J Clin Periodonio!

1996; 23: J12-118 Copyrigiu © Munks^aord 1996

Primed in Deiinwrk . AU righis rcscrxed

Clinical pcriDdontclogy
ISSN 0303-697')

Occurrence of Actinobacillus Michele Paolantonio\

Gianni di Giroiamo^-^,
Vinicio Pedrazzoli^, Carlo di
Caria Picciani^, Giovanni Catamo^,
actinomyeetemeomitans in iViarceilo Cattabriga^ and
Raffaeie Piccoiomini^

patients wearing orthodontic ^Department of Periodontology, University "G,

D'Annunzio" Chieti, Italy, ^Department of
Clinical Microbiology, University "G,
D'AnnunzJo" Chieti, Italy, ^Department of

appliances Periodontology, University "La Sapienza"

Rome, Italy

A cross-sectional study
Paolantonio M, Di Girolamo G, Pedrazzoli V. Di Murro C, Picciani C, Catamo G,
Cattabriga M. Piccolomini R: Oecwrenee o/Actinobaciiius
aetinomyeetemcomiians in patients wearing orthodontie appliances. A
cross-sectional study. J Clin Feriodontol 1996; 23: 112-118. © Munifsgaard, 1996.

Abstract. Tlie aim of the present study was to assess: (i) thie occurrence of Actino-
baeillus aetinomycetemcomitans {Aa ) in subgingival plaque from young patients
undergoing orthodontie treatment with fixed applianees; (2) a possible relation-
ship between the presence of Aa and the elinical eonditions; (3) a relation be-
tween the duration of orthodontic treatment and the microbiologieal and clinieai
parameters; (4) whether differences exist when taking into eonsideration the differ-
ent type of appiiances, i.e., bands or braekets, 34 subjeets aged between i2 and
30 years partieipated in the study. Of these, 20 subjects had worn orthodontie
appiianees (test group), while the remaining i4 subjects served as matehed eonlrol
(eontroi group). 4 to 8 sites in eaeh patient were available for ciinieal and microbio-
logical examination. Ciinicai parameters consisted of presence/absence of plaque
and gingivai bieeding index (GBI), Microbiological sampiing was performed in the
same sites as in the eiinicai examination. A statistieaiiy significant difference was
present when comparing %s of GBI positive scores between teeth from the test
group (57.5%) and teeth from the controi group (25%), Piaque was present in
53% of test siles and 37% of eontroi sites, but this dilTerenee was not statistieaiiy
significant. Aa was detected from at least one site in 85% of test subjects and in
15% of the control subjeets (/7<0,00i), Among the subjeets. 4i%> harboured Aa
at a concentration between 0.1% and 1,0%, whereas another 40% yielded Aa at
a concentration greater than 1,0%, Fiiialiy, a positive eorreiatioii was noted be-
tween the % of sites positive for Aa and the % of sites displaying a positive GBI
score (r =0.41; /)<0,005). No relation was found between the duration of ortho-
dontie treatment and the microbioiogical or clinical parameters; neither were stai-
istieally significant differences found when we eompared results from sites wearing
bands or braekets. In conclusion, the present study showed that young subjects
wearing orthodontic appiianees harbour Aa with a remarkable frequency of detec- Key words: Actinobacillus
tion, although plaque ieveis do not signifieantly differ from those of a matehed aciinomycetemeomitans-, orthodontic therapy
controi group. Accepted for publication 14 February 1995

Ini^ammation of gingival tissues during
fixed orthodontic therapy is well docu-
mented in the literature (Zachrisson &
Zachrisson 1972. Zachri.sson i& Alnaes
1973, Kloehn & Pfeifer 1974, Trossel-
io & Gianelly 1979). This situation has
been related to hampered oral hygiene
by fixed orthodontic appiianees with
eonsequent accumulation of plaque
mass (Zaehrisson i976). A few studies
are available on the relationship be-
tween orthodontic treatment and mi-
crobial colonization of gingival tissues
(Flores de Jacoby & MuUer 1982,
MDller & Fiores de Jaeoby 1982, Diam-
anti-Kipioti et al. 1987). Mulier & Flor-
es de Jacoby (1982) reported an increase
in the proportions of spiroehetes in as-

sociation with fixed orthodontie treat-
ment. In a ciinieal and microbiological
cultural study, Diamanti-Kipioti et al.
(1987) observed an inerease of black-
pigmented "Baeteroides" (including
Prevotella intermedia) following plaee-
ment of fixed orthodontic appiianees. It
has also been shown that other iatro-
genic factors can determine modifi-
cations in the composition of subgingi-
val plaque: for instance, increasing
gram negative and anaerobic species
were reported by Lang et ai, (1983) fol-
lowing placement of overhanging on-
lays.
Gingivitis and periodontitis seem to
be assoeiated with a mierofiora that
greatiy differs from that of the heaithy
periodontium in terms of bacteriai
composition (Slots i977a. Slots 1977b,
Slots et al. 1978). Actinobaeillus actino-
myeetemeomitans (Aa) is an age-related
micro-organism (Siots et al. i990, Sav-
itt & Kent 199i) frequently assoeiated
to early onset periodontitis such as Lo-
eaiized Juveniie Periodontitis (Mand-
eii & Socransky i98i. Slots et ai, 1982,
Zatnbon et ai, 1983a, Mandeli et al.
1987, Gunsolley et al, 1990) and Prepu>
bertal Periodontitis (Sweeney et al,
1987, Dclaney et al. 1987), Sinee ortho-
dontic therapy and incorrect restorative
proeedures can promote aecumulation
of bacteriai piaque (Zaehrisson 1976)
and modifications in its composition
(Fiores de Jacoby & Muiier 1982,
Muiier & Fiores de Jacoby i982, Diam-
anti-Kipioti et ai, 1987), it eouid be in-
teresting to assess whether these ioeal
factors ean infiuence coionization and
occurrenee of specific microorganisms
iike Aa in young individuais, Appar-
entiy no data are avaiiable on the oecur-
rence and distribution oi Aa in children
and young individuais wearing ortho-
dontie appiianees.
The aim of the present study was to
assess the occurrence of .4 o in subgingi-
val piaque from young subjects under-
going orthodontic treatment with fixed
appiianees; moreover we sought a poss-
ible reiationship between the presenee
of Aa and the ciinieal conditions, also
taking in consideration the different
types of fixed appliances, i.e., orthodon-
tic bands or brackets.
Material and Methods
Patients and clinical procedure
34 subjeets, 16 male and 18 female aged
between 12 and 20 years participated in
this study: 20 subjeets (test group)
Aetinobacillus aetinomyeetemcomitans in orthodontic patients
underwent orthodontie treatment with
fixed appiianees for at least 6 months
(mean orthodontie therapy duration:
18.5±8.1 months) at the Department of
Orthodontics of the University of Chie-
ti, School of Dentistry, 14 subjects (con-
trol group) were not wearing orthodon-
tic appiianees nor fixed prostheses and
matched to the test subjeets for age,
gender distribution, geographic and
cultural origins. Aii patients were free
of attaehment loss in proximai sites.
None of the subjects participating in
this study were affeeted by systemie dis-
eases, and none had taken antibiotics in
the previous 6 months. All subjects re-
eeived oral hygiene instructions about 2
months before the clinical and micro-
bioiogical examination; instructions
consisted in information about the cor-
rect use of toothbrush, dental fioss and,
for orthodontic patients, interdental
brush; the use of a mouthwash was not
allowed. The oral hygiene instruetions
were reinforced twiee during the two
months preceding the start of the study.
No mechaniea! instrumentation was
performed before clinical and microbio-
logical examination. Informed consent
was obtained from the parents prior to
the study,
15 test subjects had only upper or
lower arehes bearing orthodontie appli-
ances. Therefore these subjeets yielded
oniy 4 sites ibr ciinicai and microbio-
logieal examination. The remaining 5
patients wore a fuil-mouth orthodontie
appliance yielding 4 sites in tiie iower
arch and 4 sites in the upper areh.
Mesio-buccai sites of first molars and
disto-bticca! sites of lateral incisors were
subjected to eiinicai and microbioiogi-
cai examination. Ciinical examination
consisted of recording of presence/ab-
sence of piaque and gingivai bieeding
measured by GBI (Ainamo & Bay
1975) by 2 examiners who had been
previously ealibrated.
Microbiological sampling was per-
formed immediately after plaque re-
cording and before the assessment oi
GBI, After removal of supragingival
plaque by a sterile curette the gingival
surface was dried by a gentle air How,
Plaque sampies were obtained by inser-
tion of three steriie paper points at the
deepest part of each gingivai sulcus and
left in situ for 10 s.
Bacteriological methods
Immediately after colleetion each mi-
crobial sample was inserted into a vial
113
containing 0.5 ml of reduced transport
iluid (RTF) without EDTA, The viais
were flooded with nitrogen and trans-
ported to the bacteriological laboratory
within 40 min, where they were intro-
dueed into an anaerobie ehamber eon-
laining an atmosphere of 5% CO2, 10%
H. and 85% N..
The plaque suspension was dispersed
by mild sonieation for iO s under anaer-
obic eondition and serialiy diluted in
RTF Aiiquots of 0,1 mi of the appro-
priate dilution were plated onto tryp-
tiease soy-serum-bacitracin-vaneomyein
(TSBV) agar, a seieetive medium for
Actinobacillus actinotnycetemcomitans
(Siots i982), and onto non-seiective En-
riched Trypticase Soy Agar (ETSA) for
total anaerobic colony counts.
The inoculated seieetive and non-
selective media were then eultured at
3TC in a lO'Mi COj incubator and in an
anaerobic chamber, respeetively. After 7
days, the TSBV-agar plates where
examined for presence of Aa. Smaii,
transiucent, siightly convex, circular
coionies often with a star-like inner
strueture and adherent to the agar sur-
face were subeultured for identification.
A definitive identification was made on
the basis of gram stain; nitrate redtic-
tion; produetion of cataiase; iaek of
urease aetivity and indole produetion;
growth on McConkey agar and fermen-
tation with carbohydrates (fructose,
glueose, lactose, maitose, mannitoi. su-
crose and xilose) suppiemented by the
profiles of preformed enzymes (API-
ZIM system; BioMerieux Itaiia SpA,
Rome, Italy).
Piates containing between 30 and 300
coiony-forming units were seiected for
enumeration.
The proportion of Aa was deter-
mined by dividing its counts on the
TSBV agar by the total anaerobic col-
ony counts in tlie ETSA piates and re-
ported as a % of the viabie count. A
totai of 212 subgingivai sites (100 test,
112 eontrols) were mierobiologicaiiy
anaiysed for the presence oi Aa.
Data analysis
Clinical data were expressed as a % of
sites positive for presence of plaque and
GBI in each subject, Presenee of piaque
was visuaiiy assessed. The chnical par-
ameters were reported aeeording to 2
categories: teeth without orthodontic
apphances (eontroi sites) and teeth with
orthodontie appiianees (test sites). Data
from test sites were further differen-
114 Paolantonio et al.

Table I, Frequency distributions of test and control sites according to the presenc of Actino- supragingival plaque in test and control
baciHus actinomycetenuvmilans (Aa) and positive bleeding (GBI) and plaque scores groups (53% and 37% respectively) were
Test sites Control sites Statistical difference not statistically significant.
positive for Aa 47.5%i27.9 3.5%±5.8 /XO.OOl Results of the microbiological exam-
positive for GBI 57.5% ±28.2 25%±16.2 /XO.OOl ination are shown in Table 2. Aa was
positive for plaque 53.7%±34.8 37.5%±30.9 /)>0.05 retrieved from at least 1 site in 17 out
of the 20 test subjects, whereas only 4
individuals in the control group har-
boured Aa.
Table 2, Frequency of recovery of Actinobacillus actinomyceiemeomitans (Aa) (numbers and
%) in test and control groups
Almost half of the gingival sites in
the test group were positive for Aa
Presence of Test subjets Test sites Control subjects Control sites (48%). In contrast, Aa was present oniy
Aa CM.)
in 3.5% of the sites in the control group.
negative 3(15) 52 (52.5) 10(71.4) 108 (96.5) The differences between test and con-
positive 17(85) 48 (47.5) 4 (28-5) 4 (3.5) trol group were statistically signficant

Table 3 shows the frequency distri-

tiated into two groups: data from teeth and microbiologically evaluated. Table bution for ranges of proportions of Aa
with orthodontic bands and data from 1 presents results relative to all the gin- calculated as percentage of the total
teeth with orthodontic brackets. gival sites undergoing microbiological cultivable anaerobic flora. In the test
Microbiological data were expressed examination. Data are reported here as group 19% of Aa positive sites harbour-
as the number and percentage of sub- a % of sites positive for GBI and stipra- ed the microorganism at a coticen-
jects and sites positive for the recovery gingival plaque. A statistically signifi- tration lower than 0.!%. 41% of the
of Aa. Detection limit for Aa was iO cant difference was present when com- sites contained Aa ai a concentration
cfu/mi sample. paring percentages of bleeding between between 0.1 and 1.0%, whereas another
The weighted analysis of variance test (57.5%) and control (25%) groups. 40% yielded Aa at a concentration
(Osborn 1987) evaluated the statistical Although apparently different, the per- greater than 1.0%.
significance of differences in the percen- centage of sites displaying presence of 4 .4^-positive sites in the control
tage of test and control sites positive for
plaque, GBI and Aa. The same statisti-
cal evaluation was performed to ana- Table 4, % of sites positive for Aa,, GBI. plaque and duration of orthodontic trcatmenl in
lyse results obtained when comparing each patient
teeth wearing bands or brackets. Patient % ^^/-positive % plaque-positive % GBI-posiiivc Months of
Pearson's correlation analysis was no. sites sites sites tlierapy
employed to investigate the relationship 1 100 50 50 6
betwen the percentage of sites positive 2 75 100 100 15
for the presence of Aa and the % of sites 3 75 0 87.5 30
positive for plaque and GBI. The same 4 75 50 50 30
statistical analysis was employed to test 5 75 50 75 24
the existence of a linear correlation be- 6 62.5 0 62.5 21
tween the percentage of sites positive 7 62.5 37.5 75 15
for Aa, GBI and plaque and the dur- 8 50 0 50 21
9 50 100 50 8
ation of orthodontic treatment in each
10 50 ]00 50 23
patient.
1! 50 100 75 14
Values of /'<0.05 were accepted as 50 75 50 24
statistically significant. n
13 50 100 75 7
14 50 50 50 30
15 37-5 100 87.5 29
Results 16 25 25 0 13
Altogether, 212 periodontal sites from 17 12.5 12.5 37.5 22
test and control groups were clinically 18 0 0 0 6
19 0 75 25 18
20 0 50 100 14

Table 3, Vo of Actinobacillus actinomycetem-

comitans (Aaj of total anaerobic bacteria
from subgingival plaque in .4i7-positive sites Table 5. % of sites with orthodontic bands or brackets positive for Actinohacillus actinomyce-
from test subjects temcomitans (Aa), bleeding (GBI) and plaque and significance of differences between the 2
Proportional No. sites % sites categories
range of Aa with Aa with Aa % of sites Sites with bands Sites with brackets Statistical difference
<0.I 9 19 positive for Aa 48.7±37.5 46.2±32.7 ;?>0.05
>0.1<1.0 20 41 positive for GBI 50±38 46.2±32.7 ;j>0.05
>].O 19 40 positive for plaque 67.5±41.4 40±47.5 /)>0.05

group showed a concentration of the
miero-organism lower than 0.1%,
A positive correlation was noted be-
tween the % of sites positive for Aa and
the percentage of sites displaying a posi-
tive GBI score (j-=0.41; ;?<0,005). No
significant correlation was observed be-
tween the percentage of /ia-positive
sites and the percentage of sites positive
for supragingival plaque (r=^0.10;
Table 4 shows, for each patient, the
percentage of sites positive for Aa, GBI
and plaque and the duration of ortho-
dontic treatment. No significant corre-
lation was present between the duration
of orthodontic therapy and mierobio-
iogicai (r-0.17; /?>0.05) and clinical
parameters (GBI: r=0,22; j^>0.05;
pSaque: r^-O.U; p>0,05}.
When eomparing clinical and micro-
biological results from sites associated
either with bands or brackets (Table 5),
no statisticaliy significant differences
were found.
Discussion
In the present study, our main eoncern
was to assess oecurrence and pro-
portions of Aa in a population of sub-
jects wearing fixed orthodontie appli-
ances and to eompare the resuits with
those from a matched eontroi group.
Modifications in the composition of
subgingivai piaque foiiowing placement
of orthodontie appiianees were already
reported in the literature (Muiier &;
Fiores de Jacoby 1982, Diamanti-Kipi-
oti et ai, i987); nevertheless no report
has foeused attention on the oceurrence
of Aa in juveniles undergoing fixed or-
thodontic treatment.
A usual finding in orthodontic pa-
tients in the presence of an inflamma-
tory condition in the gingival tissues
(Zaehrisson & Zachrisson i972,
Zachrisson & Ainaes 1973, Kloehn &
Pfeifer 1974. Trosselio & Gianelly i979).
Accordingly, in the present study, the
clinical examination showed an in-
creased percentage of sites exhibiting
bleeding as measured by GBI (Table 1),
However, the 2 groups did not statisti-
caliy differ as to presenee/absenee of
supragingivai piaque in the observed
sites (Table i). Indeed, the recorded
vaiues are lower than those reported in
the literature. On the other hand, the
subjeets enrolled in our study reeeived
multipie sessions of earefui orai hygiene
instructions. This might explain why
low proportions of the examined sites
Actinobacillus aetinomycetemcomitans in orthodontic patients
exhibited piaque in both test and con-
troi groups and might also account for
the non-significant differenee between
the 2 groups. Inereased bieeding ob-
served at test sites, in spite of no sig-
nificant difference in plaque accumu-
lation, migiit result from a different
composition of the microfiora accumu-
lating at orthodontic sites. Thus, the
most interesting result of our study is
the high frequency of ^ a recovery from
subgingivai plaque of patients wearing
orthodontic apphances in comparison
to a control group: 85'>i) of test subjeets
were positive for Aa in eomparison to
28.5% of control subjects; the sought-
after baeterium was isolated in 47,5%
of test sites whereas it was detected only
in 3,5% of eontroi sites. The presence of
orthodontic appliances conceivably had
created an environment favouring a
quahtative shift in the subgingival mi-
erofiora. although this was not rcfiected
in appreciable quantitative increase of
supragingival plaque. However, record-
ing presence/absence of plaque, is a
method that does not iliustrate the
magnitude of plaque aecumuiation.
Thus, a true increase in supragingival
plaque mass might have been over-
looked.
Our results show that the duration of
the orthodontic therapy did not affeet
the percentage of sites positive for Aa
or the clinical parameters (Table 4),
No statistieai difference was noted in
terms of frequency of detection of Aa.^
plaque and bleeding when we anaiysed
the results according to band and
brackets subdivision, although ortho-
dontie bands allowed for more frequent
plaque detection than brackets (67.5%
versus 40%), This difference may be due
to the buiky configuration of bands as
compared to braekets.
It seems eonceivable to assume that
the mere presenee of an orthodontic ap-
pliance is enough to bring about quali-
tative changes in the microflora, inde-
pendent of the shape of the deviee and
the eonsequent piaque accumulation.
However, due to the design of the study
(i.e., cross-sectionai), one cannot ruie
out that Aa was present with higher fre-
quency in the test subjeets prior to the
orthodontic ireatinent, possibly as a
consequence of teeth malposition cre-
ating a suitable environment for certain
micro-organisms. However this seems
not to be the ease, as Diamanti-Kipioti
et ai, (1977) observed the occurrence of
other putative periodontopathogens
115
only 4-7 weeks after the placement of
fixed orthodontic appiianees.
An increased amount of spiroehetes
in assoeiation with fixed orthodontic
treatment has been observed by
Muiier & Fiores de Jacoby (1982) whiie
an increase oi Prevotella intermedia and
biack-pigmented Baaeroides was de-
seribed following the placement of fixed
orthodontic appliances by Diamanti-
Kipioti et ai, (1987),
The specific interest for Aa in subgin-
givai plaque from subjects undergoing
orthodontic treatment comes from the
observation that Aa is a putative peri-
odontopathogen mostly associated to
juvenile periodontitis (Mandell & Soe-
ransky 1981, Siots et al, 1982, Zambon
et al. i983a, Mandell et ai, 1987, Gun-
solley et ai, 1990). This is relevant be-
cause orthodontic treatment is mostly
performed in juveniles.
On tlie other hand Aa can be recov-
ered, in low proportions, from the sub-
gingivai fiora of subjects with healthy
periodontium (Gunsoiley et al. 1990,
Asikainen et al. 1985, Alaluusua & Asi-
kainen 1988) and in sites witii gingivitis
(Wolff et al. 1985) suggesting that the
bacterium belongs to the normal oral
microfiora (Kilian & Schiott 1975). Al-
aluusua & Asikainen (1988) and Asi-
kainen et al. (1985) found Aa in 13%
and 4% of 4-7 year old children and
healthy teenagers, respeetively
In the present study Aa was isolated
in 28.5% of control subjects; moreover
we found Aa in 3.5% of sites from eon-
troi subjects whereas Asikainen et al,
(1985) isolated the species from 2% of
sites from periodontally heaitiiy teen-
agers, Sampiing methods and subjeets
heterogeneity could account for differ-
enees between our resuits and those
from other authors.
Proportions oi Aa isolated from the
subgingival microflora of the test sub-
jects appeared quite high: 40% of test
sites harboured the microorganism
with a percentage of more than i% of
the totai anaerobic subgingivai flora
(Table 3), Mandei (1984) and Dzink et
al. (i985) reported a mean proportion
of 2% in active sites from LJP patients;
moreover Bragd et ai. (1987), in a
retrospective study, concluded that a
proportion of Aa exceeding 0.01% of
the total eultivable fiora could be as-
sociated to future attachment ioss risk
in speeifie periodontal sites. These
data, however, are ehallenged by recent
knowledge on the reiationship between
Aa and periodontal damage. Van der
 116 Paolantonio et al.
Velden et al. (1989) could find Aa only
in 18 out of 105 young subjects with
attachment loss. Aass et al. (1992) re-
ported that site-based detection of Aa
appeared Io be a poor predictor of fu-
ture radiographic bone ioss. Skaar et
al. (1992) in a follow-up case report of
Aa in human periodontal disease,
found that none of the 16 subjects
with detectable Aa in subgingival
plaque showed a significant increase in
periodontal destruction after an aver-
age of 46 months from baseline exam-
ination. In the present study, the % of
sites with detectable Aa in subgingival
plaque appeared well correlated to the
percentage of sites exhibiting clinical
signs of marginal inflammation. It is
conceivable that Aa could be associ-
ated not only to advanced periodontal
damage in young subjects but also to
gingivitis without any loss of peri-
odontal attachment (Wolff et al. 1985,
Alaluusa & Asikainen 1988). In the
present study no statistically significanl
positive correlation could be demon-
strated between the % of sites with Aa
and the % of sites displaying the pres-
ence of piaque. On the other hand, Aa
was significantly more frequent in the
study group which demonstrated more
abundant supragingival plaque than
the control group although the differ-
ence was not significant (Table 1).
The existence of serotypes of Aa
with different virulence properties, as
observed by many authors {Zambon et
al. 1983b, Zambon et al. 1988, DiRien-
zo & Slots 1990), couid explain the as-
sociation of the micro-organism to
periodontal conditions characterized
by very different severity like LJP and
gingivitis. Yet, serotype differentiation
of Aa was not performed in our study.
Individual susceptibility plays cer-
tainly an important role in the devel-
opment of periodonial destruction
(Socransky & Haffajee 1992, Slots &
Schonfeld 1991). The presence of Aa in
subgingival plaque of our test subjects
couid represent a situation in which a
putative periodontopathogen faces an
unsusceptible host leading to marginal
gingiva] inflammation instead of more
severe periodontal destruction.
In conclusion, our study shows that
young subjects wearing fixed ortho-
dontic appliances harbour Aa with a
remarkable frequency of detection as
compared to orthodontic appliance-
free matched control individuals, al-
though plaque levels do not signifi-
cantly differ between the 2 groups.
Thus, a local modification of ihe
supragingivai environment due to or-
thodontic appliances may lead to a
qualitative shift in the stibgingival
compartment favouring the growth of
a traditional putative periodontopa-
thogen like Aa.
Acknowledgement
We wish to thank Dr. Paolo De Ninis
for his statistical consultance.
Zusammenfassung
Vorkommen von Actinobacillus actinomyce-
lemcomitans bei Patienlen. die kieferortho-
padLschc Apparate tragcn, Eine Querschnitt-
studie
Das Ziel dcr vorliegenden Studie war die
Messung von: (1) dem Vorkommen von Ac-
tinobacilhis actinomycetemcomitans (Aa) in
der subgingivalen Plaque von jungen Patien-
ten. an denen eine kieferorthopadische Be-
handlting mit festsitzenden Geraten durch-
geftihrt wird; (2) einer mogJichen Beziehuiig
zwischen der Anwesenheit von Aa und dem
klinLschen Befund: (3) einer Beziehung zwi-
schen der Dauer der orthodontischcn Be-
handlung und den mikrobioiogischcn bzw.
klinischen Parametern: (4) eventuellen Dif-
ferenzen bei unterschiedlichen Verankerun-
gen, wie Bander oder Brackets. Vierunddrci-
Big Patienten im Alter zwischen 12 und 20
Jahren nahmen an der Studie teil. Davon
trugen 20 kieferorthopadische Gerate (Test-
gruppe), wahrend die anderen 14 Patienten
als alters- und geschlechtsgleiche Kontrollen
(Kontrollgruppe) dienten, Bei jedem Patien-
ten standen 48 Zahnflachen fur die klinische
und mikrobiologische Untersuchung zur
Verftigung. Die klinischen Parameter be-
standen aus Vorhandensein/Fehlen von Pia-
que und dem Gingivalen Blutungs-Index
(GBI). An den gleichen Zahnfiachen wie die
klinische Untersuchung wurden Plaquepro-
ben entnommen. Zwischen Zahnen der Test-
gruppe (57.5%) und Zahnen der Kontroll-
gruppe (25%) bestand eine statistisch signi-
fikante Differenz bei Vergleich der
Prozentsatze von GBI positiven Werten.
Plaque war bei 53% der Testflachen und
37% der Kontrollflachen vorhatiden, dieser
Unterschied war jedoch nicht statistisch si-
gnifikant. Bei 85% der Patienten der Test-
gruppe und 15% der Patienten der Kontroll-
gruppe war Aa an wenigstens einer Zahnfla-
che vorhanden (/J<0.001). Unter den
Testpersonen hatten 41% Aa in Konzentra-
tionen zwischen 0.1 undl.0% in der Tasche,
wahrend weitere 40'/o Aa in Konzentratio-
nen hoher als 1.0% hatten. SchluBendlich
wurde eine positive Korrelation zwischen
dem Prozentsatz an Zahnflachen. die positiv
fur Aa waren und dem Prozentsatz an
Zahnflachen, die cinen positiven GBI-Wert
aufwiesen ((-=0.4!; /)<0.005). Zwischen der
Dauer der orthodontischen Behandkmg und
den mikrobiologischen bzw, klinischen Para-
metern bestand keine Beziehung. DesgJei-
chen bcstanden keine statistisch signifikan-
ten Unterschiede. wenn man die Ergebnisse
von Zahnen mit Biindcrn und mit Brackets
verglich. Die SchluBfolgerung ist. daB bei
jungen Patienten, die orthodontische Gerate
tragen, Aa mit einer bemerkcnswerten Hau-
flgkcil nachgewiesen wurde, obwohl die Pia-
quewerte sich nicht signifikant von denen
der Kontrollgruppe unterschieden.
Resume
Presence i^/Actinobacillus actinomycetemco-
mitans die: les patients portciirs d'appareils
orthodontiques. Elude tran.'^versale
Le but de la presente etude etait de mettre
en evidence: (1) la presence & Actinobacillus
actinomycetemcomitans {Aa) dans la plaque
sous-gingivale de jeunes patients en traite-
ment orthodontique avec des appareils ina-
movibles; (2) une relation eventuclk entre la
presence d'Aa et I'etat clinique; (3) un rap-
port entre la duree du traitement orthodon-
tique et ies paramctres microbiologiques et
ciiniques; (4) I'existence eventuelle de diffe-
rences lorsqu'on prend en consideration k
type d'appareillage. c.-a.-d. bagucs ou brac-
kets. Cette etude portail sur 34 sujets de 12
a 20 ans. Chez 20 d'entre eux, des appareils
orthodontiques etaient en usage (test
group), tandis que les 14 sujets restani ser-
vaient de temoins apparies (control group).
Chez chacun des patients, 4 a 8 sites pou-
vaient servir pour I'examen clinique et mi-
crobiologique. Les parametres cliniqufs uti-
lises etaienl: presence/absence de plaque et
indice de saignement gingival (GBI). Les
prelevements microbiologiques etaient prati-
ques dans les mcmes sites que I'examen cli-
nique. On constatait une difference statisti-
quement significative en comparant les pro-
portions de scores de GBi positifs au niveau
des dents du groupe test (57.5%) et des
dents du groupe temoin (25%). La presence
de plaque etait mise en evidence dans 53%
des sites tests et 37% des sites temoins, mais
cette difference n'etait pas statistiquement
significative. Aa etait present dans au moins
1 site chez 85% des sujets tests et 15% des
sujcis temoins (j><Q,QQ\), Parmi Ics sujets
tests, 45% abritaient Aa a une concentration
comprise entre 0.1 et 1.0%, tandis que chez
40% cette concentration etait superieure a
1.0%. Enfln, une correlation positive a etc
notee entre la proportion de sites positifs
pour Aa et la proportion de sites presentant
un score de GBI positif ((-=0.41; /)<0.005).
Aucun rapport n'a ete mis en evidence cntrc
la duree du traitement orthodontique ct les
paramctres ciiniques ou microbiologiques;
on n'a pas non plus trouve dc difference
statistiquement significative en comparant
les resuitats des sites munis de bagues ou de
brackets. En conclusion, la presente etude a
montre que les jeunes sujets portcurs d'ap-
pareils orthodontiques abritent Aa avec une
rcmarquable frequence de detection, bien

que ies niveau de la plaque ne different pas
significativement de ceux qu'on trouve dans
un groupe de temoins apparies.
References
Aass, A, M., Preus, H, R, & Giermo, R
(1992) Association between detection of
oral Aetinobacillus aeiinomycetemcomit-
ans and radiographic bone loss in
teenagers, A 4-ycar iongitudinai study.
Journal of Feriodontohgy 63, 682-
685,
Ainamo, X & Bay, I, (1975) Problems and
proposals for recording plaque and gingi-
vitis. International Dental Journal 25,
229-235,
Aialuusua, S, & Asikainen, S, (1988) Detec-
tion and distribution of Aetinobacillus
aetinomycetemcomitans in the primary
dentition. Journal of Periodontology 59,
504--5O7.
Asikainen, S,, Alaiuusua, S., Kari, K, &
Kleemoki-Kujala, E, (1985) Subgingiva]
microflora and periodontai condition in
heaithy teenagers. Journal of Periodonlo-
logy 57, 505-511,
Asil^ainen, S,, Jousimies-Somer, H., Kaner-
vo. A, & Summanen, P, (i987) Certain
bacteria! species and morphotypes in lo-
calized juvenile periodonlitis and in
matched controls. Jownal of Periodonto-
logy 58, 224-229.
Asikainen, S,, Lai, C H,, Alaluusua, S, &.
Siots, J, (1991) Distribution of Aeiino-
bacillus aetinoniyceienwomitans serotypes
in periodontal health and disease. Oral
Microbiology and Immunology 6. 115-
ii8,
Bragd, L,, Dahlen, G, & Wiicstrftm. M. &
Slots. J, (1987) The capabiiity of Actino-
baeiHus aclinomyceietncomitans, Bacter-
oides gingivaHs and Bacteroide.'; interme-
dius to indicate progressive periodontifis;
a retrospective study, Journa! oJ Clinical
Periodontoiogv 14, 95-99,
Delaney. .1. E, '& KormTian, K. S, (i987)
Microbiology of subgingival plaque from
chiidren with localized prepubertai peri-
odontitis. Oral Microbiology and Immu-
nology 2, 71-76.
Diamanti-Kipioti, A,, Gusberti, F, A. &
Lang, N, P. (1987) Ciinical and microbio-
iogical effects of fixed orthodontic appli-
ances. Journal of Clinical Feriodoniohgy
14, 326-333.
DiRienzo, J. M. & Slots, .1. (1990) Genetic
approach to the study of epidemioiogy
and pathogenesis of Actinobacillus actino-
mycetemcotnitans in iocaiized juveniie
periodontitis. Archives of Ora! Biology
35. 795-845,
Dzink. J. L,, Tanner, A. C, R.. Haffajee, A.
D. & Socransky, S, S, (1985) Gram nega-
tive species associated with active destruc-
tive periodontal lesions. Journal of Clin-
ical Periodomology 12, 648-659.
Gunsoiiey, J, C , Ranney, R. R., Zambon, J.
J., Burmeister, J, A, & Schenkein, H, A.
Actinobacillus actinomyeetemeomitans in orthodontie patients
(i990) Aelinobaeillus actinomyceiemcomit-
ans m famiiics affected with periodonti-
tis, Journa! of Periodontology 61, 643-
648,
Fiores de Jacoiiy; L. & Muiier. H. P, (i982j
Zusammensctzung der subgingivalen
Mundflora bei Tragern abnehmbarcr kie-
ferorthopildischcr Geriite, Deutsche
Zahnarztliche Zeitsehrift 37, 925-928,
Kiiian, M, & Schiott, C, R, (i975) Haemo-
phiii and reiated bacteria in the human
orai cavity. Archives of Oral Bhiogy 20,
791-796,
Kiochn, J, S, & Pfeifer, J, S. (1974) The ef-
fect of orthodontic treatment on the peri-
odontium. Angle Orthodontist 44, 127-
134,
Lang, N, P,, Kiel, R, A, & Anderhaiden, K.
(i983) Ciinicai and microbiological ef-
fects of subgingival restorations with
overhanging or clinicaiiy perfect margins.
Journal of Clinieai Ferhdonrology 10,
563-578.
Mandeil, R, L, & Socransicy, S. S, (198i) A
selective medium for Aclinobacilhis aeti-
nomycetemcomitans and the incidence of
the organism in juvenile periodontitis.
Journal of Feriodontology 52, 593-598,
Mandell, R, L. (1984) A longitudinal micro-
biological investigation of Aetinobacillus
actinomyeetemeomitans and Eikenella
corrodens in juvenile periodontitis, Infec-
tion and hnmuniiy 45, 11%-1?<Q.
Mandeil. R, L,. Ebersole, J, L, & Socran-
sky; S. S, (1987) Clinica), microbiological
and immunoiogic features of active dis-
ease sites in juvenile periodontilis.
Journal of Clinica! Feriodontoiogv 14,
534-540.
Mtiller, H, H & Fiores de Jacoby, L. (1982)
Zusammensetzung der subgingivalen
Mundflora bei Tragern festsitzcnder kie-
ferorthopadischer Gerate, Deutsche
Zahndrztliche Zeitschrift 37. 855-860,
Osborn, S. 0987) The choice of compu-
tational unit in the statisticai analysis of
unbalanced ciinicai trials, Journa! of C!in-
ica! Feriodontoiogy 14. 519-523.
Savitt, E, D, & Kent. R, L, (1991) Distri-
bution of Aciinol-tar.illus aetinomycetem-
comitans and Porphyromonas gingivalis by
subject age. Journal of Perhdontology 62,
490-494.
Skaar, D, D , Wolff. L. P., Aeppli, D M.,
Bfoomquist, C G., LiJjemark. W E
(1992) A follow-up case report of Actino-
baeiUus aclinomycetemeomiians in human
periodontal disease, Journa! of Ciinieal
Periodontology 19, 288-292.
Siots, J. (1977a) Microflora in the healthy
gingival suicus in man, Scandinavian
Journal of Dental Research 85. 247-254,
Slots, J, (i977b) The predominant cuitivabie
microflora of advanced periodontitis,
Scandinavian Journal of Denial Researeh
85, i i ^ i 2 ] ,
Siots, J., Moenbo, D,, Langcbaeck, J, &
Frandsen, A, (i978) Microbiota of gingi-
vitis in man. Seandinavian Jourmd of
Dental Research 86, ]74-i81.
117
Slots. J. (1982) Seiective medium for iso-
lation of Actinohacillui actinomycetcm-
comilans. Journal of Clinica! Microbiology
15, 606-609,
Slots, J,. Zambon, J, J,, Rosling, B, G., Re-
ynolds, H, S,. Christersson, L, A, & Gen-
co, R, j . (1982) AciinobaciUus actinomyee-
temeomitans in human periodontal dis-
ease; association, serology, leukotoxicity
and treatment. Journa! of Periodonlal Re-
seareh 17. 447-448,
SJocs, J,, Fefk. D. & Rams, T E. (1990)
Actinobacillus iictinomycetemeomitans and
Bacteroides intermedius in human peri-
odontitis; age relationship and mutuai as-
sociation. Journal of Clinical Periodonto-
iogv 17, 659-662,
Slots, J, &. Schonfeld. S, E. (1991) Actino-
I'acilhis aetinomycetemcomitans in local-
ized juveniie periodontitis. In; Periodonlal
disease; pat!wgens and host immune re-
sponse. Holt. S. C. & McGee, J, R, (eds,)
Quintessence Publishing Co., Ltd. Tokyo,
Berlin, Chieago. London, Sao Paulo,
Hong Kong, pp, 53-64,
Socranskv, S, S, & Haffajee, A, D (1992)
The bacterial etioiogy of destructive peri-
odontai disease; current concepts. Journal
of Periodontology 63, (suppl.) 322-331.
Sweeney, E, A., Aleoforado, G, A, P, Ny-
man. S, & Siots, J, (1987) Prevalence and
microbiology of localized prepuberta)
periodontitis. Oral Microbiology and Im-
niuno!ogy 2, 65-70,
Trossello, V R. & Gianelly, A, A. (1979) Or-
thodontic treatment and periodontal sta-
tus. Journal of Periodontology 50. 665-
671.
Van der Velden. U., Abbas, F,, Van Steen-
bergen. T, J, M., De Zoete, 0, J,. Hesse,
M,. De Ruyter. C , De Laat, V H. M, &
Dc GraaC J, (1989) Prevalence of pcri-
odontai breakdown in adolescents and
presence of Actinobacillus actinomyceieni-
eoiniians in .subjects with attachment loss.
Journal of Feriodontology 60, 604—610,
Wolff. L, E, Liljemark. W, E, Bloomquist,
C. G,. Philstrom, B. L,. Schaffer, E, M, &
Bandt. C, L, (i985) The distribution of
Actinobacillus actinomyeetemeomitans in
human plaque. Journal of Periodonta} Re-
xeracl! 20, 237-250.
Zachrisson. S, & Zachrisson, B, U (1972)
Gingival condition associated with ortho-
dontic treatment. Angle Orihodontist 42,
26-34,
Zachrisson. B, U, & Alnaes. L, (1973) Peri-
odonta! condition in orthodontically
treated and untreated individuals (II), Ai-
veoiar bone ioss: radiographic findings.
.Angle Orthodontist 43, 402-412,
Zachrisson, B. U, (1976) Cause and preven-
tion of injuries to teeth and supporting
structures during orthodontic treatment.
American Journal of Orthodontics 69,
285-300,
Zambon, J, J., Christersson, L. A, & Slots,
.L (i983a) Aetinobacillus actinomycetem-
eomitans in human periodontai disease;
prevalence in patient groups and distri-
118 Paolantonio et al.

bution of biotypes and serotypes within Zambon, J. J.. Umemoto, X, DeNardin. E.. Address:
families. Journal of Periodontology 54. N a k a z a w a . E ,Christersson. L . A . & , , . , , „ ,
•7(1-7 - J I 1 " /- n . ,ir.c,c,-, , . : • < • • Mtclw e PaoUintonto
707-711. Genco, R. J. (1988) Actniobacillus acttno- ,,. , „ , -L
7 ™u T T Cl . T u ," n T • • , . , ^ i-ia della Liberazwnc 65
Zambon, J. J.. Siots. J. & Genco, R. J. mycetenuvmitans m the pathogenesis of fA/nn rl • • •
(19S3b) Serology of oral Actinobacillus human periodontal disease. Advances in , ,
actinomycetemcomitans and serotype dis- Dental Research 2. 269-274.
tribution in human periodontal disease.
Infection and Immunity 41, 19-27.