Faculty Bibliography

PURPOSE/OBJECTIVES/OBJECTIVE:The purpose of this study was to determine whether performance on a complex manual dexterity haptic test was associated with preclinical operative dentistry practical examination scores in handpiece naïve students. METHODS:Thirty-nine first-year pre-clinical operative dentistry students completed a 15-min complex manual dexterity exercise "D-circle" repeated eight times in succession before the beginning of the preclinical operative dentistry course. A composite haptic score was compared with students' subsequent preclinical operative examination performance and perceptual ability test scores. RESULTS:Mean accuracy scores on the haptic test increased, and failures decreased across the eight repetitions. Thirty students were successful at least twice in eight attempts, while nine failed all or all but one attempt. The group that failed all or all but one had lower mean scores on the first practical examination (Exam 1) (78.4 vs. 82.2, p = 0.23 Student's t-test), and 7.0 odds of failing the examination (confidence interval 0.95-51.4, p = 0.06). As a diagnostic predictor of pre-clinical operative dentistry performance, failing all, or all but one attempt at the haptic test had 60% sensitivity and 82% specificity as a predictor of failure on Exam 1. This resulted in correct classification of 79%. CONCLUSIONS:These data provide evidence for the first time that a complex manual dexterity test on a haptic simulator given to dental students was predictive of early pre-clinical success. These prospective results confirm previous retrospective studies and if replicated in larger cohorts may lead to improvements in the dental school admissions process.

BACKGROUND:In the absence of a full spectrum of evidence-based guidelines for the appropriate use of antimicrobial agents, dentists, including periodontists, remain a highly frequent antibiotic prescribing group. With the goal of understanding antibiotic prescribing practices, the authors surveyed a convenience sample of dental practitioners and periodontists to identify differences between the 2 cohorts and assess the factors that affect prescribing practices. METHODS:An institutional review board-approved 15-item survey was developed to capture antibiotic prescribing practices addressing the main research question, factors affecting systemic antibiotic prescription patterns, and prescription timing. The authors collaborated with the American Dental Association (ADA) and the American Academy of Periodontology (AAP) for survey dissemination. Responses were summarized using descriptive statistics. Multivariable models were developed to identify antibiotic prescription predictors. RESULTS:Overall, 32.4% of the participants prescribed systemic antibiotics with scaling and root planing. When comparing the 2 groups, the authors found that 46.4% and 18.7% of the AAP and ADA members, respectively, prescribed systemic antibiotics with scaling and root planing (P = .0001). The authors found a significant difference between the AAP and ADA groups in prescription timing (P = .01). The multivariable model revealed that practitioner sex (P = .03), AAP membership (P = .0001), and years of practitioner experience (P = .04) predicted antibiotic prescription practices. The geographic location, practice setting, and occupation type did not predict antibiotic prescription patterns. CONCLUSION:The authors found a lack of clarity related to prescription timing, factors determining prescription patterns, and selection of patient population who would benefit more from antibiotics. PRACTICAL IMPLICATIONS:This study confirmed a lack of clarity related to antibiotic prescription patterns in combination with nonsurgical periodontal treatment.

This case series demonstrates a surgical technique consisting of a digitally planned and guided placement of a bone ring allograft and implant in the anterior esthetic zone. Eight consecutive patients with horizontal and vertical defects in the anterior maxilla underwent augmentation with a commercially available bone ring allograft and simultaneous implant placement using two digital guides. After 6 to 8 months, implants were uncovered and restored with a screw-retained prosthesis. Follow-up periods ranged from 8 to 24 months. All eight implants met predefined success criteria with no adverse events. Radiographic measurements demonstrated stable peri-implant bone levels 1 year after implantation, with bone loss ranging from 0.0 to 1.4 mm. All patients were satisfied with the total treatment time, postsurgical healing, and final esthetic outcome. This case series describes a one-stage procedure in which a bone ring allograft and implant are simultaneously placed for treatment of a severely defective ridge in the anterior maxilla. The technique appears to be reliable for use in the esthetic zone, with minimal first-year loss of peri-implant bone. In combination with a digital guide, accurate implant and bone ring placement can be achieved, resulting in reduced chair time and fewer surgical procedures for the patient.

PURPOSE/OBJECTIVE:The increasing prevalence of obesity and/or metabolic syndrome (O/MS) and diabetes mellitus (DM) remains a global health concern. Clinically relevant and practical translational models mimicking human characteristics of these conditions are lacking. This study aimed to demonstrate proof of concept of the induction of stable O/MS and type 2 DM in a Göttingen minipig model and validate both of these disease-adjusted Göttingen minipig models as impaired healing models for the testing of dental implants. MATERIALS AND METHODS/METHODS:Nine minipigs were split into 3 groups-control (normal diet), obese (cafeteria diet), and diabetic (cafeteria diet plus streptozotocin)-followed by placement of dental implants. Inflammatory markers including tumor necrosis factor α, C-reactive protein, and cortisol were recorded for each study group. Removal torque was measured, and histomorphometric analysis (bone-to-implant contact and bone area fraction occupancy) was performed. RESULTS:O/MS pigs showed, on average, a 2-fold increase in plasma C-reactive protein (P < .05) and cortisol (P < .09) concentrations compared with controls; DM pigs showed, on average, a 40-fold increase in plasma tumor necrosis factor α levels (P < .05) and a 2-fold increase in cortisol concentrations (P < .05) compared with controls. The impact of O/MS and DM on implants was determined. The torque to interface failure was highest in the control group (200 N-cm) and significantly lower in the O/MS (90 N-cm) and DM (60 N-cm) groups (P < .01). Bone formation around implants was significantly greater in the control group than in the O/MS and DM groups (P < .02). CONCLUSIONS:Both O/MS and DM minipigs express a human-like disease phenotype, and both presented bone-healing impairment around dental implants. Our finding of no significant difference between type 2 DM and O/MS in bone formation around implants provides evidence that further investigation of the impact of O/MS is warranted.

The aim of this systematic review was to evaluate histomorphometric variables, the amount of new bone (NB), residual graft (RG) particles and soft tissue (ST), related to various grafting materials and assess the effect of graft healing time on different histomorphometric outcomes. Studies that were published before October 2015 were electronically and manually searched in three databases. We included human studies that reported the amount of NB, RG and ST in the biopsies taken from the grafted sinuses. Based on the applied grafting materials, extracted data were categorized into different groups. Furthermore, extracted data were classified into three groups based on healing time: (i) /= 9-13.5 mo. The search provided 791 titles. Full text analysis was performed for 258 articles resulting in 136 studies that met the inclusion criteria. Autogenous bone (AB) resulted in the highest amount of NB and lowest amount of RG compared to other grafting materials. Based on this meta-analysis, a significant difference was noticed in the amount of NB formation in grafts with a healing time of > 4.5 mo when compared to the grafts with less healing time. However, when comparing biopsies taken at 4.5-9 mo of healing (average = 6.22 mo) to the ones taken at >/= 9-13.5 mo (average = 10.36 mo), no significant difference was noticed in the amount of NB formation of various grafts except allografts that resulted in a significantly higher percentage of NB at 9.5 mo of healing. Based on histomorphometric analysis, AB results in the highest amount of NB formation in comparison to the other grafting materials. Bone substitute materials (allografts, alloplastic materials and xenografts) seem to be good alternatives to autogenous bone and can be considered as grafting materials to avoid disadvantages related to AB, including morbidity rate, limited availability and high volumetric change. Combining AB with alloplastic materials and xenografts brings no significant advantages regarding NB formation.

OBJECTIVE: Evaluate the effect of medications and medication changes during the Diabetes and Periodontal Therapy Trial (DPTT) on the primary study outcome, namely, change in hemoglobin A1c (HbA1c) at 6months following baseline. METHODS: The DPTT set strict criteria for changes in diabetes medications. Medication change was defined as: change in dose of any 1 oral hypoglycemic agent by more than two-fold, change in dose of insulin of >10% and/or addition or subtraction of an oral hypoglycemic agent, insulin or non-insulin injectable agents. Comparisons between the treatment (non- surgical periodontal therapy) and control (no therapy) groups used t-tests for continuous variables and chi-square tests for categorical variables, including DPTT defined diabetes medication changes between baseline (BL) and 3month visits and 3- and 6-month visits. Changes in HbA1c were compared across the four medication change categories using ANOVA models, overall and for each treatment group separately. RESULTS: Baseline medication use was similar between the treatment groups (p>0.40), as were medication changes between BL- 3month visits and 3 and 6month visits (p=0.58). Participants with higher BL HbA1c (>8%) and those taking insulin at BL were more likely to have a change in medication (p=0.03). CONCLUSIONS: The DPTT had the most rigorous definition of medication changes and medication monitoring of any trial in this field to date. The absence of a significant difference in medication changes between treatment groups may suggest that such changes did not play a role in the negative outcome of the DPTT.

BACKGROUND: We sought to evaluate: 1) effects of non-surgical periodontal treatment on serum biomarkers in persons with type 2 diabetes and chronic periodontitis who participated in the Diabetes and Periodontal Therapy Trial (DPTT); and 2) associations between diabetes markers, serum biomarkers, and periodontal measures in these patients. METHODS: DPTT participants who were randomized to receive immediate or delayed nonsurgical periodontal therapy were evaluated at baseline (BL) and six months. Serum samples from 475 participants with six-month data were analyzed for biomarkers [high sensitivity C-reactive protein (Hs-CRP), E-Selectin, tumor necrosis factor-alpha (TNF-alpha), vascular cell adhesion molecule (VCAM), interleukin-6 (IL-6), interleukin-8 (IL-8), intercellular adhesion molecule (ICAM), and interleukin-10 (IL-10)]. Changes in biomarker levels from BL and correlations between biomarker levels and clinical findings were analyzed. RESULTS: No differences between Treatment and Control Groups were observed for any biomarkers at BL or 6 months (p>0.05 for all variables). VCAM levels increased by an average (SD) of 17.9 (99.5), ng/mL (p= 0.006) and E-Selectin decreased by 2.33 (16.08) ng/mL (p=0.03) in the Treatment Group after six months. E-selectin levels were significantly correlated with diabetes-related variables [hemoglobin A1c (HbA1c) and Fasting Glucose] at BL and with six-month change in both Groups; no significant correlations were found between periodontal clinical parameters and serum biomarkers or diabetes related variables. Neither HbA1c or body mass index (BMI) varied during the study period in either Study Group. CONCLUSIONS: Non-surgical periodontal therapy and periodontal disease severity were not associated with significant changes in serum biomarkers in DPTT participants over the six-month follow-up. The correlations between changes in E-selectin, IL-6, and diabetes related variables suggest that diabetes mellitus may be the primary driver of systemic inflammation in these diabetic patients.

BACKGROUND: The aim of this pilot study was to test whether diagnostic agreement of aggressive and chronic periodontitis amongst Board Certified Periodontists, is influenced by knowledge of a patient's age. In 1999 at the International World Workshop age was removed as a diagnostic criteria for aggressive periodontitis. The impact of this change on the diagnostic reliability amongst clinicians has not yet been assessed. METHODS: Nine periodontal case reports were twice presented to sixteen board certified periodontists, once with age withheld and again with patient age provided. Participants were instructed to choose a diagnosis of Chronic Periodontitis or Aggressive Periodontitis. Diagnostic agreement was calculated using the Fleiss Kappa test. RESULTS: Including the patients' age in case report information increased diagnostic agreement (the kappa statistic) from 0.49 (moderate agreement) to 0.61 (substantial agreement). CONCLUSION: These results suggest that knowledge of a patients' age influenced clinical diagnosis, when distinguishing between aggressive periodontitis and chronic periodontitis, which may in turn impact treatment decision-making.

The treatment of infectious diseases affecting osseointegrated implants in function has become a demanding issue in implant dentistry. Since the early 1990s, preclinical data from animal studies have provided important insights into the etiology, pathogenesis and therapy of peri-implant diseases. Established lesions in animals have shown many features in common with those found in human biopsy material. The current review focuses on animal studies, employing different models to induce peri-implant mucositis and peri-implantitis.

BACKGROUND: Diabetes and its complications are a major United States public health concern. METHODS: The Diabetes and Periodontal Therapy Trial (DPTT) evaluated whether non-surgical treatment of periodontal disease influenced diabetes management among persons with Type 2 diabetes and periodontitis. The aim of this study was to evaluate DPTT's many recruitment strategies in terms of enrollment success. RESULTS/CONCLUSION: Targeted recruitment strategies were more effective in identifying individuals who met periodontal and diabetes eligibility criteria. Individuals eligible for a baseline visit/enrollment were more often male, had a younger age at diabetes diagnosis, a longer diabetes duration, more often Hispanic and less often African-American. Tracking and evaluating recruitment sources during study enrollment optimized recruitment methods to enroll a diverse participant population based upon gender, race and ethnicity.