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Chrepa V, Villasenor S, Mauney A, Kotsakis G, Macpherson L. Cannabidiol as an Alternative Analgesic for Acute Dental Pain. J Dent Res 2024; 103:235-242. [PMID: 37910667 PMCID: PMC10900863 DOI: 10.1177/00220345231200814] [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] [Indexed: 11/03/2023] Open
Abstract
Odontogenic pain can be debilitating, and nonopioid analgesic options are limited. This randomized placebo-controlled clinical trial aimed to assess the effectiveness and safety of cannabidiol (CBD) as an analgesic for patients with emergency acute dental pain. Sixty-one patients with moderate to severe toothache were randomized into 3 groups: CBD10 (CBD 10 mg/kg), CBD20 (CBD 20 mg/kg), and placebo. We administered a single dose of respective oral solution and monitored the subjects for 3 h. The primary outcome measure was the numerical pain differences using a visual analog scale (VAS) from baseline within and among the groups. Secondary outcome measures included ordinal pain intensity differences, the onset of significant pain relief, maximum pain relief, changes in bite force within and among the groups, psychoactive effects, mood changes, and other adverse events. Both CBD groups resulted in significant VAS pain reduction compared to their baseline and the placebo group, with a maximum median VAS pain reduction of 73% from baseline pain at the 180-min time point (P < 0.05). CBD20 experienced a faster onset of significant pain relief than CBD10 (15 versus 30 min after drug administration), and both groups reached maximum pain relief at 180-min. Number needed to treat was 3.1 for CBD10 and 2.4 for CBD20. Intragroup comparisons showed a significant increase in bite forces in both CBD groups (P < 0.05) but not in the placebo group (P > 0.05). CBD20 resulted in a significant difference in mean percent bite force change in the 90- and 180-min time points compared to the placebo group (P < 0.05). Compared to placebo, sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups (P < 0.05). There were no other significant psychoactive or mood change effects. This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.
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Affiliation(s)
- V. Chrepa
- UTHealth San Antonio, School of Dentistry, San Antonio, TX, USA
- Rutgers School of Dental Medicine, Newark, NJ
| | - S. Villasenor
- University of Texas at San Antonio, San Antonio, TX, USA
| | - A. Mauney
- University of Texas at San Antonio, San Antonio, TX, USA
| | - G. Kotsakis
- UTHealth San Antonio, School of Dentistry, San Antonio, TX, USA
- Rutgers School of Dental Medicine, Newark, NJ
| | - L. Macpherson
- University of Texas at San Antonio, San Antonio, TX, USA
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Siormpas KD, Leitão-Almeida B, Borges T, Kotsakis G, Mitsias ME. Aesthetic and radiographic outcomes using the root membrane technique in immediate adjacent implant placement: A retrospective clinical study with a 5- to 9-year follow-up. Int J Oral Implantol (Berl) 2022; 15:341-352. [PMID: 36377625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE The root membrane technique was designed to preserve the buccal portion of the root in situ, preventing postextraction bundle bone loss and overlying soft tissue recession. Nevertheless, maintenance of the aesthetic gingival architecture around two or multiple adjacent implants, particularly in the anterior maxilla, remains a challenge, notably regarding the gingival contour and the interimplant papillae. The present study aimed to evaluate the clinical, aesthetic and radiographic outcomes for immediate adjacent implants placed using the root membrane technique in the anterior maxilla in a sample with a 5- to 9-year follow-up. MATERIALS AND METHODS A retrospective clinical study was designed using the medical records of two private dental practices. A total of 40 patients who were treated using the root membrane technique for at least two adjacent implants and single-crown restorations between January 2010 and February 2019 were selected (100 implants). The clinical and radiographic data were analysed to assess implant survival/success, marginal bone loss and the pink aesthetic score. RESULTS The cumulative survival rate after a mean follow-up period of 81.5 ± 30.5 months was 99.0% (implant-based) and 97.5% (patient-based), respectively. Between 1 and 5 years (n = 99), the mean marginal bone loss changed from 0.39 ± 0.07 mm to 0.36 ± 0.07 mm and subsequently to 0.37 ± 0.07 mm at the 7-year follow-up (n = 71) and 0.33 ± 0.07 mm at the 9-year follow-up (n = 14). The improvement from 1 year was significant at all the follow-up time points (P = 0.000). The mean global pink aesthetic score increased from baseline (11.33 ± 1.03) to 3 months after placement of the final restoration (11.73 ± 0.95) and the final observation (12.01 ± 0.87). This was a significant increase (P = 0.000 baseline to 3 months, 3 months to final observation and baseline to final observation). CONCLUSIONS In this non-controlled retrospective study, adjacent implants placed using the root membrane technique achieved a satisfactory survival and success rate. The variation in marginal bone loss showed a significant positive trend from 1 year to 5 and 7 years. The overall pink aesthetic scores improved significantly between sequential observation periods. CONFLICT-OF-INTEREST STATEMENT Dr Leitão-Almeida receives personal fees (for sponsored lectures) and non-financial support from MegaGen (Daegu, South Korea) outside of the submitted work; the other authors declare no conflicts of interests relating to this study.
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Pohl S, Prasad H, Prasad S, Kotsakis G. Human Histologic Analysis of Implant Osseointegration in a Healed Site Grafted with Nondemineralized Autologous Tooth-Derived Graft Material. INT J PERIODONT REST 2022; 42:e199-e207. [DOI: 10.11607/prd.4923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Monje A, Amerio E, Cha JK, Kotsakis G, Pons R, Renvert S, Sanz-Martin I, Schwarz F, Sculean A, Stavropoulos A, Tarnow D, Wang HL. Strategies for implant surface decontamination in peri-implantitis therapy. Int J Oral Implantol (Berl) 2022; 15:213-248. [PMID: 36082658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.
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Casarez-Quintana A, Mealey BL, Kotsakis G, Palaiologou A. Comparing the histological assessment following ridge preservation using a composite bovine derived xenograft versus an alloplast hydroxyapatite-sugar cross-linked collagen matrix. J Periodontol 2022; 93:1691-1700. [PMID: 35661358 DOI: 10.1002/jper.22-0149] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This randomized controlled trial was designed to evaluate the histological wound healing and alveolar ridge dimensional changes following ridge preservation using two different xenograft/ collagen matrices. METHODS Fifty-four patients each with non-molar teeth that required extraction and replacement with dental implants were enrolled. Teeth extractions were completed with minimal flap reflection and were randomized to receive ridge preservation with either 90% bovine-derived xenograft granules in a 10% porcine collagen matrix (Group A) or a sponge-like matrix of 80% microparticulate hydroxyapatite alloplast graft with 20% sugar cross-linked porcine type 1 collagen (Group B). After 16 weeks of healing and at the time of implant placement, a bone core biopsy was harvested followed by dental implant placement. The primary histological outcome evaluated were percent (%) vital bone formation and connective tissue (CT)/other (fibrous tissue and marrow space). Secondary outcomes included the change in alveolar ridge width and the buccal and lingual ridge height. Statistical analysis was completed with two-sample t-test and Fisher's exact test. RESULTS Forty-four patients completed the study, 23 in group A and 21 in group B. Group B presented with statistically significantly (p = 0.02) more % vital bone (39.3 ± 17.8) than group A (26.8 ± 15.8). No statistically significant difference was observed for changes in alveolar ridge dimensions. CONCLUSIONS Group B, when used for ridge preservation, yields statistically significantly more vital bone over a 4-month healing period. Ridge dimension changes were similar between the two groups and were adequate for implant placement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Brian L Mealey
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - Georgios Kotsakis
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
| | - Archontia Palaiologou
- Department of Periodontics, UT Health San Antonio School of Dentistry, San Antonio, TX
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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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Lamont EI, Gadkari A, Kerns KA, To TT, Daubert D, Kotsakis G, Bor B, He X, McLean JS. Modified SHI medium supports growth of a disease-state subgingival polymicrobial community in vitro. Mol Oral Microbiol 2020; 36:37-49. [PMID: 33174294 PMCID: PMC7984074 DOI: 10.1111/omi.12323] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023]
Abstract
Developing a laboratory model of oral polymicrobial communities is essential for in vitro studies of the transition from healthy to diseased oral plaque. SHI medium is an enriched growth medium capable of supporting in vitro biofilms with similar diversity to healthy supragingival inocula; however, this medium does not maintain the diversity of gram‐negative bacteria more associated with subgingival plaque. Here, we systematically modified SHI medium components to investigate the impacts of varying nutrients and develop a medium capable of supporting a specific disease‐state subgingival community. A diseased subgingival plaque sample was inoculated in SHI medium with increasing concentrations of sucrose (0%, 0.1%, 0.5%), fetal bovine serum (FBS) (0%, 10%, 20%, 30%, 50%), and mucin (0.1, 2.5, 8.0 g/L) and grown for 48 hrs, then the 16S rRNA profiles of the resulting biofilms were examined. In total, these conditions were able to capture 89 of the 119 species and 43 of the 51 genera found in the subgingival inoculum. Interestingly, biofilms grown in high sucrose media, although dominated by acidogenic Firmicutes with a low final pH, contained several uncultured taxa from the genus Treponema, information that may aid culturing these periodontitis‐associated fastidious organisms. Biofilms grown in a modified medium (here named subSHI‐v1 medium) with 0.1% sucrose and 10% FBS had a high diversity closest to the inoculum and maintained greater proportions of many gram‐negative species of interest from the subgingival periodontal pocket (including members of the genera Prevotella and Treponema, and the Candidate Phyla Radiation phylum Saccharibacteria), and therefore best represented the disease community.
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Affiliation(s)
- Eleanor I Lamont
- Department of Periodontics, University of Washington, Seattle, WA, USA
| | - Archita Gadkari
- Department of Periodontics, University of Washington, Seattle, WA, USA
| | | | - Thao T To
- Department of Periodontics, University of Washington, Seattle, WA, USA
| | - Diane Daubert
- Department of Periodontics, University of Washington, Seattle, WA, USA
| | - Georgios Kotsakis
- Department of Periodontics, University of Texas Health Science Center, San Antonio, TX, USA
| | - Batbileg Bor
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Xuesong He
- Department of Microbiology, The Forsyth Institute, Cambridge, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Jeffrey S McLean
- Department of Periodontics, University of Washington, Seattle, WA, USA
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8
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Mazor Z, Horowitz R, Prasad H, Kotsakis G. Healing Dynamics Following Alveolar Ridge Preservation with Autologous Tooth Structure. INT J PERIODONT REST 2019; 39:697-702. [DOI: 10.11607/prd.4138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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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9
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Seong WJ, Kotsakis G, Huh JK, Jeong SC, Nam KY, Kim JR, Heo YC, Kim HC, Zhang L, Evans MD, Conrad H, Schumacher RJ. Clinical and microbiologic investigation of an expedited peri-implantitis dog model: an animal study. BMC Oral Health 2019; 19:150. [PMID: 31307461 PMCID: PMC6632201 DOI: 10.1186/s12903-019-0837-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/09/2019] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Animal studies are pivotal in allowing experimentation to identify efficacious treatment protocols for resolution of peri-implantitis. The purpose of this investigation was to characterize an expedited dog peri-implantitis model clinically, radiographically, and microbiologically. Methods Eight hound dogs underwent extractions (week 0) and implant (3.3 × 8.5 mm) placement with simultaneous surgical defect creation and ligature placement for induction of peri-implantitis (week 10). Ligatures were replaced at 6 weeks (week 16) and removed after 9 weeks (week 19) when supporting bone loss involved approximately 50% of the peri-implant bone. Microbial samples from the defects and healthy control implant sites collected at week 19 were analyzed utilizing a microarray. Clinical measures of inflammation were obtained and radiographic bone loss was measured from periapical radiographs. Radiographic depth and width measurements of bony defect were repeated at weeks 10 (baseline), 16, and 19. Canonical analysis of principal coordinates was used to visualize overall differences in microbial abundance between peri-implantitis and healthy implants. Results This accelerated disease protocol led to intrabony defect creation with a mean depth and width of 4.3 mm and 3.5 mm, respectively after 9 weeks of ligature placement. Microbial identification revealed 59 total bacteria in peri-implant sites, 21 of which were only present in peri-implant sites as compared to healthy controls. Overall microbial beta diversity (microbial between-sample compositional diversity) differed between peri-implantitis and healthy implants (p = 0.009). Conclusions Within the limitations of this study, this protocol led to expedited generation of peri-implant defects with a microbial profile indicative of a shift to disease and defect patterns conducive to regenerative treatment. However, the possibility of potential spontaneous resolution of lesions due to the lack of a chronicity interval as compared to chronic disease models need to be further clarified and considered during preclinical peri-implantitis model selection. Electronic supplementary material The online version of this article (10.1186/s12903-019-0837-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wook Jin Seong
- Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
| | - Georgios Kotsakis
- Department of Periodontics, School of Dentistry, UTHealth, San Antonio, TX, USA
| | - Jong-Ki Huh
- Department of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul, South Korea
| | - Soo Cheol Jeong
- Department of Restorative Dentistry, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Ki Young Nam
- Department of Dentistry, College of Medicine, Keimyung University, Daegu, South Korea
| | - Jong Ryul Kim
- Department of Endodontology, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA
| | - Young Cheul Heo
- Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Pusan National University, Pusan, South Korea
| | - Lei Zhang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Michael D Evans
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Heather Conrad
- Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Robert J Schumacher
- Center for Translational Medicine, University of Minnesota, Minneapolis, MN, USA
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Daubert D, Pozhitkov A, McLean J, Kotsakis G. Titanium as a modifier of the peri-implant microbiome structure. Clin Implant Dent Relat Res 2018; 20:945-953. [PMID: 30255621 DOI: 10.1111/cid.12676] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 07/24/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent data support the implication of accelerated titanium dissolution products in peri-implantitis. It is unknown whether these dissolution products have an effect on the peri-implant microbiome, the target of existing peri-implantitis therapies. PURPOSE This study assessed the relationship between the peri-implant microbiome, dissolved titanium levels, and peri-implantitis. MATERIALS AND METHODS Clinical, microbiome, and titanium data were collected from a periodontal population having implants in function for 10 years. Clinical examinations were performed, and submucosal plaque samples were collected from the deepest site per implant. An aliquot of the sample was used for 16S rRNA gene sequencing, with the remainder analyzed for titanium quantity using mass spectrometry. Sequences were clustered into taxonomic units at 97% minimum sequence similarity using the QIIME pipeline approach. RESULTS Fifteen implants were assessed. According to established case definitions, six had a diagnosis of peri-implantitis; nine were healthy. The genera Streptococcus, Prevotella and Haemophilus characterized peri-implant health. Peri-implantitis was associated with a marked increase in Veillonella. Quantities of dissolved titanium were identified in 40% of sites. Titanium presence was associated with peri-implant disease status (P = .02) and correlated to the first principal component of the microbiome (rho = 0.552) and its alpha-diversity (rho = -0.496). Canonical correlation analyses found that titanium levels, but not health or disease status of the implant, were significantly associated with the microbiota composition (P = .045). CONCLUSIONS These findings suggest an association between titanium dissolution products and peri-implantitis and support a role for these products in modifying the peri-implant microbiome structure and diversity.
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Affiliation(s)
- Diane Daubert
- Department of Periodontics, Clinical and Periodontal Research Laboratory, University of Washington, Seattle, WA (Washington), USA
| | - Alexander Pozhitkov
- Department of Restorative Dentistry, University of Washington, Seattle, WA (Washington), USA
| | - Jeffrey McLean
- Department of Periodontics and Oral Health Sciences, University of Washington, Seattle, WA (Washington), USA.,Department of Microbiology, University of Washington, Seattle, WA (Washington), USA
| | - Georgios Kotsakis
- Department of Periodontics, Clinical and Periodontal Research Laboratory, University of Washington, Seattle, WA (Washington), USA
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Pitcher B, Alaqla A, Noujeim M, Wealleans JA, Kotsakis G, Chrepa V. Binary Decision Trees for Preoperative Periapical Cyst Screening Using Cone-beam Computed Tomography. J Endod 2018; 43:383-388. [PMID: 28231977 DOI: 10.1016/j.joen.2016.10.046] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 09/19/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Cone-beam computed tomographic (CBCT) analysis allows for 3-dimensional assessment of periradicular lesions and may facilitate preoperative periapical cyst screening. The purpose of this study was to develop and assess the predictive validity of a cyst screening method based on CBCT volumetric analysis alone or combined with designated radiologic criteria. METHODS Three independent examiners evaluated 118 presurgical CBCT scans from cases that underwent apicoectomies and had an accompanying gold standard histopathological diagnosis of either a cyst or granuloma. Lesion volume, density, and specific radiologic characteristics were assessed using specialized software. Logistic regression models with histopathological diagnosis as the dependent variable were constructed for cyst prediction, and receiver operating characteristic curves were used to assess the predictive validity of the models. A conditional inference binary decision tree based on a recursive partitioning algorithm was constructed to facilitate preoperative screening. RESULTS Interobserver agreement was excellent for volume and density, but it varied from poor to good for the radiologic criteria. Volume and root displacement were strong predictors for cyst screening in all analyses. The binary decision tree classifier determined that if the volume of the lesion was >247 mm3, there was 80% probability of a cyst. If volume was <247 mm3 and root displacement was present, cyst probability was 60% (78% accuracy). CONCLUSIONS The good accuracy and high specificity of the decision tree classifier renders it a useful preoperative cyst screening tool that can aid in clinical decision making but not a substitute for definitive histopathological diagnosis after biopsy. Confirmatory studies are required to validate the present findings.
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Affiliation(s)
- Brandon Pitcher
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ali Alaqla
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Marcel Noujeim
- Department of Oral and Maxillofacial Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James A Wealleans
- Wilford Hall Department of Endodontics, Joint Base San Antonio-Lackland, San Antonio, Texas
| | - Georgios Kotsakis
- Department of Periodontics, University of Washington, Seattle, Washington
| | - Vanessa Chrepa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
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12
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Affiliation(s)
- Georgios Kotsakis
- Department of Periodontics, University of Washington, Seattle, Washington
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13
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Kotsakis G, Chrepa V, Marcou N, Prasad H, Hinrichs J. Flapless alveolar ridge preservation utilizing the "socket-plug" technique: clinical technique and review of the literature. J ORAL IMPLANTOL 2015; 40:690-8. [PMID: 25506661 DOI: 10.1563/aaid-joi-d-12-00028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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
It has been documented that after every extraction of one or more teeth, the alveolar bone of the respective region undergoes resorption and atrophy. Therefore, ridge preservation techniques are often employed after tooth extraction to limit this phenomenon. The benefits of a flapless procedure include maintenance of the buccal keratinized gingiva, prevention of alterations to the gingival contours, and migration of the mucogingival junction that are often experienced after raising a flap. The purpose of this article is to review the literature concerning flapless ridge preservation techniques with the aid of collagen plugs for occlusion of the socket. The term "socket-plug" technique is introduced to describe these techniques. The basic steps of the "socket-plug" technique consist of atraumatic tooth extraction, placement of the appropriate biomaterials in the extraction site, preservation of soft tissue architecture employing a flapless technique, and placement and stabilization of the collagen plug. A case example is presented that illustrates the steps used in this technique.
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Affiliation(s)
- Georgios Kotsakis
- 1 Advanced Education Program in Periodontology, University of Minnesota, Minneapolis, Minn
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14
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Konstantinidis I, Kotsakis G, Pallis K, Walter MH. A novel technique for the direct fabrication of fixed interim restorations. J Prosthet Dent 2013; 109:198-201. [PMID: 23522370 DOI: 10.1016/s0022-3913(13)60044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article describes an alternative technique for the fabrication of interim restorations. A thermoplastic, vacuum-formed template and translucent vinyl polysiloxane material are combined in the waxed diagnostic cast to fabricate a matrix in which the interim material can be placed. With this matrix, a variety of materials, such as dual-polymerized or light-polymerized resins, can be used in a predictable way. The major advantage of this technique is that it allows for the fabrication of accurate restorations with excellent reproduction of surface anatomy and for alterations of the tooth shape with light-polymerized materials.
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Affiliation(s)
- Ioannis Konstantinidis
- Department of Prosthetic Dentistry, School of Dentistry, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
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Kotsakis G, Chrepa V, Marcou N, Prasad H, Hinrichs J. Flapless alveolar ridge preservation utilizing the ''socket-plug'' technique: clinical technique and review of the literature. J ORAL IMPLANTOL 2012. [DOI: 10.1563/aaid-joi-d-12-00028.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kotsakis G, Chrepa V, Katta S. Practical Application of the Newly Introduced Natural Bone Regeneration (NBR) Concept Utilizing Alloplastic Putty. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10012-1051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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