Department of Periodontology

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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 Dentistry
Calibration 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.
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.
Treatment of an Erratic Extraction Socket for Implant Therapy in a Patient with Chronic Periodontitis
(Hindawi Publishing Corporation, 2016) Hamada, Yusuke; Prabhu, Srividya; John, Vanchit; Department of Periodontics & Allied Dental Programs
As implant therapy becomes more commonplace in daily practice, preservation and preparation of edentulous sites are key. Many times, however, implant therapy may not be considered at the time of tooth extraction and additional measures are not taken to conserve the edentulous site. While the healing process in extraction sockets has been well investigated and bone fill can be expected, there are cases where even when clinicians perform thorough debridement of the sockets, connective tissue infiltration into the socket can occur. This phenomenon, known as "erratic healing," may be associated with factors that lead to peri-implant disease and should be appropriately managed and treated prior to surgical implant placement. This case report describes the successful management of an erratic healing extraction socket in a 62-year-old Caucasian male patient with chronic periodontitis and the outcomes of an evidence-based treatment protocol performed prior to implant therapy. Careful preoperative analysis and cone beam computed tomography imaging can help detect signs of impaired healing in future implant sites and prevent surgical complications.
Peri-Implant Bone Loss and Peri-Implantitis: A Report of Three Cases and Review of the Literature
(Hindawi Publishing Corporation, 2016) John, Vanchit; Shin, Daniel; Marlow, Allison; Hamada, Yusuke; Department of Periodontics & Allied Dental Programs
Dental implant supported restorations have been added substantially to the clinical treatment options presented to patients. However, complications with these treatment options also arise due to improper patient selection and inadequate treatment planning combined with poor follow-up care. The complications related to the presence of inflammation include perimucositis, peri-implant bone loss, and peri-implantitis. Prevalence rates of these complications have been reported to be as high as 56%. Treatment options that have been reported include nonsurgical therapy, the use of locally delivered and systemically delivered antibiotics, and surgical protocols aimed at regenerating the lost bone and soft tissue around the implants. The aim of this article is to report on three cases and review some of the treatment options used in their management.
Verruciform xanthoma of the buccal gingiva: two cases with different clinical presentations
(Wiley, 2018) Marlow, Allison K.; Ramos, Elizabeth; Blanchard, Steven; Periodontics and Allied Dental Programs, School of Dentistry
Introduction: Verruciform xanthoma is an uncommon, benign, asymptomatic lesion commonly affecting the attached tissues in the oral cavity, especially the gingiva. Clinical presentation can be variable and requires biopsy to confirm the diagnosis. Case Series: Two cases of verruciform xanthoma in a 21‐year old male and a 46‐year old female are reported, emphasizing the need for thorough comprehensive analysis of all oral lesions. The clinical features, differential diagnoses, typical and atypical histological features and potential etiology are presented. Conclusions: Verruciform xanthoma should be considered in the differential diagnosis of solitary lesions in the oral cavity with a papillary, granular or verrucous surface texture, and confirmed with histopathological examination. Continued monitoring for recurrence at routine examination is necessary especially in sites where the lesion may not have been completely excised.
Diabetes or hypertension as risk indicators for missing teeth experience: An exploratory study in a sample of Mexican adults
(Medknow Publications, 2017-01-01) Delgado-Pérez, V. J.; Rosa-Santillana, R. De La; Márquez-Corona, M. L.; Ávila-Burgos, L.; Islas-Granillo, H.; Minaya-Sánchez, M.; Medina-Solís, C. E.; Maupomé, G.; Periodontics and Allied Dental Programs, School of Dentistry
Background: To determine an exploratory estimation of the strength of type 2 diabetes mellitus (T2DM) and hypertension diagnoses as risk indicators for missing teeth in a sample of Mexican adults.Materials and Methods: A comparative cross‑sectional study of sixty adult patients in a health center in Mexico included as dependent variable, the number of missing teeth (and having a functional dentition) and as independent variables, diagnoses for diabetes or hypertension, age, sex, maximum level of schooling, and tobacco use. Of the 60 participants, 20 were diagnosed with T2DM, 13 with hypertension, and 27 were otherwise diagnosed as healthy in their most recent medical checkup. A negative binomial regression (NBR) model was generated. Results: Mean age was 50.7 ± 16.2 and 50.0% were women. Mean number of missing teeth was 4.98 ± 4.17. In the multivariate NBR model, we observed that individuals with T2DM had higher risk of more missing teeth (incidence rate ratios [IRRs] = 3.13; 95% confidence interval [CI] = 2.09–4.69), followed by those with hypertension (IRRs = 2.63; 95% CI = 1.77–3.90). In addition, participants with current tobacco use were significantly more likely to have suffered tooth loss (P < 0.05) than those who were never smokers or former smokers, just like older participants (P < 0.05). Conclusions: T2DM and hypertension are independently associated with higher experience of missing teeth in an open adult population in Mexico. Future studies with a more sophisticated epidemiological design and encompassing a more detailed landscape of chronic diseases, type and length of use of long‑term medications, and patterns of dental care use are needed to better delineate these associations.Keywords: Adult, hypertension, Mexico, tooth loss, type 2 diabetes
National Survey of Oral/Dental Conditions Related to Tobacco and Alcohol Use in Mexican Adults
(MDPI, 2014-03) Medina-Solís, Carlo Eduardo; Pontigo-Loyola, América Patricia; Pérez-Campos, Eduardo; Hernández-Cruz, Pedro; Ávila-Burgos, Leticia; Mendoza-Rodríguez, Martha; Maupomé, Gerardo; Periodontics and Allied Dental Programs, School of Dentistry
Oral diseases are a major burden on individuals and health systems. The aim of this study was to determine whether consumption of tobacco and alcohol were associated with the prevalence of oral/dental problems in Mexican adults. Using data from the National Performance Evaluation Survey 2003, a cross-sectional study part of the World Health Survey, dental information from a representative sample of Mexico (n = 22,229, N = 51,155,740) was used to document self-reported oral/dental problems in the 12 months prior to the survey. Questionnaires were used to collect information related to sociodemographic, socioeconomic, and other risk factors. Three models were generated for each age group (18–30, 31–45 and 46–98 years). The prevalence of oral/dental conditions was 25.7%. Adjusting for sex, schooling, socioeconomic position, diabetes, and self-reported health, those who used tobacco (sometimes or daily) (OR = 1.15, p = 0.070; OR = 1.24, p < 0.01; and OR = 1.16, p < 0.05, for each age group respectively) or alcohol (moderate or high) (OR = 1.26, p < 0.001; OR = 1.18, p < 0.01 and OR = 1.30, p < 0.001, for each age group respectively) had a higher risk of reporting oral/dental problems. Because tobacco and alcohol use were associated with self-reported oral/dental problems in one out of four adults, it appears advisable to ascertain how direct is such link; more direct effects would lend greater weight to adopting measures to reduce consumption of tobacco and alcohol for the specific purpose of improving oral health.
Dental problems and Familismo: social network discussion of oral health issues among adults of Mexican origin living in the Midwest United States
(Dennis Barber, 2016-12) Maupomé, G.; McConnell, W. R.; Perry, B. L.; Periodontics and Allied Dental Programs, School of Dentistry
Objective: To examine the influence of collectivist orientation (often called familismo when applied to the Latino sub-group in the United States) in oral health discussion networks. Basic Research Design: Through respondent-driven sampling and face-to-face interviews, we identified respondents' (egos) personal social network members (alters). Egos stated whom they talked with about oral health, and how often they discussed dental problems in the preceding 12 months. Participants: An urban community of adult Mexican-American immigrants in the Midwest United States. We interviewed 332 egos (90% born in Mexico); egos named an average of 3.9 alters in their networks, 1,299 in total. Method: We applied egocentric network methods to examine the ego, alter, and network variables that characterize health discussion networks. Results: Kin were most often leveraged when dental problems arose; egos relied on individuals whom they perceive to have better knowledge about dental matters. However, reliance on knowledgeable alters decreased among egos with greater behavioral acculturation. Conclusions: This paper developed a network-based conceptualization of familismo. We describe the structure of oral health networks, including kin, fictive kin, peers, and health professionals, and examine how networks and acculturation help shape oral health among these Mexican-Americans.
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 Dentistry
Chronic 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.
Baseline Biomechanical Properties of Epithelia prior to Tissue Expansion in Dogs
(Lippincott, Williams & Wilkins, 2018-05-14) Bowling, Jay; Davidson, Darrell D.; Tholpady, Sunil S.; Park, Kinam; Eckert, George J.; Katona, Terrence; Chu, Tien-Min G.; Barco, Clark T.; Periodontology, School of Dentistry
Background: Soft-tissue deficiencies pose a challenge in a variety of disease processes when the end result is exposure of underlying tissue. Although multiple surgical techniques exist, the transposition of tissue from one location to another can cause donor-site morbidity, long incisions prone to dehiscence, and poor patient outcomes as a result. Use of tissue expansion prior to grafting procedures has been shown to have success in increasing available soft tissue to aid in repairing wounds. However, the current tissue expanders have biomechanical limits to the extent and rate of expansion that usually exceeds the tissue capacity, leading to incisional dehiscence or expander extrusion. Understanding the baseline biomechanical properties of the tissue to be expanded would provide useful information regarding surgical protocol employed for a given anatomical location. Therefore, the aim of this study was to test and compare the baseline (preexpansion) biomechanical properties of different common expansion sites in dogs. Methods: Four samples measuring approximately 20 × 15 × 1 mm were harvested from 8 dogs. The samples were collected from the hard palate, alveolar mucosa, scalp, and chest of the animal and analyzed for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength using a Texture Technologies TA.XT texture analyzer with corresponding biomechanical measurement software. Samples were compared as to their baseline biomechanical properties prior to any soft-tissue expansion. Histological sections of the samples were analyzed using hematoxylin eosin in an attempt to correlate the histological description to the biomechanical properties seen during testing. Summary statistics (mean, standard deviation, standard error, range) are reported for stress, strain, maximum tangential stiffness, maximum tangential modulus, and tensile strength and for the histological parameters by intraoral site. Analysis of variance was used to compare the biomechanical and histological parameters among the 4 locations while accounting for multiple measurements from each dog. Results: The scalp had significantly higher maximum stress (σmax) than chest, mucosa, and palate (P < 0.0001), with no differences among the other 3 locations (P > 0.63). Scalp site also had significantly higher maximum tangential modulus (ε) than chest, mucosa, and palate (P < 0.006), with no differences among the other 3 locations (P > 0.17). The locations did not have significantly different maximum tangential stiffness (k; P = 0.72). Histologically, 2 separate patterns of collagen disruption were evident. Conclusion: Although different results were obtained than theorized, this study showed that the scalp had the greatest resiliency to expand prior to tearing, and the highest tangential modulus, with all sites having statistically similar modulus of elasticity. Based on this study, the scalp could be expanded more aggressively compared with the other sites.

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