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Biomedical subjects

R A Reinhardt

Publications and source records attributed to R A Reinhardt.

At least 55 records · Page 3Linked to original sources
PubMed1993

IL-1 in gingival crevicular fluid following closed root planing and papillary flap debridement.

Interleukin (IL)-1 alpha and beta are cytokines which can mediate inflammatory, bone resorbing, and reparative effects in the periodontium, but few longitudinal data exist exploring their role following periodontal therapy. This study examined gingival crevicular fluid (GCF) concentrations of IL-1 alpha and IL-1 beta at sites with shallow sulci (SS) or inflamed moderate/advanced pockets (M/AP) before and 6 months after treatment with closed scaling/root planing (SC/RP) or papillary flap debridement (PFD), all in the same subject (n = 14 patients). No significant differences were noted in IL-1 alpha or beta concentrations (determined with two-site enzyme-linked immunosorbent assays) between SS and M/AP sites at baseline. While both therapies improved clinical parameters of periodontal disease, IL-1 alpha concentration increased significantly (p < 0.05) in M/AP-PFD sites 6 months after treatment, but were unchanged in other groups. IL-1 beta concentrations were numerically lower after therapy, except for a significant increase (p < 0.05) in M/AP-PFD sites. These data suggest that surgical wound healing in an inflamed, plaque-infected site (M/AP-PFD) results in prolonged production of IL-1, which may be a reflection of the extent of tissue trauma and delayed wound healing. In spite of increased IL-1 levels, these sites demonstrated significant short-term improvement in clinical attachment level (+ 1.8 mm, p < or = 0.001) postoperatively.

Adult↗
PubMed1993

Immunopathogenesis of chronic inflammatory periodontal disease: cellular and molecular mechanisms.

Recent studies of the cellular mechanisms involved in chronic inflammatory periodontal disease (CIPD) have contributed significantly to our understanding of the pathogenesis of the disease process. Functional studies have demonstrated polymorphonuclear neutrophil (PMN) chemotactic defects in some 70% of subjects with localized juvenile periodontitis while chemiluminescence data have suggested that peripheral blood PMNs from young subjects with adult periodontitis (AP) may be in a metabolically active state. Further studies have shown that stimulation of PMNs with a number of periodontopathic bacteria resulted in the production of an IL-1 inhibitor suggesting a possible regulatory role for PMNs in CIPD in addition to their established protective role. Most work on the immunoregulation of CIPD has, however, concentrated on T-cells. Recent limit dilution analysis has demonstrated the presence of periodontopathic bacteria-specific T cells in peripheral blood and the involvement and homing of these cells to the local lesions of CIPD is currently the focus of many studies. In animal studies, Actinobacillus actinomycetemcomitans (Aa)-specific T-cell clones home to the gingival tissues where they may exert a protective role. Homing and retention of lymphocytes to and in specific sites is dependent upon the expression of adhesion molecules. Recent data indicate however, that while there are increasing levels of ICAM-1, LECAM-1 and PECAM-1 expression with increasing degrees of inflammation, there are no differences between gingivitis and periodontitis lesions. Cytokine profiles may be related to the role of T-cell clones homing to the gingiva in CIPD.(ABSTRACT TRUNCATED AT 250 WORDS)

Aggressive Periodontitis↗
PubMed1993

HLA-D and T lymphocyte reactivity to specific periodontal pathogens in type 1 diabetic periodontitis.

Bacterial antigen fragments complexed with class II major histocompatibility molecules (HLA-D) on antigen presenting cells (APCs) stimulate CD4+ T lymphocyte proliferation, presumably to protect the host. This study examined these responses to antigens of two periodontal pathogens in four groups (n = 15) of age- (young adult) and sex-matched Caucasian subjects with or without type 1 diabetes and moderate to severe periodontitis: Group DP = diabetics with periodontitis; Group DnP = diabetics without periodontitis; Group nDP = nondiabetics with periodontitis; and Group nDnP = nondiabetics without periodontitis. HLA-D phenotypes for each subject were determined by lymphocytotoxicity assays. T lymphocytes purified from peripheral blood were stimulated in cell culture with APC pulsed with various concentrations of tetanus toxoid, Porphyromonas gingivalis, and Capnocytophaga sputigena antigens. T lymphocyte reactivity (3H thymidine incorporation) was numerically lower in cultures from diabetics stimulated with unpulsed APC (not significant), and antigen-pulsed cultures showed low proliferation and no significant differences among groups. Stimulation indices in cultures from diabetic patients stimulated with P. gingivalis or C. sputigena, however, were significantly elevated at all antigen concentrations compared to nondiabetic cultures. The occurrence of HLA-DR4 was moderately associated with diabetes (P < 0.05) and highly associated with periodontitis (P < 0.001, log-linear model for categorical variables); and HLA-DR53 and HLA-DQ3 were significantly associated with periodontitis (P < or = 0.02). HLA-DR was crucial to lymphocyte stimulation (anti-HLA-DR blocking experiments), but the low peripheral blood T cell reactivity to antigens of periodontal pathogens could not be linked with HLA-D type or periodontitis susceptibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Gingival crevicular fluid IL-8: correlation with local IL-1 beta levels and patient estrogen status.

Gingival crevicular fluid (GCF) IL-8 and IL-1 beta levels were determined by sandwich enzyme-linked immunosorbent assays. Associations between IL-8 and IL-1 beta GCF levels, and between these cytokines and patient estrogen status were evaluated. IL-8 and IL-1 beta were detected more frequently and in higher amounts/30 s GCF sample in estrogen-deficient patients than in estrogen-sufficient patients. IL-8 and IL-1 beta GCF levels were significantly correlated. These findings suggest that GCF IL-8 levels are associated with patient estrogen status and local IL-1 beta concentrations.

Adult↗
PubMed1992

Serum antibody responses in human periodontitis to cellular components of Capnocytophaga.

Serum levels of IgM, IgG and IgG-antibody subclasses directed against cell envelopes, lipopolysaccharides and cytoplasmic fractions from Capnocytophaga sputigena, C. gingivalis and C. ochracea were examined in age-, race- and sex-matched periodontally healthy (n = 25) subjects and subjects with adult periodontitis (n = 25). The envelopes and cytoplasmic fractions were obtained by ballistic disintegration of the cells and ultracentrifugation. Cell envelopes were treated with DNase, RNase and lysozyme. Lipopolysaccharides were obtained by hot phenol-water extraction and treated with DNase and RNase. The relative levels of the antibodies in response to the cell fractions were measured by the streptavidinbiotin micro enzyme-linked immunosorbent assay. Both groups showed IgM and IgG antibodies to each fraction of the three Capnocytophaga species, but the frequency of positive IgG subclass responses varied. The IgG4 responses were lower than the other subclasses. There were no significant differences between the IgM antibody levels of the two groups. However, the adult periodontitis group had significantly lower IgG antibody titres to the cell envelopes and cytoplasmic fractions of C. gingivalis and C. ochracea, and lipopolysaccharide of C. gingivalis. These results were reflected in the depressed levels of IgG1 and/or IgG2 to these cellular fractions from the same bacterial species. The adult periodontitis group also showed a lower level of IgG1 to the cytoplasmic fractions of C. sputigena without any depression in the total IgG antibody level. There were no significant differences between the groups in IgG3 and IgG4 antibody levels to any of the cellular fractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Bacterial↗
PubMed1991

Acute-phase protein detection and quantification in gingival crevicular fluid by direct and indirect immunodot.

The development of an assay for markers of active periodontitis, obtained directly from gingival crevicular fluid (GCF) and simply quantified, would be of great importance to the dental practitioner. The purpose of this study was to evaluate direct and indirect immunodot techniques as to their potential in easily quantifying acute-phase proteins within periodontally diseased and healthy site GCF. Indirect immunodots (GCF eluates dotted onto nitrocellulose membrane) using monoclonal antibodies and a radioactive isotope label were used to identify and establish relative amounts of C-reactive protein (CRP) and alpha-2-macroglobulin (A2M) in 2 diseased and 2 healthy sites in 24 periodontitis patients. Periodontally diseased sites were found to contain significantly lower concentrations of A2M than healthy sites (p less than 0.001), but CRP levels did not vary significantly between healthy and diseased locations. Using a direct immunodot assay (GCF absorbed directly into nitrocellulose membrane strips), A2M levels quantified with radioactive isotopes at healthy and diseased sites could be correlated with A2M levels determined by enzyme-linked antibody-colormetric probes at those same sites. Such a direct sampling and quantification system shows promise for future "in-office" diagnostic methodology.

Acute-Phase Proteins↗
PubMed1991

Clinical effects of closed root planing compared to papilla reflection and fiber optic augmentation.

Mini-surgical approaches in 4 to 7 mm probing depths have been shown to facilitate improved deposit removal as compared to closed instrumentation. At the same time this treatment is less traumatic than more extensive flap reflection for root planing. The purpose of this study was to compare the clinical effects of closed root planing (C/SCRP) to those of root planing augmented by papilla reflection and fiber optic illumination (PR/SCRP) over a 6-month period. Fourteen patients with moderate/advanced adult periodontitis received each therapy in 2 experimental periodontitis sites (PS = greater than or equal to 5 mm probing depth and greater than 5 mm attachment loss) and one non-periodontitis site (NPS = less than or equal to 3 mm probing depth and no recession). Presence of supragingival plaque, bleeding on probing, probing depths, and clinical attachment levels were measured before treatment and 6, 12, and 24 weeks posttreatment. Mean supragingival plaque levels were high and did not vary significantly over the course of the study, but bleeding on probing was significantly reduced in PS following both C/SCRP and PR/SCRP (P less than or equal to 0.0001). Mean probing depths were significantly reduced after 6 months (P less than or equal to 0.01) in NPS-PR/SCRP from 2.8 +/- 0.1 to 2.0 +/- 0.2 mm, in PS-C/SCRP from 5.5 +/- 0.2 to 4.5 +/- 0.4 mm, and in PS-PR/SCRP from 5.8 +/- 0.2 to 3.2 +/- 0.1 mm. In periodontitis sites, PR/SCRP demonstrated greater probing depth reductions than C/SCRP at all time periods (P less than or equal to 0.004). PS attachment levels also improved following C/SCRP and PR/SCRP at all postoperative times (P less than or equal to 0.01). PR/SCRP appears to provide better short-term mean probing depth reduction (2.6 mm) than C/SCRP (1.0 mm), presumably due to apical positioning of the papillae and periodontal repair following improved access for root planing.

Adult↗
PubMed1990

Intracrevicular application of tetracycline in white petrolatum for the treatment of periodontal disease.

In vitro tests in our laboratory have shown that 40% tetracycline HCl in a white petrolatum carrier (TTC-WP) has potential as a sustained release, autodissipating system. The present study tested subgingival placement of TTC-WP via syringe in vivo. Quadrants (2 diseased sites in each) in 9 patients with moderate/severe periodontitis were randomly assigned to receive the following treatments: (1) TTC-WP; (2) WP only; (3) scaling and root planing; (4) untreated control. TTC release into gingival crevicular fluid (GCF) over time (baseline, 1, 8, 24, 72 and 168 h) was measured using an agar diffusion bioassay. Clinical parameters and subgingival bacterial morphotypes (darkfield analysis) were also evaluated over time (baseline, 2, 4, 8, 12 weeks). Results indicated that TTC-WP was easily placed into periodontal pockets and biologically effective TTC was released into GCF for at least 3 days (mean concentration = 115.8 +/- 43.1 micrograms/ml at 3 days). TTC-WP reduced probing pocket depths and bleeding on probing relative to baseline measurements for 8-12 weeks post-treatment, and reduced %s of motile rods and spirochetes, with an accompanying increase in cocci, for 2-8 weeks. Similar effects were noted in the scaled and root-planed sites, but for a longer duration. TTC-WP and WP were clinically dissipated after 2 weeks and no adverse tissue reactions were observed. From these findings, subgingival TTC-WP cannot replace scaling and root planing therapy, but has characteristics useful in subgingival plaque control.

Administration, Topical↗
PubMed1989

IgG subclasses in gingival crevicular fluid from active versus stable periodontal sites.

Since IgG subclasses are common immunoglobulins associated with the periodontium and have different biological characteristics, these subclasses were measured in gingival crevicular fluid (GCF) from periodontally active (greater than or equal to 2 mm clinical attachment loss within three months of sample) versus clinically similar but stable or healthy sites. A sandwich enzyme-linked immunosorbent assay (ELISA) using monoclonal antibodies was performed to quantitate IgG subclass and albumin concentrations in serum and interproximal GCF samples from at least one each of the three disease categories from each of 20 periodontal maintenance patients. Although much variability existed among sites, mean IgG1 (p less than 0.05) and IgG4 (p less than 0.01) concentrations were higher in GCF from active periodontitis areas than stable sites, even though both had similar clinical characteristics. When IgG subclass concentrations were adjusted per mg albumin, both IgG1 and IgG4 levels in GCF from active sites were still significantly elevated over stable areas (p less than 0.05). Mean adjusted concentrations in GCF were generally greater than in serum, especially for IgG4 (active site GCF:serum = 24.2:1). GCF IgG4 concentrations may be useful as an indicator of the immunopathological changes which occur in active periodontitis.

Albumins↗
PubMed1989

Fiber optic probe augmented sonic scaling versus conventional sonic scaling.

Several factors, including access and visualization problems, make total deposit removal during scaling and root planing procedures extremely difficult. This study examined the effectiveness of a mode of therapy designed to improve access and visualization for sonic scaling compared to closed sonic instrumentation. Teeth with moderate to deep probing depths in six patients scheduled to receive immediate dentures were divided into three experimental groups: Group I, sonic scaling with access augmented by interdental papilla reflection and fiber optic illumination/transillumination (34 surfaces); Group II, closed sonic scaling (34 surfaces); and Group III, untreated controls (35 surfaces). Immediately after treatment the experimental teeth were extracted, stained with toluidine blue, and interproximal areas evaluated for remaining accretions with a microscope-digitizing pad-computer system. Group I had a significantly lower percentage (P less than 0.01) of remaining subgingival accretion coverage than Group II (1.30 +/- 0.25% vs 6.35 +/- 1.08%), and both Group I and II demonstrated significantly (P less than 0.01) fewer deposits than the control surfaces (46.61 +/- 4.32%). These findings suggest that minimal tissue reflection and fiber optic illumination/transillumination are beneficial adjuncts to deposit removal in moderate to deep periodontal pockets.

Coloring Agents↗
PubMed1988

Management of Class III furcally involved abutments for fixed prosthodontic restorations.

Class III furca-involved molars provide formidable challenges, but the literature suggests that such teeth can be successfully treated. Under specific circumstances described in this article, reasonable longevity may be expected when advanced furcal involvement of abutments has been treated with (1) open-flap root debridement, (2) root separation with metal furcal replacement, (3) root resection as a conventional FPD or splint abutment, or (4) root resection as a vertical stop for a fixed cantilever prosthesis. Well-controlled maintenance therapy is essential for success.

Bone Resorption↗
PubMed1988

In situ lymphocyte subpopulations from active versus stable periodontal sites.

The purpose of this study was to evaluate lymphocyte subset densities and distributions within gingival biopsies from active sites (greater than or equal to 2 mm clinical attachment loss within three months of biopsy) versus clinically similar but stable or healthy sites. Small interproximal gingival biopsies representing at least one of each of the above categories were obtained from each of 20 periodontal maintenance patients. Serial cryostat sections displaying a cross section of the gingiva were labeled with monoclonal antibodies for (1) pan T cells, (2) T cytotoxic/suppressor cells, (3) T helper/inducer cells and (4) pan B cells and were developed using an avidin-biotin-peroxidase system. Lymphocyte populations were enumerated in repeatable fields from the sulcular, middle and oral one-third of each section. Relative proportions of the same lymphocyte subsets were analyzed in peripheral blood samples from the same patients using direct immunofluorescence. Pan B cells were significantly more prevalent in infiltrates from active sites than in stable (P less than 0.05) or healthy (P less than 0.01) sites. The T/B cell ratio was also significantly lower in active than stable biopsies (P less than 0.05), and in active biopsies versus blood (P less than 0.05). The T helper/T suppressor cell ratio did not vary significantly between blood and any gingival tissue disease group or location, but a trend toward lower relative numbers of T helper cells in the sulcular infiltrates of active sites was noted. These results support the premise that active periodontal sites display elevated B cell populations and abnormal immune regulation possibly involving the T helper cell subset.

Adult↗
PubMed1988

Histological characteristics associated with suppurating periodontal pockets.

The purpose of this study was to characterize histologically the gingival lesion associated with suppuration in advanced periodontitis. Thirty-three bleeding, suppurating (S) and 23 bleeding, nonsuppurating (NS) interproximal biopsies were obtained from nine patients and processed for light microscopy. Pocket depths (mean +/- SD) were 6.7 +/- 1.6 mm (S) and 5.4 +/- 2.2 mm (NS). Six-micron serial sections were stained with (1) hematoxylin/eosin and (2) van Gieson. Quantitative cell types were determined by a grid intersection counting technique at x 1000. Volumetric analysis of collagen-poor (inflammation) areas was conducted using a computer biometric system that revealed three histologic patterns: Type I sites showed mild to moderate inflammation (less than 50% infiltrate, S = 15, NS = 20); Type II sites showed intense inflammation (greater than 50% infiltrate, S = 17, NS = 3); and only one (S) site had a large connective tissue abscess (Type III). The mean percentage of collagen-poor area was significantly larger in suppurating (42.1 +/- 25.5%) versus nonsuppurating (27.7 +/- 20.4%) sites (P = 0.02). In both S and NS sites, plasma cells (means = 66%) and lymphocytes (means = 27%) predominated in the inflammatory infiltrates. Histologically, suppuration appeared to be associated with increased gingival inflammation and a slight increase in connective tissue neutrophils.

Adult↗
PubMed1988

The furcation problem. Current controversies and future directions.

Effective management of furcation regions affected by periodontal destruction includes accurate assessment of etiologic factors, careful diagnosis of furcation involvement, and an appropriate plan of therapy. Many forms of therapy have been advocated; most have been designed to allow adequate professional and personal removal of plaque from the furcation. All types of traditional therapy have disadvantages that must be carefully considered by the therapist and the patient. Newer treatment modalities attempt to regenerate periodontal attachment in the furcation. The techniques do not have sufficient controlled documentation at this time to warrant unqualified support, but they appear to be biologically feasible and hold considerable clinical promise. At this time, guidelines for management of a periodontally involved furcation region must stress application of the simplest therapy that is likely to provide clinical stability. Longitudinal data from carefully controlled clinical trials comparing therapy techniques are needed to refine our clinical judgment.

Alveoloplasty↗
PubMed1987

Determination of plasma catecholamines in dogs after experimental gingival retraction with epinephrine-impregnated cord.

Blood catecholamine levels were determined by high-performance liquid chromatography after placement of the cord around two teeth in a random sequence of the following treatments: (1) untreated cord to intact gingival crevice (C), (2) epinephrine cord to intact crevice (E1), and (3) epinephrine cord to a crevice disrupted with a tapered diamond bur to simulate a subgingival procedure such as in crown preparation (E2). Each cord was left in place for 30 min while blood was drawn from the external jugular vein at 0, 5, 10, 20 and 30 min, and at 10 and 30 min after removal of the cord. Catecholamine values were compared to baseline (time 0) measurements. Treatment C resulted in no significant change in blood catecholamines. Treatment E1 caused a significant increase (p less than 0.01) in blood epinephrine levels, reaching a 641 per cent increase at 30 min. Treatment E2 produced a highly significant increase (p less than 0.001) in blood epinephrine with a greater than 5000 per cent increase 10 min after cord removal. Norepinephrine and dopamine levels were not significantly altered by any of the treatments.

Animals↗
PubMed1986

Evaluation of interproximal finishing techniques for silver amalgam restorations.

In spite of the incidence of recurrent caries and gingival inflammation surrounding the gingival margins of interproximal silver amalgam restorations, little information exists on the efficacy of finishing procedures in this location. This study was intended to evaluate surface smoothness of interproximal silver amalgams using four finishing techniques. Results indicated that surfaces finished using the carve, floss, and finishing strip polish consistently produced a measurably smoother surface (p less than 0.01) than did the other techniques. The use of finishing strips on the gingival margin of Class II silver amalgam restorations shows promise of improving interproximal surface smoothness.

Dental Amalgam↗