Publications by authors named "George Deeb"

76 Publications

The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team.

Ann Thorac Surg 2021 Mar 1. Epub 2021 Mar 1.

Michigan Medicine - University of Michigan, Department of Cardiac Surgery, Ann Arbor, MI.

Background: Infectious endocarditis is associated with substantial in-hospital mortality of 15-20%. Effective management requires coordination between multiple medical and surgical subspecialties which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality.

Methods: The multidisciplinary endocarditis Team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching.

Results: Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria definite endocarditis and at least 1 AHA indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1, 2014 to June 30, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (p<0.0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; p=0.12). Propensity score matching demonstrated similar results.

Conclusions: Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the two studied cohorts. In conjunction with previous studies demonstrating their effectiveness, this data supports that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.
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http://dx.doi.org/10.1016/j.athoracsur.2021.02.027DOI Listing
March 2021

Implant site preparation application of injectable platelet-rich fibrin for vertical and horizontal bone regeneration: A clinical report.

J Oral Implantol 2020 Dec 3. Epub 2020 Dec 3.

Virginia Commonwealth University General Practic 520 North 12th St., UNITED STATES Richmond VA 23298 Virginia Commonwealth University.

Guided bone regeneration (GBR) using a combined injectable platelet-rich fibrin (i-PRF), leukocyte- and platelet-rich fibrin (L-PRF) and biocompatible bone substitute materials, is a convenient and effective method to augment a combined vertical and horizontal bone defect. This approach can create sufficient bone quality and quantity for implant surgical sites. A 55-year-old Asian woman presented with a severe bone defect in posterior mandible. The edentulous mandibular alveolar ridge was severely resorbed vertically and horizontally.  A GBR procedure using i-PRF and L-PRF combined with particulate bone graft was performed. Postoperative cone beam computed tomography scans, 8 months after the augmentation, revealed a large regeneration of the alveolar bone sufficient for implant placement. A combination i-PRF/L-PRF and particulate bone graft may provide biologically active molecules as well as a scaffold for osteogenesis. This treatment protocol may be a viable option for a large bone defect required augmentation prior to implant placement.
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http://dx.doi.org/10.1563/aaid-joi-D-20-00031DOI Listing
December 2020

Effect of biologic materials on the outcomes of horizontal alveolar ridge augmentation: A retrospective study.

Clin Exp Dent Res 2021 Apr 4;7(2):147-155. Epub 2020 Nov 4.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA.

Purpose: The purpose of this study was to investigate if the addition of biologic agents to a particulate bone graft enhances horizontal ridge augmentation outcomes in terms of bone dimensions, bone density, and successful implant placement.

Materials And Methods: A retrospective chart review was done to assess the clinical and radiographic outcomes in 52 horizontal ridge augmentation sites in 43 patients. Information was gathered regarding surgical technique, type of graft material, biologic agents used (PRP or rhPDGF-BB), method of space maintenance, and achieved alveolar ridge width and bone density changes as quantified on CBCT scans.

Results: The use of tenting screws, a resorbable membrane, and a combination of particulate allogenic and xenogenic bone graft material provided an average horizontal bone gain of 3.6 mm in the 52 augmented sites. There was no statistically significant difference observed in the amount of horizontal bone gain between sites treated with the addition of biologic agents (n = 21), or with a particulate bone graft alone (n = 31). A marginally statistically significant difference was found in the density of the grafted bone with the addition of biologics (p value = .0653).

Conclusion: The addition of biologic agents to the graft materials did not have a significant effect on the amount of horizontal bone gain or successful implant placement; however, it marginally enhanced the bone density of the grafted area.
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http://dx.doi.org/10.1002/cre2.343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019766PMC
April 2021

Oral Soft Tissue Grafting.

Oral Maxillofac Surg Clin North Am 2020 Nov 7;32(4):611-630. Epub 2020 Sep 7.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, 521 North 11th Street, Richmond, VA 23298, USA. Electronic address:

The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.
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http://dx.doi.org/10.1016/j.coms.2020.07.006DOI Listing
November 2020

In Vitro Comparison of Time and Accuracy of Implant Placement Using Trephine and Conventional Drilling Techniques Under Dynamic Navigation.

J Oral Implantol 2020 Aug 11. Epub 2020 Aug 11.

Associate Professor, University of Ljubljana, Medical Faculty, Division for Dental Medicine, Department of Prosthodontics, Ljubljana, Slovenia, EU. University Medical Centre of Ljubljana, University Dental Clinics, Department of Prosthodontics, Ljubljana.

The aim of this randomized in vitro study was to compare the time and accuracy of implant site preparation and implant placement using a trephine drill versus a conventional drilling technique under dynamic navigation. A total of 42 implants were placed in simulation jaw models with the two drilling techniques by two operators with previous experience with dynamic navigation. The timing of each implant placement was recorded, and horizontal, vertical, and angulation discrepancies between the planned and placed implants were compared. There was no significant difference in time or accuracy between the trephine and conventional drilling techniques. Implant site preparation with a single trephine drill using dynamic navigation was as accurate under in vitro experimental conditions as a conventional drilling sequence.
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http://dx.doi.org/10.1563/aaid-joi-D-19-00125DOI Listing
August 2020

Computer-Aided Planning and Placement in Implant Surgery.

Atlas Oral Maxillofac Surg Clin North Am 2020 Sep 18;28(2):53-58. Epub 2020 Jun 18.

Department of Periodontics and General Practice, School of Dentistry, Virginia Commonwealth University, Wood Memorial Building, Room 311, 521 North 11th Street, PO Box 980566, Richmond, VA 23298-0056, USA.

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http://dx.doi.org/10.1016/j.cxom.2020.05.001DOI Listing
September 2020

Effects of two Postprocessing Methods onto Surface Dimension of in-Office Fabricated Stereolithographic Implant Surgical Guides.

J Prosthodont 2021 Jan 19;30(1):71-75. Epub 2020 Aug 19.

Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA.

Purpose: To evaluate the effects of two postprocessing methods in terms of the overall, intaglio, and cameo surface dimensions of in-office stereolithographic fabricated implant surgical guides.

Materials And Methods: Twenty identical implant surgical guides were fabricated using a stereolithographic printer. Ten guides were postprocessed using an automated method. The other ten guides were postprocessed using a series of hand washing in combination with ultrasonics. Each guide was then scanned using cone-beam computed tomography to produce a set of digital imaging and communications in medicine (DICOM) files which were converted into standard tessellation language (STL) files. The STL file was then superimposed onto the original STL design file using the best fit alignment. The average positive and negative surface discrepancy differences in terms of means and variances were analyzed using t-test (α = 0.05).

Results: For the alternative group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 77.38 ± 10.68 µm and -67.74 ± 6.55 µm; 78.83 ± 8.65 µm and -68.16 ± 5.26 µm; and 70.5 ± 8.48 µm -64.84 ± 5.55 µm, respectively. For the automated group, the average positive and negative overall, intaglio, and cameo surface discrepancies were 51.88 ± 4.38 µm and -170.7 ± 11.49 µm; 64.3 ± 4.44 µm and -89.45 ± 6.25 µm; and 83.59 ± 4.81 µm and -144.26 ± 13.19 µm, respectively. There was a statistical difference between the means of the two methods for the overall, intaglio, and cameo positive and negative discrepancies (p < 0.001).

Conclusions: For a single implant tooth-supported implant guide, using hand washing with ultrasonics appeared to be consistently better than the automated method. The manual method presented with more positive discrepancies, while the automated method presented with more negative discrepancies.
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http://dx.doi.org/10.1111/jopr.13227DOI Listing
January 2021

Anti-Tumor Effects of Biomimetic Sulfated Glycosaminoglycans on Lung Adenocarcinoma Cells in 2D and 3D In Vitro Models.

Molecules 2020 Jun 3;25(11). Epub 2020 Jun 3.

Department of Biomedical Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107 2020, Lebanon.

Lung cancer development relies on cell proliferation and migration, which in turn requires interaction with extracellular matrix (ECM) components such as glycosaminoglycans (GAGs). The mechanisms through which GAGs regulate cancer cell functions are not fully understood but they are, in part, mediated by controlled interactions with cytokines and growth factors (GFs). In order to mechanistically understand the effect of the degree of sulfation (DS) of GAGs on lung adenocarcinoma (LUAD) cells, we synthesized sulfated alginate (AlgSulf) as sulfated GAG mimics with DS = 0.0, 0.8, 2.0, and 2.7. Human (H1792) and mouse (MDA-F471) LUAD cell lines were treated with AlgSulf of various DSs at two concentrations 10 and 100 µg/mL and their anti-tumor properties were assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), trypan blue exclusion, and wound healing assays for 2D models and sphere formation assay for the 3D model. The proliferation and number of live MDA-F471 cells at the concentration of 100 µg/mL decreased significantly with the increase in the DS of biomimetic GAGs. In addition, the increase in the DS of biomimetic GAGs decreased cell migration ( < 0.001 for DS = 2.0 and 2.7 compared to control) and decreased the diameter and number of spheres formed ( < 0.001). The increased DS of biomimetic GAGs attenuated the expression of cancer stem cell (CSC)/progenitor markers in the 3D cultures. In conclusion, GAG-mimetic AlgSulf with increased DS exhibit enhanced anti-proliferative and migratory properties while also reducing growth of -mutant LUAD spheres in vitro. We suggest that these anti-tumor effects by GAG-mimetic AlgSulf are possibly due to differential binding to GFs and consequential decreased cell stemness. AlgSulf may be suitable for applications in cancer therapy after further in vivo validation.
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http://dx.doi.org/10.3390/molecules25112595DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321182PMC
June 2020

The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis.

Am J Med 2020 09 21;133(9):1101-1104. Epub 2020 Jan 21.

Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor.

Background: Coronary catheterization with angiography is often performed prior to surgical valve replacement in infectious endocarditis. There are no existing data as to whether this intervention is clinically necessary or leads to a change in surgical management. In order to determine the frequency with which coronary angiography impacts surgical management in infectious endocarditis, we conducted a retrospective review of surgically managed endocarditis cases at a tertiary care medical center.

Methods: Utilizing the institutional Society of Thoracic Surgeon's database, we identified 598 patients with surgically managed endocarditis between April 29, 2011 and December 31, 2018. Patient variables were recorded, including risk factors for coronary artery disease, whether the patient received coronary angiography prior to surgery, and if the patient underwent coronary artery bypass grafting as part of their valve surgery.

Results: There were 430 patients who received coronary catheterization with angiography prior to surgical valve replacement for infectious endocarditis, and 168 patients proceeded to surgery without coronary angiography. Nine percent of patients underwent coronary artery bypass grafting at the time of valve replacement as a result of coronary angiography findings. There was no significant difference in 30-day mortality for patients with endocarditis who underwent coronary angiography when compared with those who did not receive coronary angiography (2.6 vs 2.4%; P = 0.89).

Conclusions: Left heart catheterization with coronary angiography prior to surgical valve replacement leads to coronary artery bypass grafting in the minority of infective endocarditis patients.
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http://dx.doi.org/10.1016/j.amjmed.2019.12.019DOI Listing
September 2020

Intaglio Surface Dimension and Guide Tube Deviations of Implant Surgical Guides Influenced by Printing Layer Thickness and Angulation Setting.

J Prosthodont 2020 Feb 15;29(2):161-165. Epub 2020 Jan 15.

Department of General Practice and Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.

Purpose: To measure overall intaglio dimensional and tube deviations of implant guides printed at 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation using a stereolithographic (SLA) printer.

Materials And Methods: A surgical implant guide design from a subject missing a maxillary right central incisor, used as the original standard tessellation language (STL) were stereolithographically fabricated at each thickness and angulation, 50 and 100 µm layer thickness at 0°, 45°, and 90° angulation (n = 10 each group). The guide was then scanned using cone beam computed tomography. The digital imaging and communications in medicine (DICOM) scanned files were then converted to an STL format. The overall dimensional deviations of the intaglio surface and the positioning of the implant guide tube were then superimposed onto the original designed STL file using best-fitting alignment. A t-test and an F-test as well as ANOVA followed by a post hoc t-test were used to determine statistical significant differences (α = 0.05) for the intaglio surface and guide tube deviation, respectively.

Results: The overall intaglio surface discrepancies (µm) printed at 0°, 45°, and 90° were 55.07 ± 1.36, 52.39 ± 2.09, and 61.02 ± 15.96 for 50 µm layer; and 98.38 ± 10.55, 84.47 ± 10.61, and 90.26 ± 5 for 100 µm layer with statistically significant differences for both t-test and F-test, p < 0.001. The maximal guide tube linear deviations (µm) printed at 0°, 45°, and 90° were 10.78 ± 3.84, 8.16 ± 3.68, and 12.57 ± 5.39 for 50 µm layer (ANOVA, p = 0.096); and 10.95 ± 5.23, 16.79 ± 4.97, and 22.63 ± 2.81 for 100 µm layer (ANOVA, p < 0.001). The maximal guide tube angular deviations (°) printed at 0°, 45°, and 90° were 1.29 ± 0.30, 0.64 ± 0.13, and 0.56 ± 0.21 for 50 µm layer (ANOVA, p < 0.001); and 1.57 ± 0.29, 0.86 ± 0.14, and 1.02 ± 0.31 for 100 µm layer (ANOVA, p = 0.034). There was a statistical difference in the deviations between 50 and 100 µm layer printing in all printed angulations except at 0° (t-test, p = 0.05, p = 0.03, and p = 0.001 for 0°, 45°, and 90°) and linear deviations (t-test, p < 0.001, p = 0.009, and p = 0.001 for 0°, 45°, and 90°).

Conclusion: Printing at 50 µm layer reduces dimensional intaglio deviations in general and reduces tube angular deviations with different angulations of printing. However, the deviations were only ∼60 to 100 µm for the intaglio dimension deviations; and ∼0.04 to 0.26 mm and ∼0.25° to ∼2° for tube deviations.
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http://dx.doi.org/10.1111/jopr.13138DOI Listing
February 2020

Physician perceptions of a multidisciplinary endocarditis team.

Eur J Clin Microbiol Infect Dis 2020 Apr 14;39(4):735-739. Epub 2019 Dec 14.

Department of Cardiac Surgery, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.

Infectious endocarditis is a highly morbid infection that requires coordination of care across medical and surgical specialties, often through the use of a multidisciplinary team model. Multiple studies have demonstrated that such conferences can improve clinical outcomes. However, little is known about physicians' impressions of these groups. We surveyed 126 (response rate of 30%) internal medicine, infectious diseases, cardiology, and cardiac surgery providers 1 year after the implementation of an endocarditis team at the University of Michigan. Ninety-eight percent of physicians felt that the endocarditis team improved communication between specialties. Additionally, over 85% of respondents agreed that the group influenced diagnostic evaluation, reduced management errors, increased access to surgery, and decreased in-hospital mortality for endocarditis patients. These results suggest that multidisciplinary endocarditis teams are valued by physicians as a tool to improve patient care and serve an important role in increasing communication between providers.
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http://dx.doi.org/10.1007/s10096-019-03776-9DOI Listing
April 2020

Effect of postoperative steroids on clinical outcomes and radiographic findings of horizontal alveolar ridge augmentation: A retrospective study.

J Periodontol 2020 07 30;91(7):917-924. Epub 2019 Dec 30.

Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.

Background: The purpose of the study was to investigate if the prescription of oral postoperative steroids has an effect on clinical outcomes of horizontal ridge augmentation including implant placement and characteristics of the grafted bone.

Methods: A retrospective chart review of 73 horizontal ridge augmentation cases was completed to assess the clinical outcomes, 53 of those cases were further assessed radiographically. Information was gathered regarding surgical technique, grafting materials, postoperative healing, medications used postoperatively, bone growth, and density changes as quantified on a cone-beam computed tomography (CBCT) scan. Statistical analysis was completed to identify whether the use of postoperative oral steroids altered outcomes.

Results: Steroids were used postoperatively following various horizontal ridge augmentation procedures. The use of tenting screws and resorbable membranes with a combination of osseous allograft and xenograft was used in 73 cases, 53 of which had preoperative and postoperative CBCT scans. Graft exposure occurred in five of the cases (9%), with the majority (n = 4) among those with postoperative steroids, but this was not statistically significant (P-value = 0.6510). Use of steroids was also not significantly associated with the number of courses of antibiotics (P-value > 0.05), but it was significantly associated with increased number of postoperative visits (P-value < 0.05). Among the subset for radiographic analysis (n = 53), there were significant clinical and radiographic dimensional changes in alveolar ridge width with an average horizontal bone gain of 3.6 mm. There were no statistically significant differences found in radiographic linear bone gain or clinical outcomes with the addition of steroids. A marginally statistically significant in the density of grafted bone was found with the addition of steroids (P-value > 0.05).

Conclusion: The prescription of postoperative steroids did not make a significant difference in clinical outcomes, success of implant placement or on radiographic assessment of grafted sites following horizontal alveolar ridge augmentation.
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http://dx.doi.org/10.1002/JPER.19-0198DOI Listing
July 2020

Accuracy and precision of 3D-printed implant surgical guides with different implant systems: An in vitro study.

J Prosthet Dent 2020 Jun 23;123(6):821-828. Epub 2019 Oct 23.

Associate Professor and Director of Digital Dentistry Technologies, Department of General Practice and Department of Oral & Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Va; Associate Professor, Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Va. Electronic address:

Statement Of Problem: Implant guided surgery systems promise implant placement accuracy and precision beyond straightforward nonguided surgery. Recently introduced in-office stereolithography systems allow clinicians to produce implant surgical guides themselves. However, different implant designs and osteotomy preparation protocols may produce accuracy and precision differences among the different implant systems.

Purpose: The purpose of this in vitro study was to measure the accuracy and precision of 3 implant systems, Tapered Internal implant system (BioHorizons) (BH), NobelReplace Conical (Nobel Biocare) (NB), and Tapered Screw-Vent (Zimmer Biomet) (ZB) when in-office fabricated surgical guides were used.

Material And Methods: A cone beam computed tomography (CBCT) data set of an unidentified patient missing a maxillary right central incisor and intraoral scans of the same patient were used as a model. A software program (3Shape Implant Studio) was used to plan the implant treatment with the 3 implant systems. Three implant surgical guides were fabricated by using a 3D printer (Form 2), and 30 casts were printed. A total of 10 implants for each system were placed in the dental casts by using the manufacturer's recommended guided surgery protocols. After implant placement, postoperative CBCT images were made. The CBCT cast and implant images were superimposed onto the treatment-planning image. The implant positions, mesiodistal, labiopalatal, and vertical, as well as implant angulations were measured in the labiolingual and mesiodistal planes. The displacements from the planning in each dimension were recorded. ANOVA with the Tukey adjusted post hoc pairwise comparisons were used to examine the accuracy and precision of the 3 implant systems (α=.05).

Results: The overall implant displacements were -0.02 ±0.13 mm mesially (M), 0.07 ±0.14 mm distally (D), 0.43 ±0.57 mm labially (L), and 1.26 ±0.80 mm palatally (P); 1.20 ±3.01 mm vertically in the mesiodistal dimension (VMD); 0.69 ±2.03 mm vertically in the labiopalatal dimension (VLP); 1.69 ±1.02 degrees in mesiodistal angulation (AMD); and 1.56 ±0.92 degrees in labiopalatal angulation (ALP). Statistically significant differences (ANOVA) were found in M (P=.026), P (P=.001), VMD (P=.009), AMD (P=.001), and ALP (P=.001). ZB showed the most displacements in the M and vertical dimensions and the least displacements in the P angulation (P<.05), suggesting statistically significant differences among the M, VMD, VLP, AMD, and ALP. NB had the most M variation. ZB had the least P deviation. NB had the fewest vertical dimension variations but the most angulation variations.

Conclusions: Dimensional and angulation displacements of guided implant systems by in-office 3D-printed fabrication were within clinically acceptable limits: <0.1 mm in M-D, 0.5 to 1 mm in L-P, and 1 to 2 degrees in angulation. However, the vertical displacement can be as much as 2 to 3 mm. Different implant guided surgery systems have strengths and weaknesses as revealed in the dimensional and angulation implant displacements.
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http://dx.doi.org/10.1016/j.prosdent.2019.05.027DOI Listing
June 2020

Clinical Practice Update on Infectious Endocarditis.

Am J Med 2020 01 12;133(1):44-49. Epub 2019 Sep 12.

Department of Cardiac Surgery, University of Michigan, Ann Arbor.

Infectious endocarditis is a highly morbid disease with approximately 43,000 cases per year in the United States. The modified Duke Criteria have poor sensitivity; however, advances in diagnostic imaging provide new tools for clinicians to make what can be an elusive diagnosis. There are a number of risk stratification calculators that can help guide providers in medical and surgical management. Patients who inject drugs pose unique challenges for the health care system as their addiction, which is often untreated, can lead to recurrent infections after valve replacement. There is a need to increase access to medication-assisted treatment for opioid use disorders in this population. Recent studies suggest that oral and depo antibiotics may be viable alternatives to conventional intravenous therapy. Additionally, shorter courses of antibiotic therapy are potentially equally efficacious in patients who are surgically managed. Given the complexities involved with their care, patients with endocarditis are best managed by multidisciplinary teams.
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http://dx.doi.org/10.1016/j.amjmed.2019.08.022DOI Listing
January 2020

Brief Yoga Intervention for Dental and Dental Hygiene Students: A Feasibility and Acceptability Study.

J Evid Based Integr Med 2019 Jan-Dec;24:2515690X19855303

1 Virginia Commonwealth University, Richmond, VA, USA.

The present study investigated whether a brief yoga intervention would be feasible and acceptable for dental students. Based on empirical evidence about state mindfulness (SM), change in self-reported SM was assessed as a measure of the intervention's feasibility and acceptability. A repeated-measures within-subjects design was used. Participants were third- and fourth-year dental and dental hygiene students (76% female). The State Mindfulness Scale (SMS), a validated self-report measure of SM with 2 subscales, Mind and Body, was used. Students (n = 132) completed the SMS immediately prior to and following a 1-hour yoga intervention. Dispositional mindfulness, burnout, perceived stress, and depressive symptoms were also investigated as moderators of changes in state mindfulness to determine whether psychological variables had an effect on feasibility in this sample. Total SM significantly increased from pre- to post-intervention, (46) = 10.26, < .001. An analysis of covariance showed a significant interaction effect in the relationship between pre-/post-intervention SM of Mind ( = 0.51, = .048), such that higher levels of stress saw greater increases in SM of Mind. No other psychological variables were significant moderators. A brief yoga intervention for dental students significantly increased SM, suggesting that yoga interventions may be feasible and acceptable in this population. The results of moderation analyses suggest that a brief yoga intervention may be especially effective at increasing SM for those with high levels of stress. Future research should use a randomized control group to test group differences in SM after a brief yoga intervention for dental students.
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http://dx.doi.org/10.1177/2515690X19855303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580712PMC
March 2020

Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study.

Eur J Dent Educ 2019 Nov 13;23(4):415-423. Epub 2019 Jun 13.

School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.

Introduction: Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model.

Materials And Methods: Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05).

Results: Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001).

Discussion: Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation.

Conclusion: Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.
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http://dx.doi.org/10.1111/eje.12447DOI Listing
November 2019

Discontinuation of Denosumab as a Potential Cause of Generalized External Cervical Root Resorption: A Case Report.

J Endod 2019 May;45(5):640-644

Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia.

Generalized occurrence of external root resorption in an adult patient is a rare finding. This case report describes external cervical root resorption extensively affecting the dentition that may be associated with the use and subsequent cessation of denosumab for the treatment of osteoporosis.
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http://dx.doi.org/10.1016/j.joen.2019.02.013DOI Listing
May 2019

Trephination-based, guided surgical implant placement: A clinical study.

J Prosthet Dent 2019 Mar 30;121(3):411-416. Epub 2018 Nov 30.

Associate Professor and Director of Digital Dentistry Technologies, Department of General Practice and Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, Va; Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Va. Electronic address:

Statement Of Problem: Conventional guided implant surgery promises clinical success through implant placement accuracy; however, it requires multiple drills along with surgical sleeves and sleeve adapters for the horizontal and vertical control of osteotomy drills. This results in cumbersome surgery, problems with patients having limited mouth opening, and restriction to specific drill or implant manufacturers. A protocol for using trephination drills to simplify guided surgery and accommodate multiple implant systems is introduced.

Purpose: The purpose of this clinical study was to evaluate the accuracy of implant placement using this novel guided trephine drill protocol with and without a surgical sleeve.

Material And Methods: Intraoral scanning and preoperative cone beam computed tomography (CBCT) scans were used for implant treatment planning. Surgical guides were fabricated using stereolithography. Implant surgery was performed using the guided trephination protocol with and without a surgical sleeve. Postoperative CBCT scans were used to measure the implant placement deviations rather than the implant planning position. Surgical placement time and patient satisfaction were also documented. One-tailed t test and F-test (P=.01) were used to determine statistical significance.

Results: Thirty-five implants in 17 participants were included in this study. With a surgical sleeve, implant positional deviations were 0.51 ±0.13 mm vertically, 0.32 ±0.10 mm facially, 0.11 ±0.11 mm lingually, and 0.38 ±0.13 mm mesially. Without a surgical sleeve, implant positional deviations were 0.58 ±0.27 mm vertically, 0.3 ±0.14 mm facially, 0.39 ±0.16 mm lingually, and 0.41 ±0.12 mm mesially. No statistically significant difference was found between the 2 protocols (P>.01), except that the sleeve group had greater vertical control precision (F-test, P=.006), reduced placement time, and the time variation was reduced (t test, P=.003; F-test, P<.001).

Conclusions: This trephination-based, guided implant surgery protocol produces accurate surgical guides that permit guided surgery in limited vertical access and with the same guided surgery protocol for multiple implant systems. Guided sleeves, although not always necessary, improve depth control and reduce surgical time in implant placement.
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http://dx.doi.org/10.1016/j.prosdent.2018.06.004DOI Listing
March 2019

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

J Oral Maxillofac Surg 2018 12 19;76(12):2540-2550. Epub 2018 Jul 19.

Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA. Electronic address:

Purpose: A major advantage of guided implant surgery using 3-dimensionally printed guides is the ability to perform accurate flapless surgery. A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2 mm of keratinized tissue surrounding the implant.

Materials And Methods: This retrospective analysis included 27 maxillary and 27 mandibular implant sites that underwent treatment planning for implant-guided surgery using 3Shape Implant Studio (3Shape, Copenhagen, Denmark). Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. Analysis of variance (P < .05) and correlation coefficients were used to determine statistically significant differences in keratinized tissue among sites.

Results: No statistically significant difference was found either between the widths of buccal keratinized tissue in the maxillary anterior (4.06 ± 1.42 mm) and posterior (4.93 ± 2.54 mm) areas (P = .293) or between the amounts of buccal and lingual keratinized tissue in the mandible (P = .995). The keratinized tissue width in the maxillary buccal area was significantly different (4.48 ± 2.04 mm) from that in the mandibular posterior buccal (1.98 ± 1.41 mm) and lingual (1.98 ± 1.23 mm) areas (P < .001). Over 77% of maxillary implant sites had greater than 3 mm of gingiva, and just over 20% had sufficient gingiva in the mandible.

Conclusions: Adequate keratinized tissue was found in most of the planned maxillary implant sites, whereas most of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.
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http://dx.doi.org/10.1016/j.joms.2018.07.006DOI Listing
December 2018

Evolving trends in aortic valve replacement: A statewide experience.

J Card Surg 2018 Aug 17;33(8):424-430. Epub 2018 Jun 17.

Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan.

Methods: The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) database was used to determine the number of SAVR and TAVR cases performed from January 2012 through June 2017. Patients were divided into low, intermediate, high, and extreme risk groups based on STS predicted risk of mortality (PROM). TAVR patients in the MSTCVS-QC database were also matched with those in the Transcatheter Valve Therapy Registry to determine their Heart Team-designated risk category.

Results: During the study period 9517 SAVR and 4470 TAVR cases were performed. Total annual AVR volume increased by 40.0% (from 2086 to 2920), with a 13.3% decrease in number of SAVR cases (from 1892 to 1640) and a 560% increase in number of TAVR cases (from 194 to 1280). Greater than 90% of SAVR patients had PROM ≤8%. While >70% of TAVR patients had PROM ≤ 8%, they were mostly designated as high or extreme risk by a Heart Team.

Conclusions: During the study period, SAVR volume gradually declined and TAVR volume dramatically increased. This was mostly due to a new group of patients with lower STS PROM who were designated as higher risk by a Heart Team due to characteristics not completely captured by the STS PROM score.
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http://dx.doi.org/10.1111/jocs.13740DOI Listing
August 2018

Computer-guided implant removal: A clinical report.

J Prosthet Dent 2018 Dec 25;120(6):796-800. Epub 2018 May 25.

Associate Professor, Department of General Practice, School of Dentistry, and Director of Digital Dentistry Technologies, Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Va. Electronic address:

Occasionally, osseointegrated dental implants must be removed because of complications such as malpositioning or screw fracture. This is most often accomplished with a surgical handpiece and trephine. However, a flap is often required to access and visualize the implants. This paper presents a treatment in which computer planning and a 3-dimensional-printed, custom fabricated, surgical guide was used to assist in implant removal. This technique simplified the procedure, allowed conservative removal of peri-implant bone, and permitted subsequent immediate implant replacement.
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http://dx.doi.org/10.1016/j.prosdent.2017.10.032DOI Listing
December 2018

In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery.

J Oral Maxillofac Surg 2018 Jul 21;76(7):1431-1439. Epub 2018 Feb 21.

Associate Professor and Director, Predoctoral and Postdoctoral Implantology, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA.

Purpose: Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery. The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides.

Materials And Methods: A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P = .01), box plots, and 95% confidence intervals for the mean.

Results: Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n = 20) were 0.17 ± 0.78 mm, 0.44 ± 0.78 mm, 0.23 ± 1.08 mm, -0.22 ± 1.44 mm, and -0.32° ± 2.36°, respectively. The corresponding implant deviations for the partially guided protocol (n = 11) were 0.33 ± 1.38 mm, -0.03 ± 1.59 mm, 0.62 ± 1.15 mm, -0.27 ± 1.61 mm, and 0.59° ± 6.83°. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P = .006 and P < .001, respectively). No statistically significant difference was found between the software programs. Anterior implants had less variation in deviation than posterior implants.

Conclusions: Fully guided implant surgery is more accurate than partially guided implant surgery. Implant positional deviation is influenced by implant location but not implant systems or software. If possible, clinicians should use guided surgery protocols that allow placement of implants through a surgical guide.
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http://dx.doi.org/10.1016/j.joms.2018.02.010DOI Listing
July 2018

Helicopter Mountain Rescue in Slovenia from 2011 to 2015.

Wilderness Environ Med 2018 03 10;29(1):5-10. Epub 2018 Jan 10.

Virginia Commonwealth University, Richmond, VA. Electronic address:

Introduction: The popularity of adventure recreation in wilderness areas across the world continues to increase. Nevertheless, the risk of injury and illness remains significant. The purpose of this study is to analyze the mountain rescue operations performed in Slovenia between 2011 and 2015.

Methods: This retrospective study reports mountain rescue operations documented by the Slovenian National Mountain Rescue Association. The annual number of ground-based and helicopter-based rescues were identified and compared. For 2015, the indication for rescue and the severity of injury were also analyzed, specifically for interventions requiring the use of a helicopter.

Results: From 2011 through 2015, the number of rescues remained consistent with an annual average of 413 (SD ±15; range, 393-434) rescues. However, the percentage of ground-based rescues varied significantly year by year (P=0.016), with highest rate in 2014 (68%) and the lowest in 2015 (56%). In 2015, 434 mountain rescue operations were reported in Slovenia. Injury accounted for 44%, illness for 10%, and fatality for 9% of the rescues. In 37%, no illness or injury was reported. Helicopter rescue was used in 190 (44%) of all interventions. Among the 190 helicopter rescues, 49% of patients had nonfatal injuries, 29% required no medical treatment, 15% had illness, and 7% had fatal injuries.

Conclusions: A significant number of mountain rescue operations were conducted in Slovenia from 2011 through 2015. Most of these were needed for injured, ill, or deceased persons. A notable number of rescues in 2015 required a helicopter.
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http://dx.doi.org/10.1016/j.wem.2017.08.005DOI Listing
March 2018

A Phase II Trial of Rituximab Combined With Pegfilgrastim in Patients With Indolent B-cell Non-Hodgkin Lymphoma.

Clin Lymphoma Myeloma Leuk 2018 01 6;18(1):e51-e60. Epub 2017 Nov 6.

Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY; Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY.

Background: To explore the role of augmenting neutrophil function in B-cell lymphoma, we conducted a phase II study evaluating the safety and clinical efficacy of pegfilgrastim and rituximab in low-grade CD20 B-cell non-Hodgkin lymphoma (B-NHL).

Patients And Methods: Twenty patients with indolent B-NHL were treated with rituximab (375 mg/m) every other week for 4 doses, followed by every 2 months for 4 additional doses. Pegfilgrastim was administered subcutaneously 3 days before each dose of rituximab. Clinical activity and tolerability were assessed using standard criteria. Biologic monitoring included phenotype characteristics of the host neutrophils, changes in oxidative burst, and functional assays.

Results: The patient demographics included median age of 64 years, 70% were male, 70% had follicular lymphoma, and 90% had stage III-IV disease. The median number of previous therapies was 2 (range, 0-5); 90% had received previous anti-CD20 monoclonal antibody therapy. The addition of pegfilgrastim to rituximab did not increase rituximab-related toxicities. The overall response rate was 60% (12 of 20), with a complete response (CR) rate of 35% (7 of 20). The median progression-free survival (PFS) duration was 17.9 months (95% confidence interval, 9.9-27.6 months); the median overall survival was not reached. A shorter time-to-peak oxidative burst after the first dose of pegfilgrastim was associated with greater CR rates (P = .04) and longer PFS (P = .03).

Conclusion: The pegfilgrastim-rituximab combination was well tolerated, with favorable outcomes compared with historical controls. A shorter time-to-peak oxidative burst was associated with higher CR rates and longer PFS. Our results support further evaluation of strategies that enhance the innate immune system to improve rituximab activity in B-NHL.
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http://dx.doi.org/10.1016/j.clml.2017.09.003DOI Listing
January 2018

TAFRO syndrome: A case report and review of the literature.

Hum Pathol (N Y) 2017 Nov 21;10:1-4. Epub 2017 Apr 21.

Department of Pathology, Buffalo General Medical Center, SUNY at Buffalo, 100 High St, Buffalo, NY 14206, United States.

TAFRO syndrome is a rare clinicopathologic variant of idiopathic multicentric Castleman disease characterized by Thrombocytopenia, Ascites (anasarca), myeloFibrosis, Renal dysfunction, and Organomegaly. Here, we report a case of TAFRO syndrome in an HIV-negative young Caucasian male who presented with fever, normocytic anemia, thrombocytopenia, and acute renal insufficiency. The serum interleukin-6 (IL-6) level was elevated. Chest and abdominal CT revealed bilateral pleural effusion, ascites, splenomegaly, and multiple mildly enlarged lymph nodes. An excisional biopsy of inguinal lymph node showed a few atrophic follicles and expansion of interfollicular areas by marked vascular proliferation and polytypic plasmacytosis. HHV-8 was negative. Subsequent bone marrow biopsy was normocellular with moderately increased megakaryocytes and occasional megakaryocytic emperipolesis. His signs and symptoms improved after treatment with methylprednisolone and tocilizumab (anti-IL-6 receptor antibody). Our study confirms the distinctive nature of this syndrome, which should allow for better recognition and appropriate therapy.
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http://dx.doi.org/10.1016/j.ehpc.2017.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787913PMC
November 2017

How Accurate Are Implant Surgical Guides Produced With Desktop Stereolithographic 3-Dimentional Printers?

J Oral Maxillofac Surg 2017 Dec 5;75(12):2559.e1-2559.e8. Epub 2017 Aug 5.

Associate Professor, Director of Digital Dentistry Technologies, Department of General Dentistry, School of Dentistry; Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA.

Purpose: The use of tooth-supported static stereolithographic guides has greatly improved the ability to ideally place implants. This study was designed to determine the accuracy of in office-printed implant surgical guides.

Materials And Methods: Using 3shape Implant Studio, a treatment plan for implant placement for tooth 8 was developed using a digital intraoral scan from a Trios scanner and cone-beam computed tomography. Ten stereolithographic guides were printed using a Form2 3-dimensional printer. Pre- and post-implant insertion digital scans were used to determine distance and angulation differences in the mesiodistal and faciolingual positions of the implants compared with the planned position.

Results: The mean difference in mesiodistal direction at the alveolar crest between planned implants and placed implants was 0.28 mm (range, 0.05 to 0.62 mm) and the difference in the faciolingual direction was 0.49 mm (range, 0.08 to 0.72 mm). The mean mesiodistal angulation deviation was 0.84° (range, 0.08° to 4.48°) and the mean faciolingual angulation deviation was 3.37° (range, 1.12° to 6.43°).

Conclusions: In-office fabricated stereolithographic implant surgical guides show similar accuracy to laboratory- or manufacturer-prepared guides. This technique provides a convenient and cost-effective means of assuring proper implant placement.
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http://dx.doi.org/10.1016/j.joms.2017.08.001DOI Listing
December 2017

How Effective Is the Tent Screw Pole Technique Compared to Other Forms of Horizontal Ridge Augmentation?

J Oral Maxillofac Surg 2017 Oct 13;75(10):2093-2098. Epub 2017 Jun 13.

Assistant Professor, Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA.

Purpose: The tent screw pole technique is one of the methods available for practitioners to perform horizontal ridge augmentation to facilitate dental implant placement. The purpose of this study was to evaluate the efficacy of the tent screw pole technique for horizontal ridge augmentation and to compare the results with those of the tunnel technique and open ridge augmentation.

Patients And Methods: In this retrospective cohort study, 35 patients underwent horizontal ridge augmentation with the tent screw pole technique, a 1:1 ratio of mineralized freeze-dried bone allograft and particulate bovine hydroxyapatite, and a resorbable collagen membrane. The incidence of early wound dehiscence and membrane exposure, the number of courses of antibiotics and postoperative visits required for their management, and the number of sites that subsequently had successful implant placement were recorded. These parameters were compared with those in 21 patients who had undergone horizontal ridge augmentation by the tunnel technique and 31 patients who had been treated using an open procedure and a resorbable polytetrafluoroethylene (PTFE) membrane in the authors' previous study (J Oral Maxillofac Surg 74:1752, 2016).

Results: Implant placement rate was similar for all 3 methods (71 to 97%). However, there were significant differences among the 3 surgical techniques for membrane exposure and wound dehiscence (P = .0033), graft loss (P = .0256), courses of antibiotics (P = .0017), and postoperative visits (P = .0043). The PTFE method consistently had the highest rate of complications, whereas the tent screw and tunnel techniques were comparable.

Conclusions: All 3 techniques allowed a high rate of implant placement; however, the PTFE technique was consistently associated with increased postoperative complications compared with the other 2 methods. The tent screw technique might be more favorable than the tunnel technique in cases in which the bony deficiency is flat.
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http://dx.doi.org/10.1016/j.joms.2017.05.037DOI Listing
October 2017

Public and Patient Knowledge About Dental Implants.

J Oral Maxillofac Surg 2017 Jul 23;75(7):1387-1391. Epub 2017 Mar 23.

Assistant Professor, Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA.

Purpose: The more informed a patient is about a given procedure, the better the ultimate outcome. This study was designed to compare general public awareness and knowledge regarding oral implant treatment with those of patients presenting for such treatment and to determine the sources from which they may have obtained such information, as well as the accuracy of the information.

Patients And Methods: In this cross-sectional study, 2 groups of patients were asked to complete a questionnaire containing implant knowledge questions and questions regarding any sources they may have used to obtain information about dental implants. Group I consisted of patients presenting for treatment of a dental emergency (general population group), and group II consisted of patients presenting for an implant consultation. The χ test was used to determine whether there were differences in knowledge and information sources between the 2 groups.

Results: A total of 126 adult patients (76 dental emergency patients and 50 implant consultation patients) participated in the study. The general population group was less informed about dental implants, especially information relating to implant material and longevity, and received information from less reliable sources than patients presenting for implant screening (friends or relatives vs primary dentist). Both groups reported cost of the procedure as a primary barrier to receiving implants (89% and 90%).

Conclusions: There is still a need for continued education of the general public regarding dental implants.
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http://dx.doi.org/10.1016/j.joms.2017.03.024DOI Listing
July 2017

Mesenchymal Stem Cells in the Treatment of Traumatic Brain Injury.

Front Neurol 2017 20;8:28. Epub 2017 Feb 20.

Biomedical Engineering and Department of Mechanical Engineering, American University of Beirut , Beirut , Lebanon.

Traumatic brain injury (TBI) is characterized by a disruption in the normal function of the brain due to an injury following a trauma, which can potentially cause severe physical, cognitive, and emotional impairment. The primary insult to the brain initiates secondary injury cascades consisting of multiple complex biochemical responses of the brain that significantly influence the overall severity of the brain damage and clinical sequelae. The use of mesenchymal stem cells (MSCs) offers huge potential for application in the treatment of TBI. MSCs have immunosuppressive properties that reduce inflammation in injured tissue. As such, they could be used to modulate the secondary mechanisms of injury and halt the progression of the secondary insult in the brain after injury. Particularly, MSCs are capable of secreting growth factors that facilitate the regrowth of neurons in the brain. The relative abundance of harvest sources of MSCs also makes them particularly appealing. Recently, numerous studies have investigated the effects of infusion of MSCs into animal models of TBI. The results have shown significant improvement in the motor function of the damaged brain tissues. In this review, we summarize the recent advances in the application of MSCs in the treatment of TBI. The review starts with a brief introduction of the pathophysiology of TBI, followed by the biology of MSCs, and the application of MSCs in TBI treatment. The challenges associated with the application of MSCs in the treatment of TBI and strategies to address those challenges in the future have also been discussed.
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http://dx.doi.org/10.3389/fneur.2017.00028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316525PMC
February 2017

Mesenchymal Stem Cells in the Treatment of Traumatic Brain Injury.

Front Neurol 2017 20;8:28. Epub 2017 Feb 20.

Biomedical Engineering and Department of Mechanical Engineering, American University of Beirut , Beirut , Lebanon.

Traumatic brain injury (TBI) is characterized by a disruption in the normal function of the brain due to an injury following a trauma, which can potentially cause severe physical, cognitive, and emotional impairment. The primary insult to the brain initiates secondary injury cascades consisting of multiple complex biochemical responses of the brain that significantly influence the overall severity of the brain damage and clinical sequelae. The use of mesenchymal stem cells (MSCs) offers huge potential for application in the treatment of TBI. MSCs have immunosuppressive properties that reduce inflammation in injured tissue. As such, they could be used to modulate the secondary mechanisms of injury and halt the progression of the secondary insult in the brain after injury. Particularly, MSCs are capable of secreting growth factors that facilitate the regrowth of neurons in the brain. The relative abundance of harvest sources of MSCs also makes them particularly appealing. Recently, numerous studies have investigated the effects of infusion of MSCs into animal models of TBI. The results have shown significant improvement in the motor function of the damaged brain tissues. In this review, we summarize the recent advances in the application of MSCs in the treatment of TBI. The review starts with a brief introduction of the pathophysiology of TBI, followed by the biology of MSCs, and the application of MSCs in TBI treatment. The challenges associated with the application of MSCs in the treatment of TBI and strategies to address those challenges in the future have also been discussed.
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http://dx.doi.org/10.3389/fneur.2017.00028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316525PMC
February 2017