Medicine and Health Sciences Commons^™

Cone Beam Computed Tomographic Analysis Of Outcomes In Ridge Augmentation Using Titanium Mesh And Titanium Reinforced Ptfe Membranes, Lina Elnakka

Theses and Dissertations

Objective: The primary goal of this study is to evaluate and compare the average vertical and horizontal bone gain between titanium reinforced polytetrafluoroethylene (Ti-PTFE) and titanium mesh (Ti-mesh) using superimposition of preoperative and postoperative (CBCT). The secondary goal is to evaluate and compare the surgical outcomes between the two techniques.

Methods: A retrospective chart review was completed to assess the clinical and radiographic outcomes of patients who underwent ridge augmentation therapy using either Ti-PTFE or Ti-mesh. Preoperative and postoperative CBCT scans were superimposed using InVivo 3D imaging software. Vertical component of the augmented site (L1) was assessed along a vertical …

The Effect Of Er:Yag, Nd:Yag And Co2 Laser Combined With Hydrogen Peroxide, Sodium Hypochlorite, Chlorohexidine Or Fluoride On Reducing Oral Bacterial Count Implicated In Root Caries, Nitya Reddy

Theses and Dissertations

Purpose: Lasers have been used for treatment of dentinal hypersensitivity and for various bacterial reduction indications in periodontology. Their effectiveness in killing oral bacteria is not well known. The compounding effect of the combination of a laser treatment and adjunct antimicrobial agent use on bacterial viability is still evolving. The purpose of this in vitro study was to evaluate the effect of three lasers commonly used in dentistry in conjunction with chlorhexidine (CHX), hydrogen peroxide (H₂O₂), sodium hypochlorite (NaOCl), or sodium fluoride (NaF) on viability of oral bacteria associated with root caries.

Methods: Three …

Exploring Dynamic Navigation For Palatally Impacted Canine Uncovery Surgery., Daniel Joseph Hall

Theses and Dissertations

Purpose: The objective of this study was to compare the exposure/uncovery of palatally impacted canines via the use of dynamic navigation guidance to the traditional freehand approach. Outcomes evaluated include the time to plan and perform exposure, area/size of initial access to locate the impacted tooth and the final size of the osteotomy to completely uncover the impacted tooth.

Methods: In order to simulate various frequently encountered clinical scenarios, three different model types were used. Six plastic models of each model type were fabricated from epoxy resin. Each model contained 2 bilaterally, palatally impacted canines, that were randomly embedded in …

Peri-Implantitis Incidence And Effect Of Supportive Periodontal Therapy On Outcomes: Retrospective Cohort Study, Michael Ha

Theses and Dissertations

Purpose: Management of peri-implantitis is becoming an increasing component of dental practice. Dental implants can develop peri-implantitis lesions which occur in a non‐linear and accelerating pattern compared to a gradual periodontitis lesion. It is crucial to diagnose and treat this disease early, or ideally prevent it. Contemporary implants have a rough surface texture which is difficult to properly decontaminate as a crucial component for treatment prognosis. Evidence on the long-term effects of Periodontal implant maintenance therapy (PIMT) on implants is limited. This study aims to investigate the effect of periodontal maintenance on peri-implant tissue health.

Methods: A retrospective chart review …

Amixicile, A Novel Antimicrobial Agent, And Its Effect On The Salivary And Subgingival Microbiome In Rhesus Macaque Monkeys, Erin E. Block

Theses and Dissertations

Background/Purpose: Periodontitis is an inflammatory disease with a bacterial etiology in a susceptible host. A selective antibiotic with minimal systemic side effects could be a useful adjunct to traditional periodontal therapy. Amixicile is a novel antimicrobial agent that targets pyruvate: ferredoxin oxidoreductase (PFOR), an enzyme that is critical for anaerobic bacterial metabolism and has been found to have little-to-no side-effects in animal models. The aim of this study was to prospectively evaluate the effect of amixicile on clinical periodontal parameters and the composition of the oral microbiome in rhesus macaque monkeys. It was hypothesized that the amixicile would reduce growth …

Antibiotic-Loaded Dendrimer Hydrogels In Periodontal Bone Regeneration: A Feasibility Study, Nicholas G. Yesbeck

Theses and Dissertations

Purpose: Prescription of a complete course of oral antibiotics following bone grafting procedures is a common clinical practice in surgical periodontics. Prophylactic administration of antibiotics reduces the risk of surgical site infection and systemic administration is preferred over local delivery because of short duration of action in the latter circumstance. The goal of this study is to demonstrate the ability of dendrimer hydrogels (DH) to prolong the release kinetics of antibiotics in-vitro. A secondary goal will be to analyze the effect of different particulate bone allografts on the release kinetics of the antibiotic.

Methods: Dendrimer hydrogels (DH) were synthesized …

The Effects Of Exosomes On The Regeneration Of Rat Calvaria, Jill T. Beitz

Theses and Dissertations

Periodontal disease is a bacterial induced chronic inflammatory condition that occurs in a susceptible host, affecting the teeth, gingiva, periodontal ligament, and alveolar bone. The resultant pathological bone defects often require surgical intervention, with the ultimate goal being regeneration of the periodontium through the application of grafting materials and biologics. Mesenchymal stem cells (MSCs) show great potential in regenerative medicine for their ability to enhance cell proliferation and differentiation, increase angiogenesis, and modulate the immune response. Stem cell-derived by-products, known as exosomes are a specific class of lipid-membrane-bound extracellular vesicles that are proliferative and chemotactic, are able to inhibit cytokine …

Characteristics Of Alveolar Bone Marrow Cells From Patients Undergoing Dental Extractions Or Dental Implant Therapy, Meng H. Lee

Theses and Dissertations

Alveolar bone marrow stromal cells (aBMSCs) play important roles in craniofacial wound healing. To establish an easy, efficient and reliable method to harvest aBMSCs, we compared three different methods: extraction socket aspiration, osteotomy aspiration and bone core digestion. Samples of aBMSC were collected from two groups of subjects. Group 1 (dental extraction): after dental extraction, 22.5-gauge needles were used to collect 0.5-1cc marrow aspirate. Group 2 (dental implant): during implant surgeries, bone core and 0.5-1cc marrow aspirate were obtained from the osteotomy. Samples were cultured in petri dishes and attached cells were expanded. The population doubling time (PDT), surface markers, …

Amixicile As A Novel Antimicrobial Treatment For Periodontitis: A Pilot Study In The Non-Human Primate, Macaca Mulatta, Denver J. Lyons

Theses and Dissertations

Periodontitis is an inflammatory disease with a bacterial etiology in a susceptible host. Given the bacterial etiology, a selective antimicrobial agent with minimal side effects could be a useful adjunct to traditional therapy. Amixicile is a novel antimicrobial that targets the pyruvate: ferredoxin oxidoreductase (PFOR) which is an enzyme that is critical for anaerobic bacterial metabolism. It has been found to have no effect on commensal, aerobic microbes and has little to no side-effects thus far in animal models. In this study, two nonhuman primates of the Macaca mulatta species with naturally occurring mild chronic periodontitis were studied before and …

Directing Mesenchymal Stem Cells For Periodontal Regeneration, Charles Stoianovici

Theses and Dissertations

Background: Directing autogenous Mesenchymal Stem Cell (MSC) to defect sites has a great promise in bone regeneration. We designed a MSC specific, bone affinity peptide (E7HA7) by conjugating E7 with a polyglutamate hydroxyapatite (HA) binding motif. We sought to characterize the in-vivo releasing pattern and bioactivity of E7HA7. Methods: HA discs were coated with fluorescent labeled peptides E7HA7, E7HA2 or E7 were subcutaneously implanted in Sprague Dawley rats. In an ectopic bone formation model was used to test the in-vivo bioactivity of E7HA7 conjugated to DBM. Results: E7HA7 showed slower peptide release from scaffolds in comparison to other groups, being …

The Effects Of Amixicile On Sub-Gingival Biofilm Cultured From Humans, Kian Azarnoush

Theses and Dissertations

Periodontitis is an inflammatory disease of the oral cavity induced by anaerobic bacteria, that remains to be the primary cause of tooth loss in adults worldwide. Finding an anti-microbial therapeutic to selectively target periodontal pathogens has proven to be difficult, and current treatment modalities only provide a transient benefit. Amixicile is a non-toxic, readily bioavailable novel antimicrobial that targets strict anaerobes through inhibition of the activity of Pyruvate Ferredoxin Oxidoreductase (PFOR), a major enzyme mediating oxidative decarboxylation of pyruvate, a critical step in metabolism. Our study aimed to evaluate the efficacy of amixicile in inhibiting the growth of bacteria harvested …

The Periodontal Specialty: A Survey Regarding Our Future, John H. White

Theses and Dissertations

Purpose: To determine the characteristics influencing periodontal practices in Virginia and report on the anticipated changes in practice.

Methods: A REDCap survey was emailed to Virginia based American Academy of Periodontology (AAP) members assessing personal and practice demographics, trends in dental treatment and practice models, and how periodontists will adjust to account for these trends.

Results: The response rate was 31% (n=46). Respondents report greater referrals from more experienced general practitioners (GPs). Student debt was associated with age. Respondents ranked biologic advances, treatment of peri-implantitis, digital dentistry, development of corporate and group practice models, and GPs incorporating more periodontal …

The Effect Of Biologic Materials And Oral Steroids On Radiographic And Clinical Outcomes Of Horizontal Alveolar Ridge Augmentation., Amy Reichert

Theses and Dissertations

The purpose of this study was to investigate if the addition of biologic materials and/or oral steroids would affect horizontal bone gain, or the bone density of the grafted bone in horizontal alveolar ridge augmentations. A retrospective chart review was completed to assess the clinical and radiographic outcomes of 53 ridge augmentation patients. An average bone gain of 3.6mm of width was found in our study based on radiographic analysis. There were no statistically significant differences found in the linear bone gain with the addition of biologic materials and steroids. A marginally statistically significant difference was found in the bone …

Trna Profiling Of Mesenchymal Stem Cell Exosome, Khin Mimi San

Theses and Dissertations

Background: Exosomes have great potential in regenerative medicine through the

transfer of their bioactive cargos, such as RNA. tRF RNA and tiRNA are tRNAderived

non-coding RNA. Here, we sought to identify the tRF/tiRNA profile in human

mesenchymal stem cell (hMSC) exosomes. Methods: Bone marrow hMSCs were

cultured with/without osteogenic differentiation medium and exosomes were

harvested. RNA was extracted from: 1) control cells (Cell-NT); 2) control exosomes

(EXO-NT); 3) differentiated cells (Cell-OM); 4) exosomes produced by differentiated

cells (EXO-OM). RNA was sequenced to profile the small RNA with a focus on

tRF/tiRNA. Results: tRF/tiRNA was highly enriched in hMSC exosomes. Less …

Profiling Precursor Lipids For Specialized Pro-Resolution Molecules In Platelet-Rich Fibrin Following Fish Oil And Aspirin Intake, Danielle M. Mccormack

Theses and Dissertations

Background: Current research has demonstrated that aspirin and fish oil (EFA) increase plasma levels of specialized pro-resolution molecules (SPMs). This study investigates their effects on SPM precursor pools in platelet rich fibrin (PRF). Methods: Twenty healthy volunteers were randomly assigned to take aspirin; EFA or aspirin and EFA. Four hours later, SPM precursor levels were quantified using combined Liquid Chromatography tandem mass spectrometry. The differences between the groups: Aspirin (yes or no), EFA (yes or no), were analyzed by ANCOVA, testing for group differences after covarying out the baseline value. Results: There were 4 significant interactions, 1 with an aspirin …

Amixicile Inhibits Anaerobic Bacteria Within An Oral Microbiome Derived From Patients With Chronic Periodontitis, Kane Ramsey

Theses and Dissertations

Periodontitis is a chronic inflammatory disease caused by pathogenic bacteria residing in a complex biofilm within a susceptible host. Amixicile is a non-toxic, readily bioavailable novel antimicrobial that targets strict anaerobes through inhibition of the activity of Pyruvate Ferredoxin Oxidoreductase (PFOR), a major enzyme mediating oxidative decarboxylation of pyruvate. Our study aimed to evaluate the efficacy of amixicile, when compared to metronidazole, in inhibiting the growth of bacteria present in a microbiome harvested from patients with chronic periodontitis.

Plaque samples were harvested from patients with severe chronic periodontitis and cultured under anaerobic conditions. The microbiomes were grown in the presence …

The Role Of Human Msc Derived Exosomes In The Treatment Of Periodontal Diseases, Sonia S. Talegaonkar

Theses and Dissertations

Periodontal disease affects 47% of Americans over 30. Characterized by microbial dysbiosis and unregulated inflammation, severe periodontitis causes degradation of bone and soft tissue around teeth. Current treatments have limited regenerative outcomes and frequent reinfection by harmful bacteria. Human mesenchymal stem cells (hMSCs) have been shown to promote wound healing and tissue regeneration. Many therapeutic benefits of hMSCs are due to their secretome products, like exosomes. Our long-term goal is to develop periodontal therapies with hMSC exosomes. The objectives of this study were to determine the effect of hMSC-derived exosomes on cellular activity of hMSCs and investigate whether hMSC exosome …

Profiling Precursor Lipids For Specialized Pro-Resolution Molecules In Platelet-Rich Plasma Following Fish Oil And Aspirin Intake, Lisa A. Turner

Theses and Dissertations

Background: Unfavorable outcomes following periodontal surgeries can be attributed to impaired resolution mechanisms likely due to decreased levels of specialized pro-resolution molecules (SPM). The current study investigates if SPM substrate pools in platelet-rich plasma preparations (PRP) can be increased by essential fatty acid (EFA) and / or aspirin supplementation. Methods: Nineteen healthy volunteers were randomly assigned to take i) aspirin; ii) EFA; iii) aspirin and EFA. Four hours after intake, the lipid precursor pools in PRP were quantified using combined Liquid Chromatography tandem mass spectrometry (LC-MS/MS) and the data statistically analyzed using ANCOVA. Results: Of the 77 metabolites screened, only …

Trabecular Bone Microarchitecture In Association With Systemic And Local Factors As Potential Predictors Of Implant Failure, Diego A. Camacho Dmd

Theses and Dissertations

Clinicians have described the success rates of dental implants. The use of implants is projected to increase in the future. With a 5-10% failure rate, it is unclear the exact factors that are associated with implant failures. To improve upon these success rates, it is critical to understand parameters associated with implant failure including: periodontitis, peri-implantitis, systemic diseases, site preparation, dental history of the implant site, bone quality, materials, occlusion, and treatment timelines. While bone quality is associated with failure, objective measures to assess bone quality and characteristics are scarce. Therefore, the aim of this study is to determine whether …

The Role Of Leukocyte-Platelet Rich Fibrin In Human Alveolar Ridge Preservation: A Randomized Clinical Trial, Thomas F. Glazier, Thomas C. Waldrop, John C. Gunsolley, Robert Sabatini

Theses and Dissertations

PURPOSE: The aim of this study is to examine the healing of intact extraction sockets grafted with leukocyte-platelet rich fibrin (L-PRF) as compared to sockets grafted with freeze-dried bone allograft (FDBA) and a resorbable collagen barrier membrane (RCM).

METHODS: This prospective randomized, examiner blinded pilot study included 17 subjects randomized to two treatment groups. Serum total cholesterol, low density lipoprotein (LDL), 25-hydroxyvitamin-D₃, and platelet counts were determined preoperatively in all subjects. The experimental arm consisted of 8 posterior tooth-bounded intact extraction sites receiving L-PRF plugs. The control group consisted of 9 posterior tooth-bounded intact extraction sites receiving FDBA …

Peracetic Acid: A Practical Agent For Sterilizing Heat-Labile Polymeric Tissue-Engineering Scaffolds, William R. Trahan

Theses and Dissertations

Advanced biomaterials and sophisticated processing technologies aim to fabricate tissue-engineering scaffolds that can predictably interact within a biological environment at a cellular level. Sterilization of such scaffolds is at the core of patient safety and is an important regulatory issue that needs to be addressed prior to clinical translation. In addition, it is crucial that meticulously engineered micro- and nano- structures are preserved after sterilization. Conventional sterilization methods involving heat, steam and radiation are not compatible with engineered polymeric systems because of scaffold degradation and loss of architecture. Using electrospun scaffolds made from polycaprolactone (PCL), a low melting polymer, and …

Characterization Of Leukocyte-Platelet Rich Fibrin, A Novel Biomaterial, Fadi K. Hasan

Theses and Dissertations

Autologous platelet concentrates represent promising innovative tools in the field of regenerative medicine and are successfully used in oral surgery. Several commercial systems exist that generate various forms of platelet concentrates including Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF). The alpha- granules of entrapped platelets release a variety of peptide growth factors that promotes healing. Usually PRP is a suspension that can be injected into the site of injury or used as a gel with the addition of thrombin (PRP-gel). In contrast Choukroun’s L-PRF is a dense fibrin based biomaterial enriched with platelets and growth factors. The physical state of …

Factors Affecting Gingival Excess, Altered Passive Eruption And Recession In The Mandibular Anterior And Premolar Sites, William Bohlen

Theses and Dissertations

Abstract FACTORS AFFECTING GINGIVAL EXCESS, ALTERED PASSIVE ERUPTION AND RECESSION IN THE MANDIBULAR ANTERIOR AND PREMOLAR SITES By William F Bohlen, D.M.D. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Major Director: Thomas Waldrop, DDS, MS Program director, Department of Periodontics, Virginia Commonwealth University AIM: The aim of this study was to determine the factors affecting gingival excess, altered passive eruption and recession. METHODS: 100 subjects were examined clinically and models of their mandible were fabricated. Demographic, periodontal and cast measurements were …

The Prevalence Of Maxillary Altered Passive Eruption In A Dental School Population., Francisco Carlos

Theses and Dissertations

AIM: The aim of this investigation is to determine the prevalence of maxillary altered passive eruption in a dental school population. METHODS: 100 subjects were examined clinically and had models fabricated of their maxilla. Demographic, periodontal, cast measurements were recorded for each subject. Demographic variables recorded included age, gender, and ethnicity, history of orthodontic treatment, presence of incisal /occlusal wear, appearance of gingival excess, and presence of gingival asymmetry. Measurements made on cast included clinical crown length, clinical crown width, papillary height, and distance from the lateral gingival zenith to the gingival aesthetic line. Clinical crown width-to-length ratio was calculated. …

Heritability Of Autoantibody Levels In A Twin Population, Amal Rastogi

Theses and Dissertations

AIM: This study aims to determine what portion of specific autoantibody phenotypes are genetically determined by using a twin model. METHODS: This study specifically examines Anti-Ro(SSA), Anti-La (SSB), Anti-Sn/RNP, Anti-Sm, Anti-Jo-1, Anti-Scl-70, Anti-Tg & Anti-TPO, Anti-dsDNA, Anti-PS, and Anti-cardiolipin antibodies for their heritability. This study examined 104 same-sex adult twins (66 monozygous, 38 dizygous) for the above mentioned autoantibody values. The serum autoantibody values in each subject were quantified using automated ELISA. Descriptive statistics including, distributions, quantiles, and moments were calculated by zygosity for continuous antibody values, subject ages, gender, race and smoking status. Categorical antibody levels were used to …

The Effect Of Single Nucleotide Polymorphisms (Snps) In Toll-Like Receptors -2, -4, -9, And Cd14 Genes In An African-American Population With Chronic Periodontitis, Willard Maughan

Theses and Dissertations

AIM: to determine if a relationship exists between TLR-2, TLR-4, TLR-9, or CD14 polymorphisms and risk for developing chronic periodontal disease in an African-American population. This is the first study conducted to determine role of SNPs in TLR genes and CD14 gene in a periodontally-diseased African-American population. Additionally, this is the first study to assess the role of TLR-9 polymorphism in periodontitis patients. METHODS: A total of 130 subjects were involved in the study. The chronic periodontitis (CP) group contained 73 subjects, and the healthy control (NP) group 57subjects. Genotyping was performed in TLR2 (G2408A), TLR4 (A896G),TLR9 (T1486C) and CD14 …

Frequency Of Tlr-2, 4, 9 And Cd14 Polymorphisms In Aggressive Periodontitis Population In African-Americans, Melanie Chou

Theses and Dissertations

Aim: The aim of this study is to determine the frequency of single nucleotide polymorphisms (SNPs) in various pattern recognition receptor (PRR) genes, including Toll like receptors (TLR) -2, -4, -9, and CD14 in chronic (CP), localized (LAP) and generalized aggressive (GAP) periodontitis and periodontally healthy (NP) patients in an African American population. Methods: A total of 205 subjects were involved in the study. The LAP group consists of 25 subjects, the GAP group 50 subjects, the CP group 73 subjects and the NP group 57subjects. Genotyping was performed in TLR2 (G2408A), TLR4 (A896G),TLR9 (T1486C) and CD14 (C260T) genes by …

The Prevalence Of The Need For Esthetic Crown Lengthening In Post Orthodontically Treated Subjects, Bryan Marc Konikoff

Theses and Dissertations

Prevalence information on excessive gingival display in post-orthodontic patients is limited. By studying one aspect, namely the size relationship of the clinical crowns of teeth, in an orthodontic population, we can begin to quantify their need for periodontal plastic surgery. In this two part study, 200 plaster models were used as subjects, followed by a clinical exam of 31 of those subjects. These models represented patients before and directly after orthodontic therapy, and the Part 2 clinical exams were performed at least five years later. The lengths and widths of the six anterior teeth were measured and these values were …

Serum Anti-Phosphorylcholine And Anti-Cardiolipin Concentrations Following Periodontal Scaling And Root Planing, Reve W. Chaston

Theses and Dissertations

Atherosclerosis is an insidious disease with serious morbidity and mortality including ischemic heart disease, stroke, and myocardial infarction. This condition is progressive and can start early in life eventually leading to large plaques and arterial occlusion. Two key components of this process are the immune system and lipids; in particular, LDL which accumulates within the arterial walls and macrophages which recognize and engulf oxidized-LDL (oxLDL) to form foam cells. Knowing that certain antibodies directed against bacterial antigens such as phosphorylcholine (PC) and cardiolipin (CL) show opsonizing cross-reactivity with oxLDL it can be proposed that there is a link between immune …

Demographic Variables Affecting Patient Referrals From General Practice Dentists To Periodontists, Mark Roy Zemanovich

Theses and Dissertations

BackgroundWithin dentistry, a limited body of literature exists regarding the referral relationships between general practitioners (GPs) and specialists. The purpose of this study was to investigate the referral relationship between GPs and periodontists within the state of Virginia. MethodsA survey focused on the demographic variables in the referral relationship between GPs and periodontists was developed. The survey was mailed to 800 dentists throughout the state of Virginia. Descriptive statistics was completed along with multivariate logistic regression analysis comparing the responses with the number of patients referred per month to a periodontist. ResultsFemale respondents were more likely to refer three or …