• Antioxidants in periodontitis: A systematic review

      Blasi Beriain, Gonzalo; Aichelmann-Reidy, Mary Beth (2016)
      The involvement of reactive oxygen species in periodontal disease is still not clear but it will possibly be modulated by antioxidants defense. There is some evidence of reduced antioxidant defense in periodontitis. The goal of this review is to determine local antioxidant capacity in gingival crevicular fluid as seen in periodontal disease and in health. A comprehensive literature search through January 2016 was performed using Ovid Medline, Scopus and Cochrane Library for all literature related to antioxidant markers in gingival crevicular fluid in health and disease in humans. Seventeen articles satisfied the inclusion and exclusion criteria. Four antioxidants including, total antioxidant capacity (TAOC), superoxide dismutase (SOD), melatonin, and lactoferrin, were significantly reduced in periodontitis when compared to healthy controls. In conclusion, our findings suggest that TAOC, SOD and melatonin are quantitatively higher in healthy gingiva than diseased and appear to reflect increased oxygen radical activity during periodontal inflammation. In contrast lactoferrin levels increase in periodontal disease GCF.
    • Comparison of Enamel Matrix Derivative Alone or in Combination with Bone Replacement Graft Materials in the Treatment of Intrabony Defects: A Systematic Review

      Soleymanzadeh, Ahad; Aichelmann-Reidy, Mary Beth (2015)
      The ultimate goal of any periodontal therapy is to regenerate all lost tissues of the periodontium: bone, cementum and periodontal ligament. The purpose of this systematic review was to compare the outcome when BRG was combined with EMD vs. EMD alone for the treatment of periodontal intrabony defects. A comprehensive literature search through February 11, 2015 was performed using Medline and EMBASE for all literature related to intrabony defects treatment using EMD with and without bone graft. Either EMD or combination of EMD with BG resulted in improved clinical outcomes. In conclusion, most studies report differences for gingival recession with the addition of bone graft but this trend was not statistically significant. Bone fill, as measured at reentry, was the only variable yielding more favorable outcome with the combined approach. Mean defect fill 2.36 ± 3.9 mm and 3.78 ± 0.7mm (p< 0.05) for EMD alone and combination therapy, respectively.
    • The Effect and Predictability of Root Surface Biomodification on Periodontal Surgical Outcomes

      Hawasli, Ahmad Hammami; Aichelmann-Reidy, Mary Beth (2015)
      Recent systematic reviews showed the use of root surface bio-modifiers provides no benefit of clinical significance to root coverage and chronic periodontitis treatments. The purpose of this systematic review is to determine whether chemical root surface biomodification improves the predictability of attaining positive clinical results following chronic periodontitis treatment or root coverage procedures. Material and Methods: The selected studies met the inclusion criteria. Mean change in clinical measurements and mean coefficient of variability for treatment outcomes were evaluated. Results: after reviewing 4996 articles, 19 articles were included in the study based on inclusion criteria. No significant differences were found between treatment groups for chemical root surface biomodification regardless of treatment type. Conclusion: The addition of chemical root surface biomodification to treatment of chronic periodontitis or root coverage procedures produced no significant change in mean clinical outcomes. Chemical root surface biomodification does not improve the predictability of periodontal surgical clinical outcomes.
    • The Effect of Non-Surgical Therapy on the Markers of Oxidative Stress in Patients with Chronic Periodontitis

      Akhtar, Sheema Shireen; Aichelmann-Reidy, Mary Beth (2016)
      Background and Purpose: Several investigators have analyzed the role of oxidative stress in the pathogenesis of periodontitis. Chronic inflammatory disease may be associated with an imbalance of increased markers of oxidative stress and reduced antioxidant defenses, which has been shown to return to normal levels with successful non-surgical therapy. This systematic review focused on all available evidence of the effect of non-surgical periodontal therapy on markers of localized oxidative stress in patients with periodontitis. Methods: An electronic search was conducted to identify all clinical trials that evaluated oxidative stress biomarkers in patients pre- and post-treatment with periodontitis and clinical parameters of the disease. Three reviewers conducted the search and verification of article selection. Eligibility criteria were applied to determine the final selection of publications for full text review. Bibliographies of relevant papers were searched for additional studies and a search of periodontal journals published in the last 3 years was performed to verify inclusion of all available clinical trials. Results: The initial search of three databases yielded 2,523 articles. The final selection consisted of 13 articles after removing those that did not include non-surgical therapy of periodontitis or markers of oxidative stress in systemically healthy patients. Change of oxidative stress markers (OSM) ranged from 0 to 81 percent. A statistically significant reduction of OSM was reported in 8 studies. 5 studies were used to calculate the unweighted percent change, which was 48.74%, and the weighted percent change, which was 57.83%. Conclusions: There is high variability in the OSM concentrations in periodontitis patients. OSM decreased following non-surgical therapy. More longitudinal, randomized clinical controlled trials of are required to understand the modulation of OSM following periodontal treatment.
    • The Effect of Vertical Implant Position in Relation to Interdental Crestal Bone Height of Adjacent Teeth on Implant Marginal Bone Loss: A Retrospective Radiographic Study

      Ji, Chao; Aichelmann-Reidy, Mary Beth (2017)
      The aim of the study was to investigate the effect of vertical implant position relative to the interdental bone of adjacent teeth on implant marginal bone loss. Electronic Health Records from 2011 to 2016 were screened for subjects with tooth bound single implants. Nobel Ti-Unite implants functionally loaded for over one year were included. The vertical distance from implant platform to interdental bone levels, relative to the adjacent tooth CEJ, and the marginal implant bone level were measured on the insertion and post- treatment radiographs. A total of 178 patients with 213 single implants were included. The overall implant survival rate was 99.1% over an average of 34.8 months follow-up. The mean vertical distance from implant platform to the interdental bone level was 1.28 ± 1.04 mm mesially and 0.83 ± 1.03 mm distally. The mesial platform was consistently deeper than the distal platform, with more bone loss at the mesial surface than the distal surface.
    • The Effects of Air Polishing Abrasives on the TiUnite® Implant Surface at Standardized Distance, Exposure Time, and Pressure Level: An in vitro Scanning Electron Microscopic Evaluation

      Metzger, Joshua Adam; Aichelmann-Reidy, Mary Beth (2014)
      Background: Air polishing abrasives are becoming increasingly popular as a part of the treatment for decontaminating implants with identified peri-implantitis. This study sought to evaluate via scanning electron microscopy (SEM) the effect of three commercially available air abrasive powders on the TiUnite® implant surface, at pre-determined standardized settings. Methods: 20 NobelReplace® Select implants were mounted on a custom jig which travelled uni-directionally at a constant speed. The implants passed across a fixed air polisher unit with the tip set 5mm from the implant surface. Each implant provided evaluation of one test abrasive (or control) which included three grooves of the TiUnite® surface, and was aligned with an orientation notch scored on the implant collar. The formulations of abrasives tested included sodium bicarbonate (EMS®, 60-70mm), glycine (EMS®, 60-70mm), and calcium carbonate (KaVo®, 65mm). For each test implant at 1000x magnification, an SEM image was captured at the center of each of the first three grooves of the TiUnite® surface for visual and statistical analyses. The characteristic micro-porosities of this particular roughened surface were identified and recorded within a standardized 100mm2 area, then subjected to statistical analysis (ANOVA) to determine significance between the abrasives on the surface. Results: It was found that both sodium bicarbonate (mean 145.1, SD 4.4) and calcium carbonate formulations (mean 20.0, SD 11.0) demonstrated significant reductions of identifiable micro-porosities and alteration of the anodized surface, when compared to the control group (mean 205.5, SD 2.2). The glycine abrasive powder, however, did not demonstrate a statistically significant difference (mean 199.3, SD 7.7) nor was there any notable alteration at magnifications up to 5000x. Conclusions: Sodium bicarbonate and calcium carbonate air abrasives formulations induce extensive irreversible surface effects when compared to glycine, which did not demonstrate a significant loss of the porous topography. Whether this alteration in surface topography is beneficial or facilitates equivalent biofilm removal that is compatible with re-osseointegration remains to be evaluated.
    • The Effects of Neodymium: Yttrium-Aluminum-Garnet Laser (Nd:YAG) On TiUnite® Surface at Set Distance and Energy Level in Different Ambient Environments: An in vitro Scanning Electron Microscopic Evaluation.

      Versteegh, Thu Mai; Aichelmann-Reidy, Mary Beth (2014)
      Background: Lasers are gradually being used more for the surface treatment of contaminated implants in cases of peri-implantitis. Surface effects were recently characterized to evaluate changes to implants in a dry environment, using a single pass of a Nd:YAG laser at a variety of energy densities. The clinical surface treatment of ailing implants is usually complicated by the presence of blood and saliva. The aim of this study was to evaluate via scanning electron microscopy (SEM) the effect of a single pass of a Nd:YAG laser on the TiUnite® implant at 10mm distance and at 3.0 W energy level in different environments (dry, saline, saliva, blood). Methods: A total of eight NobelReplace® TiUnite® Tapered implants were mounted on a jig and pulled at a constant speed across a Nd:YAG laser at an energy level of 3.0W and at a distance of 10mm. Each experimental group (dry, saline, saliva, blood) consisted of two implants. Each of these two implants per group was irradiated on three different surfaces, contributing six samples to each experimental group. Each irradiated surface contributed four threads to the analysis. ImageJ software was used to calculate the area of surface alteration for each thread. Results: It was found that all irradiated implants (wet or dry) had damage on the irradiated surfaces using Nd:YAG laser at the set distance and energy level. The surface alterations on the implants included charring, blackening, loss of surface roughness, flattening, cracking, and in severe cases melting and crater formation. After one-way ANOVA analysis of all experimental groups, there was a statistically significant difference in surface alterations amongst groups (dry or wet). Verified with Tukey HSD test, it was found that there was no statistical difference in surface alterations between the saline and saliva groups. Conclusions: The application of Nd:YAG laser on TiUnite® implants regardless of the ambient environments produced surface damage when observed under SEM with the least damage observed in saline and saliva. Based on this study, it is desirable to irrigate implant surfaces with saline while using Nd:YAG in order to minimize the surface alterations seen in a blood environment.
    • Evaluation of Periodontal Changes Adjacent to Extraction Sites Following Orthodontic Tooth Movement

      Courtney, Sarah; Aichelmann-Reidy, Mary Beth (2015)
      There is an intimate relationship between orthodontic therapy and the periodontal changes that occur during tooth movement. Orthodontic therapy often includes premolar extractions to accomplish an ideal occlusion. The purpose of this study was to evaluate the impact on the periodontium of tooth movement through an extraction site. Subjects requiring premolar extraction prior to orthodontic tooth movement were selected. Periodontal clinical parameters and hard tissue measurements were completed. Pre- and post- treatment measurements were subject to paired t-test and multivariate analysis of variance. In the results, probing depth, recession and CAL were similar pre- and post-treatment. Pre and post treatment recession differences were noted between Asian, Hispanic and African American subjects. Overall, the findings support limited soft tissue changes following tooth movement into an extraction site. Soft tissue changes following tooth movement into an extraction site appear not detrimental to the periodontal tissues.
    • The Impact of Gender on Dental Implant Stability assessed using Resonance Frequency: A Systematic Review

      Matthews, Marissa; Aichelmann-Reidy, Mary Beth (2014)
      Resonance Frequency Analysis (RFA) is a non-invasive surrogate method of measuring implant stability and measuring changes in the bone implant interface over time. Factors that can influence this value include bone density, preparation of the osteotomy, the length and diameter of the implant, and design of the implant. There are inherent gender differences in bone density, particularly with respect to post-menopausal women. The purpose of this systematic review was to determine if there was a difference in RFA value based on patient gender. A comprehensive literature search up to March 15, 2014 was performed using Medline and Embase for all literature related to implant stability as measured by RFA in humans. Inclusion criteria consisted of controlled studies including healthy men and women, RFA value at the time of placement, and the mean and standard deviation separately for gender. Exclusion criteria excluded studies where implants were not placed in alveolar bone, and studies where implants were placed in conjunction with sinus lifts, biologics, or grafting. A comprehensive search yielded 2712 articles; 2591 articles failed to meet the inclusion criteria, and of the remaining 131, 117 were excluded based on a lack of data with regard to gender, leaving 14 articles for review and 7 for meta-analysis. The meta-analysis showed no significant difference in RFA value with respect to gender. These results must be interpreted with caution, given the limited available data. Two studies reported females having higher RFA values than males, although one study reported more mandibular implants were placed in women than men. Research stratified by age is necessary to determine whether age-related changes in bone density are related to RFA values. Such an association would necessitate changes in recommendations for ISQ stability values based on age and gender.
    • Maxillary Sinus Morphology: A Radiographic Retrospective Evaluation of Sinus Septa in Caucasian and African-American Subjects

      Van-Dinh, Kim-Thi; Reynolds, Mark A., D.D.S., Ph.D.; Aichelmann-Reidy, Mary Beth (2012)
      Anatomic variations of maxillary sinus morphology including volume and septa impact the success of sinus augmentation procedures for dental implant placement. Anatomy has been investigated mainly with respect to age and gender; however, the effect of race has not been examined. The purpose of this study was to evaluate variations of maxillary septa sinus anatomy of African-American and Caucasian subjects, given differences significantly impact treatment success. This retrospective study examined consecutive computerized tomographic scans (CT) of patients scheduled for maxillary implant surgery at the University of Maryland School of Dentistry between 2009 to 2011. A total of 259 CT scans of 139 African-American and 120 Caucasian subjects were evaluated, of which, 62.5% of subjects (162/259) had identifiable septa. A total of 343 septa were identified in 518 sinuses (66.2%). Caucasians had more septa than African-Americans (1.56 compared to 1.09, p=0.006). The effect of gender was approaching significance (p=0.07). The adjusted mean number of sinus septa in female subjects was 1.48 compared to 1.17 in males. Sinuses were divided into three sections: anterior (premolars), middle (first and second molars), and posterior (third molar). In both the anterior and middle sections, race had a significant effect (p=0.033 and p=0.035). In the anterior, the adjusted mean number of septa for Caucasians was nearly twice that of African-Americans (0.32 compared to 0.17). In the middle section, the adjusted mean for African-Americans was 0.57 compared to 0.79. With respect to the posterior section, only gender had a significant effect (p=0.008). Women had an adjusted average of 0.51 septa compared to men with a 0.29 average. The majority of septa were found in the middle segment (51.3%, 176/343), and 17.5% (60/343) were identified in the anterior segment. Sinus septa complicate Schneiderian membrane elevation therefore increasing likelihood of membrane perforation, a common complication of sinus augmentation procedures. The dentally relevant sinus segments contain the majority of sinus septa (68.8%) and have a direct impact on clinicians performing sinus augmentation procedures. Both race and gender impact maxillary implant treatment planning with a greater frequency of detectable septa in Caucasians and females when compared to African-American males.
    • Retrospective Analysis of the Impact of Diabetes on Implant Success

      Achille Schmick, Kara; Aichelmann-Reidy, Mary Beth (2017)
      Purpose: The aim of this retrospective study is to investigate implant success and bone loss in diabetic patients when compared to non-diabetic patients at the University of Maryland School of Dentistry. Materials and Methods: The electronic health record database and radiographs were reviewed for diabetic and non-diabetic patients receiving implants between 2011 and 2016. One or two implants per patient were selected. Results: 62 diabetic patients and 70 non-diabetic patients were included in the study to make up a sample of 203 NobelBiocare implants. Patient age, gender, medical history, dental history, and implant history were recorded. Conclusions: Diabetics exhibited significantly greater thread exposure than non-diabetics, controlling for patient age, smoking status, and months from implant placement. Smokers exhibited significantly greater thread exposure than nonsmokers, controlling for patient age, diabetic status, and months from implant placement.