Publications by authors named "Mark A Reynolds"

128 Publications

Decreasing Tryptophan and Increasing Neopterin Plasma Levels During Pregnancy are Associated with High First Trimester Porphyromonas gingivalis K-Serotype IgG Serointensity in a cohort of Hispanic Women.

Curr Top Med Chem 2022 Apr 4. Epub 2022 Apr 4.

Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD, USA.

Background: Immune activation or high levels of stress may lead to increased metabolism of tryptophan during pregnancy. Porphyromonas gingivalis (Pg), the "keystone" periodontal pathogen, induces immune and indoleamine 2,3-dioxygenase (IDO) activation. Thus, we hypothesized that larger gestational decreases in tryptophan and elevations in neopterin and kynurenine would occur in pregnant women with elevated Ig G antibodies to Pg capsular (K) serotypes.

Methods: Venous blood of 52 Hispanic pregnant women with a mean age (SD) of 31.8 (5.9) years was sampled once per trimester of pregnancy (V1, V2, V3), and plasma was obtained and stored. ELISAs were used to measure Pg capsular (K) serotype IgG serointensity (V1 only) and neopterin levels (V1-V3). Tryptophan and kynurenine (V1-V3) were measured with high-performance liquid chromatography. The participants having IgG serointensity for any of the seven Pg K serotypes in the highest quartile were defined as the "High PgK_IgG" group and those having Ig G serointensity for all K serotypes in the lowest three quartiles were defined as the "Low PgK_IgG" group . Statistics included multivariable linear and nonparametric methods.

Results: Significant decreases in plasma tryptophan levels and increases in neopterin during gestation were found in "High PgK_IgG" women but not in "Low PgK_IgG". Kynurenine changes were not significantly different between the two groups.

Conclusions: If replicated in larger studies and further characterized clinically, radiologically, and microbiologically, our results may potentially lead to novel interventional targets as well as developing more complete prognostic and predictive interactive biomarkers for adverse obstetrical outcomes and peripartum depression, and their prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1568026622666220404115543DOI Listing
April 2022

Oral Inflammatory Burden and Carotid Atherosclerosis Among Stroke Patients.

J Endod 2022 May 7;48(5):597-605. Epub 2022 Feb 7.

Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Medical and Dental Center of the Military Police of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Introduction: This study aimed to test the hypothesis that oral inflammatory burden (OIB) is independently associated with the carotid atherosclerotic burden (CAB) among individuals with ischemic stroke (IS) or transient ischemic attack (TIA).

Methods: This cross-sectional observational study included 240 hospital patients with the diagnosis of IS or TIA. The main exposures were apical periodontitis (AP), root canal treatment (RCT), and crestal alveolar (periodontal) bone loss (BL), and the main outcome was the CAB. Exposure and outcome variables were measured through a head and neck multidetector computed tomography angiography and CAB was dichotomized in <50% and ≥50% vessel occlusion. OIB scored as a composite measure of the endodontic and periodontal disease exposure. Hospital health records provided information on sociodemographic and medical covariates. Prevalence ratios (PRs) were calculated through Poisson regression models, estimating the relationship between the oral exposures and CAB, with = 5%.

Results: Mean age was 62.15 ± 13.1 years, with 56.7% men. Univariate analyses showed that AP ≥2 (PR = 1.83; 95% confidence interval [CI], 1.05-3.17) and endodontic burden (EB) (AP and/or RCT ≥ 2) (PR = 1.98; 95% CI, 1.13-3.47) were associated with CAB ≥50%. Multivariate models, adjusted for sociodemographic and medical covariates, revealed that pooled periodontal and endodontic parameters (OIB = BL ≥ 5 mm and EB ≥ 2) were independently associated with CAB ≥ 50% (PR = 2.47; 95% CI, 1.04-5.87).

Conclusion: A higher OIB was independently associated with increased levels of CAB among hospital patients with IS or TIA. The combination of endodontic and periodontal parameters strengthened the observed association and should be evaluated in future studies on the relationship between oral health and cardiovascular outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joen.2022.01.019DOI Listing
May 2022

Effecting change in academic dentistry through small groups.

J Dent Educ 2021 Aug 2. Epub 2021 Aug 2.

Department of Periodontics, University of Maryland School of Dentistry, Baltimore, Maryland, USA.

Purpose/objective: The work of faculty, staff, and students is driven by their alignment with an institution's vision and purpose, as set forth in its strategic plan. Any plan that calls for innovative growth must address certain aspects of organizational culture as roadblocks to success and should foster relationship building to achieve long-standing progress. This demonstration project investigates a method for effecting change through a Small Group Initiative (SGI).

Methods: Representatives from faculty and staff were selected by purposive sampling, placed into eight groups of six, and one member of each group was made a facilitator to participate in or facilitate monthly structured discussion-based meetings for a 1-year time period. Participants read one chapter a month of 12: The Elements of Great Managing, which corresponds to the Gallup Q12 Employee Engagement survey that each participant completed at the beginning and end of the program.

Results: Findings indicate an overall increase in participant levels of employee engagement and increased levels of personal ownership in regard to the strategic plan after participating in the SGI.

Conclusions: Many other institutional efforts aimed at the advancement of school-wide vision and employee engagement can be cumbersome to implement and require a substantial allocation of resources. The SGI, however, requires minimal resources, limited infringement on regular activity, and minimal direct cost to implement. These factors suggest that the SGI could be tailored to meet specific needs of leadership and may have broad-based applicability across various academic settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jdd.12746DOI Listing
August 2021

'Face time' for the first time: Video communication between relatives and junior doctors in the COVID-19 pandemic.

Clin Med (Lond) 2021 05;21(3):211-214

University Hospital Llandough, Llandough, UK.

Working on a COVID-19 ward presents a number of challenges to staff, with communication between families, patients and staff being highlighted as a key challenge. Novel methods are needed to overcome the barriers presented by COVID-19, with many turning to technology to offer solutions. Recognising these challenges as an area for improvement on our own ward, we sought to introduce new methods of communication to improve patient, relative and staff understanding and wellbeing. Through our own experiences and a discussion of the literature on this topic, we have identified some key themes which we believe can assist in the development of communication strategies in the developing pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7861/clinmed.2020-0925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140704PMC
May 2021

To scan or not to scan - D-dimers and computed tomography pulmonary angiography in the era of COVID-19.

Clin Med (Lond) 2021 Mar 16;21(2):e155-e160. Epub 2021 Feb 16.

University Hospital Llandough, Cardiff and Vale University Health Board, and senior clinical lecturer, School of Medicine, Swansea University

The COVID-19 pandemic has had many ramifications on healthcare delivery and practice. As part of this, utilising biomarkers to risk stratify patients has become increasingly popular. During the COVID-19 pandemic the use of D-dimer has increased due to the evidence of COVID-19 induced thrombo-embolic disease. We evaluated the use of D-dimer on all hospital admissions during the peak of the pandemic and evaluated its sensitivity in diagnosing pulmonary embolic disease (PE). Patients without COVID-19 infection were as likely to have evidence of PE as their COVID-positive counterparts. However, the sensitivity of a D-dimer was higher in COVID-positive patients at a lower D-dimer level (>1,500 μg/L, sensitivity 81%, specificity 70%) than in those without clinical, immunological or radiological evidence of COVID-19 infection (D-dimer >2,000 μg/L, sensitivity 80%, specificity 76%). These data suggest higher D-dimer thresholds should be considered for the exclusion of pulmonary emboli.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7861/clinmed.2020-0664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002780PMC
March 2021

Quantile regression to estimate the survivor average causal effect of periodontal treatment effects on birthweight and gestational age.

J Periodontol 2021 07 5;92(7):975-982. Epub 2020 Nov 5.

Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.

Background: Survival average causal effect (SACE) can give valid estimates of the periodontal treatment effect on birth outcomes in randomized controlled trials when fetal losses are unequal across the treatment arms. A regression-based method to estimate SACE using ordinary least squares (OLS) regression can be biased if the treatment effect varies across the outcome distribution. In this case quantile regression may be a suitable alternative.

Methods: We compared OLS and quantile regression models estimating SACE to calculate the effect of periodontal treatment on birthweight and gestational age in secondary analyses of publicly available Obstetrics and Periodontal Therapy (OPT) trial data.

Results: Periodontal treatment tended to increase birthweight and gestational age at the lowest quantiles, remained flat in the middle quantiles, and trended to decrease both birthweight and gestational age in the highest quantiles. In quantile regression models estimating SACE the β-coefficients: 95% confidence intervals (CI) for the 5th, 50th, and 95th percentiles were 277.5:  -141.0 to 696.0 g, 1.4: -107 to 110.3 g, and -84: -344 to 175.3 g for birthweight, and 0.6: -1.0 to 2.2 weeks, -0.1: -0.5 to 0.2 weeks, and -0.6: -1.0 to -0.1 weeks for gestational age. Estimates from OLS models estimating SACE were close to the null, β: 95% CI -4.7: 132.3 to 123.0 g for birthweight, and 0.03: -0.72 to 0.78 weeks for gestational age.

Conclusions: OLS models to evaluate SACE for periodontal treatment effects on birthweight and gestational age may be biased towards the null. Quantile regression may be a preferable alternative.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.20-0376DOI Listing
July 2021

Adherence to and acceptability of three alcohol-free, antiseptic oral rinses: A community-based pilot randomized controlled trial among pregnant women in rural Nepal.

Community Dent Oral Epidemiol 2020 12 13;48(6):501-512. Epub 2020 Jul 13.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Objectives: Antiseptic oral rinses have been evaluated as interventions to reduce the risk of adverse pregnancy outcomes associated with periodontal disease in pregnant women. Oral rinse use is not common in Nepal or other countries in South Asia, where the prevalence of adverse pregnancy outcomes is high. Understanding whether pregnant women in rural communities in this region would incorporate rinse use into their daily teeth cleaning routine is an important prerequisite to future research on this topic in South Asia.

Methods: We conducted a community-based pilot randomized controlled trial of three alcohol-free, antiseptic oral rinses among pregnant women <22 weeks pregnant in rural Nepal with the aim of assessing rinse acceptability, adherence, and effect on clinical periodontal measures. At baseline, participants underwent a clinical periodontal examination, and then were classified as healthy or having at least mild gingivitis (≥1 site with probing depth (PD) 3 mm and bleeding on probing (BOP) or ≥4 mm (PD)). Participants were stratified by periodontal status and randomized within each exposure category to chlorhexidine (CHX) (0.12%), cetylpyridinium chloride (CPC) (0.05%), salt and water (NaCl), or control (no rinse). Rinse participants were followed weekly for 12 weeks, and all participants underwent a second periodontal examination and answered a questionnaire.

Results: Pregnant women in the rural Terai region of Nepal showed high adherence to (mean weekly rinse use: 185 mL (standard deviation: 66 mL)) a recommended 210 mL and acceptability of all three rinses. Participants reported greater frequency of tooth brushing with toothpaste and improvements in other recommended oral hygiene behaviours. CHX significantly reduced rates of gingivitis (defined as a participant with BOP ≥ 10% of sites) and the extent of BOP (gingivitis at the end of follow-up for CHX vs control: RR 0.37, 95% CI: 0.16, 0.84). CPC and NaCl rinse groups had rates of gingivitis and extent of BOP similar to the control group (gingivitis at the end of follow-up for CPC: RR 0.81, 95% CI: 0.47, 1.38; NaCl: RR 0.92, 95% CI: 0.55, 1.56).

Conclusions: Adherence to and acceptability of three alcohol-free, antiseptic oral rinses were high among pregnant women in rural Nepal. Among participants with mild gingivitis at baseline, CHX rinse was most effective at reducing signs of disease compared to the control group. Oral rinse should be considered as a supplement to current oral self-care routines for pregnant women in settings where rinse use is uncommon and access to oral health services is limited.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cdoe.12562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689705PMC
December 2020

Evaluation of poly lactic-co-glycolic acid-coated β-tricalcium phosphate for alveolar ridge preservation: A multicenter randomized controlled trial.

J Periodontol 2021 04 12;92(4):524-535. Epub 2020 Oct 12.

Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, Iowa, USA.

Background: Alveolar ridge preservation via socket grafting (ARP-SG) is indicated to attenuate physiologic alveolar bone resorption as a consequence of tooth extraction. However, a specific bone grafting material that is patently superior has not been identified yet. The aim of this randomized controlled trial was to evaluate the efficacy of a moldable alloplastic graft, Poly Lactic-Co-Glycolic Acid-Coated β-Tricalcium Phosphate (PLGA-β-TCP), for ARP purposes [Group A] compared to freeze-dried bone allograft (FDBA) particles covered with a rapidly absorbable collagen dressing (RACD) (Group B) in function of a panel of radiographic, histomorphometric, and implant-related outcomes.

Methods: Patients in need of extraction of a single posterior tooth (premolar or molar) and subsequent replacement with a dental implant were recruited and randomly allocated into one of the two treatment groups. Follow-up visits took place at 1, 2, 4, 8, and 16 weeks. Cone-beam Computed Tomography (CBCT) scans were obtained at baseline and at 16 weeks. Sites were re-entered at 20 weeks for bone core biopsy harvesting and subsequent implant placement. After delivery of the final implant-supported restoration, follow-up visits were scheduled at 6 and 12 months to monitor peri-implant tissue health and marginal bone levels using standardized intraoral periapical radiographs.

Results: A total of 45 patients were initially enrolled in the study, of whom 43 received an implant and 32 completed the study. Healing was uneventful in all sites after ARP-SG and implant placement. No site required bone augmentation to allow for implant placement. CBCT scan analyses showed no statistically significant differences between groups in terms of reduction of horizontal width, midbuccal / midlingual height and ridge volume. Histomorphometric assessments revealed a statistically significant difference between both groups in terms of mineralized tissue formation (Group A = 27.0% ± 22.1% versus Group B = 38.2% ± 12.5%; P < 0.05). On the contrary, no significant differences were observed regarding percent of remaining bone grafting material and non-mineralized tissue. No implant failed throughout the study period and marginal bone level change was negligible in both groups.

Conclusions: Although a higher proportion of mineralized tissue was associated with the use of FDBA+RACD compared to PLGA-β-TCP alone, both ARP-SG approaches rendered comparable outcomes in terms of maintenance of alveolar bone dimensions, feasibility of implant placement, implant survival, and peri-implant bone level stability up to 12 months post-loading.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/JPER.20-0360DOI Listing
April 2021

Risk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort study.

BMJ Open 2020 08 20;10(8):e036515. Epub 2020 Aug 20.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objectives: Observational studies have identified associations between periodontitis and adverse pregnancy outcomes, but randomised controlled trials evaluating the efficacy of periodontal therapy have yielded inconsistent results. Few studies have explored relationships between gingival inflammation and these outcomes or been conducted in rural, low-income communities, where confounding risk factors differ from other settings.

Methods: We conducted a community-based, prospective cohort study with the aim of estimating associations between the extent of gingival inflammation in pregnant women and incidence of preterm birth in rural Nepal. Our primary exposure was gingival inflammation, defined as bleeding on probing (BOP) ≥10%, stratified by BOP <30% and BOP ≥30%. A secondary exposure, mild periodontitis, was defined as ≥2 interproximal sites with probing depth (PD) ≥4 mm (different teeth) or one site with PD ≥5 mm. Our primary outcome was preterm birth (<37 weeks gestation). We used Poisson regression to model this relationship, adjusting for potential confounders.

Results: Of 1394 participants, 554 (39.7%) had gingival inflammation, 54 (3.9%) mild periodontitis and 197 (14.1%) delivered preterm. In the adjusted regression model, increasing extent of gingival inflammation was associated with a non-significant increase in risk of preterm birth (BOP ≥30% vs no BOP: adjusted relative risk (aRR) 1.37, 95% CI: 0.81 to 2.32). A secondary analysis, stratifying participants by when in pregnancy their oral health status was assessed, showed an association between gingival inflammation and preterm birth among women examined in their first trimester (BOP ≥30% vs no BOP: aRR 2.57, 95% CI: 1.11 to 5.95), but not later in pregnancy (BOP ≥30% vs no BOP: aRR 1.05, 95% CI: 0.52 to 2.11).

Conclusions: Gingival inflammation in women examined early in pregnancy and poor oral hygiene behaviours were risk factors for preterm birth. Future studies should evaluate community-based oral health interventions that specifically target gingival inflammation, delivered early in or before pregnancy, on preterm birth.

Trial Registration Number: Nepal Oil Massage Study, NCT01177111.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-036515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443267PMC
August 2020

Immediate Tooth Replacement Therapy in Postextraction Sockets: A Comparative Prospective Study on the Effect of Variable Platform-Switched Subcrestal Angle Correction Implants.

Int J Periodontics Restorative Dent 2020 Jul/Aug;40(4):509-517

Immediate tooth replacement therapy (ITRT), ie, immediate implant placement and provisional restoration in postextraction sockets, has been shown to achieve favorable outcomes in reference to soft tissue stability and esthetics. However, avoiding socket perforation with uniaxial implants in the anterior maxilla can be challenging due to the inherent anatomy. Dual or co-axis subcrestal angle correction (SAC) implants have been developed to change the restorative angle of the clinical crown restoration subcrestally at the implant-abutment interface to enhance the incidence of screw-retained definitive restorations. An additional benefit of this macrodesign implant feature is variable platform switching (VPS) that increases soft tissue gap distance above the implant platform. The purpose of this prospective study on ITRT in maxillary anterior postextraction sockets was to investigate the effect of SAC with VPS (SAC/VPS) compared to conventional platform-switch-design implants (PS) relative to ridge dimension stability and peri-implant soft tissue thickness. A total of 29 patients had undergone ITRT and received either a PS or SAC/VPS implant; previously described measurements were made compared to the contralateral natural tooth sites. When the comparison of buccal soft tissue thickness was made, SAC/VPS showed a greater increase compared to PS (3.12 mm vs 2.39 mm, respectively) with statistical significance ( = .05). The increase was independent from periodontal phenotype. Therefore, SAC/VPS may increase peri-implant soft tissue thickness and help minimize recession following ITRT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/prd.4440DOI Listing
June 2020

Tooth loss is associated with atherosclerosis and a poorer functional outcome among stroke patients.

Clin Oral Investig 2020 Dec 21;24(12):4541-4548. Epub 2020 May 21.

Graduate Program in Dentistry, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, 6681 Av. Ipiranga, prédio 6, 90619900, Porto Alegre, RS, Brazil.

Objectives: The purpose of the study was twofold: (1) to test the hypothesis that tooth loss is independently associated with carotid atherosclerotic burden (CAB) among individuals with ischemic stroke (IS) or transient ischemic attack (TIA) and (2) to test the association between tooth loss and disability following the occurrence of cerebral ischemia.

Materials And Methods: This observational study included 418 patients with IS or TIA. Tooth loss and the CAB were measured through a head and neck multidetector computed tomography angiography. CAB was analyzed in both common, internal, and external carotid arteries and classified in five levels of vascular occlusion. The modified Rankin Scale (mRS) was used to evaluate the functional outcome at patient discharge. Health records provided information on sociodemographic and medical covariates. The association between CAB and tooth loss, as well as between tooth loss and subtypes of cerebral ischemia were estimated through Poisson regression. Cox regression was carried out to evaluate the association between tooth loss and the mRS, with α = 5%.

Results: Mean age was 65.6 ± 13.8 years, with 52.4% males. Multivariate analyses revealed that severe tooth loss (> 23 missing teeth) was independently associated with CAB ≥ 50% (PR = 2.86, 95% CI = 1.19-6.89) and mRS scores (> 2) (HR = 1.97, 95% CI = 1.10-3.75).

Conclusion: Tooth loss was independently associated with CAB and predicted a poorer functional outcome among IS and TIA patients.

Clinical Relevance: Clinical assessment of tooth loss may provide important information on risk for CAB and poorer functional outcome among stroke patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00784-020-03319-zDOI Listing
December 2020

Feasibility of training community health workers to conduct periodontal examinations: a validation study in rural Nepal.

BMC Health Serv Res 2020 May 11;20(1):412. Epub 2020 May 11.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.

Background: In many low- and middle-income countries, insufficient human resources limit access to oral health services. Shifting clinical tasks to less specialized health professionals, such as community health workers, has been used as a strategy to expand the health workforce, especially in remote or underserved locations. The objective of this study was to evaluate the validity of periodontal examinations conducted by auxiliary nurse midwives in a rural home setting in Nepal.

Methods: Twenty-one pregnant women < 26 weeks gestation from Sarlahi District, Nepal, underwent full mouth periodontal examinations measuring probing depth (PD) and bleeding on probing (BOP) on 6 sites per tooth by one of five auxiliary nurse midwives, who were trained for this study but had no previous training in dentistry. After a 15-min break, each participant was examined again by an experienced dentist. Measures of validity for PD and BOP were calculated comparing the pooled and individual auxiliary nurse midwives to the dentist. A multivariable GEE model estimated the effect of periodontal characteristics on agreement between the auxiliary nurse midwives and the dentist.

Results: Participant mean age was 22 years (SD: ±3 years), mean PD was 1.4 mm (SD: 03 mm), and 86% of women had BOP (according to the dentist). Percent agreement, weighted kappa scores, and intraclass correlation coefficients for PD, with an allowance of ±1 mm, exceeded 99%, 0.7, and 0.9, respectively, indicating an acceptable level of agreement. Auxiliary nurse midwives tended to report higher PD scores relative to the dentist, although this over-estimation was small and unlikely to impact population-based estimates of important indicators of oral health status. GEE regression modeling indicated similar agreement for mandible vs. maxilla, left vs. right side, and PD (≤2 mm, > 2 mm), and lower agreement for posterior teeth and lingual and proximal sites.

Conclusion: Auxiliary nurse midwives were able to accurately conduct periodontal examinations in a rural home setting, suggesting the potential to shift tasks away from highly trained dentists and periodontal examiners in low-resource communities.

Trial Registration: ClinicalTrials.gov Identifier: NCT01177111 (Nepal Oil Massage Study); registered on August 6th, 2010.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12913-020-05276-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212579PMC
May 2020

Predicted Economic Benefits of a Novel Biomarker for Earlier Sepsis Identification and Treatment: A Counterfactual Analysis.

Crit Care Explor 2019 Aug 7;1(8):e0029. Epub 2019 Aug 7.

Critical Care Medicine, Ohio State University Wexner Medical Center, Columbus, OH.

To estimate the potential clinical and health economic value of earlier sepsis identification in the emergency department using a novel diagnostic marker, monocyte distribution width.

Design: The analysis was conducted in two phases: 1) an analysis of the pivotal registration trial evidence to estimate the potential benefit of monocyte distribution width for early sepsis identification and (2) a cost-consequence analysis to estimate the potential economic and clinical benefits that could have resulted from earlier administration of antibiotics for those patients.

Setting: Sepsis identified in the emergency department which led to inpatient hospitalizations.

Patients: Adult sepsis patients admitted through the emergency department.

Interventions: None. This was a model simulation of clinical and economic outcomes of monocyte distribution width based on results from a noninterventional, multicenter clinical trial.

Measurements And Main Results: Among the 385 patients with sepsis, a total of 349 were eligible for inclusion. Sixty-seven percent of patients were predicted to benefit from monocyte distribution width results, resulting in an estimated mean reduction in time to antibiotics administration from 3.98 hours using standard of care to 2.07 hours using monocyte distribution width + standard of care. Based on this simulated reduction in time to antibiotics, monocyte distribution width + standard of care could have resulted in a less than or equal to 14.2% reduction (27.9% vs 32.5%) in mortality, a mean reduction of 1.48 days (10.0 vs 11.5 d) in length of stay, and $3,460 ($23,466 vs $26,926) savings per hospitalization. At the hospital level, based on an established national mean of 206 sepsis hospitalizations per hospital per year, earlier identification with monocyte distribution width is predicted to result in a total of $712,783 in annual cost savings per hospital.

Conclusions: Improved early identification of sepsis using monocyte distribution width along with current standard of care is estimated to improve both clinical and economic outcomes of sepsis patients presenting in the emergency department. Further research is warranted to confirm these model projections.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCE.0000000000000029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063955PMC
August 2019

Charcoal-based mouthwashes: a literature review.

Br Dent J 2020 02;228(4):290-294

Professor, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA.

The commercial marketplace has seen a rapid increase in the number of over-the-counter charcoal-containing mouthwashes. The purpose of this systemic review was to examine the clinical and laboratory evidence supporting therapeutic claims of efficacy and safety of use of charcoal-based mouthwashes. Secondly, the product labels and information of 36 commercially marketed charcoal mouthwashes were reviewed for active ingredients. Only 8% of charcoal mouthwashes contained an active ingredient, such as cetylpyridinium chloride or chlorhexidine. There is insufficient evidence to substantiate the therapeutic and cosmetic marketing claims of charcoal-based mouthwashes, including antimicrobial activity, anti-halitosis, tooth whitening, periodontal disease control, caries reduction and tooth remineralisation, among others. Moreover, there is no available information on charcoal particulate size or abrasivity of any of these products. Dental clinicians should advise their patients to exercise caution when using over-the-counter charcoal-containing mouthwashes because of the lack of evidence supporting therapeutic or cosmetic effectiveness as well as safety.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41415-020-1265-8DOI Listing
February 2020

Changes in Peri-implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft. Part II: A Comparative Retrospective Case Series Using a Subcrestal Angle Correction Implant Design.

Int J Periodontics Restorative Dent 2020 July/August;40(4):539–547. Epub 2020 Feb 11.

Immediate tooth replacement therapy (ITRT) in the maxillary anterior sextant is an increasingly frequent treatment option sought by patients and performed by clinicians worldwide. Achieving long-term results that are predictable, stable, esthetic, and healthy is the ultimate goal. This trend also lends itself to minimally invasive surgery as well as defining the procedure to a singular surgical intervention. Preserving and augmenting hard and soft tissues at the time of immediate implant placement provides the best opportunity to achieve these goals. Incorporating an implant with a subcrestal angle correction [SAC] or biaxial feature facilitates screw-retention of both provisional and definitive restorations through the cingulum portion of the crown. Compared to uniaxial implants, these implants also feature an extended or variable platform switch [VPS] facially. Measurements of the peri-implant soft tissue thickness 2.0 mm apical to the facial free gingival margin were compared between two groups of 15 consecutively treated patients with different implant designs to evaluate the effect of SAC/VPS for ITRT. The null hypothesis was that there is no difference between uniaxial and biaxial implants with bone grafting and dermis allograft. These authors contend that using a combined hard and soft tissue grafting approach along with SAC/VPS biaxial implants has a synergistic effect on increasing peri-implant soft tissue thickness compared to uniaxial implants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.11607/prd.4583DOI Listing
June 2020

Periodontal Pathogens and Neuropsychiatric Health.

Curr Top Med Chem 2020 ;20(15):1353-1397

Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, United States.

Increasing evidence incriminates low-grade inflammation in cardiovascular, metabolic diseases, and neuropsychiatric clinical conditions, all important causes of morbidity and mortality. One of the upstream and modifiable precipitants and perpetrators of inflammation is chronic periodontitis, a polymicrobial infection with Porphyromonas gingivalis (P. gingivalis) playing a central role in the disease pathogenesis. We review the association between P. gingivalis and cardiovascular, metabolic, and neuropsychiatric illness, and the molecular mechanisms potentially implicated in immune upregulation as well as downregulation induced by the pathogen. In addition to inflammation, translocation of the pathogens to the coronary and peripheral arteries, including brain vasculature, and gut and liver vasculature has important pathophysiological consequences. Distant effects via translocation rely on virulence factors of P. gingivalis such as gingipains, on its synergistic interactions with other pathogens, and on its capability to manipulate the immune system via several mechanisms, including its capacity to induce production of immune-downregulating micro-RNAs. Possible targets for intervention and drug development to manage distal consequences of infection with P. gingivalis are also reviewed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1568026620666200110161105DOI Listing
March 2021

Iron oxide nanoparticle-calcium phosphate cement enhanced the osteogenic activities of stem cells through WNT/β-catenin signaling.

Mater Sci Eng C Mater Biol Appl 2019 Nov 6;104:109955. Epub 2019 Jul 6.

Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore 21201, USA; Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; University of Maryland Marlene and Stewart Greene Baum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address:

Calcium phosphate cement (CPC), functionalized with iron oxide nanoparticles (IONP), is of great promise to promote osteoinduction and new bone formation. In this work, the IONP powder was added into the CPC powder to fabricate CPC + IONP scaffolds and the effects of the novel composite on bone matrix formation and osteogenesis of human dental pulp stem cells (hDPSCs) were explored. A series of CPC + IONP magnetic scaffolds with different IONP contents (1%, 3% and 6%) were fabricated using 5% chitosan solution as the cement liquid. Western blotting and RT-PCR were used to analyze the signaling pathway. The IONP incorporation substantially enhanced the performance of CPC + IONP, with increases in both mechanical strength and cellular activities. The IONP addition greatly promoted the osteogenesis of hDPSCs, elevating the ALP activity, the expression of osteogenic marker genes and bone matrix formation with 1.5-2-fold increases. The 3% IONP incorporation showed the most enhancement among all groups. Activation of the extracellular signal-related kinases WNT/β-catenin in DPSCs was observed, and this activation was attenuated by the WNT inhibitor DKK1. The results indicated that the osteogenic behavior of hDPSCs was likely driven by CPC + IONP via the WNT signaling pathway. In conclusion, incorporate IONP into CPC scaffold remarkably enhanced the spreading, osteogenic differentiation and bone mineral synthesis of stem cell. Therefore, this method had great potential for bone tissue engineering. The novel CPC + IONP composite scaffolds with stem cells are promising to provide an innovative strategy to enhance bone regenerative therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msec.2019.109955DOI Listing
November 2019

The authors reply.

Crit Care Med 2019 09;47(9):e785-e786

Health Economics and Reimbursement, Beckman Coulter, Inc., Brea, CA Health Economics and Outcome Research, BluePath Solutions, Los Angeles, CA Critical Care Medicine, Ohio State University Wexner Medical Center, Columbus, OH.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CCM.0000000000003877DOI Listing
September 2019

Engineering of L-Plastin Peptide-Loaded Biodegradable Nanoparticles for Sustained Delivery and Suppression of Osteoclast Function In Vitro.

Int J Cell Biol 2019 5;2019:6943986. Epub 2019 May 5.

Department of Oncology and Diagnostics, School of Dentistry, University of Maryland, Baltimore, USA.

We have recently demonstrated that a small molecular weight amino-terminal peptide of L-plastin (10 amino acids; "MARGSVSDEE") suppressed the phosphorylation of endogenous L-plastin. Therefore, the formation of nascent sealing zones (NSZs) and bone resorption are reduced. The aim of this study was to develop a biodegradable and biocompatible PLGA nanocarrier that could be loaded with the L-plastin peptide of interest and determine the efficacy in osteoclast cultures. L-plastin MARGSVSDEE (P1) and scrambled control (P3) peptide-loaded PLGA-PEG nanoparticles (NP1 and NP3, respectively) were synthesized by double emulsion technique. The biological effect of nanoparticles on osteoclasts was evaluated by immunoprecipitation, immunoblotting, rhodamine-phalloidin staining of actin filaments, and pit forming assays. Physical characterization of well-dispersed NP1 and NP3 demonstrated ~130-150 nm size, < 0.07 polydispersity index, ~-3 mV -potential, and a sustained release of the peptide for three weeks. Biological characterization in osteoclast cultures demonstrated the following: NP1 significantly reduced (a) endogenous L-plastin phosphorylation; (b) formation of NSZs and sealing rings; (c) resorption. However, the assembly of podosomes which are critical for cell adhesion was not affected. L-plastin peptide-loaded PLGA-PEG nanocarriers have promising potential for the treatment of diseases associated with bone loss. Future studies will use this sustained release of peptide strategy to systematically suppress osteoclast bone resorption activity in mouse models demonstrating bone loss.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/6943986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6525930PMC
May 2019

Calcium phosphate cement scaffold with stem cell co-culture and prevascularization for dental and craniofacial bone tissue engineering.

Dent Mater 2019 07 7;35(7):1031-1041. Epub 2019 May 7.

Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address:

Objective: Calcium phosphate cements (CPCs) mimic nanostructured bone minerals and are promising for dental, craniofacial and orthopedic applications. Vascularization plays a critical role in bone regeneration. This article represents the first review on cutting-edge research on prevascularization of CPC scaffolds to enhance bone regeneration.

Methods: This article first presented the prevascularization of CPC scaffolds. Then the co-culture of two cell types in CPC scaffolds was discussed. Subsequently, to further enhance the prevascularization efficacy, tri-culture of three different cell types in CPC scaffolds was presented.

Results: (1) Arg-Gly-Asp (RGD) incorporation in CPC bone cement scaffold greatly enhanced cell affinity and bone prevascularization; (2) By introducing endothelial cells into the culture of osteogenic cells (co-culture of two different cell types, or bi-culture) in CPC scaffold, the bone defect area underwent much better angiogenic and osteogenic processes when compared to mono-culture; (3) Tri-culture with an additional cell type of perivascular cells (such as pericytes) resulted in a substantially enhanced prevascularization of CPC scaffolds in vitro and more new bone and blood vessels in vivo, compared to bi-culture. Furthermore, biological cell crosstalk and capillary-like structure formation made critical contributions to the bi-culture system. In addition, the pericytes in the tri-culture system substantially promoted stability and maturation of the primary vascular network.

Significance: The novel approach of CPC scaffolds with stem cell bi-culture and tri-culture is of great significance in the regeneration of dental, craniofacial and orthopedic defects in clinical practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dental.2019.04.009DOI Listing
July 2019

Survival of dental implants at sites after implant failure: A systematic review.

J Prosthet Dent 2020 Jan 23;123(1):54-60. Epub 2019 Apr 23.

Professor, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD.

Statement Of Problem: Despite an overall high survival rate for dental implants, the effectiveness of implant retreatment remains unclear.

Purpose: The purpose of this systematic review was to examine the survival rate of implants placed at sites which had an implant failure and to investigate factors that might affect outcomes after retreatment.

Material And Methods: A search of electronic databases limited to English language articles was conducted using the following MeSH terms: "dental implants," "dental implantation," or "dental restoration failure," combined with "retreatment," "replacement," or "reoperation." A hand search of selected journals was also performed. Of the retrieved 668 publications, 8 retrospective clinical studies met the inclusion criteria, providing the survival outcome for 673 implants in 557 patients after retreatment. Implant- and patient-related characteristics related to implant failures were assessed.

Results: The weighted mean survival rate for implants after retreatment was 86.3%, with follow-up ranging from less than 1 year to over 5 years. The survival rates of smooth-surfaced and rough-surfaced implants were compared in 217 retreated implants, revealing a significantly higher survival rate for rough-surfaced implants than for smooth-surfaced implants (90% versus 68.7%). Insufficient data were available to evaluate the effect of patient- or treatment-related characteristics on the survival of implants after retreatment.

Conclusions: The survival rate of retreated implants is lower than that generally reported after initial implant placement. Higher survival rates were reported with rough-surfaced implants than with smooth-surfaced implants in retreatment. An overall implant survival rate of 86.3% after retreatment suggests that most initial implant failures are likely attributable to modifiable risk factors, such as implant architecture, anatomic site, infection, and occlusal overload.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.prosdent.2018.11.007DOI Listing
January 2020

Effects of single species versus multispecies periodontal biofilms on the antibacterial efficacy of a novel bioactive Class-V nanocomposite.

Dent Mater 2019 06 13;35(6):847-861. Epub 2019 Mar 13.

Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address:

Objective: The objectives of this studywere to: (1) develop a novel bioactive nanocomposite for Class V restorations with subgingival margins to inhibit periodontal pathogens; and (2) investigate if the bioactive nanocomposite could inhibit multi-species periodontal biofilms with a potency as strong as that against single species biofilms.

Methods: Nanocomposite was fabricated using dimethylaminohexadecyl methacrylate (DMAHDM), 2-methacryloyloxyethyl phosphorylcholine (MPC) and nanoparticles of amorphous calcium phosphate (NACP). Biofilms with 1, 3, 6 and 9 species of periodontal pathogens were grown on the composites and tested for live/dead staining, colony-forming units (CFU), metabolic activity, and biofilm matrix polysaccharide production.

Results: The bioactive composite reduced protein adsorption by an order of magnitude (p < 0.05) and greatly reduced biofilm viability. It decreased the biofilm CFU by more than 3 orders of magnitude for all four types of periodontal biofilms, compared to control composite. With increasing the biofilm species from 1 to 9, the antibacterial efficacy of DMAHDM composite decreased; the CFU reduction folds decreased from 947 folds to 44 folds. In contrast, the MPC + DMAHDM composite maintained a CFU reduction folds of greater than 3000, showing a similar antibacterial potency from 1 to 9 species in the biofilms (p > 0.1).

Conclusion: Dual agents MPC + DMAHDM achieved the greatest inhibition in biofilm, without decreasing its antibacterial potency when the biofilm species was increased from 1 to 9. A single agent became less effective when the biofilm species was increased from 1 to 9.

Significance: The multifunctional MPC + DMAHDM composite is promising for root caries treatment and Class V restorations with subgingival margins to effectively inhibit multispecies periodontal biofilms, combat periodontitis and protect the periodontium.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dental.2019.02.030DOI Listing
June 2019

Novel magnetic calcium phosphate-stem cell construct with magnetic field enhances osteogenic differentiation and bone tissue engineering.

Mater Sci Eng C Mater Biol Appl 2019 May 28;98:30-41. Epub 2018 Dec 28.

Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; University of Maryland Marlene and Stewart Greene Baum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address:

Superparamagnetic iron oxide nanoparticles (IONPs) are promising bioactive additives to fabricate magnetic scaffolds for bone tissue engineering. To date, there has been no report on osteoinductivity of IONP-incorporated calcium phosphate cement (IONP-CPC) scaffold on stem cells using an exterior static magnetic field (SMF). The objectives of this study were to: (1) develop a novel magnetic IONP-CPC construct for bone tissue engineering, and (2) investigate the effects of IONP-incorporation and SMF application on the proliferation, osteogenic differentiation and bone mineral synthesis of human dental pulp stem cells (hDPSCs) seeded on IONP-CPC scaffold for the first time. The novel magnetic IONP-CPC under SMF enhanced the cellular performance of hDPSCs, yielding greater alkaline phosphatase activities (about 3-fold), increased expressions of osteogenic marker genes, and more cell-synthesized bone minerals (about 2.5-fold), compared to CPC control and nonmagnetic IONP-CPC. In addition, IONP-CPC induced more active osteogenesis than CPC control in rat mandible defects. These results were consistent with the enhanced cellular performance by magnetic IONP in media under SMF. Moreover, nano-aggregates were detected inside the cells by transmission electron microscopy (TEM). Therefore, the enhanced cell performance was attributed to the physical forces generated by the magnetic field together with cell internalization of the released magnetic nanoparticles from IONP-CPC constructs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.msec.2018.12.120DOI Listing
May 2019

Periodontal, metabolic, and cardiovascular disease: Exploring the role of inflammation and mental health.

Pteridines 2018 Feb 13;29(1):124-163. Epub 2018 Nov 13.

Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome Consortium for Research and Education (MVM-CoRE), Denver, CO 80220, USA; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD 21201, USA,

Previous evidence connects periodontal disease, a modifiable condition affecting a majority of Americans, with metabolic and cardiovascular morbidity and mortality. This review focuses on the likely mediation of these associations by immune activation and their potential interactions with mental illness. Future longitudinal, and ideally interventional studies, should focus on reciprocal interactions and cascading effects, as well as points for effective preventative and therapeutic interventions across diagnostic domains to reduce morbidity, mortality and improve quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1515/pteridines-2018-0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350811PMC
February 2018

Novel metformin-containing resin promotes odontogenic differentiation and mineral synthesis of dental pulp stem cells.

Drug Deliv Transl Res 2019 02;9(1):85-96

Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.

This represents the first report on the development of metformin-containing dental resins. The objectives were to use the resin as a carrier to deliver metformin locally to stimulate dental cells for dental tissue regeneration and to investigate the effects on odontogenic differentiation of dental pulp stem cells (DPSCs) and mineral synthesis. Metformin was incorporated into a resin at 20% by mass as a model system. DPSC proliferation attaching on resins was evaluated. Dentin sialophosphoprotein (DSPP), dentin matrix phosphoprotein 1 (DMP-1), alkaline phosphatase (ALP), and runt-related transcription factor 2 (Runx2) genes expressions were measured. ALP activity and alizarin red staining (ARS) of mineral synthesis by the DPSCs on resins were determined. DPSCs on metformin-containing resin proliferated well (mean ± SD; n = 6), and the number of cells increased by 4-fold from 1 to 14 days (p > 0.1). DSPP, ALP, and DMP-1 gene expressions of DPSCs on metformin resin were much higher than DPSCs on control resin without metformin (p < 0.05). ALP activity of metformin group was 70% higher than that without metformin at 14 days (p < 0.05). Mineral synthesis by DPSCs on metformin-containing resin at 21 days was 9-fold that without metformin (p < 0.05). A novel metformin-containing resin was developed, achieving substantial enhancement of odontoblastic differentiation of DPSCs and greater mineral synthesis. The metformin resin is promising for deep cavities and perforated cavities to stimulate DPSCs for tertiary dentin formation, for tooth root coatings with metformin release for periodontal regeneration, and for root canal fillings with apical lesions to stimulate bone regeneration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13346-018-00600-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214117PMC
February 2019

Gingival clefts revisited: Evaluation of the characteristics that make one more susceptible to gingival clefts.

Am J Orthod Dentofacial Orthop 2018 Nov;154(5):677-682

School of Dentistry, University of Maryland, Baltimore, MD.

Introduction: Orthodontic space closure after premolar extraction commonly results in the formation of a gingival cleft, which may contribute to orthodontic relapse and poor periodontal health. The purpose of this study was to examine clinical parameters that may predispose patients to gingival clefts.

Methods: Twenty-nine patients planned for treatment with premolar extractions (n = 87) and orthodontic space closure were evaluated in this prospective study. The clinical measures included width of keratinized buccal gingiva, thickness of buccal gingiva, thickness of buccal bone, time of space closure, and the occurrence (presence or absence) and severity (volume) of cleft formation. The association of the clinical measures with gingival cleft formation and severity was assessed separately for patients according to age group: young adolescent (≤13 years of age), adolescent (14-18 years of age), and adult (≥19 years of age).

Results: The overall incidence of gingival cleft formation was 73.2%, with a trend toward greater cleft formation in the young adolescents (79.4%) than in the adolescent and adult groups (69.2% and 68.2%, respectively). The mean severity of clefts exhibited a significant positive association with age group-young adolescent (26.6 mm), adolescent (27.9 mm), and adult (41.5 mm). Buccal bone thickness was significantly correlated with gingival phenotype in the adolescent and adult groups (r = 0.42 and r = 0.52, respectively; both, P <0.05). Rate of space closure was significantly correlated with cleft formation (r = 0.71; P <0.001) in the adult group.

Conclusions: The formation of gingival clefts is common after premolar extraction and space closure. Adults with a thinner gingival phenotype were more likely to develop gingival clefts of greater severity. The rate of space closure was significantly and inversely correlated with cleft formation in adults, reflecting a greater likelihood of cleft formation with slower space closure. Although various clinical parameters show a correlation to both severity and incidence of clefts, all patients undergoing postextraction space closure appear to be at risk and should be monitored.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajodo.2018.01.018DOI Listing
November 2018

Advanced smart biomaterials and constructs for hard tissue engineering and regeneration.

Bone Res 2018 22;6:31. Epub 2018 Oct 22.

2Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, MD USA.

Hard tissue repair and regeneration cost hundreds of billions of dollars annually worldwide, and the need has substantially increased as the population has aged. Hard tissues include bone and tooth structures that contain calcium phosphate minerals. Smart biomaterial-based tissue engineering and regenerative medicine methods have the exciting potential to meet this urgent need. Smart biomaterials and constructs refer to biomaterials and constructs that possess instructive/inductive or triggering/stimulating effects on cells and tissues by engineering the material's responsiveness to internal or external stimuli or have intelligently tailored properties and functions that can promote tissue repair and regeneration. The smart material-based approaches include smart scaffolds and stem cell constructs for bone tissue engineering; smart drug delivery systems to enhance bone regeneration; smart dental resins that respond to pH to protect tooth structures; smart pH-sensitive dental materials to selectively inhibit acid-producing bacteria; smart polymers to modulate biofilm species away from a pathogenic composition and shift towards a healthy composition; and smart materials to suppress biofilms and avoid drug resistance. These smart biomaterials can not only deliver and guide stem cells to improve tissue regeneration and deliver drugs and bioactive agents with spatially and temporarily controlled releases but can also modulate/suppress biofilms and combat infections in wound sites. The new generation of smart biomaterials provides exciting potential and is a promising opportunity to substantially enhance hard tissue engineering and regenerative medicine efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41413-018-0032-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196224PMC
October 2018

Developing a New Generation of Therapeutic Dental Polymers to Inhibit Oral Biofilms and Protect Teeth.

Materials (Basel) 2018 Sep 17;11(9). Epub 2018 Sep 17.

Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, MD 21201, USA.

Polymeric tooth-colored restorations are increasingly popular in dentistry. However, restoration failures remain a major challenge, and more than 50% of all operative work was devoted to removing and replacing the failed restorations. This is a heavy burden, with the expense for restoring dental cavities in the U.S. exceeding $46 billion annually. In addition, the need is increasing dramatically as the population ages with increasing tooth retention in seniors. Traditional materials for cavity restorations are usually bioinert and replace the decayed tooth volumes. This article reviews cutting-edge research on the synthesis and evaluation of a new generation of bioactive dental polymers that not only restore the decayed tooth structures, but also have therapeutic functions. These materials include polymeric composites and bonding agents for tooth cavity restorations that inhibit saliva-based microcosm biofilms, bioactive resins for tooth root caries treatments, polymers that can suppress periodontal pathogens, and root canal sealers that can kill endodontic biofilms. These novel compositions substantially inhibit biofilm growth, greatly reduce acid production and polysaccharide synthesis of biofilms, and reduce biofilm colony-forming units by three to four orders of magnitude. This new class of bioactive and therapeutic polymeric materials is promising to inhibit tooth decay, suppress recurrent caries, control oral biofilms and acid production, protect the periodontium, and heal endodontic infections.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ma11091747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165509PMC
September 2018

Magnetic field and nano-scaffolds with stem cells to enhance bone regeneration.

Biomaterials 2018 11 21;183:151-170. Epub 2018 Aug 21.

Department of Advanced Oral Sciences & Therapeutics, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address:

Novel strategies utilizing magnetic nanoparticles (MNPs) and magnetic fields are being developed to enhance bone tissue engineering efficacy. This article first reviewed cutting-edge research on the osteogenic enhancements via magnetic fields and MNPs. Then the current developments in magnetic strategies to improve the cells, scaffolds and growth factor deliveries were described. The magnetic-cell strategies included cell labeling, targeting, patterning, and gene modifications. MNPs were incorporated to fabricate magnetic composite scaffolds, as well as to construct delivery systems for growth factors, drugs and gene transfections. The novel methods using magnetic nanoparticles and scaffolds with magnetic fields and stem cells increased the osteogenic differentiation, angiogenesis and bone regeneration by 2-3 folds over those of the controls. The mechanisms of magnetic nanoparticles and scaffolds with magnetic fields and stem cells to enhance bone regeneration were identified as involving the activation of signaling pathways including MAPK, integrin, BMP and NF-κB. Potential clinical applications of magnetic nanoparticles and scaffolds with magnetic fields and stem cells include dental, craniofacial and orthopedic treatments with substantially increased bone repair and regeneration efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.biomaterials.2018.08.040DOI Listing
November 2018
-->