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Steigmann L, Gunaratnam S, Giannobile WV, Van Til M, Daignault-Newton S, Herman WH, Gunaratnam N, Katulanda P, Sarma AV. Poor Glycemic Control Increases Dental Risk in a Sri Lankan Population. Healthcare (Basel) 2024; 12:358. [PMID: 38338243 PMCID: PMC10855197 DOI: 10.3390/healthcare12030358] [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: 11/27/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction: The aim of our study was to investigate the impact of diabetes-related factors on the dental disease outcomes of diabetes patients in Trincomalee, Sri Lanka. Materials and Methods: Dental data were collected from 80 type-2-diabetic individuals. A dental risk score was calculated based on the frequency of dental outcomes observed and categorized as low risk (≤3 dental outcomes) and high risk (>3 dental outcomes). Results: In this cohort of men and women with type 2 diabetes, there was a high frequency of periodontal related outcomes, including missing teeth (70%), gingival recessions (40%), tooth mobility (41%), and bleeding (20%). Thirty-nine (39%) of participants had high dental risk, while forty-nine (61%) had low risk. Conclusions: After controlling for age, participants with higher capillary blood glucose levels had 3-fold greater odds of a high dental risk score (OR = 2.93, 95%CI = 1.13, 7.61). We found that poor glycemic control indicated by elevated capillary blood glucose was associated with increased dental risk.
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Affiliation(s)
- Larissa Steigmann
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Sejal Gunaratnam
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - William V. Giannobile
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA 02115, USA
| | - Monica Van Til
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | | | - William H. Herman
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | | | - Prasad Katulanda
- Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Aruna V. Sarma
- Department of Urology, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
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Elad A, Pul L, Rider P, Rogge S, Witte F, Tadić D, Mijiritsky E, Kačarević ŽP, Steigmann L. Resorbable magnesium metal membrane for sinus lift procedures: a case series. BMC Oral Health 2023; 23:1006. [PMID: 38097992 PMCID: PMC10722874 DOI: 10.1186/s12903-023-03695-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The purpose of this case series was to demonstrate the use of a magnesium membrane for repairing the perforated membrane in both direct and indirect approaches, as well as its application in instances where there has been a tear of the Schneiderian membrane. CASE PRESENTATION The case series included four individual cases, each demonstrating the application of a magnesium membrane followed by bone augmentation using a mixture of xenograft and allograft material in the sinus cavity. In the first three cases, rupture of Schneiderian membrane occurred as a result of tooth extraction, positioning of the dental implant, or as a complication during the procedure. In the fourth case, Schneiderian membrane was perforated as a result of the need to aspirate a polyp in the maxillary sinus. In case one, 10 mm of newly formed bone is visible four months after graft placement. Other cases showed between 15 and 20 mm of newly formed alveolar bone. No residual magnesium membrane was seen on clinical inspection. The vertical and horizontal augmentations proved stable and the dental implants were placed in the previously grafted sites. CONCLUSION Within the limitations of this case series, postoperative clinical examination, and panoramic and CBCT images demonstrated that resorbable magnesium membrane is a viable material for sinus lift and Schneiderian membrane repair. The case series showed successful healing and formation of new alveolar bone with separation of the oral cavity and maxillary sinus in four patients.
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Affiliation(s)
| | - Luka Pul
- Department of Dental Medicine, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000, Osijek, Croatia
| | | | - Svenja Rogge
- Botiss Biomaterials GmbH, 15806, Zossen, Germany
| | - Frank Witte
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, Aßmannshauser Straße, 4-6, 14197, Berlin, Germany
| | - Dražen Tadić
- Botiss Biomaterials GmbH, 15806, Zossen, Germany
| | - Eitan Mijiritsky
- Department of Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, The Sackler Faculty of Medicine, Tel-Aviv University, 6139001, Tel Aviv, Israel
| | - Željka Perić Kačarević
- Botiss Biomaterials GmbH, 15806, Zossen, Germany.
- Department of Anatomy, Histology, Embryology, Pathology Anatomy and Pathology Histology, Faculty of Dental Medicine and Health Osijek, J.J. Strossmayer University of Osijek, Crkvena 21, 31 000, Osijek, Croatia.
| | - Larissa Steigmann
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, MA, USA
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Gargallo-Albiol J, Dastouri E, Sabri H, Steigmann L, Pérez-García S, Wang HL. Evaluation of hemodynamic changes and patient-reported outcome measures in surgical therapy with or without intravenous sedation: a prospective controlled clinical study. Clin Oral Investig 2023; 27:7683-7693. [PMID: 37910239 DOI: 10.1007/s00784-023-05358-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES To determine whether intravenous (IV) sedation would contribute to the stabilization of patients' hemodynamics during periodontal and oral surgical procedures, and to evaluate the patient-reported outcome measures (PROMs). MATERIALS AND METHODS Periodontal or oral surgery patients were recruited and distributed into two groups: (1) sedation group (SG): intravenous sedation plus local anesthesia; (2) control group (CG): local anesthesia only. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and oxygen saturation (SaO2), were monitored at 15-min intervals from sitting in the dental chair (baseline) until the end of the treatment. In addition, a subjective assessment of PROMs was obtained through a post-operative questionnaire. RESULTS Forty-nine patients (25 in SG and 24 in CG) were included. The highest SBP and DBP were significantly higher in CG compared to the SG (141.1 ± 18.4 and 133.6 ± 15.1, respectively in SBP; and 85.5 ± 11.0 and 82.9 ± 10.1, respectively in DBP), but no mean significant differences were found between groups (P value of 0.85 and 0.72 for systolic and diastolic BP, respectively). HR and SaO2 did not show statistical intra- and inter-group differences. The overall patient satisfaction score was significantly higher in the SG group compared to CG. CONCLUSIONS Intravenous moderate sedation seems to contribute to the stabilization of patient's hemodynamics, especially the systolic blood pressure, although small differences have been found. CLINICAL RELEVANCE Intravenous sedation seems to contribute to stabilize the hemodynamic values, and enhances the patient satisfaction after periodontal and oral surgical treatment in the dental office.
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Affiliation(s)
- Jordi Gargallo-Albiol
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Oral and Maxillofacial Surgery Department, Universitat Internacional de Catalunya, C/JosepTrueta s/n, Sant Cugat del Vallés, Barcelona, Spain
| | - Ebrahim Dastouri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hamoun Sabri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Larissa Steigmann
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Periodontics Department, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Silvia Pérez-García
- Oral and Maxillofacial Surgery Department, Universitat Internacional de Catalunya, C/JosepTrueta s/n, Sant Cugat del Vallés, Barcelona, Spain.
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Boeriu S, Steigmann L, Di Gianfilippo R. Acellular dermal matrix for the treatment of multiple gingival recession defects associated with carious and previously-restored cervical lesions: a case report with 10 years of follow-up. Clin Adv Periodontics 2023. [PMID: 37116504 DOI: 10.1002/cap.10245] [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: 02/09/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Limited evidence exists on the outcome of the modified coronally advanced tunnel (MCAT) with acellular dermal matrix (ADM) for the treatment of gingival recession defects (GRD) especially when complicated by restored cervical lesions. Therefore, the aim of this case report was to assess the short- and long-term clinical outcomes of maxillary Type 1 recession defects (RT1) associated with restored cervical lesions treated with MCAT with ADM. CASE PRESENTATION A 43-year-old female patient, presented with multiple adjacent RT1 recessions in the left maxilla, previously treated with overhanging cervical resin restorations. The case was approached with a careful evaluation of the diagnostic determinants of root coverage, removal of the aberrant resin restorations, treatment with MCAT with ADM, and periodical evaluation over a follow-up of 10 years. The treatment was followed by complete root coverage, improvement of gingival phenotype and perfect root coverage esthetic score. Outcomes were periodically assessed, and were maintained over 10 years of follow-up. CONCLUSION MCAT with ADM is an effective technique for the treatment of multiple GRD complicated by cervical restorations. Complete root coverage and excellent esthetic outcomes were obtained and maintained in the long term. This article is protected by copyright. All rights reserved One-sentence summary: Complete root coverage was obtained and maintained over 10 years with modified coronally advanced tunneling and acellular dermal matrix for treatment of multiple gingival recessions with cervical restorations.
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Affiliation(s)
- Sorin Boeriu
- Private Practice, Toledo-Findlay-Maumee, Ohio, USA
| | - Larissa Steigmann
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Riccardo Di Gianfilippo
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Steigmann L, Steigmann M, Di Gianfilippo R, Wang IC, Wang HL, Chan HL. Comparative Assessment of Flap-Advancing Techniques in an Ex Vivo Cadaverous Porcine Model. Int J Oral Maxillofac Implants 2022; 37:823-829. [PMID: 35904840 DOI: 10.11607/jomi.9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 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 Since flap advancement is a prerequisite for tension-free primary closure and successful regenerative procedures, the aim of this study was to test the efficacy of six surgical approaches for flap advancement in an ex vivo porcine model. MATERIALS AND METHODS A total of 60 fresh mandibles from pigs were randomized into one of six groups: (1) trapezoidal full-thickness flap design with two vertical releasing incisions (control), (2) trapezoidal flap with linear periosteal scoring, (3) mucosal detachment technique, (4) mucosal detachment with horizontal extension, (5) mucosal detachment with horizontal and vertical extension, and (6) mucosal detachment with horizontal vertical and cutback extension. Coronal advancement of the flap was recorded as the primary variable; the surface area of exposed mucosa and the tear strength were recorded as secondary variables. RESULTS Homogeneity existed among groups for preoperative keratinized tissue width and tissue thickness. Mucosal detachment with horizontal, vertical, and, cutback extensions achieved the highest amount of advancement. All remaining groups achieved a statistically higher advancement compared with the trapezoidal full-thickness flap (control). Pairwise comparison demonstrated statistical significance between any two groups (P < .001). A positive correlation was noted between exposed mucosa and flap advancement; the advancement increased 0.62 mm for each 10 mm2 of increase in the exposed mucosal surface. Strength at tear stress was the highest in the trapezoidal full-thickness flap (control) and mucosal detachment with horizontal-vertical-cutback incisions (P < .001). CONCLUSION Coronal flap advancement was maximized in the mucosal detachment techniques and positively correlated with the area of exposed mucosa.
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Steigmann L, Miller R, Trapani VR, Giannobile WV, Braffett BH, Pop-Busui R, Lorenzi G, Herman WH, Sarma AV. Type 1 diabetes and oral health: Findings from the Epidemiology of Diabetes Interventions and Complications (EDIC) study. J Diabetes Complications 2022; 36:108120. [PMID: 35000860 PMCID: PMC9241440 DOI: 10.1016/j.jdiacomp.2021.108120] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/01/2021] [Accepted: 12/21/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe long-term oral health outcomes and examine associations between sociodemographic factors, clinical characteristics, and markers of diabetes control on tooth loss in participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. RESEARCH DESIGN AND METHODS Oral health outcomes related to tooth loss were reported at annual visits during EDIC years 22-26 (2015-2019). Generalized estimating equation models were used to assess the association of individual risk factors and tooth loss, over repeated time points. RESULTS A total of 165 (17%) participants with type 1 diabetes reported 221 oral health outcomes related to tooth loss over a five-year period. After controlling for age and current tobacco use, the presence of diabetic peripheral neuropathy was significantly associated with an increased odds of tooth loss (OR = 1.88, 95% CI 1.24, 2.87) while higher mean HDL/LDL cholesterol ratio was significantly associated with a decreased odds of tooth loss (OR = 0.87, 95% CI = 0.79, 0.97). CONCLUSIONS These findings suggest that diabetes-related complications, either resulting from or independent of poor glycemia, may be directly associated with oral health conditions, and support the need for individuals with type 1 diabetes and providers to implement lifestyle and medical interventions to reduce oral health risks.
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Affiliation(s)
- Larissa Steigmann
- University of Michigan, School of Dentistry, Department of Periodontics and Oral Medicine, Ann Arbor, MI, United States
| | - Ryan Miller
- University of Maryland, School of Medicine, Division of Pediatric Endocrinology, Baltimore, MD, United States
| | - Victoria R Trapani
- George Washington University, Biostatistics Center, Rockville, MD, United States
| | - William V Giannobile
- Harvard University, School of Dental Medicine, Department of Oral Medicine, Infection, and Immunity, Boston, MA, United States
| | - Barbara H Braffett
- George Washington University, Biostatistics Center, Rockville, MD, United States
| | - Rodica Pop-Busui
- University of Michigan, School of Medicine, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI, United States
| | - Gayle Lorenzi
- University of California, San Diego, School of Medicine, Department of Medicine, Division of Metabolism, Endocrinology and Diabetes, La Jolla, CA, United States
| | - William H Herman
- University of Michigan, School of Medicine, Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, Ann Arbor, MI, United States; University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Aruna V Sarma
- University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States; University of Michigan, School of Medicine, Department of Urology, Ann Arbor, MI, United States.
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Zipprich H, Weigl P, Di Gianfilippo R, Steigmann L, Henrich D, Wang HL, Schlee M, Ratka C. Comparison of decontamination efficacy of two electrolyte cleaning methods to diode laser, plasma, and air-abrasive devices. Clin Oral Investig 2022; 26:4549-4558. [PMID: 35322316 DOI: 10.1007/s00784-022-04421-0] [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: 12/20/2021] [Accepted: 02/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the in vitro decontamination efficacy of two electrolytic cleaning methods to diode laser, plasma, and air-abrasive devices. MATERIAL AND METHODS Sixty sandblasted large-grit acid-etched (SLA) implants were incubated with 2 ml of human saliva and Tryptic Soy Broth solution under continuous shaking for 14 days. Implants were then randomly assigned to one untreated control group (n = 10) and 5 different decontamination modalities: air-abrasive powder (n = 10), diode laser (n = 10), plasma cleaning (n = 10), and two electrolytic test protocols using either potassium iodide (KI) (n = 10) or sodium formate (CHNaO2) (n = 10) solution. Implants were stained for dead and alive bacteria in two standardized measurement areas, observed at fluorescent microscope, and analyzed for color intensity. RESULTS All disinfecting treatment modalities significantly reduced the stained area compared to the untreated control group for both measurement areas (p < 0.001). Among test interventions, electrolytic KI and CHNaO2 treatments were equally effective, and each one significantly reduced the stained area compared to any other treatment modality (p < 0.001). Efficacy of electrolytic protocols was not affected by the angulation of examined surfaces [surface angulation 0° vs. 60° (staining %): electrolytic cleaning-KI 0.03 ± 0.04 vs. 0.09 ± 0.10; electrolytic cleaning-CHNaO2 0.01 ± 0.01 vs. 0.06 ± 0.08; (p > 0.05)], while air abrasion [surface angulation 0° vs. 60° (staining %): 2.66 ± 0.83 vs. 42.12 ± 3.46 (p < 0.001)] and plasma cleaning [surface angulation 0° vs. 60° (staining %): 33.25 ± 3.01 vs. 39.16 ± 3.15 (p < 0.001)] were. CONCLUSIONS Within the limitations of the present in vitro study, electrolytic decontamination with KI and CHNaO2 was significantly more effective in reducing bacterial stained surface of rough titanium implants than air-abrasive powder, diode laser, and plasma cleaning, regardless of the accessibility of the contaminated implant location. CLINICAL RELEVANCE Complete bacterial elimination (residual bacteria < 1%) was achieved only for the electrolytic cleaning approaches, irrespectively of the favorable or unfavorable access to implant surface.
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Affiliation(s)
| | - Paul Weigl
- Department of Postgraduate Education, Faculty of Oral and Dental Medicine, J. W. Goethe University, 60596, Frankfurt am Main, Germany
| | - Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, The University of Michigan - School of Dentistry, 1011 North university Avenue, Ann Arbor, MI, 48109, USA.
| | - Larissa Steigmann
- Department of Periodontics and Oral Medicine, The University of Michigan - School of Dentistry, 1011 North university Avenue, Ann Arbor, MI, 48109, USA
| | - Dirk Henrich
- Department of Trauma, Hand & Reconstructive Surgery, Goethe University, 60596, Frankfurt am Main, Germany
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, The University of Michigan - School of Dentistry, 1011 North university Avenue, Ann Arbor, MI, 48109, USA
| | - Markus Schlee
- Department of Maxillofacial Surgery, Goethe University, 60596, Frankfurt am Main, Germany
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Polymeri A, Loos BG, Aronovich S, Steigmann L, Inglehart MR. Risk factors, diagnosis and treatment of peri-implantitis: A cross-cultural comparison of U.S. and European periodontists' considerations. J Periodontol 2021; 93:481-492. [PMID: 34390497 PMCID: PMC10138758 DOI: 10.1002/jper.21-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/07/2021] [Revised: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peri-implantitis (PI) is a growing concern in the dental community worldwide. The study aimed to compare U.S. vs. European periodontists' considerations of risk factors, diagnostic criteria, and management of PI. MATERIALS AND METHODS 393 periodontists from the U.S. and 100 periodontists from Europe (Germany, Greece, Netherlands) responded to anonymous surveys electronically or by mail. RESULTS Compared to U.S. periodontists, European respondents were younger, more likely to be female and placed fewer implants per month (9.12 vs. 13.90;p = 0.003). Poor oral hygiene, history of periodontitis, and smoking were considered as very important risk factors by both groups (rated >4 on 5-point scale). European periodontists rated poor oral hygiene (4.64 vs. 4.45;p = 0.005) and history of periodontitis (4.36 vs. 4.10;p = 0.006) as more important and implant surface (2.91 vs. 3.18;p = 0.023), occlusion (2.80 vs. 3.75;p<0.001) and presence of keratinized tissue (3.27 vs. 3.77;p<0.001) as less important than did U.S. periodontists. Both groups rated clinical probing, radiographic bone loss, and presence of bleeding and suppuration as rather important diagnostic criteria. They rated implant exposure/mucosal recession as relatively less important with U.S. periodontists giving higher importance ratings than European periodontists (3.99 vs. 3.54;p = 0.001). Both groups nearly always used patient education, plaque control and mechanical debridement when treating PI. U.S. periodontists were more likely to use antibiotics (3.88 vs. 3.07;p<0.001), lasers (2.11 vs. 1.68;p = 0.005), allograft (3.39 vs. 2.14;p<0.001) and regenerative approaches (3.57 vs. 2.56;p<0.001), but less likely to use resective surgery (3.09 vs. 3.53;p<0.001) than European periodontists. CONCLUSIONS U.S. and European periodontists' considerations concerning risk factors, diagnosis and management of PI were evidence-based. Identified differences between the two groups can inform future educational efforts. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Angeliki Polymeri
- Department of Periodontology, University of Amsterdam and Vrije Universiteit, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Bruno G Loos
- Department of Periodontology, University of Amsterdam and Vrije Universiteit, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Sharon Aronovich
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Larissa Steigmann
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Marita R Inglehart
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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Steigmann L, Steigmann M, Wang HL. Mucosal Detachment Technique for Flap Advancement in a Thin Tissue Phenotype: Technique Illustration. INT J PERIODONT REST 2021; 41:555-560. [PMID: 34328474 DOI: 10.11607/prd.5072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
Passive-tension flap closure of primary wounds remains the most important factor for achieving predictable bone augmentation outcomes. So far, no specific surgical technique has been proposed for major flap advancement, specifically in the thin tissue phenotype (≤ 1.5 mm thick). This article illustrates a detailed description of the Mucosal Detachment Technique (MDT), which separates the mucosal tissue from the underneath periosteum and aims to achieve adequate flap flexibility to cover high-volume augmentation in the thin tissue phenotype. Separating the mucosa from the periosteum allows maintenance of vascularization and an even distribution of tension among the advanced flap. The MDT allows bone augmentation procedures in thin tissue phenotype flap. The flap advancement permits tension-free primary closure in all tissue phenotypes (both thin and thick), independent of the degree of volume augmentation.
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Di Gianfilippo R, Wang IC, Steigmann L, Velasquez D, Wang HL, Chan HL. Efficacy of microsurgery and comparison to macrosurgery for gingival recession treatment: a systematic review with meta-analysis. Clin Oral Investig 2021; 25:4269-4280. [PMID: 33928441 DOI: 10.1007/s00784-021-03954-0] [Citation(s) in RCA: 3] [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: 02/22/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Microsurgical principles, techniques, and armamentarium have made significant contributions to the periodontal plastic surgery. The present meta-analysis aimed to investigate the overall efficacy of microsurgery on root coverage, and its clinical outcomes when compared to traditional macrosurgery. MATERIAL AND METHODS Electronic searches on PubMed, Embase, and CINAHL were used to retrieve prospective clinical trials. Primary outcomes were the mean root coverage (mRC) and probability of achieving complete root coverage (cRC), with secondary outcomes as other periodontal parameters and patient-reported outcome measures (PROMs). RESULTS Nineteen studies were included in the quantitative analysis. Microsurgery was estimated to achieve 83.3% mRC and 69.3% cRC. From a subgroup of 9 comparative studies, it was estimated microsurgery increased mRC by 6.6% (p<0.001) and cRC by 27.9% (p<0.01) compared to macrosurgical control treatments. Operating microscope (OM) yielded a significantly 6.7% higher mRC than the control group (p=0.002), while using loupes showed 6.16% increase in mRC with a borderline significance (p=0.09). OM and loupes-only had a 31.05% (p=0.001) and 25.54% (p=0.001) increases in achieving cRC compared to control, respectively. As for PROMs, microsurgery reduced postoperative pain (p<0.001) and enhanced esthetics (p= 0.05). CONCLUSIONS Microsurgery significantly improved mean root coverage, probability of achieving complete root coverage, esthetics, and post-surgical recovery. Microsurgery enhances not only subclinical healing but also clinical outcomes, possibly owing to its minimally invasive approach and surgical precision. CLINICAL RELEVANCE Periodontal plastic microsurgery is minimally invasive, inducing less surgical trauma and ultimately resulting in improved clinical outcomes, patient's satisfaction, and quality of life.
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Affiliation(s)
- Riccardo Di Gianfilippo
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - I-Ching Wang
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - Larissa Steigmann
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - Diego Velasquez
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA.,Private Practice, 415 North Alloy Drive, Fenton, MI, 48430, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan - School of Dentistry, 1011 North University Avenue, Ann Arbor, MI, USA.
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Steigmann L, Maekawa S, Sima C, Travan S, Wang CW, Giannobile WV. Biosensor and Lab-on-a-chip Biomarker-identifying Technologies for Oral and Periodontal Diseases. Front Pharmacol 2020; 11:588480. [PMID: 33343358 PMCID: PMC7748088 DOI: 10.3389/fphar.2020.588480] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
Periodontitis is a complex multifactorial disease that can lead to destruction of tooth supporting tissues and subsequent tooth loss. The most recent global burden of disease studies highlight that severe periodontitis is one of the most prevalent chronic inflammatory conditions affecting humans. Periodontitis risk is attributed to genetics, host-microbiome and environmental factors. Empirical diagnostic and prognostic systems have yet to be validated in the field of periodontics. Early diagnosis and intervention prevents periodontitis progression in most patients. Increased susceptibility and suboptimal control of modifiable risk factors can result in poor response to therapy, and relapse. The chronic immune-inflammatory response to microbial biofilms at the tooth or dental implant surface is associated with systemic conditions such as cardiovascular disease, diabetes or gastrointestinal diseases. Oral fluid-based biomarkers have demonstrated easy accessibility and potential as diagnostics for oral and systemic diseases, including the identification of SARS-CoV-2 in saliva. Advances in biotechnology have led to innovations in lab-on-a-chip and biosensors to interface with oral-based biomarker assessment. This review highlights new developments in oral biomarker discovery and their validation for clinical application to advance precision oral medicine through improved diagnosis, prognosis and patient stratification. Their potential to improve clinical outcomes of periodontitis and associated chronic conditions will benefit the dental and overall public health.
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Affiliation(s)
- Larissa Steigmann
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Shogo Maekawa
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Corneliu Sima
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States
| | - Suncica Travan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - Chin-Wei Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
| | - William V Giannobile
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States.,Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, United States.,Biointerfaces Institute and Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, United States
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Steigmann L, Sommer C, Kornman KS, Wang HL. Staging and Grading Discussion of Borderline Cases in Gray Zones. Clin Adv Periodontics 2020; 11:98-102. [PMID: 33058530 DOI: 10.1002/cap.10129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/20/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Staging and grading for chronic periodontal disease, as described in 2018, is designed to focus on key distinctions with the recognition that there is a subset of individuals who are on a different clinical trajectory of disease. The staging and grading framework aids the clinician in generating a periodontal diagnosis, however, some cases fall into gray zones in which the simple diagnostic parameters make it challenging to categorize the patient. These cases do not present with clear clinical findings and medical and dental histories that fit within the simple guidelines defined in the staging and grading tables and subsequent algorithms. CASE PRESENTATION Two cases are presented and demonstrate typical clinical scenarios that fall into gray zones when it comes to differentiating whether the patient will respond predictably to standard principles of care. Case 1 presents a scenario in which the patient's early history suggests the potential for disease progression and increases the likelihood that the patient may develop a need for complex rehabilitation due to periodontal breakdown. Clinical judgment was used to evaluate whether the patient remained at elevated risk and the potential implications for disease progression. Case 1 was diagnosed with generalized Stage III, Grade B. The initial presentation of Case 2 had a higher severity and complexity and therefore was diagnosed with generalized Stage IV, Grade C. The need for complex rehabilitation in Case 2, however, was not primarily due to periodontitis. CONCLUSION Decision guidelines and algorithms help in establishing a standardized diagnosis, however cases that fall into gray zones require clinical judgment to establish the most appropriate diagnosis to guide a treatment plan that is personalized based on current knowledge.
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Affiliation(s)
- Larissa Steigmann
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Celia Sommer
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Kenneth S Kornman
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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Abstract
INTRODUCTION Irritable bowel disease (IBD) is a gastrointestinal disorder characterized by chronic granulomatous inflammation of the entire digestive system, which includes the oral cavity. Oral manifestations of IBD includes aphthous ulcerations which may appear spontaneously and resemble episodes of active flare ups of IBD. The presence of oral mucosal ulcerations, in addition with other systemic symptoms and exclusion of other etiological causes, requires an interdisciplinary team approach to diagnose and manage. CASE PRESENTATION A 19-year-old female presented with significant ulcerations next to a surgical site after a tooth extraction and ridge preservation procedure. The patient reported a history of preexisting episodes of ulcerations and continued to develop ulcers while the surgical site was healing. A referral to a gastroenterologist lead to a confirmed diagnosis of IBD. CONCLUSION This case report presents a case of mucosal ulceration after surgical intervention that lead to the diagnosis of IBD. Appropriate and timely identification of oral manifestations of systemic disease conditions is key in early diagnosis and disease management. Connecting oral lesions to early presentation of systemic conditions potentially reduces a patient's systemic disease burden and improves their quality of life.
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Affiliation(s)
- Larissa Steigmann
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Celia Sommer
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI
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