Department of Periodontology

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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.
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 Dentistry
Dental 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.
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 Dentistry
Background 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.
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.
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 Dentistry
Background 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.
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.
Canine impaction – A review of the prevalence, etiology, diagnosis and treatment
(Elsevier, 2019-06) Hamada, Yusuke; Timothius, Celine Joyce Cornelius; Shin, Daniel; John, Vanchit; Periodontology, School of Dentistry
The signs and symptoms of canine impaction can vary, with patients only noticing symptoms when they are suffering from unsightly esthetics, faulty occlusion, or poor cranio-facial development. While various surgical interventions have been proposed to expose and help erupt impacted canines, these treatment modalities have a high degree of difficulty compared to other types of dental cosmetic surgeries. This paper focuses on multi-disciplinary strategies for treating and managing canine impaction, reviews patient and clinical selection criteria, and discusses the evidence underlying existing interventions to reduce complications and improve patient-centered outcomes following treatment.
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.

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