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Ghazal SS, Alshahry RM, Mills MP, Martin W, Aghaloo TL, Cochran DL. Bone-level Tapered Implants for Single Tooth Replacement. Immediate vs Delayed Placement: A Randomized, Controlled, Multi-center One-year No-inferiority Clinical Study. Int J Oral Maxillofac Implants 2024; 0:1-46. [PMID: 38607360 DOI: 10.11607/jomi.10504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
MATERIALS AND METHODS Post-market, prospective, randomized, controlled, multi-center study with a primary endpoint of one year. 53 subjects were randomized to receive either immediate implant placement (test group) or delayed implant placement (control group). The mean crestal bone-level changes from implant loading to 12 months post-implant loading were measured using standardized, digital periapical radiographs. Changes in facial plate thickness measured on cone-beam computed tomography (CBCT) images, implant success and survival, implant stability, soft tissue changes, patient-centered outcomes, and adverse effects were measured to assess outcomes between the test and control treatments at 12 months post-loading. RESULTS 46 subjects completed the study (23 in each group). Mean bone changes from loading to the 12 month follow-up were recorded with no statistically significant difference (p=0.950) between both groups. The hypothesis was confirmed that immediate implant placement (Test) in extraction sockets is similar to delayed placement (Control). The test group was found to be similar to the control group (P=0.022) in terms of mean changes in facial plate thickness. Implant survival and success were 95.8% in the test group and 92% in the control group. Stability in the control group was superior at the time of surgery, but there was no difference between both groups at implant loading, producing a non-significant p-value of (0.563). CONCLUSION This randomized, controlled, multi-center one-year study showed comparable outcomes 1-year after prosthetic loading in the immediate and delayed placement groups.
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Mungia R, Funkhouser E, Cochran DL, Cunha-Cruz J, Gordan VV, Rindal DB, Meyerowitz C, Allareddy V, Fellows JL, Gilbert GH. Recruitment strategies and retention rates for five National Dental PBRN studies. J Clin Transl Sci 2024; 8:e56. [PMID: 38617061 PMCID: PMC11010183 DOI: 10.1017/cts.2024.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Background We describe a retrospective assessment of practitioner and patient recruitment strategies, patient retention strategies, and rates for five clinical studies conducted in the National Dental Practice-Based Research Network between 2012 and 2019, and practitioner and patient characteristics associated with retention. Methods Similar recruitment strategies were adopted in the studies. The characteristics of the practitioners and patients are described. The proportion of patients who either attended a follow-up (FU) assessment or completed an online assessment was calculated. For studies with multiple FU visits or questionnaire assessments, rates for completing each FU were calculated, as were the rates for completing any and for completing all FU assessments. The associations of practitioner and patient characteristics with all clinic FU visits, and with the completion of all assessments for a study were ascertained. Results Overall, 591 practitioners and 12,159 patients were included. FU rates by patients for any assessment varied from 91% to 96.5%, and rates for participating in all assessments ranged from 68% to 87%. The mean total number of patients each practitioner recruited was 21 (sd = 15); the mean number per study was 13 (sd = 7). For practitioners, practice type and patient enrollment were associated with greater clinic retention, while only race was associated with their patients completing post-visit online assessments. For patients, age was associated with clinic retention, while female gender, age, race, and education were all associated with greater completion of post-visit online assessments. Conclusion The Network efficiently recruited practitioners and patients and achieved high patient retention rates for the five studies.
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Affiliation(s)
- Rahma Mungia
- Department of Periodontics, School of Dentistry, The
University of Texas Health San Antonio, San Antonio,
TX, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, School of Medicine,
University of Alabama at Birmingham, Birmingham,
AL, USA
| | - David L. Cochran
- Department of Periodontics, School of Dentistry, The
University of Texas Health San Antonio, San Antonio,
TX, USA
| | - Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry,
University of Alabama at Birmingham, Birmingham,
AL, USA
| | - Valeria V. Gordan
- Director of Practice-based Research and Associate Dean for Research,
University of Florida, College of Dentistry,
Gainesville, FL, USA
| | - Donald B. Rindal
- Associate Dental Director for Research, HealthPartners Dental Group,
HealthPartners Institute, Minneapolis,
MN, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester School of Medicine
and Dentistry, Rochester, NY,
USA
| | - Veerasathpurush Allareddy
- Brodie Craniofacial Endowed Chair, and Head of Department of Orthodontics,
University of Illinois Chicago College of Dentistry,
Chicago, IL, USA
| | | | - Gregg H. Gilbert
- Department of Clinical & Community Sciences, Distinguished Professor
and the James R. Rosen Chair of Dental Research Chair, School of Dentistry,
University of Alabama at Birmingham, Birmingham,
AL, USA
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3
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Cunha-Cruz J, Gilbert GH, Allareddy V, Cochran DL, Fellows J, Kopycka-Kedzierawski DT, McBurnie M, Meyerowitz C, Mungia R, Rindal DB, Gordan VV. Characteristics of dentists in the National Dental Practice-Based Research Network. J Dent 2023; 137:104653. [PMID: 37572986 PMCID: PMC10528504 DOI: 10.1016/j.jdent.2023.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures. METHODS Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics. RESULTS Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%). CONCLUSIONS Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients. CLINICAL SIGNIFICANCE Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States
| | - Veerasathpurush Allareddy
- University of Illinois Chicago College of Dentistry, 801 S. Paulina Street, Chicago, Illinois 60612, United States
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Jeffrey Fellows
- Center for Health Research, Kaiser Permanente, 3800N. Interstate Avenue, Portland, OR 97227-1098, United States
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, PO Box 683, Rochester, NY 14620, United States
| | - MaryAnn McBurnie
- Kaiser Permanente Center for Health Research, 3800N. Interstate Avenue, Portland, OR 97114, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester. 601 Elmwood Avenue, Box 686, Rochester, NY 14642, United States.
| | - Rahma Mungia
- Department of Periodontics, The University of Texas Health San Antonio, 8403 Floyd Curl Drive; MC 8258; Suite 300.29, San Antonio, TX 78229, United States
| | - D Brad Rindal
- HealthPartners Institute, HealthPartners Dental Group, 8170 33rd Avenue South | P.O. Box 1524, MS 21112R, Minneapolis MN 55440-1524, United States
| | - Valeria V Gordan
- University of Florida College of Dentistry, Restorative Dental Sciences Department, PO Box 100415, Gainesville FL 32610-0415, United States
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4
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Sugita R, Jones AA, Kotsakis GA, Cochran DL. Radiographic evaluation of a novel bone adhesive for maintenance of crestal bone around implants in canine oversized osteotomies. J Periodontol 2022; 93:924-932. [PMID: 34652825 DOI: 10.1002/jper.20-0876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND A novel bone adhesive (tetracalcium phosphate and O-phospho-L-serine) has been developed as an osteoconductive, biodegradable bone-adherent material. The purpose of this study was to evaluate the maintenance of crestal bone/material level by standardized radiographs. METHODS This was a randomized, controlled, three arm, prospective study. Twenty-six mixed breed hound dogs were included in this study. Three implants were placed on either side of the mandible with either bone adhesive (BA), bovine bone mineral (BBM), or no biomaterial (negative control [NC]). Standardized periapical radiographs were taken immediately after implant placement and at every month up to 1 year. The vertical distance between the implant platform to the first radiopaque material on both the mesial and distal surfaces were measured and crestal bone/material level changes were analyzed. RESULTS The crestal bone/material level adjacent to BA was stable and maintained throughout the study. There were statistically significant differences found between BA and NC in terms of maintenance of crestal bone levels at any given timepoint. CONCLUSION This study demonstrated that BA maintained crestal bone levels and had a similar ability to maintain that level over 1 year compared with BBM.
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Affiliation(s)
- Ryushiro Sugita
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Archie A Jones
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - Georgios A Kotsakis
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX
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5
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Albrektsson T, Tengvall P, Amengual-Peñafiel L, Coli P, Kotsakis G, Cochran DL. Implications of considering peri-implant bone loss a disease, a narrative review. Clin Implant Dent Relat Res 2022; 24:532-543. [PMID: 35639515 PMCID: PMC9542069 DOI: 10.1111/cid.13102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/16/2022]
Abstract
Background Peri‐implantitis has been suggested to cause significant increasing proportions of implant failure with increasing time. Purpose To assess whether implant failure rates in long term studies are matching the supposed high prevalence of peri‐implantitis. Material and Methods This paper is written as a narrative review of the long‐term clinical investigations available in the literature. Results Some implant systems have seen unacceptable marginal bone loss figures with time coupled to increased implant failure rates, resulting in the withdrawal of these systems. The reasons for such mishap are generally unknown, with the exception of one system failure that was found to be due to improper clinical handling. Modern, moderately rough implant systems have functioned excellently over 10–15 years of follow up with minor problems with marginal bone loss and implant failure rates within a few per cent. Machined implants have functioned adequately over 20–30 years of follow up. Implant failures occur predominantly during the first few years after implant placement. No significant increase of implant failures has been observed thereafter over 20–30 years of follow up. Over the years of our new millennium, scientific and technical advances have allowed the discovery of numerous molecular pathways and cellular interactions between the skeletal and immune system promoting the development of the interdisciplinary field called osteoimmunology. Nowadays, this knowledge has not only allowed the emergence of new etiologic paradigms for bone disease but also a new dynamic approach on the concept of osseointegration and MBL around oral implants, re‐evaluating our older disease oriented outlook. This facilitates at the same time the emergence of translational applications with immunological perspectives, scientific approaches based on omics sciences, and the beginning of an era of personalized dental implant therapy to improve the prognosis of oral implant treatment. Conclusions Oral implant systems have been found to function with very good clinical outcome over follow‐up times of 20–30 years. Registered implant failures have occurred predominantly during the first few years after implantation, and there has been no significant increase in late failures due to peri‐implantitis.
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Affiliation(s)
- Tomas Albrektsson
- Department of Biomaterials, Institute Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pentti Tengvall
- Department of Biomaterials, Institute Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Pierluigi Coli
- Specialist in Periodontics and Prosthodontics, Edinburgh Dental Specialists, Edinburgh, UK.,Department of Prosthetic Dentistry/Dental Material Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Georgios Kotsakis
- Department of Prosthetic Dentistry/Dental Material Science, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - David L Cochran
- Department of Periodontology, University of Texas, San Antonio, USA
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6
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Cochran DL, Jones AA, Sugita R, Brown MC, Prasad H, Kay GW. Twelve Month Evaluation of a Novel Mineral Organic Adhesive Material Used to Stabilize Dental Implants Placed in Oversized Osteotomies in Vivo in an Animal Model. Clin Oral Implants Res 2022; 33:391-404. [PMID: 35132693 DOI: 10.1111/clr.13899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/16/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate long-term in vivo stability of dental implants stabilized at time of placement in oversized osteotomies with a novel, self-setting, mineral-organic bone adhesive. MATERIALS/METHODS Canine (26) mandibular teeth were removed, and 3 oversized osteotomies prepared bilaterally. Implants were placed with either adhesive, particulate xenograft or with blood clot filling the implant/osteotomy gaps. Removal torque and histology were assessed. RESULTS The adhesive provided significant and clinically relevant immediate implant stability of 22.2N-cm (95%CI 5.3; 39.0) which continued throughout the early postoperative course and persisted through the nine- (155N-cm 95%CI 113; 197) and twelve-month (171N-cm 95%CI 134.2; 209.4) time points. This is in comparison to the blood clot of 1.4N-cm (95%CI 0.7; 2.1), 128.6N-cm (95%CI 66.8; 190.4), and 140.7N-cm (95%CI 78.8; 202.5) and particulate xenograft, 1.3N-cm (95%CI 0.6; 2.0), 132.1N-cm (95%CI 94.5; 169.7), and 101.5 (95%CI 59.5; 143.5) respectively. Histological examination shows the adhesive establishes intimate contact with the implant and bony walls and is replaced with new bone without compromising stability. Soft tissue does not penetrate the adhesive and marginal bone/biomaterial level is maintained. Control sites filled with xenograft or blood clot heal with reduced bone levels and, in some cases, xenograft particles were encapsulated in connective tissue. CONCLUSIONS Implants placed in oversized osteotomies and lacking primary stability can be stabilized at placement with a novel, highly osteoconductive and resorbable adhesive. Gradual replacement of the biomaterial allows osseointegration without loss of stability through 12 months of follow-up. This novel adhesive has the potential to stabilize implants placed in sites with inadequate bony support.
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Affiliation(s)
- David L Cochran
- Department of Periodontics, UT Health Science Center, San Antonio, TX, USA
| | - Archie A Jones
- Department of Periodontics, UT Health Science Center, San Antonio, TX, USA
| | - Ryushiro Sugita
- Department of Periodontics, UT Health Science Center, San Antonio, TX, USA
| | | | - Hari Prasad
- Hard Tissue Research Laboratory, University of Minnesota, Minneapolis, Minnesota, USA
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7
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Gilbert GH, Allen GJ, Burton VA, Calnon WR, Cochran DL, Fellows JL, Gordan VV, Meyerowitz C, Rindal DB. Addressing Knowledge Gaps. J Am Dent Assoc 2021; 152:258-259. [PMID: 33775284 DOI: 10.1016/j.adaj.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gregg H Gilbert
- Distinguished Professor and Chair, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | | | - Vanessa A Burton
- Chief of Professional Services, HealthPartners Dental Group, Minneapolis, MN
| | - William R Calnon
- Clinical Professor of Dentistry, University of Rochester Medical Center, Rochester, NY; General Dentistry Private Practice, Rochester, NY
| | - David L Cochran
- Professor and Chair, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jeffrey L Fellows
- Senior Investigator, Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - Valeria V Gordan
- Professor, Interim Associate Dean for Research, College of Dentistry, University of Florida, Gainesville, FL
| | - Cyril Meyerowitz
- Professor, University of Rochester Medical Center, Rochester, NY
| | - D Brad Rindal
- Senior Investigator, HealthPartners Dental Group and HealthPartners Institute, Minneapolis, MN
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8
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Huang RY, Hsiao PY, Mau LP, Tsai YWC, Cochran DL, Weng PW, Cheng WC, Chung CH, Huang YC. Synthesis and Characterization of Melatonin-Loaded Chitosan Microparticles Promote Differentiation and Mineralization in Preosteoblastic Cells. J ORAL IMPLANTOL 2020; 46:562-570. [PMID: 32838427 DOI: 10.1563/aaid-joi-d-19-00208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In terms of a novel scaffold with well good osteoinductive and osteoconductive capacity, melatonin (Mel) possesses positive effects on chemical linkage in scaffold structures, which may allow osteogenic differentiation. The aim of this study is to fabricate Mel-loaded chitosan (CS) microparticles (MPs) as a novel bone substitute through generating a Mel sustained release system from Mel-loaded CS MPs and evaluating its effect on the osteogenic capacity of MC3T3-E1 in vitro. The physical-chemical characteristics of the prepared CS MPs were examined by both Fourier transform infrared spectroscopy and scanning electron microscopy. The released profile and kinetics of Mel from MPs were quantified, and the bioactivity of the released Mel on preosteoblastic MC3T3-E1 cells was characterized in vitro. An in vitro drug release assay has shown high encapsulation efficiency and sustained release of Mel over the investigation period. In an osteogenesis assay, Mel-loaded CS MPs have significantly enhanced alkaline phosphatase (ALP) mRNA expression and ALP activity compared with the control group. Meanwhile, the osteoblast-specific differentiation genes, including runt related transcription factor 2 (Runx2), bone morphogentic protein-2 (Bmp2), collagen I (Col I), and osteocalcin (Ocn), were also significantly upregulated. Furthermore, quantificational alizarin red-based assay demonstrated that Mel-loaded CS MPs notably enhanced the calcium deposit of MC3T3-E1 compared with controls. In essence, Mel-loaded CS MPs can control the release of Mel for a period of time to accelerate osteogenic differentiation of preosteoblast cells in vitro.
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Affiliation(s)
- Ren-Yeong Huang
- School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Po-Yan Hsiao
- Graduate of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Lian-Ping Mau
- Department of Periodontics, Chi Mei Medical Center, Tainan, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Wen Cathy Tsai
- School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - David L Cochran
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | - Pei-Wei Weng
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wan-Chien Cheng
- School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Cheng Huang
- Department of Food Science, College of Life Science, National Taiwan Ocean University, Keelung, Taiwan
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Chang PC, Luo HT, Lin ZJ, Tai WC, Chang CH, Chang YC, Cochran DL, Chen MH. Regeneration of critical-sized mandibular defect using a 3D-printed hydroxyapatite-based scaffold: An exploratory study. J Periodontol 2020; 92:428-435. [PMID: 32761906 DOI: 10.1002/jper.20-0110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing has become an available technology to fabricate customized tissue engineering scaffolds with delicate architecture. This exploratory study aimed to evaluate the potential of a 3D-printed hydroxyapatite-based scaffold as a biomaterial for obtaining guided bone regeneration (GBR) in vivo. METHODS Scaffolds composed of 90% hydroxyapatite and 10% poly(lactic-co-glycolic acid) were printed using a microextrusion process to fit 4 mm diameter and 0.5 mm thick through-and-through osseous defects on the mandibular ramus of rats, with unfilled defects serving as controls. Specimens were analyzed for regeneration-associated gene expression on day 7, and micro-computed tomography (micro-CT) and histology assessments were carried out on day 28. RESULTS The scaffolds were 3.56 ± 0.43 mm (x-axis) and 4.02 ± 0.44 mm (y-axis) in diameter and 0.542 ± 0.035 mm thick (z-axis), with a mean pore size of 0.420 ± 0.028 × 0.328 ± 0.005 mm2 . Most scaffolds fit the defects well. Type I collagen, VEGF, and Cbfa1 were upregulated in the scaffold-treated defects by day 7. By day 28, de novo osteogenesis and scaffold-tissue integration were evident in the scaffold-treated defects, and entire mineralized tissue, as well as newly formed bone, was significantly promoted, as seen in the micro-CT and histologic analyses. CONCLUSION The 3D-printed hydroxyapatite-based scaffold showed acceptable dimensional stability and demonstrated favorable osteoregenerative capability that fulfilled the need for GBR.
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Affiliation(s)
- Po-Chun Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.,School of Denstistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Ting Luo
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Division of Periodontics, Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Zhi-Jie Lin
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Wei-Chiu Tai
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Ching-He Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - Ying-Chieh Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
| | - David L Cochran
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Min-Huey Chen
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan
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10
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Boller LA, Jones AA, Cochran DL, Guelcher SA. Compression-Resistant Polymer/Ceramic Composite Scaffolds Augmented with rhBMP-2 Promote New Bone Formation in a Nonhuman Primate Mandibular Ridge Augmentation Model. Int J Oral Maxillofac Implants 2020; 35:616-624. [PMID: 32406661 DOI: 10.11607/jomi.7877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE This study was designed to test the hypothesis that compression-resistant (CR) scaffolds augmented with recombinant human bone morphogenetic protein-2 (rhBMP-2) at clinically relevant doses in a nonhuman primate lateral ridge augmentation model enhances bone formation in a dose-responsive manner without additional protective membranes. MATERIALS AND METHODS Defects (15 mm long × 8 mm wide × 5 mm deep) were created bilaterally in the mandibles of nine hamadryas baboons. The defect sites were implanted with poly(ester urethane) (PEUR)/ceramic CR scaffolds augmented with 0 mg/mL rhBMP-2 (CR control), 0.75 mg/mL rhBMP-2 (CR-L), or 1.5 mg/mL rhBMP-2 (CR-H). The primary outcome of ridge width and secondary outcomes of new bone formation, cellular infiltration, and integration with host bone were evaluated using histology, histomorphometry, and microcomputed tomography (micro-CT) at 16 weeks following implantation. RESULTS New bone formation in the mandible was observed in a dose-responsive manner. CR-H promoted significantly greater new bone formation compared with the CR control group. In all groups, ridge width was maintained without an additional protective membrane. CONCLUSION CR scaffolds augmented with a clinically relevant dose of rhBMP-2 (1.5 mg/mL) promoted significant new bone formation. These results suggest that a CR PEUR/ceramic composite scaffold without a protective membrane may be a potential new rhBMP-2 carrier for clinical use.
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11
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Refai AK, Cochran DL. Harnessing Omics Sciences and Biotechnologies in Understanding Osseointegration- Personalized Dental Implant Therapy. Int J Oral Maxillofac Implants 2020; 35:e27-e39. [PMID: 32406647 DOI: 10.11607/jomi.7272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A number of significant advances (omics and bioengineering) now enable seamless stratification of patients according to their individual genotypes. This allows for more precise diagnoses coupled with patient phenotypes and improved treatment planning and predictable outcomes. Collectively, these advances are designated as "personalized dental medicine." To become an essential part of personalized dental medicine, this term will have a robust impact on dental implant practice. This narrative review elucidates the importance of utilizing advanced bioengineering techniques and biotechnologies in the realm of dental implants, aiming to understand gene expression profiles controlling endosseous wound healing and promoting bone formation. Thus, the first objective of the review was to present the state of the art of conceptualizing osseointegration as a phenomenon. The second objective was to pave the way for personalized dental implant therapy and to introduce "implantogenomics" for the first time.
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12
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Oeschger CE, Bosshardt DD, Roehling S, Gahlert M, Cochran DL, Janner SFM. Crestal bone response to loaded zirconia and titanium implants: a radiographic and histometric analysis in canines. Clin Oral Investig 2020; 24:3609-3617. [PMID: 32034546 DOI: 10.1007/s00784-020-03235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the crestal bone response to a two-piece zirconia implant compared with a control titanium implant using periapical radiographs (PAs) and histometry. MATERIALS AND METHODS Thirty zirconia and 30 titanium implants were placed in healed posterior mandibles of five canines. Full-ceramic single-tooth restorations were cemented after 6 weeks of healing. Three observers measured the distance between the implant shoulder and the crestal bone (DIB) at placement, loading, and harvesting after 4 or 16 weeks in function. The influence of implant material and loading time on DIB as well as the inter-observer agreement were analyzed. Additionally, histometric distance between implant shoulder and most coronal bone-to-implant contact (IS-cBIC) was compared with DIB. RESULTS Mean DIB values increased between 4 and 16 weeks of loading for both zirconia (from 1.66 to 2.25 mm; P < 0.0001) and titanium (from 1.81 to 1.95 mm; P = 0.06). Zirconia yielded mean IS-cBIC values of 2.18 mm and 2.48 mm (P < 0.001) and titanium 2.23 mm and 2.34 mm (P = 0.27) after 4 and 16 weeks, respectively. The raters reached an excellent intraclass correlation coefficient. PAs underestimated the bone loss on average by 0.39 mm. CONCLUSIONS Zirconia implants showed a greater increase of DIB during early healing and function than titanium. CLINICAL RELEVANCE Crestal peri-implant tissue dimensions may show more pronounced changes around two-piece zirconia implants during early healing. PAs may underestimate peri-implant bone loss.
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Affiliation(s)
- Corinne E Oeschger
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.,Private Practice, Solothurn, Switzerland
| | - Dieter D Bosshardt
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Stefan Roehling
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Private Dental Clinic Prof. Gahlert and Dr. Röhling, Munich, Germany
| | - Michael Gahlert
- Private Dental Clinic Prof. Gahlert and Dr. Röhling, Munich, Germany.,Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland.,Department for Oral Surgery, Faculty of Medicine at the Sigmund Freud University Vienna, Vienna, Austria
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Simone F M Janner
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland. .,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
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13
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Garrett PW, Johnston GW, Bosshardt DD, Jones AA, Sasada Y, Ong JL, Cochran DL. Hard and soft tissue evaluation of titanium dental implants and abutments with nanotubes in canines. J Periodontol 2019; 91:516-523. [PMID: 31490010 DOI: 10.1002/jper.18-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Little is known regarding the interaction of dental implant surface nanotubes and oral soft and hard tissues. The purpose of this study was to evaluate both histologically and radiographically the qualitative and quantitative effects of dental implant surface nanotubes on hard and soft tissue in a canine model. METHODS Three subgroups consisting of a combination of test and control implants and abutments (Group A: control implant/control abutment, Group B: control implant/test abutment: Group C: test implant/test abutment) were placed in edentulous mandibles of six large-breed canines. Implants and abutments were placed on one side at baseline, and on the opposite side of the mandible at week 10; sacrifice occurred at week 12. Quantitative and qualitative analyses were used to measure newly formed hard and soft tissues histologically and radiographically. RESULTS The mean radiographic change in marginal bone level from weeks 0 to 12 between implant groups was not statistically significant (P > 0.05). Mean soft tissue contact (junctional epithelium + connective tissue) for Groups A, B, and C were 2.29, 2.33, and 2.31 mm, respectively, with no statistically significant difference (P > 0.05) between the groups. All connective tissue fibers were oriented parallel to the abutment regardless of surface treatment. CONCLUSIONS The findings of this study suggest that healing of hard and soft tissues around implants and abutments is similar when comparing grit-blasted surfaces to machined, turned surfaces with nanotubes. Both resulted in similar soft tissue contact values, as well as connective tissue fiber orientation.
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Affiliation(s)
- Phillip W Garrett
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | | | - Dieter D Bosshardt
- Robert K. Schenk Laboratory of Oral Histology, University of Bern, Bern, Switzerland
| | - Archie A Jones
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Yuya Sasada
- Funakoshi Research Institute of Clinical Periodontology, Fukuoka, Japan
| | - Joo L Ong
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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Huynh‐Ba G, Hoders AB, Meister DJ, Prihoda TJ, Mills MP, Mealey BL, Cochran DL. Esthetic, clinical, and radiographic outcomes of two surgical approaches for single implant in the esthetic area: 1‐year results of a randomized controlled trial with parallel design. Clin Oral Implants Res 2019; 30:745-759. [DOI: 10.1111/clr.13458] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/18/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Guy Huynh‐Ba
- Department of Periodontics University of Texas Health Science Center at San Antonio San Antonio Texas
| | | | | | - Thomas J. Prihoda
- Department of Pathology University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Michael P. Mills
- Department of Periodontics University of Texas Health Science Center at San Antonio San Antonio Texas
| | - Brian L. Mealey
- Department of Periodontics University of Texas Health Science Center at San Antonio San Antonio Texas
| | - David L. Cochran
- Department of Periodontics University of Texas Health Science Center at San Antonio San Antonio Texas
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15
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Gilbert GH, Cochran DL, Fellows JL, Gordan VV, Makhija SK, Meyerowitz C, Rindal DB. Engaging clinicians in research. J Am Dent Assoc 2018; 149:1007-1008. [DOI: 10.1016/j.adaj.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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McCauley JL, Gilbert GH, Cochran DL, Gordan VV, Leite RS, Fillingim RB, Brady KT. Prescription Drug Monitoring Program Use: National Dental PBRN Results. JDR Clin Trans Res 2018; 4:178-186. [PMID: 30931705 DOI: 10.1177/2380084418808517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The American Dental Association recommends that dentists use a prescription drug monitoring program (PDMP) prior to prescribing an opioid for acute pain management. OBJECTIVE The objective of this study was to examine dentists' experiences using their state PDMP, as well as the impact that state-mandated registration policies, mandated use policies, and practice characteristics had on the frequency with which dentists used their PDMP. METHODS We conducted a web-based cross-sectional survey among practicing dentist members of the National Dental Practice-Based Research Network ( n = 805). The survey assessed prescribing practices for pain management and implementation of risk mitigation strategies, including PDMP use. Survey data were linked with network Enrollment Questionnaire data to include practitioner demographics and practice characteristics. RESULTS Nearly half of respondents ( n = 375, 46.6%) reported having never accessed a PDMP, with the most common reasons for nonaccess being lack of awareness ( n = 214, 57.1%) and lack of knowledge regarding registration and use ( n = 94, 25.1%). The majority of PDMP users reported the program to be very helpful (58.1%) or somewhat helpful (31.6%). Dentists reported that PDMP use most often did not change their intended prescribing behavior (40.2%), led them not to prescribe an opioid (33.5%), or led them to prescribe fewer opioid doses (25.5%). Presence of a mandated use policy was significantly associated with increased frequency of PDMP use across a variety of situations, including prior to 1) prescribing any opioid for pain management, 2) issuing refills, 3) prescribing to new patients, and 4) prescribing to patients deemed high risk. CONCLUSION Findings suggest that the majority of dentists find PDMPs helpful in informing their opioid-prescribing practices. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study. KNOWLEDGE TRANSFER STATEMENT Findings from this national survey suggest that the majority of practicing dentists find PDMPs helpful in informing their opioid-prescribing practices; however, consistent PDMP use was not common. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.
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Affiliation(s)
- J L McCauley
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - G H Gilbert
- 2 Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - D L Cochran
- 3 Department of Periodontics, UT Health San Antonio, San Antonio, USA
| | - V V Gordan
- 4 Department of Restorative Dental Sciences, University of Florida, Gainesville, FL, USA
| | - R S Leite
- 5 Department of Stomatology, Medical University of South Carolina, Charleston, SC, USA
| | - R B Fillingim
- 6 Department of Restorative Dental Sciences, University of Florida, USA
| | - K T Brady
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,7 Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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- 8 National Dental PBRN Collaborative Group, which includes practitioner, faculty, and staff investigators who contributed to this activity ( http://nationaldentalpbrn.org/collaborative-group.php )
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Tallarico M, Canullo L, Wang HL, Cochran DL, Meloni SM. Classification Systems for Peri-implantitis: A Narrative Review with a Proposal of a New Evidence-Based Etiology Codification. Int J Oral Maxillofac Implants 2018; 33:871-879. [PMID: 30025004 DOI: 10.11607/jomi.6242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To present the different definitions of peri-implantitis proposed in the literature and to propose a new evidence-based etiology-driven classification of peri-implantitis to accurately and fully describe the etiology of peri-implantitis. MATERIALS AND METHODS Full-text papers on the selected topic were obtained for all abstracts and titles that appeared to meet the inclusion criteria. Additional papers were included from the reference lists of the selected studies. No methodologic and reporting quality of the included papers was applied in order to collect the greatest number of articles. RESULTS One hundred twenty-two studies were found according to the search criteria. After filter activation, abstract evaluation, and duplicate removal, 16 articles were deemed useful for the aim of the present narrative review. A manual search using personal contact and references of published works and contributions by the authors included another 16 articles, resulting in a total of 32 articles. After full-text article selection and reading, 15 articles were finally included. CONCLUSION There is not a generally accepted classification system of the various degrees of peri-implantitis. An etiology-driven classification was proposed as a tool to assist the clinician in properly detecting and classifying etiology-based peri-implantitis. This classification may also support the assignment of prognosis, and if needed, therapy to arrest/prevent peri-implantitis.
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18
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Berger MB, Cohen DJ, Olivares-Navarrete R, Williams JK, Cochran DL, Boyan BD, Schwartz Z. Human osteoblasts exhibit sexual dimorphism in their response to estrogen on microstructured titanium surfaces. Biol Sex Differ 2018; 9:30. [PMID: 29970177 PMCID: PMC6029108 DOI: 10.1186/s13293-018-0190-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/25/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Osseointegration is dependent on the implant surface, surrounding bone quality, and the systemic host environment, which can differ in male and female patients. Titanium (Ti) implants with microstructured surfaces exhibit greater pullout strength when compared to smooth-surfaced implants and exhibit enhanced osteogenic cellular responses in vitro. Previous studies showed that 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3] has a greater effect on rat osteoblast differentiation on microstructured Ti compared to smooth Ti surfaces and tissue culture polystyrene (TCPS). The stimulatory effect of 17β-estradiol (E2) on differentiation is observed in female osteoblasts on micro-rough Ti, but it is not known if male osteoblasts behave similarly in response to E2 and microtopography. This study assessed whether human male and female osteoblasts exhibit sex-specific differences in response to E2 and 1α,25(OH)2D3 when cultured on microstructured Ti surfaces. METHODS Osteoblasts from three male and three female human donors were cultured on Ti discs with varying surface profiles: a smooth pretreatment (PT), a coarse grit-blasted/acid-etched (SLA), and an SLA surface having undergone modification in a nitrogen environment and stored in saline to maintain hydrophilicity (modSLA). Cells cultured on these surfaces were treated with E2 or 1α,25(OH)2D3. RESULTS Male and female human osteoblasts responded similarly to microstructure although there were donor-specific differences; cell number decreased, and osteocalcin (OCN), osteoprotegerin (OPG), and latent and active transforming growth factor 1 increased on SLA and modSLA compared to TCPS. Female osteoblasts had higher alkaline phosphatase activity and OCN production than male counterparts but produced less OPG. Both sexes responded similarly to 1α,25(OH)2D3. E2 treatment reduced cell number and increased osteoblast differentiation and factor production only in female cells. CONCLUSIONS Male and female human osteoblasts respond similarly to microstructure and 1α,25(OH)2D3 but exhibit sexual dimorphism in substrate-dependent responses to E2. E2 affected female osteoblasts, suggesting that signaling is sex-specific and surface-dependent. Donor osteoblasts varied in response, demonstrating the need to test multiple donors when examining human samples. Understanding how male and female cells respond to orthopedic biomaterials will enable greater predictability post-implantation as well as therapies that are more patient-specific.
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Affiliation(s)
- Michael B Berger
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284-3068, USA
| | - David J Cohen
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284-3068, USA
| | - Rene Olivares-Navarrete
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284-3068, USA
| | | | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284-3068, USA. .,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
| | - Zvi Schwartz
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, 601 West Main Street, Richmond, VA, 23284-3068, USA.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
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19
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Alkan EA, Mau LP, Schoolfield J, Guest GF, Cochran DL. Prevalence of Dental Implants and Evaluation of Peri-implant Bone Levels in Patients Presenting to a Dental School: A Radiographic Cross-Sectional 2-Year Study. Int J Oral Maxillofac Implants 2018; 33:145-151. [PMID: 29340349 DOI: 10.11607/jomi.5756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the number of patients with dental implants who present to a dental school clinic for screening and to report the prevalence of peri-implant bone level change detected on digital panoramic radiographs of those subjects. MATERIALS AND METHODS Patient screening files for 9,422 patients over a 2-year period were examined to see how many patients presented with dental implants. Those patients with at least one implant were further evaluated by measuring the bone level on the mesial and distal sides of the implant using the screening radiograph. RESULTS A total of 187 patients (2%) had at least one implant. In regard to implants, 423 were examined and 146 (33%) had no detectable bone loss defined as bone level below the top of the implant. When thresholds of bone loss were evaluated, 109 implants (25%) had ≥ 2 mm of bone loss on either the mesial or distal sides or both. The median bone loss was 1.74 mm for the 277 implants with detectable bone loss and 2.97 mm for the 109 implants that had ≥ 2 mm bone loss. Interestingly, patients who were ≥ 70 years of age had significantly (P = .03) more bone loss in the mandible compared with the maxilla, while patients who were 60 to 69 years of age had significantly greater loss in the maxilla. CONCLUSION These data reveal that for patients presenting to the dental school for a screening over a 2-year period, 1.98% had one or more dental implants. Furthermore, those patients with implants had a minimum amount of bone loss as measured from the top of the implant.
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20
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Sasada Y, Cochran DL. Implant-Abutment Connections: A Review of Biologic Consequences and Peri-implantitis Implications. Int J Oral Maxillofac Implants 2018; 32:1296-1307. [PMID: 29140374 DOI: 10.11607/jomi.5732] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clinicians very often have seen marginal bone loss around dental implants at the crest level early on after implant placement and uncovering. Early clinical publications had suggested that this bone loss occurred during the first year of loading. Thus, numerous attempts have been made to minimize or eliminate such bone loss. However, the timing and reason for this bone loss are not always apparent. The objective of this study was to review the evidence regarding marginal bone loss around dental implants from the standpoint of biologic consequences to help understand marginal bone changes around dental implants. One hypothesis for the bone loss around these implants was related to the presence of bacteria in the interfaces between the implant and abutment connections. The literature was reviewed regarding the three major types of implant-abutment crestal connections, including butt-joint, platform-switched, and no interface (tissue-level or one-body). This review article revealed that 1.5 to 2.0 mm of bone loss occurred around bone-level, butt-joint connections when the interface was created because the microgap was wide enough for penetration and colonization of bacteria, and that this bone loss was not observed around implants with no interface because they did not have a contaminated interface at the bone crest. Many studies have shown an advantage in the amount of marginal bone resorption for implants with a platform-switched connection, and there appears to be a significantly different biologic reaction. Recent publications indicate that such contaminated implant-abutment connections might have an effect on peri-implantitis and failure over time.
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21
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Talley AD, Boller LA, Kalpakci KN, Shimko DA, Cochran DL, Guelcher SA. Injectable, compression-resistant polymer/ceramic composite bone grafts promote lateral ridge augmentation without protective mesh in a canine model. Clin Oral Implants Res 2018; 29:592-602. [PMID: 30240051 DOI: 10.1111/clr.13257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to test the hypothesis that a compression-resistant bone graft augmented with recombinant human morphogenetic protein-2 (rhBMP-2) will promote lateral ridge augmentation without the use of protective mesh in a canine model. MATERIALS & METHODS Compression-resistant (CR) bone grafts were evaluated in a canine model of lateral ridge augmentation. Bilateral, right trapezoidal prism-shaped defects (13-14 mm long × 8-9 mm wide × 3-4 mm deep at the base) in 13 hounds (two defects per hound) were treated with one of four groups: (i) absorbable collagen sponge + 400 μg rhBMP-2/ml (ACS, clinical control) protected by titanium mesh, (ii) CR without rhBMP-2 (CR, negative control), (iii) CR + 200 μg rhBMP-2 (CR-L), or (iv) CR + 400 μg rhBMP-2 (CR-H). All animals were euthanized after 16 weeks. Ridge height and width and new bone formation were assessed by μCT, histology, and histomorphometry. The release kinetics of rhBMP-2 from CR bone grafts in vitro and in vivo in a femoral condyle defect model in rabbits was also evaluated. RESULTS All four bone grafts promoted new bone formation (11-31.6 volume%) in the lateral ridge defects. For CR grafts, ridge height and width increased in a dose-responsive manner with increasing rhBMP-2 concentration. Ridge height and width measured for CR-H without the use of protective mesh was comparable to that measured for ACS with a protective mesh. CONCLUSIONS At the same dose of rhBMP-2, an injectable, compression-resistant bone graft resulted in a comparable volume of new bone formation with the clinical control (ACS). These findings highlight the potential of compression-resistant bone grafts without the use of protective mesh for lateral ridge augmentation.
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Affiliation(s)
- Anne D Talley
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, Tennessee
| | - Lauren A Boller
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee
| | | | | | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Scott A Guelcher
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee.,Center for Bone Biology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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22
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Alkan Ö, Kaya Y, Alkan EA, Keskin S, Cochran DL. Assessment of Gingival Biotype and Keratinized Gingival Width of Maxillary Anterior Region in Individuals with Different Types of Malocclusion. Turk J Orthod 2018; 31:13-20. [PMID: 30112508 DOI: 10.5152/turkjorthod.2018.17028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022]
Abstract
Objective The aim of the present study is to evaluate the relationship of gingival thickness and width of keratinized gingiva with different malocclusion groups and amount of crowding. Methods A total of 181 periodontally healthy subjects were enrolled in the present study. The study participants were divided into three malocclusion groups: Angle Class I, Angle Class II, and Angle Class III. Each group was divided into subgroups according to the amount of dental crowding, namely mild, moderate, and severe. The width of keratinized gingiva was calculated as the distance between mucogingival junction and free gingival margin, whereas gingival thickness was determined by a transgingival probing technique. Results Tooth numbers 13 and 23 were observed to have thin gingival biotype. The width of keratinized gingiva for tooth numbers 13 and 23 was narrower in the severe crowding group than in the moderate and mild crowding groups. The relationship of gingival thickness and width of keratinized gingiva with Angle classification was not found to be significant. Conclusion Although it is thought that there is a relationship between gingival thickness, width of keratinized gingiva, and Angle classification with regard to malaligned teeth, this cross-sectional evaluation of 181 patients failed to show a significant relationship.
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Affiliation(s)
- Özer Alkan
- Department of Orthodontics, Yüzüncü Yıl University School of Dentistry, Van, Turkey
| | - Yeşim Kaya
- Department of Orthodontics, Yüzüncü Yıl University School of Dentistry, Van, Turkey
| | - Eylem A Alkan
- Department of Periodontics, Yüzüncü Yıl University, Van, Turkey
| | - Sıddık Keskin
- Department of Biostatistics, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - David L Cochran
- Department of Periodontics, Health Science Center, University of Texas School of Medicine, San Antonio, Texas, USA
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23
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Janner SFM, Gahlert M, Bosshardt DD, Roehling S, Milz S, Higginbottom F, Buser D, Cochran DL. Bone response to functionally loaded, two-piece zirconia implants: A preclinical histometric study. Clin Oral Implants Res 2017; 29:277-289. [PMID: 29288505 DOI: 10.1111/clr.13112] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the bone response to a two-piece zirconia implant in comparison with a control titanium implant in the canine mandible 4 and 16 weeks after restoration. MATERIAL AND METHODS Zirconia and titanium implants were alternately placed bilaterally in healed mandibular molar and premolar sites of five canines. Full-ceramic single-tooth restorations were cemented after 6 weeks of transmucosal healing, allowing for full functional loading of the implants. Histologic and histometric analyses were performed on orofacial and mesiodistal undecalcified sections of the specimens obtained upon sacrifice after 4 and 16 weeks of functional loading. Bone-to-implant contact (BIC), multinucleated giant cells-to-implant contact (MIC), crestal bone level, and peri-implant bone density were histometrically assessed. RESULTS All 60 implants and 60 restorations were still in function after 4 and 16 weeks of loading in both test and control groups. No implant loss, no implant or abutment fracture, and no chipping of the restorations could be detected. Histometric analysis showed no statistically significant differences between zirconia and titanium implants in BIC, crestal bone level, and peri-implant bone density at both time points. Between 4 and 16 weeks, the crestal bone level around zirconia implants showed a small but statistically significant increase in its distance from the implant shoulder. MIC was very low on both implant types and both time points and decreased statistically significantly overtime. CONCLUSION The present two-piece zirconia implant showed a similar bone integration compared to the titanium implant with similar surface morphology after 4 and 16 weeks of loading.
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Affiliation(s)
- Simone F M Janner
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Michael Gahlert
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland.,Private Practice, Munich, Germany
| | - Dieter D Bosshardt
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Stefan Roehling
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Milz
- Anatomische Anstalt, Ludwig-Maximilians University, Munich, Germany
| | | | - Daniel Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Tallarico M, Meloni SM, Xhanari E, Pisano M, Cochran DL. Minimally Invasive Sinus Augmentation Procedure Using a Dedicated Hydraulic Sinus Lift Implant Device: A Prospective Case Series Study on Clinical, Radiologic, and Patient-Centered Outcomes. INT J PERIODONT REST 2017; 37:125-135. [PMID: 27977827 DOI: 10.11607/prd.2914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to evaluate clinical and radiologic outcomes of a novel device that allows simultaneous hydraulic sinus membrane elevation, bone grafting, and implant placement. A sample of 18 consecutive participants with severe atrophy of the posterior maxilla underwent transcrestal elevation of the sinus membrane and implant placement. At the 6-month follow-up, the following parameters were assessed: implant success, any complications, marginal bone loss (MBL), three-dimensional (3D) graft measurements, implant stability quotient (ISQ), and graft density. No implants failed during follow-up (10.8 ± 2.8 months; range: 7-14 months). No membrane tears or other adverse events were observed. Mean residual alveolar ridge height was 4.78 ± 0.88 mm. Six months after the procedure, the mean MBL was 0.18 mm. The mean sinus membrane elevation was 12.78 ± 2.18 mm (range: 10.7-14.23). Along the basic 3D reference planes, the dimensions of grafted bone measured around implants were as follows: axial area = 239.7 ± 57.68 mm2; sagittal area = 257.0 ± 60.83 mm2; coronal area = 143.3 ± 29.46 mm2. The mean volume of the graft was 2.38 ± 0.26 mL at baseline and 2.05 ± 0.24 mL 6 months after graft maturation (difference: 0.33 ± 0.29 mL, P = .0090). Graft density (in Hounsfield units [HU]), improved during healing from 322.0 ± 100.42 HU to 1,062.0 ± 293.7 HU; difference 740.0 ± 295.35 HU (P = .0001). The mean ISQ value was 65.5 at implant placement, and it increased to 74.1 at the 6-month examination (P = .0014). Of 18 patients, 12 experienced no pain (66.6%) and 10 experienced no swelling (55.5%). No severe pain or swelling was reported in any of the cases. The mean number of analgesic tablets consumed was 0.78 ± 0.67. Mean surgical time was 24.0 ± 4.07 minutes. The iRaise Sinus Lift System may provide a new option for minimally invasive transcrestal sinus surgery with minimal patient discomfort. A physiologic contraction of 13.9% of its original volume was experienced during healing. Long-term clinical studies are needed to confirm these preliminary results.
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Tallarico M, Cochran DL, Xhanari E, Dellavia C, Canciani E, Mijiritsky E, Meloni SM. Crestal sinus lift using an implant with an internal L-shaped channel: 1-year after loading results from a prospective cohort study. Eur J Oral Implantol 2017; 10:325-336. [PMID: 28944359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of a one-stage crestal sinus elevation procedure using a self-tapping endosseous implant system (iRaise, Maxillent, Herzliya, Israel) developed for sinus augmentation, 1 year after loading. MATERIALS AND METHODS Patients needing restoration in the posterior maxilla with a residual alveolar crest of 3 to 8 mm in height and 5 mm in width distal to the canine as measured on CBCT scan were treated using the iRaise sinus lift system. Outcome measures were: implant and prosthetic failures, any complications, increased bone height (iBH), marginal bone loss (MBL), implant stability quotient (ISQ), radiographic tissue remodelling patterns using the sinus grafting remodelling index (SGRI), volumetric measurements of sinus graft, patient self-reported post-surgical swelling, consumption of pain medication and histological analysis. RESULTS A total of 30 consecutive participants with a mean age of 54.2 ± 9.4 years underwent a transcrestal elevation of the sinus membrane, insertion of bone graft, and implant placement. A total of 50 implants were placed (30 iRaise system implants and 20 adjunctive iSure implants, Maxillent). The mean follow-up was 15.8 ± 2.1 months after implant loading. One patient dropped out at the 1-year after loading follow-up examination. No implants and no prostheses failed during the entire follow-up. One patient experienced a small membrane tear. Before implant insertion, the mean residual alveolar ridge height was 4.64 ± 0.86 mm (range: 3.4-6.4 mm; 95% CI: 4.39-5.01 mm). One year after loading, the bone height was 16.86 ± 3.13 mm (95% CI 15.83-18.07 mm). At the 1-year after loading follow-up, the mean MBL was 0.19 ± 1.05 mm (95% CI 0.02-0.78 mm). The mean ISQ at implant placement was 65.2 ± 5.4 (95% CI 63.6-67.4) and increased during the healing period reaching the mean value of 73.6 ± 3.7 (95% CI 73.1-75.9; range 62-79). The difference was statistically significant (8.4 ± 5.3; 95% CI 5.9-39.7; P = 0.0000). One year after loading, SGRI score was evaluated in 23 implants. Overall, the mean SGRI value was 2.29 ± 2.41 mm (95% CI 1.22-2.98 mm). Bone volume at implant placement was 2.41 ± 0.25 CC (95% CI 2.22-2.48 CC). During the 6-month, submerged healing period, a slight bone contraction of 11.3% were observed. (2.13 ± 0.24 CC;95% CI 2.02-2.26; difference = 0.27 ± 0.25 CC; 95% CI 0.10-0.36; P = 0.0011). At the first year post-loading period, the bone graft remained stable (2.11 ± 0.22 CC; 95% CI 2.02-2.24). The difference was not statistically significant (0.02 ± 0.07 CC; 95% CI 0.01-0.04; P = 0.2166). From the patient's point of view, the mean pain value was 0.52 ± 0.74 (range 0-3); mean swelling value was 0.27 ± 0.52 (range 0-2); and the mean consumption of analgesic was 0.87 ± 4.94 tablets (range 0-4) 3 days after surgery. Morphological and histomorphometric analyses showed that all the samples had a normal structure without inflammatory infiltrate, six months after healing. The following fractions (%) were found: bone (immature bone + mature bone): 44.07 ± 4.91; residual biomaterial: 23.98 ± 2.64; medullary spaces: 31.95 ± 3.16. CONCLUSIONS Sinus floor augmentation can be successfully accomplished with a transcrestal approach using a dedicated implant system. A physiologic contraction of 11.3% of the original volume of the bone graft was experienced during the first 6 months of healing; afterwards, no additional graft volume reduction was observed. Long-term clinical studies are needed to confirm these preliminary results.
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Janner SFM, Bosshardt DD, Cochran DL, Chappuis V, Huynh-Ba G, Jones AA, Buser D. The influence of collagen membrane and autogenous bone chips on bone augmentation in the anterior maxilla: a preclinical study. Clin Oral Implants Res 2016; 28:1368-1380. [DOI: 10.1111/clr.12996] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Simone F. M. Janner
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Dieter D. Bosshardt
- Robert K. Schenk Laboratory of Oral Histology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - David L. Cochran
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Vivianne Chappuis
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Guy Huynh-Ba
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Archie A. Jones
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Daniel Buser
- Department of Oral Surgery and Stomatology; School of Dental Medicine; University of Bern; Bern Switzerland
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Abstract
An implant-abutment interface at the alveolar bone crest is associated with sustained peri-implant inflammation; however, whether magnitude of inflammation is proportionally dependent upon interface position remains unknown. This study compared the distribution and density of inflammatory cells surrounding implants with a supracrestal, crestal, or subcrestal implant-abutment interface. All implants developed a similar pattern of peri-implant inflammation: neutrophilic polymorphonuclear leukocytes (neutrophils) maximally accumulated at or immediately coronal to the interface. However, peri-implant neutrophil accrual increased progressively as the implant-abutment interface depth increased, i.e., subcrestal interfaces promoted a significantly greater maximum density of neutrophils than did supracrestal interfaces (10,512 ± 691 vs. 2398 ± 1077 neutrophils/mm2). Moreover, inflammatory cell accumulation below the original bone crest was significantly correlated with bone loss. Thus, the implant-abutment interface dictates the intensity and location of peri-implant inflammatory cell accumulation, a potential contributing component in the extent of implant-associated alveolar bone loss.
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Affiliation(s)
- N Broggini
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 78229, USA
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Better H, Slavescu D, Barbu H, Cochran DL, Chaushu G. Patients perceptions of recovery after maxillary sinus augmentation with a minimally invasive implant device. Quintessence Int 2016; 45:779-87. [PMID: 25126647 DOI: 10.3290/j.qi.a32510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients' perceptions of recovery following sinus augmentation procedures have scarcely been documented. The aim of the present prospective pilot clinical study was to evaluate the patient's perception of immediate postoperative recovery after sinus augmentation, using a minimally invasive implant device. METHOD AND MATERIALS Eighteen patients (8 men, 10 women), average age 52 (median 48, range 38 to 72), who had been scheduled for sinus augmentation procedures, were asked to enroll in a prospective clinical study. A healthrelated quality-of-life questionnaire was given to the patient. The questionnaire was designed to assess patient's perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. The questionnaire was compared to the surgical chart that described the surgical details and to the outcome. RESULTS Patients' perceptions of postoperative symptoms in the four tested areas: pain, oral function, general activity, and other symptoms were mostly scored "not at all" or "very little" from postoperative day (POD) 1. Most patients returned to work on POD 1. CONCLUSION The current results offer a preliminary indication that patients undergoing sinus augmentation using a minimally invasive implant device can expect to experience minimum discomfort and immediate return to everyday activity.
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Miron RJ, Sculean A, Cochran DL, Froum S, Zucchelli G, Nemcovsky C, Donos N, Lyngstadaas SP, Deschner J, Dard M, Stavropoulos A, Zhang Y, Trombelli L, Kasaj A, Shirakata Y, Cortellini P, Tonetti M, Rasperini G, Jepsen S, Bosshardt DD. Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol 2016; 43:668-83. [PMID: 26987551 DOI: 10.1111/jcpe.12546] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
BACGROUND On June 5th, 2015 at Europerio 8, a group of leading experts were gathered to discuss what has now been 20 years of documented evidence supporting the clinical use of enamel matrix derivative (EMD). Original experiments led by Lars Hammarström demonstrated that enamel matrix proteins could serve as key regenerative proteins capable of promoting periodontal regeneration including new cementum, with functionally oriented inserting new periodontal ligament fibres, and new alveolar bone formation. This pioneering work and vision by Lars Hammarström has paved the way to an enormous amount of publications related to its biological basis and clinical use. Twenty years later, it is clear that all these studies have greatly contributed to our understanding of how biologics can act as mediators for periodontal regeneration and have provided additional clinical means to support tissue regeneration of the periodontium. AIMS This review article aims to: (1) provide the biological background necessary to understand the rational for the use of EMD for periodontal regeneration, (2) present animal and human histological evidence of periodontal regeneration following EMD application, (3) provide clinically relevant indications for the use of EMD and (4) discuss future avenues of research including key early findings leading to the development of Osteogain, a new carrier system for EMD specifically developed with better protein adsorption to bone grafting materials.
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Affiliation(s)
- Richard J Miron
- Department of Periodontology, Nova Southeastern University, Fort Lauderdale, Florida, USA.,Department of Periodontology, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stuart Froum
- Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA
| | - Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlos Nemcovsky
- Department of Periodontology and Dental Implantology, Dental School, Tel-Aviv University, Tel-Aviv, Israel
| | - Nikos Donos
- Department of Periodontology, Queen Marry University of London, London, UK
| | | | - James Deschner
- Section of Experimental Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany
| | - Michel Dard
- New York University, College of Dentistry, New York, NY, USA
| | | | - Yufeng Zhang
- Department of Oral Implantology, Wuhan University, Wuhan, China
| | - Leonardo Trombelli
- Department of Periodotology, Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Adrian Kasaj
- Department of Operative Dentistry and Periodontology, University Medical Center, Mainz, Germany
| | - Yoshinori Shirakata
- Department of Periodontology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | - Maurizio Tonetti
- European Research Group on Periodontology (ERGOPerio), Genova, Italy
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.,Foundation IRCCS Ca' Granda Polyclinic, Milan, Italy
| | - Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
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Lin Z, Rios HF, Cochran DL. Emerging regenerative approaches for periodontal reconstruction: a systematic review from the AAP Regeneration Workshop. J Periodontol 2016; 86:S134-52. [PMID: 25644297 DOI: 10.1902/jop.2015.130689] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
More than 30 years have passed since the first successful application of regenerative therapy for treatment of periodontal diseases. Despite being feasible, periodontal regeneration still faces numerous challenges, and complete restoration of structure and function of the diseased periodontium is often considered an unpredictable task. This review highlights developing basic science and technologies for potential application to achieve reconstruction of the periodontium. A comprehensive search of the electronic bibliographic database PubMed was conducted to identify different emerging therapeutic approaches reported to influence either biologic pathways and/or tissues involved in periodontal regeneration. Each citation was assessed based on its abstract, and the full text of potentially eligible reports was retrieved. Based on the review of the full papers, their suitability for inclusion in this report was determined. In principle, only reports from scientifically well-designed studies that presented preclinical in vivo (animal studies) or clinical (human studies) evidence for successful periodontal regeneration were included. Hence, in vitro studies, namely those conducted in laboratories without any live animals, were excluded. In case of especially recent and relevant reviews with a narrow focus on specific regenerative approaches, they were identified as such, and thereby the option of referring to them to summarize the status of a specific approach, in addition to or instead of listing each separately, was preserved. Admittedly, the presence of subjectivity in the selection of studies to include in this overview cannot be excluded. However, it is believed that the contemporary approaches described in this review collectively represent the current efforts that have reported preclinical or clinical methods to successfully enhance regeneration of the periodontium. Today's challenges facing periodontal regenerative therapy continue to stimulate important research and clinical development, which, in turn, shapes the current concept of periodontal tissue engineering. Emerging technologies--such as stem cell therapy, bone anabolic agents, genetic approaches, and nanomaterials--also offer unique opportunities to enhance the predictability of current regenerative surgical approaches and inspire development of novel treatment strategies.
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Affiliation(s)
- Zhao Lin
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, VA
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Huang RY, Cochran DL, Cheng WC, Lin MH, Fan WH, Sung CE, Mau LP, Huang PH, Shieh YS. Risk of lingual plate perforation for virtual immediate implant placement in the posterior mandible: A computer simulation study. J Am Dent Assoc 2016; 146:735-42. [PMID: 26409983 DOI: 10.1016/j.adaj.2015.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/22/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study sought to determine which factors are correlated to a higher risk of lingual plate perforation (LPP) when placing a virtual implant in the area of the anticipated extraction site of the posterior mandible. METHODS Computed tomographic images of 300 patients (1,279 teeth) were analyzed in regard to the shape of the mandible (convergent, parallel, or undercut type), dimensional parameters of lingual concavity (angle, height, depth) and its relation to the inferior alveolar canal (zones A, B, C), distance from root apex to inferior alveolar canal, and probability of LPP. The odds ratio of variables was determined by multiple logistic regression modeling. RESULTS The overall probability of LPPs on virtual implant placement was 3.1%. This perforation was most commonly observed at the second molar and with a U-type ridge. After adjusting cofounders, a concave point located in zone A is 17.34 times more likely to have a LPP than one in zone C. The probability of LPPs was reduced by 34% for every 1-millimeter increase in distance from root apex to inferior alveolar canal on virtual implant placement of posterior mandible region. CONCLUSIONS Three-dimensional cone-beam computed tomographic imaging is essential for planning immediate implant placement in the anticipated extraction sites of the posterior mandible region as proved by anatomic findings that can only be understood from preoperative imaging analysis. PRACTICAL IMPLICATIONS Presurgical cross-sectional images can be analyzed to identify anatomic features relative to the lingual concavities in the posterior mandible region, which can help to avoid unpleasant complications, specifically when performing immediate implant procedures.
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Mau LP, Cheng WC, Chen JK, Shieh YS, Cochran DL, Huang RY. Curcumin ameliorates alveolar bone destruction of experimental periodontitis by modulating osteoclast differentiation, activation and function. J Funct Foods 2016. [DOI: 10.1016/j.jff.2016.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Talley AD, Kalpakci KN, Shimko DA, Zienkiewicz KJ, Cochran DL, Guelcher SA. Effects of Recombinant Human Bone Morphogenetic Protein-2 Dose and Ceramic Composition on New Bone Formation and Space Maintenance in a Canine Mandibular Ridge Saddle Defect Model. Tissue Eng Part A 2016; 22:469-79. [PMID: 26800574 DOI: 10.1089/ten.tea.2015.0355] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Treatment of mandibular osseous defects is a significant clinical challenge. Maintenance of the height and width of the mandibular ridge is essential for placement of dental implants and restoration of normal dentition. While guided bone regeneration using protective membranes is an effective strategy for maintaining the anatomic contour of the ridge and promoting new bone formation, complications have been reported, including wound failure, seroma, and graft exposure leading to infection. In this study, we investigated injectable low-viscosity (LV) polyurethane/ceramic composites augmented with 100 μg/mL (low) or 400 μg/mL (high) recombinant human bone morphogenetic protein-2 (rhBMP-2) as space-maintaining bone grafts in a canine mandibular ridge saddle defect model. LV grafts were injected as a reactive paste that set in 5-10 min to form a solid porous composite with bulk modulus exceeding 1 MPa. We hypothesized that compression-resistant LV grafts would enhance new bone formation and maintain the anatomic contour of the mandibular ridge without the use of protective membranes. At the rhBMP-2 dose recommended for the absorbable collagen sponge carrier in dogs (400 μg/mL), LV grafts maintained the width and height of the host mandibular ridge and supported new bone formation, while at suboptimal (100 μg/mL) doses, the anatomic contour of the ridge was not maintained. These findings indicate that compression-resistant bone grafts with bulk moduli exceeding 1 MPa and rhBMP-2 doses comparable to that recommended for the collagen sponge carrier support new bone formation and maintain ridge height and width in mandibular ridge defects without protective membranes.
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Affiliation(s)
- Anne D Talley
- 1 Department of Chemical and Biomolecular Engineering, Vanderbilt University , Nashville, Tennessee
| | | | | | - Katarzyna J Zienkiewicz
- 1 Department of Chemical and Biomolecular Engineering, Vanderbilt University , Nashville, Tennessee
| | - David L Cochran
- 3 Department of Periodontics, University of Texas Health Science Center at San Antonio , San Antonio, Texas
| | - Scott A Guelcher
- 1 Department of Chemical and Biomolecular Engineering, Vanderbilt University , Nashville, Tennessee.,4 Department of Biomedical Engineering, Vanderbilt University , Nashville, Tennessee.,5 Center for Bone Biology, Vanderbilt University Medical Center , Nashville, Tennessee
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Miron RJ, Chandad F, Buser D, Sculean A, Cochran DL, Zhang Y. Effect of Enamel Matrix Derivative Liquid on Osteoblast and Periodontal Ligament Cell Proliferation and Differentiation. J Periodontol 2015; 87:91-9. [PMID: 26334247 DOI: 10.1902/jop.2015.150389] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Enamel matrix derivatives (EMDs) have been used clinically for more than a decade for the regeneration of periodontal tissues. The aim of the present study is to analyze the effect on cell growth of EMDs in a gel carrier in comparison to EMDs in a liquid carrier. EMDs in a liquid carrier have been shown to adsorb better to bone graft materials. METHODS Primary human osteoblasts and periodontal ligament (PDL) cells were exposed to EMDs in both gel and liquid carriers and compared for their ability to induce cell proliferation and differentiation. Alizarin red staining and real-time polymerase chain reaction for expression of genes encoding collagen 1, osteocalcin, and runt-related transcription factor 2, as well as bone morphogenetic protein 2 (BMP2), transforming growth factor (TGF)-β1, and interleukin (IL)-1β, were assessed. RESULTS EMDs in both carriers significantly increased cell proliferation of both osteoblasts and PDL cells in a similar manner. Both formulations also significantly upregulated the expression of genes encoding BMP2 and TGF-β1 as well as decreased the expression of IL-1β. EMDs in the liquid carrier further retained similar differentiation potential of both osteoblasts and PDL cells by demonstrating increased collagen and osteocalcin gene expression and significantly higher alizarin red staining. CONCLUSIONS The results from the present study indicate that the new formulation of EMDs in a liquid carrier is equally as potent as EMDs in a gel carrier in inducing osteoblast and PDL activity. Future study combining EMDs in a liquid carrier with bone grafting materials is required to further evaluate its potential for combination therapies.
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Affiliation(s)
- Richard J Miron
- Faculty of Dentistry, Dental School, Laval University, Québec City, QC.,Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern
| | - Fatiha Chandad
- Faculty of Dentistry, Dental School, Laval University, Québec City, QC
| | - Daniel Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - David L Cochran
- Department of Periodontics, Dental School, University of Texas Health Science Center, San Antonio, TX
| | - Yufeng Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST), School and Hospital of Stomatology, Wuhan, China
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Caram SJ, Huynh-Ba G, Schoolfield JD, Jones AA, Cochran DL, Belser UC. Biologic width around different implant-abutment interface configurations. A radiographic evaluation of the effect of horizontal offset and concave abutment profile in the canine mandible. Int J Oral Maxillofac Implants 2015; 29:1114-22. [PMID: 25216137 DOI: 10.11607/jomi.3068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this experimental study was to analyze radiographically in a dog model how different implant-abutment interface configurations influence alveolar crestal bone changes. MATERIALS AND METHODS Six different experimental implant-abutment connections were evaluated in six mixed-breed dogs. The following parameters were tested: absence of microgap, microgap proximal to bone crest, and microgap distant from bone crest. In addition, two different cervical abutment profiles, one straight and one featuring a supracrestal concavity, were evaluated. Implants were based on a cylindrical full-body screw design and made from cold-worked grade IV commercially pure titanium. The diameter (at thread tips) measured 4.1 mm, whereas the inner diameter was 3.5 mm. Standardized periapical digital radiographs were obtained for comparative analysis at baseline and at 3, 4, 5, 6, 7, 8, and 9 months after implant placement. Radiographs were randomized and calibrated for linear measurements. For statistical analysis, mixed-model repeated-measures analysis of variance was used. RESULTS All implants integrated successfully and remained stable during the entire period of the study. Radiographically, when comparing groups with straight profiles, crestal bone remodeling in group C (one-piece design) was significantly less than in group A (matching diameters) and B (nonmatching diameters). In fact, implant group C showed the least crestal bone remodeling of all groups. When comparing groups with a concave profile but different microgap configurations, all three designs demonstrated bone loss with no significant differences among the three groups. CONCLUSION A nonsubmerged one-piece implant design demonstrated the least amount of bone remodeling of all groups. Implant-abutment connections with a concave profile established crestal bone levels immediately apical to the concavity regardless of the microgap variable.
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Huynh-Ba G, Meister DJ, Hoders AB, Mealey BL, Mills MP, Oates TW, Cochran DL, Prihoda TJ, McMahan CA. Esthetic, clinical and patient-centered outcomes of immediately placed implants (Type 1) and early placed implants (Type 2): preliminary 3-month results of an ongoing randomized controlled clinical trial. Clin Oral Implants Res 2015; 27:241-52. [DOI: 10.1111/clr.12577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Guy Huynh-Ba
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | | | - Ashley B. Hoders
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Brian L. Mealey
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Michael P. Mills
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Thomas W. Oates
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - David L. Cochran
- Department of Periodontics; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - Thomas J. Prihoda
- Department of Pathology; University of Texas Health Science Center at San Antonio; San Antonio TX USA
| | - C. Alex McMahan
- Department of Pathology; University of Texas Health Science Center at San Antonio; San Antonio TX USA
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Rios HF, Bashutski JD, McAllister BS, Murakami S, Cobb CM, Patricia Chun YH, Lin Z, Mandelaris GA, Cochran DL. Emerging Regenerative Approaches for Periodontal Reconstruction: Practical Applications From the AAP Regeneration Workshop. Clin Adv Periodontics 2015; 5:40-46. [PMID: 26146593 DOI: 10.1902/cap.2015.140052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/09/2014] [Indexed: 12/16/2022]
Abstract
Focused Clinical Question: Can emerging technologies for periodontal regeneration become clinical reality? Summary: Emerging technologies are presenting options to hopefully improve the outcomes of regeneration in challenging clinical scenarios. Cellular allografts represent a current technology in which cells and scaffolds are being delivered directly to the periodontal lesion. Recombinant human fibroblast growth factor 2 and teriparatide (parathyroid 1-34) have each been tested in controlled prospective human randomized clinical trials, and both have been shown to have potential for periodontal regeneration. These examples, as well as other emerging technologies, show promise for continued advancement in the field of periodontal regenerative therapy. Conclusions: At present, there are indications that emerging technologies can be used successfully for periodontal regeneration. Case reports and clinical trials are being conducted with a variety of emerging technologies. However, many are yet to be approved by a regulatory agency, or there is a lack of evidence-based literature to validate their expanded use.
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Affiliation(s)
- Hector F Rios
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Jill D Bashutski
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Bradley S McAllister
- Department of Periodontology, Oregon Health and Science University, Portland, OR.,Private practice, Tigard, OR
| | - Shinya Murakami
- Department of Periodontology, Graduate School of Dentistry, Osaka University, Osaka, Japan
| | - Charles M Cobb
- Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO
| | - Yong-Hee Patricia Chun
- Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, TX.,Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio,TX
| | - Zhao Lin
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, VA
| | - George A Mandelaris
- Private practice, Park Ridge and Oakbrook Terrace, IL.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Louisiana State University, New Orleans, LA.,Department of Graduate Periodontics, College of Dentistry, University of Illinois at Chicago, Chicago, IL
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, TX
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Villar CC, Zhao XR, Livi CB, Cochran DL. Effect of living cellular sheets on the angiogenic potential of human microvascular endothelial cells. J Periodontol 2015; 86:703-12. [PMID: 25594425 DOI: 10.1902/jop.2015.140362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A fundamental issue limiting the efficacy of surgical approaches designed to correct periodontal mucogingival defects is that new tissues rely on limited sources of blood supply from the adjacent recipient bed. Accordingly, therapies based on tissue engineering that leverage local self-healing potential may represent promising alternatives for the treatment of mucogingival defects by inducing local vascularization. The aim of this study is to evaluate the effect of commercially available living cellular sheets (LCS) on the angiogenic potential of neonatal dermal human microvascular endothelial cells (HMVEC-dNeo). METHODS The effect of LCS on HMVEC-dNeo proliferation, migration, capillary tube formation, gene expression, and production of angiogenic factors was evaluated over time. RESULTS LCS positively influenced HMVEC-dNeo proliferation and migration. Moreover, HMVEC-dNeo incubated with LCS showed transcriptional profiles different from those of untreated cells. Whereas increased expression of angiogenic genes predominated early on in response to LCS, late-phase responses were characterized by up- and downregulation of angiostatic and angiogenic genes. However, this trend was not confirmed at the protein level, as LCS induced increased production of most of the angiogenic factors tested (i.e., epidermal growth factor [EGF], heparin-binding EGF-like growth factor, interleukin 6, angiopoietin, platelet-derived growth factor-BB, placental growth factor, and vascular endothelial growth factor) throughout the investigational period. Finally, although LCS induced HMVEC-dNeo proliferation, migration, and expression of angiogenic factors, additional factors and environmental pressures are likely to be required to promote the development of complex, mesh-like vascular structures. CONCLUSION LCS favor initial mechanisms that govern angiogenesis but failed to enhance or accelerate HMVEC-dNeo morphologic transition to complex vascular structures.
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Affiliation(s)
- Cristina C Villar
- Department of Periodontics, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Vierra M, Mau LP, Huynh-Ba G, Schoolfield J, Cochran DL. A lateral ridge augmentation study to evaluate a synthetic membrane for guided bone regeneration: an experiment in the canine mandible. Clin Oral Implants Res 2014; 27:73-82. [DOI: 10.1111/clr.12517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Matthew Vierra
- Department of Periodontics; University of Texas Health Science Center at San Antonio (UTHSCSA); San Antonio TX USA
| | - Lian Ping Mau
- Department of Dentistry; Chi Mei Medical Center; Tainan City Taiwan
| | - Guy Huynh-Ba
- Department of Periodontics; University of Texas Health Science Center at San Antonio (UTHSCSA); San Antonio TX USA
| | - John Schoolfield
- Department of Periodontics; University of Texas Health Science Center at San Antonio (UTHSCSA); San Antonio TX USA
| | - David L. Cochran
- Department of Periodontics; University of Texas Health Science Center at San Antonio (UTHSCSA); San Antonio TX USA
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Cochran DL, Cobb CM, Bashutski JD, Chun YHP, Lin Z, Mandelaris GA, McAllister BS, Murakami S, Rios HF. Emerging regenerative approaches for periodontal reconstruction: a consensus report from the AAP Regeneration Workshop. J Periodontol 2014; 86:S153-6. [PMID: 25317603 DOI: 10.1902/jop.2015.140381] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Historically, periodontal regeneration has focused predominantly on bone substitutes and/or barrier membrane application to provide for defect fill and/or selected cell repopulation of the lesion. More recently, a number of technologies have evolved that can be viewed as emerging therapeutic approaches for periodontal regeneration, and these technologies were considered in the review paper and by the consensus group. The goal of this consensus report on emerging regenerative approaches for periodontal hard and soft tissue reconstruction was to develop a consensus document based on the accompanying review paper and on additional materials submitted before and at the consensus group session. METHODS The review paper was sent to all the consensus group participants in advance of the consensus conference. In addition and also before the conference, individual consensus group members submitted additional material for consideration by the group. At the conference, each consensus group participant introduced themselves and provided disclosure of any potential conflicts of interest. The review paper was briefly presented by two of the authors and discussed by the consensus group. A discussion of each of the following topics then occurred based on the content of the review: a general summary of the topic, implications for patient-reported outcomes, and suggested research priorities for the future. As each topic was discussed based on the review article, supplemental information was then added that the consensus group agreed on. Last, an updated reference list was created. RESULTS The application of protein and peptide therapy, cell-based therapy, genetic therapy, application of scaffolds, bone anabolics, and lasers were found to be emerging technologies for periodontal regeneration. Other approaches included the following: 1) therapies directed at the resolution of inflammation; 2) therapies that took into account the influence of the microbiome; 3) therapies involving the local regulation of phosphate and pyrophosphate metabolism; and 4) approaches directed at harnessing current therapies used for other purposes. The results indicate that, with most emerging technologies, the specific mechanisms of action are not well understood nor are the specific target cells identified. Patient-related outcomes were typically not addressed in the literature. Numerous recommendations can be made for future research priorities for both basic science and clinical application of emerging therapies. The need to emphasize the importance of regeneration of a functional periodontal organ system was noted. The predictability and efficacy of outcomes, as well as safety concerns and the cost-to-benefit ratio were also identified as key factors for emerging technologies. CONCLUSIONS A number of technologies appear viable as emerging regenerative approaches for periodontal hard and soft tissue regeneration and are expanding the potential of reconstructing the entire periodontal organ system. The cost-to-benefit ratio and safety issues are important considerations for any new emerging therapies. Clinical Recommendation: At this time, there is insufficient evidence on emerging periodontal regenerative technologies to warrant definitive clinical recommendations.
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Affiliation(s)
- David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, TX
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Sehlke BM, Wilson TG, Jones AA, Yamashita M, Cochran DL. The use of a magnesium-based bone cement to secure immediate dental implants. Int J Oral Maxillofac Implants 2014; 28:e357-67. [PMID: 24278939 DOI: 10.11607/jomi.te16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The use of a magnesium-based bone cement, OsteoCrete, has shown promise as a means to secure bone and tendon-to-bone connections in orthopedic medicine. The presence of a bone cement to fill the residual socket and stabilize a dental implant during healing could make immediate implant placement in molar sites more predictable. The aim of this study was to determine whether this magnesium-based bone cement can be used predictably for this purpose. MATERIALS AND METHODS The mandibular third premolars and first molars were extracted bilaterally from four mongrel dogs (60 to 80 lb each). Implants were placed in each extraction socket and supported by only 2 to 3 mm of apical furcation bone. OsteoCrete bone cement was placed randomly for implant stabilization in half of the sites. Clinical healing was evaluated until the 4-month time point. All animals were then sacrificed, and mandibular en bloc resection was performed for histologic evaluation of the biologic response and bone-to-implant contact. RESULTS Clinically, healing showed a poor response when the test site implant was left exposed in a one-stage manner. No statistically significant difference was noted in bone-to-implant contact (52% in test sites versus 44% in control sites). Histologic specimens showed no adverse biologic response to the material but only minimal replacement at 4 months. CONCLUSIONS OsteoCrete bone cement was successful in stabilizing the immediate dental implant in a large extraction socket when placed in a closed environment in the dog model but did not show a benefit as compared to controls. The limited data warrant further studies to determine the further potential of this material.
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Scheyer ET, Nevins ML, Neiva R, Cochran DL, Giannobile WV, Woo SB, King WN, Spitznagel JK, Bates D, McGuire MK. Generation of Site-Appropriate Tissue by a Living Cellular Sheet in the Treatment of Mucogingival Defects. J Periodontol 2014; 85:e57-64. [DOI: 10.1902/jop.2013.130348] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Osawa G, Nakaya H, Mealey BL, Kalkwarf K, Cochran DL. Specialty education in periodontics in Japan and the United States: comparison of programs at Nippon Dental University Hospital and the University of Texas Health Science Center at San Antonio. J Dent Educ 2014; 78:481-495. [PMID: 24609350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Japan has institutions that train qualified postdoctoral students in the field of periodontics; however, Japan does not have comprehensive advanced periodontal programs and national standards for these specialty programs. To help Japanese programs move toward global standards in this area, this study was designed to describe overall differences in periodontics specialty education in Japan and the United States and to compare periodontics faculty members and residents' characteristics and attitudes in two specific programs, one in each country. Periodontal faculty members and residents at Nippon Dental University (NDU) and the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School participated in the survey study: four faculty members and nine residents at NDU; seven faculty members and thirteen residents at UTHSCSA. Demographic data were collected as well as respondents' attitudes toward and assessment of their programs. The results showed many differences in curriculum structure and clinical performance. In contrast to the UTHSCSA respondents, for example, the residents and faculty members at NDU reported that they did not have enough subject matter and time to learn clinical science. Although the residents at NDU reported seeing more total patients in one month than those at UTHSCSA, they were taught fewer varieties of periodontal treatments. To provide high-quality and consistent education for periodontal residents, Japan needs to establish a set of standards that will have positive consequences for those in Japan who need periodontal treatment.
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Affiliation(s)
- Ginko Osawa
- Nippon Dental University Hospital, Division of General Dentistry, 2-3-16 Fujimi Chiyoda-ku, Tokyo, Japan 102-8158;
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Osawa G, Nakaya H, Mealey BL, Kalkwarf K, Cochran DL. Specialty Education in Periodontics in Japan and the United States: Comparison of Programs at Nippon Dental University Hospital and the University of Texas Health Science Center at San Antonio. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.3.tb05698.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ginko Osawa
- Division of General Dentistry; Nippon Dental University Hospital; Tokyo Japan
| | - Hiroshi Nakaya
- Division of General Dentistry; Nippon Dental University Hospital; Tokyo Japan
| | - Brian L. Mealey
- Department of Periodontics; Dental School, University of Texas Health Science Center; San Antonio
| | - Kenneth Kalkwarf
- Dental School, University of Texas Health Science Center; San Antonio
| | - David L. Cochran
- Department of Periodontics; Dental School, University of Texas Health Science Center; San Antonio
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Lin MH, Mau LP, Cochran DL, Shieh YS, Huang PH, Huang RY. Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: a virtual implant placement study. J Dent 2014; 42:263-70. [PMID: 24394585 DOI: 10.1016/j.jdent.2013.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES To investigate the prevalence and morphological parameters of lingual concavity, and whether these factors are related to a higher risk of inferior alveolar nerve (IAN) injury when performing an immediate implant surgery in posterior mandible region. METHODS The CBCT images from 237 subjects (1008 teeth) were analysed the shape of the mandibles (C, P, U type), dimensional parameters of lingual concavity (angle, height, depth), and its relation to inferior alveolar canal (IAC) (A, B, C zone), RAC (distance from root apex to IAC) and probability of IAN injury. Multiple logistic regression modelling to determine the odds ratio of variables that made an important contribution to the probability of IAN injury and to adjust for confounding variables. RESULTS The U type ridge (46.7%) and the most concave point located at C zone (48.8%) are most prevalent in this region. The mandibular second molar presents highest risk for IAN injury than other tooth type (p<0.001), which were 3.82 times to occur IAN injury than the mandibular second premolar. The concave point located at A zone and B zone were 7.82 and 3.52 times than C zone to have IAN damage, respectively. The probability of IAN injury will reduce 26% for every 1mm increase in RAC (p<0.001). CONCLUSIONS The tooth type, morphological features of lingual concavities, and RAC are associated with risks of IAN injury during immediate implant placement. CLINICAL SIGNIFICANCE Pre-surgical mapping of the IAC and identification of its proximity relative to the lingual concavity in the posterior mandible regions may avoid unpleasant complications, specifically when performing immediate implant procedures.
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Affiliation(s)
- Ming-Hung Lin
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Lian-Ping Mau
- Department of Periodontics, Chi Mei Medical Center, Tainan, Taiwan
| | - David L Cochran
- Department of Periodontics, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Yi-Shing Shieh
- Department of Oral Diagnosis and Pathology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Po-Hsien Huang
- Department of Dentistry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
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Stout BM, Alent BJ, Pedalino P, Holbrook R, Gluhak-Heinrich J, Cui Y, Harris MA, Gemperli AC, Cochran DL, Deas DE, Harris SE. Enamel matrix derivative: protein components and osteoinductive properties. J Periodontol 2013; 85:e9-e17. [PMID: 23919251 DOI: 10.1902/jop.2013.130264] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although enamel matrix derivative (EMD) has demonstrated the ability to promote angiogenesis and osteogenesis both in vitro and in vivo, the specific elements within the EMD compound responsible for these effects remain unknown. METHODS Nine different protein pools from a commercially produced EMD were collected based on molecular weight. Six of these pools, along with the complete EMD unfractionated compound and positive and negative controls, were tested for their ability to induce bone formation in a calvarial induction assay. Immunocytochemistry of phosphorylated SMAD1/5/8 (phospho-SMAD), osterix, and vascular endothelial growth factor A (VEGF-A) was carried out at selected time points. Finally, proteomic analysis was completed to determine the specific protein-peptide content of the various osteoinductive pools. RESULTS One of the lower-molecular-weight pools tested, pool 7, showed bone induction responses significantly greater than those of the other pools and the complete EMD compound and was concentration dependent. Dynamic bone formation rate analysis demonstrated that pool 7 was optimally active at the 5- to 10-μg concentration. It was demonstrated that EMD and pool 7 induced phospho-SMAD, osterix, and VEGF-A, which is indicative of increased bone morphogenetic protein (BMP) signaling. Proteomic composition analysis demonstrated that pool 7 had the highest concentration of the biologically active amelogenin-leucine-rich amelogenin peptide and ameloblastin 17-kDa peptides. CONCLUSIONS These studies demonstrate that the low-molecular-weight protein pools (7 to 17 kDa) within EMD have greater osteoinductive potential than the commercially available complete EMD compound and that the mechanism of action, in part, is through increased BMP signaling and increased osterix and VEGF-A. With this information, selected components of EMD can now be formulated for optimal osteo- and angio-genesis.
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Affiliation(s)
- Bradshaw M Stout
- Department of Periodontics, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX
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Coomes AM, Mealey BL, Huynh-Ba G, Barboza-Arguello C, Moore WS, Cochran DL. Buccal bone formation after flapless extraction: a randomized, controlled clinical trial comparing recombinant human bone morphogenetic protein 2/absorbable collagen carrier and collagen sponge alone. J Periodontol 2013; 85:525-35. [PMID: 23826643 DOI: 10.1902/jop.2013.130207] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Flapless extraction of teeth allows for undisturbed preservation of the nearby periosteum and a source of osteoprogenitor cells. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has been used for different bone augmentation purposes with great osteoinductive capacity. The aim of this study is to compare the bone regenerative ability of rhBMP-2 on an absorbable collagen sponge (ACS) carrier to a collagen sponge (CS) alone in extraction sites with ≥50% buccal dehiscence. METHODS Thirty-nine patients requiring extraction of a hopeless tooth with ≥50% buccal dehiscence were enrolled. After flapless extraction and randomization, either rhBMP-2/ACS carrier or CS alone was placed in the extraction site. After extraction, a baseline cone beam computed tomography (CBCT) scan was obtained of the site, and a similar scan was obtained 5 months postoperatively. Medical imaging and viewing software were used to compare the baseline and 5-month postoperative images of the study site and assess ridge width measurements, vertical height changes, and buccal plate regeneration. RESULTS Radiographically, CBCT analysis showed that with ≥50% of buccal bone destruction, rhBMP-2/ACS was able to regenerate a portion of the lost buccal plate, maintain theoretical ridge dimensions, and allow for implant placement 5 months after extraction. The test group performed significantly (P <0.05) better in regard to clinical buccal plate regeneration (4.75 versus 1.85 mm), clinical ridge width at 5 months (6.0 versus 4.62 mm), and radiographic ridge width at 3 mm from the alveolar crest (6.17 versus 4.48 mm) after molar exclusion. There was also significantly (P <0.05) less remaining buccal dehiscence, both clinically (6.81 versus 10.0 mm) and radiographically (3.42 versus 5.16 mm), at 5 months in the test group. Significantly (P <0.05) more implants were placed in the test group without the need for additional augmentation. The mean loss in vertical ridge height (lingual/palatal) was less in the test sites but was not significantly (P = 0.514) different between the test and control groups (0.39 versus 0.64 mm). CONCLUSIONS rhBMP-2/ACS compared to CS alone used in flapless extraction sites with a buccal dehiscence is able to regenerate lost buccal plate, maintain theoretical ridge dimensions, and allow for implant placement 5 months later.
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Affiliation(s)
- Angela M Coomes
- Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, TX
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Mamalis AA, Cochran DL. The Role of Hypoxia in the Regulation of Osteogenesis and Angiogenesis Coupling in Intraoral Regenerative Procedures: A Review of the Literature. INT J PERIODONT REST 2013; 33:519-24. [DOI: 10.11607/prd.0868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Cochran DL, Mau LP, Higginbottom FL, Wilson TG, Bosshardt DD, Schoolfield J, Jones AA. Soft and Hard Tissue Histologic Dimensions Around Dental Implants in the Canine Restored with Smaller-Diameter Abutments: A Paradigm Shift in Peri-implant Biology. Int J Oral Maxillofac Implants 2013; 28:494-502. [DOI: 10.11607/jomi.3081] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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