Emerging Therapeutic Strategies and Future Challenges in Clinical Periodontics.

Currently, the protocol for treating periodontitis follows a standardized and straightforward algorithm: 1) review and reinforce oral hygiene; 2) perform scaling and root planing; 3) proceed to periodontal surgery if the disease process has not been arrested; then 4) enroll the patient in a customized periodontal maintenance recall program to maintain the health of the reduced periodontium. Multiple longitudinal studies have demonstrated that the aforementioned treatment regimen can arrest the progression of periodontitis and can increase the likelihood of tooth retention and periodontal stability.

Peri-Implant Disease--A Significant Complication of Dental Implant Supported Restorative Treatment.

Over past several decades, oral rehabilitation of fully or partially edentulous patients with dental implants has become a routine procedure in daily practice. Dental implant supported and retained prosthesis can provide a wide variety of treatment options to patients due to their high predictability and survival rate. While many patients treated with dental implants have had high long term success, they are not completely free of complications. Proper patient selection, treatment planning, surgical and prosthodontic procedures, material selection and routine maintenance around the peri-implant tissues are keys to this long term success rate.

Periodontal Disease and Systemic Diseases: An Update for the Clinician.

A link between periodontal disease and various systemic diseases has been investigated for several years. Interest in unearthing such a link has grown as the health care profession is looking for a better understanding of disease processes and their relationships to periodontal and other oral diseases. The article aims to provide recent information on the relationship between periodontal disease and systemic diseases such as; cardiovascular, respiratory, endocrine, musculoskeletal, and reproductive system related abnormalities.

Rule-Based Text Classification of Dental Diagnosis.

Unstructured medical records boast an abundance of information that could greatly facilitate medical decision-making and improve patient care. With the development of Natural Language Processing (NLP) methodology, the free-text medical data starts to attract more and more research attention. Most existing studies try to leverage the power of such unstructured data using Machine Learning algorithms, which would usually require a relatively large training set, and high computational capacity. However, when faced with a smaller-scale project, opting for an alternative approach may be more effective and practical. This project proposes an efficient and light-weight rule-based approach to categorize dental diagnosis data. It not only fills the void of dental records in the medical free-text processing area, but also demonstrates that with expertly designed research structure and proper implementation, simple method could achieve our study goal very competently.

Effects of IL-34 and anti-IL-34 neutralizing mAb on alveolar bone loss in a ligature-induced model of periodontitis.

Macrophage colony-stimulating factor (M-CSF) and interleukin-34 (IL-34) are ligands for the colony-stimulating factor-1  receptor (CSF-1r) expressed on the surface of monocyte/macrophage lineage cells. The importance of coordinated signaling between M-CSF/receptor activator of the nuclear factor kappa-Β ligand (RANKL) in physiological and pathological bone remodeling and alveolar bone loss in response to oral bacterial colonization is well established. However, our knowledge about the IL-34/RANKL signaling in periodontal bone loss remains limited. Recently published cohort studies have demonstrated that the expression patterns of IL-34 are dramatically elevated in gingival crevicular fluid collected from patients with periodontitis. Therefore, the present study aims to evaluate the effects of IL-34 on osteoclastogenesis in vitro and in experimental ligature-mediated model of periodontitis using male mice. Our initial in vitro study demonstrated increased RANKL-induced osteoclastogenesis of IL-34-primed osteoclast precursors (OCPs) compared to M-CSF-primed OCPs. Using an experimental model of ligature-mediated periodontitis, we further demonstrated elevated expression of IL-34 in periodontal lesions. In contrast, M-CSF levels were dramatically reduced in these periodontal lesions. Furthermore, local injections of mouse recombinant IL-34 protein significantly elevated cathepsin K activity, increased the number of tartrate-resistant acid phosphatase (TRAP)-positive osteoclasts and promoted alveolar bone loss in periodontitis lesions. In contrast, anti-IL-34 neutralizing monoclonal antibody significantly reduced the level of alveolar bone loss and the number of TRAP-positive osteoclasts in periodontitis lesions. No beneficial effects of locally injected anti-M-CSF neutralizing antibody were observed in periodontal lesions. This study illustrates the role of IL-34 in promoting alveolar bone loss in periodontal lesions and proposes the potential of anti-IL34 monoclonal antibody (mAb)-based therapeutic regimens to suppress alveolar bone loss in periodontitis lesions.

Periodontal diagnosis and treatment planning - An assessment of the understanding of the new classification system.

OBJECTIVES: Substantial variations are seen among clinicians in the diagnosis and treatment planning of periodontal diseases. Accurate diagnosis and treatment planning are fundamental requirements for effective outcome-based patient care. The aim of this study was to evaluate the understanding of the American Academy of Periodontology and the European Federation of Periodontology 2017 periodontal disease classifications in diagnoses and treatment plans across four study groups. METHODS: The study recruited at least 20 participants in each of the four study groups. These included 1) Periodontal faculty and residents at Indiana University School of Dentistry (IUSD-PF) 2) IUSD general practice faculty (IUSD-GPF), 3) private practice periodontists (PPP), and 4) general practitioners (GP). The participants were provided with 10 HIPPA de-identified case records and a link to a survey. The survey comprised five demographic questions and two questions on diagnosis and treatment plan for each case along with a fixed list of responses. The responses were then compared against gold standards that were determined by a group of three board-certified periodontists. RESULTS: Overall, for diagnostic questions, GP (69%) were correct significantly less often than IUSD-PF (86%, p < 0.001), IUSD-GPF (79%, p = 0.002), and PPP (80%, p = 0.001). No significant differences (p > 0.05) in the overall correct treatment plan responses were found among the four groups (IUSD-PF: 69%, IUSD-GPF: 62%, PPP: 68%, and GP: 60%). The multi-rater kappas for with-in-group agreement on overall diagnosis ranged from 0.36 (GP) to 0.55 (IUSD-PF) and on overall treatment plan ranged from 0.32 (IUSD-GPF) to 0.42 (IUSD-PF). Overall agreement for diagnosis and treatment plans among the four groups was relatively low and none of the groups were statistically different from each other (p > 0.05). CONCLUSION: Regular participation in calibration sessions may lead to more accurate adoption of the 2017 periodontal classification and thereby help provide consistent diagnosis and treatment.

The impact of dental curriculum format on student performance on the national board dental examination.

PURPOSE/OBJECTIVE: The effectiveness of different curriculum types has long been debated by dental educators aiming to provide the best education possible to their students. This study aimed to evaluate the effect of curriculum type (hybrid problem-based learning [PBL] vs. traditional) on National Board Dental Examination (NBDE) part I and II pass rates METHODS: A retrospective cohort study was conducted with a hybrid PBL cohort and traditional cohort. NBDE part I and II pass rates for the two cohorts were acquired, along with demographic and scholastic variables. Pass rates, scholastic variables, and demographic variables were compared using two-sample t-tests and chi-square tests. Associations of the variables with pass rates were analyzed using logistic regression. Significance was set at 5% RESULTS: No significant differences in pass rates for NBDE part I and II were observed between the cohorts. Cumulative dental school grade point average (GPA) was found to be an independent predictor of success for NBDE part I (odds ratio (OR): 1.40, 1.24-1.59 for 0.1 point intervals) and II (OR: 1.34, 1.18-1.52 for 0.1 point intervals), (p < 0.01). DAT biology sub-score was found to be predictive of success for NBDE part I (OR: 1.58, 1.14-2.19), (p = 0.01) CONCLUSIONS: No significant difference in NBDE part I and II pass rates between the cohorts was found. Dental school GPA was the most predictive variable for success on NBDE part I and II. These findings may be helpful considerations as institutions assess the structure of their school curricula.

Diagnosis and treatment planning using the 2017 classification of periodontal diseases among three dental schools.

OBJECTIVES: The American Academy of Periodontology and the European Federation of Periodontology developed a new classification system for periodontal diseases in 2017. The next step in its widespread implementation involves training dental students to improve consistency in clinical decisions. This study conducted in 2020-2021 aimed to evaluate knowledge in periodontal diagnosis and treatment planning using the new classification, among first, second, third- and fourth-year dental students at Indiana University School of Dentistry (IUSD), University of Texas School of Dentistry at Houston (UTSD), and University of Louisville School of Dentistry (ULSD). METHODS: A minimum of 20 dental students per class year from each of the three schools participated. Ten HIPPA de-identified case records and a questionnaire with a fixed list of answer options, comprising two demographic questions and two questions on diagnosis and treatment planning of each case, were presented to the participants. A group of three board-certified periodontists established the answers for all cases which were used to score the appropriateness of diagnosis and treatment planning among the participants. RESULTS: A total of 263 students participated. Overall, 22.6% of IUSD responses, 25.2% of UTSD, and 27.6% of ULSD responses were correct for diagnosis (no statistically significant differences). For the treatment plan, 64.9% of IUSD responses, 66.2% of UTSD, and 68.9% of ULSD responses were correct (no statistically significant differences). CONCLUSION: Based on the findings from our study, we suggest that additional training be considered to improve the understanding of the 2017 classification of periodontal and peri-implant diseases among dental students.

Correlation between Advanced Dental Admission Test performance and dental MATCH success.

PURPOSE/OBJECTIVES: The Advanced Dental Admissions Test was developed in 2016 to aid residency programs evaluate qualified applicants. Since its conception, however, there have been no studies seeking to evaluate the usefulness of the exam regarding an applicants' ability to match with a residency program through the Postdoctoral Dental Matching Program (MATCH). The aim of this study was to evaluate the impact of the Advanced Dental Admission Test performance on student MATCH success into a post-doctoral pediatric residency program. METHODS: This retrospective study evaluated the academic records of pediatric residency applicants using the ADEA PASS and MATCH program between 2017 and 2019. Five scholastic and 7 demographic variables were extracted from student ADEA PASS applications. Applicant MATCH status and preference was obtained from the Postdoctoral Dental Matching Program. Descriptive statistics for each application cycle was calculated and used to evaluate applicant demographic and scholastic data. Correlation coefficients assessed for associations between scholastic/demographic factors and MATCH status/preference. Logistic regression models estimated the probability of MATCH status/preference. Significance was set at 5%. RESULTS: An association was found between ADAT scores and MATCH status, but the influence was minimal (odds ratio: 1.004, 95% confidence interval: 1.001-1.008). Applicant age (P < 0.0216) and dental schools that ranked students (P < 0.0002) were the most significant factors for MATCH status and preference, respectively. CONCLUSIONS: ADAT scores played a minimal role in applicants matching to pediatric residency programs. Applicant age and schools that provide class ranks were found to be significant predictors when considering MATCH status and preference to pediatric residency programs.

Assessing readiness to manage medical emergencies among dental students at four dental schools.

BACKGROUND AND PURPOSE: Dentists treat a wide range of patients, including patients with compromised health conditions. While rendering treatment, various medical emergencies can and do occur. To help increase the knowledge required to manage such emergencies, dental students must be trained while in dental school. This study aims to assess the level of medical emergency preparedness and knowledge among dental students at four dental schools. MATERIAL AND METHODS: The participating dental schools were IUSD, Case Western Reserve University School of Dentistry, Marquette University School of Dentistry, and the University of Alabama School of Dentistry. Groups were designed to include 20 dental students from Years 1 to 4. Students were asked to fill out a survey and were then tested on 10 clinical medical emergency scenarios. RESULTS: A total of 331 dental students participated in the study. The scores based on 10 case scenarios presented with a range of 4.35-8.02. There was no statistically significant difference in the level of preparedness when dental schools were compared. However, Year 1 and Year 2 dental students had significantly lower total scores than those of Years 3 and 4. The students in Years 1 and 2 demonstrated less confidence in their current knowledge to manage medical emergencies. Satisfaction with the training received ranged from 38% to 84%. CONCLUSION: The results from this study indicate that students' preparedness to manage medical emergencies at these four dental schools is statistically similar. Additional yearly training could enhance students' preparedness in the management of medical emergencies in the dental setting.

Periodontal Health and Systemic Conditions.

According to the new classification proposed by the recent 2017 World Workshop on Periodontal and Peri-implant Diseases and Conditions, periodontitis, necrotizing periodontal diseases, periodontitis as a manifestation of systemic diseases, and systemic diseases or conditions affecting the periodontal supporting tissues, are considered as separate entities. Scientific evidence has demonstrated that periodontal diseases are not just simple bacterial infections but rather complex diseases of multifactorial complexity that interplay with the subgingival microbes, the host immune, and inflammatory responses. Despite dental plaque biofilm being considered the primary risk factor for periodontitis in the vast majority of patients that dentists encounter on a daily basis, there are other factors that can also contribute and/or accelerate pathologic progressive attachment loss. In this article, the authors aim to briefly review and discuss the present evidence regarding the association between periodontal diseases and systemic diseases and conditions.

Periodontal maintenance therapy: an integral part of dental practice. Case reports on three periodontally involved patients.

Periodontal maintenance therapy is an integral aspect of any general dental or specialist practice. Numerous studies have indicated that periodontal therapy in the absence of a carefully designed maintenance program invariably results in the relapse of the disease condition. Accordingly, dental practices that provide periodontal care without a maintenance program deal with significant patient management and disease management issues. In this article, three cases are presented with varying levels of disease severity but all sharing the common trait of having being enrolled in a good maintenance program with positive treatment outcomes.

Assessing Effectiveness of an Audiovisual Educational Tool for Improving Dental Students' Probing Depth Consistency.

Dental students often underestimate their probing depth (PD) measurements, which emphasizes the need for effective and novel methods for teaching proper probing technique. The aim of this study was to evaluate the efficacy of audiovisual learning aids, recorded from the point of view of examiners, for improvement in PD agreement in dental students. In 2017-18, 22 third-year dental students were randomized into test and control groups. Each student and a single blinded faculty examiner performed PD measurements on a minimum of three patients. The test group viewed a video demonstrating proper probing technique, while the control group received only probing technique instruction from prior lectures. All measurements, the periodontal diagnoses, and the total time taken to complete PD measurements were recorded. A survey of student attitudes about the audiovisual tool was conducted after the intervention; all 22 students completed the survey. A total of 11,426 PD sites were measured. The test group had 10% greater accuracy in PD sites=4 mm. The control group had a minor but statistically significant increase in accuracy for 2 mm PD sites. For all incorrect measurements at sites PD≥4, the students tended to underestimate the PD. Tooth type, site location around tooth, and diagnosis had no significant effect on PD measurement agreement. No significant difference between groups was found for the proportions of gingivitis and periodontitis patients or for examination time. This study found that use of the audiovisual learning aid "Calibrated Periodontal Training Video" improved the students' probing depth accuracy for sites with PD of 4 mm.

Changes in gingival dimensions following connective tissue grafts for root coverage: comparison of two procedures.

BACKGROUND: The purpose of this study was to investigate the changes in gingival dimensions and root coverage using the same surgical procedure but varying the amount of the connective tissue graft left uncovered. METHODS: Twenty-five Class I or II recession defects in 20 healthy subjects were randomly assigned to test (exposed connective tissue group; E group) or control (fully covered connective tissue group; FC group) groups and treated with a connective tissue graft procedure. In the E group, 1 to 2 mm of the graft was left uncovered at the completion of the surgery, whereas the FC group had the graft completely covered by the flap. Clinical parameters assessed included probing depth, recession depth, clinical attachment level, width of keratinized tissue, mobility, and plaque score. RESULTS: At 12 weeks, the mean root coverage percentages for FC and E groups were 93% and 88%, respectively. The difference between the groups was not statistically significant (P=0.48). Complete root coverage was observed in 79% and 64% of the subjects in FC and E groups, respectively. There was greater increase in the width of keratinized tissue in the E group (1.5+/-1.1 mm) than the FC group (0.9+/-0.9 mm), although this difference did not reach statistical significance (P=0.16). There were no statistically significant differences between the groups for the changes in other parameters. CONCLUSIONS: Both procedures resulted in successful root coverage with an increase in the width of keratinized tissue. Leaving a portion of the graft exposed resulted in a greater increase of keratinized tissue, and complete coverage of the graft resulted in greater root coverage. However, these differences did not reach statistical significance.

Periodontal Diagnosis and Treatment Planning Among Indiana Dental Faculty, Periodontists, and General Practice Dentists: A Multi-Group Comparison.

Diagnosis and treatment planning for periodontal disease are fraught with challenges because of the complex and multifactorial nature of the disease as well as the inherent variability in interpretation of clinical findings. It is important for all practitioners to be accurate and consistent in formulating diagnoses based on the American Academy of Periodontology classification guidelines and to implement treatment plans to adequately address patients' needs. The aim of this study was to compare diagnoses and treatment plans among four groups of participants: full-time and part-time periodontology faculty at Indiana University School of Dentistry (IUSD), full-time and part-time IUSD general practice faculty, full-time periodontists in private practice, and full-time general practitioners in private practice. The study, conducted September 2016 to February 2017, also sought to determine if the calibrated participants had more correct diagnoses and treatment plans than those who had not received calibration training. Each of the four groups had 20 participants each. Participants evaluated ten de-identified case records and selected a diagnosis and treatment plan for each case. In the results, the 20 IUSD periodontal faculty members, most of whom had participated in calibration sessions, had overall better agreement and more correct responses for diagnoses and treatment plans than the IUSD general practice faculty members, private practice general practitioners, and private practice periodontists (only one of those 60 participants had participated in calibration sessions). The results supported the notion that periodic calibration is needed to standardize faculty criteria, facilitate better agreement and accuracy, and enhance consistency in the use of clinical criteria during training for dental students and in practice.

Preliminary Performance of the Advanced Dental Admission Test (ADAT): Association Between ADAT Scores and Other Variables for Applicants to Residency Programs at a U.S. Dental School.

Historically, dental residency programs have used numerical assessment criteria to evaluate and identify qualified candidates for admission. Recent elimination of such assessment tools has undermined many programs' holistic evaluation process. The Advanced Dental Admission Test (ADAT) was developed and recently piloted in hopes of addressing this issue. The aim of this study was to evaluate the preliminary performance and validity of the ADAT by exploring the association between ADAT scores and other variables for a sample of applicants to residency programs. The WebAdMIT admissions database was used to identify the test scores and educational and demographic information of 92 individuals who completed the pilot ADAT and were seeking a 2017 postgraduate specialty position at Indiana University School of Dentistry. The results showed that the ADAT had strong to weak correlations with certain applicant variables (p<0.05). No significant differences were found for age, race, school location, or country of origin. However, males performed better than females (p<0.05), and non-Hispanics performed better than Hispanics (p<0.01). ADAT component scores were also higher for individuals with a history of research activity (p<0.05). This study found that significant associations existed between the ADAT and indices typically associated with competitive applicants. These findings suggest that the ADAT may serve as a useful numerical assessment instrument, with the potential to identify high-performing candidates. Furthermore, the ADAT seemed to be a plausible option for programs seeking to incorporate a quantitative assessment instrument as part of a holistic candidate selection process.

Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study.

With the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental school's standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes.