Department of Prosthodontics Works

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Barriers to Dental Care in Individuals with Special Healthcare Needs in Qatif, Saudi Arabia: A Caregiver’s Perspective
(Dove Press, 2021-01-22) Alfaraj, Amal; Halawany, Hassan S.; Al-Hinai, Muntasar T.; Al-Badr, Abid H.; Alalshaikh, Marwa; Al-Khalifa, Khalifa S.; Prosthodontics, School of Dentistry
Objective: Access to dental care is a key factor influencing oral health outcomes. Individuals with special healthcare needs are at risk of not having access to dental care services which they need to maintain their oral health. This study assessed the magnitude of this problem and identified barriers responsible for the difficulties in accessing dental care in Qatif, Saudi Arabia, as reported by caregivers of individuals with special healthcare needs. Methods: This cross-sectional study collected data using a self-administered survey questionnaire from caregivers of individuals with special healthcare needs across 11 centers (eight special needs centers and three schools) in Qatif, Eastern Province of Saudi Arabia, between February and April 2019. Results: A total of 186 caregivers participated in the study, 102 (54.8%) of whom reported difficulties in getting access to dental care. The key barriers included lack of time on the part of caregivers (60.8%), unsuitable clinic environment (53.9%), difficulties with transportation (51.9%), medical/health status of the individual with special healthcare needs (51.0%), and geographically distant dental clinics (51.0%). Caregiver demographics (age, gender, and educational level) had no significant influence on the difficulties reported by caregivers in getting access to dental care for individuals with special healthcare needs (p>0.05). Conclusion: A large proportion of caregivers in Qatif, Saudi Arabia, experience difficulties with access to dental care services for individuals with special healthcare needs. The most common barriers are physical accessibility of dental facilities (for individuals with special healthcare needs), affordability, and lack of skills and knowledge of dental care providers.
Bead-anchored surgical templates for static computer-assisted implant surgery: A dental technique
(Wiley, 2022-10) Orgev, Ahmet; Pellerito, John; Polido, Waldemar; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry
This technique report describes an alternative method to stabilize surgical templates throughout full-arch static computer-assisted implant surgery (FA s-CAIS). In FA s-CAIS, remaining teeth, mucosa, existing implants, custom occlusal device, bone, or any combination thereof, could be used as an initial positioning mechanism to position surgical templates. Different anchoring mechanisms are then used to stabilize the surgical templates during surgery. In this report, a novel design of surgical templates using remaining dentition and opposing occlusal surfaces as initial positioning mechanism followed by the combination of bone block fixation screw and stainless-steel beads as secondary anchoring mechanisms is described. The advantages, limitations, and comparisons with surgical templates using other anchoring mechanisms are also discussed.
Bimix antimicrobial scaffolds for regenerative endodontics
(Elsevier, 2014-11) Palasuk, Jadesada; Kamocki, Krzysztof; Hippenmeyer, Lauren; Platt, Jeffrey A.; Spolnik, Kenneth J.; Gregory, Richard L.; Bottino, Marco C.; Department of Restorative Dentistry, IU School of Dentistry
INTRODUCTION: Eliminating and/or inhibiting bacterial growth within the root canal system has been shown to play a key role in the regenerative outcome. The aim of this study was to synthesize and determine in vitro both the antimicrobial effectiveness and cytocompatibility of bimix antibiotic-containing polydioxanone-based polymer scaffolds. METHODS: Antibiotic-containing (metronidazole [MET] and ciprofloxacin [CIP]) polymer solutions (distinct antibiotic weight ratios) were spun into fibers as a potential mimic to the double antibiotic paste (DAP, a MET/CIP mixture). Fiber morphology, chemical characteristics, and tensile strength were evaluated by scanning electron microscopy, Fourier transform infrared spectroscopy, and tensile testing, respectively. Antimicrobial efficacy was tested over time (aliquot collection) against Enterococcus faecalis (Ef), Porphyromonas gingivalis (Pg), and Fusobacterium nucleatum (Fn). Similarly, cytotoxicity was evaluated in human dental pulp stem cells. Data were statistically analyzed (P < .05). RESULTS: Scanning electron microscopy and Fourier transform infrared spectroscopy confirmed that electrospinning was able to produce antibiotic-containing fibers with a diameter mostly in the nanoscale. The tensile strength of 1:1MET/CIP scaffolds was significantly (P < .05) higher than pure polydioxanone (control). Meanwhile, all other groups presented similar strength as the control. Aliquots obtained from antibiotic-containing scaffolds inhibited the growth of Ef, Pg, and Fn, except pure MET, which did not show an inhibitory action toward Pg or Fn. Antibiotic-containing aliquots promoted slight human dental pulp stem cell viability reduction, but none of them were considered to be cytotoxic. CONCLUSIONS: Our data suggest that the incorporation of multiple antibiotics within a nanofibrous scaffold holds great potential toward the development of a drug delivery system for regenerative endodontics.
Biodegradable nanofibrous drug delivery systems: effects of metronidazole and ciprofloxacin on periodontopathogens and commensal oral bacteria
(Springer-Verlag, 2014-12) Bottino, Marco C.; Arthur, Rodrigo A.; Waeiss, R. Aaron; Kamocki, Krzysztof; Gregson, Karen S.; Gregory, Richard L.; Department of Restorative Dentistry, IU School of Dentistry
OBJECTIVES: The purposes of this study were to fabricate biodegradable polydioxanone (PDS II®) electrospun periodontal drug delivery systems (hereafter referred to as matrices) containing either metronidazole (MET) or ciprofloxacin (CIP) and to investigate the effects of antibiotic incorporation on both periodontopathogens and commensal oral bacteria. MATERIALS AND METHODS: Fibrous matrices were processed from PDS polymer solution by electrospinning. Antibiotic-containing PDS solutions were prepared to obtain four distinct groups: 5 wt.% MET, 25 wt.% MET, 5 wt.% CIP, and 25 wt.% CIP. Pure PDS was used as a control. High-performance liquid chromatography (HPLC) was done to evaluate MET and CIP release. Dual-species biofilms formed by Lactobacillus casei (Lc) and Streptococcus salivarius (Ss) were grown on the surface of all electrospun matrices. After 4 days of biofilm growth, the viability of bacteria on biofilms was assessed. Additionally, antimicrobial properties were evaluated against periodontopathogens Fusobacterium nucleatum (Fn) and Aggregatibacter actinomycetemcomitans (Aa) using agar diffusion assay. RESULTS: A three-dimensional interconnected porous network was observed in the different fabricated matrices. Pure PDS showed the highest fiber diameter mean (1,158 ± 402 nm) followed in a descending order by groups 5 wt.% MET (1,108 ± 383 nm), 25 wt.% MET (944 ± 392 nm), 5 wt.% CIP (871 ± 309 nm), and 25 wt.% CIP (765 ± 288 nm). HPLC demonstrated that groups containing higher amounts (25 wt.%) of incorporated drugs released more over time, while those with lower levels (5 wt.%) the least. No inhibitory effect of the tested antibiotics was detected on biofilm formation by the tested commensal oral bacteria. Meanwhile, CIP-containing matrices inhibited growth of Fn and Aa. CONCLUSION: CIP-containing matrices led to a significant inhibition of periodontopathogens without negatively impairing the growth of periodontal beneficial bacteria. CLINICAL RELEVANCE: Based on the proven in vitro inhibition of periodontitis-related bacteria, future in vivo research using relevant animal models is needed to confirm the effectiveness of these drug delivery systems.
CAD-CAM Hollow Obturator Prosthesis: A Technical Report
(Wiley, 2022) Alfaraj, Amal; Su, Fang-Yu; Lin, Wei-Shao; Prosthodontics, School of Dentistry
An obturator with a hollow bulb can decrease the overall weight of the prosthesis, stress on the underlying tissues, and patient discomfort. Although many techniques and materials have been proposed in the literature for hollowing the obturator prosthesis, they are often time-consuming and technique sensitive. This proposed technique used an open-source software program to hollow digital design of solid obturator base from a commercially available software in one single convenient step. The hollowing process allowed precise control of prosthesis thickness at the hollow space area for desirable hermetic seal and prosthesis strength.
Caries lesion remineralization with fluoride toothpastes and chlorhexidine - effects of application timing and toothpaste surfactant
(SciELO, 2018-06-11) Almohefer, Sami A.; Levon, John A.; Gregory, Richard L.; Eckert, George J.; Lippert, Frank; Restorative Dentistry, School of Dentistry
INTRODUCTION: Habitual toothbrushing with fluoridated toothpaste followed by rinsing with antibacterial mouthwashes is a method to maintain good oral hygiene and to diminish the occurrence and severity of dental caries and periodontal disease. However, our understanding of how antimicrobial agents in mouthwashes affect fluoride-mediated caries lesion remineralization is still poor. OBJECTIVE: The objectives of this in vitro study were a) to determine the effects of the waiting period of chlorhexidine (CHX) rinsing after fluoride toothpaste use and b) to further determine the effect of the type of toothpaste surfactant [sodium dodecyl sulfate (SDS) or cocamidopropyl betaine (CAPB)] on caries lesion remineralization associated with CHX rinsing. MATERIAL AND METHODS: Caries lesions were formed in bovine enamel specimens and assigned to 10 treatment groups (n=18) based on Vickers surface microhardness (VHN). Lesions were then pH-cycled for 10 days with daily regimen comprised of twice daily toothpaste slurry treatments (1150 ppm fluoride, with SDS or CAPB), followed by CHX solution treatments [0, 15, 30 or 60 minutes following slurry treatment or no CHX treatment (negative control)]. VHN was measured again and the extent of lesion remineralization calculated (∆VHN). RESULTS: ∆VHN with SDS-toothpaste was significantly lower than with CAPB-toothpaste, indicating more remineralization for the CAPB-toothpaste. ∆VHN with 0-minute waiting time was significantly lower than with 30-minute waiting time and with negative control. CONCLUSIONS: The absence of CHX as an adjunct to fluoride toothpastes led to greater remineralization of enamel lesions compared with the immediate use of CHX treatment for both SDS- and CAPB-toothpastes. CAPB-toothpastes indicated significantly greater remineralization than SDS-toothpastes, and can be suggested for patients at high risk of caries. A 30-minute waiting time for CHX treatment is recommended after brushing.
Clinical performance of intentionally tilted implants versus axially positioned implants: A systematic review
(Wiley, 2018-10) Lin, Wei-Shao; Eckert, Steven E.; Prosthodontics, School of Dentistry
Objectives The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge. Materials and methods A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence‐based Medicine—Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed. Results A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full‐text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta‐analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient‐reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws. Conclusions Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.
Coronavirus disease 2019 (COVID-19): Experiences and protocols from the Department of Prosthodontics at the Wuhan University
(Elsevier, 2020-07-10) Sa, Yue; Lin, Wei-Shao; Morton, Dean; Huang, Cui; Prosthodontics, School of Dentistry
Statement of problem: The novel Coronavirus Disease 2019 (COVID-19) is a global pandemic, and many countries and regions are still currently in the midst of the outbreak. This pandemic has caused prosthodontics units to suspend their clinical and educational operations in academia. Purpose: The purpose of this article was to review the experiences from the Department of Prosthodontics, Wuhan University School and Hospital of Stomatology (DP-WHUSHS) during the COVID-19 outbreak and the protocols DP-WHUSHS utilized to resume clinical activities after the outbreak. Material and methods: The descriptive approach was used in this article to provide a chronological narrative of the experiences and protocols from the DP-WHUSHS during the COVID-19 outbreak and after the outbreak. Results: During the COVID-19 outbreak period, clinical care was provided for patients with dental emergencies using enhanced Grade 2 or Garde 3 personal protective equipment (PPE). Teledentistry was used to provide care for patients with non-emergency needs. Online webinars and lectures were provided for the predoctoral students, residents, and dentists to minimize the interruption in their education and engage the dental community amid the pandemic. Various factors were considered before clinical activities resumed after the outbreak subsided. Additional resources were allocated for facility preparation and management and employee training. New infection control and clinical operation protocols were developed to minimize the healthcare-associated infection of airborne transmission diseases. The psychological health and mental wellness of the employees were emphasized. Distance or online education is still under rapid development to provide students and dentists opportunities to advance their knowledge amid the pandemic. Conclusions: Within the limitation of this descriptive review, the following conclusions were drawn. Patient welfare and emergency needs should be considered amid the pandemic. Enhanced Grade 2 or Grade 3 PPE should be used during the outbreak. Multifactorial considerations for work resumption after the outbreak included facility preparation and management, training for employees, and clinical operation management. In-person psychological consultation and online mental wellness programs were available to employees to improve their mental wellness. Distance or online education was under rapid development to minimize the interruption in education for the students and to engage the dental community amid a pandemic.
Curcumin—A Natural Medicament for Root Canal Disinfection: Effects of Irrigation, Drug Release, and Photoactivation
(Elsevier, 2019-11) Sotomil, Julian M.; Münchow, Eliseu A.; Pankajakshan, Divya; Spolnik, Kenneth J.; Ferreira, Jessica A.; Gregory, Richard L.; Bottino, Marco C.; Prosthodontics, School of Dentistry
Introduction Curcumin incorporation into polymeric fibers was tested for its antimicrobial properties and potential use in root canal disinfection. Methods Curcumin-modified fibers were processed via electrospinning and tested against a 7-day old established Actinomyces naeslundii (An) biofilm. The medicaments tested were as follows: curcumin-modified fibers at 2.5 and 5.0 mg/mL, curcumin-based irrigant at 2.5 and 5.0 mg/mL, saline solution (negative control), and the following positive controls: 2% chlorhexidine, 1% NaOCl, and triple antibiotic paste (TAP, 1 mg/mL). All medicaments, except for the positive controls, were allocated according to the light exposure protocol: photoactivation with an LED every 30 s for 4 min or without photoactivation. After treatment, the medicaments were removed and 1 mL of saline solution was added; the biofilm was scraped from the well and used to prepare a 1:2000 dilution. Spiral plating was done using anaerobic blood agar plates. After 24 h, colony-forming units (CFU/mL, n=11/group) were counted to determine the antimicrobial effects. Results Data exhibited significant antimicrobial effects on positive control groups, followed by the curcumin irrigants, and lastly, the photoactivated curcumin-modified fibers. There was a significant reduction of viable bacteria in curcumin-based irrigants, which was greater than the TAP-treated group. Curcumin-free fibers, saline, and the non-photoactivated curcumin-modified fibers did not display antimicrobial activity. Conclusions Curcumin seems to be a potential alternative to TAP when controlling infection, but it requires a minimal concentration (2.5 mg/mL) to be effective. Photoactivation of curcumin-based medicaments seems to be essential to obtain greater antibiofilm activity.
Delphi Project on the trends in Implant Dentistry in the COVID-19 era: Perspectives from Latin America
(Wiley, 2021) Alarcón, Marco Antonio; Sanz‐Sánchez, Ignacio; Shibli, Jamil Awad; Treviño Santos, Alejandro; Caram, Santiago; Lanis, Alejandro; Jiménez, Paola; Dueñas, Ricardo; Torres, Ronald; Alvarado, Jacinto; Avendaño, Adrián; Galindo, Roberto; Umanzor, Vilma; Shedden, Mónica; Invernizzi, Carlos; Yibrin, Caroll; Collins, James; León, Roberto; Contreras, Luis; Bueno, Luis; López‐Pacheco, Andrea; Málaga‐Figueroa, Lilian; Sanz, Mariano; Prosthodontics, School of Dentistry
Aim To establish trends in Implant Dentistry in Latin America in the COVID‐19 pandemic. Material and methods A steering committee and an advisory group of experts in Implant Dentistry were selected among eighteen countries. An open‐ended questionnaire by Delphi methodology was validated including 64 questions, divided in 7 topics, concerning the various trends in dental implantology. The survey was conducted in two rounds, which provided the participants in the second round with the results of the first. The questionnaires were completed on August 2020, and the online meeting conference was held on September 2020. The final prediction was developed through consensus by a selected group of experts. Results A total of 197 experts from Latin America answered the first and second questionnaire. In the first round, the established threshold for consensus (65%) was achieved in 30 questions (46.87%). In the second round, performed on average 45 days later, this level was achieved in 47 questions (73.43%). Consensus was completely reached on the item “Diagnostic” (100%), the field with the lowest consensus was “Demand for treatment with dental implants” (37.5%). Conclusions The present study in Latin America has provided relevant and useful information on the predictions in the education and practice of Implant Dentistry in the COVID‐19 era. The consensus points toward a great confidence of clinicians in the biosecurity protocols used to minimize the risk of SARS‐CoV‐2 transmission. It is foreseen as an important change in education, with introduction of virtual reality and other simulation technologies in implant training.

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