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Item Long-Term Outcome of Autotransplantation of a Complete Root Formed a Mandibular Third Molar(Hindawi, 2021-11-27) Kimura, Hiroyuki; Hamada, Yusuke; Eida, Taro; Kumano, Tsuyoshi; Okamura, Kazutoshi; Yokota, Makoto; Periodontology, School of DentistryAutogenous tooth transplantation is a procedure to reposition an autogenous tooth to another extraction area or surgically created recipient site. The autotransplantation procedures have been documented well in the literature, and the survival rate of the transplanted teeth was reported to be more than 90% after ten years. Therefore, autotransplantation might have been overlooked as a treatment option. The purpose of this case report is to evaluate the long-term (29-year) success and periodontal stability of the tooth autotransplantation from the mandibular third molar to the second molar. A 24-year old female presented to a clinic with a large caries lesion with periapical radiolucnecy on to tooth #18. The tooth was extracted with the site and treated with autogenous tooth transplantation from #17 with a complete root form. Endodontic treatment was completed 3 months post autotransplantation; the final prosthesis was placed 6 months postoperatively. The patient has shown excellent oral hygiene care and high compliance with the regular maintenance recall program. The transplanted tooth has been still functioning without any symptoms. Radiographic and clinical examinations revealed stable periodontal and endodontic conditions over the 29 years after the procedure. This case report showed the long-term success of autotransplantation of the mandibular third molar with a closed root apex to the second molar site. Autotransplantation can be an option when an adequate donor site is available to reconstruct the occlusion after the tooth extraction.Item Graduate Periodontics Manual(2024) Gibson, MonicaItem Diagnostic efficacy of novel cephalometric parameters for the assessment of vertical skeletal dysplasia(Tabriz University of Medical Sciences, 2022) Gandhi, Kaveri Kranti; Rai, Anshu; Periodontology, School of DentistryBackground. An accurate diagnosis of vertical skeletal abnormalities presents several challenges. Specific cephalometric parameters can be effectively used for this purpose; however, the diagnostic accuracy of these parameters has not been entirely ascertained. This study examines the effectiveness of two novel cephalometric parameters for diagnosing vertical dysplasia. Methods. In this retrospective study, orthodontic patients were distributed into three study groups: average growth (AGG), horizontal growth (HGG), and vertical growth (VGG). The efficacies of the sum of angles (maxillary, mandibular, and ramal) and the height ratio (lower anterior facial height [LAFH]/upper anterior facial height [UAFH]) in identifying different growth patterns were examined. Receiver operating characteristic (ROC) curves were employed to assess the diagnostic precision quantitatively. Results. A total of 150 patients were included and divided equally among the three study groups. The ramal and mandibular angles varied across AGG, HGG, and VGG; however, the maxillary angle and the sum of these three angles did not vary significantly. There was a substantial variance in LAHF, UAHF, and their ratio in the three groups. The height ratio had 88% and 92% sensitivity to diagnose VGG and HGG, with cut-off values of 46 and 34, respectively (P<0.001). Conclusion. Height ratio values varied considerably depending on the facial growth patterns, suggesting its efficacy as a diagnostic tool for skeletal dysplasia, with greater reliability for positive treatment outcomes.Item Effects of IL-34 and anti-IL-34 neutralizing mAb on alveolar bone loss in a ligature-induced model of periodontitis(Wiley, 2023-10-30) Duarte, Carolina; Yamada, Chiaki; Ngala, Bidii; Garcia, Christopher; Akkaoui, Juliet; Birsa, Maxim; Ho, Anny; Nusbaum, Amilia; AlQallaf, Hawra; John, Vanchit; Movila, Alexandru; Periodontology, School of DentistryMacrophage colony-stimulating factor (M-CSF) and interleukin-34 (IL-34) are ligands for the colony-stimulating factor-1 receptor (CSF-1r) expressed on the surface of monocyte/macrophage lineage cells. The importance of coordinated signaling between M-CSF/receptor activator of the nuclear factor kappa-Β ligand (RANKL) in physiological and pathological bone remodeling and alveolar bone loss in response to oral bacterial colonization is well established. However, our knowledge about the IL-34/RANKL signaling in periodontal bone loss remains limited. Recently published cohort studies have demonstrated that the expression patterns of IL-34 are dramatically elevated in gingival crevicular fluid collected from patients with periodontitis. Therefore, the present study aims to evaluate the effects of IL-34 on osteoclastogenesis in vitro and in experimental ligature-mediated model of periodontitis using male mice. Our initial in vitro study demonstrated increased RANKL-induced osteoclastogenesis of IL-34-primed osteoclast precursors (OCPs) compared to M-CSF-primed OCPs. Using an experimental model of ligature-mediated periodontitis, we further demonstrated elevated expression of IL-34 in periodontal lesions. In contrast, M-CSF levels were dramatically reduced in these periodontal lesions. Furthermore, local injections of mouse recombinant IL-34 protein significantly elevated cathepsin K activity, increased the number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts and promoted alveolar bone loss in periodontitis lesions. In contrast, anti-IL-34 neutralizing monoclonal antibody significantly reduced the level of alveolar bone loss and the number of TRAP-positive osteoclasts in periodontitis lesions. No beneficial effects of locally injected anti-M-CSF neutralizing antibody were observed in periodontal lesions. This study illustrates the role of IL-34 in promoting alveolar bone loss in periodontal lesions and proposes the potential of anti-IL34 monoclonal antibody (mAb)-based therapeutic regimens to suppress alveolar bone loss in periodontitis lesions.Item The Oxidative Response of Human Monocytes to Surface Modified Commercially Pure Titanium(Frontiers Media, 2021-06-02) De Poi, Robert P.; Kowolik, Michael; Oshida, Yoshiki; El Kholy, Karim; Periodontology, School of DentistryCellular responses to implanted biomaterials are key to understanding osseointegration. The aim of this investigation was to determine the in vitro priming and activation of the respiratory burst activity of monocytes in response to surface-modified titanium. Human peripheral blood monocytes of healthy blood donors were separated, then incubated with surface-modified grade 2 commercially pure titanium (CPT) disks with a range of known surface energies and surface roughness for 30- or 60-min. Secondary stimulation by phorbol 12-myrisate 13-acetate (PMA) following the priming phase, and luminol-enhanced-chemiluminescence (LCL) was used to monitor oxygen-dependent activity. Comparison among groups was made by incubation time using one-way ANOVA. One sample from each group for each phase of the experiment was viewed under scanning electron microscopy (SEM) and qualitative comparisons made. The results indicate that titanium is capable of priming peripheral blood monocytes following 60-min incubation. In contrast, 30 min incubation time lead to reduced LCL on secondary stimulation as compared to cells alone. At both time intervals, the disk with the lowest surface energy produced significantly less LCL compared to other samples. SEM examination revealed differences in surface morphology at different time points but not between differently surface-modified disks. These results are consistent with the hypothesis that the titanium surface characteristics influenced the monocyte activity, which may be important in regulating the healing response to these materials.Item Periodontal diagnosis and treatment planning – An assessment of the understanding of the new classification system(Wiley, 2022-12) Kakar, Arushi; Blanchard, Steven; Shin, Daniel; Maupomé, Gerardo; Eckert, George J.; John, Vanchit; Periodontology, School of DentistryObjectives Substantial variations are seen among clinicians in the diagnosis and treatment planning of periodontal diseases. Accurate diagnosis and treatment planning are fundamental requirements for effective outcome-based patient care. The aim of this study was to evaluate the understanding of the American Academy of Periodontology and the European Federation of Periodontology 2017 periodontal disease classifications in diagnoses and treatment plans across four study groups. Methods The study recruited at least 20 participants in each of the four study groups. These included 1) Periodontal faculty and residents at Indiana University School of Dentistry (IUSD-PF) 2) IUSD general practice faculty (IUSD-GPF), 3) private practice periodontists (PPP), and 4) general practitioners (GP). The participants were provided with 10 HIPPA de-identified case records and a link to a survey. The survey comprised five demographic questions and two questions on diagnosis and treatment plan for each case along with a fixed list of responses. The responses were then compared against gold standards that were determined by a group of three board-certified periodontists. Results Overall, for diagnostic questions, GP (69%) were correct significantly less often than IUSD-PF (86%, p < 0.001), IUSD-GPF (79%, p = 0.002), and PPP (80%, p = 0.001). No significant differences (p > 0.05) in the overall correct treatment plan responses were found among the four groups (IUSD-PF: 69%, IUSD-GPF: 62%, PPP: 68%, and GP: 60%). The multi-rater kappas for with-in-group agreement on overall diagnosis ranged from 0.36 (GP) to 0.55 (IUSD-PF) and on overall treatment plan ranged from 0.32 (IUSD-GPF) to 0.42 (IUSD-PF). Overall agreement for diagnosis and treatment plans among the four groups was relatively low and none of the groups were statistically different from each other (p > 0.05). Conclusion Regular participation in calibration sessions may lead to more accurate adoption of the 2017 periodontal classification and thereby help provide consistent diagnosis and treatment.Item Investigating the Effects of Dehydrated Human Amnion-Chorion Membrane on Periodontal Healing(MDPI, 2022-06-20) Imamura, Kentaro; Hamada, Yusuke; Yoshida, Wataru; Murakami, Tasuku; Nakane-Koyachi, Saki; Yoshikawa, Kouki; Saito, Atsushi; Periodontology, School of DentistryEach growth factor (GF) has different effects and targets, and plays a critical role in periodontal healing. Dehydrated human amnion-chorion membrane (dHACM) contains various GFs and has been used to enhance wound healing. The purpose of this study was to evaluate the effects of dHACM on periodontal healing, using in vitro and in vivo experimental approaches. Standardized periodontal defects were created in rats. The defects were randomly divided into three groups: Unfilled, filled with hydroxypropyl cellulose (HPC), and dHACM+HPC. At 2 and 4 weeks postoperatively, periodontal healing was analyzed by microcomputed tomography (micro-CT), and histological and immunohistochemical analyses. In vitro, periodontal ligament-derived cells (PDLCs) isolated from rat incisors were incubated with dHACM extract. Cell proliferation and migration were evaluated by WST-1 and wound healing assay. In vivo, micro-CT examination at 2 weeks revealed enhanced formation of new bone in the dHACM+HPC group. At 4 weeks, the proportions of vascular endothelial growth factor (VEGF)-positive cells and α-smooth muscle actin (α-SMA)-positive blood vessels in the dHACM+HPC group were significantly greater than those in the Unfilled group. In vitro, dHACM extracts at 100 µg/mL significantly increased cell proliferation and migration compared with control. These findings suggest that GFs contained in dHACM promote proliferation and migration of PDLCs and angiogenesis, which lead to enhanced periodontal healing.Item Management of Recurrent Gummy Smile After 7 Years: A Case Report(2021) Yeh, Yu-Ting; Blanchard, Steven B.; Periodontology, School of DentistryEsthetic 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.Item 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 DentistryBackground: 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.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.