Publications by authors named "Howard C Tenenbaum"

62 Publications

Early multidrug treatment of SARS-CoV-2 infection (COVID-19) and reduced mortality among nursing home (or outpatient/ambulatory) residents.

Med Hypotheses 2021 Jun 5;153:110622. Epub 2021 Jun 5.

Concerned Ontario Doctors, Toronto, ON, Canada. Electronic address:

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including initial viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic anti-blood clotting agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found hydroxychloroquine-based multidrug regimens were associated with a statistically significant > 60% reduction in mortality. Going forward, we conclude that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients e.g. LTF or ALF) has a reasonable probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus prior to symptoms worsening. Given the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of acute COVID-19 patients is a reasonable strategy to reduce the risks of hospitalization and death. If elderly high-risk patients in such congregated nursing home type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. The issue is timing of therapeutics, and we argue that early treatment before hospitalization, is the right time and can potentially save lives, especially among our higher-risk elderly populations hit hardest by severe illness and death from COVID-19. We must reiterate, we are talking about 'early' treatment before the disease is far along in the disease sequelae where the patient then needs hospitalization and aggressive interventions. We are referring to the initial days e.g. day one, post infection when symptoms emerge or there is strong clinical suspicion. This early therapeutic option deserves serious and urgent consideration by the medical establishment and respective decision-makers. Doctors must be allowed their clinical discretion in how they optimally treat their patients. Doctors must be brave and trust their skilled judgements and do all to save the lives of their patients. We therefore hypothesize that early outpatient ambulatory treatment, once initiated as soon as symptoms begin in high-risk positive persons, would significantly reduce hospitalizations and prevent deaths. Specifically, the provision of early multi-drug sequenced therapy with repurposed drugs will reduce hospitalization and death in elderly patients being cared for in long-term-care facilities. The most important implications of our hypothesis are: 1) hospitalizations and deaths would be reduced 2) transmission would be reduced due to the mitigation of symptoms and 3) recovery following infection and treatment provides for natural exposure immunity that is broad based, durable, and robust (helping towards natural immunity within the population). The end result is reduced strain on hospitals and systems that would allow for other non-COVID illnesses to receive care.
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http://dx.doi.org/10.1016/j.mehy.2021.110622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178530PMC
June 2021

Horizontal Guided Bone Regeneration Using a Dehydrated Amnion/Chorion Membrane: A Case Report.

Int J Periodontics Restorative Dent 2021 May-Jun;41(3):375-381

This article describes a novel approach for horizontal guided bone regeneration (GBR) using a dehydrated amnion/chorion membrane (dHACM) in conjunction with a composite mixture of cortical autogenous particulate bone scrapings and mineralized bovine bone particulate in the anterior maxilla, allowing for placement of dental implants in a previously deficient alveolar ridge. The grafted region was reentered 8 months after GBR surgery, and a substantial increase in horizontal bone width was observed. Endosseous dental implants were placed with excellent primary stability in a prosthetically driven manner (which could not have been done prior to GBR) and successfully restored with a screw-retained bridge prosthesis. To the authors' knowledge, this is the first reported documentation of successful horizontal GBR using dHACM with subsequent implant placement and restoration, and the first to demonstrate the excellent clinical potential of this biomaterial.
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http://dx.doi.org/10.11607/prd.4634DOI Listing
June 2021

Clinical performance of CAD-CAM crowns provided by predoctoral students at the University of Toronto.

J Prosthet Dent 2021 Jan 7. Epub 2021 Jan 7.

Associate Professor, Department of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.

Statement Of Problem: The clinical success of monolithic lithium disilicate glass-ceramic (LDGC) crowns manufactured with computer-aided design and computer-aided manufacturing (CAD-CAM) technology provided by predoctoral students has not been fully investigated.

Purpose: The purpose of this retrospective clinical study was to evaluate the performance of laboratory-fabricated monolithic posterior LDGC CAD-CAM crowns provided by predoctoral students at the University of Toronto. Specific patient- and provider-related factors were also investigated.

Material And Methods: A sample of posterior LDGC CAD-CAM crowns (IPS e.max) provided by predoctoral students was evaluated. Crown preparations were made according to specific criteria, and crowns were milled in an in-house laboratory by using the CEREC Bluecam system. The crowns were cemented with Rely-X Unicem (3M ESPE) and Calibra Universal (Dentsply Sirona) resin cements. Clinical assessments of the crowns and supporting periodontal structures were performed following the modified California Dental Association (CDA) criteria. Intraoral photographs and periapical and bitewing radiographs were obtained for further assessment by 2 evaluators. Descriptive statistics, McNemar, t test, log rank (Mantel-Cox) tests, Pearson chi-squared tests, simple logistic regression, odds ratios, and Kaplan Meier survival analyses were performed (α=.05).

Results: A total of 189 patients receiving 210 crowns (108 premolar and 102 molar) were examined with a follow-up period of up to 6 years. Altogether, 28 complications were observed (12 technical, 11 biological, and 5 esthetic). No significant association was found between patient age, sex, periodontal condition, tooth type, tooth vitality, cement type, and crown longevity. However, significantly lower survival and success rates were found for mandibular crowns than for maxillary crowns (P=.029). The provider's experience had no significant effect on the clinical performance of LDGC CAD-CAM crowns. The 6-year cumulative survival rate was 93.0%, and the success rate was 86.4%.

Conclusions: The ease of use of the CAD-CAM system and clinical performance of LDGC suggest that this technology should be used in the dental school setting by predoctoral students.
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http://dx.doi.org/10.1016/j.prosdent.2020.09.048DOI Listing
January 2021

The effect of pamidronate delivery in bisphosphonate-naïve patients on neutrophil chemotaxis and oxidative burst.

Sci Rep 2020 10 27;10(1):18309. Epub 2020 Oct 27.

Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.

The pathogenesis of medication-related osteonecrosis of the jaw (MRONJ), a morbid condition associated with bisphosphonate administration, has not been fully elucidated. Recent research utilizing a murine model has revealed that the neutrophil becomes dysfunctional following exposure to bisphosphonates. Accordingly, the impairment of neutrophil function could play an important role in the pathogenesis of MRONJ via an infectious mechanism mediated by the suppression of the innate immune system. Currently, the existing human data are insufficient to substantiate this theory. To investigate, we isolated neutrophils from blood and oral rinse samples from bisphosphonate-naïve patients who were recently diagnosed with multiple myeloma both prior to and one month following their initial infusion of pamidronate, an intravenous bisphosphonate agent. Stimulated blood and oral neutrophil superoxide production and chemotactic capabilities were found to be impaired relative to baseline values. These results suggest that impaired neutrophil function may partially contribute to the aetiology underlying the pathophysiological processes linked to the development of MRONJ. Further, as the functional status of circulating neutrophils was reflected in the oral cavity where sampling can be accomplished in a non-invasive fashion, it is conceivable that neutrophil function could serve as a potential biomarker for MRONJ prognostication.
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http://dx.doi.org/10.1038/s41598-020-75272-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591900PMC
October 2020

The Neutrophil: Constant Defender and First Responder.

Front Immunol 2020 24;11:571085. Epub 2020 Sep 24.

Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.

The role of polymorphonuclear neutrophils (PMNs) in biology is often recognized during pathogenesis associated with PMN hyper- or hypo-functionality in various disease states. However, in the vast majority of cases, PMNs contribute to resilience and tissue homeostasis, with continuous PMN-mediated actions required for the maintenance of health, particularly in mucosal tissues. PMNs are extraordinarily well-adapted to respond to and diminish the damaging effects of a vast repertoire of infectious agents and injurious processes that are encountered throughout life. The commensal biofilm, a symbiotic polymicrobial ecosystem that lines the mucosal surfaces, is the first line of defense against pathogenic strains that might otherwise dominate, and is therefore of critical importance for health. PMNs regularly interact with the commensal flora at the mucosal tissues in health and limit their growth without developing an overt inflammatory reaction to them. These PMNs exhibit what is called a para-inflammatory phenotype, and have reduced inflammatory output. When biofilm growth and makeup are disrupted (i.e., dysbiosis), clinical symptoms associated with acute and chronic inflammatory responses to these changes may include pain, erythema and swelling. However, in most cases, these responses indicate that the immune system is functioning properly to re-establish homeostasis and protect the status quo. Defects in this healthy everyday function occur as a result of PMN subversion by pathological microbial strains, genetic defects or crosstalk with other chronic inflammatory conditions, including cancer and rheumatic disease, and this can provide some avenues for therapeutic targeting of PMN function. In other cases, targeting PMN functions could worsen the disease state. Certain PMN-mediated responses to pathogens, for example Neutrophil Extracellular Traps (NETs), might lead to undesirable symptoms such as pain or swelling and tissue damage/fibrosis. Despite collateral damage, these PMN responses limit pathogen dissemination and more severe damage that would otherwise occur. New data suggests the existence of unique PMN subsets, commonly associated with functional diversification in response to particular inflammatory challenges. PMN-directed therapeutic approaches depend on a greater understanding of this diversity. Here we outline the current understanding of PMNs in health and disease, with an emphasis on the positive manifestations of tissue and organ-protective PMN-mediated inflammation.
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http://dx.doi.org/10.3389/fimmu.2020.571085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541934PMC
May 2021

Periodontitis is an inflammatory disease of oxidative stress: We should treat it that way.

Periodontol 2000 2020 10;84(1):45-68

Department of Dentistry, Mount Sinai Hospital, Thodupuzha, India.

Periodontitis is a highly prevalent disease. As it progresses, it causes serious morbidity in the form of periodontal abscesses and tooth loss and, in the latter stages, pain. It is also now known that periodontitis is strongly associated with several nonoral diseases. Thus, patients with periodontitis are at greater risk for the development and/or exacerbation of diabetes, chronic obstructive pulmonary disease, and cardiovascular diseases, among other conditions. Although it is without question that specific groups of oral bacteria which populate dental plaque play a causative role in the development of periodontitis, it is now thought that once this disease has been triggered, other factors play an equal, and possibly more important, role in its progression, particularly in severe cases or in cases that prove difficult to treat. In this regard, we allude to the host response, specifically the notion that the host, once infected with oral periodontal pathogenic bacteria, will mount a defense response mediated largely through the innate immune system. The most abundant cell type of the innate immune system - polymorphonuclear neutrophils - can, when protecting the host from microbial invasion, mount a response that includes upregulation of proinflammatory cytokines, matrix metalloproteinases, and reactive oxygen species, all of which then contribute to the tissue damage and loss of teeth commonly associated with periodontitis. Of the mechanisms referred to here, we suggest that upregulation of reactive oxygen species might play one of the most important roles in the establishment and progression of periodontitis (as well as in other diseases of inflammation) through the development of oxidative stress. In this overview, we discuss both innate and epigenetic factors (eg, diabetes, smoking) that lead to the development of oxidative stress. This oxidative stress then provides an environment conducive to the destructive processes observed in periodontitis. Therefore, we shall describe some of the fundamental characteristics of oxidative stress and its effects on the periodontium, discuss the diseases and other factors that cause oxidative stress, and, finally, review potentially novel therapeutic approaches for the management (and possibly even the reversal) of periodontitis, which rely on the use of therapies, such as resveratrol and other antioxidants, that provide increased antioxidant activity in the host.
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http://dx.doi.org/10.1111/prd.12342DOI Listing
October 2020

Resveratrol and insulin association reduced alveolar bone loss and produced an antioxidant effect in diabetic rats.

J Periodontol 2021 05 12;92(5):748-759. Epub 2020 Sep 12.

Dental Research Division, School of Dentistry, Paulista University, São Paulo, Brazil.

Background: The present investigation studied the effects of systemic administration of resveratrol (RSV) on the development of experimental periodontitis (EP) and on the release of markers of inflammation, bone metabolism, and oxidative stress in diabetic rats.

Methods: Seventy-five male rats were divided into five groups: DM+PLAC: Diabetes Mellitus + placebo solution; DM+INS: DM + insulin therapy; DM+RSV: DM + RSV; DM+RSV+INS: DM + RSV and insulin; NDM: non-diabetic. Streptozotocin was used to induce DM and EP was induced by the placement of a ligature at the fist mandibular and the second maxillary molars. Euthanasia occurred 30 days after the initiation of the study and mandible specimens were subjected for morphometric analysis of bone level. Gingival tissues from mandibular molars were collected for quantification of inflammatory and oxidative stress markers by multiplex assay system and ELISA assay, respectively. Maxillary gingival tissues were processed for real-time polymerase chain reaction (real-time PCR) assessment of markers of bone metabolism and oxidative stress.

Results: Morphometric analysis revealed greater bone loss in DM+PLAC and DM+INS in comparison to the other treatments (P < 0.05). RSV used in conjunction with INS reduced the levels of interleukin (IL)-1β, IL-6, IL-17, interferon-gamma (IFN-γ) and superoxide dismutase 1 (SOD) (P < 0.05). RSV alone reduced nicotinamide adenine dinucleotide phosphatase oxidase (NADPH oxidase) levels, in comparison to DM+INS and DM+RSV+INS (P < 0.05). All treatments upregulated mRNA levels for osteoprotegerin (OPG) in comparison to PLAC (P < 0.05). Sirtuin 1 (SIRT) mRNA levels were lower in PLAC when compared to DM+RSV, DM+RSV+INS and NDM (P < 0.05).

Conclusion: RSV reduced the progression of EP and the levels of NADPH oxidase. Co-treatment with RSV and insulin reduced the levels of pro-inflammatory factors (either proteins or mRNA) and increased the levels of SOD. The data also demonstrated that treatment with RSV and INS alone or in combination had beneficial effects on bone loss.
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http://dx.doi.org/10.1002/JPER.19-0718DOI Listing
May 2021

Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners.

BMC Oral Health 2020 08 6;20(1):220. Epub 2020 Aug 6.

Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, 14620, USA.

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.
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http://dx.doi.org/10.1186/s12903-020-01199-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7409672PMC
August 2020

Structural abnormalities in the temporalis musculo-aponeurotic complex in chronic muscular temporomandibular disorders.

Pain 2020 08 11;161(8):1787-1797. Epub 2020 Mar 11.

Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.

Some forms of chronic pain are thought to be driven and maintained by nociceptive input, which can drive plasticity within nociceptive pathways. We have previously identified abnormalities along the entire nociceptive pathway in chronic myalgic temporomandibular disorders (mTMD), including the trigeminal nerves, brainstem pathways, and in the thalamus and somatosensory cortex. These data suggest that there is a peripheral nociceptive drive in mTMD, but the source of this nociceptive activity remains unknown. Here, our aim was to determine whether structural abnormalities exist in the muscles of mastication of patients with chronic mTMD. Specifically, we tested whether the volume of the temporalis muscle and its tendon-aponeurosis complex (TAC, a structure that dissipates forces in a muscle) in mTMD patients differ compared to age- and sex-matched controls. To do so, we segmented these structures on T1-weighted structural magnetic resonance images. We found that muscle volumes in mTMD were not different to controls. However, the mTMD group had significantly smaller volumes of the bilateral temporalis TAC, and thus a smaller TAC-to-muscle volume ratio. These findings were consistent across 2 independent cohorts of 17 mTMD patients, compared to 17 age- and sex-matched controls. We propose a model where reduced TAC-to-muscle ratio could result in a predisposition to muscle tissue injury. In sum, abnormalities of the temporalis muscles in mTMD supports our hypothesis that chronic mTMD pathophysiology may be related to peripheral nociceptive barrage originating from the muscles of mastication.
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http://dx.doi.org/10.1097/j.pain.0000000000001864DOI Listing
August 2020

Oral inflammatory load: Neutrophils as oral health biomarkers.

J Periodontal Res 2020 Oct 6;55(5):594-601. Epub 2020 May 6.

Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.

Periodontal diseases present a significant challenge to our healthcare system in terms of morbidity from the disease itself as well as their putative and deleterious effects on systemic health. The current method of diagnosing periodontal disease utilizes clinical criteria solely. These are imprecise and are somewhat invasive. There is thus significant benefit to creating a non-invasive test as a method of screening for and monitoring of periodontal diseases, and, in particular, chronic periodontitis. Oral polymorphonuclear neutrophil (oPMN) counts have been found to correlate with extent of oral inflammation and the presence and severity of periodontal diseases. Potentially then, quantification of oPMNs might be used to identify and measure the severity of oral inflammation (oral inflammatory load; OIL) in subjects with healthy and inflamed periodontal tissues, demonstrating a positive correlation between higher oPMN counts and the extent/severity of OIL. These findings support the development and utilization of a non-invasive chair-side test enabling rapid, accurate, and objective screening of OIL based on measurement of oPMN numbers (similar to white blood cell levels in blood as used in medicine for assessment of infection). The use of such a test before, during, and after treatment of gingivitis and periodontitis could lead to improvements in timing of intervention (ie, when inflammation is active) thereby reducing long-term morbidity.
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http://dx.doi.org/10.1111/jre.12758DOI Listing
October 2020

Older adults and the disparity in oral health status; the problem and innovative ways to address it.

Isr J Health Policy Res 2020 05 4;9(1):24. Epub 2020 May 4.

Faculty of Dentistry, 124 Edward St. 4th floor, Toronto, ON, M5G 1G6, Canada.

The impact of oral health inequalities on one's ability to maintain good oral health is cumulative throughout life and accentuated in older age groups. While studies on factors influencing the decisions made by elders to seek dental care have been conducted in Israel and worldwide, the issue of access to and provision of dental care is complex. However, the need to address oral health issues is being voiced in high-level international meetings and there was never a better momentum to rethink the current oral health care delivery model beyond issues related solely to accessibility. Here we outline unique opportunities to ensure sustainable models of preventive services and oral health the effects of which would be amplified in concert with increases in the availability universal dental healthcare.
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http://dx.doi.org/10.1186/s13584-020-00381-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199366PMC
May 2020

Treatment of Gingival Fenestration With a Double Pedicle Flap Approach and Dehydrated Amnion-Chorion Membrane: A Case Report.

Clin Adv Periodontics 2020 12 7;10(4):200-203. Epub 2020 Apr 7.

Sinai Health System, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.

Introduction: Although gingival fenestrations (GFs) occur with relative infrequency, their actual incidence is thought to be much higher. Furthermore, if left untreated, these mucogingival defects can lead to unfavorable sequelae which can compromise the esthetics and stability of the teeth affected. Most GFs require surgical treatment for closure. Previously reported modalities of treatment include connective tissue grafting, acellular dermal matrix allograft, and pedicle flap approaches. This case demonstrates the first documented use of a dehydrated amnion-chorion membrane (dHACM) to treat GF.

Case Presentation: A surgical approach involving a double pedicle flap and dHACM with 15 months follow-up is described. Following gentle cleansing of the defect and careful split-thickness elevation of a double pedicle flap, the area of exposure fenestration was covered with dHACM. The overlying flap was then closed carefully to completely cover the dHACM. The case presented shows a successful clinical outcome as characterized by successful closure of the fenestration defect with nice tissue maturation.

Conclusion: The technique described in this case report demonstrates that GFs can be successfully treated with a periodontal plastic surgical approach using dHACM with minimal patient discomfort.
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http://dx.doi.org/10.1002/cap.10094DOI Listing
December 2020

Clinical performance of chairside monolithic lithium disilicate glass-ceramic CAD-CAM crowns.

J Esthet Restor Dent 2019 11 29;31(6):613-619. Epub 2019 Sep 29.

Faculty of Dentistry, Department of Prosthodontics, University of Toronto, Toronto, Ontario, Canada.

Objectives: To evaluate the clinical performance and the effect of various patient and provider-related factors on the longevity of chairside monolithic posterior lithium disilicate glass-ceramic (LDGC) computer-aided design (CAD)-computer-aided manufacturing (CAM) crowns provided by predoctoral students.

Materials And Methods: A sample of posterior LDGC CAD-CAM crowns was evaluated. Crown preparations were milled chairside using the CEREC Omnicam system and cemented with Rely-X Unicem or Calibra Universal resin cements. Clinical assessment of the crowns and supporting periodontal structures was performed using the modified California Dental Association (CDA) criteria. Intraoral photographs as well as radiographs were taken for further assessment by two evaluators. Kaplan-Meier survival analysis was performed.

Results: A total of 40 crowns were inserted in 32 patients and evaluated for 4 years. Three complications were observed (two-technical and one-biological). No chipping or fracture of crowns was observed. No significant association was found between age, sex, periodontal condition, tooth type, tooth vitality, cement type, and longevity. The 4-year cumulative survival and success rates were 95.0 and 92.3%, respectively.

Conclusion: Chairside LDGC CAD-CAM crowns exhibited a high survival rate after 4 years in function and were shown to be a viable and reliable treatment option for posterior teeth.

Clinical Significance: The high survival rate of chairside CAD-CAM crowns observed in this study suggests the likelihood of predictable performance in the predoctoral setup.
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http://dx.doi.org/10.1111/jerd.12531DOI Listing
November 2019

Subperiosteal Papilla Augmentation With a Non-Animal-Derived Hyaluronic Acid Overlay Technique.

Clin Adv Periodontics 2020 03 4;10(1):4-9. Epub 2019 Oct 4.

Discipline in Periodontics, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.

Introduction: Loss of the interdental papilla, leading to the formation of black triangular spaces just below the contact area of adjacent teeth, is one of the most challenging periodontal conditions to treat and often requires an interdisciplinary approach by the periodontist, restorative dentist, and orthodontist. Although these "black triangles" may appear quite small from a clinician's standpoint, they can have a significant impact on oral health satisfaction for patients. This case series illustrates a novel minimally invasive approach to restore interdental papilla deficiencies.

Case Presentation: Four interdental papilla defects were treated in three females. No patients were lost to follow-up over 6 months. The surgery consisted of a horizontal incision placed apical to the area of papillary loss in the alveolar mucosa just beyond the mucogingival junction. An interdental subperiosteal tissue space was then created by tunneling toward and under the dental papilla. Once adequate release was achieved, dermal filler was administered into and underneath the deficient papilla. The papillary margins were then sealed with cyanoacrylate and additional dermal filler was injected as needed to achieve ideal papillary fill. Six months after treatment there was an improvement in patient-satisfaction regarding papilla fill demonstrated by a mean increase in visual analogue scale (VAS) measurements of 62.46%. Mean papilla fill was 1.75 mm.

Conclusion: This surgical technique demonstrates the restoration of deficient interdental papillae between teeth and implants, and perhaps as importantly, a considerable improvement in patient-based outcomes quantified through VASs.
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http://dx.doi.org/10.1002/cap.10075DOI Listing
March 2020

Oral inflammatory load in patients with coronary artery disease.

J Oral Sci 2019 ;61(3):412-417

Faculty of Dentistry, University of Toronto.

Periodontitis is an oral inflammatory disease that may have an association with coronary artery disease (CAD). Oral inflammatory load (OIL) can be quantified by assesment of oral polymorphonucleocytes (oPMN) in an oral rinse assay. The aim of the present study was to prospectively correlate OIL with CAD on angiography assessed in terms of SYNTAX score in patients presenting with stable angina or acute coronary syndrome (ACS). Consecutive eligible patients at a cardiac center were prospectively recruited. Two sets of oral rinse samples were collected before and after angiography, and the relationship between oPMN and SYNTAX score was assessed. Of the 137 patients recruited, 32.8% (n = 45) were female and 34.3% (n = 47) had diabetes mellitus. The overall mean oPMN count was low (mean 1.3 × 10 cells/mL), and the mean SYNTAX score was 7.4 ± 8.5. Most of the patients presented with stable angina (89.8%, n =123). Patients with oPMN ≥1.45 × 10 (periodontitis threshold) were more likely to be elderly males presenting with stable angina. No significant correlation was established between oPMN and SYNTAX score. Although this prospective study did not demonstrate a correlation between OIL and the severity of CAD, most patients had low mean oPMN values. Larger studies are required before definite conclusions can be drawn.
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http://dx.doi.org/10.2334/josnusd.18-0299DOI Listing
November 2019

Morphological characterization of para- and proinflammatory neutrophil phenotypes using transmission electron microscopy.

J Periodontal Res 2018 Dec 5;53(6):972-982. Epub 2018 Aug 5.

Matrix Dynamics Group, Department of Dentistry, University of Toronto, Toronto, Ontario, Canada.

Background And Objective: Bacterial challenge is constant in the oral cavity. To contain the commensal biofilm, partly activated neutrophils are continuously recruited as part of a normal physiologic process, without exposing the host to the harmful effect of a fully active neutrophil response. This intermediate immune state has been termed para-inflammation, as opposed to the fully activated proinflammatory state in oral disease. Directly visualizing these cells and their components via transmission electron microscopy (TEM) enhances our understanding of neutrophil activation state differences in oral health and disease, as obtained from molecular studies. The aim of this study was to describe the morphology of the para-inflammatory phenotype displayed by oral neutrophils in health, and compare it to the morphology of the naïve blood neutrophil, and the proinflammatory oral neutrophils in chronic periodontitis. This morphology was characterized by differences in granule content, phagosome content and cytoplasm and nuclear changes. We also examined the morphological changes induced in naïve neutrophils, which were stimulated in vitro by bacteria, and in oral neutrophils in full tissue samples in vivo.

Material And Methods: Neutrophils were isolated from blood and saliva samples of patients with chronic periodontitis and healthy individuals. The cells were viewed under TEM and analyzed in imaging software examining granularity, cytoplasm density, euchromatin amount in the nucleus and phagosome content. A separate cohort of blood neutrophils was incubated with Streptococcus oralis and analyzed under TEM in the same manner. Gingival tissue samples were obtained from patients with chronic periodontitis and viewed under TEM, with the neutrophils present analyzed in the same manner.

Results: The proinflammatory cells showed less granulation, lighter cytoplasm and higher amount of nuclear euchromatin. These changes were accentuated in the proinflammatory oral chronic periodontitis neutrophils compared to the para-inflammatory oral health neutrophils. The oral chronic periodontitis neutrophils also contained more phagosomes and had more phagosomes containing undigested bacteria. These changes were partially reproduced in the naïve blood cells after exposing them to S. oralis. The neutrophils in the gingival tissues displayed naïve morphology when viewed in the blood vessels and gradually showed proinflammatory morphological changes as they traveled through the connective tissue into the epithelium.

Conclusion: Oral neutrophils display morphological changes consistent with partial or full activation, corresponding to their para- or proinflammatory states. These changes can also be induced in naïve cells by incubating them with commensal bacteria. Neutrophils change their morphology towards an activated state as they travel through the gingival tissue.
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http://dx.doi.org/10.1111/jre.12595DOI Listing
December 2018

Resveratrol derivative-rich melinjo seed extract induces healing in a murine model of established periodontitis.

J Periodontol 2018 05;89(5):586-595

Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.

Background: Products of internal defense systems, like pro-inflammatory cytokines, reactive oxygen species, and leukocytes, are released which attack periodontal bacteria in periodontitis, but at the same time, lead to tissue destruction as well. We hypothesize that resveratrol derivative-rich melinjo seed extract (MSE), an edible plant extract that has antioxidant properties, should promote healing of periodontal bone loss and modulating immune-inflammatory systems that leads periodontal tissue destruction.

Methods: We used an experimentally induced periodontitis (EP) model in mice. Ligatures were placed first for development of EP (15 days). MSE was intraperitoneally administrated (0.001% (w/w)) to reverse bone loss that had already occurred in established EP and mice were then sacrificed (day 17, 20 and 22).

Results: Morphometric outcomes revealed lower bone-loss in the MSE groups compared to control. Immunohistochemistry assays demonstrated lower oxidative stress in MSE groups. MSE also inhibited M-CSF/sRANKL mediated osteoclast formation and down-regulated osteoclast activity.

Conclusions: Treatment with MSE in EP actually caused healing of bone, and these effects are probably related to decreases in local oxidative damage and osteoclast activity. Given MSE's positive effects on osteodifferentiation as well, these findings suggest that MSE could be a useful therapeutic agent for the management of periodontitis.
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http://dx.doi.org/10.1002/JPER.17-0352DOI Listing
May 2018

Modulation of Jaw Muscle Motor Response and Wake-Time Parafunctional Tooth Clenching With Music.

J Oral Facial Pain Headache 2018 02 28;32(2):167–177. Epub 2018 Feb 28.

Aims: To evaluate the effects of Guided Music Listening (GML) on masticatory muscles and on the amplitude of wake-time tooth clenching in individuals with higher vs lower frequency of clenching episodes.

Methods: The electromyographic (EMG) activity of the right masseter was recorded during three 20-minute music (relaxing, stress/tension, and favorite) tasks and a control no-music task in 10 (mean age ± standard deviation [SD] = 21.4 ± 3.0 years) and 11 (22.6 ± 2.9 years) healthy volunteers with higher (HP) vs lower (LP) frequency of tooth-clenching episodes, respectively. EMG episodes greater than 10% of the maximum voluntary contraction (EMG activity of the masseter during tooth clenching) and below 10% (EMG activity during rest) were analyzed. Nonparametric tests were used to assess between-group and within-group (between-task) differences in primary outcome measures.

Results: In both groups, EMG activity during rest was the greatest during the stress/tension task, and it was the lowest during the favorite task in the LP group and the relaxing task in the HP group (all P < .001). In the HP group, the amplitude of clenching episodes was significantly lower during the favorite and stress/tension tasks than during the relaxing task (all P < .05), while in the LP group, it was significantly lower during the stress/tension task than during the control task (P = .001). The experiment did not affect the frequency or duration of clenching episodes.

Conclusion: GML modulates masticatory muscle activity. The response to GML depends on the frequency of clenching and the type of music.
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http://dx.doi.org/10.11607/ofph.1960DOI Listing
February 2018

Inter-personal diversity and temporal dynamics of dental, tongue, and salivary microbiota in the healthy oral cavity.

NPJ Biofilms Microbiomes 2017 26;3. Epub 2017 Jan 26.

Faculty of Dentistry, University of Toronto, Toronto, ON Canada.

Oral microbes form a complex and dynamic biofilm community, which is subjected to daily host and environmental challenges. Dysbiosis of the oral biofilm is correlated with local and distal infections and postulating a baseline for the healthy core oral microbiota provides an opportunity to examine such shifts during the onset and recurrence of disease. Here we quantified the daily, weekly, and monthly variability of the oral microbiome by sequencing the largest oral microbiota time-series to date, covering multiple oral sites in ten healthy individuals. Temporal dynamics of salivary, dental, and tongue consortia were examined by high-throughput 16S rRNA gene sequencing over 90 days, with four individuals sampled additionally 1 year later. Distinct communities were observed between dental, tongue, and salivary samples, with high levels of similarity observed between the tongue and salivary communities. Twenty-six core OTUs that classified within , and genera were present in ≥95% samples and accounted for ~65% of the total sequence data. Phylogenetic diversity varied from person to person, but remained relatively stable within individuals over time compared to inter-individual variation. In contrast, the composition of rare microorganisms was highly variable over time, within most individuals. Using machine learning, an individual's oral microbial assemblage could be correctly assigned to them with 88-97% accuracy, depending on the sample site; 83% of samples taken a year after initial sampling could be confidently traced back to the source subject.
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http://dx.doi.org/10.1038/s41522-016-0011-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5445578PMC
January 2017

Effects of enamel matrix derivative on non-surgical management of peri-implant mucositis: a double-blind randomized clinical trial.

Clin Oral Investig 2017 Sep 30;21(7):2379-2388. Epub 2016 Dec 30.

Faculty of Dentistry, University of Toronto, Toronto, Canada.

Background: Peri-implant diseases have been recognized as being among the ever-increasing complications related to dental implants. The aim of this study was to evaluate the adjunctive use of enamel matrix derivative (EMD) to mechanical debridement (MD) in patients with these conditions in terms of clinical parameters and cytokine levels of peri-implant crevicular fluid (PICF).

Methods: In the present double-blind clinical trial, 46 patients with peri-implant mucositis (PM) were randomly divided into control and test groups. Two different therapeutic protocols, consisting of non-surgical MD alone (control group) and MD with the application of EMD (test group), were considered for the two groups. Clinical parameters [bleeding on probing (BOP) and probing depth (PD)] and sampling from PICF were carried out before treatment and 3 months postoperatively. The levels of IL-6 and IL-17 cytokines in PICF were evaluated by enzyme-linked immunosorbent (ELISA).

Results: Three-month post-interventional assay revealed significant improvements in BOP and PD in the test group in comparison to the control group (P < 0.0001). Relative to control, IL-6 and IL-17 levels were reduced significantly (p < 0.05) in the test group compared to the control group.

Conclusion: Application of EMD can be considered an adjunct to MD in the non-surgical treatment of PM. However, complete recovery was not observed using either treatment approach showing that management of implant-associated disease is still a significant clinical problem.
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http://dx.doi.org/10.1007/s00784-016-2033-7DOI Listing
September 2017

Oral neutrophil levels: a screening test for oral inflammatory load in pregnancy in a medical setting.

J Periodontol 2015 Jan;86(1):72-81

Department of Paediatrics, Faculty of Dentistry, University of Toronto, Toronto, ON.

Background: A multitude of studies suggest an association between periodontal disease and adverse birth outcomes, but the findings have been equivocal. Although the evidence is controversial, it is biologically plausible, and the key link may be inflammation. Because periodontitis is at times either active or inactive, trying to correlate the presence of pockets, for example, to adverse outcome of pregnancy might be preordained to failure or at least confusion. Alternatively, if inflammatory activity associated with periodontitis could be measured, it might be possible to correlate oral inflammatory load (OIL) to adverse pregnancy outcomes more precisely, but given the low incidence of adverse pregnancy outcomes, large populations must be studied. This underscores the need to use a means for assessment of OIL that is reliable, reproducible, and so simple to perform that it does not require dental expertise and can be used for large numbers of patients attending obstetrics units. The objective of this study was to demonstrate that OIL can be measured in a cohort of pregnant females presenting for obstetric care and secondarily to ensure that there was a realistic correlation to the presence of periodontitis.

Methods: Sixty-three pregnant females were recruited, and 15-second saline rinses were collected to measure OIL as represented by counts of oral neutrophil levels. Periodontal examinations were performed to determine the extent of the correlation between the presence of clinical markers of periodontitis, such as pockets and clinical attachment loss to the OIL.

Results: Using this small cohort of patients, a test for oral inflammatory disease could be administered successfully in a non-dental setting. In addition, there was a statistically significant increase (two-fold, P < 0.05) in oral neutrophil counts found in patients with periodontitis compared with those without periodontitis.

Conclusion: The rinse assay can be used as a screening tool for oral inflammation, which was also related to the presence of periodontitis, in pregnant females attending a medical clinic.
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http://dx.doi.org/10.1902/jop.2014.140116DOI Listing
January 2015

Perioperative use of non-steroidal anti-inflammatory drugs might impair dental implant osseointegration.

Clin Oral Implants Res 2016 Feb 30;27(2):e1-7. Epub 2014 Sep 30.

Department of Prosthodontics, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.

Objective: To appraise whether adverse biological events following oral implant placement may be associated with perioperative use of non-steroidal anti-inflammatory drugs (NSAIDs).

Methods: All patients treated in a university faculty postgraduate dental clinic between 1979 and 2012 that had experienced a failing and surgically removed dental implant (292 implants in 168 patients) were contacted to solicit additional information about their present dental and medical status and frequency of current and past use of NSAIDs. Potential associations between perioperative NSAIDs use and the occurrence of adverse biological events were explored by the use of 2 × 2 tables and two-tailed Fisher's exact tests.

Results: One hundred and four patients with initially 468 implants had experienced 238 implant failures, of which 197 were due to failing osseointegration (42%). Sixty of the participants, initially with 273 implants, had used NSAIDs perioperatively and experienced 44% implant failures, versus 38% in the non-NSAID cohort. The NSAID cohort experienced 3.2 times more cases of radiographic bone loss greater than 30% of the vertical height of their remaining implants and 1.9 times more cases of cluster failures, defined as failure of 50% or more of the implant(s) placed.

Conclusions: Notwithstanding that a retrospective study design is open to potential bias, the current data indicate that dental implant osseointegration may be affected negatively by an inhibitory effect of NSAIDs on bone healing in vulnerable patients. Future and better clinical studies than the current should be designed to appraise more precisely the potential effects of NSAIDs on implant osseointegration in study populations that are not limited by stringent medical inclusion and exclusion criteria.
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http://dx.doi.org/10.1111/clr.12493DOI Listing
February 2016

Evaluation of periodontal disease and oral inflammatory load in adults with special needs using oral neutrophil quantification.

Spec Care Dentist 2014 Nov-Dec;34(6):303-12. Epub 2014 Jun 24.

Staff Pediatric Dentist, Department of Dentistry, Holland Bloorview Kids Rehabilitation Hospital, Toronto, MSc Pediatric Dentistry Graduate, Faculty of Dentistry, University of Toronto, Former Dental Resident, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.

The purpose of this study was to validate and assess the feasibility of using an assay of oral neutrophils to measure periodontal inflammation in uncooperative adults with special needs. Conventional periodontal measurements and neutrophil counts obtained from oral swabs were performed on patients having dental care under general anesthesia (GA) and at subsequent recall. Forty-nine patients were assessed under GA and 30 (61%) returned for follow-up. A high prevalence of gingival inflammation was found at baseline and oral neutrophil levels positively correlated with traditional periodontal parameters (p < 0.05). Neutrophils were acquired using swabs for 100% of patients examined at recall and a significant reduction in oral inflammatory load was noted after a single treatment session (p < 0.05), despite the persistence of poor oral hygiene and prolonged recall intervals. This study demonstrates that oral neutrophil quantification may serve as a novel and standardized method for clinical assessment of periodontal diseases in people with special needs.
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http://dx.doi.org/10.1111/scd.12077DOI Listing
September 2016

Enhanced medial prefrontal-default mode network functional connectivity in chronic pain and its association with pain rumination.

J Neurosci 2014 Mar;34(11):3969-75

Division of Brain, Imaging and Behaviour-Systems Neuroscience, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada M5S 1A8, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada M5G 1G6, Mount Sinai Hospital Dental Clinic, Toronto, Ontario, Canada M5G 1X5, Department of Surgery, University of Toronto, Toronto, Ontario, Canada M5T 1P5, Department of Neuroscience, Physiology and Pharmacology, University College London, United Kingdom WC1E 6BT, Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel 3498838, and University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada M5T 1P8.

Rumination is a form of thought characterized by repetitive focus on discomforting emotions or stimuli. In chronic pain disorders, rumination can impede treatment efficacy. The brain mechanisms underlying rumination about chronic pain are not understood. Interestingly, a link between rumination and functional connectivity (FC) of the brain's default mode network (DMN) has been identified within the context of mood disorders. We, and others, have also found DMN dysfunction in chronic pain populations. The medial prefrontal cortex (mPFC) is a key node of the DMN that is anatomically connected with the descending pain modulatory system. Therefore, we tested the hypothesis that in patients with chronic pain, the mPFC exhibits abnormal FC related to the patient's degree of rumination about their pain. Seventeen patients with idiopathic temporomandibular disorder (TMD) and 17 age- and sex-matched healthy controls underwent resting state functional MRI, and rumination about pain was assessed through the rumination subscale of the Pain Catastrophizing Scale. Compared with healthy controls, we found that TMD patients exhibited enhanced mPFC FC with other DMN regions, including the posterior cingulate cortex (PCC)/precuneus (PCu) and retrosplenial cortex. We also found that individual differences in pain rumination in the chronic pain patients (but not in healthy controls) were positively correlated to mPFC FC with the PCC/PCu, retrosplenial cortex, medial thalamus, and periaqueductal/periventricular gray. These data implicate communication within the DMN and of the DMN with the descending modulatory system as a mechanism underlying the degree to which patients ruminate about their chronic pain.
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http://dx.doi.org/10.1523/JNEUROSCI.5055-13.2014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705280PMC
March 2014

Effects of photodynamic therapy on clinical and gingival crevicular fluid inflammatory biomarkers in chronic periodontitis: a split-mouth randomized clinical trial.

J Periodontol 2014 Sep 14;85(9):1222-9. Epub 2014 Feb 14.

Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: There are limited clinical experiments addressing the effects of photodynamic therapy (PDT) as an adjunct to conventional scaling and root planing (SRP) on clinical and biologic features of periodontitis. This trial compares the clinical parameters and cytokine profiles in gingival crevicular fluid of patients with moderate-to-severe chronic periodontitis (CP) who have been treated using SRP alone or SRP + PDT.

Methods: Twenty-two patients with two contralateral teeth affected with moderate-to-severe CP were selected. After SRP, the participants' teeth were randomized to receive either no further treatment or a single application of PDT using a 638-nm laser and toluidine blue. Although the change in probing depth was the primary outcome, bleeding on probing, clinical attachment level, gingival recession, interleukin-1β, tumor necrosis factor (TNF)-α, and matrix metalloproteinase 8 and 9 were also evaluated at baseline and 3 months postintervention. An oral rinse assay was also performed to determine the total levels of oral polymorphonuclear cells (PMNs) before and 3 months after the treatments.

Results: Within each group, significant improvements (P <0.001) were found for all variables in 3-month follow-up compared with baseline. Only TNF-α was significantly improved in the PDT + SRP versus SRP group. Total levels of PMNs were reduced for all patients compared with baseline levels (P <0.001).

Conclusion: In patients with CP, a single application of PDT (using a 638-nm laser and toluidine blue) did not provide any additional benefit to SRP in terms of clinical parameters or inflammatory markers 3 months following the intervention.
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http://dx.doi.org/10.1902/jop.2014.130464DOI Listing
September 2014

Oral health comparison between children with neutropenia and healthy controls.

Spec Care Dentist 2014 Jan-Feb;34(1):12-8. Epub 2012 Nov 22.

Staff Paediatric Dentist, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.

The purpose of this cross-sectional study was to assess and compare the oral health of children with neutropenia, who are under the active care of a hematologist in a designated marrow failure and myelodysplasia program, to a healthy control group. Children aged 6-18 with neutropenia attending the Marrow Failure and Myelodysplasia Program at SickKids Hospital and controls attending the Children's Clinic, Faculty of Dentistry, University of Toronto were asked to participate in the study consisting of a patient questionnaire followed by a dental and radiographic examination. Fifteen patients with neutropenia (mean age 12.14 ± 4.04 years) and 26 healthy controls (mean age 11.61 ± 3.82 years) participated in this study. Patients with neutropenia reported significantly increased mouth sores (p < .008) and bleeding gums while brushing (p < .001). The dmft/t score was significantly lower for the neutropenia group (p < .009). The clinical examination also showed that there were no statistically significant differences with respect to ulcerations, gingival recession, tooth mobility, gingival inflammation, periodontal bone loss, DMFT/T scores, plaque, and calculus levels. Preliminary data demonstrates that pediatric patients who are under the active care of a hematologist do not present with an increased risk of oral diseases.
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http://dx.doi.org/10.1111/j.1754-4505.2012.00299.xDOI Listing
October 2015

Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature.

J Biomed Mater Res B Appl Biomater 2014 Apr 7;102(3):643-50. Epub 2013 Oct 7.

Department of Preventive, University of Toronto, Toronto, Ontario, Canada.

The significance of keratinized mucosa (KM) around dental implants is still not well explained and has been controversial. The aim of this systematic review was to evaluate the importance of KM around dental implants. The electronic databases Cochrane library, MEDLINE, EMBASE, and Virtual Health Library (VHL) databases were utilized to search original articles from 2006 to March 2013. The inclusion and exclusion criteria used to select the articles were: (1) Human studies published in the English language; (2) Study published in international peer-viewed journals; (3) Studies evaluated the association between KM width and the peri-implant tissue health; (4) Studies that have follow up of greater than 12 months; (5) Publication of studies not older than 10 years. The searches retrieved 285 citations. Seven articles fulfilled all of the inclusion criteria. Out of these, three studies were ranked as presenting high methodological quality, and four were judged to be of moderate quality. This systematic review concludes that the presence of an adequate zone of keratinized tissue may be necessary because it was shown to be related to better peri-implant tissue health. Further randomized controlled trials are necessary to support this statement.
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http://dx.doi.org/10.1002/jbm.b.33042DOI Listing
April 2014

Clinical efficacy of antibiotics in the treatment of peri-implantitis.

Int Dent J 2013 Aug 9;63(4):169-76. Epub 2013 Apr 9.

College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.

Objectives: The aim of the present study was to review the pertinent literature with reference to the clinical efficacy of antibiotics in the treatment of peri-implantitis.

Methods: To address the focused question 'Are locally and systemically delivered antibiotics useful in the treatment of peri-implantitis?' PubMed/Medline and Google-scholar databases were explored from 1992 until February 2013 using a combination of the following keywords: 'antibiotic,' 'dental implant,' 'inflammation,', 'peri-implantitis' and 'treatment'. Letters to the editor, case-reports and unpublished data were excluded.

Results: Ten studies were included. In six studies, peri-implantitis was treated using a non-surgical approach (scaling and root planing), whereas in four studies, a surgical approach was adopted for treating peri-implantitis. In three studies systemic antibiotics were administered and in six studies locally delivered antibiotics were used for treatment. One study used the oral route for antibiotic delivery. In three studies, minocycline hydrochloride was locally delivered as an adjunctive therapy to non-surgical mechanical debridement of infected sites. Nine studies reported that traditional peri-implantitis treatment with adjunct antibiotic therapy reduces gingival bleeding, suppuration and peri-implant pocket depth. In one study, despite surgical debridement of infected sites and systemic antibiotic cover, nearly 40% of the implants failed to regain stability. There was no placebo or control group in eight out of the nine studies included.

Conclusion: The significance of adjunctive antibiotic therapy in the treatment of peri-implantitis remains debatable.
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http://dx.doi.org/10.1111/idj.12034DOI Listing
August 2013
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