Perceptions regarding the use of a three-dimensionally-printed manufactured educational simulator for periodontal treatment of intraosseous and interradicular lesions.

PURPOSE/OBJECTIVES: Treating intraosseous lesions (IOLs) and interradicular bone lesions (IRLs) is an extremely technical dental procedure in periodontics. Instrumentation of these lesions is often perceived as difficult by students and inexperienced dentists before they perform a certain number of procedures on patients in the clinic. The aim of this article is to evaluate a cost-effective three-dimensional (3D)-printed educational simulator for the periodontal treatment of IOLs/IRLs (including scaling, incisions and sutures). METHODS: The simulators were first developed digitally, and then manufactured using printable resins and specific materials; finally, they were assembled using different bonding systems. To evaluate the simulators, assessments were gathered from two target populations: undergraduate students and periodontics experts. These individuals tested the simulator and completed a cross-sectional questionnaire based on a Likert scale with comparative and pedagogical items scored from one to five. The purpose of the questionnaire was to compare our simulator to clinical reality (i.e., operation on human jaws) and to an animal simulator (i.e., simulation of porcine jaws). The results are expressed as the mean and standard deviation and were statistically analyzed with the Wilcoxon signed-rank test. RESULTS: Overall, the results were satisfactory for both groups of testers (4.70 and 4.61 out of five for students and experts, respectively, for global satisfaction). CONCLUSIONS: The overall educational relevance of the simulator designed herein highlights the fact that 3D-printed educational simulators could enable efficient cognitive-functional learning for clinical IOL/IRL treatment.

OSCEGame: A serious game for OSCE training.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are amongst the most anxiety-provoking competency assessment methods. An online serious game (OSCEGame) was developed and implemented within the OSCE curriculum. This study aimed to evaluate the usefulness of this serious game on preparedness and reducing OSCE-related stress. METHODS: A serious game was designed to help dental students train for OSCEs. Two game courses (4 stations each) were designed according to year of undergraduate training (4th and 5th year), based on 6 pre-existing multi-competency OSCE stations. The OSCEGame was available online on a learning platform 4 to 6 weeks before the summative OSCEs. Game use was evaluated by analysing connection data. Preparedness, stress and time management skills were assessed using a questionnaire following the summative OCSEs. The results of 4th -year students (OSCE naive population) were compared to those of 5th -year students to assess usefulness and benefits of such preparation method. RESULTS: In total, 97% and 60% of the students in 4th year and 5th year, respectively, used the game. The game was seen as an essential preparation tool to reduce anxiety (for 60% of all students) and increase time management skills (65% of all students). However, significant differences were observed between 4th- and 5th -year students (anxiety reduction: 65% vs. 22%, p < 0.001; time management skills: 59% vs. 41%, p < 0.05) suggesting that it is most useful for OSCE naive students. CONCLUSION: This serious game is a useful time efficient online tool, for OSCE preparation, especially in OSCE naive students.

Emerging Nanotechnology in Non-Surgical Periodontal Therapy in Animal Models: A Systematic Review.

Periodontitis is one of the most prevalent inflammatory diseases. Its treatment, mostly mechanical and non-surgical, shows limitations. The aim of this systematic review was to investigate the effect of nanoparticles as a treatment alone in non-surgical periodontal therapy in animal models. A systematic search was conducted in Medline/PubMed, Web of Science, The Cochrane Library and Science Direct. The eligibility criteria were: studies (i) using nanoparticles as chemotherapeutic agent or as delivery system; (ii) including preclinical controlled animal model (experimental periodontitis); (iii) reporting alveolar bone loss; (iv) written in English; and (v) published up to June 2019. Risk of bias was evaluated according to the SYstematic Review Centre for Laboratory Animal Experimentation. On the 1324 eligible studies, 11 were included. All reported advantages in using nanoparticles for the treatment of periodontitis, highlighted by a reduction in bone loss. Agents modulating inflammation seem to be more relevant than antibiotics, in terms of efficiency and risk of antibiotic resistance. In addition, poly(lactic-co-glycolic acid) or drugs used as their own carrier appear to be the most interesting nanoparticles in terms of biocompatibility. Risk of bias assessment highlighted many criteria scored as unclear. There are encouraging preclinical data of using nanoparticles as a contribution to the treatment of periodontitis.

Periodontal reconstruction by heparan sulfate mimetic-based matrix therapy in Porphyromonas gingivalis-infected mice.

BACKGROUND: Periodontitis is a set of chronic inflammatory diseases affecting the supporting structures of the teeth, during which a persistent release of lytic enzymes and inflammatory mediators causes a self-perpetuating vicious cycle of tissue destruction and repair. A matrix-based therapy using a heparan sulfate (HS) analogue called ReGeneraTing Agent (RGTA) replaces destroyed HS by binding to available heparin-binding sites of structural molecules, leading to restoration of tissue homeostasis in several inflammatory tissue injuries, including a hamster periodontitis model. METHODS: The ability of RGTA to restore the periodontium was tested in a model of Porphyromonas gingivalis-infected Balb/cByJ mice. After 12 weeks of disease induction, mice were treated weekly with saline or RGTA (1.5 mg/kg) for 8 weeks. Data were analyzed by histomorphometry. RESULTS: RGTA treatment restored macroscopic bone loss. This was related to (1) a significant reduction in gingival inflammation assessed by a decrease in infiltrated connective tissue, particularly in cells expressing interleukin 1ß, an inflammatory mediator selected as a marker of inflammation; (2) a normalization of bone resorption parameters, i.e. number, activation and activity of osteoclasts, and number of preosteoclasts; (3) a powerful bone formation reaction. The Sharpey's fibers of the periodontal ligament recovered their alkaline phosphatase coating. This was obtained while P. gingivalis infection was maintained throughout the treatment period. CONCLUSIONS: RGTA treatment was able to control the chronic inflammation characteristic of periodontitis and blocked destruction of periodontal structures. It ensured tissue regeneration with recovery of the periodontium's anatomy.

Position paper for the evaluation and management of oral status in patients with valvular disease: Groupe de Travail Valvulopathies de la Société Française de Cardiologie, Société Française de Chirurgie Orale, Société Française de Parodontologie et d'Implantologie Orale, Société Française d'Endodontie et Société de Pathologie Infectieuse de Langue Française.

Oral health is of particular importance in patients with heart valve diseases because of the risk of infective endocarditis. Recommendations for antibiotic prophylaxis before dental procedures have been restricted, but the modalities of oral evaluation and dental care are not detailed in guidelines. Therefore, a multidisciplinary working group reviewed the literature to propose detailed approaches for the evaluation and management of buccodental status in patients with valvular disease. Simple questions asked by a non-dental specialist may draw attention to buccodental diseases. Besides clinical examination, recent imaging techniques are highly sensitive for the detection of inflammatory bone destruction directly related to oral or dental infection foci. The management of buccodental disease before cardiac valvular surgery should be adapted to the timing of the intervention. Simple therapeutic principles can be applied even before urgent intervention. Restorative dentistry and endodontic and periodontal therapy can be performed before elective valvular intervention and during the follow-up of patients at high risk of endocarditis. The detection and treatment of buccodental foci of infection should follow specific rules in patients who present with acute endocarditis. Implant placement is no longer contraindicated in patients at intermediate risk of endocarditis, and can also be performed in selected high-risk patients. The decision for implant placement should follow an analysis of general and local factors increasing the risk of implant failure. The surgical and prosthetic procedures should be performed in optimal safety conditions. It is therefore now possible to safely decrease the number of contraindicated dental procedures in patients at risk of endocarditis.

Accelerated craniofacial bone regeneration through dense collagen gel scaffolds seeded with dental pulp stem cells.

Therapies using mesenchymal stem cell (MSC) seeded scaffolds may be applicable to various fields of regenerative medicine, including craniomaxillofacial surgery. Plastic compression of collagen scaffolds seeded with MSC has been shown to enhance the osteogenic differentiation of MSC as it increases the collagen fibrillary density. The aim of the present study was to evaluate the osteogenic effects of dense collagen gel scaffolds seeded with mesenchymal dental pulp stem cells (DPSC) on bone regeneration in a rat critical-size calvarial defect model. Two symmetrical full-thickness defects were created (5 mm diameter) and filled with either a rat DPSC-containing dense collagen gel scaffold (n = 15), or an acellular scaffold (n = 15). Animals were imaged in vivo by microcomputer tomography (Micro-CT) once a week during 5 weeks, whereas some animals were sacrificed each week for histology and histomorphometry analysis. Bone mineral density and bone micro-architectural parameters were significantly increased when DPSC-seeded scaffolds were used. Histological and histomorphometrical data also revealed significant increases in fibrous connective and mineralized tissue volume when DPSC-seeded scaffolds were used, associated with expression of type I collagen, osteoblast-associated alkaline phosphatase and osteoclastic-related tartrate-resistant acid phosphatase. Results demonstrate the potential of DPSC-loaded-dense collagen gel scaffolds to benefit of bone healing process.

ReGeneraTing agents matrix therapy regenerates a functional root attachment in hamsters with periodontitis.

Matrix-based therapy restoring the cell microenvironment is a new approach in regenerative medicine successfully treating human chronic pathologies by using a heparan sulfate mimetic (ReGeneraTing agents [RGTA]). Periodontitis are inflammatory diseases destroying the tooth-supporting tissues with no satisfactory therapy. We studied in vivo RGTA ability to fully restore the tooth-supporting tissues. After periodontitis induction, hamsters were treated with RGTA (1.5 mg kg(-1) w(-1)) or saline. Bone loss was evaluated and immunohistochemical labeling of molecules expressed during cementum development was performed. RGTA treatment restored alveolar bone and the attachment apparatus where fibers were inserted in acellular decorin-negative cementum. RGTA treatment increased the epithelial rests of Malassez, previously depleted by periodontitis. Bone morphogenetic protein (BMP) expressions were compartmentalized: BMP-3 was strongly expressed by epithelial rests of Malassez; BMP-7 was expressed by cells lying on the cementum and BMP-2 by osteoprogenitors around bone formation sites but not at the root-bone interface. Cells near the cementum and bone expressed the ALK2 receptor. This is the first evidence that reconstructing the extracellular matrix scaffold with a heparan sulfate mimetic regenerated the root interface despite the persistence of the bacteria responsible for the disease The improved cellular microenvironment led to the sequential recruitment of cell populations involved in attachment apparatus regeneration.

Impact of periodontitis definition in epidemiological research. Results from the EPIPAP study in postpartum women.

The purpose of this investigation was to study the impact of using various definitions of periodontitis on the frequency of periodontitis and on the associations with some known risk factors for periodontitis in a population of postpartum women in France. A clinical examination was performed within 2-4 d postpartum in 932 at-term women at five maternity units. We studied six definitions of periodontitis; five were applicable if at least two teeth were found to have the following: (i) a proximal clinical attachment level (CAL) of ≥ 3 mm; (ii) a probing depth (PD) of ≥ 4 mm; (iii) a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site; (iv) a proximal PD of ≥ 5 mm or a proximal CAL of ≥ 4 mm; or (v) a PD of ≥ 4 mm and a CAL ≥ 3 mm and bleeding on probing at the same site. The sixth definition required the involvement of four teeth with a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site. Associations between case status according to each definition and maternal characteristics (age, educational level, smoking before pregnancy, and time since last dental visit) were analyzed using generalized estimating equation models. The definition of periodontitis had an impact on the frequency of periodontitis, which ranged from 12.1% to 37.7%, and produced different ORs for the associations with risk factors for periodontitis.

Dense fibrillar collagen matrices sustain osteoblast phenotype in vitro and promote bone formation in rat calvaria defect.

Two pure collagen materials were prepared from acidic collagen solutions at 5 and 40 mg/mL. Benefits of collagen concentration on bone repair were evaluated in vitro with human calvaria cells and in vivo in a rat cranial defect. Both materials exhibited specific structures, 5 mg/mL was soft with an open porous network of fibrils; 40 mg/mL was stiffer with a plugged surface and bundles of collagen fibrils. Osteoblasts seeded on 5 mg/mL formed an epithelioid layer with ultrastructural characteristics of mature osteoblasts and induced mineralization. Numerous osteoblasts migrated inside 5 mg/mL, triggering reorganization of their actin cytoskeleton, whereas on 40 mg/mL osteoblasts remained in a resting state. In rat calvaria defects, both materials induced active bone formation. Dual-energy X-ray absorption bone area measures after 4 weeks averaged 84.0% with 5 mg/mL, 88.4% with 40 mg/mL, and 36.7% in the controls (p < 0.05). Tartrate-resistant acid phosphatase-positive giant cells releasing amounts of metalloproteinase-2 progressively degraded the implants at 76.5% with 5 mg/mL and 38.2% with 40 mg/mL (p < 0.05), whereas alkaline phosphatase-positive osteoprogenitors invaded collagen remnant. Hence, the dense structure of collagen materials allowed cell invasion and raise their mechanical behavior without addition of chemical cross-linkers. Collagen concentration can be tuned to form 3D matrices for in vitro investigations or to fit degradation rate to different bone repair purposes.

Maternal periodontitis and the causes of preterm birth: the case-control Epipap study.

AIM: To analyse the association between maternal periodontitis and preterm birth (<37 weeks' gestation) according to the causes of preterm birth. MATERIALS AND METHODS: Epipap is a case-control multi-centre study of singleton livebirths. One thousand one hundred and eight women with preterm deliveries and 1094 with deliveries at term (> or =37 weeks) at six French maternity units were included. Periodontal examinations after delivery identified localized and generalized periodontitis. Cases were classified according to four causes of preterm birth. Polytomous logistic regression analysis was used to control for confounders (maternal age, parity, nationality, educational level, marital status, employment during pregnancy, body mass index before pregnancy, smoking status) and the examiner. RESULTS: Localized periodontitis was identified in 129 (11.6%) cases and in 118 (10.8%) control women and generalized periodontitis in 148 (13.4%) and 118 (10.8%), respectively. A significant association was observed between generalized periodontitis and induced preterm birth for pre-eclampsia [adjusted odds ratio 2.46 [95% confidence intervals (95% CI)1.58-3.83]. Periodontitis was not associated with spontaneous preterm birth or preterm premature rupture of membranes or with the other causes. CONCLUSION: Maternal periodontitis is associated with an increased risk of induced preterm birth due to pre-eclampsia.