Publications by authors named "Assem Soueidan"

39 Publications

Combination of bone substitutes and vectors in periodontology and implantology: A systematic review.

Dent Mater J 2021 Jun 12. Epub 2021 Jun 12.

Department of Periodontology, Faculty of Dental Surgery, University of Nantes.

The aim of the systematic review was to analyze the use of combination of bone substitutes and vectors in periodontology and implantology among animals models and humans. Electronic databases were searched, and additional hand search was performed. The research strategy was achieved according to the PRISMA guidelines. The including criteria were: combination of bone substitutes and vectors, in vivo studies, a precise number of specimens, histological and radiographic analysis, written in English. The risk of bias was evaluated for individual studies. Thirty-two articles were selected and investigated in this systematic review. The results do not show a superiority of the use of composite biomaterial in comparison with simple biomaterial but suggest the efficacity of their utilization as a carrier of bioactive agents. Future studies need to identify the suitable association of bone substitutes and vectors and explore interest in their use such as the support of growth factors.
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http://dx.doi.org/10.4012/dmj.2020-361DOI Listing
June 2021

Periodontal Diseases and Adverse Pregnancy Outcomes: Review of Two Decades of Clinical Research.

Oral Health Prev Dent 2021 ;19(1):77-83

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected.
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http://dx.doi.org/10.3290/j.ohpd.b898969DOI Listing
January 2021

Periodontitis, erectile dysfunction, reproductive hormones, and semen quality: A systematic review.

Andrology 2021 05 2;9(3):769-780. Epub 2021 Jan 2.

Université de Nantes, UFR Odontologie, Nantes, France.

Background: There is increasing evidence that periodontitis may affect male sexual health (MSH) (erectile function, production of sex hormones, and semen quality). However, a limited number of clinical studies demonstrate the association between MSH and periodontitis.

Objectives: The aim of this study was to explore the relationship between periodontitis and MSF.

Materials And Methods: A comprehensive systematic review of the published literature in MEDLINE, PubMed, Scopus, Cochrane, EMBASE, and Web of Science databases from the earliest available online indexing year until October 2020 was performed, in accordance with the PRISMA guidelines. Keywords related to periodontitis were combined with words describing MSH.

Result: A total of 19 studies were included and discussed in the systematic review. The number of study participants ranged from 53 to 197,136 individuals, aged between 18 and 95 years (mean age, 41.2 years). Six studies did not report the age of the participants. Out of nine studies, eight found a significant association between erectile dysfunction (ED) and periodontitis. Only three studies evaluated the association between sex hormone levels and periodontitis, and two of these studies showed that patients with periodontitis are expected to exhibit higher levels of testosterone. Finally, out of five studies, two demonstrated a significant association between semen quality and periodontitis.

Discussion: The findings in this review were limited by the quality and the few available studies. Results from the observational studies might have been affected by recall bias and confounded by cofactors.

Conclusion: The results of this systematic review revealed a significant association between periodontitis and ED, although the responsible mechanisms remain unclear. The potential associations between sex hormone levels, semen quality, and periodontitis are yet to be demonstrated. In order to improve patient management, dentists and physicians need to be aware of the association between male sexual health problems and periodontitis.
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http://dx.doi.org/10.1111/andr.12961DOI Listing
May 2021

Effect of Reinforced Oral Hygiene on Periodontally Healthy Dental Students: A Four-year Follow-up Clinical Trial.

Oral Health Prev Dent 2020 10 27;18(1):945-951. Epub 2020 Oct 27.

Purpose: In periodontally healthy individuals, mean crevicular depth ranges from 1 to 3 mm. This depth threshold has been used as an indicator to differentiate a physiological dentoalveolar sulcus from a periodontal pocket needing further treatment. Because many studies have shown the important contribution of oral hygiene status to periodontal health, the purpose of this study was to explore the clinical effect of reinforced oral hygiene on the periodontal status of periodontitis-free dental students.

Materials And Methods: In our longitudinal observational clinical study, we assessed the periodontal status of healthy individuals attending the dental school by measuring the periodontal pocket depth, bleeding on probing, and plaque index. The follow-up reassessment was carried out four years later at the end of the dental curriculum.

Results: The study showed that oral hygiene improvement led to a slight but significant reduction in the mean sulcus depth (-0.049 mm; p<0.0001).

Conclusions: Reinforcement of oral hygiene contributes to the reduction of probing depth even in periodontally healthy patients.
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http://dx.doi.org/10.3290/j.ohpd.a45434DOI Listing
October 2020

Comparative assessment of complete-coverage, fixed tooth-supported prostheses fabricated from digital scans or conventional impressions: A systematic review and meta-analysis.

J Prosthet Dent 2020 Oct 31. Epub 2020 Oct 31.

Professor of Periodontology, Department of Periodontology, Rmes U1229, University of Nantes, Nantes, France. Electronic address:

Statement Of Problem: Intraoral scanners have significantly improved over the last decade. Nevertheless, data comparing intraoral digital scans with conventional impressions are sparse.

Purpose: The purpose of this systematic review and meta-analysis was to determine the impact of impression technique (digital scans versus conventional impressions) on the clinical time, patient comfort, and marginal fit of tooth-supported prostheses.

Material And Methods: The authors conducted a literature search based on the Population, Intervention, Comparison, and Outcome (PICO) framework in 3 databases to identify clinical trials with no language or date restrictions. The mean clinical time, patient comfort, and marginal fit values of each study were independently extracted by 2 review authors and categorized according to the scanning or impression method. The authors assessed the study-level risk of bias.

Results: A total of 16 clinical studies met the inclusion criteria. The mean clinical time was statistically similar for digital scan procedures (784 ±252 seconds) and for conventional impression methods (1125 ±159 seconds) (P>.05). The digital scan techniques were more comfortable for patients than conventional impressions; the mean visual analog scale score was 67.8 ±21.7 for digital scans and 39.6 ±9.3 for conventional impressions (P<.05). The mean marginal fit was 80.9 ±31.9 μm and 92.1 ±35.4 μm for digital scan and conventional impressions, respectively, with no statistically significant difference (P>.05).

Conclusions: Digital scan techniques are comparable with conventional impressions in terms of clinical time and marginal fit but are more comfortable for patients than conventional impression techniques.
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http://dx.doi.org/10.1016/j.prosdent.2020.09.017DOI Listing
October 2020

Post-operative discomforts in children after extraction of primary teeth.

Clin Exp Dent Res 2020 12 23;6(6):650-658. Epub 2020 Aug 23.

Centre Hospitalier Universitaire de Nantes Pole Hospitalo-Universitaire 4, Nantes, France.

Objectives: This prospective observational study aimed to evaluate discomfort after extraction of deciduous teeth under local anesthesia. The primary objective was to describe the prevalence of post-extraction pain (PEP), post-extraction bleeding (PEB), post-extraction biting injury (PEBI), and analgesic usage in children. The secondary objective was to define whether it is possible to determine a profile of patients or a type of extraction procedure predictive to PEP, administration of analgesics, PEB, or PEBI.

Methods: One hundred and twenty-five children, aged 3-13 years, with indications of at least one deciduous tooth extraction, were included. Immediately after extraction, information concerning the patient and the extraction were collected. Eighteen to 32 hr after extraction, parents were called by phone to request reports concerning the onset and intensity of PEP assessed using the Wong-Baker Faces (WBF) scale, the administration of paracetamol (acetaminophen) to their children, and the appearance of PEB and/or PEBI.

Results: Of the children, 37.3% reported PEP (WBF ≥2), but 23.3% of these children did not receive any analgesic drugs to help relieve pain. Pain appeared before 3 hr after extraction in 69% of the children. Higher incidences of PEP and usage of analgesics were found both in the group of children with unfavorable socioeconomic level compared to favorable level and in the group with pre-operative pain compared to no pre-operative pain (p < .05).

Conclusions: About a third of the children reported pain after extraction, but the instructions for pain relief were not followed by all parents. The socioeconomic level of the young patient and the pain felt during the extraction were important predictors of discomfort. Therefore, our study could help the dentist to provide information on predicted post-operative discomfort and to allow suitable care depending on the patient's profile or procedure.
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http://dx.doi.org/10.1002/cre2.316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745079PMC
December 2020

Periodontal pockets: A potential reservoir for SARS-CoV-2?

Med Hypotheses 2020 Oct 30;143:109907. Epub 2020 May 30.

Department of Periodontology (Rmes U1229, UIC 11), Faculty of Dental Surgery, University of Nantes (CHU de Nantes), Nantes, France. Electronic address:

Periodontal pockets are the major clinical manifestation of Periodontitis, a chronic inflammatory oral disease affecting the teeth-supporting tissues and has high prevalence in the adult population. Periodontal pockets are ideal environments for subgingival bacterial biofilms, that interact with the supragingival oral cavity, mucosal tissues of the pocket and a peripheral circulatory system. Periodontal pockets have been found to harbor viral species such as the Herpes simplex viruses' family. Recently, the SARS-CoV-2 has gained major interest of the scientific/medical community as it caused a global pandemic (Covid-19) and paralyzed the globe with high figures of infected people worldwide. This virus behavior is still partially understood, and by analyzing some of its features we hypothesized that periodontal pocket could be a favorable anatomical niche for the virus and thus acting as a reservoir for SARS-CoV-2.
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http://dx.doi.org/10.1016/j.mehy.2020.109907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833827PMC
October 2020

Periodontal Diseases and Age-Related Macular Degeneration: Is There a Link? A Review.

Perm J 2019 25;23. Epub 2019 Oct 25.

Centre Hospitalier Universitaire de Nantes, France.

Background: Age-related macular degeneration (AMD) induces irreversible loss of vision in older people. The exact physiopathology remains unclear, but numerous studies highlight the role of inflammation and multiple risk factors. Recent data show an altered periodontal condition subject to AMD. Periodontal diseases lead to the destruction of tooth-supporting tissues, mainly caused by the periodontal infection inducing a chronic inflammation. Periodontal diseases are known to be associated with several extraoral diseases such as diabetes, polyarthritis (rheumatoid arthritis), cardiovascular disease, and preeclampsia.

Objectives: To assess emerging evidence suggesting an association between periodontitis and AMD.

Methods: To support this review, we performed a literature search using PubMed, Cochrane, and Google Scholar databases, completed by manual searches in periodontology journals. We included only the original studies published before July 2017 reporting data on periodontal diseases and AMD. No restrictions were made on the language.

Results: Persons with AMD showed more periodontal diseases, fewer teeth, and more alveolar bone loss than those without AMD. Also, a significant association was observed between periodontal diseases and AMD, but only in the youngest individuals studied.

Conclusion: According to the studies included in this review, periodontal disease may be a plausible risk factor for AMD and may have a potential role in the earlier stages of this eye disease. Further studies should be encouraged for better understanding of this potential new relationship.
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http://dx.doi.org/10.7812/TPP/18.260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836525PMC
August 2020

Periodontal regenerative medicine using mesenchymal stem cells and biomaterials: A systematic review of pre-clinical studies.

Dent Mater J 2019 Dec 11;38(6):867-883. Epub 2019 Sep 11.

Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, University of Nantes.

The aim of the systematic review was to analyze the use of mesenchymal stem cells (MSC) and biomaterial for periodontal regeneration from preclinical animal models and human. Electronic databases were searched and additional hand-search in leading journals was performed. The research strategy was achieved according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The including criteria were as follows: MSC, biomaterial, in vivo studies, with histologic and radiologic analysis and written in English. The risk of bias was assessed for individual studies. A total of 50 articles were selected and investigated in the systematic review. These results indicate that MSC and scaffold provide beneficial effects on periodontal regeneration, with no adverse effects of such interventions. Future studies need to identify the suitable association of MSC and biomaterial and to characterize the type of new cementum and the organization of the periodontal ligament fiber regeneration.
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http://dx.doi.org/10.4012/dmj.2018-315DOI Listing
December 2019

Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia.

Int J Clin Pediatr Dent 2018 Jul-Aug;11(4):344-348. Epub 2018 Aug 1.

Professor, Department of Periodontology, University of Nantes, Nantes France; Faculty of Dentistry, McGill University, Montreal, Canada.

Localized aggressive periodontitis (LAP) in child involving primary dentition is a rare disease. The main characteristics of LAP are deep periodontal pockets, bone loss, tooth mobility, and, sometimes, spontaneous tooth loss. The LAP involves only some specific teeth. Glanzmann's thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. The paper's aim is to present the case of a 5-year-old girl with GT presenting LAP, and discuss her clinical management. Prud'homme T, Roy E, Soueidan A, Fouassier M, Dajean-Trutaud S, Badran Z. Multidisciplinary Clinical Management of a Localized Aggressive Periodontitis diagnosed in a Child with Glanzmann's Thrombasthenia. Int J Clin Pediatr Dent 2018;11(4):344-348.
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http://dx.doi.org/10.5005/jp-journals-10005-1536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212666PMC
August 2018

Twenty Years of Full-Mouth Disinfection: The Past, the Present and the Future.

Open Dent J 2018 31;12:435-442. Epub 2018 May 31.

Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, F-44042, France.

Background: Conventional periodontal treatment, performed quadrant by quadrant in multiple visits, was re-evaluated in the early 1990s when the full-mouth disinfection concept was introduced. Over the years, several modifications to the full-mouth disinfection approach have been suggested.

Objective: The purpose of this article is to review the evolution of full-mouth disinfection during the past 20 years, to specify its indications and to consider the prospects for this approach.

Materials And Methods: An electronic and manual search of the literature, ending in December 2016, was performed by two independent researchers. Only pivotal studies and randomized controlled clinical trials published in the English language that evaluated a new approach to full-mouth disinfection were selected.

Results: According to the studies included in our analysis (21 articles), several modified full-mouth disinfection protocols have been designed including: full-mouth treatment without chlorhexidine, the extension of hygiene methods and an increase in the duration of post-treatment chlorhexidine use, the replacement of chlorhexidine with other antiseptics, supplementation with antibiotics or probiotics, full-mouth antimicrobial photodynamic therapy and one-stage full-mouth disinfection combined with a periodontal dressing.

Conclusion: Since 1995, several modifications have been suggested to improve the effectiveness of full-mouth disinfection. The majority of the studies demonstrate that the results obtained with full-mouth disinfection and its variants are equivalent to each other and to those obtained with the conventional quadrant method. Currently, the selection of this technique remains empirical and depends on the preferences of the practitioner and the patient. In the future, a patient-centered approach should be the best indication for the use of this technique.
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http://dx.doi.org/10.2174/1874210601812010435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997853PMC
May 2018

Evaluation of a hydrogel membrane on bone regeneration in furcation periodontal defects in dogs.

Dent Mater J 2018 Sep 20;37(5):825-834. Epub 2018 Jun 20.

INSERM, UMR-S 1229, RMeS, Faculty of Dental Surgery, University of Nantes.

The aim of the study was to evaluate bone regeneration using a canine model with surgically created periodontal defects filled for 12 weeks using a stratified biomaterial consisting in a biphasic calcium phosphate (BCP) covered with a crosslinking hydrogel acting as polymer membrane of silated hydroxypropyl methylcellulose (Si-HPMC) as the tested new concept. Bilateral, critical-sized, defects were surgically created at the mandibular premolar teeth of six adult beagle dogs. The defects were randomly allocated and: (i) left empty for spontaneous healing or filled with: (ii) BCP and a collagen membrane; (iii) BCP and hydrogel Si-HPMC membrane. At 12 weeks, the experimental conditions resulted in significantly enhanced bone regeneration in the test BCP/Si-HPMC group. Within the limits of this study, we suggest that the hydrogel Si-HPMC may act as an occlusive barrier to protect bone area from soft connective tissue invasion and then effectively contribute to enhance bone regeneration.
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http://dx.doi.org/10.4012/dmj.2017-238DOI Listing
September 2018

B cell subset distribution is altered in patients with severe periodontitis.

PLoS One 2018 15;13(2):e0192986. Epub 2018 Feb 15.

UMR1227, Université de Brest, Inserm, Brest, France.

Several studies have recently highlighted the implication of B cells in physiopathogenesis of periodontal disease by showing that a B cell deficiency leads to improved periodontal parameters. However, the detailed profiles of circulating B cell subsets have not yet been investigated in patients with severe periodontitis (SP). We hypothesised that an abnormal distribution of B cell subsets could be detected in the blood of patients with severe periodontal lesions, as already reported for patients with chronic inflammatory diseases as systemic autoimmune diseases. Fifteen subjects with SP and 13 subjects without periodontitis, according to the definition proposed by the CDC periodontal disease surveillance work group, were enrolled in this pilot observational study. Two flow cytometry panels were designed to analyse the circulating B and B1 cell subset distribution in association with the RANKL expression. A significantly higher percentage of CD27+ memory B cells was observed in patients with SP. Among these CD27+ B cells, the proportion of the switched memory subset was significantly higher. At the same time, human B1 cells, which were previously associated with a regulatory function (CD20+CD69-CD43+CD27+CD11b+), decreased in SP patients. The RANKL expression increased in every B cell subset from the SP patients and was significantly greater in activated B cells than in the subjects without periodontitis. These preliminary results demonstrate the altered distribution of B cells in the context of severe periodontitis. Further investigations with a larger cohort of patients can elucidate if the analysis of the B cell compartment distribution can reflect the periodontal disease activity and be a reliable marker for its prognosis (clinical trial registration number: NCT02833285, B cell functions in periodontitis).
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192986PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5814041PMC
April 2018

The use of laser Doppler flowmetry to evaluate oral soft tissue blood flow in humans: A review.

Arch Oral Biol 2018 Feb 22;86:58-71. Epub 2017 Nov 22.

Department of Periodontology, UIC Odontology, Nantes Dental School 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France. Electronic address:

The objective of this work is to define the conditions for improving the use of laser Doppler flowmetry (LDF) and to determine the limits for the use of this technique. This article systematically reviews the literature on the evaluation of oral soft tissue blood microcirculation by LDF. We analysed the available literature through October 2016 using the database resources Medline/PubMed, the Cochrane Oral Health Group Specialist Trials Register and the ISI Web of Knowledge. Several points emerged from this literature review The use of LDF involves specific constraints; however, the influence of different factors (temperature, tobacco, pressure etc.) must be adequately controlled when using LDF. LDF measurements of soft tissue within the oral cavity vary depending on the anatomical site. In dentistry, LDF can be used to track healing progress in periodontal surgery and to diagnose vascular flow changes in the connective tissue of mucosae covered by a removable prosthesis at an early stage prior to the onset of clinical inflammation signs.
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http://dx.doi.org/10.1016/j.archoralbio.2017.11.009DOI Listing
February 2018

Silicon Nitride (SiN) Implants: The Future of Dental Implantology?

J Oral Implantol 2017 Jun 16;43(3):240-244. Epub 2017 Mar 16.

3   Unit of Periodontology, Dental Institute, King's College, London, UK.

For decades titanium has been the preferred material for dental implant fabrication, with mechanical and biological performance resulting in high clinical success rates. These have been further enhanced by incremental development of surface modifications aimed at improving speed and degree of osseointegration and resulting in enhanced clinical treatment options and outcomes. However, increasing demand for metal-free dental restorations has also led to the development of ceramic-based dental implants, such as zirconia. In orthopedics, alternative biomaterials, such as polyetheretherketone or silicon nitride, have been used for implant applications. The latter is potentially of particular interest for oral use as it has been shown to have antibacterial properties. In this article we aim to shed light on this particular biomaterial as a future promising candidate for dental implantology applications, addressing basic specifications required for any dental implant material. In view of available preclinical data, silicon nitride seems to have the essential characteristics to be a candidate for dental implants material. This novel ceramic has a surface with potentially antimicrobial properties, and if this is confirmed in future research, it could be of great interest for oral use.
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http://dx.doi.org/10.1563/aaid-joi-D-16-00146DOI Listing
June 2017

An analysis model for investigating the staining effect of various chlorhexidine-based mouthwashes.

J Clin Exp Dent 2017 Mar 1;9(3):e410-e416. Epub 2017 Mar 1.

Prof, PhD, UFR d'odontologie. 1, Place A. Ricordeau, 44082, Nantes cedex2.

Background: There are different mouthwashes containing chlorhexidine in different concentrations, as well as various excipients. Chlorhexidine induce stains or discoloration in teeth and mucous membranes. The aim of this work was to design a model to reproduce staining associated with the use of different mouthwashes containing chlorhexidine.

Material And Methods: We used as substrates of natural teeth and elephant ivory slices. Different incubation baths were conducted over 21 days in culture dishes at 37°C. At the beginning of experiment before incubation (D0) and after 21 days (D21) of incubation with different mouthwashes, pictures of substrates were taken in a standardized manner and an image analysis software was used to analyse and quantify the staining under the various conditions by using the 3 main colours (Red, Green, Blue, RGB).

Results: The results of this work demonstrate a very good reproducibility of the protocol, and secondly, a different expression statistically significant of the primary blue colour. We suggest that for a given concentration of chlorhexidine, the staining effects may vary depending on the excipients used.

Conclusions: This replicable model, easy to implement over a relatively short duration, can be used for evaluation of existing mouthwashes, and to test the excipients anti discoloration proposed by manufacturers. In vitro, chlorhexidine, mouthwashes, dental stain, tooth discoloration.
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http://dx.doi.org/10.4317/jced.53375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347291PMC
March 2017

The oral cavity microbiota: between health, oral disease, and cancers of the aerodigestive tract.

Can J Microbiol 2017 Jun 3;63(6):475-492. Epub 2017 Mar 3.

c EA 3826 Thérapeutiques cliniques et expérimentales des infections, Faculté de médecine, CHU hôtel-Dieu, Université de Nantes, 1, rue G. Veil, 44000 Nantes, France.

Many studies show that the human microbiome plays a critical role in the chronic pathologies of obesity, inflammatory bowel diseases, and diabetes. More recently, the interaction between cancer and the microbiome has been highlighted. Most studies have focused on the gut microbiota because it represents the most extensive bacterial community, and the body of evidence correlating it with gut syndromes is increasing. However, in the strict sense, the gastrointestinal (GI) tract begins in the oral cavity, and special attention should be paid to the specific flora of this cavity. This study reviewed the current knowledge about the various microbial ecosystems of the upper part of the GI tract and discussed their potential link to carcinogenesis. The overall composition of the microbial communities, as well as the presence or absence of "key species", in relation to carcinogenesis is addressed. Alterations in the oral microbiota can potentially be used to predict the risk of cancer. Molecular advances and the further monitoring of the microbiota will increase our understanding of the role of the microbiota in carcinogenesis and open new perspectives for future therapeutic and prophylactic modalities.
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http://dx.doi.org/10.1139/cjm-2016-0603DOI Listing
June 2017

Clinical Performance of Narrow-Diameter Titanium-Zirconium Implants: A Systematic Review.

Implant Dent 2017 Apr;26(2):316-323

*Clinical Instructor, Department of Oral Implantology, Faculty of Dental Surgery, University of Nantes, Nantes, France; Associate Professor, Department of Periodontology, Faculty of Dental surgery, (Inserm U791/UIC 11) CHU de Nantes, France. †Clinical Instructor, Department of Oral Implantology, Faculty of Dental Surgery, University of Nantes, Nantes, France. ‡Adjunct Assistant Professor, Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, and Institut Straumann, Basel, Switzerland. §Professor and Head, Department of Periodontology, Faculty of Dental surgery, (Inserm U791/UIC 11) CHU de Nantes, Nantes, France. ¶Associate Professor and Head, Department of Oral Implantology, Faculty of Dental Surgery, University of Nantes, Nantes, France.

Purpose: Implant-supported prosthetic rehabilitations are in constant augmentation in everyday dental practice. This is largely due to increasing demand from patients for fixed or implant-stabilized prosthesis, although they are frequently reticent to complex preimplant bone augmentation surgeries, whenever bone volume is lacking. Narrow-diameter implants (NDI; ≤3.5 mm) have been developed to offer relatively simple implant solutions in challenging bone-deficient sites. However, concerns regarding their mechanical properties have been raised. Special titanium-zirconium material (Ti-Zr), with superior mechanical resistance, compared with pure titanium alloys has been introduced into the market. The purpose of this systematic review was to determine the available data on clinical performance of Ti-Zr NDI.

Materials And Methods: A literature search of all available clinical articles dealing with Ti-Zr NDI has been carried out. After including only prospective clinical trials, 14 papers were retrieved for thorough reviewing.

Conclusion: Short-term results from preliminary clinical reports are quite promising, although the number of published studies and the follow-up periods are still insufficient to determine the real benefit of this hybrid material compared with titanium, especially when using NDI.
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http://dx.doi.org/10.1097/ID.0000000000000557DOI Listing
April 2017

Clinical management of an atypical dental invagination.

Eur J Dent 2016 Oct-Dec;10(4):579-582

Department of Operative Dentistry and Endodontics, Faculty of Dental Surgery, CHU de Nantes, Nantes, France.

Dental invagination (DI) is a tooth malformation that usually affects permanent teeth. Its precise etiology is still controversial and represents a clinical challenge as it can favor the development of carious lesion or periodontal inflammation. This paper presents a case of a 23-year-old Caucasian male, where an atypical buccal DI could not be completely diagnosed in the dens invaginatus category. Furthermore, other differential diagnoses could not be confirmed. The dental malformation was seen on a permanent maxillary first incisor and was associated with periodontal inflammation and attachment loss. Successful clinical management of this case consisted of surgical restorative treatment and regular follow-up, accompanied by thorough oral hygiene procedures.
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http://dx.doi.org/10.4103/1305-7456.195167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5166320PMC
January 2017

Pilot Study of Laser Doppler Measurement of Flow Variability in the Microcirculation of the Palatal Mucosa.

Biomed Res Int 2016 1;2016:5749150. Epub 2016 Jun 1.

Department of Periodontology, UIC Odontologie, LIOAD U-791, 1 Place Alexis Ricordeau, 44042 Nantes, France.

Background. Histopathological alterations can arise when the denture-supporting mucosa experiences microbial and mechanical stress through the denture base and diagnosis of these diseases usually follows microvascular changes. Microcirculation measurement could allow for detection of such dysfunction and aid in the early diagnosis of palatal mucosa pathologies. Materials and Methods. We tested the sensitivity of laser Doppler for measuring the microcirculation of the palatal mucosa, assessing the median raphe (MR), Schroeder area (SA), and retroincisive papilla (RP). A Doppler PeriFlux 5000 System, containing a laser diode, was used. 54 healthy participants were recruited. We compare the measurements of PU (perfusion unit) using ANOVA test. Results. The numerical values for palatal mucosa blood flow differed significantly among the anatomical areas (p = 0.0167). The mean value of Schroeder area was 92.6 (SD: 38.4) and was significantly higher than the retroincisive papilla (51.9) (SD: 20.2) (p < 0.05), which in turn was higher than that of median raphe (31.9) (SD: 24.2) (p < 0.0001). Conclusion. Schroeder area appeared to have the greatest sensitivity, and vascular flow variability among individuals was also greatest in this region. We suggest that analysis of blood stream modification with laser Doppler of the palatal mucosa can help to detect onset signs of pathological alterations.
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http://dx.doi.org/10.1155/2016/5749150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908244PMC
February 2017

Relationship between removable prosthesis and some systemics disorders.

J Indian Prosthodont Soc 2015 Oct-Dec;15(4):292-9

Department of Periodontology, Faculty of Dentistry, CHU Nantes, 1 Place Alexis Ricordeau, 44042 Nantes, France.

This article reviews the dental literature concerning the potential impact of the removable prosthesis (RP) on the health status of patients with certain systemic diseases. Literature was surveyed using Medline/PubMed database resources, as well as a manual search, up to 2015 to identify appropriate articles that addressed the aim of this review. The research used keywords about associations between RP and six pathologies: Human immunodeficiency virus infection, diabetes mellitus, pulmonary diseases, gastric-Helicobacter pylori, cancer, and cardiovascular diseases. Analysis of literature showed that in patients with dentures having one or more of the six general conditions listed, Candida albicans organism is more frequently found in the oral flora compared to healthy denture wearer. Although causality has not been established and pending further research on this topic, the hygienic practices necessary to minimize the risk of numerous pathologies should be strengthened in the case of these patients, all the more in the presence of physical or psychological disability. The relationship between the general diseases and increasing of oral candidiasis denture patients is not explained. Therefore, attention to oral hygiene and professional care for removing C. albicans may be beneficial in these medically compromised patients.
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http://dx.doi.org/10.4103/0972-4052.171828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762353PMC
March 2016

Oral Infections and Pregnancy: Knowledge of Gynecologists/Obstetricians, Midwives and Dentists.

Oral Health Prev Dent 2016 ;14(1):41-7

Purpose: To establish an inventory of knowledge, attitudes and daily pratice of dental and medical practitioners in France regarding oral health care and its relationship to pregnancy, particularly to preterm delivery and low birth-weight infants.

Materials And Methods: A questionnaire was distributed to health-care professionals (n= 460), consisting of 100 prenatal care practitioners (obstetricians, midwives) and 360 dentists, about their knowledge of oral alterations during pregnancy, the possible association between periodontal disorders and preterm/low birth weight, and their conduct toward their patients.

Results: Bleeding gums and pregnancy gingivitis were the oral manifestations most often cited by all the practitioners. In contrast, prenatal care practitioners were unaware of epulis and a greater percentage of them than dentists believed caries risk to increase during pregnancy. The most adverse pregnancy outcomes cited were risk of premature delivery and chorioamniotis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point out the lack of continuing education on this topic.

Conclusion: The present results underline the need for a better initial professional education and continuing education regarding pregnancy and oral health conditions and emphasise the need to update the guidelines in health care practices for pregnant women for a more effective prevention of risk-related adverse pregnancy outcomes, such as pre-term birth or pre-eclampsia.
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http://dx.doi.org/10.3290/j.ohpd.a34376DOI Listing
May 2016

Periodontitis as a risk factor for systemic disease: Are microparticles the missing link?

Med Hypotheses 2015 Jun 2;84(6):555-6. Epub 2015 Mar 2.

Department of Periodontology (UIC Odontology, CHU, LIOAD Inserm U791), Faculty of Dental Surgery, University of Nantes, France. Electronic address:

Periodontitis is an oral inflammatory disease affecting the teeth supportive tissue. Its bacterial infectious etiology is well established. Periodontitis has been associated with increased prevalence of systemic diseases such as cardiovascular diseases, diabetes, rheumatoid arthritis, preeclampsia, preterm birth and inflammatory bowel disease. The rational of considering periodontitis as risk factor for systemic disease is the passage of inflammatory cytokines and/or bacteria in the bloodstream, thus affecting distant organs. Membrane microparticles are released by multiple cells in inflammatory environment. Recent data suggested the role of these microparticles in the pathogenic process of many systemic diseases, that can be also associated to periodontitis. We hypothesized that periodontitis could be a chronic reservoir of microparticles, hence elucidating partially the interaction with systemic diseases initiation or progression.
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http://dx.doi.org/10.1016/j.mehy.2015.02.013DOI Listing
June 2015

The association of hydrogel and biphasic calcium phosphate in the treatment of dehiscence-type peri-implant defects: an experimental study in dogs.

J Mater Sci Mater Med 2013 Dec 3;24(12):2749-60. Epub 2013 Aug 3.

Laboratory of Osteo-Articular and Dental Tissue Engineering (LIOAD), INSERM, U791, 1 Place Alexis Ricordeau, 44042, Nantes, France.

Hydrogel polymers have many applications in regenerative medicine. The aim of this study in dogs was to investigate bone regeneration in dehiscence-type peri-implant defects created surgically and treated with (i) biphasic calcium phosphate (BCP) granules alone; (ii) a composite putty hydroxypropyl methylcellulose (HPMC)/BCP (MBCP/putty); and (iii) a polymer crosslinked membrane of silanized-HPMC (Si-HPMC/BCP) compared with empty controls. At 3 months, new bone formation was significantly more important in defects filled with HPMC/BCP or Si-HPMC/BCP compared with spontaneous healing in control (P = 0.032 and P = 0.046 respectively) and more substantial compared with BCP alone. Furthermore, new bone formation in direct contact with the implant surface was observed in all three groups treated with BCP. The addition of HPMC to the BCP granules may have enhanced the initial stability of the material within the blood clot in these large and complex osseous defects. The Si-HPMC hydrogel may also act as an occlusive membrane covering the BCP, which could improve the stability of the granules in the defect area. However, the crosslinking time of the Si-HPMC is too long for easy handling and the mechanical properties remain to be improved. The composite MBCP/putty appears to be a valuable bone-graft material in complex defects in periodontology and implantology. These encouraging results should now be confirmed in clinical studies.
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http://dx.doi.org/10.1007/s10856-013-5019-xDOI Listing
December 2013

Gingival biotype assessement: visual inspection relevance and maxillary versus mandibular comparison.

Open Dent J 2013 24;7:1-6. Epub 2013 Jan 24.

Department of Orthodontics, School of Dentistry, Nantes, France.

Objective: This clinical study was aimed at evaluating the accuracy of gingival visual inspection procedures during clinical examination and determining whether differences existed between the maxillary and mandibular gingival biotypes.

Materials And Methods: The study included 53 patients and 124 clinicians. The clinicians were asked to assign to each subject, using photographic documents, one of three biotypes: thin-scalloped, thick-scalloped, or thick-flat gingival biotype. A total of 19716 responses were collected for statistical analysis.

Results: Identification accuracy of the gingival biotype and the intra-examiner repeatability presented poor highlighting of the limited relevance of visual inspection. In addition, the percent of agreement between classifications based on the global view of both the maxilla and mandible and the classification based on the individual mandibular or maxillary anterior teeth was not statistically significant.

Conclusion: Based on the above results, it can be concluded that a simple visual inspection is not effective for the identification of gingival biotype. Furthermore, evidence suggests that a difference of biotype between the maxilla and the mandible in the same patient is conceivable. Therefore, orthodontic clinical examination should incorporate a reproducible method of determining the individualized gingival biotype for each group of teeth that will be moved.
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http://dx.doi.org/10.2174/1874210601307010001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565230PMC
February 2013

[Dental care during pregnancy].

Schweiz Monatsschr Zahnmed 2012 ;122(11):1047-63

Département de parodontologie, UFR d'odontologie, 1, place A. Ricordeau, 44042 Nantes , France.

Aim: to understand and analyze knowledge and practices of dentists regarding dental care during pregnancy using a questionnaire which focuses on the knowledge of the relationship between oral infections and complications of pregnancy, the attitude of practitioners on the implementation of dental care during pregnancy and the training of practitioners.

Results: 53.9% of pregnant women are not referred by an obstetrician. Only 59.8% of practitioners believe that dental anesthesia is not contraindicated, and most practitioners believe that the best time for care is the second trimester or after pregnancy. During pregnancy, practitioners realize the motivation for hygiene (90.7%), drainage of an abscess (82.2%), scaling (76.1%), the placement of a splint (74.1%), the treatment of caries (70%), and the removable prosthesis (67.2%).

Conclusion: these results indicate the existence of a gap between the care of pregnant women and the state of the art in dental science, despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second and third trimester. Moreover, the results highlight the need to reinforce the initial training of dental students, but also to develop the training for practitioners in this field.
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January 2013

Clinical outcomes after nonsurgical periodontal therapy with an Er:YAG laser device: a randomized controlled pilot study.

Photomed Laser Surg 2012 Jul 3;30(7):347-53. Epub 2012 May 3.

Department of Periodontology (CHU de Nantes), Faculty of Dental Surgery, Nantes, France.

Objective: The purpose of this study was to compare the short-term effects of nonsurgical periodontal treatment with the short-term effects of Er:YAG laser debridement (ERL) and manual scaling and root planning (SRP) in nonsmoking patients with chronic periodontitis.

Methods: Nineteen nonsmoking patients (mean age 60.7) with chronic generalized periodontitis were randomly treated with ERL or SRP in a split-mouth design. Clinical attachment level (CAL), periodontal pocket depth (PPD), and bleeding on probing (BOP) were recorded. Immediately after completion of the treatment procedure, patients used a visual analogue scale (VAS) to grade the degree of discomfort experienced during treatment.

Results: Both groups showed significant reductions in their PPD, CAL, and BOP values 2 months after treatment. The sites treated with Er:YAG laser demonstrated mean PPD changes that varied from 5.00 ± 0.63 to 3.54 ± 0.83 mm, mean CAL changes that varied from 5.19 ± 0.69 to 3.86 ± 0.94 mm, and BOP changes that varied from 26.57 ± 12.54 to 13.17 ± 7.52 mm. Sites treated with manual SRP demonstrated mean PPD changes that varied from 4.91 ± 0.55 to 3.51 ± 0.98 mm, mean CAL changes that varied from 5.08 ± 0.59 to 3.95 ± 1.16 mm, and BOP values that varied from 24.81 ± 7.65 to 15.41 ± 6.32 mm. Comparison of the two techniques demonstrated the statistically significant superiority of Er:YAG only for the CAL scores (p<0.05).

Conclusions: Within the limits of this study, ERL may be posited as an alternative to mechanical treatment in the management of chronic periodontitis. In addition, ERL may be performed on patients who are sensitive to the use of injectable anesthetics. Future studies, with larger samples, are needed to determine the long-term clinical outcomes of ERL.
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http://dx.doi.org/10.1089/pho.2011.3215DOI Listing
July 2012

Distribution Patterns of E-Cadherin, Type VII Collagen and Fibronectin in Denture-Related Stomatitis: A Preliminary Study.

Open Dent J 2012 13;6:14-22. Epub 2012 Jan 13.

Department of Prosthodontics, Faculté de Chirurgie Dentaire Université de Nantes 1, Place Alexis Ricordeau 44042 Nantes, France.

The distribution of epithelial E-cadherin, basement membrane type VII collagen, and underlying connective tissues fibronectin were investigated immunohistochemically and compared in normal palatal mucosa and in denture-related stomatitis (DRS) derivatives using monoclonal antibodies.Biopsies of palatal mucosa were obtained from twelve patients enrolled in this study, 8 with type II DRS and 4 with healthy mucosa.Our findings bring to the fore, using the expression of three components (E-cadherin, collagen type VII, fibronectin), the continuities of the disorder among epithelial, basement membrane and connective tissue in the case of DRS. In type II denture-related stomatitis, we found an expression of E-cadherinin all the strata of epithelia, and the diffuse and strong expression of type VII collagen at the interface between connective tissue and epithelial cells with discontinuities in BM. The strong expression of fibronectin in underlying connective tissue with penetration in some areas of the palatal mucosa may be an early consequence of advanced DRS. Nevertheless; no single change is pathognomonic of this inflammatory process.In normal tissues (healthy clinical aspect), E-cadherin was found to be restricted to the upper strata of the epithelia, and type VII collagen revealed thin linear staining in the basement membrane and fibronectin in underlying connective tissue combined epithelia.In the case of denture-related stomatitis DRS, these three markers reflect the immunohistological modifications from the superficial layer of the epithelium to the lamina propria.
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http://dx.doi.org/10.2174/1874210601206010014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267086PMC
August 2012

Assay of in vitro osteoclast activity on dentine, and synthetic calcium phosphate bone substitutes.

J Mater Sci Mater Med 2012 Mar 22;23(3):797-803. Epub 2011 Dec 22.

Osteo-Articular and Dental Tissue Engineering Laboratory LIOAD, Department of Periodontology, School of Dental Surgery, INSERM U791, Nantes, France.

Resorption of synthetic bone substitute materials is essential for the integration of these materials into the natural bone remodeling process. Osteoclast behavior in the presence of calcium phosphate bioceramics (CaPB) is partially understood, and a better understanding of the underlying mechanisms is expected to facilitate the development of new synthetic bone substitutes to improve bone regeneration. In the present study, our aim was to investigate osteoclastic resorption of various synthetic CaPB. We used neonatal total rabbit bone cells to generate osteoclasts. Osteoclast-generated resorption on dentine and multiple CaPB was investigated by quantifying the surface resorbed and measuring tartrate resistant acid phosphatase (TRAP) enzyme activity. In this study, we observed that osteoclastic cells responded in a different way to each substrate. Both dentine and CaPB were resorbed but the quantitative results for the surface resorbed and TRAP activity showed a specific response to each substrate and that increased mineral density seemed to inhibit osteoclast activity.
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http://dx.doi.org/10.1007/s10856-011-4534-xDOI Listing
March 2012

Treatment of periodontal defects in dogs using an injectable composite hydrogel/biphasic calcium phosphate.

J Mater Sci Mater Med 2011 Jul 25;22(7):1707-17. Epub 2011 May 25.

INSERM, U791, Laboratory for Osteo-Articular and Dental Tissue Engineering (LIOAD), Faculty of Dental Surgery, University of Nantes, 1 Place Alexis Ricordeau, BP 84215, 44042 Nantes, France.

An injectable composite silanized hydroxypropyl methyl cellulose/biphasic calcium phosphate (Si-HPMC/BCP) has been investigated in humans with promising results. The aim of this study was to evaluate his efficacy for treating periodontal defects (canine fenestration and premolar furcation) in dog models. At 3 months, we observed that bone formation around BCP particles in furcation model is more discernible but not statistically significant in defects filled with Si-HPMC/BCP compared to healing in control. We suggest that BCP particles sustain the bone healing process by osteoconduction, while the Si-HPMC hydrogel enhances intergranular cohesion and acts as an exclusion barrier. Furthermore, bone ingrowth is not so distinctive in superficial defects where the biomaterial appears unstable. These results with Si-HPMC/BCP are encouraging. In addition, this biomaterial is easy to use and simplifies the process of filling periodontal lesions. However, more researches are needed to improve the viscosity and hardness to adjust the material to the specificities of periodontal defects.
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http://dx.doi.org/10.1007/s10856-011-4344-1DOI Listing
July 2011