Department of Periodontology Works

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Alveolar Ridge Augmentation Around Exposed Mandibular Dental Implant With Histomorphometric Analysis
(Wiley, 2021-03) Ibraheem, Ahmed Gamil; Blanchard, Steven B.; Periodontology, School of Dentistry
Introduction Alveolar ridge augmentation either before or during implant placement is a predictable procedure under certain conditions. A major complication during the healing phase is incision line opening and membrane exposure, which may result in reduced bone gain and reduced implant survival. This case report describes alveolar bone regeneration around three dental implants despite membrane exposure that developed during healing post-surgically. Case Presentation A 72-year-old female presented requesting dental implants to replace tooth numbers 18, 19, and 20. A cone-beam computed tomography (CBCT) scan showed loss of horizontal and vertical ridge dimensions. All implants were placed with a variable degree of implant thread exposure on their buccal surfaces, ranging from 3 to 4.5 mm. Simultaneous bone grafting was performed using freeze dried bone allograft and deproteinized bovine bone mineral that was covered by a d-PTFE membrane that was secured with tacking screws. Primary closure was obtained, and flaps were sutured. Three weeks post-surgically, membrane exposure occurred. Exposure was monitored and patient was instructed to follow strict oral hygiene instructions around the exposed membrane. Membrane exposure gradually increased without infection and was removed at 16 weeks. Membrane removal revealed dense fibrous tissues covering all implant surfaces. At the second stage surgery, new bone was seen covering all the implants coronal to the cover screws. A trephine core biopsy specimen revealed significant new bone formation and connective tissue around any residual grafted bone. Conclusion d-PTFE membrane exposure does not necessarily lead to adverse healing outcomes for alveolar ridge augmentation if handled properly with close patient follow-up.
Amnion–Chorion Allograft Barrier Used on Root Surface for Regenerative Procedures: Case Report
(Wiley, 2020-12) Hamada, Yusuke; Yeh, Yu-Ting; Blanchard, Steven B.; Periodontology, School of Dentistry
Introduction Guided tissue regeneration (GTR) has been well documented with combination of bone graft substitutes and biologic modifiers to improve the outcomes of periodontal regenerative procedures. Amnion-chorion allograft membrane (ACM) is a placenta-derived resorbable allograft membrane which contains growth factors found in the placenta. The primary purpose of the barrier membranes for GTR was to exclude the epithelial down-growth along with the root surface, however, the ACM can be used as an additional biologic modifier because of the release of growth factors from the ACM after placement. The aim of this case report is to evaluate the efficacy and the application of ACM on the previously diseased root surface to treat periodontal intrabony defect. Case Presentation A 60-year-old Caucasian male with deep and wide intrabony defect on mesial #19 was treated with a regenerative procedure with combination of application of ACM on the root surface and filling the intrabony defect with the corticocancellous freeze-dried bone allograft. The bone substitute was covered with another layer of ACM and primary closure was achieved. Wound healing process was uneventful, and the clinical and radiographic outcomes were favorable up to 18 months after the surgical procedure. Conclusion This case report demonstrated that the application of ACM on the root surface with a combination of bone substitute might enhance to the radiographic bone fill and the clinical attachment level gain and minimize the risk of post-operative gingival recession.
The Application of a CO2 Laser in Implant Site Development: A Case Report
(2019) Villanueva, Justin; Blanchard, Steven B.; Hamada, Yusuke; Periodontology, School of Dentistry
Introduction: Ridge preservation procedures have been utilized to minimize the alveolar ridge dimensional changes following tooth extraction. This case report describes a novel approach to ridge preservation with an application of a carbon dioxide laser (CO2 laser) to stabilize blood clot formation and stimulate wound healing. Case presentation: A 76-year-old Caucasian male with history of type 2 diabetes was referred for extraction of #8 and placement of a dental implant to reconstruct the area. Extraction was performed in a minimal traumatic manner and a mineralized freeze-dried bone allograft was placed in the socket. A 10,600 nm wavelength CO2 laser was used in setting of 1.0 watts focused continuous wave energy to stabilize the blood clot over the extraction site. The laser was used until a char layer was formed. This char layer was a non-bleeding stable blood clot, and the end-point of laser application was set as “no blood flow from the clot are within 10 seconds.” No membranes or sutures were used. Eleven weeks after the extraction and ridge preservation, a 4.1x10mm dental implant was placed with >35N/cm of primary stability and Implant stability quotient (ISQ) value of 83. A provisional crown was delivered at the time of implant placement. Three months following implant placement, the final restoration was delivered. The soft and hard tissue healing were uneventful to achieve esthetic and functional outcomes. Conclusion: Within limits of this case report, the application of CO2 laser for “Laser-Assisted Blood Clot Formation” may enhance the soft and hard tissue healing following extraction for ridge preservations.
Comparative evaluation of mandibular canal visibility on crosssectional cone-beam CT images: a retrospective study
(British Institute of Radiology, 2015) Miles, Mahogany S.; Parks, Edwin T.; Eckert, George J.; Blanchard, Steven B.; Department of Periodontics and Allied Dental Programs, IU School of Dentistry
OBJECTIVES: The purpose of this study was to determine the visibility of the mandibular canal (MC) in CBCT images and if the visibility of the MC is affected by gender, location and/or age. METHODS: CBCT images were evaluated for the visibility of the MC by a board-certified oral and maxillofacial radiologist, a board-certified periodontist and a periodontics resident. Representative slices were examined for the first premolar (PM1), second premolar (PM2), first molar (M1) and second molar (M2) sites by all examiners. The visibility of the MC was registered as either present or absent. RESULTS: 360 total CBCT cross-sectional images were examined, with the MC identified in 204 sites (56%). Age had a significant effect on MC visibility, but it differed by location: for PM1, age 47–56 had lower visibility than age 65+ (p = 0.0377). Gender also had a significant effect on canal visibility, where females had lower visibility than males overall (p = 0.0178) and had the most pronounced difference for PM1 (p = 0.0054). Location had a significant effect on visibility, but it differed by age and by gender: for age 65+, M2 had lower visibility than PM1 (p = 0.0411) and PM2 (p = 0.0180), while for females, PM1 had lower visibility than M1 (p = 0.0123) and M2 (p = 0.0419). CONCLUSIONS: The MC was visualized only in just over half of the CBCT images. Age, gender and location had significant effects on the visibility.
Effects of platelet‐rich fibrin on human gingival and periodontal ligament fibroblast proliferation from chronic periodontitis versus periodontally healthy subjects
(Wiley, 2021-08) Goel, Apoorv; Windsor, L. Jack; Gregory, Richard L.; Blanchard, Steven B.; Hamada, Yusuke; Periodontology, School of Dentistry
Background: Platelet-rich fibrin (PRF), an autogenous blood concentrate, contains multiple growth factors and is used as an adjunct in the periodontal regeneration and implant site development procedures to stimulate wound healing. Patient-related factors such as chronic periodontitis may affect the quality of PRF. Objectives: This study aimed to investigate and compare PRF's effects from patients diagnosed with generalized moderate or severe chronic periodontitis to patients who presented with intact periodontium on human gingival fibroblast (HGF) and human periodontal ligament fibroblast (HPLF) proliferation. Materials and methods: A total of 33 ml of whole intravenous blood was collected from each subject and centrifuged at 2700 rpm for 12 min in three 10 ml tubes, and 3 ml of blood was used for Complete Blood Count analysis. Three PRF clots were compressed to produce the membranes and liquid exudate. PRF membrane and 10% liquid exudate were exposed to 20,000 HPLFs/well or 25,000 HGFs/well in triplets from each subject in a 48 cell well plate. After 72 h of incubation, the conditioned media were evaluated by Water Soluble Tetrazolium-1 assays to determine fibroblast proliferation. Controls included cells alone and media without cells. Complete blood counts were measured. Results: Subjects in both groups were age and gender-matched (intact 46.7 ± 11.4 years and periodontitis 54.8 ± 10.4 years, p-value = 0.1344). Body Mass Index and White Blood Corpuscles in the periodontitis group was significantly higher than the intact group (p = 0.0176 and p = 0.0038) whereas no differences were seen for Red Blood Corpuscles (p = 0.2020), Hemoglobin (p = 0.2290) and Platelets (p = 4,094). There were no significant differences in the HGF and HPLF proliferation with PRF exudates and membranes between intact periodontium and periodontitis groups (all p > 0.05). However, PRF exudates in both groups induced significant more cell proliferation when compared to PRF membranes. Conclusions: PRF exudates induced significant proliferation of fibroblasts and can play a vital role in wound healing. The current study concluded that PRF membranes, in combination with PRF exudates, can be utilized for their therapeutic and wound healing potential, not affected by the periodontal condition of the patient.
In vitro comparison of root surface roughness and bacterial adhesion following treatment with three different instruments
(Wiley, 2021) Haroon, Farah; Gregory, Richard L.; Hara, Anderson; Blanchard, Steven B.; Hamada, Yusuke; Periodontology, School of Dentistry
Background A novel device, piezoelectric 11 Gracey curet tip, reportedly combines benefits of a piezoelectric device and manual curet. The primary objective of this study was to compare root surface roughness outcomes between traditional manual curets and piezoelectric devices, as compared with this novel device. The secondary aim was to assess the level of adhesion of Streptococcus mutans on the root surface after instrumentation. Methods The groups consisted of the following: 1) Gracey curet; 2) piezoelectric scaler; 3) piezoelectric 11 Gracey curet tip; and 4) untreated control. Root specimens were obtained from extracted human teeth and randomly assigned to each group. Surface roughness measurements (Ra and Rz) were taken with a profilometer before and after instrumentation. After instrumentation, root specimens were inoculated with S. mutans and biofilm was dislodged. Various dilutions of resuspended biofilm were incubated on blood agar plates and colony forming units (CFU) values were measured. Results The experimental device resulted in significantly lower Ra and Rz compared with other groups (P < 0.01), and the Gracey curet was significantly lower than the piezoelectric tip and untreated control (P < 0.05). The Gracey curet and experimental device tip had significantly lower CFU values compared with the control (P < 0.05). There were no significant CFU value differences between the Gracey curet and both the piezoelectric and experimental device tips. There were no significant CFU differences between piezoelectric tip and both experimental device and control. There was no correlation between Ra and CFU values for Gracey curet, piezoelectric tip, or the control. However, correlation between Ra values and CFU approached significance for the experimental device (correlation = 0.66, P = 0.05). Conclusions Piezoelectric 11 Gracey curet tip is effective at resulting in a significantly smoother surface compared with traditional piezoelectric and hand instruments. CFU values with piezoelectric 11 Gracey curet tip were significantly lower than non-instrumented surfaces, but there were no significant differences compared with conventional methods.
An in-vitro comparison of four antibacterial agents with and without nicotine and their effects on human gingival fibroblasts
(Wiley, 2021) Batra, Chandni; Alalshaikh, Marwa; Gregory, Richard L.; Windsor, L. Jack; Blanchard, Steven B.; Hamada, Yusuke; Periodontology, School of Dentistry
Background To compare anti-bacterial activity of 0.12% Chlorhexidine (CHX), 10% Povidone Iodine (PVD), Vega Oral Care Gel (VEGA), and Antioxidant Gel (AO) on Streptococcus mutans, Streptococcus sanguis, Fusobacterium nucleatum, and Porphyromonas gingivalis with and without nicotine and to evaluate their effects on human gingival fibroblasts (HGFs). Methods S. mutans, S. sanguis, P. gingivalis, and F. nucleatum were incubated with serial dilutions (1/4, 1/8, 1/16, 1/32, and 1/64) of anti-bacterial agents in media (with and without nicotine). Minimum inhibitory and minimum bactericidal concentrations (MIC/MBC) were measured, and confocal microscopy was performed. HGFs were exposed to serial dilutions (1/10, 1/100, 1/1000, and 1/10,000) of antibacterial agents with media. Water-soluble tetrazolium-1 (WST-1) assay and lactate dehydrogenase (LDH) assay were used to assess proliferation and cytotoxicity towards HGFs. Results CHX and PVD significantly inhibited growth of all bacterial species (P < 0.0001) at all dilutions. AO and VEGA inhibited growth of all bacterial species up to only the 1/4 dilution. CHX and PVD decreased HGF proliferation at 1/10 and 1/100 dilution, whereas AO at all dilutions (P < 0.05). CHX and AO were cytotoxic at all dilutions (P < 0.05). VEGA was not cytotoxic to HGFs and did not affect HGF proliferation at any dilution (P > 0.05). An increased bacterial growth was seen for all species except P. gingivalis with addition of nicotine. Conclusion CHX and PVD demonstrate superior antibacterial properties, but significantly reduce HGF proliferation. AO is bacteriostatic at lower dilutions but is highly toxic to HGFs. VEGA was bacteriostatic and demonstrated no detrimental effects on HGF's.
Levels of growth factors from platelet-rich fibrin from chronic periodontitis versus periodontally healthy subjects: a pilot study
(Springer, 2020) Chang, Jennifer; Blanchard, Steven B.; Windsor, L. Jack; Gregory, Richard L.; Hamada, Yusuke; Periodontology, School of Dentistry
Objectives This study aimed to (1) compare the amounts of growth factors from platelet-rich fibrin (PRF) between chronic periodontitis and periodontally healthy subjects and (2) evaluate the relationships between the amounts of growth factors from PRF with complete blood counts (white blood cell (WBC) and platelet counts) and the serum concentrations of IL-1β, IL-6, and tumor necrosis factor-α (TNF-α). Materials and methods Venous blood was collected from chronic periodontitis (test) and periodontally healthy subjects (control). PRF and serum were collected from the centrifuged blood. Liquid exudates from the compression of PRF were collected. The compressed PRF membranes were incubated in saline, and eluted aliquots were collected at 1, 24, and 72 h, and the membranes were then digested with trypsin. Epidermal growth factor, insulin-like growth factor-1, platelet-derived growth factor-BB, transforming growth factor-β1, and vascular endothelial growth factor in the exudates and eluents were quantified by ELISA. Serum was used for IL-1β, IL-6, and TNF-α quantifications. Complete blood counts were measured. Results There were no significant differences in the amounts of growth factors from PRF exudates and membranes measured between groups (all p > 0.05). The test group had significantly higher WBC (p < 0.05). However, there was no significant correlation between the WBC and the amounts of the growth factors from PRF (all p > 0.05). Conclusions PRF can be utilized as an autologous source of growth factors not affected by periodontal condition and WBC level.
Management of Recurrent Gummy Smile After 7 Years: A Case Report
(2021) Yeh, Yu-Ting; Blanchard, Steven B.; Periodontology, School of Dentistry
Esthetic crown lengthening is a periodontal surgical procedure to correct excess gingival display (ie, "gummy smile"). The procedure may require soft-tissue excision only, osseous resection, or a combination of both. However, the long-term healing responses, such as soft-tissue relapse or recession and hard-tissue regrowth and resorption, have not been fully reported in the literature. This case report describes the management of a patient with esthetic concerns about a gummy smile. The patient stated that the maxillary anterior area had been previously treated with periodontal surgery 7 years earlier but the condition had slowly recurred over time. The authors highlight the possible reasons for the recurrence and the keys to successfully managing the case.

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