Publications by authors named "Zahi Badran"

40 Publications

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

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

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

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

Viability of Quercetin-Induced Dental Pulp Stem Cells in Forming Living Cellular Constructs for Soft Tissue Augmentation.

J Pers Med 2021 May 18;11(5). Epub 2021 May 18.

Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia.

Autogenous gingival grafts used for root coverage or gingival augmentation procedures often result in donor site morbidity. Living cellular constructs as an exogenous alternative have been proven to be associated with lower morbidity. With the available background information, the present study aims to assess if quercetin-induced living cell constructs, derived from dental pulp stem cells, have the potential to be applied as a tool for soft tissue augmentation. The characterized dental pulp stem cells (positive for CD73, CD90, and negative for CD34, HLA-DR) were expanded in Dulbecco's Modified Eagle's medium (DMEM) supplemented with 10 mM quercetin. The handling properties of the quercetin-induced dental pulp stem cell constructs were assessed by visual, and tactile sensation. A microscopic characterization using hematoxylin and eosin staining, and qRT-PCR-based analysis for stemness-associated genes (OCT4, NANOG, SOX2, and cMyc) was also performed. Dental pulp stem cells without quercetin administration were used as the control. Dental pulp stem cell constructs induced by quercetin easily detached from the surface of the plate, whereas there was no formation in the control cells. It was also simple to transfer the induced cellular construct on the flattened surface. Microscopic characterization of the constructs showed cells embedded in a tissue matrix. Quercetin also increased the expression of stemness-related genes. The use of quercetin-induced DPSC living constructs for soft tissue augmentation could provide an alternative to autogenous soft tissue grafts to lower patient morbidity and improve esthetic outcomes.
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http://dx.doi.org/10.3390/jpm11050430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158115PMC
May 2021

The effect of aging on the bone healing properties of blood plasma.

Injury 2021 Jul 9;52(7):1697-1708. Epub 2021 May 9.

College of Dental Medicine, Qatar University, Doha, Qatar. Electronic address:

Objectives: Age-related changes in blood composition have been found to affect overall health. Thus, this study aimed to understand the effect of these changes on bone healing by assessing how plasma derived from young and old rats affect bone healing using a rat model.

Methods: . Blood plasma was collected from 6-month and 24-month old rats. Differences in elemental composition and metabolome were assessed using optical emission spectrometry and liquid mass spectrometry, respectively. Bilateral tibial bone defects were created in eight rats. Young plasma was randomly applied to one defect, while aged plasma was applied to the contralateral one. Rats were euthanized after two weeks, and their tibiae were analyzed using micro-CT and histology. The proteome of bone marrow was analyzed in an additional group of three rats.

Results: Bone-defects treated with aged-plasma were significantly bigger in size and presented lower bone volume/tissue volume compared to defects treated with young-plasma. Histomorphometric analysis showed fewer mast cells, macrophages, and lymphocytes in defects treated with old versus young plasma. The proteome analysis showed that young plasma upregulated pathways required for bone healing (e.g. RUNX2, platelet signaling, and crosslinking of collagen fibrils) whereas old plasma upregulated pathways, involved in disease and inflammation (e.g. IL-7, IL-15, IL-20, and GM-CSF signaling). Plasma derived from old rats presented higher concentrations of iron, phosphorous, and nucleotide metabolites as well as lower concentrations of platelets, citric acid cycle, and pentose phosphate pathway metabolites compared to plasma derived from young rats.

Conclusion: bone defects treated with plasma-derived from young rats showed better healing compared to defects treated with plasma-derived from old rats. The application of young and old plasmas has different effects on the proteome of bone defects.
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http://dx.doi.org/10.1016/j.injury.2021.05.001DOI Listing
July 2021

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

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

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

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

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

Université de Nantes, UFR Odontologie, Nantes, France.

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

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

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

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

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

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

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

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

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

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

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

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

Postoperative Administration of the Acetylcholinesterase Inhibitor, Donepezil, Interferes with Bone Healing and Implant Osseointegration in a Rat Model.

Biomolecules 2020 09 14;10(9). Epub 2020 Sep 14.

Faculty of Dentistry, McGill University, Montreal, QC H3A0C7, Canada.

Donepezil is an acetylcholinesterase inhibitor commonly used to treat mild to moderate Alzheimer's disease. Its use has been associated with increased bone mass in humans and animals. However, the effect of postoperative administration of donepezil on bone healing remains unknown. Therefore, this study aimed to assess the impact of postoperative injection of donepezil on bone healing, titanium-implant osseointegration, and soft tissue healing. Twenty-two Sprague-Dawley rats were randomly assigned to receive a daily dose of either donepezil (0.6 mg/kg) or saline as a control. In each rat, a uni-cortical defect was created in the right tibia metaphysis and a custom-made titanium implant was placed in the left tibiae. After two weeks, rats were euthanized, and their bones were analysed by Micro-CT and histology. The healing of bone defect and implant osseointegration in the rats treated with donepezil were significantly reduced compared to the saline-treated rats. Histomorphometric analysis showed lower immune cell infiltration in bone defects treated with donepezil compared to the saline-treated defects. On the other hand, the healing time of soft tissue wounds was significantly shorter in donepezil-treated rats compared to the controls. In conclusion, short-term administration of donepezil hinders bone healing whereas enhancing soft tissue healing.
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http://dx.doi.org/10.3390/biom10091318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563209PMC
September 2020

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

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

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

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

Dental Management of Neurofibromatosis Type 1: A Case Report and Literature Review.

Int J Clin Pediatr Dent 2019 Nov-Dec;12(6):577-581

Pediatric Dentistry Department, CHU/Université Nantes, France; UMR 1246 - SPHERE "Methods in Patient-centered Outcomes and Health Research", Université Nantes et Tours, France.

Neurofibromatosis type 1 (NF1) is a clinically heterogeneous neurocutaneous genetic disorder that manifests in the form of coffee-milk spots on the skin, Lish nodules, lentigines on the underarms and on the inguinal region, and neurofibromas. Orofacial manifestations of NF1 are common. Through a review of the literature, bone lesions, orthodontic and dental abnormalities, periodontal manifestations, and caries related to NF1 will be explored. In this study, we present a clinical case of a patient with neurofibroma in the oral cavity and infraocclusion of primary molars, as well as his dental management.

How To Cite This Article: Wotjiuk F, Hyon I, Dajean-Trutaud S, Dental Management of Neurofibromatosis Type 1: A Case Report and Literature Review. Int J Clin Pediatr Dent 2019;12(6):577-581.
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http://dx.doi.org/10.5005/jp-journals-10005-1668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229384PMC
May 2020

Educational gaming for dental students: Design and assessment of a pilot endodontic-themed escape game.

Eur J Dent Educ 2020 Aug 15;24(3):449-457. Epub 2020 Mar 15.

Department of Endodontics and Restorative Dentistry, Faculty of Dental Surgery, University of Nantes, Nantes, France.

Introduction: The concept of escape games dedicated to dental students is a new learning experience that has not yet been extensively explored. The aim of this pilot study was to assess the impact and perceived value of an endodontic-themed escape game as assessed by fourth-year dental students.

Methods: This study was conducted at the University of Nantes, Faculty of Dental Surgery using a cross-sectional pre- and post-test research design to assess students' changes in performance. Students in the fourth year of dental surgery study (n = 18) were divided in four groups for this study. The answers to the pre-test/post-test were 50 true/false questions. Moreover, a 20-question perception survey was given to all the participants after completion of the escape game. The study data were collected in May 2019. An unpaired t test analysed the mean differences between the groups.

Results: The results showed a statistically significant increase in post-test results (75.33% ± 10.17% of correct answers) compared to the pre-test results (67.33% ± 5.94% of correct answers) P < .05. Analysis of variance revealed that this change in score was not significantly different between the four groups. The students perceived the endodontic-themed escape game to be relevant. A one-sample t test indicated that students' mean (SD) perception 4.4 (0.7) was statistically significantly higher than the mean value of the evaluation scale P < .001. The students found this educational game to be a useful experience that helped them recall/apply knowledge whilst promoting teamwork.

Conclusion: Therefore, this type of game can enhance students' learning and motivation.
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http://dx.doi.org/10.1111/eje.12521DOI Listing
August 2020

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

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

Centre Hospitalier Universitaire de Nantes, France.

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

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

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

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

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

Postimplantation radiation therapy in head and neck cancer patients: Literature review.

Head Neck 2020 04 3;42(4):794-802. Epub 2020 Jan 3.

Laboratoire des sarcomes osseux et remodelage des tissus calcifiés, Unité Mixte de Recherche, Faculté de Médecine, 1 rue Gaston Veil, Nantes Cedex, France.

There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This systematic review focused on the literature about the outcomes of implants placed during ablative surgery in patients with HNC who underwent postoperative RT. Implants placed after radiation therapy and implants placed in reconstructed jaws were excluded. Four comparative studies involving 755 native mandible primary implants were analyzed. The survival rate with postimplantation RT was 89.6% vs 98.6% in patients with no additional radiation. The overall success of implant-retained overdenture in patients with RT performed postimplantation was 67.4% vs 93.1% in patients with implant surgery that was carried out 1 year after the completion of radiation therapy. Only five cases of osteoradionecrosis (ORN) of the jaw were reported. The outcomes for implant survival rates appear to be positive for irradiated implants.
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http://dx.doi.org/10.1002/hed.26065DOI Listing
April 2020

Regenerative Effect of Platelet Concentrates in Oral and Craniofacial Regeneration.

Front Cardiovasc Med 2019 3;6:126. Epub 2019 Sep 3.

Faculty of Dentistry, McGill University, Montreal, QC, Canada.

Platelet concentrates (PCs) are biological autologous products derived from the patient's whole blood and consist mainly of supraphysiologic concentration of platelets and growth factors (GFs). These GFs have anti-inflammatory and healing enhancing properties. Overall, PCs seem to enhance bone and soft tissue healing in alveolar ridge augmentation, periodontal surgery, socket preservation, implant surgery, endodontic regeneration, sinus augmentation, bisphosphonate related osteonecrosis of the jaw (BRONJ), osteoradionecrosis, closure of oroantral communication (OAC), and oral ulcers. On the other hand, no effect was reported for gingival recession and guided tissue regeneration (GTR) procedures. Also, PCs could reduce pain and inflammatory complications in temporomandibular disorders (TMDs), oral ulcers, and extraction sockets. However, these effects have been clinically inconsistent across the literature. Differences in study designs and types of PCs used with variable concentration of platelets, GFs, and leucocytes, as well as different application forms and techniques could explain these contradictory results. This study aims to review the clinical applications of PCs in oral and craniofacial tissue regeneration and the role of their molecular components in tissue healing.
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http://dx.doi.org/10.3389/fcvm.2019.00126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733887PMC
September 2019

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Delivery systems of local anesthetics in bone surgery: are they efficient and safe?

Drug Discov Today 2018 11 26;23(11):1897-1903. Epub 2018 Jun 26.

CEISAM, CNRS UMR 6230, University of Nantes, Nantes, France; Faculty of Pharmaceutical Sciences, University of Nantes, Nantes, France. Electronic address:

Management of postoperative pain following bone surgery includes administration of local anesthetics (LAs). Smart delivery systems, including triggered systems, have been designed to provide a continuous release of LA in situ. However, these systems can provide a high level of LA locally. This review will examine the state-of-the-art regarding the LA delivery systems optimized for management of postoperative pain in bone surgery and will discuss the potential adverse effects of LAs on the overall pathways of bone healing, including the inflammation response phase, hemostasis phase, tissue repair phase and remodeling phase. There is a clinical need to document these effects and the potential impacts on the clinical outcome of the patient.
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http://dx.doi.org/10.1016/j.drudis.2018.06.019DOI Listing
November 2018

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

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

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

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

Strategies for Optimizing the Soft Tissue Seal around Osseointegrated Implants.

Adv Healthc Mater 2017 Oct 27;6(20). Epub 2017 Sep 27.

Division of Biomedical Sciences, Faculty of Dentistry, McGill University, Montreal, H3A 1G1 QC, Canada.

Percutaneous and permucosal devices such as catheters, infusion pumps, orthopedic, and dental implants are commonly used in medical treatments. However, these useful devices breach the soft tissue barrier that protects the body from the outer environment, and thus increase bacterial infections resulting in morbidity and mortality. Such associated infections can be prevented if these devices are effectively integrated with the surrounding soft tissue, and thus creating a strong seal from the surrounding environment. However, so far, there are no percutaneous/permucosal medical devices able to prevent infection by achieving strong integration at the soft tissue-device interface. This review gives an insight into the current status of research into soft tissue-implant interface and the challenges associated with these interfaces. Biological soft/hard tissue interfaces may provide insights toward engineering better soft tissue interfaces around percutaneous devices. In this review, focus is put on the history and current findings as well as recent progress of the strategies aiming to develop a strong soft tissue seal around osseointegrated implants, such as orthopedic and dental implants.
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http://dx.doi.org/10.1002/adhm.201700549DOI Listing
October 2017

Platelet concentrates for bone regeneration: Current evidence and future challenges.

Platelets 2018 Mar 26;29(2):105-112. Epub 2017 Jun 26.

b Division of Biomedical Sciences, Faculty of Dentistry , McGill University , Montreal , QC , Canada.

Activated platelet concentrates are autologous blood preparations containing supraphysiological concentration of platelets. Platelet concentrates are commonly used for bone regeneration purposes based on the fact that growth factors released from activated platelets alpha granules have osteoinductive effects on bone cells. Although most preclinical and clinical studies show that platelet concentrates improve the outcomes of bone regeneration procedures, some studies reported conflicting results and even negative effects on bone healing. Several confounding parameters have been suggested as possible reasons for such inconsistencies (i.e. preparation and activation methods). However, heterogeneity in clinical studies makes drawing evidence-based conclusions difficult. On the other hand, recent findings show that the constituents of platelets dense granules (i.e. serotonin, ATP, Ca) have potential inhibitory effects on bone metabolism. Accordingly, we suggest that a partial explanation for the conflicting results could be the potential negative effects that dense granules may have on bone healing.
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http://dx.doi.org/10.1080/09537104.2017.1327656DOI Listing
March 2018

Extracellular Matrices for Bone Regeneration: A Literature Review.

Tissue Eng Part A 2017 12 12;23(23-24):1436-1451. Epub 2017 Jul 12.

1 Faculty of Dentistry, McGill University , Montreal, Canada .

The gold standard material for bone regeneration is still autologous bone, a mesenchymal tissue that consists mainly of extracellular matrix (ECM) (90% v/v) and little cellular content (10% v/v). However, the fact that decellularized allogenic bone grafts often present a clinical performance comparable to autologous bone grafts demonstrates the crucial role of ECM in bone regeneration. For long, the mechanism by which bone allografts function was not clear, but recent research has unveiled many unique characteristics of ECM that seem to play a key role in tissue regeneration. This is further confirmed by the fact that synthetic biomaterials with composition and properties resembling bone ECM present excellent bone regeneration properties. In this context, ECM molecules such as glycosaminoglycans (GAGs) and self-assembly peptides (SAPs) can improve the performance of bone regeneration biomaterials. Moreover, decellularized ECM derived either from native tissues such as bone, cartilage, skin, and tooth germs or from cells such as osteoblasts, chondrocytes, and stem cells has shown promising results in bone regeneration applications. Understanding the role of ECM in bone regeneration is crucial for the development of the next generation of biomaterials for bone tissue engineering. In this sense, this review addresses the state-of-the-art on this subject matter.
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http://dx.doi.org/10.1089/ten.TEA.2017.0026DOI Listing
December 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clinical management of an atypical dental invagination.

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

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

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

Relationship between removable prosthesis and some systemics disorders.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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