Browsing by Author "Blanchard, Steven"
Now showing 1 - 10 of 16
Results Per Page
Sort Options
Item Assessing Effectiveness of an Audiovisual Educational Tool for Improving Dental Students' Probing Depth Consistency(Wiley, 2019-04) Prabhu, Srividya; John, Vanchit; Blanchard, Steven; Eckert, George J.; Hamada, Yusuke; Periodontology, School of DentistryDental students often underestimate their probing depth (PD) measurements, which emphasizes the need for effective and novel methods for teaching proper probing technique. The aim of this study was to evaluate the efficacy of audiovisual learning aids, recorded from the point of view of examiners, for improvement in PD agreement in dental students. In 2017‐18, 22 third‐year dental students were randomized into test and control groups. Each student and a single blinded faculty examiner performed PD measurements on a minimum of three patients. The test group viewed a video demonstrating proper probing technique, while the control group received only probing technique instruction from prior lectures. All measurements, the periodontal diagnoses, and the total time taken to complete PD measurements were recorded. A survey of student attitudes about the audiovisual tool was conducted after the intervention; all 22 students completed the survey. A total of 11,426 PD sites were measured. The test group had 10% greater accuracy in PD sites=4 mm. The control group had a minor but statistically significant increase in accuracy for 2 mm PD sites. For all incorrect measurements at sites PD≥4, the students tended to underestimate the PD. Tooth type, site location around tooth, and diagnosis had no significant effect on PD measurement agreement. No significant difference between groups was found for the proportions of gingivitis and periodontitis patients or for examination time. This study found that use of the audiovisual learning aid “Calibrated Periodontal Training Video” improved the students' probing depth accuracy for sites with PD of 4 mm.Item Assessing readiness to manage medical emergencies among dental students at four dental schools(Wiley, 2021-09) Solanki, Charmi; Geisinger, Maria L.; Luepke, Paul G.; Al-Bitar, Kinan; Palomo, Leena; Lee, Wangsoo; Blanchard, Steven; Shin, Daniel; Maupome, Gerardo; Eckert, George J.; John, Vanchit; Periodontology, School of DentistryBackground and Purpose Dentists treat a wide range of patients, including patients with compromised health conditions. While rendering treatment, various medical emergencies can and do occur. To help increase the knowledge required to manage such emergencies, dental students must be trained while in dental school. This study aims to assess the level of medical emergency preparedness and knowledge among dental students at four dental schools. Material and Methods The participating dental schools were IUSD, Case Western Reserve University School of Dentistry, Marquette University School of Dentistry, and the University of Alabama School of Dentistry. Groups were designed to include 20 dental students from Years 1 to 4. Students were asked to fill out a survey and were then tested on 10 clinical medical emergency scenarios. Results A total of 331 dental students participated in the study. The scores based on 10 case scenarios presented with a range of 4.35–8.02. There was no statistically significant difference in the level of preparedness when dental schools were compared. However, Year 1 and Year 2 dental students had significantly lower total scores than those of Years 3 and 4. The students in Years 1 and 2 demonstrated less confidence in their current knowledge to manage medical emergencies. Satisfaction with the training received ranged from 38% to 84%. Conclusion The results from this study indicate that students’ preparedness to manage medical emergencies at these four dental schools is statistically similar. Additional yearly training could enhance students’ preparedness in the management of medical emergencies in the dental setting.Item Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study(ADEA, 2018-05) de Bedout, Tatiana; Kramer, Kyle; Blanchard, Steven; Hamada, Yusuke; Eckert, George J.; Maupome, Gerardo; John, Vanchit; Oral and Maxillofacial Surgery and Hospital Dentistry, School of DentistryWith the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental school’s standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes.Item Assessment of the Calibration of Periodontal Diagnosis and Treatment Planning Among Dental Students at Three Dental Schools(American Dental Education Association, 2015-01) Lane, Brittany A.; Luepke, Paul; Chaves, Eros; Maupome, Gerardo; Eckert, George J.; Blanchard, Steven; John, Vanchit; Department of Periodontics and Allied Dental Programs, IU School of DentistryCalibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.Item Association between intracranial carotid artery calcifications and periodontitis: A cone-beam computed tomography study(AAP, 2021-10) AlSakr, Abdulaziz; Blanchard, Steven; Wong, Phillip; Thyvalikakath, Thankam; Hamada, Yusuke; Periodontology, School of DentistryBackground Intracranial carotid artery calcifications (ICACs) are one type of calcification that may be detected as incidental findings in cone-beam computed tomography (CBCT). This retrospective study aimed to examine the prevalence of ICACs on CBCT images and their associations among age, gender, chronic periodontitis, and patient-reported cardiovascular diseases (CVDs). Methods A total of 303 CBCT scans were reviewed and a total of 208 patients met the inclusion criteria. The presence or absence of ICACs was evaluated in the ophthalmic and cavernous segments of each scan. Patient demographic data, including age, gender, and medical history, specifically focused on CVDs were recorded. The presence or absence of periodontitis was recorded from each subject with full mouth radiographs and clinical measurements. Odds ratios (ORs) were calculated as part of the logistic regression analysis. Results Overall, ICACs were found in 93 subjects (45%). The bilateral ICACs were found in 43 subjects (21% of the total subjects, 46% of the subjects with ICACs). There were statistically significant associations between presence of ICACs and periodontitis (OR = 4.55), hypertension (OR = 3.02), hyperlipidemia (OR = 2.87), increasing age (OR = 2.24), and the male gender (OR = 1.85). Smoking status was not significantly correlated with ICACs. Conclusion This study revealed that nearly half (45%) of the subjects displayed ICACs on the CBCT images. ICACs are significantly related to the status of chronic periodontitis, age, gender, and CVDs. A more careful review of CBCT scans is highly recommended to detect these calcifications and refer patients for further medical evaluation.Item Biomechanical and histological evaluation of a new zirconia implant in a canine model(2015) Hamada, Yusuke; Chu, Tien-Min Gabriel; Prakasam, Sivaraman; Zunt, Susan L.; Liu, Sean Shih-Yao; Blanchard, StevenBackground: Currently titanium implant fixtures are considered as a gold standard because of their biocompatibility and their clinical success rates have been well documented. The esthetic outcome of restorations supported by titanium implants may be compromised if the dark gray color of the implant shows through a thin peri-implant mucosa or if the implant fixture becomes visible following soft tissue recession. Also titanium might cause allergic reactions. For these reasons, zirconia implants have been considered as alternative materials because of their white color, high material properties and biocompatibilities. Still, further investigations are necessary to confirm the in-vivo performance of these implants. Purpose: The purpose of this study is to determine the histomorphometric and biomechanical properties of zirconia implants manufactured by Shofu Inc. with a sand-blasted and acid-etched surface treatment, compared to that of the titanium implants from the same manufacturer with a sand-blasted and acid-etched surface treatment in a canine model. Material and Methods: Six beagle dogs (1-2 years old) will be used in this split mouth trial. After 8 weeks following extraction of the second to fourth mandibular premolars, zirconia implants (experimental group) and titanium implants (control group) were placed on the each side of mandible. At 8 weeks and 12 weeks after implant placement, the animals were sacrificed, and implants were removed in block sections, and histological and histomorphometric analyses were measured. Specifically, the bone-implant contact (BIC), bone area (BA), removal torque (RTQ), mineral apposition rate (MAR), bone forming area (BFA), and Periotest value (PTV) of the two groups were studied and compared. Results: At 12 weeks post operatively, one Shofu thread type Ti implant were not integrated. Over all failure implant was 0/12 in zirconia group, and 1/12 in titanium group. In 8 weeks samples, only statistical differences were higher BA (p=0.02) in macro threads area and BFA (p=0.02) in zirconia implants group than titanium implants group. In 12 weeks group, zirconia implant group showed higher MAR at 9-10 and 10-11weeks time frame (p=0.02, and 0.04 restectively), and PVT value (p=0.01) than titanium implants group. Removal torque value increased in both titanium and zirconia group with time. Average of removal torque value showed higher in titanium implants than zirconia implants, but the differences were not statistically significant in both 8 weeks (Ti; 64.16±16.93 N-cm, ZrO₂: 42.5±6.01 N-cm : p=0.247) and 12 weeks (Ti; 82.5±9.41 N-cm, ZrO₂: 51.3±19.38 N-cm: p=0.16). In the removal torque analysis, it is observed that the bone-implant interface seems to be of more rigid and brittle in nature as indicated by the lower averaged onset angle, peak angle, area under curve and RTQ. Conclusion: Zirconia implants group showed higher value of BA with macro thread and BFA in 8weeks and MAR at 9-10, 10-11 weeks period, and PVT in 12 weeks post operatively. Within the limited number of samples tested in this study, there is no difference between the BIC and RTQ of zirconia and titanium implants after 8 and 12 weeks of implantation.Item A CLINICAL AND HISTOMORPHOMETRIC STUDY OF CALCIUM SULFATE (DENTOGEN®), COMPARED TO FREEZE DRIED BONE ALLOGRAFT (FDBA) FOR ALVEOLAR RIDGE PRESERVATION(Office of the Vice Chancellor for Research, 2011-04-08) Toloue, Samira; Eckert, George; Blanchard, StevenThere is significant ridge resorption following tooth extraction. Freeze dried bone allograft (FDBA) is most widely used for ridge preservation and calcium sulfate has begun to show popularity. The objective of this study is to evaluate if DentoGen® (calcium sulfate) is as effective in preserving post extraction ridge dimensions compared to FDBA. Thirty consecutive single rooted extraction sites were selected that met the inclusion criteria for the study. Post extraction clinical measurements were made with a pre-fabricated stent and dental calipers. The sites were then divided randomly into the test group (calcium sulfate) or the control group (FDBA). Patients were recalled after 3 months, sites were reentered and clinical measurements were again made. A trephine bone core was harvested and sent for histomorphometric analysis. A total of 21 subjects with 41 potential sites were recruited to this study (IRB approval # 1003-56). Following extraction, 29 sites met the inclusion criteria. To date, no significant change in vertical ridge height pre to post surgery was noted within the test and control groups (0.53 + 1.63mm, 0.35 ± 1.13mm, respectively). There was a significant decrease in buccal-lingual ridge width within both groups, (-1.23 + 1.14mm test group. 0.93 + 0.94mm control group) There was no significant difference in the preservation performance between the two treatment groups for both ridge width and vertical height. Histological samples are currently being analyzed. Results suggest no statically significant differences between the use of calcium sulfate versus FDBA in preserving post extraction ridge dimensions.Item Diagnosis and treatment planning using the 2017 classification of periodontal diseases among three dental schools(Wiley, 2022-05-29) Gandhi, Kaveri K.; Katwal, Diksha; Chang, Jennifer; Blanchard, Steven; Shin, Daniel; Maupome, Gerardo; Eckert, George J.; John, VanchitObjectives: The American Academy of Periodontology and the European Federation of Periodontology developed a new classification system for periodontal diseases in 2017. The next step in its widespread implementation involves training dental students to improve consistency in clinical decisions. This study conducted in 2020–2021 aimed to evaluate knowledge in periodontal diagnosis and treatment planning using the new classification, among first, second, third- and fourth-year dental students at Indiana University School of Dentistry (IUSD), University of Texas School of Dentistry at Houston (UTSD), and University of Louisville School of Dentistry (ULSD). Methods: A minimum of 20 dental students per class year from each of the three schools participated. Ten HIPPA de-identified case records and a questionnaire with a fixed list of answer options, comprising two demographic questions and two questions on diagnosis and treatment planning of each case, were presented to the participants. A group of three board-certified periodontists established the answers for all cases which were used to score the appropriateness of diagnosis and treatment planning among the participants. Results: A total of 263 students participated. Overall, 22.6% of IUSD responses, 25.2% of UTSD, and 27.6% of ULSD responses were correct for diagnosis (no statistically significant differences). For the treatment plan, 64.9% of IUSD responses, 66.2% of UTSD, and 68.9% of ULSD responses were correct (no statistically significant differences). Conclusion: Based on the findings from our study, we suggest that additional training be considered to improve the understanding of the 2017 classification of periodontal and peri-implant diseases among dental students.Item Differential profiles of soluble and cellular toll like receptor (TLR)-2 and 4 in chronic periodontitis(PLOS, 2018-12-20) AlQallaf, Hawra; Hamada, Yusuke; Blanchard, Steven; Shin, Daniel; Gregory, Richard; Srinivasan, Mythily; Periodontology, School of DentistryChronic periodontitis is a common inflammatory disease initiated by a complex microbial biofilm and mediated by the host response causing destruction of the supporting tissues of the teeth. Host recognition of pathogens is mediated by toll-like receptors (TLRs) that bind conserved molecular patterns shared by large groups of microorganisms. The oral epithelial cells respond to most periodontopathic bacteria via TLR-2 and TLR-4. In addition to the membrane-associated receptors, soluble forms of TLR-2 (sTLR-2) and TLR-4 (sTLR-4) have been identified and are thought to play a regulatory role by binding microbial ligands. sTLR-2 has been shown to arise from ectodomain shedding of the extracellular domain of the membrane receptor and sTLR-4 is thought to be an alternate spliced form. Many studies have previously reported the presence of elevated numbers of viable exfoliated epithelial cells in the saliva of patients with chronic periodontitis. The objective of this study was to investigate the potential value of salivary sTLR-2 and sTLR-4 together with the paired epithelial cell-associated TLR-2/4 mRNA as diagnostic markers for chronic periodontitis. Unstimulated whole saliva was collected after obtaining informed consent from 40 individuals with either periodontitis or gingivitis. The sTLR-2 and sTLR4 in saliva was measured by enzyme-linked immunosorbent assay. The TLR-2 and TLR-4 transcript in the epithelial cells in saliva was measured by real time polymerase chain reaction. While levels of sTLR-2 exhibited an inverse correlation, sTLR-4 positively correlated with clinical parameters in the gingivitis cohort. Interestingly, both correlations were lost in the periodontitis cohort indicating a dysregulated host response. On the other hand, while the sTLR-2 and the paired epithelial cell associated TLR-2 mRNA exhibited a direct correlation (r2 = 0.62), that of sTLR4 and TLR-4 mRNA exhibited an inverse correlation (r2 = 0.53) in the periodontitis cohort. Collectively, assessments of salivary sTLR2 and sTLR4 together with the respective transcripts in the epithelial cells could provide clinically relevant markers of disease progression from gingivitis to periodontitis.Item Differential profiles of soluble and cellular toll like receptor (TLR)-2 and 4 in chronic periodontitis(PLOS, 2018-12-20) AlQallaf, Hawra; Hamada, Yusuke; Blanchard, Steven; Shin, Daniel; Gregory, Richard; Srinivasan, Mythily; Periodontology, School of DentistryChronic periodontitis is a common inflammatory disease initiated by a complex microbial biofilm and mediated by the host response causing destruction of the supporting tissues of the teeth. Host recognition of pathogens is mediated by toll-like receptors (TLRs) that bind conserved molecular patterns shared by large groups of microorganisms. The oral epithelial cells respond to most periodontopathic bacteria via TLR-2 and TLR-4. In addition to the membrane-associated receptors, soluble forms of TLR-2 (sTLR-2) and TLR-4 (sTLR-4) have been identified and are thought to play a regulatory role by binding microbial ligands. sTLR-2 has been shown to arise from ectodomain shedding of the extracellular domain of the membrane receptor and sTLR-4 is thought to be an alternate spliced form. Many studies have previously reported the presence of elevated numbers of viable exfoliated epithelial cells in the saliva of patients with chronic periodontitis. The objective of this study was to investigate the potential value of salivary sTLR-2 and sTLR-4 together with the paired epithelial cell-associated TLR-2/4 mRNA as diagnostic markers for chronic periodontitis. Unstimulated whole saliva was collected after obtaining informed consent from 40 individuals with either periodontitis or gingivitis. The sTLR-2 and sTLR4 in saliva was measured by enzyme-linked immunosorbent assay. The TLR-2 and TLR-4 transcript in the epithelial cells in saliva was measured by real time polymerase chain reaction. While levels of sTLR-2 exhibited an inverse correlation, sTLR-4 positively correlated with clinical parameters in the gingivitis cohort. Interestingly, both correlations were lost in the periodontitis cohort indicating a dysregulated host response. On the other hand, while the sTLR-2 and the paired epithelial cell associated TLR-2 mRNA exhibited a direct correlation (r2 = 0.62), that of sTLR4 and TLR-4 mRNA exhibited an inverse correlation (r2 = 0.53) in the periodontitis cohort. Collectively, assessments of salivary sTLR2 and sTLR4 together with the respective transcripts in the epithelial cells could provide clinically relevant markers of disease progression from gingivitis to periodontitis.