodontal disease and impaired lipid metabolism. We evaluated
the eect of periodontal therapy on total cholesterol (TC),
triglyceride (TRG), low-density lipoprotein cholesterol (LDL-C),
high-density lipoprotein cholesterol (HDL-C) in hyperlipidaemic
patients. The study population included 50 patients aged 34
66 years with mild or moderate hyperlipidaemia. The subjects were
divided into two groups and standard periodontal therapy was
performed on the study group. Standard blood chemistry variables
including plasma TRG, TC, LDL-C, HDL-C levels and periodontal parameters including plaque index, gingival index, probing
pocket depth, clinical attachment level, gingival recession and
bleeding on probing measurements were evaluated. Systemic and
periodontal evaluations were performed at baseline and in third
month of the periodontal treatment. Periodontal treatment resulted
in a signicant reduction of both periodontal parameters and
plasma TC and LDL-C levels. For untreated and treated groups,

mean baseline and third month plasma TC levels were

237.28 24.20 and 227.88 30.37, and 244.88 21.22 and
213.60 32.59 (P < 0.001), respectively. Mean baseline and third
month plasma LDL-C levels of untreated and treated groups were
146.63 14.82 and 142.95 19.93, and 155.22 19.02 and
115.80 37.07 (P < 0.001), respectively. This study indicates that
periodontal therapy has benecial eects on metabolic control of
hyperlipidaemia.

154
Correlation between the presence of periodontal
pathogenic bacteria in dental plaque and in
atherosclerotic arteries
A. Pucar*, J. Milasin and V. Lekovic et al.
School of Dentistry, University of Bgd, SAM
Periodontitis has been associated with an increased risk of
atherosclerosis and coronary artery disease. The aim of this study
was to assess the presence of periodontal pathogens in subgingival
plaque and atheroma samples of patients undergoing vascular
surgery. 58 patients were enrolled in the study. A complete clinical
and periodontal examination was performed, with the collection of
plaque samples. Atherosclerotic plaques (eight aorta abdominalis,
11 carotid, 18 coronary, 16 internal mammary arteries, and nine
A. femoralis samples) were obtained during surgery. In four cases,
coronary and mammary artery specimens were taken from same
patient. Specimens were analysed by PCR for the presence of
Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans,
Prevotela intermedia and Tannerella forsythensis. Forty-two out
of 58 subgingival plaque samples (72.4%) were positive for
P. gingivalis, 20 (34.5%) for A. actinomycetemcomitans, 37
(63.8%) for P. intermedia and 15 (25.9%) for T. forsythensis.
Bacterial DNA was found in 24 of 62 atheroma samples (38.7%):
P. gingivalis in 21 (33.9%), A. actinomycetemcomitans and P. intermedia in 13 each (21%), and T. forsythensis in 1 (1.6%). There was
a positive correlation between the presence of P. gingivalis in
biopsy samples and pocket depth of 6mm and more (P < 0.05).
Periodontal pathogenic bacteria are frequent inhabitants of
atherosclerotic plaques, and may play a role in the development
and progression of atherosclerosis.

155
Detection of periopathogens in subgingival and vessel
samples in atherosclerosis affected patients
R. Elkaim*, M. Dahan, L. Kocgoglu and S. Werner et al.
Parogene, ERT 10-61 INSERM U595, Strasbourg, France
Objective: The aim of the present study was to investigate the
presence of periopathogens in atherosclerotic and healthy vessel
samples and try to correlate with both clinical and bacteriological
periodontal assessments.
Materials and methods: Twenty-two patients treated with
atherosclerosis repair surgery were included and allocated to
either a moderate generalized chronic periodontitis group (mGCP;
n = 11) or a severe generalized chronic periodontitis group (sGCP;
n = 11) after a periodontal examination the day before vascular
surgery. Bacterial samples were collected from four periodontal
diseased sites in each patient. Specimens from atheromatous
plaques, internal mammary arteries and saphenous veins were
harvested during vascular surgery. Bacterial detection was done for
20 species using a modication of the checkerboard
DNA-DNA
hybridisation procedure.
Results and Discussion: An increase of the total DNA probe counts
and of the main periodontal pathogens appeared in the sGCP
group compared to the mGCP group for both periodontal and
vessel samples. Surprisingly, the percentage of internal mammary

155

Posters: Clinical tips and cases: Periodontology

arteries and saphenous veins colonized by periopathogens were
similar than the percentage of atheromatous plaque in which the
same pathogens could be detected. These results show clearly that

periopathogens enter the circulation system, which lead to

bacteraemia, but call into question the contributing role of these
pathogens in the development of atherosclerosis.

Posters: Clinical tips and cases: Periodontology

156
Self-reported oral symptoms poorly predict CRP-levels
in general population of young adults
P. V. Ylstalo*, M. R. Jrvelin, J. Laitinen and M. L. Knuuttila
University of Oulu, Finland; Institute of Occupational Health, Finland
Objectives: Previous studies have suggested that periodontitis
associates with C-reactive protein (CRP) levels. In addition,
stress, insulin resistance, inammatory diseases, smoking, diet,
physical exercise and obesity are known to associate with CRPlevels. Our aim in this study was to investigate the role of selfreported gingival bleeding, tooth loss and dental caries as sources
of elevated CRP-levels.
Materials and methods: The study population consisted of a
subsample (n = 8.463) of 1966 Northern Finland Cohort. A
health examination included CRP and serum lipid determinations.
The participation rate was 71% (n = 6.033). Gingival bleeding,
tooth loss and dental caries were determined using a postal
questionnaire. Potential confounders used in the multivariate
regression model included smoking, alcohol use, physical exercise,
obesity, angina pectoris, diabetes and rheumatoid arthritis.
Results: After controlling for the potential confounders, gingival
bleeding and tooth loss had only a slight increasing eect on CRPlevels. The proportion of variation explained by them was low,
being less than 1%. The most important determinant was obesity,
followed by lipid prole and gender, which together explained
about 90% of the explained variation in CRP-levels. The model
explained 12% of the total variation in CRP-levels.
Conclusion: Self-reported gingival bleeding, tooth loss or dental
caries poorly predict CRP-levels among a general population of
young adults.

157
Glycaemic control and periodontal disease: a case
report of berardinelli-seip syndrome
R. Montenegro* Jr, D. L. F. Lima, D. M. Rego and A. I. S. Barros
PPGCSA-UFRN; UNIFOR; UFC
Total Generalized Lipodystrophy or Berardinelli-Seip Syndrome
(BSS) is a rare hereditary disease characterized by absence of
adipose tissue, insulin resistance and other manifestations like
acanthosis nigricans, hepatomegaly, hyperandrogenism, muscular
hypertrophy and diabetes mellitus. A 32 year-old woman with
history of BSS presenting persistent uncontrolled glycaemic levels
(>600 mg/dL) and many dental problems was evaluated. Periodontal and dental examinations were performed. Probing depth
(PD), clinical attachment loss (CAL), gingival overgrowth (GO),
gingival bleeding index (GBI) and presence of decays were
assessed. Radiographic exam was performed using panoramic
and periapical radiography. The patient had 20 teeth where only
one was intact. Eighteen presented only the roots because the
crowns were completely destroyed by the decay. A high degree of
gingival bleeding (100%) was observed. Gingival overgrowth was
present. Periodontal probing showed the presence of periodontal
pockets with PD > 6 mm and CAL > 7 mm. Panoramic and
periapical radiographies were analysed. Periapical lesions and an

156

osteoradionecrosis region were detected. All teeth were extracted

and after two weeks the fasting plasma glucose (FGB) was 151 mg/
dL. One month after the last extractions FGB was 151 mg/dl and
45 days after the last extractions FGB was 131 mg/dL. We
conclude that dental infections like periodontal disease can
compromise the glycaemic control of a diabetic patient.

158
Phacomatosis pigmentokeratotica: oral and periodontal
manifestations of a rare syndrome
S. Salina*, S. Masiero, C. Maiorana and M. Simion
Dental Clinic University of Milan, Milan, Italy
Phacomatosis Pigmentokeratotica is a rare genetic syndrome. It is
supported by the genetic mechanism of twin spotting. Here the case
of a young lady. She manifested a speckeled-lentiginous nevus on
the left shoulder and epidermal nevus spread on the right hemi
soma, ipotrophy, dysesthesia, hyperpathia and hyperhydrosis of
the right hemi soma; she shows torticollis, left facial hemiatrophy,
dextroconvex scoliosis. She developed a primary lymphatic
oedema. Radiographic and clinical periodontal examination conrmed a localized severe plaque induced periodontitis with bone
loss associated with multiple epulises, oral dysesthesia expressed
with monolateral hypersensibility enhanced on the right side. The
syndrome origin from a young post-zygotic mutation that results in
twin-spotting phenomenon: the patient would be heterozygous for
two dierent recessive mutations in the same chromosome and at
an early stage of embriogenesis a postzygotic recombination would
result in two homozygous daughter cell representing stem cells of
the two types of nevi. We suppose a genetic substrate inuencing
pathogenetical response to periodontal pathogens with a dierent
neurological distribution of pain in intraoral areas. We present the
case for the specic oral ndings: these include gingival localized
enlargements and periodontitis, bone loss, dysesthesia. We treated
the biggest epulises by surgery 2 years ago, but they relapsed. At
the moment these epulises were solved by using a Nd:YAG laser.

159
Association of radiomorphometric index and
relationship with periodontal diseases. Valoration of
vitamin D receptor gene polymorphism
N. Souki*, F. Mesa and R. Martinez
Service of Periodontics, University of Granada, Spain
Introduction: The objective of this study was to investigate the
relationship of periodontal diseases as a radiomorphometric index
to measured mandible cortical density and to evaluate alveolar and
basal bone in jaws of patients with periodontal diseases and
compared with healthy population. Research has therefore focused
to evaluate by panoramic radiographs that interaction by
radiomorphometric index and then by informatics program
compared measured jaw bone mass. In addition, we determined
using a PCR-based method genetic polymorphism in the vitamin D
receptor (VDR) associated with periodontal diseases.
Patients and methods: Selected clinical history between 1998 and
2004 approximately 8000 histories. Of the 480 patients chosen for

Posters: Clinical tips and cases: Periodontology

inclusion in the study 240 were periodontal disease patients and 240
healthy normal. A nearly even distribution between both sexes,
racial groups, smoking habit and age from 30 to 45 years was
obtained. Who had neither metabolic disease nor local lesion
aecting skeletal metabolism was selected. Radiographs were
obtained digitalis and captured by informatic program. Were
taken the morphometric and densitometry measurements of
alveolar and basal bone, we classied periodontal diseases in
panoramic radiography accordance with the ruler of Shei.
Analysed the genotypes to determine the VDR: 25 patients of
Chronic Periodontitis, 25 Aggressive Periodontitis and 25 controls.
Results: Preliminary or nal analysis of this study will be available
in Europerio 2006.

160
Oral lichen planus and desquamative gingivitis:
analysis of 59 cases
M. Daz*, R. Lpez, B. Rivera, L. Arriba and G. Hern
ndez
Complutense University of Madrid, European University, Madrid, Spain
Desquamative gingivitis (DG) is characterized by a diuse
erythema of the marginal and attached gingiva, associated with
several areas of desquamation. Desquamative gingivitis represents
a reaction of the gingival, which conceals other pathological
entities such as hormonal disturbances, chronic irritation, lichen
planus and pemphigus vulgaris among others. In attempt to
determine the frequency of desquamative gingivitis in oral lichen
planus we present 59 cases of patients with oral lichen planus
attending to the Oral Medicine Department of the Complutense
University at Madrid. We found 59 cases of patients with oral
lichen planus, 34 of them present reticular lichen planus, 24
atrophic lichen planus and only one bullous lichen planus. There
are 30 patients coexisting desquamative gingivitis and oral lichen
planus; we found 19 cases of DG and atrophic lichen planus, 10
cases of DG and reticular lichen planus and one case of DG and
bullous lichen planus. We study clinical features, diagnosis and
treatment of most common oral lesions.

161
Evaluation of papillary blood flow using laser Doppler
flowmetry
H. Develioglu*, V. Bostanc, H. Ozdemir and G.
zcan
Department of Periodontology, Uni Cumhuriyet, Sivas, TR
Objective: Previous investigations have shown that there is an
interaction between gingival blood ow and gingival health. The
purpose of this study was to compare the papillary blood ow at
sites treated with the blood ow at untreated sites.
Design: Twenty persons with resin faced, xed partial dentures
were enrolled in the study. The contralateral natural teeth of the
site symmetrical to that of the restorations were used as controls.
The blood ow was measured from the middle point of the papilla
from both from test and control sites by laser Doppler owmetry
(LDF). The plaque index, papillary bleeding index, and probing
depth measurements were recorded.
Results: There was a statistically signicant dierence between the
test and control groups in papillary blood ow measurements
(P < 0.05). In contrast, no signicant dierence between two sites

clinical indices was found (P > 0.05).
Conclusions: It should be emphasized that there is an important
relationship between resin-faced, xed partial dentures and
papillary blood ow. Blood ow measurements provide
information about the microcirculation of the tissues. It seems
that it is necessary to evaluate, in detail, the eects of xed bridges
on proximal periodontal health conditions.

162
Wegener's granulomatosis report of a case with
pronounced gingival alterations as a first sign
E. Hornecker
ZMK, University of Goettingen, Germany
Wegeners Granulomatosis (WG) is a triad involving primarily the
vascular, the respiratory and the renal system. Necrotizing
granulomatous lesions of the upper respiratory tract, generalized
vasculitis in various organs and necrotizing glomerulonephritis are
the classic ndings. WG may also aect other tissues and atypical
presentations have been reported, for example cutaneous and oral
lesions. The awareness of these atypical or partial presentations
ensures early diagnosis of a disease that is usually fatal if untreated.
For the dentist the appearance of an enlarged strawberry-like

gingiva may be the rst distinctive sign suggesting WG.
Case: A 48-year-old male was referred to the Dental Clinic by his
dentist. Unusual generalized gingival alterations somehow
granulated
persisted about 6 weeks and were refractory to
treatment. The patient was reasonably suspected of having acute
leukaemia. The result of an outpatient bone marrow biopsy
performed at the Medical Clinic was negative. Next, a
granulomatous disorder was supposed, e.g. Crohns disease or
WG, but the nding of the gingiva biopsy showed no specic
indications. Several days after the rst presentation the oral
situation had worsened and the patient complained of having
remittent fever. Within the next week symptoms at the paranasal
sinuses appeared. Four days later the patient was hospitalized in
the Medical Clinic. The diagnosis of WG was established by
serologic ndings and the cytostatic therapy started.

163
Why periodontal patients come to dental office?
M. Calvo*, M. Moya, A. Sanchez, M. Serrano and E. Wojtovic
Universidad de Murcia, Espaa
Aims: Periodontal patients go to dental oce due to dierent
reasons. The purpose of this study is to know these reasons, in
order to orient the type of information available in dental service,
improving the communication with the patient.
Materials and methods: Clinical histories of 47 periodontal patients
have been reviewed. These patients came during a period of one
year to Faculty of Dentistry of Murcia demanding periodontal
care. Special attention was paid to the reasons for consultation.
Results: The reasons because of periodontal patients came to the
dental school were the following ones: dental cleaning (46.8%),
dental revision (25.5%), gingival bleeding (14.8%), gingival
recession (4.2%), others (8.5%).
Conclusion: Most of periodontal patients come to dental oce by
no periodontal symptoms. Gingival bleeding is the most frequent
recognized by patients, followed of recessions. Any patients came
by other periodontal symptoms like sensitivity, dental mobility,
migrations or halitosis. For that reason, it seems suitable to have
informative brochures in waiting room so that patients become
aware from the importance of the periodontal disease, its
symptoms and its treatment.

164
Association between periodontal status and fertility
parameters in males attending infertility and in vitro
fertilization clinics
A. Klinger*,1 and O. Schonberger2
1
Department of Periodontics, Hadassah; 2IVF Lab, Bikur Holim
More than 400 species of bacteria inhabit the human oral cavity.
Some of these have been associated with bacterial endocarditis,

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Posters: Clinical tips and cases: Periodontology

aspiration pneumonia, ischaemic heart disease and low birth
weight. Recently, an association has been found between dental
infections and infertility. The aim of the present study was to
examine the possible association between infertility and periodontal condition. The study population consisted of men attending
fertility and in vitro fertilization clinics. The test group consisted of
men with diminished semen quality, according to the specications
of the World Health Organization. Patients requiring surgical
procedures for the retrieval of semen (TESE, FNA or EEJ) were
also included in the study. Control group included men with
normal semen quality. Patients received a comprehensive clinical
periodontal examination followed by routine sperm analysis.
Subjects were diagnosed as either healthy (8%), with Gingivitis
(48%), Chronic Periodontitis (40%) or Aggressive Periodontitis
(4%). Sixty ve percent of patients with Oligozoospermia, suered
from Gingivitis compared to only 46% of men with Normospermia. Eighty percent of patients with Azoospermia were diagnosed
with Chronic Periodontitis compared to only 40% with Normospermia. These ndings may implicate an association between
infertility, diminished semen quality and periodontal infections.

165
Solitary gingival lymphangioma: a case report
C. Kalpidis*,1, S. Lysitsa2, J. Samson2 and T. Lombardi2
1
Aristotle University, Greece; 2University of Geneva, Switzerland
Background: Lymphangiomas are rare, hamartomatous, lymphatic
malformations that usually involve dermal and subcutaneous
tissues. Oral lymphangiomas are most frequently encountered on
the tongue and buccal mucosa. The purpose of this report was to
present an extremely rare case of localized, supercial
lymphangioma observed on the gingiva of a 16-year old girl.
Materials and methods: The lesion involved the buccal surface of
the interdental papilla between the lower left incisor and canine
and appeared as an irregularly erythematous small swelling with a
vesicular texture. The patient was in good general health without
other abnormalities elsewhere on the body. Local ultrasonic
debridement had no benecial eect and an excisional biopsy
was performed to establish a denitive diagnosis.
Results: Histological analysis revealed several lymphatic vascular
cavities of various size, lined with a attened endothelium. Most of
these lymphatic structures were located supercially, just
underneath the overlying epithelium. The endothelial cells were
negative for the CD34 antigen. Healing of the excision wound was
uneventful and no signs of recurrence were observed.
Conclusion: Even though lymphangiomas are encountered very
infrequently on gingival tissues, they should be considered in the
dierential diagnosis of related conditions. Dierential diagnosis
should include local inammatory reactive lesions, acquired
lymphangiectasia, and other vascular hamartomas or tumours.

166
Actinomycosis-mimicking periodontitis : a report of
two cases
B. Loir
Private practice, Waterloo, Belgium
Actinomycosis is a suppurative systemic infectious disease concentrating in 50% of the cases in the cervico-facial region. It can cause
sudden, acute and localized loss of periodontal tissue as encountered in aggressive periodontitis. Two patients have been diagnosed
for both periodontal disease and actinomycosis (diagnostic conrmed by biopsy) mimicking localized aggressive periodontitis.
Patients with periodontitis could be in certain circumstances more
susceptible to actinomycosis because of the chronic mucosal barrier
failure and the presence of anaerobic bacteria. Furthermore,
considering the severity of the periodontal tissue destruction,

158

actinomyces species should be reconsidered as not being part of the

protective bacteria such as described in the literature. The
diagnosis based on clinical examination is dicult: the presentations can vary widely mimicking other diseases or even tumours
such as lymphoma, less than 50% of the culture is positive and it
can subsequently be largely underdiagnosed. The recommended
diagnostic methods are biopsy or ne needle aspiration. Recurrence is not rare. The hypothesis of a relationship between these
two separate entities could be based on a specic bacterial shift
after brushing or periodontal treatment as actinomyces species has
been shown as one of the rst biolm recolonizing the tissues a few
hours after periodontal treatment.

167
Hypophosphatemic vitamin D-resistant rickets. a casereport with 30-years follow-up
B. Yankova*, H. De Bruyn and R. De Moor
Department of Periodontology, University of Ghent, Belgium
The main eect of hypophosphatemic vitamin D-resistant rickets
(HVDRR) is impaired mineralization of teeth, bone and cartilage
resulting in rachitic changes at the growth plate and osteomalacia.
The oral manifestations are multiple abscesses around the teeth,
osteodystrophy, enlarged pulp chambers, elongated pulp horns
that may reach the dentinoenamel junction and interglobular
dentin. Literature on the dental condition in adult patients with
this metabolic disease is absent. The long-term follow-up of a case
of a HVDRR patient is reported radiographically and clinically.
She was treated at the Dental school from the age of 20 to till
50 years. Initially de patient had 27 teeth and minor chronic
periodontitis. During follow-up the mean plaque and bleeding on
probing varied from 1530%. No furcation involvement has yet
been recorded. Despite of maintenance and good compliance she
lost 14 teeth. Prosthetic treatment was necessary to keep the
dentition functional. Gradually, horizontal bone loss converted
into infrabony defects without signs of inammation. The cost for
keeping the dentition functional was overall 15.500; the yearly
expense for periodontal maintenance was 185. Despite of good
functional rehabilitation, endodontic and periodontal treatment
the condition went gradually downhill due to attachment loss
without clinical signs of infection. From a cost-benet point of
view this is disappointing.

168
Neurofibromatosis with unilateral gingival
hyperplasia a case report
M. Pllnen*, K. Vhtalo and S. Syrjnen
Institute of Dentistry, University of Turku, Finland
Gingival hyperplasia is commonly associated with hormonal
changes and medications. More unusual causes are systemic
diseases like leukaemia and genetic syndromes. Neurobromatosis
(NF) is a group of genetic disorders (NF I-III) that may also
manifest in the oral cavity. Oral lesions occur mainly as submucosal nodes but also gingival enlargement, intraosseal defects and
vascular malformations have been reported. This case report
presents diagnosis of neurobromatosis in the mandibular ramus
and cerebellum of a 13-year-old girl. She was referred to the Turku
University Hospital because of unilateral gingival and alveolar
hyperplasia. Anamnestically, she was healthy but had had
prolonged bleeding after surgical exposure of the lower left
molar. At age of seven plexiformic neurobroma had been
removed from her left forearm. The face was symmetric and she
had several pigmented nodules on the skin. The left side of the
gingiva and alveolar processes in both maxilla and mandibular had
prominent hyperplasia. Gingival biopsy showed no pathological

Posters: Clinical tips and cases: Periodontology

ndings. Because of radiolucency seen in the panoramic tomography in the left mandibular ramus, wisdom tooth extraction
including biopsy at medial side of ramus was performed. Histological diagnosis was neurobromatosis. MRI examination showed
lesions also in cerebellum, which later on were diagnosed neurobromatic foci. This case report shows that gingival hyperplasia
can be a sign of severe systemic disorders such as neurobromatosis.

169
Localized lesions of cervical external root resorption: a
case report
D. Nikolidakis, R. Junker, J. Smeeken, F. Rathe* and A. Sculean
Pract Enschede; Department of Periodontology, RUMC Nijmegen,
Netherlands
Cervical external root resorption was reported at natural teeth
involving one or more teeth in the same patient. The incidence of
these lesions appears to be random and the aetiology is still
unclear. The aim of the present case report is to present the
therapeutic approach and the 2-year results following treatment of
multiple external cervical resorptions in a 46-year old Caucasian
male patient. At baseline, the clinical and radiographic examination showed circumscribed lesions in the cervical region of the teeth
13, 23 and 33. The aected teeth were vital and the x-ray
examination revealed no signs of periapical pathology. Following
initial periodontal therapy periodontal surgery was performed
involving ap elevation and removal of the granulation tissue,
which occupied the resorption cavity. During surgery, an invasion
of the bone into the defect was observed and ostectomy performed
to expose the cervical defects. The cavity was debrided, shaped and
lled with glass-ionomer cement. The histological examination of
the removed granulation tissue revealed the presence of multinucleated cells similar to osteoclast indicated a resorptive activity. At
6 months after therapy the soft tissue measurements did not reveal
any signicant changes compared to baseline values (PPD less than
3 mm) and clinical/radiographic re-examination at 2 years indicated a stable periodontal situation and without any further
deterioration of the cervical defects.

Conclusions: Due to the overlap of these syndromes, we argue that

the identication of the genetic pathways and mechanisms will be
the most important factor in classifying these disorders, with the
phenotype playing a minor role.

171
Clinical evaluation of free gingival graft shrinkage in
two dimensions: fifteen consecutively treated patients
H. G. Keceli*, H. Hatipoglu, T. F. Tzm and D. Sengn
Department of Periodontology, Hacettepe University, TR
Free gingival graft (FGG) is a predictable method for obtaining a
satisfying amount of keratinized tissue. Shrinkage of FGG is a well
known clinical phenomenon but there are limited studies demonstrating the dimensional changes during healing in FGG and there
is no published study on determining shrinkage of the graft in
either two dimensions. Aim of study is to examine shrinkage of
FGG in both horizontal and vertical dimensions, calculate changes
in surface area of the graft and record the complaints of the
patients. Mandibular anterior areas of 15 patients were treated.
Graft sizes and areas were measured and shrinkage of graft was
calculated at baseline and 10, 21, 180 days. Haemorrhage, sense
and pain symptoms were also examined. Five, six and seven
patients demonstrated surface area changes at rst, second and
third follow-up visits respectively. When dimensional changes of
graft were analysed, observed changes in horizontal direction were
not statistically signicant during study period. However there
were statistically signicant reductions in vertical direction at all
visits except 10 days. Calculated area was also signicantly reduced
during the study period. Five patients had postoperative bleeding,
ve patients had sense alterations. Eight patients had slight
postoperative pain in their both recipient and donor sites. Our
ndings suggest that reduction in vertical dimension seems to be
the major factor aecting the calculated graft area and clinical
outcomes of the FGG procedure.

172
Oral health in diabetic and not diabetic subjects: with
especial reference to periodontal diseases
J. Montoya*, M. Saura, A. S
nchez, I. Morata and A. Jornet
Periodontology department, University of Murcia, Spain

170
The phenotypic overlap of syndromes associated with
hereditary gingival fibromatosis: a follow-up of a family
for five years
M. C. Haytac* and O. Ozcelik
Cukurova University, Turkey
Background: Hereditary gingival bromatosis (HGF) is
characterized by the slowly progressive, brous enlargement of
gingival tissue. It usually develops as an isolated disorder but can
also be one feature of various syndromes. The currently preferred
terminology of these syndromes mainly describes the clinical
features of the disorder without identifying the cause. In this
report, we describe a family with HGF and features of three
previously described syndromes: Jones syndrome, ZimmermanLaband syndrome and HGF-hypertrichosis syndrome.
Methods and results: The 45-year-old father had HGF,
hypertrichosis, hearing loss and short stubby ngers and toes
with hypoplasia of the terminal phalanges, hypoplasia of the nails
on the thumbs. The features of 13-year-old son were almost
identical to those of his father except for hypertrichosis but in
addition he was mentally retarded. While the 10-day-old son had
HGF and defective ngers, the mother and 7-year-old daughter
was unaected.

Background: Diabetes is a pathology with a high prevalence in our

society. Some authors relate the diabetes with an increase both
severity and number of injuries in the oral cavity. The relation
between oral pathology and diabetes is for many authors
bidirectional.
Aims: To value the level of oral health in a group of diabetic
patients and other one of not diabetic patients, to compare the level
of oral health in both groups and to value the existing relation
between diabetes and disease periodontal.
Materials and methods: An exploration was realized to a group of
diabetic patients and to other one of not diabetics. The variables
that were object of study were the following ones: Age, Gender,
Consumption of Tobacco, Consumption of Alcohol, Type of
treatment of the diabetes, Presence of other associate pathologies,
Pathology in oral mucous, dental state by means of CAOD,
Community Periodontal Index, Glycated haemoglobin (diabetic
patients).
Results: We nd statistically signicant dierences between both
groups as well as the presence of disease periodontal as associate
systemic diseases.
Conclusions: Diabetes is not related to the number of caries.
Diabetes is related to the disease periodontal. The diabetic subjects
present major frequency of other systemic diseases: arterial
hypertension and stroke accident. We nd major number of oral

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mucous injuries in the diabetic patients, although this information
does not statistically signicant.

173
Legal aspects and risk management in periodontal
practice: case report
F. Zangari
Ravenna Medical Center, Ravenna, Italy
The failure to detect, diagnose, treat or refer a patient for treatment
of periodontal disease may be negligent and such failures are often
litigated in dental malpractice actions. Failing to diagnose periodontal disease may be responsible of an untreated progressive
destruction of the periodontal tissues up to severe or irreversible
clinical conditions, frequently resulting in the loss of one or more
teeth. Moreover, failing in providing adequate periodontal care
may lead to xed and/or removable prosthetic rehabilitations on
teeth with poor or hopeless prognosis. On the other hand, since
bacterial plaque is by far the most important etiologic agent for the
occurrence of periodontal disease, it is evident that patient
compliance in the daily plaque control is necessary to obtain and
maintain successful treatment outcomes. It is noteworthy that a
noncompliant patient may be adjudged negligent in court, but to
support a claim of contributory negligence, the dentist must be able
to show that the patient did in fact contribute to his or her injury.
In our litigious society, a complete periodontal charting results
necessary to document diagnosis and treatment or referral in the
case of a lawsuit, inasmuch as only clear and accurate clinical
records may prove the best defence in a malpractice suit. From the
analysis of a professional liability case, attention is focused on the
legal standard of periodontal care, essential to avoid a malpractice
claim and to prevent a lawsuit.

174
Evaluation of the clinical results of the surgical
correction of gingival recession 4 years results
T. Keglevich*, P. Windisch, A. Horv
th and I. Gera
Semmelweis University, Department of Periodontology, Hungary
Introduction: It has long been one of the objectives of the
corrective periodontal surgery to cover the denuded root
surfaces. There are several surgical techniques on the eld of
aesthetic mucogingival surgery. The most widely used techniques
are the subepithelial connective tissue grafts and the epithelialized
free gingival grafts. The long-term evaluation of the results after
surgical correction of gingival recession cases is scare in
periodontal literature.
Material and methods: Between 2000 and 2001, 18 epithelialized
and 18 subepithelial connectives tissue graft operations were
performed at the Department of Periodontology, 75% of cases
were Miller III-IV defects. The mean age of the patients were
34 years. Only patients with excellent oral hygiene were surgically
treated.
Clinical results and discussion: The average improvement of the
gingival recession after 1 year was 42% with the subepithelial
connective tissue graft and 72% with the free gingival graft. The
mean width of the keratinized gingiva increased by 3.15
2.01 mm and 5.25 2.00 mm with the subepithelial connective
tissue graft and with the epithelialized graft respectively. The
follow-up of our cases shoved a sustained gingival coverage after
4 years and only minimal additional denudation and gingival
shrinkage occurred. The success and the durability of surgical
results were dependant on the morphology of the gingival
recession, the surgical techniques and the periodontal supportive
therapy.

160

175
Combined treatment with GTR and connective tissue
graft of a periodontal necrosis after RCT with
radiosurgery
a case report
A. Horvath* and I. Gera
Semmelweis University, Department of Periodontology, Hungary
Background: The surgical techniques utilizing radiofrequency has
had a wide publicity recent years. A 28-year-old female patient referred to our out-patient service had root canal treatment with
a radiosurgical
instrumentations. Around the treated tooth
suddenly developed serious gum and alveolar bone necrosis.
Material and methods: Around her #12 tooth a necrotized alveolar
crest, complete lack of marginal gingival, severe tooth mobility and
an opened access cavity were seen at admittance. The treatment
was started with wound debridement and provisional Ca (OH) 2
medication was placed in the root canal. The mobile lateral incisor
was temporally splinted. Subsequently SRP and denitive root
canal lling was performed using step back and lateral
condensation techniques. Two months later a full thickness
mucoperiostal ap was elevated and after defects debridement
NBM graft covered with barrier membrane were used. Before
suturing a subepithelial connective tissue graft was transplanted
under the gingival ap to augment the attached gingival.
Results: Both the clinical and the radiological parameters showed
CAL gain at 6 months and 1-year controls. The temporary splint
was removed at month 18 postsurgically and the tooth became
rm.
Conclusion: Certainly radiosurgery in dentistry has its well-dened
indications. It should be kept in mind that the inadequate
application can lead serious periodontal cosequencies.

176
Comparison of genetical, microbiological,
immunological findings and periodontal status of
dizygous twin
I. Saygun1, P. Emecen2, and R. M. Nohutcu*,2 et al.
1
Gata Hospital, Turkey; 2Hacettepe University, Turkey
In this report twin female patients one of who had advanced
periodontal disease and the other had initial localized periodontal
problem were compared from the view of genetical, microbiological, immunological ndings and periodontal status. Type of the
HLA antigen was determined by PCR for immunological evaluation. Immunophenotype was examined including CD3, CD4,
CD8, CD19, CD3-CD16+CD56, CD45, CD14, CD4/CD8.
HCMV, HSV-1, EBV viruses and A. a, F. n., C. r., P. g., T. f.,
P. i. bacteria were quantiated by real-time PCR in the subgingival
plaque samples for microbiological evaluation. IL-1A, IL-1B,
IL-1RN, IL-6, VDR and OPN gene polymorphisms were determined. HLA antigens were found the same and immunophenotype
results were recorded in normal limits. EBV-1 virus was found as
3.5 105 in only the patient with advanced periodontal disease. In
the same patient C. r. (3.3 106), F. n. (5.1 107), P. g. (4.3 107),
T. f. (4.3 107), P. i. (6.1 108) were determined. In the other twin
no virus detected. However F. n. (6.1 108), T. f. (2.1 107), P. i.
(7.1 106) were observed in this patient. Although the genotype
analyses of IL-1A, IL-1B, IL-1RN, and OPN gene polymorphisms
were the same, VDR and IL-6 gene polymorphisms were found to
be dierent. Even the environmental factors were shared and the
immunological response can be thought to be the similar due to
HLA antigens match, the microbiological and genetical factors
seem to play important roles in the initiation and the progression of
periodontitis.

Posters: Clinical tips and cases: Periodontology

177
Labial piercing and localized periodontal
destruction partial periodontal regeneration
following periodontal debridement: a case report
I. Kapferer*, S. Hienz and C. Ulm
Department of Periodontology, Medical University, Vienna, Austria
Background: Localized periodontal destruction has been reported
as a rare complication of intraoral piercing. The purpose of this
case report is to illustrate the destructive nature of a lip stud and to
describe the successful treatment of this case.
Case: A 26-year-old female patient attended to the emergency
dental department with the chief complaint of inamed lower front
teeth
. Clinical examination revealed a labial lip stud with an
intraoral closure in region 31/41, isolated probing depths up to
9 mm on teeth 41 and 31, increased mobility, recessions, and the
presence of calculus. Probing depths of the remaining dentition
were within normal limits (1 to 3 mm). The lip stud was removed
and supra- and subgingival debridement was performed. Due to a
shallow vestibule, the absence of keratinized gingiva, and the
strong frenulum insertion at the gingival margins, a free gingival
graft was placed.
Results: Subsequently the patient demonstrated a signicant
amount of osseous regeneration and partial coverage of the
recession, which has been clinically and radiographically
(computer tomography) documented.
Discussion/Conclusion: It is generally accepted that periodontal
wound healing is age-dependent and is faster in younger
individuals than in older individuals. Consequently, since body
piercing is popular among young people, a higher potential for
osseous regeneration might be expected in this patient population
after removing the etiologic agents.

178
The aggressive periodontitis in Morocco:
heterogeneity of the clinical forms
B. E lhouari*, K. Amine, N. Khlil and J. Kissa
Department of periodontology, UNIV HASSAN II, Casablanca, Morocco
Periodontologists have been studying and listing the various
clinical forms of periodontal diseases. Many classications have
been made. Because of diculties in standardizing, the choice of
these classications, the consensus of the world workshop of 1999
was to go back and trough some specic parameters of classications to simplify the diagnosis of the periodontal diseases: The
aggressive periodontitis was born, a new form that has regrouped
several entities. Therefore, there are a variety of clinical forms of
the aggressive periodontitis observed in Morocco. The confrontation of these aggressive periodontitis, regarding to specic standards of classication, will allow emphasizing the heterogeneity of
these pathologies and diculty of putting a denite diagnosis.

179
Periodontal plastic surgery for the orthodontic
treatment
K. Amine*, B. El Houari, F. Bourzgui and J. Kissa
Department of Periodontology, UNIV HASSAN II, Casablanca, Morocco
The orthodontic movements act on all the supporting tissue of the
dental organ. The anatomical interdependence makes the supercial periodontal aect the deep periodont. In a way that of the
orthodontic therapy implemented comes to a failure. Because of an
orthodontic treatment to the child, the adolescent or the adult, the
plastic periodontal surgery can have either a preventive or curative
results according to the dierent elements of the supercial and
deep periodont. Not to forget the periodontal typology, the

topography of the frenom or the existence of a muco-gingival

injury. A careful periodontal clinic examination is therefore a
required and essential for a better orthodontic treatment. It helps
the patient combine with a therapeutic form that is adapted to his
periodontal morphology as well as and to the proposed orthodontic movements propose. The periodontal plastic surgery can then
implemented in three levels: in pre, per and post orthodontic. The
clinic cases, which represent the dierent situations, are added.
They will be worked on so as to show the situations that need a
pre-orthodontic surgical preparation, to dene the serious risks of
the supercial periodont during the orthodontic treatment and to
illustrate specic techniques, aiming to recover some aesthetic
damage that could get the periodont after the orthodontic
treatment.

180
Laser assisted periodontal therapy with
the use of ND-YAG laser
Cleopatra Nacopoulou
Private Practice, Athens, Greece
Purpose: To evaluate the use of ND-Yag laser for the treatment of
ulcerative gingivitis, early, moderate and advanced Periodontitis.
Periodontal defects form as a result of a disease process that is
initiated by the presence of subgingival microorganisms. The toxins
from the microorganisms provoke a constant inammatory state
that gradually breaks down the epithelial attachment and leads to
resorption of the alveolar bone. If the disease is not untreated,
periodontal bone loss will progress to tooth mobility and
eventually to tooth loss. The ND-Yag laser has bactericidal
eect, deactivates the endotoxins, alterates the root surface and
biostimulates the cells of the host for tissue and bone regeneration.
The ND-Yag laser has a penetration depth up to 1100 lm.
Materials and methods: In this study we used the ND-Yag laser to
treat four patients with ulcerative gingivitis, early, moderate and
advanced Periodontitis. We performed conventional and surgical
therapy as needed. In conventional therapy no anaesthesia was
necessary. In the surgical phase and especially at gingivectomy
topical anaesthesia was used and no stitches were needed.
Results and conclusion: The case involving ulcerative gingivitis had
immediate improvement clinically and systemically, due to the
reduction of fever and lymph glands swelling. At the intrabony
defects we found: reduction of periodontal pockets, gain of
attachment level, no bleeding on probing and reduction of tooth
mobility.

181
Soft tissue grafts to manage lesions of oral
pemphigus: a case report and review of he literature
A. Santos*, M. Savoini, A. Pascual and M. Cirach
Director, Periodontology Department, UIC; BCN, Spain
Introduction: Pemphigus is a rare cause of desquamative gingivitis.
Description in the management of a patient with periodontitis and
multiple oral lesions of pemphigus vulgaris is presented.
Material and methods: A 40-year-old female with a 3-years history
of painful, ulcerated, and bleeding gingiva, diagnosed of
pemphigus vulgaris 7 years ago. Patient was treated with
systemic and topical corticosteroids. Due to side eects,
physicians suspended their use. Other treatments were tried
(dapsone) with no success. After clinical and radiographic
evaluation the patient was diagnosed of moderate periodontitis
and oral pemphigus lesions. The patient received oral hygiene
instructions and the use of a 0.2% chlorohexidine mouthrinse for
15 days. Instrumentation with local anaesthesia was performed to
eliminate supra and subgingival calculus. Six weeks after treatment

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pocket depths were reduced in general, but the patient still referred
soreness, spontaneous bleeding, and diculty to brush in several
areas. After her consent, soft tissue autografts in those areas were
performed.
Results: After 24 months, the patient shows the excellent clinical
appearance of the gingival tissues and no bleeding and soreness is
referred.
Conclusion: This report demonstrates the successful treatment with
soft tissue autografts of multiple buccal gingival pemphigusassociated lesions in a patient with pemphigus vulgaris with
relative contraindication to corticosteroids.

182
Clinical crown lengthening in high aesthetic areas: a
new surgical technique
L. De Micheli* and C. Coraini
Instituto Stomatologico Italiano, Milan, Italy
The objective of this work is to illustrate a variation of the clinical
crown lengthening surgical procedure for the restoration of dental
elements of aesthetic interest. Our department treated 17 cases of
single teeth (15 upper and two lower) with this modied surgical
technique. Following a sulcular incision both in the buccal and
palatal/lingual side of the compromised tooth, a total thickness
debridement reveals the bone crest. The ostectomy and the
osteotomy are performed with burs and scalpels. Two vertical
buccal incisions, with a very long internal bevel are made, which
start at the papillas base and extend beyond the mucogingival line.
The ap is divided in three parts (two papilla and one intermediate
sector) and cut to partial thickness to be repositioned apically at
dierent levels. The intermediate part is stabilized more apically to
increase, in the apical coronal sense, the gingival margin, minimizing the formation of interproximal spaces and the attening of
the gingival prole. Stabilizing stitches are positioned. This
technique has specic indications for the frontal upper area, for
defects that are more accentuated buccally and the great advantage
of treating all gingival biotypes. A small correction of the
roundness of the gingival prole sometimes becomes necessary
later. This modied clinical crown lengthening procedure in
aesthetic areas is a valuable solution since it is easily performed,
it has good predictability and great aesthetic results.

183
Treatment of amlodipine-induced gingival enlargement:
a case report
R. E. Toprakseven*,1, . Noyan1,2 and L. Kuru1
1
Marmara University; 2Yeditepe University, Istanbul, Turkey
Gingival enlargement may be seen in patients taking amlodipine, a
relatively new drug belonging to the calcium channel blocker group
applied to hypertension and angina. This is a report of periodontal
management of a 54-year-old hypertensive male who had been
using this drug 10 mg/day for about 10 years. His complaints were
gingival swelling, spontaneous bleeding, diculty in chewing and
speaking, and poor appearance. Moderate to severe gingival
enlargement was observed on both mandible and maxilla, with
more pronounced enlargement at the upper right molar area.
Gingiva was also oedematous, red, smooth and shiny, and bled
easily on probing. The amlodipine was replaced with an angiotensin II receptor blocker after consultation with his physician. Oral
hygiene instruction, scaling and root planning with adjunctive use
of chlorohexidine and, extraction of 16, 26, 28, 48 teeth were
performed. After initial treatment, gingival enlargement was so
reduced that surgical removal of overgrown gingival tissues was
performed in certain areas only. Change from amlodipine to
another drug and periodontal treatment resulted in signicant

162

improvements in clinical parameters (1 year changes, plaque index

2.3, sulcus bleeding index 3, probing depth 2.8 mm, gingival
hyperplasia score 2.3), function and aesthetics. A combined
approach of periodontal treatment and suspension of amlodipine
was eective in the management of gingival enlargement up to
1 year after completion of treatment.

184
Connective tissue grafting on resin ionomer in
localized gingival recession: a case report
I. Keskiner*, A. Alkan, S. Akarsu and E. Yuzbasioglu
Faculty of Dentistry, Ondokuz Mays University, Turkey
One of the main objectives of periodontal reconstructive surgery is
the coverage of exposed roots that occurred due to gingival
recession. In some occasions, where caries, root resorption or an
amalgam lling exists on the exposed root surface, the treatment
planning becomes more complex. This case report describes the use
of a subepithelial connective tissue graft on resin ionomer-restored
root surface to treat a gingival recession that is complicated with all
the abovementioned handicaps. Amalgam lling and caries lesion
were removed following full thickness ap reection and the cavity
was restored with glass ionomer cement. A subepithelial connective
tissue graft was placed onto the restoration and the ap was
coronally positioned. Porcelain crown restoration was performed
9 months after surgery. At 3 and 9 months follow-ups, probing
depths were reduced and gain in attachment level was obtained
with no clinical signs of inammation in gingiva. Monthly
periodontal controls revealed that creeping attachment has
occurred on the restoration during the follow-up period. This
single case report serves as a good example to show that
subepithelial connective tissue grafting can be successfully performed to treat gingival recession associated with glass ionomerrestored root surface.

185
A multidisciplinary treatment of idiopathic gingival
overgrowth in a class iii malocclusion: a case report
R. Ramos*, S. Marques, A. Ferreira and M. Pinto
School of Dental Medicine, University of Porto, Portugal
Background/Aims: Idiopathic gingival overgrowth is a rare
disorder, characterized by proliferative brous increase of
gingival connective tissue, teeth mal-position and retention.
These clinical features associated with a Class III malocclusion
cause diculties to orthodontic therapy. Recurrence of the gingival
overgrowth after periodontal surgery may occur. The aim of this
presentation is to show, after 3 years, the results of a
multidisciplinary approach to treat the combine disorders.
Materials and methods (Treatment Approach): A 16-year-old male
presenting generalized severe gingival overgrowth, covering almost
all teeth, with a Class III malocclusion was treated with a reverse
bevel gingivectomy, without osteotomy, under general anaesthesia,
mainly to allow the orthodontic therapy. At the end of treatment,
gingival contour was corrected using the same surgical technique.
Histological analysis of the excised tissues was performed.
Results/Discussion: The surgical postoperative course was
uneventful and, after 3 years, no recurrence of the overgrowth
was found. After orthodontic and periodontal therapy a good
aesthetic outcome was achieved.
Conclusion: This multidisciplinary treatment of idiopathic gingival
overgrowth in a Class III malocclusion seems to have good results.
Teeth sequestrum may complicated the orthodontic and
periodontal therapy however a good occlusal and aesthetic
outcome was accomplished.

Posters: Clinical tips and cases: Periodontology

186
A split mouth study to determine the effect of
bioactive glass (novamin) in the treatment of teeth
hypersensitivity post periodontal surgery
M. Camps*, M. Savoini, A. Santos and A. Pascual
Universitat Internacional de Catalunya
Introduction: The dentinal hypersensitivity is a usual problem that
aect among 830% of the adults, especially with periodontal
disease. In the market, there are several agents to treat this
problem. Bioactive Glass (NovaminR) is a new product, which
reduce the hypersensitivity, by forming crystals of hydroxyapatite
that occlude dentinal tubule.
Objective: The aim of this study using a placebo control is to assess
the therapeutic value of Bioactive Glass (NovaminR) in dentine
hypersensitivity after periodontal surgery.
Material and methods: The study is a single-centre, randomized,
placebo controlled, split mouth design with active and placebo
preparations applied to test teeth in contralateral arches, after a
periodontal surgery. 30 patients with at least two similar
periodontal surgery in contralateral arches are recruited into the
study. Sensitivity was scored by the subjects on a 010 visual
apologue scale, before the surgery, and one week and one month,
after the surgery.
Conclusions: All the recorded results will be analysed to determine
if Bioactive Glass (NovaminR) is eective in the treatment of the
dentine hypersensitivity.

187
The effects of topical doxycycline in the periodontal
management of Down syndrome patients
D. Tenorio*, N. Pandya and F. Hughes
Bromley PCT, Barts and The London SMD, London, UK
Individuals with Down Syndrome (DS) have an increased prevalence of periodontal diseases. Our previous investigation found that
mechanical debridement alone in DS patients largely failed to
prevent tooth loss (Tenorio et al., 2003). The aim of this study was
to test the ecacy of adjunctive topical Doxycycline (8.5%
Doxycycline oral gel, Atridox) for the treatment of DS-associated
periodontal disease. Subjects received full periodontal assessment
and a split mouth design was adopted. OHI was given and the test
side received nonsurgical therapy and a single application of
doxycycline gel to pockets >5 mm. The control side received
nonsurgical therapy alone. After 1 week there was an overall
reduction in gingival inammation in test sites clinically and
reduction of DI. BI score remained unchanged. At baseline, mean
gures for pocket depth (45 sites) were 5.9 mm in test and 5.8 mm
in controls. At 12 weeks mean test sites were 4.7 mm against
5.3 mm in controls. The results show an average decrease in pocket
depth of 1.2 mm in test as compared with 0.5 mm in controls.
Mobility was also decreased. DI and BI gures remained
unchanged. Our ndings are in agreement with previous studies
on the ecacy of adjunctive topical antimicrobials. The results
support the use of Doxycycline as an adjunct to conventional
therapy in DS patients although longer term follow-up would be
useful to determine the potential benets of this treatment.

188
Recurrent ulcerations on attached gingiva in a patient
with iron deficiency anemia
E. Efeoglu, A. Kkrer, G. T. Eyyupoglu* and M. Bayk
Marmara University, Istanbul, Turkey
This is the case report of a 24-year-old female patient suering
from bleeding gums and recurrent oral ulcers (ROU), who was

referred to our clinic. Her clinical examination revealed chronic

marginal gingivitis due to poor oral hygiene and mouth breathing.
Recurrent minor and major ulcerations were present in any
location of the oral cavity, atypically on attached gingiva and
hard palate close to gingiva. Initial periodontal therapy performed
to remove plaque and calculus resulted in resolution of present
inammation. At 3 and 6 months recall, ROU were still present.
Because of these observations, Behcets disease or systemic eect of
a haematological disease was suspected and the patient was
referred to dermatology and haematology clinics for further
examinations. Patergy test and serological analysis of Herpes
Simplex Virus type 1 and 2 were negative. However, haematological analysis demonstrated anaemia of iron deciency. After
treatment with oral iron supplementation, anaemia resolved and
major oral ulcers healed. Minor ulcers were observed rarely in
menstrual cycles during 5 years follow up period. Although the
relationship between these ulcers and iron deciency anaemia is not
clear, this association needs to be further evaluated.

189
Benefits of laser treatment as an adjunct to
conventional periodontal treatment: a case
series study
_I. Maden*, . Bas er, Z. Kazak, F. Yaln and S intan
University of Istanbul, Istanbul, Turkey
Recently Nd:YAG laser is used for enhancing the results of
conventional phase I periodontal treatment, which consists of
scaling and root planning (SRP).
Aim: To evaluate the benets of laser treatment as an adjunct to
conventional periodontal treatment in clinical means.
Materials and methods: Four periodontitis patients who had
moderate or advanced were included in the study. Plaque Index
(PI), Sulcus Bleeding Index (SBI), Pocket Depth (PD) and Clinical
Attachment Level (CAL) were used for clinical evaluation. After
SRP in all sites, patients
1st and 4th quarters received Nd:YAG
laser treatment (SRP + L) in this split mouth study. The laser
treatment was performed three times in the same week. The
Nd:YAG laser that was used had 1064 lm wave length, 100 mj/
pulse energy, 20 Hz frequency, power of 2 W and was used in very
short pulse mode. No statistical method was performed.
Results: In the SRP received sites PI scores reduced from 1.74 to
0.82; SBI scores reduced from 3.06 to 2.15. In the SRP + L
received sites PI scores reduced from 1.76 to 0.95; SBI scores
reduced from 3.25 to 2.30. SRP received sites with 46 mm. PD
showed a reduction of 1.72 mm, whereas SRP + L received sites
decreased 1.91 mm The dierence of PD in SRP received sites with
68 mm was 3.45 mm, whereas SRP + L received sites showed a
reduction of 4.55 mm.
Conclusion: Laser treatment in addition to conventional
periodontal therapy showed positive eects on clinical values.

190
Vitamin complex on periodontal wound healing
C. Mor*, M. Savoini and A. Santos
Universitat Internacional de Catalunya, Spain
Nutrition is one of the modifying factors that can inuence the
immune response and the integrity of hosts hard and soft tissues.
Vitamin-B complex may be important for periodontal wound
healing. Vitamin-C can inuence on gingivitis early stages and on
decreasing gingival bleeding. Vitamin-C deciency could alter the
permeability of the sulcular epithelium. Low levels of calcium
could inuence a more aggressive progression of periodontal
disease. Vitamin-D stimulates osteoclasts activity, which mobilizes
bone calcium. Vitamin-E can accelerate wound-healing process

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Posters: Clinical tips and cases: Periodontology

during early stages of granulation and epithelialization. Vitamin-E
and Selenium inhibit oxygen free radicals from phagocytic inammatory cells that can participate on collagen destruction.
Objectives: The aim of this study is to assess if nutritious complex
LACER VIT improves tissues response to periodontal surgery ap.
Material and methods: This study is a randomized, double-masked,
placebo-controlled clinical trial. A total of 30 patients with
generalized moderate to severe chronic periodontitis are being
studied. All of them presented two or more teeth in the same
quadrant with probing depth equal or >5 mm and bleeding upon
probing in need of access ap surgery. Fifteen subjects will be
instructed to take two capsules a day of Lacer Vit (test group) and
the other subjects will take a placebo (control group).
Measurements of PD, CAL, BOP and GI will be taken at
baseline and 4, 8, 12, 24 and 48 weeks.

191
The menopause and the climacteric when the
periodontal diseases occur
E. Carvalho*, R. Cunha, R. Garcia and B. Moura
Faculdade de odontologia da UFBA, Brazil
The periodontal disease is characterized by its multi faceted
aetiology, which has the presence of the bacterial plaque, as its own
determinant condition. Currently, the knowledge about this disease
elucidates the acting of others associate elements, among them the
hormonal alterations present in menopause or the climacteric,
which inuence in the severity and the progression of the disease.
The purpose of this article is to discuss over the relationship of
menopause with the periodontal disease, because during this period
of the life of women there is reduction of estrogenic and
progesterone hormones, resulting in physiological alterations,
with manifestations also in the mouthpiece cavity such as xerostomia and desquamated gingivitis. Another common discovery in this
phase is osteoporoses and osteopeny, which occur in the mouthpiece cavity such as accentuated osseous wastage, endangering the
dental stability, which can induce to the premature lost of the units.
All these alterations are worsened by the emotional instability,
which characterizes menopause and climacteric, being this subject
of essential importance within the context of the periodontal
medicine, because the function of the psychosocial factors is
already well documented in the immune answer, which guarantees
the integrity of the general health of the individuals.

linear IgA disease. The treatments were: topical steroid therapy to

77.7% of the cases, systemic steroids to 7.4% of the cases,
chlorohexidine digluconate to 7.4% of the cases, 3.7% with
systemic sulfone and a 3.7% was not treat for being asymptomatic.
After treatment with topical steroid therapy resulted in complete
remission of 57.1% of the patients and in partial remission of
42.8% of the patients. The patients treated with systemic therapy
resulted in partial remission.

193
Guided tissue regeneration following treatment with
two bioabsorbable membranes in combination with
DFDBA
V. Lekovic, Z. Aleksic, T. Divnic and B. Nikolic*
Periodontology Department, Faculty of dentistry, University of
Belgrade, SerbMont
The purpose of this study was to compare the clinical ecacy of a
combination of calcium sulphate barrier and DFDBA to collagen
membrane and DFDBA for the treatment of human periodontal
defects. Using a split-mouth design, eighteen pairs of intrabony
periodontal defects were treated and surgically re-entered six
months after the initial surgery. Periodontal defects were randomly
treated with either a combination of DFDBA with calcium
sulphate barrier experimental and DFDBA with a collagen
membrane control. Clinical measurements were recorded at the
baseline and after six months when all study sites were surgically
re-entered for evaluation. Preoperative probing depths, clinical
attachment levels and intra-operative bone measurements were
similar for the experimental and control sites at baseline and
showed statistically signicant improvement six months after the
surgery (P < 0.001). Between experimental and control sites there
were no statistically signicant changes in pocket depth (PD),
clinical attachment level (CAL) and bone ll (BF) six months after
the surgery (mean PD reduction 3.16 1.42 and 3.34 1.51,
mean CAL gain 2.63 1.60 and 2.85 1.68) (P > 0.05).
Re-entry evaluation revealed a mean BF 2.38 1.32 experimental
and 2.41 1.26 control sites (P > 0.05). Improved clinical
measurements were achieved with DFDBA and CS as well as
DFDBA and collagen membrane, which indicate that DFDBA
with CS represents a therapeutic combination that can be highly
eective in periodontal regeneration.

192
Incidence of periodontal manifestations in
mucocutaneous diseases

194
A randomised study to value the efficacy of the diode
laser application with a bioadhesive gel of potassium
nitrate 10% in dentine hypersensitivity

I. Gallardo, M. Serrera*, P. Gutierrez and A. Mtnez Sahuquillo

School of Dentistry, University of Seville, Spain

A. Sicilia, S. Cuesta and A. Su

rez et al.
University of Oviedo, Spain

In the 1999 international workshop on the classication of

periodontal diseases, the non-plaque-induced gingival lesions
include the manifestation of systemic conditions. Mucocutaneous
disorders in gingiva used to show as redness and persistent gingival
soreness that is named as desquamative gingivitis (DG). Diagnosis
is based on the history and clinical features, but biopsy and direct
immunouorescent staining may be needed.
Material and Methods: A total of 27 patients with DG were
enrolled in this study, their average age was 61.2 years. The
diagnosis of the disease was made after take a biopsy and
histopathologic study. The patients were evaluated at two and
four weeks and two months, and the results were classied as
partial remission if they improved the symptoms or the clinical
signs, and as complete if they disappeared both.
Results: Of the 27 patients, 66.6% corresponded to OLP; 22.2% to
mucous membrane pemphigoid, 3.7% to pemphigus and 3.7% to

To compare the ecacy on dentine hypersensitivity (DH) evaluated by the examiner using Evaporative Stimulus (ES), Tactile
Stimulation (TS) and Global Subjective Evaluation (GSE) of two
treatments: application of the diode laser with another treatment
based in the application of a bioadhesive gel of NK 10%, taking as
reference a placebo laser and a placebo gel. A consecutive sample
of 60 patients were informed and were willing to participate in a
pilot triple blind study, controlled with placebo and a random
distribution treatment for 60 days. The volunteers suer DH and
will be randomly divided in three homogeneous groups: test
LASER: Diode laser and placebo gel. Control +: Placebo laser
and NK10%. Control ): Placebo laser and placebo gel. Once in the
research, the patient will be checked in the clinic in order to take
the baseline data and next it will be applied an only one session of
the diode laser or placebo laser on the teeth that suer DH. At 15
and 30 min after putting the laser irradiation it will be taken

164

Posters: Clinical tips and cases: Periodontology

another data and it will be written down. From there on, the
patient will use each 12 h/day, NK10%gel or placebo, applied by
him/herself on the teeth with DH for 15 days. New data will be
taken after 2, 7, 14, 30 and 60 days. The experimental phase will be
nished January 2006.

195
Localized aggressive periodontitis in a prepubertal
patient: case report
M. Molnar*, B. M. Sepic Matanovic
Dental Clinic Zagreb, Zagreb, Croatia
Periodontal diseases are among the most frequent diseases aecting
children and adolescents. These include gingivitis, localized or
generalized aggressive periodontitis and periodontal diseases associated with systemic disorders. A 12-year-old boy presented with
generalized gingival inammation, extensive localized bone loss,
and mobility of 32, 31, 41, 42, as well as the beginning of bone loss
in the rst molars. Clinical and RTG examinations led us to the
diagnosis of aggressive periodontitis. Neither unusual infection,
nor traumas were detected. Also, there was no sing of the
periodontal disease in the childs parents. Microbiologic examinations revealed the presence of Actinobacillus actinomycetemcomitans. Treatment consisted of supragingival and subgingival
debridement, devitalizing and splinting mobile teeth, root scaling
and planning combined with 10 days prescription of amoxicillin
and metronidazole. Basic immunological tests revealed decline in
Natural Killer cells and CD 56 deciency. Clinical and microbiologic follow-up was continued over next year. After six months
A. actinomycetemcomitans could not be isolated, and although the
situation is at present stabile, the long-term prognosis is questionable, because of the late diagnosis, the great amount of bone loss
initially presented immunologic status.

196
Designing Brazilian smiles: experiences from
periodontology
D. Rego*, D. Lima, G. Santos, D. Tatakis et al.
University of Fed. RN, Brazil; Ohio State University, USA
Ideally the smile should expose minimal gingival, therefore patients
with gummy smile and passive eruption altered or excessive
marginal gingivae, usually excessive gingival display because
incomplete anatomical crown exposure is present. If the maxillary
incisor show at rest is optimal, active upper incisor intrusion
should not be initiated. To achieve a smile with minimal gingival
exposure, the anatomic crown should be fully exposed by surgical
crown lengthening. Precise determination of the location of
cementoenamel junction prior to surgery, precise placement of
incisions and correct establish of biological width are necessary in
order to achieve this goal. One protocol is described and clinical
results from 20 Brazilian subjects, after three years post surgery are
showed.

197
Manifestation of systemic diseases in the
periodontium a report of two cases
Y. K. Chan
Oral Health Division, Ministry of Health, Malaysia
A variety of systemic diseases could manifest in the periodontium
especially in the gingiva. These include mucocutaneous disorders
such as lichen planus, pemphigoid, pemphigus vulgaris, erythema
multiforme and lupus erythematosus; gastro-intestinal disease such
as Crohns disease, ulcerative colitis and haematological disorders
such as leukaemia. The periodontist could play an important role

in the diagnosis of these conditions as they might rst present in the

oral cavity. Early diagnosis would ensure appropriate management
are instituted as soon as possible. This is a report of two cases,
acute myeloid leukaemia and pemphigus that manifested in the
gingiva.

198
Investigation on the use of a micro-endoscope for open
and closed periodontal treatment
M-A. Geibel
Department of Maxillofacial Surgery, University of Ulm
Aims: The use of a newly developed micro-endoscope (Gyrus,
Tuebingen, Germany, according to a design established by the
author) for the optical control of open and closed periodontal
treatment was investigated.
Materials and methods: Under direct view, a exible microendoscope with a 200-lm bre and a 1.00-mm optics was used in
16 patients. The endoscopic examination occurred in the closed
pocket for visual control before and after supra- and sub-gingival
scaling and root planning as well as within the scope of an open
periodontal-surgical treatment. Clinical documentation was
performed by video or digital storage.
Results: Due to the small optics and additional exibility new
perspectives arise for the periodontology with respect to
documentation and therapy control also in the distal area of
posterior teeth. The endoscopic support of periodontal-surgical
treatments permits further ndings such as caries (radiologically
not veriable) and concrement residuals. The extent of bone
defects, the identication of root fractures and root ssures as well
as insucient crown margins can be diagnosed and documented
intra-surgically.
Conclusion: The endoscope used therefore proved suitable for
secure pre-and post-surgical diagnosing and documentation in
conservative and surgical periodontology.

199
Sliding overlap pedicle flap design in mandibular
second molar surgery
J. Y. Kim
UCLA School of Dentistry, USA
Reduction of periodontal pocket in the mandibular retromolar
region has been clinically challenged by diculty in access, osseous
anatomy, quality and quantity of the gingiva, and by the presence
of vital structure in the immediate surroundings. Distal wedge
procedure and variations have been utilized commonly, however,
the respective procedure does require abundance of gingiva preoperatively, which may not be common. The lingual nerve,
according to the literature, may lie within the retromolar triangle.
The Sliding Overlap Pedicle (SOP) Flap was devised to reduce
redundant tissue, but to ensure preservation of gingiva, and to
honour vital structures. An oblique distal releasing incision is made
from the disto-lingual line angle of second molar. It is approached
facially as it advances distally as to follow the bony anatomy. Once
reected, the facial aspect of the ap is thinned appropriately. The
lingual ap is raised in full thickness. On completion of osseous
surgery, the aps are reproximated, and the amount of tissue
overlap assessed. The supercial aspect of the lingual ap is
depithelialized via means of ne haemostat and surgical blade or
scissors. The periosteum is left intact as this is most likely region
where lingual nerve is housed. The excess buccal ap is overlapped,
sliding over the depithelialized lingual ap and sutured appropriately. Predictable clinical results were observed in 164 consecutive
cases, over a four-year period.

165

Posters: Clinical tips and cases: Periodontology

200
Nonsurgical periodontal therapy in smokers: a concept
to redefine?
Lalla-Itri Jazouli
Department Of Periodontology, Paris Vii University
Cigarette smoking is a strong predictor of progressive periodontitis, the eect of which is dose related. Given the eect of smoking
on the prevalence and severity of periodontal disease, and its
multitude of eects on the host, it has been also demonstrated a
poor response to periodontal treatment in smokers compared to
non smokers. Smokers showed less gain of attachment and remain
culture positive for periodontal pathogens after therapy compared
to non smokers. The objectives of this presentation are to
determine through a literature revue and under the light of clinical
cases, an evidence based therapeutic which combine the eect of
smoking cessation on response to conventional scaling and root
planning, the association of topical subgingival applications of
antibiotics and the use of a new generation of ultrasonic instrumentation.

201
Evaluation of morbidity after periodontal surgery
A. Lpez*, N. Carri, J. Calvo and T. Santos
Universitat Internacional de Catalunya, Barcelona, Spain
Evaluation of morbidity after periodontal surgery.
Introduction: Postoperative course after surgery is a mayor
concern for dentists and patients. Also, it is well known that the
professional experience is one of the most important factors that
can aect the postoperative days.
Aim: Evaluate the postoperative morbidity after periodontal
surgery comparing the results between experienced periodontists
and postgraduate students of periodontics.
Material and methods: The number of patients evaluated will be of
at least 30, all of them attending dierent oces from experienced
periodontitis and also the university clinic. A questionnaire will be
delivered to the patients the day the sutures will be removed. The
next parameters will be recorded: systemic diseases, usual
medication, toxic habits, medications used after the surgery and
its compliance, teeth sensitivity to percussion, thermal sensitivity,
swelling, pain experience, and other.
Results: The results will be obtained with an analysis of variance
statistic program in which the responses from the patients will be
entered. Relation between professional experience and the
postoperative course after the surgery will be determinated.
Discussion and conclusion: The experience of the professional is
one of the main factors that aect the postoperative course of the
periodontal surgery.

202
Optimum timing of performing periodontal surgery in
the adult orthodontic patient
E. Sinanioti* and G. Aggelopoulos
Priv. Clinic ltd to Periodontics and Implants
The control and elimination of gingival inammation through
conservative periodontal treatment is the prerequisite for the
initiation and the progress of the orthodontic treatment in adult
patients with periodontal problems. Some patients will benet from
the initiation of periodontal surgery before orthodontic treatment
and others may receive benets through a reversal of these
procedures. Proper sequencing may not only improve the periodontal stability of the aected area, but also be critical to the
esthetic considerations in the patients treatment. The purpose of
this oral presentation is to dene the factors leading to the selection
of the optimum time for the performance of periodontal surgery in

166

relation to orthodontic treatment. Eight cases with combined

periodontal orthodontic problems will be presented in order to
dene the advantages and limitations of performing periodontal
surgery prior or after the removal of orthodontic appliances. Long
term results with attractive, esthetic dentitions and smiles, which
provide the stability of combined therapy result, are present in
most of the cases. In conclusion, good prognosis of therapeutic
results after a combined periodontal orthodontic treatment in
adult patients is directly related in many cases to the choice
selection of optimum time for the performance of periodontal
surgery in connection with the application of orthodontic treatment.

203
Aggressive periodontitis: multidisciplinary approach
N. Ausalah Taoufik*, S. Fassy, B. El Houari and J. Kissa
Periodontology Dep., Casablanca, Morocco
Aggressive periodontitis (A.A.P 1999) are characterised by inammation, gingival recession, tooth mobility, sometimes suppuration
and dental migration. One aim of periodontal therapy is to arrest
further loss of periodontal attachment and to ensure an aesthetic
and functional outcome (Van winkelho 2000). Rehabilitation of
dentition with aggressive periodontitis disease is a complicated
treatment procedure which requires skills in several disciplines of
dentistry. The functional, esthetic and post treatment stability
demands of each case dictate the need for a team approach
including periodontist, orthodontist and prosthodontist. There
must be an agreed upon treatment plan by all disciplines involved
with treatment objectives and limitations clearly understood
(Gazit, Lieberman) we will illustrate our work with clinical cases
of aggressive periodontitis with multidisciplinary approach.

204
Histological analysis of palatal healing following
connective tissue graft harvesting
G. De Quincey*, J. Maltha, R. Junker and A. Sculean
Univ. Nijmegen
The purpose of the study was to histologically evaluate the healing
of the soft tissues following the harvesting of a palatal connective
tissue (CT) graft. Eight patients requiring multiple root coverage or
soft tissue augmentation procedures were harvested the second,
third or fourth CT-graft at 46 months following the rst or
second harvesting procedure. No prolonged paresthesia of the
palate following either rst or second harvesting was observed in
any of the patients. Patients were harvested a second CT-graft from
the previously harvested area and submitted to histological
analysis. Clinically, all CT-grafts harvested a second time revealed
a slightly more brous consistency than that of a normal CT-graft.
Tissue volume was always more than adequate at the second
harvest. Clinical performance was identical to tissue from the rst
harvest. Histologically, all reharvested CT-grafts presented as
being more brous than normal palatal soft/connective tissue. The
tissue was less vascularised and reduced innervation was observed.
Glandular and adipose components were limited. There was slight
scarring following CT-graft harvesting at a timeframe of 46 months post-operatively. It was concluded that: (a) the palate
can be used successfully for a second harvest (from the same side/
region) of a CT-graft 4-6 months after the rst harvest and, (b)
clinically, the second harvest performs equally well to a rst harvest
CT-graft.

Posters: Clinical tips and cases: Periodontology

205
Use of glass fiber reinforced composites as part of the
treatment options in periodontally compromised
patients
T. M. Varrela* and P. K. Valittu
Dept. of Prosth & Biomat, Univ. of Turku, Finland

207
Tacrolimus is not related to drug-induced gingival
overgrowth in renal transplant patients
B. Afacan*, G. Emingil, H. Tz, D. Bozkurt and T. Kse et al.
_
Ege Univ., Izmir,
Turkey

Periodontal splinting has been successfully used as part of

periodontal treatment although there is no actual scientic
evidence of its eects on the health of periodontal tissue, or its
role in the preventing the progression of the periodontal diseases. It
has been shown that teeth with healthy but severely reduced
periodontium can be maintained for long time with the aid of splint
or xed bridges. Traditional metal-frame bridges and splints are
good but expensive and time-consuming treatment option. For
chair-side use splinting materials such as metal wires, aramid,
polyethylene and glass bers have been used widely. There are
considerable dierences between the dierent bers available,
depending mainly on weather they have been pre-impregnated with
monomer resin or polymer. Proper bonding between the bers and
composite and correct design of splints are key factors for the
success. Pre-impregnated glass ber reinforced composite (FRC)
splints have gained popularity due to their minimally invasiveness,
handling properties and esthetics. Therefore, FRC can oer
dynamic and cost eective alternatives in stabilizing periodontally
involved teeth or replacing single or multiple missing teeth. This
presentation describes the advantages of novel pre-impregnated
glass ber reinforcement (everStick) and its use in the treatment
of periodontal patients. Patient cases will be presented and
discussed to illustrate dierent treatment solutions and designing
principles.

Aim: The aim of this study was to examine the prevalence and
severity of gingival overgrowth (GO) in patients using tacrolimus
and to compare demographic, pharmacological and periodontal
parameters associated with GO of these patients with those using
cyclosporine (CsA).
Methods: Oral examinations were performed on 46 patients
receiving tacrolimus and 97 patients taking CsA. All renal
transplant patients were at least 12-month post transplant,
medicated with either CsA or tacrolimus. Tacrolimus group had
been taking tacrolimus since transplantation. Demographic and
pharmacological data including age, gender, time since transplant,
calcium channel blocker, diabetes, azathioprine and prednisolone
dosage were recorded. Periodontal parameters including plaque
index (PI), papillary bleeding index (PBI) and hyperplasia index
(HI) were recorded for whole mouth. Patients with HI index scores
2 or 3 at 6 sites were considered as having severe GO.
Results: Age and gender distribution were similar between
tacrolimus and CsA group. PI and PBI scores of the two groups
were also similar. None of the patients in the tacrolimus group had
GO (HI = 0). On the other hand, 32% of CsA group had severe
GO. Pharmacological data were not dierent between both groups.
Conclusion: These results indicate that tacrolimus is not associated
with GO in renal transplant patients. Therefore, this drug could be
considered as an alternative drug in patients who are susceptible to
CsA-induced GO.

206
Corticotomy-facilitated orthodontics on patients with
chronic periodontitis

208
Orthodontic treatment of Moroccan patients with
aggressive periodontitis

S. Clotten* and R. Poturak

Unicare Privat Praxis

B. Abbassi*, N. Khlil and J. Kissa

Department of Perio, Faculty dental med, Casablanca, Morocco

Frequently Orthodontic therapy is equivalent to bone loss and root

resorption. Hence, it can be assumed that the treatment of patients
with chronic periodontitis is challenging. This presentation describes the inuence of inammation-mediated osteopenia on the
regional acceleratory phenomenon during healing and regeneration
of bone by using a corticotomy-facilitated and augmentation
technique in conjunction with orthodontic therapy. 18 Patients
with chronic peridontitis were treated with corticotomy-facilitated
orthodontic procedure (AOO). Plaque scores, probing depths, and
probing attachment levels were recorded before and after the
completion of the orthodontic treatment. During the orthodontic
treatment of adults with advanced periodontal diseases; it is
probable that a further bone and tooth loss will take place. Also
the reection of full-thickness aps result in future bone resorption.
It is therefore important to combine the surgical procedure with
local bone augmentation and nd a constructive way for a
successful orthodontic therapy. It appears corticotomy-facilitated
orthodontics in combination with bone augmentation makes it
even possible to treat patients with a remarkable bone loss and
greatly decrease the overall treatment time. From our point of
view, tooth movement can be achieved into a bone graft made of
demineralized bone matrix (Grafton) and with a biomaterial (BioOss). Further studies are necessary to examine the various eects
of this procedure.

The aggressive periodontitis causes localized breakdown of periodontal attachment. The common symptom is rapid attachment
loss (AAP 1999). The attachment loss can result in pathologic
migration of the teeth. Orthodontic treatment of this disease not
only improves esthetics and function but also helps prevent
inammation and the recurrence of periodontal breakdown. In
Morocco, the frequency of the aggressive peridontitis is increased.
Orthodontic therapy may be needed for alignment of teeth which
have pathologically migrated following severe bon loss associated
with aggressive periodontitis. Migration was present on anterior
teeth as aring (fanning out labially), diastema, rotation, and
extrusion. The potential detrimental aects to the periodontium
from moving teeth with existing active disease must not be
outweighed by the desire to improve aesthetics (Zachrisson,
1997). Initial and corrective periodontal therapy should be completed before initiating orthodontics therapy. Plaque should be
controlled. There has to be sucient bone for orthodontic
treatment to be undertaken, and permanent retention of the
aligned tooth/teeth may be required. Treatment planning should be
undertaken jointly between the orthodontist, periodontist, and
patient. Supportive periodontal maintenance is essential during
orthodontic treatment (Clerehugh and Tugnait, 2001). Through
our work, we will approach our daily experiment in the assumption
of responsibility of these patients.

167

Posters: Clinical tips and cases: Periodontology

209
Orofacial granulomatosis as a manifestation of crohn's
disease: a case report
M. A. Krahenmann* and G. R. Persson
Univ. of Berne, Switzerland
Background: Crohns disease is an inammatory disease with
chronic diarrhoea and/or abdominal pain, and may involve the
oral cavity.
Summary: We report an 18-year old anorexic woman under severe
stress, and severe oral pain. The patient had been diagnosed with
Crohns disease and on systemic corticosteroids. The patient was
unemployed and on social welfare. She presented with fever,
generalised acute gingivitis with spontaneous bleeding, ulcerations,
and severe lesions on the palate. Emergency care included
disinfection (betadine) and pain control. No probing depths
>5 mm, but clinical attachment loss was found. At the follow
up, microbial testing showed a unique presence of Campylobacter
rectus and Micromonas micros (95%). Additional debridement was
performed. Zithromax 500 mg once daily for ve days, and
Ibuprofen (500 mg tid) was prescribed. Following treatment the
oral conditions improved drastically. Palatal lesions have
disappeared but there is a tendency of recurrence of ulcerative
gingivitis. The microbiota from pockets, and palatal areas have
normalized but M.micros and C. rectus are consistently present. At
the most recent visit the subgingival microbiota was dominated by
C.rectus, M.micros, Fusobacterium spp. Porphyromonas gingivalis,
Tannerella forsythia. Actinobacillus actinomycetemcomitans was not
found.
Conclusions: In spite of frequent dental recalls, the use of
antibiotics, and medical attention have only partly controlled the
oral conditions.

210
Treatment of periodontal-endodontic lesions longterm results
B. Schacher*, S. Bauriedl and P. Ratka-Krger et al.
Depts. of Perio., Univ. Frankfurt and Freiburg, Germany
Aims: Because of close anatomical relationships between the
periodontium and the pulp a bacterial infection originating in
one of these tissues may involve the other. The aims of our study
were to nd out prognostic parameters and to recognize the
reasons for tooth loss by evaluation of the long-term results after
treatment of periodontal-endodontic lesions (PEL).
Methods: Fifty-nine teeth (37 molars, 13 premolars, 5 incisors, 4
canines) with PEL received rst endodontic and -if indicated6 months later periodontal therapy according to a special
treatment plan. Questioning of patients, clinical and radiographic
examinations were performed 510 years after endodontic
treatment.
Results: 52.5% (n = 31) of PEL were found in patients with
generalized periodontal disease. Mandibular molars (n = 28) were
mostly aected. Teeth restored by crowns (n = 35) developed PEL
more often than teeth with (n = 12) or without (n = 12) llings.
61% (n = 36) of all PEL teeth could be maintained more than
5 years after therapy. 13 of 23 teeth with primary endodontic
lesions, 2 of 7 with primary periodontal and 9 of 28 with true
combined lesions could be maintained throughout the observation
period. The main reasons for tooth loss (n = 35) were periodontal
problems (n = 12), endodontic complications (n = 9) and vertical
root fractures (n = 5).
Conclusion: The long-term prognosis after treatment of PEL seems
to be determined by correct primary diagnosis, general periodontal
conditions and careful endodontic treatment.

168

211
Clinical guidelines improving the outcome of
regenerative procedures using deproteinized bovine
derived xenograft (BDX)
F. Brseler* and C. Tietmann
Praxis fr Parodontologie, Aachen, Germany
Initial Background: Regenerative treatment using BDX is not
commonly accepted to yield to successful long-term results. The
aim of the presentation is to give step-by-step clinical guidelines for
predictable and stable long-term outcomes of regenerative
procedures with BDX based on the data of retrospective studies
in our private practice.
Materials and methods: The guidelines to be presented have been
developed during the years 19992004 while more than 900
infrabony defect sites have been regeneratively treated using
BDX. The validity of the established specied standard protocol
is underlined by a high success rate of more than 95%. Success was
dened as absence of inammatory signs, reduction of tooth
mobility and PPD, high radiographical CAL gain as well as
predictable esthetic outcome.
Results: The systematic management includes a standard protocol
as following: Presurgical: Initial therapy including FMD, microbial
DNA-testing if indicated, OH instruction, re-evaluation and
therapy design decision. Surgical: Microsurgical approach, ap
design, membrane coverage if indicated, primary closure using
microsurgical sutures. Postsurgical: medication options, chemical
plaque control at regeneratively treated sites, splinting in case of
severe tooth mobility, short recall interval.
Conclusion: The standard protocol to be presented improves the
predictability for successful long-term clinical outcome in the
treatment of infrabony defects using BDX.

212
Periodontal treatment and placement of a dental
implant in a case of hadju-cheney syndrome (HCS)
T. P. Vrahopoulos* and E. Bazopoulou et al.
Dental School, University of Athens, Greece
HCS is an inheritable rare disorder of bone metabolism associated
with rapidly progressive periodontitis. The aim of this case report
was to present the periodontal treatment and the placement of a
dental implant in a 22 year-old female with HCS. Physical
examination revealed a short stature, small face, prominent
epicanthal fold, thin lips, small mouth and short hands. There
were no abnormal biochemical, hematological or hormonological
data. Tests for Bone Mineral Density were indicative of osteoporosis. Local ndings included hypoplasia of the midface, pathological mobility of all standing teeth and a generalized horizontal
bone loss of about 50%. The gingival was mildly inamed.
Periodontal treatment included supra- and sub-gingival scaling and
root planning. 4 teeth were extracted. A dental implant was
inserted surgically in the upper jaw in order to test its ability for
osseointegration. The patient was enrolled in a maintenance
program with recall visits every 3 month. Periodontal recordings
registered during the last 18 months showed an overall improvement on all clinical parameters. Radiographic evaluation of the
submerged implant at 3 and 6 months post-op were indicative of a
successful course for the osseointegration process. In conclusion,
non-surgical periodontal management combined with a strict
maintenance program proved to be eective in HCS periodontitis.
Implant therapy may also be considered as a recommended
approach for such patients.

Posters: Clinical tips and cases: Implantology

213
Surgical correction of hereditary gingival
fibromatosis case series

of the surgery is critical to avoid recurrences. Postoperatively all

patients need perfect plaque control and comprehensive
orthodontic rehabilitation.

I. Gera*, D. Tihanyi and P. Rosta

Semmelweis Univ., Dept. Periodontal., Hungary

214
Effect of oral contraceptives pill on the gingival and
periodontal health

Introduction: The heredity gingival bromatosis inherited by an

autosamal dominant or recessive trait and develops in the early
ages. The treatment is denitively surgical but the too early
operation can lead to rapid recurrence. Conventional gingivectomy
was preferred in the past, but today mostly reversed beveled
gingivectomy techniques are used.
Cases: The rst case was corrected with conventional gingivectomy
techniques more than two decades before with acceptable esthetical
outcomes. The second case was rst detected at the age of 7 and
followed up for over another 7 years. Because of patients young
age the surgery was postponed till the rapid phase of the skeletal
development will have been nished. The excessive mass of brotic
tissue in the maxilla was removed by internal beveled incision and
the palatal and buccal gingival aps were united with sutures
resulting in uneventful healing in ten days. The third case is a
18 years old young adult who had been orthodontically treated for
more than 1.5 years to extrude his teeth without any success but he
had gingival brosis.
Results and discussion: Today the more conservative internal
beveled incision is preferred over the conventional gingivectomy
providing more predictable healing and better esthetics. The timing

Dr. Najwa Nassrawin*, Msc. Periodontology

KHMC royal medical services, Amman, Jordan
Abstract object: To study the eects of oral contraceptives
(Lo-femenal) on the periodontium.
Material: This study includes 155 women who were using
(Lo-femenal) as the study group. Two hundred women who
never used contraceptives, as the control group. Both groups were
clinically examined for plaque levels, gingival condition and loss of
periodontal attachment. Structural questionnaire for the purpose
of this study was lled for each woman.
Results: Gingival index was signicantly higher among
contraceptives users than non-users (P < 0.05), which was
correlated with the duration of usage (r = 0.8). Loss of
attachment was signicantly higher among users of contraceptives
for more than 2 years while no signicant dierence in plaque index
was found between both groups.
Conclusion: The use of contraceptive pill (Lo-femenal for long
periods increases the likelihood of gingival inammation and loss
of attachment.

Posters: Clinical tips and cases: Implantology

215
Follow up of plaque and gingival index in patients with
dental implants
M. Serrano*, M. Moya, A. Sanchez, M. Calvo and E. Wojtovic
Universidad de Murcia, Espaa
Background and aims: Much have been written about the
association between mucositis and peri-implantitis. In this study,
we sought to determine the ecacy of early diagnosis of mucositis
in avoiding the development of peri-implantitis. To detect
mucositis we basically look for the presence of clinical signs
related to plaque accumulation and bleeding on probing.
Materials and methods: For a period of three years 150 patients
underwent dental implantation. Plaque index (Silness and Loe) and
gingival index (Loe and Silness) were recorded in the follow-up
appointments. Patients were recalled for appointments after
15 days, 1 month, 3 months, 6 months and 9 months following
the implantation. All patients received oral hygiene advice after the
rst visit.
Results: An increase in the score was observed in plaque index at
the rst recall visit because of the fear experimented by patients at
the time of brushing. After that, on the rst month, patients got a
lower score which continued decreasing till the sixth monthly
revision after which increased slightly. The gingival index followed
a similar pattern.
Conclusions: Both indexes present a high correlation showing a
worsening after two weeks but improving later from the rst the
sixth. Afterwards they follow a stable situation whenever the

patients receive hygiene advice and/or periodontal maintenance.

Recall visits should not exceed six months, in order to allow an
adequate control of peri-implant mucositis.

216
The art and science of precision implant placement:
the incision and position guide
J. Y. Kim*, H. J. Lee and R. Ju
UCLA, USA; Private practice Seoul, Korea
The importance of precise surgical placement of dental implant
according to its functional and esthetic needs cannot be overstated.
Various protocols and techniques for fabricating a surgical guide
exist. A surgical guide has to be: (1) simple and cost-eective to
fabricate, (2) good retention (adjacent teeth or landmark), (3)
ability to translate pre-surgical work-up information accurately to
surgical site, and (4) allow easy access of drills / guide pins /
osteotomes intra-operatively. The presentation will cover the steps
involved in planning a surgical case from a restorative stand point,
including location and direction of the anticipated implant and of
the specic incision design anticipated. Utilizing a surveyor and
several specically designed guide pins and jigs, and a choice of
materials, a simple guide can be constructed within minutes that
can double as radiographic guide as well as incision template. The
authors have been utilizing this protocol coined, EZ Guide, over a
period of 4 years on several hundred cases, with great degree of
accuracy.

169

Posters: Clinical tips and cases: Implantology

217
Flapless, one piece implant surgery
T. S. Dung*, Kim-Choy Low, Hunghui Chi and Hsuan-Po Chou
Tzuchi Hospital, Yang-Ming Univ., Taipei, Taiwan
The mainstream of periodontal therapy in the 21st century is
simple, convenient, and minimum invasive. Recent case studies
indicated that the success rate of one-piece implant surgery is
similar to that of two piece one. Flapless implant surgery is to place
implant without opening a ap and with no needs for sutures.
While there are not many controlled clinical documentations,
apless one-piece implant surgery can be a treatment alternative at
appropriate condition. In general, it requires enough keratinized
mucosa, ridge width and height, and good bone density to provide
initial implant stability and ideal implant position for apless
approach. Six case reports are presented to demonstrate the
indications and treatment procedures of apless implant surgery.
The advantages of single stage, apless, one piece implant are to
reduce surgical time and post-operative discomfort, to eliminate
secondary surgery, and to reduce post-surgical maintenance care,
prosthetic works, and treatment time and cost. However, apless
surgery of one-piece implant is more dicult to perform. In case of
meticulous patient selection and proper treatment planning, the
success rate of one-piece implant shall improve dramatically in the
near future and thus become a popular treatment option among
dental implant candidate. More clinical studies are required to
validate the predictability and long-term success of one-piece
implant.

218
Implant treatment in the edentulous mandible:
a 5-year follow up report
A. Arab Oghli, Ch. Mertens* and H. Steveling
Univ, Heidelberg, Germany
This prospective study reports the clinical and radiographic
performance of osseointegrated implants which support mandibular over denture over than 5 years. The implants were placed in
eleven edentulous patients between 1996 and 1999. Orthopantomograms were used for radiological evaluation. For each
implant, the radiographs were evaluated regarding marginal
bone height, and its changes over time using the upper edge of
the xture as a reference point. The cumulative implant survival
rate was 100%, and the survival rate of the superstructures was
100%. Of the sites were no signs of inammation and all implants
were plaque free. The mean bone level was 1 mm below the
reference point after 5 years. The mean total marginal bone loss
was 0.04 mm in the second year, and 0.34 mm in the fth year.
The present study has demonstrated that Astra Tech implants
oer a reliable and appropriate method for rehabilitation of
mandibular edentulism.

219
Preservation of remaining labial ridge around
immediately placed implants into fresh extraction
socket
U. W. Jung*, G. J. Chae, C. S. Kim, K. S. Cho and S. H. Choi
Yonsei Univ., Seoul, Republic of Korea
Aims: The Aims of this study were to compare three procedures
for preservation of the labial plate following immediate
implantation; bone graft, e-PTFE membrane, titanium reinforced
e-PTFE membrane (TR membrane).
Materials and methods: (1) A 21-year old female with coronal
fracture on upper right lateral incisor. Thin labial plate (about
1 mm) and a 3 mm gap remained on the coronal aspect following

170

implantation. Cerasorb(b-TCP) alone was grafted at the coronal

defect. (2) A 32-year old male with root rest on upper left lateral
incisor. The defect was treated by a regenerative procedure with
e-PTFE membrane. (3) A 43-year old female with root rest on
upper left lateral incisor. The defect was treated by a regenerative
procedure with TR membrane. At second surgery after six months,
all of the implants were evaluated for the thickness of labial plate
and the resolution of the coronal gap.
Results: In the case of bone graft alone, labial ridge showed
considerable resorption with appositional bone growth within the
defect. The thickness of remaining labial plate was reduced to
1 mm. The two procedures using ePTFE and TR-membrane
maintained original thickness of labial plate. All coronal gaps were
completely lled with bone.
Conclusion: If thin labial plate remains following immediate
placement of implant, it would be helpful to use regenerative
procedures with the ePTFE or TR-membrane for preservation of
the labial plate.

220
Healing of the bone defect after immediate dental
implant placement
D. Katanec*, T. Kuna and D. Gabric
Oral Surgery, School of Dental Medicine, Croatia
Immediate implantation of the dental implant after tooth extraction has great advantages over postponed implantation, i.e. fewer
surgical operations, shorter period up to prosthetic restoration,
prevention of bone resorption and better positioning of implant.
The aim of the report is evaluation of clinical value of immediate
placement of the dental implant with augmentation of the bone
defect by autologous bone transplant following tooth extraction. In
a group of 15 patients with indication for tooth extraction, a dental
implant (Replace Select by Nobel Biocare) was inserted immediately after extraction and remaining bone defect was augmented
with autologous bone transplant taken from the chin symphisis.
Follow up was performed on RVG images 1, 6 and 12 months after
implant placement and clinical monitoring was included measuring
implant stability by analysis of resonant frequency. Results were
assessed on the basis of computer guided densitometric analysis on
previous RVG images at 8 points, 1 mm in diameter placed on the
cervical, middle and apical part of the newly formed bone around
the implant. The results show great density of the newly formed
bone around inserted implants supported by intraoral bone
autotransplant. Primary and secondary stability was between 70
90 Hz. No implant after prosthetic reconstruction and follow up in
period of 12 months was lost in all 15 cases.

221
Periotest utility in diagnostic of factors affect to
implantology stability
M. Moya*, A. Sanchez, M. Serrano, M. Calvo and E. Wojtovicz
Universidad De Murcia, Espaa
Introduction: Primary stability is the most important factor in
order to achieve immediately load as well as delayed load.
Moreover, secondary stability depends on some variables
dierent of primary stability.
Aim: To establish what factors aect to values of implantology
mobility in primary or secondary stability.
Material and methods: They underwent to the study a total of 40
implants, which were inserted with a dynamometric key (torque of
30 Ncm) until the polished ring was located to the height of the
bony crest. Once inserted, we placed on the implant a transfer,
applying a torque of 20 Ncm) in the prosthetic screw. After that,
we proceeded to measure the mobility of the implant with the

Posters: Clinical tips and cases: Implantology

Periotest (mobility 1), striking from a perpendicular way to the
transfer, in its half part. This procedure repeated 2 months after
the implantation (healing period), obtaining the mobility 2 of the
implant.
Results: The mobility 1 depends on variables like type of bone and
implantology location. However, the mobility 2 does not depend
on factors like type of bone, location, diameter or longitude of
implant, age or gender.
Conclusions: The Periotest provides an useful method to value
the stability of the implant and it would help us to decide the load
protocol.

222
Immediate loading of dental implants in the edentulous
mandible
T. Eccellente, M. Piombino*, A. Rossi and M. Ortolani
Private Practice, Grumo Nevano (NA)
Aim: To present the clinical results and the protocol of a simplied
technique of immediate loading in edentulous mandible.
Material and method: In 19 patients, a total of 76 implants
(Ankylos, Friadent, Mannheim, Germany) were placed in
edentulous mandibles (four intraforaminally implants in each
jaw) and immediately loaded. 41 implants were immediately
inserted into fresh extraction sockets; 8 were placed as delayed
implants. Following the surgery all implants were connected with
prefabricated conical abutments that are manufactured with a
precise t to secondary conical copings. These copings were
polymerised into the denture base chairside as described by May &
Romanos 2001. Panoramic radiographs, mSBI and mPlI were
recorded in dierent time intervals. Patient satisfaction was
evaluated.
Result: During the healing period 1 implant was removed due to
mobility. After a total observation period of 27.3 months (range
1246 months) the remaining implants presented healthy periimplant hard and soft tissue conditions (mSBI > 1; mPlI = 1).
Cumulative success rate was 98.6%. Suppuration was not
observed. All patients appreciated function, aesthetic and
retention of the rehabilitation.
Conclusion: The present data validates the predictability of
immediate loading in edentulous mandible, showing a high
success rate in accordance with literature. This simplied
technique reduces treatment time and costs of dental
rehabilitation, with relevant satisfaction for the patients.

223
Immediate loading of dental implants in the edentulous
maxilla
T. Eccellente, M. Piombino, A. Rossi and M. Ortolani*
Private Practice, Grumo Nevano (NA)
Aim: To present the clinical result of 23 cases of immediate loaded
implants in the edentulous maxilla with a new treatment concept.
Material and method: In 23 patients, a total of 92 implants
(Ankylos, Friadent, Mannheim, D) were placed in edentulous
maxillae (four implants in each jaw) and immediately loaded. 21
implants were immediately inserted into the fresh extraction
sockets; 25 were placed as delayed implants. Subsequently all
implants were connected with prefabricated conical abutments,
which are manufactured with a precise t to secondary conical
copings. These copings were polymerised into the denture base
chairside as described for the edentulous mandible by May &
Romanos 2001. Panoramic radiographs, mSBI and mPlI were
recorded in dierent time intervals. Patient satisfaction was
evaluated.

Result: During the healing period 2 implants were removed due to

mobility. After a total observation period of 27.6 months (range
1542 months) all remaining implants presented healthy periimplant hard and soft tissue conditions (mSBI >1; mPlI >1).
Cumulative success rate was 97.8%. Suppuration was not
observed. All patients appreciated function, aesthetic and
retention of the rehabilitation.
Conclusion: Basing on the present data it was concluded that four
implants with high primary stability, may support immediate
loading in edentulous maxilla. Additionally this simplied
technique reduces treatment time and costs of dental
rehabilitation, with relevant satisfaction for the patients.

224
Periodontal compromised patients: full immediate
placement for optimal immediate function
C. Coutinho Alves and M. Neves*
Clinica Med. Dent. Manuel Neves, Porto, Portugal
Aim: Periodontal compromised patients, specially those young
adults needing a full arch implantsupported rehabilitation, are,
some times, candidates to immediate implant placement followed
by immediate function. In this poster presentation we will describe
step by step, all the clinical fazes of our protocol, making its
illustration with a clinical case with 2-year follow-up.
Materials and methods: A 40 year-old, female, non-smoking
patient was referred to us presenting all her 11 maxillary teeth
with severe bone loss and mobility. The treatment plan was to
extract every teeth and immediately place 10 implants. In the same
surgical step, bilateral sinus lifting was done with the simultaneous
placement of 2 implants in each one. An acrylic provisional xed
implant-supported full bridge was made and adapted to the 6
implants in the rst 24 h. After 4 months a denitive ceramic
fused-to metal complete implant-supported bridge was placed.
Results: None of the 10 immediate placed implants was lost. The
2-year follow-up radiographic control, showed great bone-implant
contact of the total 10 implants and a perfect adjustment of the
prosthetic components. The clinical 2-year follow-up showed an
optimal aesthetic nal stable result.
Discussion/Conclusion: The rationale to use the concept Immediate
Placement & Immediate Function in periodontal full arch
compromised patients is to minimize the psychological and
functional consequences of a full arch natural dentition extraction.

225
Rationale of the surgical approach for different types of
alveolar ridges with GBR using astra tech implants
D. Gonz
lez F*, G. Olmos, L. Gallardo and G. Cabello
Private practice
Introduction: In the last years, there has been a lot of concerns
about marginal recession in the zenith of implant-supported
crowns in the esthetic zone. This recession occurs because of
decit of bone at implant placement or bone resorption occurring
during the biological width formation. Astra tech implantsupported restorations have shown stability of marginal bone
and gingival levels along the years.
Objective: To expose a rationale for treatment with guided bone
regeneration of alveolar ridge on the esthetic zone, according to
bone amount, in such a way that implants can be placed with good
esthetic outcome.
Material and methods: Three single tooth cases in the esthetic zone
to be restored by implants. One case with proper amount of bone
to receive an implant. Another case with a limited amount of
bone to receive an implant but producing a dehiscence defect and a
last case with extremely limited bone amount vertically and

171

Posters: Clinical tips and cases: Implantology

horizontally that could not receive an implant. An approach based
on GBR is proposed to treat each case.
Results: All three cases were treated successfully with good esthetic
result. All implants showed total stability of marginal bone and
gingival level one year after loading.
Conclusion: Treatment of the single tooth anterior edentulous
ridge under this GBR approach show stability of bone and gingival
levels and good esthetic result.

226
Increasing the attached gingiva around endosseous
implant using acellular dermal matrix allograft
J. B. Park*, Kim, Seol, Lee, Ku, Rhyu, S. Han and C. Chung
Dept. of Periodontology, Seoul National University, Korea

showed healthy conditions around all the rehabilitations. All the

patients reported complete satisfaction and minimal swelling, pain
and discomfort in the immediate and 1-week post-operative
interviews.
Conclusions: Adoption of image-viewing software and motion
tracking devices during the implant placement allows the correct
insertion of xtures improving the functional and esthetic results,
minimizing intra-operative risks and prosthetic complications.

228
Four-year follow-up of 174 implants supporting fixed
bridges in maintenance therapy
T. Eccellente, M. Piombino, A. Rossi*,1 and E. Conserva1
1
Private Practice, University of Genova, Napoli

The aim of this study is to investigate the clinical ecacy of the

acellular dermal matrix allograft to achieve increased attached
gingiva around implant.
Materials and methods: Ten male patients having attached gingiva
less than 2 mm on the facial aspect of implant treated site were
included in this study. The raised partial thickness ap was
positioned apically and secured to the periosteum by the
absorbable sutures. Then the patients received acellular dermal
matrix allografts, which had been rehydrated in sterile saline for a
minimum of 10 minutes. The grafts were placed on the rm
periosteal bed with the connective tissue side against the
periosteum. Patients were seen at 3-month follow-up to monitor
healing and plaque control. Dierences in PI, GI, PD, and ATW
between baseline, 2 weeks and 3-month post surgery were assessed
by Wilcoxon signed rank test.
Results: The soft tissue healing was uneventful and no patients had
postoperative complications besides mild pain and/or swelling. The
change in PI, GI, and PD was not statistically signicant. ATW
increased from a mean of 1.0 0.6 mm to 5.0 0.9 mm at
2 weeks, and 3.0 0.9 mm at 3 months. The mean graft width
was 4.5 0.8 mm and the shrinkage rate at 3 month was
39.2 17.2%.
Conclusions: Within the limit of my study, it is concluded that the
ADM grafts could be applied as a substitute for autogenous
connective tissue grafts to increase the zone of the attached
gingiva.

Aim: To present the clinical result of 174 implants in maintenance

therapy.
Methods: Between February 2000 and March 2001, 174 implants
(Ankylos, Friadent, Mannheim, D) were inserted in 62 patients.
After a conventional healing period, 38 implants were loaded with
single crowns, 93 implants with 38 bridgework and 43 implants
were used for 6 full arch bridges. After the prosthetic treatment, all
patients were submitted to a quarterly control. In dierent time
intervals mPlI, mSBI, standardized peri-apical radiographs,
technical complications, patients satisfaction were recorded.
Results: After a total loading period of 52.4 months (range 44
59 months), no implant was lost. All implants presented healthy
peri-implant soft tissue conditions (mPlI = 1, mSBI>1) and a
stable peri-implant bone level. No patient reported suppuration.
During the observation period, six patients reported ceramic
fractures. Seven patients were not satised with the aesthetic result.
Conclusion: The long-term success of implant therapy depends
undoubtedly from osseointegration; hence the soft tissue
integration is not less important. The characteristic design of the
implant-abutment connection leads to negligible microgap which
signicantly inuences the peri-implant soft tissue and stability of
the bone level. It can be concluded that a sucient oral hygiene, the
presence of keratinized mucosa and the microgap design, could
inuence the stability of peri-implant tissues and the longevity of
implants.

227
Computer assisted implant surgery with an image
guided navigational system: 18 months clinical and
radiographic follow-up

229
Inlay-onlay grafting of autogenous mandibular bone for
augmentation of the atrophic posterior maxilla. clinical
results

M. Fabrizi*, A. Quaranta, S. Ciavardini and G. Pompa

University La Sapienza, Rome, Italy

L. Cordaro, F. Torsello*, C. Rossini and V. Mirisola

Dept of Periodontics, Eastman Dental Hospital, Roma

Aims: Description of the adoption of an Image Guided

Navigational system (Den X, Moshav Israel) to place dental
implants in 10 patients.
Methods: Ten healthy non-smokers patients (age 4055 years)
were selected to insert a total of 32 xtures (Imtec Implants
U.S.A.) using the Den X System that tracks the actual position of
the hand piece in real-time. The tracking method used by this
system is an optical three linear camera tracker Flashpoint 5000
system (Image Guided Technologies. Boulder, Colorado USA)
The type, size, position and orientation of the implants were
planned based on CT data with IGI Software from DenX Ltd.
adopting a Dentascan CT protocol. No intra or post-operative
injuries or accidents were reported.
Results: All the CT Scan and Orthopantomograms control
examinations performed after 1 week showed the correct implant
position and a complete radiographic superimposition. The periimplant parameters (PPD, CAL, BOP, Mobility, and Essudate)

Background: Few papers describe the results of posterior maxilla

reconstruction when combined vertical and horizontal alveolar
ridge augmentation is required. Three-dimensional reconstruction
of the resorbed posterior section of the maxillary arch has been
achieved using dierent surgical methods: a combination of sinus
oor elevation and vertical ridge augmentation with barrier
membranes, sinus oor elevation and onlay bone grafts harvested
from the iliac crest. The aim of this study was to evaluate the
clinical results of alveolar reconstruction of the posterior maxilla
with autogenous mandibular bone.
Methods: Twelve patients were consecutively treated with a
combination of inlay particulate grafts after elevation of the
sinus membrane and vertical or horizontal bone block grafts
secured with titanium screws in a single procedure. The clinical and
radiological results were evaluated. 34 implants were inserted (4 at
the time of reconstruction and 30 in a second stage). Follow up
varied from 6 to 30 months after loading.

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Posters: Clinical tips and cases: Implantology

Results: At implant placement mean vertical inlay augmentation
was 8.4 mm, mean vertical onlay augmentation (8 cases) was
3.4 mm and mean horizontal augmentation was 4.2 mm. All
implant survived, two implants showed marginal bone loss of more
than 2 mm and were considered partial success.
Conclusions: The use of mandibular inlay-onlay bone grafts has
shown excellent results in the reconstruction of composite defects
in the posterior maxilla.

230
Periodontitis and periimplantitis: microbiological
relationships. Review and practical observations
S. D. Aspriello, M. Piemontese and F. Antenucci* et al.
Univ Polytechnic of Marche, Italy
Successfully osteointegrated dental implants are colonized principally by facultative Gram-positive cocci and road. Periimplant sites
of partially edentulous subjects harboured higher percentages of
Bacteroides and Capnocytophaga than do edentulous sites. Also
periodontal pathogens are present in periimplant sites. Periodontal
status of subjects (probing depth) and microbiota on periodontal
pockets and remaining teeth are the major inuence on periimplant
microbiota. No dierences were observed in the microbiota
between implants or abutments with dierent surfaces. In edentulous subjects A. actinomycetemcomitans and P. gingivalis are not
detect. In experimental and in vivo periimplantitis the periodontal
species detected principally are P. intermidia/nigrescens, A. a., P. g.,
T. forsythensis, following by spirochete (as T. denticola), Fusobacterium, staphylococcus, Enterics and streptococcus in a variable
frequency. Failing dental implants have been associated with
periodontal pathogens such as T. f., Fusobacterium, spirochetes
and P. micros. Evidence and ours observations support the strictly
relation between periodontal status and the risk for periimplantitis
and a dierent detection of periimplant pathogens between
partially edentulous and edentulous subject. Periimplantitis in
edentulous subjects have microbiological features peculiars, in fact
in these cases perio-pathogenes such as A. a., il P. g.,P. i./n. e
Bacteroides e Capnocytophaga are decreased or not found.

231
Peri-apical implant pathology: etiology, diagnosis and
treatment options
T. F. Tzm, U. Aksoy*, I. Saygun and M. Senimen
Hacettepe Univ, Glhane Mil.Med.Acad., Ankara, Turkey
Osseointegration is the healing of alveolar bone around dental
implants so that the direct anchorage of the implant is then
maintained allowing functional loading without the growth of
brous tissue at the bone-dental implant interface. Although a high
success rate has been reported, many reports demonstrated implant
failures. Peri-implantitis is an inammatory process aecting the
tissues around an osseointegrated implant in function, resulting in
loss of supporting alveolar bone, where a bone defect arises in the
marginal portion of the dental implant site and has the shape of a
crater that may cause implant failure. As well as peri-implantitis,
peri-apical implant pathology has been recently dened where the
loss/removal of the implant is suggested. The etiology of peri-apical
implant pathology is speculated as overloading and excessive
tightening of the dental implant, bone overheating during surgical
procedure, fenestration of the supporting bone, presence of preexisting bone pathology, contamination of the dental implant
surface, pre-existing microbial pathology, or poor bone quality. A
limited number of reports are published about peri-apical implant
pathology, and most of them are treated with resective surgery. The
present report aims to introduce the diagnosis and the treatment of
peri-apical implant pathologies with regenerative surgery. Further,

a detailed literature review will be provided about the etiology,

diagnosis and the possible treatment options.

232
Evaluation of implant treatment from a position of risk
factors. Biological and prosthetic complications
A. Orujov*, T. Babayev, E. Farajov and O. Seidbekov
Azerb. State Inst. Doctors, Med. Uni., Azerbaijan
Purpose: The purpose of this article is to present clinical results
and evaluate the types of risk factors associated with complications
after placement of dental implants with the following implantsupported xed partial prosthetics (FPP).
Materials and methods: This study generalized the clinical results
that were received after treatment by FPP. There were 74 patients,
who received HiTech and NobelBiocare implants between 2000
and 2004. Totally 248 implants were inserted. Prosthetics: 203metal porcelain and 45- cast metal crowns. Complications:
biological (inammatory and surgical) and prosthetic
complications.
Results: Total loss - 20 implants (8%) Visible displays of mucouss
inammation (reddening) were around of 32 implants (12.9%).
Sucient marginal bone loosing was registered with 35 implants
(14.11%) after 1-year follow-up. Only 10 (4%) abutments were
lost. Fractures of metal framework - 5 (2.06%), of porcelain
veneers - 10(4%) crowns. Loss of cement bond - 28 crowns
(11.3%). Hygienic condition of an oral cavity after implant
treatment were not sucient with most patients.
Conclusion: The results of this study shows, using of HiTech and
Radix implants in our department is a safe and good-prognosable
method for the treatment of partially edentulous patients. Its
important to stress the level of oral care for patients with FPP plays
a signicant role for further successful functioning of implantsupported FPP.

233
Osseointegrated implants in a patient with PapillonLefevre syndrome : (a 10-year follow-up)
R. Orbak, M. Ozgoz, M. Zihni*, F. Kavrut and A. Eltas
Faculty of dentistry, Ataturk univ., Erzurum, Turkey
The 25-year-old female reported in present case was diagnosed with
Papillon-Lefevre syndrome. Oral function, fonation and aesthetics
were supplied with implant treatment after the conventional
periodontal treatment were completed. The 10-year follow-up
dental records, including full-mouth radiographs, intra-oral photographs, microbiological samples, leukocyte function tests, and
clinical indexes were evaluated. The treatment of the periodontal
disease and implant treatment in our case was successful. Initially,
the patient had depressed polymorphonuclear leukocyte (PMN)
chemotaxis and adherence as well as evidence of periodontal
infection with Actinobacillus actinomycetemcomitans (A. a),
Capnocytophaga, F.nucleatum, E.corodens. But 10-year followup showed normal PMN function treatment must be considered a
dierent mode of treatment for maintenance of oral function and
aesthetics of patients with Papillon- Lefevre syndrome.

234
Peri-implantitis treatment in an HIV-infected patient
F. Franch*, A. Liares and N. Donos
Eastman Dental Institute, University of London, UK
Objective: Report the ndings of GBR treatment for a periimplant defect in an HIV+ patient.
Materials and methods: An HIV+ patient with reduced CD4counts and a history of chronic periodontitis was referred to the
EDI for treatment of a peri-implant defect in position 26. The

173

Posters: Clinical tips and cases: Implantology

patient received non-surgical therapy under antibiotic coverage
(Metronidazole). The reassessment at 8 weeks showed a reduction
in PPD in all sites except for the area 26 where residual PPD
6 mm were encountered. The peri-implant defect was treated with a
combination of Bio-Oss and Bio-guide. Following the removal
of the granulation tissue and calculus from the implant surface with
ultrasonics and thorough rinsing of the surface with saline and
CHX, Bio-Oss granules were placed and covered by two
membranes. Primary closure was achieved and antibiotic therapy
for 2 weeks was prescribed. Follow-up appointments were carried
out for 1 month on a weekly basis. Following 6 months of healing,
overall PPD of 4 mm was achieved around the implant and the
bleeding on probing was reduced. A three-month recall program
was established and the clinical measurements were maintained for
12 months after surgery, where radiological bone ll of the defect
was also seen.
Conclusion: This case indicates that in HIV+ patient with reduced
CD4-counts, the GBR principle might provide clinical
improvements when used for the treatment of peri-implant defects.

235
Implant prosthesis treatment in angulated posterior
sector. Two techniques to improve the protetical
emergency profile
C. Ivorra*, J. Novell, F. Novell, Perramon and D. Romero
Univ. Santiago de Compostela, Spain
Objective: The objective of this study is to explain two techniques
to achieve a correct emergency prole in the replacement of the rst
molar when the second molar is mesioangulated compromising the
prostodonthical restauration.
Materials and methods: The second molar mesioangulation has
negative consequences for the rst molar prostodonthical
rehabilitation like the food impactation between the rst and
second molar. We have treated 18 patients from this pathology.
The patients were distributed in two aleatory groups. The patients
from group A had a denite implant to do the orthodontic
treatment. The patients from group B had one or two
microimplants distal to the second molar to do the orthodontic
traction.
Results: All the patients except one received the full treatment. The
patient left lost the implant positioned in the place of the rst
molar. In group B the mean treatment time was longer than the one
from group A. Two patients of group B lost one of the
microimplants. The most grave problems appeared in the
orthdontical treatment. All the patients were screened during one
year. They presented a good gum health of the second molar and
also a good health of our implant.
Conclusions: The mesioangulation of the second molar will always
have to be treated before or during the rehabilitation of rst molars
with implants. Both techniques that have been described have some
inconvenient and some advantages. To extract more conclusions
we have to do a study with bigger groups.

236
Treatment of a hypodontia patient with implants and
tooth supported fixed partial dentures: a case report
C. Yildiz*, A. Parlar, A. Gultan and V. Akalin
Gazi university, Ankara, Turkey
Patients who are congenitally missing one or several teeth are
frequently encountered in routine practice. Hypodontia is dened
as the developmental absence of one tooth or more and may
present with varying degrees of severity. This condition is
frequently combined with hypoplasia of alveolar bone in the
sites of missing teeth. In such cases in addition to functional

174

insuciency and esthetic compromise, psychosocial development is

another important concern for the young patients. Traditional
therapeutic approaches for the rehabilitation of these abnormalities
have included removable partial dentures, xed prostheses with
minimal tooth preparation and orthodontic movement of teeth to
close spaces. Dental implants represent an alternative to the
traditional treatment methods, especially in patients who have
moderate/severe hypodontia. This case report demonstrates the
rehabilitation of a dysfunctional malocclusion caused by a moderate/severe hypodontia utilizing a combination of orthodontic,
prosthodontic, surgical treatment and, dental implants to replace
the missing teeth. An 18 year-old woman patient with hypodontia
of the permanent teeth and partially retained primary teeth was
decided to receive implant and tooth supported by multidisciplinary team that included an orthodontists, a prostodontist and a
periodontist.

237
Success of dental implants placed by inexperienced
dentists. Results at 36 months
M. Pastor*, S. Garca, C. Subir and J. J. Echeverra
School of Dentistry, University of Barcelona, Spain
Introduction: Although, it is generally accepted that implant
surgery has a long learning period, very few studies have
considered, whether the lack of surgical experience of the
operator has an impact on the short term success after implant
placement.
Objective: To determine the success rate and the cumulative
survival rate of endosseous implants placed by general
practitioners without previous experience in implant surgery.
Materials and methods: During three consecutive years, a one-week
implant training program was oered to general dentists without
prior experience in the surgical phase of implant therapy. 251 Astra
Tech implants were placed in 84 patients. All implants were
installed under closed supervision. The success rate and the
cumulative implant survival rate were analysed up to 36 months.
Results: Twenty-four (29.5%) patients received single implants, 46
(56.7%) patients received between 24 implants and 14 (16.6%)
patients received ve or more implants. Implants failures occurred
in ve patients, who received more than one implant. Of the 251
implants placed, six failed (2.4%), all of them before occlusal
loading. The success rate and the cumulative implant survival rate
was 97.6%.
Conclusion: Within the limits of this study, clinician previous
experience did not seem to be an inuencing variable on implant
success.

238
A prospective cohort study of the dental implants
systems in patients with and without a history of
periodontal disease - long-term implant prognosis
V. Nicolaescu*, M. Damian, C. Mocanu
University of Apollonia, Ias i, Romania
Aims: The aim of this 5-year study was to compare the failure,
success and complication rates between patients having lost their
teeth due to periodontitis or other reasons.
Material and methods: Eighty-ve patients who received 112
hollow screw implants of the Nobel Biocare and Alpha Bio
Dental Implant System were divided into two groups: group A
twenty three with 21 implants having lost their teeth due to
periodontal disease; group B sixty two patients with 91 implants
without a history of periodontitis. The incidences of periimplantitis
were noticed during of a regular supportive periodontal therapy.

Posters: Clinical tips and cases: Implantology

Results: Success criteria at 5 years were set at: pocket probing
depth (PPD) # 5 mm, bleeding on probing (BoP), bone loss <
0.2 mm annually. The survival rate for the group with a history of
periodontal disease (group A) was 90.5%, while for the group with
no past history of periodontitis (group B) it was 96.5%. Group A
had a higher incidence of peri-implantitis than group B (28.6% vs.
5.8%). With the success criteria set, 52.4% in group A and 79.1%
of the implants in group B were successful.
Conclusions: Patients with implants replacing teeth lost due to
periodontal disease demonstrated lower survival rates and more
biological complications than patients with implants replacing
teeth lost due to reasons other than periodontitis during a 5-year
maintenance period.

239
Horizontal ridge augmentation by simultaneous use of
guided bone regeneration (GBR) and osseointegrated
implants in edentulous mandible jaw
V. Piperias* and E. Sinanioti
Private. Practise. lmt in Periodontics & Implants, Athens
Ideal architectural structure of the alveolar crest facilitate the
optimal prosthetic placement of implants from an aesthetic and
functional point of view. The reconstruction of decient alveolar
ridges through Guided Bone Regeneration (GBR) is capable of
promoting new bone formation in horizontal or vertical dimensions or both. The purpose of this poster was the presentation of
the therapeutic approach to two cases with large alveolar ridge
deformities in lower jaw in a bucco lingual dimension. In the rst
case the placement of three implants in an ideal prosthetic position
has resulted in a large buccal implants exposure outside the bony
housing in non-space making bone defects because of the insufcient crest width for implant placement in the mandible. Titanium
- reinforced membrane was applied supported by bone graft
materials following perforation of the surrounding cortical bone
plate to achieve a bleeding bone surface. 6 months later, after the
removal of the membrane the results were excellent. An overdenture provided a satisfactory solution for the patient. In the 2nd case
the placement of four implants in an ideal prosthetic position has
resulted in a moderate buccal implant exposure in the mandible. A
collagen membrane was applied supported by bone graft materials.
The result was excellent and a xed prosthesis provided a
satisfactory long- term result. The primary stability of the implants
was of paramount importance for the successful results in both
cases.

240
Modification of the index of oral hygiene in patients
carrying mandibular implant overdentures on bars
J. Faus-Lpez*, E. Canet, J. P. Firmino and E. Palomero
Periodontology, Univ.Cardenal Herrera-CEU, Valencia
Aim: Create useful tool in health and hygiene evaluation in
patients carrying mandibular implant overdentures on bars.
Modicate the plaque index Silness & Loe and calculus index to
the characteristics of this treatment.
Material and method: Forty patients, with two implants
mandibular overdentures on gold or titanium bar. Modied
plaque index is measured: Score 0, no plaque. Score 1, no plaque
at rst sight, the presence is demonstrated sliping probe on
abutment and/or on bar. Score 2, moderate plaque at rst sight on
abutment and/or on bar. Score 3, plaque at rst sight, abundant,
that occupies more than 1/3 of abutment and/or of bar. Modied
calculus index: Score 0, no calculus. Score 1, supragingival calculus
only on the abutment and/or on bar. Score 2, moderate subgingival

calculus, existing or not supragingival. Score 3, abundant

subgingival calculus, existing or not supragingival.
Result: 22.5% presented plaque score 0; 50% score 1; 25% score 2,
2.5% score 3. 10% presenting visible plaque on the bar, not on
abutments, described traditionally like score 0 but according to this
modication is included within score 2. Calculus index: 75% nonpresent, 22.5% score 1 2.5%, score 2.
Conclusion: Plaque and calculus index are valid for studies of
periimplant health. Avoid bar hygiene suppose an allocation of
plaque and calculus values lower to the real ones, poor hygiene is
infravalued. Necessary include oral hygiene protocol to avoid
subsequent periimplant complications.

241
Immediate implants and immediate function clinical
considerations
R. Almeida* and C. Falco
University Fernando, Pessoa, Portugal
The aim of this presentation is to discuss the clinical aspects of this
kind of treatment, and the limitations that we still have to take in
account. The sociologic and cultural advances of the society in the
last years has inuenced Dental Medicine. The concern about
perfection in aesthetics
is nowadays one of the objectives of our
treatment. The new techniques and materials have changed and we
can oer to the patients better results in a reduced time. In fact the
nal results of these treatments are not only health and function
but also aesthetics and in the fewer time possible. In this
presentation we will discuss the indications and limits of immediate
implants in concern to perfection in aesthetics
, and also the
immediate loading, their biological principles, indications and
limits. We will present the clinic protocols with clinical cases and
discuss the results published in the literature. From our point of
view immediate loading and immediate function can be a predictable treatment option if pre-operative factors are favourable.

242
The use of platelet-rich fibrin in the osteotome sinus
floor elevation technique: preliminary results
A. Diss*, D. Dohan, J. Choukroun and P. Mahler
Lasio, Nice, France
The purpose of this prospective study is to document radiographically tissue remodeling patterns around implants placed according
to the bone-added osteotome sinus oor elevation technique with
the use of platelet-rich brin as bone graft material.
Materials and methods: Three men and 10 women, aged between
42 and 73 years (mean age 51.7 yr), were treated with 23 implants
placed according to osteotome sinus oor elevation technique.
Platelet-Rich Fibrin (PRF) membranes was prepared during the
surgery from a blood sample of the patient and served as bone graft
material. Intraoral radiographs were obtained presurgically and
postsurgically at 12 months.
Results: The implant survival rate was 100% after 12 months. The
mean preoperative distance between the sinus oor and the crest
was 5.4 mm (range 2.79.4 mm). The mean distances between the
implant apex and the initial sinus oor were: 4.63 1.92.
12 months postchirugically, the mean bone height increase of the
new bone reaching apically to the implants was 0.02 0.22 mm.
Conclusion: PRF is an autologous brin matrix with a high platelet
concentration. The grafted area apical to the implants undergoes
resorption which is stopped by the implant extremity. PRF could
be used as a bone graft in the osteotome elevation with
simultaneous implant placement.

175

Posters: Clinical tips and cases: Implantology

243
Aetiological hypothesis and treatment for an implant
periapical lesion: a clinical case
M.Farneti* and E.Bondi
Centro Odontoiatrico, Bologna, Italy
There are two categories of complications that occur in implant
therapy: biological and technical (mechanical) Biological complications refer to disturbance in the function of the implant characterized by biological processes that aect the tissues supporting the
implant. A particular group of biological complications are the
implant periapical lesions. These lesions can be similar to periapical
scare found at the tooth apex and characteristically could presents no
clinical symptomatology, as well as infected lesion usually accompanied by stula development. The scientic literature reports an
incidence next to 0.2% but probably this percentage is very far from
the real frequency. The occurrence of these lesions is also inuenced
by an unscrupulous analysis of bone characteristics of the site
suitable to implant insertion. The purpose of the presentation is to
investigate the aetiopathogenetic factors that are responsible of such
peri-implant pathologies by means of a clinical case exhibition. It is
also suggested a modied classication and the strategies of
treatment related to the dierent forms. The required condition to
achieve the treatment successful is an advanced diagnosis. It can be
reach by a well-organized supportive care program.

244
Multidiscipline management of oligodontia (multiple
agenesis): the relationship between an
interdisciplinary team
A. Peivandi*, R. Bugnet, E. Debize and J. L. Beziat
Maxillofac Surg department. University of Lyon I, France

vertical alveolar bone augmentation is possible. However, resorbable collagen barriers seems to be an interesting alternative because
they are easy to manipulate, well accepted by oral tissues and they
dont have to be removed after the surgery. The aim of this
presentation is to show that vertical and horizontal bone augmentation is possible with collagen membranes in implant dentistry.
Comparison between dierent types of collagen barriers will be
exposed and advantage of resorbable membranes will be discussed.
Guided bone regeneration was performed in several clinical cases
with a collagen membrane that resorbs in 6 months. Autograft and
xenograft were used to support the membrane and avoid collapse.
Membranes were not xed to alveolar bone and gingival tissues
were sutured with horizontal mattress and interrupted sutures.
Results have shown that vertical and horizontal ridge augmentation is possible with collagen membranes. This technique seems to
be very predictable and incidence of complications is very low.
Other clinical reports that use resorbable barriers can be found in
the literature, but there are not scientic studies with a high
number of patients. In conclusion, this membrane seems to be a
promising alternative to expanded politetrauorethilene barriers,
because they could simplify the technique and increase its
predictability.

246
Success, biological and technical complications
with screw retained fixed partial dentures on
implants in the edentulous mandible; 36 year results
D. Jeluic*, D. Bozic, D. Plancak and M. Krmpotic
Dept. of Perio., School of Dent. Med, Zagreb, Croatia

Initial background: Oligodontia few teeth this term designates

the lack of at least of the permanent teeth.
Aims of the report: Multidisciplinary treatment has improved our
ability to restore patients with oligodontia using orthodontic,
maxillo-facial surgery and implants for aesthetics and
functionality. The use of a combination treatment approach may
facilitate predictable success.
Materials and methods: Amongst the numerous oligodontia cases
that we have treated, three cases were chosen. A 22 year old patient
presenting 26 missing teeth, a 16 years old patient presenting 25
missing teeth and nally a 15 years old patient presenting 17
missing teeth. All three patients were treated by an interdisciplinary
team composed of a dental surgeon, an orthodontist, a maxillofacial surgeon and an implant surgeon. The rst patient was treated
by orthodontics, bi-cortical parietal bone grafts and dental
implants. The second patient was treated by orthodontics
,
orthognatic surgery and dental implants and the third patient
was treated by orthodontics, orthognatic surgery, bi-cortical
parietal bone grafts and nally dental implants.
Discussion/conclusion: The more severe the Oligodontia case, the
more obvious is the need of a multidiscipline approach. This hand in
hand cooperation of the overall specialists is essential in order to
obtain the patients motivation as well the one of his or her entourage.

Aim: To assess in a period of 36 years the success, biological and

technical complications of screw retained xed partial dentures
(FPD) on AstraTech implants.
Materials and methods: In 42 patients a total of 238 implants were
placed in edentulous mandibles. Of the 238 implants 75 were
immediate, 22 were placed after 68 weeks, others were placed in a
standard procedure. Of the 42 patients 32 received 6 implants, 3
received 5, while 7 received 4. In 38 patients the implants were
placed in the inter-foraminal region, in four patients the implants
were placed in the entire mandible.
Results: One implant failed to osseointegrate (0.4%). 28 implants
had exposed implant necks (11.7%), while 7 implants had
periimplantitis (2.9%). FPD: 28 were metal-ceramic (66.6%), 14
were metal-acrylic (33.3%), and there were 131 cantilevers. Five
FPD experienced metal framework fractures (11.9%) and were
remade, porcelain fractured in 11 cases (26.2%), acrylic fracture
occurred once (2.3%). Screw fractured in seven cases (2.5%),
abutment fracture occurred once (0.4%).
Conclusions: Implant borne screw retained FPD are a reliable
method of treating complete edentulous patients. A relatively high
incidence of technical complications for the screw retained FPD
could be because of the problems with the passive t of the metal
framework leading to the deformation of the suprastructure. With
the new developments such as the Cresco system for the passive t
a number of complications could be eliminated.

245
Vertical and horizontal ridge augmentation with
resorbable barriers, a simpler and more predictable
technique

247
Cad cam drilling guides for transferring CT-based
digital planning to flapless placement of oral implants
in complex cases

F. Llamb s*
Private practice, Valencia, Spain

F. Valente* and A. Sbrenna

Guided bone regeneration with non-resorbable membranes has

been well documented, studies have shown that horizontal and

176

Two of the most notable trends in modern surgical specialties are

minimally invasive surgery and the integration of computerized
diagnostics and computer-guided surgery. In oral implantology

Posters: Clinical tips and cases: Aesthetics

these two trends are now mainstream in the form on one side of the
so-called apless surgery and on the other side of the computeraided implantology. Even tough apless surgery can be performed
in some cases without the aid of the computer and a computeraided approach not always allows a apless procedure, these two
approaches can be often combined with great advantage. Flapless
surgery reduce pain almost to zero and should be used whenever
possible. However, no matter how advantageous it is, apless
implant surgery remains a blind surgical technique, dicult to
perform and prone to errors leading to potentially serious
complications. It can be transformed in a relatively simple
procedure thanks to the computer-aided implantology. There are
now numerous CT-based software available for 3-D implant
planning. The one shown in the present lecture is the SimPlant
software (Materialise, Leuven, Belgium). Computer assisted surgery is an exciting eld whose popularity is rapidly increasing
among implantologists all over the world. This approach can be
used with great advantage not only in good bone ideal cases, but
also in so called complex cases, where bone dimensions are less
then ideal, entailing the use of tilted implants.

248
Soft tissue management of post-extraction sockets as a
pre-implantological concept in the aesthetic zone
K.-L. Ackermann*, A. Kirsch and G. Neuendorff
DGI, EDA, APW, DGZMK, Nippon Dental Univ., Niigata
Background: Three dimensional soft and / or hard tissue
deciencies after tooth extraction often require signicant
manipulation of the mucosa which can compromise the
aesthetical outcome and increase the risk for post-operative
wound dehiscences.
Aim: The aim of this evaluation was to analyse whether lling of
the fresh extraction sockets with a space maintaining material (BioOss Collagen) and subsequent healing without primary wound
closure will result in the formation of an adequate amount and
appearance of soft tissue as a pre-implantological or preaugmentative procedure.
Materials and methods: In our private practice we performed until
now an evaluation in 45 patients and 59 sites. At least one anterior
tooth (1424) per patient had to be extracted and was planned to

be replaced by a dental implant. The fresh extraction sockets were

lled with Bio-Oss Collagen.
Results: The results in soft tissue amount and appearance were
adequate to an aesthetical acceptable situation. In some cases only
in the apical defect region one could nd bone formation. This was
the fact where only the Bio-Oss Collagen was used and no
membrane had been applied to cover the socket.
Conclusion: Soft tissue management by lling the socket with a
bone substitute can lead to adequate soft tissue amount and
appearance at the time of augmentation and / or implant insertion.
Clinical, histological and restorative results of the clinical
evaluation will be presented and discussed.

249
ALL-ON-4 immediate function in edentulous patients
J. Espirito Santo*, H. Franco and J. Suarez
Hugo Franco Jose Suarez Quintanilha
Dental implants are used increasingly in dental treatment, as they
can often oer many advantages for the replacement of the lost
tooth. The ALL-ON-4 technique represents an alternative treatment when the amount of bone available in the posterior area of
the maxilla is insucient. For this purpose inclination of the
posterior or distal implants is used. In this way it is possible to
create an ideal support for an acrylic bridge that can be designed
and placed within a few hours after the surgical intervention.
Objectives: To present the indications and contraindications for
the ALL-ON-4 technique, and the diagnosis, treatment plan,
surgical techniques, types of implants and prostheses for the
technique.
Clinical implications: The surgical procedure can be performed by
the dentist with appropriate surgical experience. The dentist should
be trained in diagnosis, in performing the treatment plan. They
should have knowledge of the surgical technique, of post-operative
follow up, and should be able to evaluate their results in the
medium to long term.
Conclusions: ALL-ON-4 is an impressive advance for the treatment
of the edentulous maxilla. In addition to its simplicity and
predictability, from a surgical point of view the protocol allows the
placement of implant-retained prostheses with immediate function.

Posters: Clinical tips and cases: Aesthetics

250
Supraperiosteal envelope in soft tissue grafting for
multiple root coverage. Technique and case report

251
Enhancing aesthetics using astra' s implant system
abutments

J. Alcazar* and A. Santos

Universitat Internacional de Catalunya, Spain

G. Eid* and A. Berberi

Private Practice

The search for predictable clinical solutions to the problem of

gingival recession has led to several important surgical advances in
the last years. Free connective tissue grafting for root coverage
combines an overlying ap and an underlying vascular bed for
graft nourishment. Langer developed the subepithelial connective
tissue graft technique to treat in both isolated and multiple
adjacent areas of recession. Raetzke in 1985 described the envelope
technique to manage isolated areas of root exposure. Allen in 1994
described the rationale and technique of the supraperiosteal
envelope to include multiple adjacent areas of recession. The
presentation will show two case reports with multiple adjacent
areas of recession were covered with the supraperiosteal envelope
in soft tissue grafting described by Allen.

In the past ten years, Implantology has made great progress. In the
beginning, function was the main objective. However, due to
the signicant achievement of osseointegration, aesthetic
becomes
the main goal and is increasingly asked for by our patients. Above
all it now represents a social phenomenon. Most Dental implant
systems have improved their components or developed new devices
and procedures that allow for the production of more natural and
aesthetically pleasing restorations. Astra dental implant system has
greatly contributed to the revolutionary and improvement of
implantology by its conical design which oers a measureless
stability between abutment and xture. On the other hand, the
Microthread design allows even distributed forces around the
implant head resulting in marginal soft tissue stability, thus long

177

Posters: Clinical tips and cases: Regeneration

lasting aesthetic results. These properties allow Astra dental
implant system to develop new prosthetic components such as
Titanium Abutment with dierent heights and widths, which
permit the production of appropriate restorations replacing missing teeth, regardless of implants diameter, simultaneously making
the maintenance easier in posterior regions as well as empowering
aesthetics in anterior region.

252
Aesthetic reconstruction of impacted maxillary canine
associated with AOT
S. M. Lee*, J. H. Park, H. M. Kim, J. Y. Lee and M. Y. Kim
Dept. of Perio & Ortho., Gil medical center, Korea
Adenomatoid odontogenic tumour is classied as an odontogenic
epithelial tumour. It is predominantly found in young and female
patients, located more often in the incisor-canine -premolar region
in most cases associated with an unerupted permanent tooth. The
management of unerupted tooth associated AOT is important to
the patient in aesthetic and functional purposes. So the reconstruction is considered a multi-disciplinary entity requiring the expertise
of a number of specialists. It included not only rehabilitation of the
occlusion but also periodontally esthetic aspects. Otherwise,
reconstructed teeth is accompanied with unfavourable gingival
condition; root recession, lacked attached gingiva, and gingival
concavity and surgical scar. This case report is the repair of
unesthetic gingival condition resulted from orthodontic eruption
and surgical excision of impacted canine teeth related to AOT
using subepithetial connective tissue graft in a 21-year-old woman.
It has followed up for 6 months and maintained a favourable
gingival esthetics.

253
Periodontal management and role of CAD-CAM
technologies in esthetic dentistry
L. De Micheli and C. Coraini*
Istituto Stomatologico Italiano, Milan, Italy
The aim of the present work is to evaluate from a clinical point of
view the relations existing between soft tissues, surgically treated,
and prosthetic therapies performed by means of CAD-CAM
technologies. We considered clinical cases treated with dierent
kinds of surgical techniques. The nal prosthesis was given by the
system CAD/CAM Procera, and the material used was the densely
sintered alumina. We also used a CAM technology to obtain metalfree temporary crowns. The relationship between biological widths,
placing of the nishing line, gingival biotype, type of preparation
and the working area are elements to be considered. But these
factors are strictly correlated to the type of material used for
restoration. The clinical experience matured through the use of the
auro-galvanic crowns (AGC), and many dierent metal-free
methodologies, has shown us that there is a signicant dierence
in tissue response and in the consequent natural gingival trophism
obtainable, part of it intrinsically linked to the core utilized. In fact,
in optimal conditions of oral hygiene, the constant factors are high
tissue naturalness, and gingival health with the absence of irritation
around the prosthetic restoration. An ulterior element of interest is
the observation of the extreme naturalness of transmission of light
through the deep cervical gingival tissues. CAD-CAM technologies
are ready for our use, but its realistic for us to consider whether we
are really ready to use them.

Posters: Clinical tips and cases: Regeneration

254
A treatment of severe periodontal and periodontalendodontic lesions without a membrane

lesion. Successful clinical outcomes have been reviewed for a

period of ve years.

Dr. Nik. V. Pandya* BDS, MSc, DGDP

Colchester. England. Barts and The London, London, UK

255
Evaluation of bone healing after odontogenic cyst
enucleation with and without guided bone
regeneration with CT

The objective of this study was to regain clinical attachment for

teeth that would normally have been extracted due to severe
periodontal disease or periodontal-endodontic lesions. The material used was synthetic and resorbable, which has a bio-engineered
surface charge that up regulates the gene factor, and has added
benet that no membrane is required. The aim was to review the
stability of the newly formed tissues over a ve-year period. CIP
disease may present as pockets with/without suppuration. The
aected the tooth may exhibit tenderness to percussion, increased
mobility and presence of a bony defect. Such symptoms may also
be present due to irritants in the root canal(s) of the tooth. The
success of both periodontal and endodontic therapy depends on
the elimination of both disease processes, whether they exist
separately or as a combined lesion. The main constituent of the
bone substitute is a multi-porous b-Tri-Calcium Phosphate. A
Calcium Sulphate matrix allows formation of mouldable material
which sets hard and acts as a cell-occlusive barrier. It also allows
space maintenance into which bone will grow when placed in a
bony defect. The material also contains other ions and a bioengineered surface charge to enhance bone growth. The matrix
has additional benet of being bacteriostatic. This may be an
important factor in the treatment of the periodontal-endodontic

178

S. Kahraman*, S.Gultekin, S.Cetiner and S.Yucetas

Gazi Univ, Ankara, Turkey
This prospective, controlled and randomized study was planned to
evaluate bone regeneration by using allogenic bone graft (ABG)
and collagen membrane (CM) after removal of large odontogenic
cysts. Twenty-four patients with odontogenic cysts selected and
divided into two, as control and study groups. The control group
was treated by enucleation and primary closure, whereas ABG and
CM were applied to the cavities of the study group after
enucleation. CT scans were taken postoperatively on the tenth
day and in the third, sixth and twelfth months to measure residual
cavity volume and density of the newly formed tissue. Initial and
remaining cavity volumes were compared on CT images and
density was measured in Hounseld units. Means and standard
deviations were calculated for all variables in the groups. Similar
results were observed in control and study groups. A progressive
reduction in the volume of the cavities both with and without graft
material was apparent. Findings for the mean density of the newly
formed tissue in the third, sixth and twelfth postoperative months

Posters: Clinical tips and cases: Regeneration

were also similar. The mean residual volume at each observation
period did not show statistical dierences between the groups.12th
month CT scans showed a signicant increase in the average
density of the newly formed bone in the mandible when compared
to the maxilla. Results of this study suggest that using grafts
doesnt contribute to increased bone regeneration and large cyst
defects can regenerate spontaneously.

256
The long-term effect of infra-osseous defects treatment
with EMD and bone substitutes
I. Rudnic*, S. Martu and St. Zanoaga
University of Medicine, Ias i, Romania
Aims: The purpose of this study was to evaluate the long-term
treatment outcome of the use of Emdogain and BioGran in
periodontal treatment of infra-osseous defects in conjunction with
surgical procedures in order to obtain higher clinical attachment
levels.
Method: The protocol included 20 patients with at least two
interproximal sites in the same jaw, appropriately separated and
randomly distributed in pair test and control sites. The
morphologic characteristics were pocket depth 6 mm,
infraosseous defects with at least 4 mm depth and 2 mm width.
Clinical parameters included API, PBI, periodontal pockets depth,
clinical attachment level, gingival recession and radiographic
evaluation. Statistical analysis used t-Student test (SPSS 10.0)
with the patient as statistic unit, considering the greater attachment
level value, mean and standard deviation.
Results: The average values of the clinical attachment level in the
test sites were 1.8 mm at 6 months, 2.1 mm after 12 months and
2.5 after 18 months, for the group treated with Emdogain and
Biogran and respectively 1.1 mm at 6 months 1.2 mm at
12 months and 1.4 mm after 18 months for the group treated
with Emdogain only.
Conclusions: Periodontal regeneration using EMD and bone
substitute can be used in the areas with severe bone loss resulting
from periodontitis. The results are rst observed in the reduction of
probing depth, while the bone gain is evident after 2 months and it
continues to improve.

257
Effects of demineralized bone matrix implantation on
repair of alveolar socket of diabetic rats (type I)
M. Kadkhodazadeh*, F. Mollaverdi and S. H. Ahmadpoor
Tehran University, Iran
Aim: The aim of this study was to determine the eects of DBM on
repair of alveolar bone of diabetic rats treated with insulin.
Methods: This study was carried out on 80 adult 8 weeks old rats
(Albino) with average weight 200250 gram; The animal are
divided in to four groups (N:5) as follow: rst group; control
and second, third and fourth monohydrate through veins of tail.
Diabetes was only controlled in group 4 with insulin NPH, 1 unit
daily. After 10 days upper right incisor extracted by an adapted
instrument, and socket was lled with DBM in groups 4, 3. In the
end of rst, second, third and fourth weeks animals scaried.
Specimens were prepared and stained with H.E.
Results: In group 4; in the end of rst week osteoblastic activity
and bone formation invicinty of DBM with collagenbers was
observed in the end of second, third and fourth. Thick trabecular
bone formation was observed whereas in group 3(untreated with
insulin) bone trabecular formed dispersly around the DBM
particles. In group 2 (untreated, no DBM) in the end of rst and
second weeks haematoma and inammation was the dominant

histological feature, in addition bone formation showed poorly in

the third and fourth weeks.
Conclusion: The results of this study showed that osteogenesis and
trabecular formation in alveolar socket of group 4 that received
DBM and insulin, was better than other groups. It seems DBM
stimulated osteoprogenitor cell to produce osteoblastic cell.

258
Osteoconductive potential of collagen/hydroxyapatite/
chondroitin sulphate biomaterial in alveolar bone
reconstruction
A. Scabbia*, R. Farina, L. Minenna and L. Trombelli
Res. Cent. Study Periodontal. Dis., Univ. Ferrara, Italy
Background: The aim of this study was to describe the clinical and
histologic outcome of reconstructive procedure for a critical-size,
post-extraction alveolar bone defect with a collagen/
hydroxyapatite/chondroitin sulphate graft (Biostite) and a
collagene bioabsorbable membrane (Paroguide).
Materials and methods: After tooth removal and socket
degranulation, Biostite was implanted to ll the defect. A
Paroguide membrane was trimmed and adapted to completely
cover the defect and the implanted graft. Flaps were mobilized and
sutured to ensure primary closure. After 12 and 36 months, hard
tissue biopsies were harvested.
Results: Healing progressed uneventfully, no esfoliation or infective
complication were recorded. Radiographic follow-up along the
observation period showed a progressive reduction in diameter of
the grafted biomaterial and, parallely, an increase in radiopacity of
the defect. Histologically, a mature, well-vascularized, newly
formed bone was present. Particles of biomaterial integrated with
surrounding bone were still evident at both observation intervals. A
scarce number of CD68-positive cells was observed at 12 and
36 months, suggesting a slow resorption rate of the biomaterial.
Conclusions: This case report supports the osteoconductive
potential of a collagen/hydroxyapatite/chondroitin sulphate graft.
This study was partly supported by VEBAS s.r.l., Italy and
Research Center for the Study of Periodontal Diseases, University
of Ferrara.

259
Surgical treatment of advanced periodontal defects
by combined use of GTR-barriers and bovine bone. a
follow-up of 29 patients for up to 5 years
C. Slotte*, B. Asklw and D. Lundgren
The Inst. for Postgr. Dent. Edn Jnkping, Sweden
Background: Long-term clinical data on the combined use of
GTR-barriers and ller materials in periodontal surgery are scarse.
This report comprise up to 5-year follow-ups of advanced
periodontal defects treated with GTR-barriers and bovine bone
mineral.
Material and methods: Twenty-six patients, consecutively treated
are reported. After examination and oral hygienic treatment the
extensive periodontal defects of various topography included in the
study were surgically exposed, debrided, lled with bovine bone
mineral (Bio-Oss), and covered with bioresorbable GTR-barriers
(Guidor or Bio-Gide). Postoperatively, patients were advised to
refrain from brushing in the surgical area, instead rinsing with
0.1% chlorhexidine for 6 weeks. After 6 months of close
monitoring, supportive periodontal therapies were given with
individual re-call intervals. Clinical and radiographic
examinations were then made annually.
Results: 26, 17 and 17 patients have so far been examined at one-,
three- and ve-years follow-up respectively. Mean probing depth
(PPD) was 9.9 2.0 mm at baseline, 4.7 1.9 mm at year one,

179

Posters: Clinical tips and cases: Regeneration

4.3 1.3 mm at year three and 4.6 1.9 mm at year ve. Gain
of mean clinical attachment level (CAL) was 3.8 mm at year one,
4.3 mm at year three and 4.0 mm at year ve.
Conclusion: The study shows that, extensive periodontal defects
can be successfully treated by the combined use of GTR-barriers
and bovine bone mineral resulting in a substantial reduction of
PPD and achievement of a stable, long-term gain of CAL.

260
Radiographic anatomy of intrabony defects as a
predictor of the response to periodontal treatment
P. Buitrago, V. Ramn*, E. Juarez, C. Granados and P. Alpiste
Department Of Periodontics, University of Valencia, Spain
Introduction: The presence of periodontal intrabony defects is a
main indication of regenerative therapies. Although the recent
regenerative procedures are more predictable, the disparity of the
results orient us to consider the inuence of unknown variables.
Aim: To study the possible inuence of morphological
radiographic variables of bone defect over the bone response to
the treatment with open ap debridement, valued radiographically.
Material and methods: We have compiled a total of 430
periodontal patients of a dental oce dedicated to the treatment
of periodontal disease. They were treated with SRP, open ap
debridement and participate regularly in a supportive periodontal
therapy program each 36 months during at least 12 months. As
radiographic variables we have considered the bone ll, rate of
bone ll, crown-root ratio and type, depth and angle of the defect.
Results: There have been analysed by a computerized method 55
intrabony defects of a minimum depth of 2 mm. The average time
of participation in the supportive periodontal therapy program was
of 69 months. We have found a signicant statistical relation
between bone ll and depth and angle of the defect.
Conclusions: Our results suggest that the radiographic morphology
and more concretely the depth-width ratio are valid predictors of
the response to the therapy employed. This reinforces the
contemplation of the characteristics of the defect as main factors
that indicate the use of regenerative therapies predictably.

261
Periodontal and bone cicatrisation after the rescue
surgery (surgical repositioning) of impacted lower
second molars
D. Torres*, M. Gonz
lez, D. Gallego and J. Cabezas et al.
Oral Surgery Department, Univ of Seville, Spain
The rescue surgery includes a group of surgical techniques that,
alone or aided by other dental techniques allow the reposition of an
included or retained tooth in its normal situation inside the dental
arch. Inside these techniques is the surgical repositioning, that
pursues the placement of the tooth in their correct position by
means of a slight elevation of the same one, elongating, but not
breaking, their vascular-nervous package. In the case of the
impacted lower second molars, this elevation, besides repositioning
correctly the tooth, create an empty space in mesial of the relocated
tooth. They have intended dierent treatments with the purpose of
that in this space are regenerated the normal structures of support
of the tooth (materials of bone ller, bone regeneration or tissular
guided regeneration, etc.). In our work we apply this technique on
ten retained second lowers molars, valuing the protocol used in the
bone and periodontal cicatrisation of our sample, and comparing
our results with those of other published studies.

180

262
Early orthodontic movement in periodontally involved
teeth treated with GTR: report of three cases
C. Ghezzi, M. Silvestri, L. Passaler* and G. Raperini
University Milan, Italy
Background: The orthodontic needs in case of periodontal disease
with deep infrabony defects, require both orthodontic and
regenerative therapy. The sequence and the timing of these
therapies is still unclear and lack of information exist in the
literature on this issue, moreover, few data are available about the
best clinical periodontal approach in this cases.
Aim: The aim of this study was to evaluate the inuence of the
early orthodontic movement after GTR.
Material and methods: Three patients were treated with
regenerative procedure in aesthetic area. Clinical parameters such
as PD, CAL and REC, were recorded at baseline, 3, 6 and
12 months. X-rays were taken at baseline, and at the end of the
orthodontic therapy. The orthodontic treatment started after
twelfth months after surgery in one case, sixth months in the
second case and three months in the last case.
Results: Clinical results showed a signicant mean reduction of the
baseline parameters in terms of PD and CAL with an improvement
of the soft tissue conditions, such as gingival margin and
interdental papillae high.
Conclusions: Within the limits of the study we observed that in all
three cases the regenerative procedure combined with the
orthodontic movement gave satisfactory results in terms of PD,
CAL and REC gain and as aesthetic nal outcome. The dierent
timing of the beginning of the orthodontic force application did not
inuenced the nal result. The reduction of the therapy duration
resulted in less discomfort for the patients.

263
Bone regeneration in surgical and no surgical cases
M. Kruczan*
Soc. Franaise de Parodont. et Implant. Orale
Introduction: The aim of this study is to compare the clinical and
radiological results of the treatment of deep periodontal pockets
accompanied by bone defects after using surgical and no surgical
therapies.
Materials and methods: Calcium carbonate biomaterial (Biocoral)
as bone substitute and Metronidazole 25% (Elyzol) antimicrobic
medication for local use. Studies demonstrate that porosity of natural
coral, constituted fundamentally of calcium carbonate, is important
for bone graft regeneration. The absorption of the material and newly
formed bone are also demonstrated. Antimicrobic release on the
infection site supplies a higher concentration on infected spot with
advantage of minimizing side systemic order eects.
Results: Improvement in radiological and clinical parameters
which indicates osseous regeneration in all cases.
Conclusion: Despite technique followed the most important thing
is that therapy is actually eective as a function of a correct patient
selection, an adequate indication and execution of technical
procedure and a periodic maintenance.

264
Treatment of a perio-endo complicated tooth by
intentional replantation after emdogain application
a case report
D. Nikolidakis, G. Nikou*, R. Junker and A. Sculean
Perio Dpt, Radboud UMC Nijmegen, The Netherlands
Root-canal infection has been shown to provoke an inammatory
reaction in the periodontium. The prognosis of teeth with

Posters: Clinical tips and cases: Regeneration

periodontal problems combined with root-canal infection is often
doubtful. The application of EMD to replanted teeth may enhance
regeneration of the periodontal ligament and prevent ankylosis.
The aim of this case report is to present the treatment of a 45-yearold female patient displaying a combined periodontal-endodontic
pathology. At baseline, a deep periodontal pocket
(PPD = 12 mm) was detected at the palatal medial region of
tooth 15. The tooth had already received endodontic treatment
5 years ago. Radiographic examination indicated periapical radiolucency. A diagnosis of periapical endodontic lesion with suppurative apical periodontitis was established. The treatment
consisted of initial periodontal therapy followed by periodontal
surgery. After ap elevation, visual examination revealed a
draining sinus tract on the palatal bone plate associated with an
angular bony defect. The tooth was intentionally extracted and the
buccal and lingual cortical bone plates remained intact. The
periapical lesion was removed and Emdogain was applied to the
root surface. The tooth was then replanted back into its socket and
splinted. At 1-year following therapy, the PPD was reduced to less
than 3 mm whereas the radiographic examination revealed an
almost complete resolution of the apical radiolucency indicating a
stable clinical situation.

assess the clinical and radiographic eect of this combination

(Allomatrix Injectable Putty) in periodontal treatment. Eight
chronic periodontitis patients who had radiographical interproximal defects with an associated probing depth (PD) of 6 and an
intrabony component of 4 mm, were included. Prior to surgical
treatment and at 8 months, plaque and sulcus bleeding indices, PD,
marginal soft tissue and relative attachment levels, probing bone
and radiographic bone levels were measured. No adverse event
related to the use of Allomatrix was noted. Favourable clinical
outcomes in soft and hard tissue measurements were achieved
when compared to baseline (P < 0.01). Considering the deepest
site of the defects, 4.0 1.41 mm of PD reduction,
2.5 1.31 mm of attachment gain, 1.33 0.65 mm of recession,
were obtained. The mean clinical and radiographic bone gain was
2.12 0.90 mm and 2.67 1.3 mm, respectively. Within the
limits of this study, it was concluded that Allomatrix Injectable
Putty is promising for clinical and radiographic improvements in
the treatment of intrabony periodontal defects.

267
Enamel matrix proteins and bovine derived xenograft
in the treatment of intrabony periodontal defects

265
Influence of osteoporosis on periodontal regeneration

L. Ugurel, Kuru, Noyan, Ipci and Yilmaz

Yeditepe University, Marmara University, Istanbul, Turkey

J. Leusic*, K. Temmer and N. Luksic-Dolenc

Dental Polyclinic, Zagreb, Croatia

The aim of the present study was to present cases and assess the
clinical and radiographical outcome of the EMD + BDX therapy
in intrabony periodontal defects. Fourteen chronic periodontitis
patients who received non-surgical periodontal therapy and had
radiographical interproximal defects with an associated probing
depth (PD) of 6 and an intrabony component of 4 mm, were
included. Prior to surgical treatment and at 8 months, plaque and
sulcus bleeding indices, PD, marginal soft tissue and relative
attachment levels, probing bone and radiographic bone levels were
measured. Favourable clinical outcomes in soft and hard tissue
measurements were achieved when compared to baseline
(P < 0.001). Considering the deepest site of the defects, 4.32
1.31 mm of PD reduction, 3.21 0.97 mm of attachment gain,
0.82 0.54 mm of recession, were obtained. The mean clinical
and radiographic bone gain was 2.64 0.60 mm and 2.57
0.39 mm, respectively. Within the limits of this study, the combined
application of EMD with BDX in intrabony periodontal defects
signicantly improves the clinical and radiographical parameters.

The aim of present study is to evaluate new bone density following

periodontal surgical therapies, and to analyse signicant factors
associated with clinical outcome. Material comprised 40 female
patients with chronic periodontitis separated into two groups
(group A, n = 20 without any systemic disease; group B, n = 20,
with osteoporosis without systemic therapy). Before surgical
therapy periodontal indexes were measured together with radiography and radiodensitometry. Bone density was measured by
computer program THROPHY-RWG-UI
, and expressed as a
part of grayscale (0256). Following re-evaluation, they were
treated with surgical therapy with mucoperiostal full thickness ap.
Infrabony defects were lled with Bio-oss spongiosa and covered
with Bio-gide. Control measurements were done after 6 months
and after 1 year. After 6 months post surgical measurements of
bone density in both groups showed bigger density values (Group
A, +84 50, P < 0.0001; Group B, +12 14, P < 0.002),
and dierence between group A and group B was in favour of
group A (P < 0.0001). After 1-year post surgical measurements
showed minimal increase compared to measurements after
6 months (Group A, +14 30, P = 0.0002; Group B,
+1 1, P < 0.0001). This minimal increase was in favour of
group A (P = 0.005). This shows usefulness of periodontal
surgical therapy, and draws attention to the fact that regeneration
of new bone is rather inferior in female patients with osteoporosis,
but without systemic therapy.

266
Allomatrix injectable putty in periodontal regeneration:
a preliminary study
Kotil*, Yilmaz, Kuru, Noyan, Cakar and Sculean
Yeditepe, Marmara University, Istanbul, Turkey, Radboud University,
The Nertherlands
Demineralized bone matrix (DBM) with a synthetic calcium
sulphate has demonstrated clinical success in periodontal regeneration. A new evolution of this biomaterial was achieved in
orthopedic surgery through the combination of human DBM in
a medium of surgical grade calcium sulphate and pharmaceutical
grade sodium carboxymethylcellulose. The present study aims to

268
Decision making guidelines for grafting in sinus floor
elevation procedures
J. Caubet*, J. Iriarte, M. Morey, J.Mayoral and C S
ez
Maxillofacial Unit, GBCOM Palma de Mallorca, Spain
Purpose: The average dimensions of the adult maxillary sinus are
2535 mm (width), 3645 mm (height) and 3845 mm (length) so a
majority of the sinus augmentations can be performed with 23 cc
of autogenous bone in a composite graft. We propose a decisionmaking guidelines for grafting in sinus oor elevation procedures.
Materials and methods: We evaluated the results obtained in 62
sinus lift procedures. In 46 sinus lift procedures (70%) the grafts
were autologous bone grafts obtained from oral cavity harvested
using a safe scraper device. In 16 sinus lift procedures (30%) tibial
and calvarial grafts were harvested. Survival rates for implants
placed in the augmented sinus were 95% after the one year followup period.
Results: In all cases new bone formation was conrmed
radiologically and implant placement was performed successfully.
The analysis of samples obtained by biopsy revealed the presence
of mature bone. No healing problems were observed in any case.

181

Posters: Clinical tips and cases: Restorative aspects

Conclusions: Those sinuses presenting normal pneumatization in
the radiologic examination can be augmented with a mixture of
bovine hydroxyapatite and autogenous bone obtained from oral
cavity with the use of a bone scraper. If the pneumatization of the
sinus is high, the requirements of bone graft become increased and
other donor sites for autogenous bone such as the iliac crest, tibia
or calvaria must be taken into account.

269
Use of rhBMP-2 and demineralized bone matrix in
periodontal surgery in humans
U. Mueller*, K.-H. Schuckert and S. Jopp
Indente, Inst. of Oral Surgery and Dentistry, Germany
Aims: Clinical trials in animals and humans have demonstrated the
high osseoinductive potential of rhBMP-2. Since rhBMP-2 became
registered medication for specic treatments of bones in 2002
thousands of patients have successfully been treated for these
indications. In comparison to the carrier material ACS as part of
the medical kit DBM meets the requirements of a more stable
consistence. In individual cases it was expected to observe the
ability of rhBMP-2/DBM (a) to repair periodontal bone defects by
de novo bone and (b) to create vertical bone without the presence
of surrounding bony walls.
Material and methods: In four individual cases rhBMP-2/DBM
was used as a new strategy in patients with periodontal bone
lesions who could not successfully be treated in the conventional
way. RhBMP-2 was applied on DBM and implanted in the
periodontal defect using a modied operation technique. The
evaluation was conducted by measurement of pocket depth, clinical
observation and x-ray control.
Results: The probing pocket depth of 5 to 8 mm could be reduced
in all cases to the physiological standard of 2 to 3 mm. The x-ray
control clearly shows vertical bone growth without prior existing
bony walls.
Discussion: The newly developed method of augmentation with the
high osseoinductive rhBMP-2 on DBM shows good and promising

results in four individual cases concerning vertical de novo bone

growth in periodontal bony defects. Following clinical trials should
conrm these results.

270
Evaluation of effectiveness between deproteinized
bovine derived bone graft alone and combined with an
autogenous bone graft in intrabony defects
D. Ilhan* and A. Efeoglu
Periodontology Dept., Univ. Istanbul, Turkey
Aim: This study was designed to evaluate the eectiveness between
deproteinized bovine derived bone graft alone and combined with
an autogenous bone graft in periodontal intrabony defects.
Materials and methods: Forty-two interproximal intrabony defects
in 17 systemically healthy patients with chronic periodontitis have
been included in the study. The control group, in which Bio-Oss
alone has been used, consisted of 21 defects. The test group, in
which Bio-Oss has been combined with an autogenous bone graft,
consisted of 21 defects. In this study, Silness-Loe plaque index,
Loe-Silness gingival index, location of the gingival margin,
periodontal probing depth, clinical attachment level, sounding
measurements have been performed. Besides re-entry
measurements have been used to measure the formation of new
mineralized tissue in 25 defects.
Results: The gain of clinical attachment level in the control group
2.26 mm, in the test group 2.12 mm was observed at the end of a
6-month healing period. In the transgingival measurements; bone
ll of 2.5 mm in the control group, 2.76 mm in the test group was
obtained. During the re- entry surgery, bone ll of 3.13 mm in the
control group, 3.81 mm in the test group was gained. In all the
clinical measurements the dierences between two groups were
found statistically insignicant.
Conclusion: These ndings indicated that both two treatment
choices have been found to be eective in the treatment of
intrabony defects.

Posters: Clinical tips and cases: Restorative

aspects
271
Aesthetic rehabilitation using mixed
metallo-nonmetallic prosthetic appliances
I. Gradinaru*, I. Cliveti, G. Tanasa and F. Tanasa
UMF. Iasi, Romania, Klass Dent 03 Iasi, Romania
The dento-somatho-facial aesthetic eld has as main purpose to
create the illusion of the natural aspect. The aim was to evaluate
the possibilities of the aesthetic rehabilitation by using metalloceramic/metallo-composite prosthetic appliances. We realized 12
metallo-ceramic and 15 metallo-composite prosthetic appliances
used for dierent partial edentations treatment. The metallic
frameworks made up of Ni-Cr-Mo alloy, realized on working casts
mounted into an Whip-Mix articulator, were conditioned for an
optimum link between the constructions elements. The ceramic(IPS
d.SIGN)or the composite(SR ADORO)aesthetic element covered
the entire metallic framework. In both technologies the aesthetic
material application was possible in successive layers, corresponding to the dental tissues components. While metallo-ceramic
constructions detain the supremacy in the individual aesthetic
elaboration, metallo-composite technology is characterized by a

182

shorter working time, a lower price compared to metallo-ceramic

constructions and chromatic eects similar to those of ceramic. The
new biomaterials and the performant technologies create the
conditions to obtain a superposition between the optical, mechanical and biological properties of prosthetic constructions and those
of natural teeth. Metallo-ceramic and metallo-composite therapy
makes possible a morpho-functional recovery of the aected dental
arches by partial edentations and an exceptionally dento-somathofacial aesthetic rehabilitation.

272
'Restorative alveolar interface (RAI)' revisited
H. C. Lee*, Y. J. Seol, Y. M. Lee, Y. Ku and S. B. Han et al.
Mokdong Ye D. H., Korea,Seoul Nat'l. Univ., Korea
Background: There are a lot of ways of treatment in case of the
crown root fracture. The surgical crown lengthening procedure, the
surgical extrusion, the forced eruption and extraction are possible
treatments, but their cons exist. Ross et al. (1982, 1983) showed the
surgical management of the restorative alveolar interface (RAI).
These cases are the modications of the RAI concept to overcome

Posters: Miscellaneous
the shortcoming of the Andreasens method (1994) in the crown
root fracture.
Materials and methods: The four cases (two incisors, two molars)
of the subgingival crown root fractures were managed by the
following method. After the aps were made, the fractured
subgingival root surfaces were prepared with the high speed and
low speed diamond burs. If the fracture lines were in the alveolar
bone, the osseous surgery was done. The aps were repositioned or
apically positioned if the positive architectures were possible. After
the soft tissue healing was completed, the margins of restoration
were made in the newly created shallow sulcus.
Results: In all cases the BOPs were negative, the PDs were 2 to
3 mms and esthetics was obtained.
Conclusion: This method is easy, fast and clinically highly
predictable in compared with the other methods in case of the
crown root fracture, especially in molars. If the fractured line is in
the bone, the combined treatment with the forced eruption or the
surgical extrusion is recommended to avoid the osseous surgery.

273
An alternative to immediate loading for implant cases
in totally edentulous patients
J. L. Bustos*, A. Mellado, E. Gonz
lez and J. Casas
Facultad de Odontologa, Valencia, Espaa
In recent years there have been many articles and presentations
about totally edentulous patients treated with immediate loaded
xed prostheses over implants. It is obvious that the results of this
type of treatment, as seen in the literature, are quite similar to that
of delayed loading, when respecting a few basic rules. Nevertheless,
there are several factors (the inexperience of the clinician in
immediate loading, the busy professional life of some patients that

prevent them attending for the numerous appointments for this

kind of treatment) that can lead us to oer our patients other
alternatives to immediate loading. We present some cases of totally
edentulous patients to which a sucient number of implants were
co-located in order to restore them with a xed restoration after the
osseointegration period. During the time taken to make this nal
restoration, patients were restored with a provisional metal-resin
xed prosthesis made on a few strategic teeth that, despite their bad
periodontal prognosis, were retained during the osseointegration
period to serve as abutments for the provisional restorations.

274
Porcelain laminated veneer restorations in periodontal
patients
J. Casas*, E. Gonzalez, A. Melladoy and J. L. Bustos
Facultad de Odontologa, Valencia, Espaa
One of the most common problems when completing periodontal
treatment, especially after surgical procedures, is the creation of
broad interdental spaces that, in the anterosuperior area, means an
important esthetic defect. In this context, one of the most esthetic
restorative treatments used in Prosthodontics, the porcelain
laminated veneers, has not been used enough to hide these black
triangles. Probably, this fact has been due to the frequent
association between this type of treatment and very conservative
dental preparations that are not going to be done in periodontal
patients because of the need of locating the contact point closer to
the new ubication of the osseous cresta. In this abstract, we present
some clinical cases of periodontal patients restored with porcelain
laminated veneers in which we can check not only the esthetic
improvement of the anterior region, but also the excellent
adaptation of periodontal tissues to the restorations.

Posters: Miscellaneous
275
Immunohistochemical evaluation of plasminogen
activators and their inhibitors in drug-induced
gingival overgrowth
N. Buduneli, E. Buduneli and S. Cinar* et al.
Ege Univ, Turkey, Louisville Univ, USA
Aim: To evaluate expression of plasminogen activator enzymes
and their inhibitors by immunohistochemical techniques in druginduced gingival overgrowth tissue samples.
Methods: Fourteen cyclosporin-, three phenytoin-, ve nifedipineinduced overgrown tissues, 10 control tissues from gingivitis
patients, and 14 control tissues from healthy subjects were
evaluated. Clinical periodontal recordings and tissue sampling
were performed at baseline. Expression of tissue-type (t-PA) and
urokinase-type (u-PA) plasminogen activators, plasminogen
activator inhibitor-1 (PAI-1) and PAI-2 were determined in
formalin-xed/paran-embedded tissue sections. Data were
evaluated by anova, post-hoc Sidak test with modied Bonferroni
correction and Pearson correlation analysis.
Results: The t-PA expression was signicantly more in cyclosporin,
nifedipine, and gingivitis groups than in healthy control
(P < 0.01). All drug-induced gingival overgrowth groups
exhibited signicantly more expressions of PAI-2 than healthy
control group (P < 0.01). u-PA expression in cyclosporin- and
phenytoin-treated groups was signicantly higher than gingivitis
and healthy control groups (P < 0.01). Cyclosporin group

revealed signicantly more expression of PAI-1 than nifedipine

and healthy groups (P < 0.05).
Conclusion: In conclusion, signicant increases in gingival tissue
expressions of plasminogen activators and their inhibitors may
indicate involvement of this system in drug-induced gingival
overgrowth pathogenesis.

276
Endocannabinoid, anandamide in gingival tissue
regulates the periodontal inflammation through
NF-kB pathway inhibition
Y. Nakajima*, Y. Furuichi and T. Matsuyama, et al.
Univ. of Kagoshima, H. S. Univ. Hokkaido, Japan
Aims: Anandamide (AEA) exhibits anti-inammatory eects.
However, its role in the periodontal eld remains unknown. In
this study, we investigated the roles of AEA and its receptors in the
pathogenesis of periodontal disease.
Materials and methods: The levels of AEA in gingival crevicular
uid (GCF) were measured using High Performance Liquid
Chromatography (HPLC). Localization of cannabinoid receptors
(CB1 and CB2) in periodontal tissue were carried out by means of
immunohistochemistry. Expression of cannabinoid receptors in
human gingival broblasts (HGFs) were examined with the
RT-PCR and Western blot analysis. The productions of proinammatory cytokines from HGFs were measured by ELISA. Gel
shift assay was employed to detect NF-jB activation.

183

Posters: Miscellaneous
Results: We found that GCF contained a detectable level of AEA.
CB1 and CB2 were expressed by HGFs, and markedly
up-regulated under pathological conditions. AEA signicantly
reduced the production of pro-inammatory mediators (IL-6, IL-8
and MCP-1) induced by Porphyromonas gingivalis (Pg) LPS in
HGFs, and this eect was attenuated by AM251 and SR144528,
selective antagonists of CB1 and CB2, respectively. Moreover,
AEA completely blocked Pg LPS-triggered NF-kB activation.
Discussion/Conclusion: Our results imply that AEA may downregulate inammatory reactions in periodontitis through NF-kB
pathway inhibition.

277
The possible relationship between insulin-like growth
factor-I and central giant cell granuloma: a preliminary
report
I. Saygun, T. F. Tzm, C. Erdal* and K. M. Oku et al.
Glhane Mil. Med. Acad, Hacettepe University, Ankara, Turkey
Central giant cell granuloma (CGCG) is an intraosseous nonneoplastic lesion consisting of brous tissue that contains aggregations of multinucleated giant cells, broblast proliferation, foci
of haemorrhage and trabeculae of woven bone. Although many
studies are presented about CGCG, the relationship between
CGCG and the systemic polypeptides is still unclear. The aim of
the present report is to analyse the possible relationship between
insulin-like growth factor (IGF) and CGCG. Patients diagnosed as
CGCG in maxillary or mandibular sites participated in the study.
A laboratory investigation of complete blood count, systemic
hormone levels and systemic biochemical prole was analysed prior
to surgery, and at 3 and 6 months post-surgery. A 3 to 5-fold-of
increase in systemic IGF-I level prior to surgery was noted in all
cases. After immunohistochemical staining, a signicant IGF-I
staining was obtained at intra-cytoplasmic areas of multiple
multinucleated giant cells at baseline specimens. Following surgical
therapies, systemic evaluation of IGF-I demonstrated a trend of
reduction at 3 months that resulted with normal limits at 6 months
post-surgery. The relationship between neoplastic tumours and
IGF-I is clear. However, to the authors
knowledge, this is the rst
report demonstrating the possible relationship between CGCG, a
non-neoplastic lesion, and IGF-I. It is speculative that circulating
IGF-I levels may inuence the etiology and progression of CGCG.

278
The impact of clinical inflammation on peri-implant
sulcus fluid and gingival crevice fluid myeloperoxidase
and nitrite levels
T. F. Tzm, A. C. Akman* and N. Yamalik et al.
Hacettepe University, Ankara, Turkey
As enzymes and free radicals play important roles in inammatory
process, the aim of the present study was to analyse the impact of
the presence/severity of clinical inammation on peri-implant
sulcus uid (PISF) and gingival crevice uid (GCF) myeloperoxidase and nitrite levels. Forty-two implants and 67 natural teeth
were included. Clinical parameters were recorded, and PISF and
GCF myeloperoxidase and nitrite levels were spectrophotometrically determined at each sampling site. Dierences between noninamed and inamed implant and tooth sites, and correlations
between clinical parameters, and nitrite and myeloperoxidase levels
were statistically analysed. Inamed teeth and implant sites both
exhibited higher uid volume, myeloperoxidase and nitrite levels
than non-inamed sites (P < 0.05). The number of sites with
detectable levels of nitrite was generally higher than sites with
detectable levels of myeloperoxidase. Despite the higher GCF
myeloperoxidase levels at all sites and higher nitrite levels at non-

184

inamed sites, dierences between PISF and GCF were not

signicant. Correlations were more prominent between gingival
inammation, bleeding and myeloperoxidase levels than nitrite
levels (P < 0.05). PISF nitric oxide metabolites and myeloperoxidase may serve as measures of inammatory response at periimplant sites. When nitrite and myeloperoxidase levels are
concerned, the inammatory process around implants and natural
teeth seem to present similarities.

279
Neutrophil functions before and after periodontal
treatment in generalized aggressive periodontitis
H. Grsoy*, Noyan, Yilmaz, Demiralp and Kuru
Yeditepe University, Marmara University, Istanbul, Turkey
The objective of this study was to evaluate clinical parameters,
phagocytosis and oxidative burst functions of neutrophils in
generalized aggressive periodontitis (GAP) and chronic periodontitis (CP) before and after initial periodontal therapy. 10 GAP, 10
CP patients and 10 healthy individuals were included. At 0. and
49 days peripheral blood analyses including phagocytosis and
oxidative burst functions have been performed by ow cytometric
method. At the same days plaque index, bleeding on probing,
probing depth and relative attachment level were measured.
Signicant clinical improvements were observed in two patient
groups (P < 0.01) compared to their respective baseline values
only with the exception of relative attachment level changes in CP.
Intergroup comparisons revealed no signicant dierences.
Regarding to the immunological evaluations % phagocytosis
and oxidative burst functions demonstrated no signicant
dierences between the three groups. The dierences between %
phagocytosis and oxidative burst functions in intergroup comparison did not reveal statistical signicance. The mean uorescence
intensity considered as the degree of phagocytosis was found to be
much higher in GAP patients than in CP and healthy group before
the initial periodontal treatment but reached almost similar levels
after the treatment. It can be concluded that the investigated
neutrophil functions of GAP can be considered as in expected
normal ranges.

280
The role of dietary habits in the aetiology of recurrent
aphthous ulcers -a preliminary study
F. O.
zden*, B.
zden and G. Akgz
University of Ondokuz Mays, Samsun, Turkey
Recurrent aphthous ulcer (RAU) is one of the most common oral
mucosal disorders characterized with painful, recurrent ulcers on
unattached mucosa. The aetiology of RAU remains unsolved but
factors such as stress, trauma, genetic predisposition, haematological deciencies, gastrointestinal disorders, immunologic abnormalities, hormonal disturbances, viral factors and food
hypersensitivity have all been implicated. There are some contradictory reports about the relationship between RAU and food
sensitivity. In this preliminary study, we aimed to investigate some
of the suspected foods in a group of RAU patients by questionnaire. Thirty patients suering with RAU were aged between 19
55 years old and were all healthy otherwise. They were compared
with 17 non-RAU subject aged between 2245 years old. Results
are discussed under the light of some of the previously reported
studies. Some allergenic foods like; wheat avours, chocolate, nuts,
milk, tomatoes were investigated and allergenic food consumption
was found to be statistically higher in RAU group when compared
with the control group (P < 0.05). Elimination diets due to the
suspected foodstus may have an importance treatment role in some
of RAU patients who are haematologically and immunologically

Posters: Miscellaneous
healthy. Dietary treatment is advised only if the denite allergenic
factor is known and may be a useful treatment method in RAU
patients who are resistant to other treatment modalities.

281
IL-1A, IL-1B and TNF-A gene polymorphisms in Turkish
lap patients
E. Guzeldemir*, M. Gunhan, O. Ozcelik and H. Tastan
Department of Periodontology, Ankara University, Turkey
IL-1 and TNF-a are a potent immunomodulators and proinammatory cytokines implicated in the pathogenesis of autoimmune
and infectious diseases. As in other inammatory diseases of
infectious origin, periodontitis could be linked to altered proinammatory cytokine expression. Localized aggressive periodontitis (LAP) is a genetic disorder in which inammatory pathways
mediate disease. The aim of this study was to investigate the
association of the polymorphisms in IL-1a+4845, IL-1b+3954and
TNF a-308 genes with LAP patients in Turkish population. The
LAP group consisted of 31 patients, and the control group included
31 healthy subjects. All subjects were genotyped for IL-1a +4845,
IL-1b+3954and TNF a-308 loci by standard PCR amplication
followed by restriction enzyme digestion and gel electrophoresis. A
higher frequency of heterozygous of the IL-1a +4845 was found in
LAP (65%) than controls (35%). While allele 1 of the IL-1b+3954
was the most frequent genotype in LAP (62%), there was no allele
1 of the IL-1b+3954 in the controls. For both of these traits, the
dierences were statistically signicant (P < 0.05). The frequency
of the allele 1 of the TNF-a was similar in LAP and controls; the
dierence was not statistically signicant. These ndings suggest
that both IL-1 polymorphisms are associated with LAP in Turkish
population and provide risk factors for LAP. Knowledge of IL
genotype is valuable in risk management, treatment planning and
prediction of tooth survival.

282
Differences in the composition of the subgingival
microflora among Hispanic American populations
M. Oteo*, A. Contreras, N. Silva and D. Herrera
Un.Valle, Colombia; Santiago, Chile; Complutense, Spain
To compare the subgingival microbiota of distinct patient populations demonstrating Periodontitis, in Colombia, Chile and Spain.
Patients and methods: Patients suering chronic Periodontitis were
selected. Microbiological pooled samples were taken at four sites
per patient and analysed by culture. Identical training in anaerobic
culturing procedures was provided for the three centers. Clinical
parameters were recorded at the sampled sites. Results were
statistically analysed by means of anova or Kruskall-Wallis, and
Chi square tests.
Results: Samples from 37 Chilean, 41 Colombian and 26 Spanish
patients were analysed. No dierences were found in age or gender
distribution, but a signicant lower proportion of smokers was
found in Colombia (P < 0.05). The mean probing depth was
signicantly higher for Colombian patients (P < 0.001). The mean
anaerobic total counts were signicantly higher in Chile
(P < 0.05). No signicant dierences were found for the
frequency
of
detection
of
P.
gingivalis
and
A. actinomycetemcomitans, but important dierences were
detected for T. forsythia, P. intermedia, M. micros, F. nucleatum
or enteric rods. Regarding the proportions of ora in positive sites,
signicant dierences were found for most pathogens, being of
special relevance those of P. gingivalis (P < 0.001) and of
T. forsythia (P = 0.04).

Conclusions: Important dierences were detected in the

subgingival microora of three distinct populations from
dierent geographical origins.

283
b-FGF regulates MMP and TIMP mRNA expressions
of PDL cells
S. S. Hakki*, E. E. Hakki and R. M. Nohutcu
Selcuk Univ, Kenya, Hacettepe Univ, Ankara, Turkey
Basic-Fibroblast Growth Factor has been suggested as a valuable
molecule to consider in designing therapies to regenerate periodontal tissues. In this study, the eects of b-FGF on periodontal
ligament cells behaviour were examined. Specically we evaluated
b-FGF eects on (a) matrix metalloproteinase(MMP)-1,2,3 and
tissue inhibitor of matrix metalloproteinase(TIMP)-1,2 mRNA
expression; (b) mineralization; and (c) cell morphology. PDL cells
were obtained from premolar teeth extracted for orthodontic
reasons. Cells were cultured with DMEM media containing: (1)
5%Fetal Bovine Serum, (2) 5%FBS+ascorbic acid (AA, 50 mg/
mL), (3) 5%FBS + b-FGF (10 ng/mL) + AA. Cells within each
group were evaluated on day 14 and 21 for gene expression prole
using semi quantitative RT-PCR for MMP-1,2,3 and TIMP-1,2
and on day 21 for mineralization by von Kossa staining. Results
from this study demonstrated that while b-FGF stimulated
markedly MMP-1 and MMP-3 mRNA expression and inhibited
TIMP-2 mRNA expression, no dierences were noted in MMP-2
and TIMP-1 transcripts at both time points when compared to
control groups. b-FGF blocked the mineralization activity of PDL
cells. Inhibition of mineralization by b-FGF is correlated with an
increase in the levels of MMP-1,3 expressions and a decrease in
TIMP-2 transcripts. These results suggested that b-FGF may block
PDL cell mediated biomineralization, and regulate MMP and
TIMP allowing for a balance between hard and soft tissues
required for complete regeneration.

284
Effects of diode laser irradiation on IGF-1, receptor of
IGF-1, and basic FGF in gingival fibroblast and
osteoblastic cells
I. Saygun, T. F. Tzm*, S. Karaay and A.
zdemir et al.
Glhane Mil.Med.Acad, Hacettepe University, Ankara, Turkey
Laser enhanced biostimulation produces metabolic changes within
the cells. Among many physiological eects of low level laser
(LLL) irradiation, it is important to recognize that LLL may aect
immune cells, which secrete various growth factors for broblasts
and osteoblasts. Therefore, the aim of the present study was to
examine the eects of LLL irradiation on the secretion of insulin
like growth factor-1 (IGF-1), receptor of IGF-1, and basic
broblast growth factor (bFGF) from broblasts and osteoblasts.
Laser irradiation was carried out with a diode laser. The study
consisted of two experimental groups (24 and 48 hours irradiated)
and a control group (non-irradiated) for both broblast and
osteoblast cells. The IGF-1, receptor of IGF-1, and bFGF analysis
of experimental and control groups were performed. The irradiated
broblast and osteoblast cells revealed considerably higher growth
factors than the control. The dierences were signicant in both 24
and 48 hours irradiation groups compared to control. LLL therapy
causes increases in IGF-1, receptor of IGF-1, and bFGF in
broblast and osteoblast cultures. LLL irradiation causes an
increase in the secretion of growth factors that play important role
in periodontal wound healing and regeneration. This may reveal
the eects of LLL on biostimulation of gingival broblasts and
osteoblasts.

185

Posters: Miscellaneous
285
Effects of low-power CO2 laser in growth and
proliferation of cultured human pdl fibroblast in vitro.
I. K. Jang, J. S. Lee* , G. J. Chae, U. W. Jung, S. H. Choi
Department of periodontology, Yonsei University, Korea
The aim of this study is to evaluate the eect of low-power CO2
laser in growth and proliferation of cultured human PDL
broblast in vitro and to nd out the most effective degree of
energy and power density where cell proliferation and differentiation to osteoblastic cells highly takes place after laser
irradiation. The experimental groups were divided into 4 groups
by applying different irradiating distances from cultured cell
to laser tip; 2Cm(Focal spot=?0.74mm), 3Cm(Focal spot =
?1.04mm) and different irradiating time; 1 second, 3 seconds.
And they were applied to laser at a power of 0.5W with 50Hz
under continuous mode. The control group was not applied to
laser. MTT and ALP activity test were performed to observe the
growth of PDL cells and cell differentiation to osteoblastic cells.
On the 5th day after laser irradiation, statistically signicant
increase of cells were found in all groups. But, no signicant
differences were found among groups. Statistically signicant
increase of ALP activity was seen on the 3rd, 5th, 7th, and 10th
day after laser irradiation compared to the baseline. In this
study, there was a weak effect of low-power CO2 laser on cell
proliferation, but there was a better effect on cell differentiation.
2cm,1sec irradiation was found to be the most effective condition
for PDL cell differentiation in this study and 3cm,3sec was
found to be efcient.

286
Effectiveness of an anaesthetic gel (Dynexan) on
pain sensivity and early wound healing following
non-surgical periodontal therapy
Kasaj*, Willershausen, Sculean and Zafiropoulos
Univ. of Mainz, Germany, Univ. Med. C. Holland
The purpose of the present study was to evaluate clinically the
eect of an anaesthetic gel on pain sensivity and early wound
healing following nonsurgical periodontal therapy. A total of 40
patients with chronic periodontitis were enrolled in this randomized, split-mouth, double-blind, placebo-controlled trial. Each
subject had 3 sites in each of 2 contra-lateral jaw quadrants with
a probing pocket depth (PPD) of 5 mm and bleeding on
probing (BOP+). All teeth received scaling and root planning
without local anesthesia followed by irrigation with sterile saline
and assessment of pain sensivity using a standardized Visual
Analogue Scale (VAS). After treatment, the patients randomly
received the active or placebo gel into the periodontal pockets
and overall pain was again assessed after 10, 20 and 30 min. The
VAS showed a statistically signicant (P < 0.0001) reduction in
reported pain, favouring the active gel over the placebo at all 3
dierent points in time. After 30 minutes the median VAS score
was 0.3 in the Dynexan group as opposed to 4.4 in the placebotreated group (P = 0.0001). In terms of wound healing no
dierences were found between the test and control sites after
1 week. The results of the study showed that the anaesthetic gel
was statistically more eective than the placebo in reducing pain
following non-surgical periodontal therapy. However, in terms of
early wound healing no signicant dierences were seen between
the two treatment sites.

186

287
Histomorphometric study on the effect of interimplant
distances on papilla formation an crestal resorption in
implants with a morse cone connection
A. Novaes*, R. Oliveira and V. Papalexiou et al.
Fac Odontologia de Ribeirao Preto, Univ. Sao Paolo, Brazil
The aim was to evaluate the eect that dierent interimplant
distances, after prosthetic restoration, will have on papilla formation and crestal resorption in sub and non-submerged implants. 56
Ankylos implants were placed, 1.5 mm subcrestally, in seven dogs.
They were placed so that two bridges, with three interimplant
contacts, with 1(group 1), 2 (group 2) and 3 mm (group 3)
distances could be constructed on each side. The sides and the
position of the groups were randomly selected. After 12 weeks, the
implants received metallic prostheses with 5 mm between the
contact point and the bone crest. After 8 weeks, the distances
between the contact point and the papilla was measured. Histomorphometry of the distance from the top of the implant to
the rst interimplant bone-implant contact (CP-IP) was made.
The clinical measurement of CP-P for submerged (sub) and
non-submerged (nonsub) implants was for group 1: 3.57 1.17
and 3.10 0.82 mm, for group 2 it was: 3.57 0.78 and
3.16 0.87 mm and for group 3 it was 3.35 0.55 and
3.07 0.93 mm respectively. The CP-IP for sub and nonsub
group 1 was: 0.3 0.17 and 0.32 0.1, for group 2 it was
0.21 0.09 and 0.19 0.07 and for group 3 it was 0.24 0.15
and 0.3 0.13 mm respectively. Interimplant distances of 1 to
3 mm, submerged or not, did not signicantly aect papilla
formation or crestal resorption. The contact point to bone crest
distance should be less than 5 mm if interimplant papilla formation
is the objective.

288
The levels of plasma lipids in younger patients with
aggressive periodontits
B. M. Sepic Matanovic*, M. Molnar and Z. Blazic Potocki
Dental Clinic Zagreb, Zagreb, Croatia
Periodontitis a disease which comprises bacterial infection and
local chronic inammation. Epidemiological studies suggest a
relationship between periodontitis and some systemic diseases,
diabetes mellitus, coronary artery diseases, etc. Studies presented
periodontal disease associated with an increased risk of cardiovascular disease, which in term is associated with hyperlipidemia,
amongst other factors. The aim of this study was to measure levels
of plasma lipids in younger patients with aggressive periodontitis.
Materials and methods: We have measured levels of plasma lipids
in 26 subjects with aggressive periodontitis (CPITN score IV
pocket depth 6 mm and more), mean age 35.4 3 years and 26
age and sex matched control subjects. Both groups were healthy
without any systemic diseases. Some of the subjects and control
had a smoking habit (10 and 6 respec).
Results: Total cholesterol (CHL) and triglycerides (TG) were
signicantly higher in case group 9% (P < 0.03) and
42%(P < 0.001), respectively, when compared to controls. HDL
and LDL cholesterol were slightly higher in case subj. but with no
signicant dierence. Pathologic values of TG and CHL were
signicantly higher in patients.
Conclusion: The results indicate that hyperlipidemia may be
associated with AP in younger healthy subjects, but it remains
unclear whether hyperlipidemia comes due to periodontitis or
whether periodontal and cardiovascular diseases share
hyperlipidemia as a risk factor.

Posters: Miscellaneous
289
Periodontitis in essential hypertensive patients: a
preliminary investigation
O. Turkoglu* and N. Baris et al.
Ege Univ., Dokuz Eylul University, Izmir, Turkey
Aim: The study was designed to search the relationship between
control of essential hypertension (EH) and severity of periodontal
disease.
Materials and methods: Patients over 34 years of age using
antihypertensive drugs for EH (n = 56) were enrolled. Patients
with diabetes and coronary artery disease were excluded. Patients
were considered uncontrolled hypertensive if systolic blood
pressure was greater than or equal to 140 mmHg and/or diastolic
reading was 90 mmHg or higher. Cardiovascular risk (CVR)
factors including body mass index, hsCRP, haptoglobin, alpha1antitripsin, lipid levels were recorded. Periodontal examination
included probing depth (PD), bleeding on probing, plaque index,
tooth loss. Association of periodontitis with EH, after adjusting for
age, gender, smoking, education and CVR factors was analysed by
logistic regression analysis.
Results: Forty ve percent of 56 hypertensive patients had
moderate/severe periodontitis and 20% of them had uncontrolled
EH. Compared to patients with no/mild periodontitis (< 4 of nonadjacent teeth with PD > 4 mm), patients with moderate/severe
periodontitis (> 3 of non-adjacent teeth with PD > 4 mm) were
less likely to have uncontrolled EH, but this dierence wasnt
statistically signicant. After adjusting demographic characteristics
and CVR factors, association of EH and periodontitis was
statistically insignicant.
Conclusion: The control of EH and severity of periodontitis
doesnt seem to be related in Turkish population.

290
Calcium sulphate versus bioabsorbable membranes in
periodontal defects: a split-mouth study. long-term
results
M. Orsini*, G. Orsini, D. Benlloch, J. J. Aranda and M. Sanz
Private Practice, L'Aquila UCM, Spain
Abstract: The aim of this study was to evaluate the long-term
results obtained with calcium sulphate, and to compare them with
the results obtained using bio absorbable membranes.
Materials and methods: A split-mouth design was used in 30
patients. Thirty 3-wall periodontal defects were treated using
calcium sulphate + autologous bone graft (test) and compared
with 30 contralateral defects treated with absorbable
membrane + autologous bone graft (control). Before surgery,
patients were instructed about oral hygiene and S/RP was
completed. All patients were put in periodontal maintenance
program. Probing depth (PD), clinical attachment level (CAL) and
bleeding on probing (BOP) were recorded at baseline, six months
and six years.
Results: At baseline, mean PD was 8.1 1.06 mm (control) and
8.2 1.24 mm (test). Mean CAL was 9.067 1.36 mm (control)
and 9.2 1.24 mm (test). At 6 months, mean PD was
3.77 0.82 (P < 0.001) for control defects and 3.87 0.68
(P = 0.001) for test defects. CAL showed a mean of 5.23 0.93
for controls (P = 0.001) and 5.43 0.75 for test defects
(P = 0.001). At 6 years, mean PD was 4.56 1.33 (P < 0.001)
for control defects and 3.99 0.68 (P = 0.001) for test defects.
CAL showed a mean of 6.03 1.38 for controls (P = 0.001) and
6.23 1.36 for test defects (P = 0.001).

Conclusions: Both therapies led to both short and long-term

improvement of the measured parameters. None of them showed
to be superior over the other one.

291
Serum IgG antibody response to periodontopathogens
in three ethnic groups with periodontitis in Malaysia
Z. A. Khamiza*, T. B. T. Ali and W. Sosroseno
Univ Malaya, Univ Science Malaysia
Objectives: To determine serum IgG response to four
periodontopathogens among three ethnic groups in Malaysia and
whether increased levels of serum IgG antibody to one species were
associated with another species.
Methods: Thirty subjects with advanced chronic periodontitis and
30 healthy controls who were ethnically, gender and age-matched
were equally selected in numbers from each race. Serum IgG
antibody levels to Pg, Tf, Pi and Aa were assessed by enzymelinked immunosorbant assay (ELISA).
Results: Mean serum IgG antibody response to Pi was found to be
signicantly higher in the Malays while serum IgG antibody to Aa
was lowest in the Indian subpopulation. IgG levels to Tf and Aa in
the Chinese population were higher than those in Malays and
Indians. Irrespective of the ethnic groups, the diseased subjects had
higher mean serum IgG antibody response as compared to the
healthy subjects. There was a signicant positive correlation
between serum IgG antibody response to Tf and Pg and also
between serum IgG antibody response to Pi and Aa.
Conclusions: Pg, Tf, Pi and Aa were found in the Malays, Chinese
and Indians in the present study. Elevated serum IgG antibody to
Tf appeared to be positively associated with that of Pg and that to
Aa likewise appeared to be associated with increase in serum IgG
to Pi. Study supported by Vote F 0131/2003C

292
Periodontal status of patients with crohn's disease
J. Stein, R. Smeets and G. Conrads et al.
Univ. Aachen, Germany; Univ. Bonn, Germany
Objectives: Crohns disease (CD) has been reported to have
periodontal manifestations. However, data on periodontal
parameters and microbiology is rare. Recent studies showed an
association of single nucleotide polymorphisms (SNPs) in the
NOD2/CARD15 gene with CD. These SNPs are involved in
immune response towards bacterial products. Our aim was to
investigate the periodontal status of patients with CD taking into
account periodontal pathogens and the NOD2 SNPs 8, 12 and 13.
Methods: The periodontal status of 147 patients with CD was
assessed. Detection of periodontopathic bacteria were established
by PCR using 16S rRNA probes. NOD2 genotyping was done with
the Taqman assay.
Results: Mean clinical attachment level (CAL) was 3.79 +/- 1.01
mm and mean probing depth (PD) 3.59 +/- 0.79 mm. 89.1% of the
patients had at least one site with CAL > 3.5 mm and 32.0 % at
least one site with CAL >5.5 mm. There was no signicant
dierence of CAL and PD between the 3 SNP! s. A.
actinomycetemcomitans was detected in 76.8%, T. forsythensis in
64.6% and C. rectus in 94.6%. Smoking and medication had no
inuence on CAL, PD and detection of pathogens.
Discussion: Our results suggest that CD patients have an increased
prevalence but only moderate severity of periodontal disease. Our
data do not support a role of NOD2/CARD15 on periodontal
status in CD. However, colonization of periodontal pathogens, in
particular C. rectus, might be of particular value for periodontal
manifestation of CD.

187

Posters: Miscellaneous
293
Evolution of salivary chlorhexidine concentrations after
oral application of three bioadhesive gels
A. S
nchez, A. Legaz, G. Garca*, M.D. Alc
zar
University of Murcia, *Lcer, S.A. Spain.
Introduction and aims: Concentration and permanence time of
bioadhesive gels of chlorhexidine may vary according to the drug
dose and formulation involved. This study investigates the salivary
chlorhexidine concentration after the single application of three
bioadhesive gels. Material and methods: Forty healthy subjects
were included in a randomized, double blind cross-over comparative study. A single oral application of three 0.2% bioadhesive gels
(Lacer, Perio-Kin and Bexident Enc as).All patient singed an
Informed consent. Salivary samples were collected at baseline and 5

188

minutes and 1, 2, 6, 12, 24, 36 and 48 hours after application. Mean

chlorhexidine concentration at each control timepoint, maximum
concentration, clearance rate and area under the concentrationtime curve were registered. The study was authorized by the
Clinical Research Ethics Committee of Virgen de la Arrixaca
Hospital (Murcia, Spain). Results: All 40 subjects completed the
study. No signicant dierences were detected among the three gels
for any of the study variables. Although the salivary levels of
chlorhexidine were high after 5 minutes, they decreased rapidly at
the controls made after 1 and 2 hours. Nevertheless, chlorhexidine
was still detected in saliva at the last control (48 hours).
Conclusions: Forty-eight hours after a single application of three
bioadhesive chlorhexidine gels, the antiseptic is still detectable in
saliva with no signicant dierences among the three formulations.