College of Dentistry - M.Dent. Projects

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Assessment of Gingival Tissue Hemodynamics by Optical Spectroscopy in Diagnosis of Periodontal Disease - Multicenter Clinical Trials
(2015) Xiang, Xiaoming; Cholakis, Anastasia; Shah, A.; Sowa, M.; Atout, Reem; Liu, K.Z.
Background: Currently used diagnostic methods in periodontics are unable to identify disease activity and progression until significant attachment loss has happened. New diagnostic modalities and parameters are needed to monitor disease progression and detect disease activity at an early stage. Aims: To determine the features of the in vivo optical spectra characteristic of periodontitis, gingivitis and healthy gingival tissue and the potential to use these spectral signatures to differentiate periodontitis from gingivitis and healthy gingiva and determine the risk of progression from gingivitis to periodontitis. Materials and Methods: 12 cross-sectional clinical trials were conducted at 6 university based dental clinics or research centers in Canada, China, Italy and Brazil from 2007 to 2014 including 562 patients with moderate to severe chronic periodontitis. Optical spectra were obtained at the chair-side using a custom designed optical probe from 705 periodontitis, 1306 gingivitis and 1691 healthy sites in situ. A modified Beer-Lambert unmixing model was used to determine tissue oxygen saturation and relative contribution of oxygenated and deoxygenated hemoglobin components. Results: Multiple hemodynamic parameters were simultaneously derived from the optical spectra of gingival tissue including tissue oxygen saturation, oxygenated hemoglobin, deoxygenated hemoglobin and total hemoglobin indices. The tissue oxygen saturation and oxygenated hemoglobin index in periodontitis was significantly lower than gingivitis and healthy gingiva (p < 0.0001) but no significant difference in oxygenated hemoglobin between gingivitis and healthy gingiva (p > 0.05). On the other hand, deoxygenated hemoglobin in periodontitis was significantly increased compared to gingivitis and healthy gingiva (p < 0.0001 ). A classification model was established to predict the risk level of gingivitis based on the features of the optical spectra of characteristic of health gum and periodontitis. Conclusions: 1) multiple local hemodynamic profiles such as tissue oxygenation and perfusion can be simultaneously generated by optical spectroscopy to reflect subclinical gingival inflammation. 2) Decreased tissue oxygenation saturation in periodontitis and gingivitis was mainly due to increased concentration of deoxygenated hemoglobin. 3) Optical spectroscopy has the potential to diagnose periodontal disease and monitor disease progression at an early stage. More longitudinal studies are needed to validate this potential.
Open Access
A comparison of the efficacy of two different interdental protocols around dental implants in maintenance patients: a randomized controlled trial
(2015) Nwachukwu, Omonkhele G.; Renvert, S.; Cholakis, Anastasia; Atout, Reem
Background: Although there are multiple studies comparing the efficacy of different interdental hygiene aids on natural teeth, little or no data exists to show what method of interdental cleaning may be most effective on dental implants. The aim of this study was to compare the effectiveness of two interdental hygiene aids (an interdental brush v. dental floss) on dental implants, assessing their effects on clinical parameters that impact on impact tissue health, as well as cytokines in peri-implant crevicular fluid. Method: This was a single blind, randomized controlled trial in a single centre. Thirty-two implant patients currently under maintenance was evaluated at baseline, 3 and 6 months. One implant was studied per participant. Sixteen patients used dental floss while the other 16 used interdental brushes. All hygiene aids used were supplied to participants after randomized allocation. Clinical parameters evaluated include full-mouth plaque scores and full-mouth bleeding on probing, width of implant keratinized mucosa, distance of papilla from the occlusal point of prosthesis, implant probing depths, implant plaque levels and implant bleeding on probing. Peri-implant crevicular fluid samples were also taken and IL-2, IL-4, IL-6, IL-10, TNF-alpha and IFN-gamma levels were measured. Results: The mean and median levels of all clinical variables and cytokines for both groups were calculated and compared analytically. A repeated measures analysis to compare group-time interaction was also carried out. There were reductions from baseline to 6 months in most variables for both groups. While most results were not statistically significant, there was an increase in mean probing depth of interdental brush group at 6 months for the distobuccal (0.4mm) and lingual (0.25mm) implant surfaces that was statistically significant. Conclusion: Although floss slightly outperformed interdental brushes in implant plaque index and full mouth bleeding scores, other indices showed relatively comparative values between the two groups. We were unable to reject the null hypothesis as determined within the limits of these 6-months results.
Open Access
The Relationship between Periodontal Disease and Vitamin D
(2015) Bonnet, Colin; Cholakis, Anastasia; Batista, Eraldo; Moffatt, Michael; Schroth, Robert
Background: As vitamin Dis known to have functions in bone homeostasis and immune system regulation, it is plausible that vitamin D levels could affect the progression of periodontal disease. Currently, there is conflicting evidence regarding the role of vitamin D in the progression of periodontal disease. The purpose of this study was to explore the relationship between plasma 2S{OH}D concentration and periodontal disease measured by gingival inflammation {GI} and loss of attachment {LOA}. It is hypothesized that lower 2S{OH}D levels will be associated with higher measures for GI and LOA. Methods: This cross-sectional study used data from the Canadian Health Measures Survey {CHMS} on subjects aged 13 - 79 years of age. Vitamin D status was determined by measuring plasma 25{OH}D concentrations in nmol/L. Periodontal disease was measured by assessing (GI} using Lee's gingival index and by calculating (LOA}. Student's t-tests and chi-square tests were used to perform a bivariate analysis between potential independent variables including 2S(OH}D and the dependent variables of GI and LOA. Multiple logistic regression analyses were then performed for GI and LOA to determine the adjusted correlation between 2S{OH}D and GI and 25{OH}D and LOA and to control for potential confounding variables. Results: Plasma 25{OH}D concentration less than 50 nmol/L and less than 75 nmol/L, but not mean plasma 2S{OH}D concentration, were associated with GI at the bivariate level. However, no association was found between mean plasma 25(OH}D concentration, 2S(OH}D concentration less than 50 nmol/, or 25(OH}D concentration less than 75 nmol/L and GI in the multiple regression analysis. None of mean plasma 25{OH}D concentration, 25{OH}D concentration less than 50 nmol/L, or 2S(OH}D concentration less than 75 nmol/L were associated with LOA at the bivariate level. A statistically significant association was observed between 2S(OH}D concentration less than 75 nmol/L and LOA in the multiple regression analysis, but not mean plasma 2S{OH}D concentration or 2S{OH}D concentration less than 50 nmol/L. Conclusion: Vitamin D status was inversely associated with GI at the bivariate level, but not at the multivariate level. Conversely, vitamin D status was not associated with LOA at the bivariate level, but it was inversely associated with LOA at the multivariate level. These results provide modest evidence supporting a relationship between low plasma 25(OH}D concentrations and periodontal disease as measured by GI and LOA.
Open Access
A 6-month comparison of piezo ultrasonic scaler and hand instrumentation in the maintenance of peri-implant tissues: a randomized clinical trial
(2016) Castro, Maria; Atout, Reem; Renvert, A.; Cholakis, Anastasia
Objectives: The aim of this study was to compare the clinical effects, presence of inflammatory cytokines, and the patients' perceived discomfort of two mechanical non-surgical methods of peri-implant maintenance: the piezo ultrasonic scaler vs hand instrumentation. Material and Methods: A total of thirty-four (34) patients with at least one healthy or with peri-implant mucositis dental implant were randomly assigned to the piezo ultrasonic scaler or to the hand instrumentation groups. The clinical parameters analyzed at the implant level were the following: Plaque Index (Pl), Bleeding on Probing (BOP), Probing Depths (PD), Keratinized tissue (KT) and Recession (REC). All these measurements were recorded at baseline, three, and six months. Full mouth plaque index (FPI) and full mouth bleeding on probing (FBOP) were also calculated. Samples of Peri-Implant Crevicular Fluid (PICF) from the four aspects of the implant were collected for analysis of cytokine levels followed by the corresponding maintenance therapy. At the end of the study patients were asked to fill in a pain questionnaire (Visual analogue scale, VAS). Results: Thirty-one (31) subjects completed the study (Piezo=17, SRP=14). Even though, reduction on FPI and FBOP were observed, it was found that the FPI and FBOP did not have a statistically significant difference over the 6 months or at any of the checkup times (0, 3, 6 months) for any of the treatment groups. Both peri-implant therapies slightly reduced the implant plaque index and implant probing depths in healthy and peri-implant mucositis implants from O to 6 months; however, these differences were not statistically significant. The model results indicated that the presence of KT and REC were not statistically significant different between treatments at any given time. This study demonstrated that the anti-inflammatory cytokine IL-4 statistically significant increased for both therapies from baseline to 6 months (P<0.05). There were not statistically association between the implant PD, Pl, and BOP and the cytokines levels (IL-2, IL-4, IL-6, ILB, IL-10, TNFa, and IFNy) during the six-month study period. In addition, subjects from both therapies reported minimum perceived discomfort after treatment. Conclusion: Within the limits of this study, it was demonstrated that both peri-implant therapies had a beneficial clinical effect in the reduction of all clinical parameters; however, these results were not statistically significant. In addition, there was no statistically significant difference in the clinical outcomes measurements at any given time between the two groups and the study could not demonstrated that peri-implant therapy decreases the presence of inflammatory cytokines.
Open Access
Comparison of Cyanoacrylate Tissue Adhesives to Polytetrafluoroethylene Sutures in the Donor Site of Connective Tissue Grafts – A Randomized Clinical Trial
(2018-06) Stavropoulou, Chrysi
Purpose: The aim of this study was to compare patient-centered outcomes, wound healing and post-operative complications at palatal donor area of SECT grafts between cyanoacrylates tissue adhesives and Polytetrafluoroethylene (PTFE) sutures. Methods: 36 patients who required harvesting of SECT graft were enrolled in this prospective randomized clinical trial and assigned to one of two groups. In the “suture” group, wound closure was achieved with standardized continuous interlocking 6-0 PTFE sutures, while in the “cyanoacrylate” group, a high viscosity blend of n-butyl and 2-octyl cyanoacrylate was applied until hemostasis was achieved. The primary outcome was the discomfort (eating, speaking etc) from the donor site during the first post-operative week; this was self-reported on a visual analogue scale (VAS) questionnaire. Secondary outcomes were the time required for suture placement or cyanoacrylate application, the patient self-reported pain on the first day, and the first week after surgery, the analgesic-intake and the modified early-wound healing index (MEHI). Results: The median value of discomfort was 1.49 cm in the “suture” group and 1.86 cm in the “cyanoacrylate” (p=0.56). The mean time required for suture placement was 7.31 minutes and for cyanoacrylate application 2.16 minutes (p<0.0001). No statistically significant differences were found between the two methods in reported level of pain, in analgesic intake and in MEHI. Conclusion: Cyanoacrylate can safely be used for wound closure of donor palatal site of SCTG. The application was about 5 minutes faster than conventional suture placement, reducing the total time of the surgical procedure.
Open Access
A Randomized Clinical Trial of the in vivo effect of non-metallic vs metallic hand scalers on zirconia implant supported crowns during a year of peri-implant maintenance
(2019) Roemermann, Dayna L.; Atout, Reem; Franca, R.; Pesun, I.; Cholakis, Anastasia
Background: This study examined whether the degree of abutment surface modification that may occur with regular periodontal instrumentation has a clinical impact in terms of increased plaque accumulation and increased peri-implant tissue inflammation on zirconia implant abutments. Methods: 13 patients who had zirconia implant crowns were recruited in this randomized clinical trial. Each patient acted as their own control, and had either the buccal or lingual surface of their screw retained implant restoration scaled with a metallic scaler, and the other surface with a non-metallic scaler at 3, 6, 9 and 12 months. Cytokine testing of the peri-implant crevicular fluid was completed at 0, 3 and 12 months, for IL-2, IL-4, IL-6, IL-8, IL-10, TNF-a or IFNy. Implant crowns were removed at 12 months and evaluated under an atomic force microscope for the RA, or average roughness, and the Ra, or root mean square roughness, scores. The implant crowns were polished and re-inserted. Results: There were strong significant differences in surface roughness (Ru and Ra) between the metallic and non-metallic scalers, with average Ru values of 417.7m (s = 276.1nm) and 233.9nm (s = 155.6nm), and RA values of 301.0nm (s = 214.2nm) and 176.1nm (s = 123.1nm) respectively. However, there were no significant associations between the type of scaler used and the amount of clinical inflammation or cytokine production. Conclusion: Metallic scalers produce deeper, more aggressive surface alterations to the abutment/crown zirconia surface but there was no statistically significant difference between the degree of surface alterations, amount of BOP, and the amplitude of cytokine inflammation produced.
Open Access
Volumetric changes of soft and hard tissues following alveolar ridge preservation: Freezedried bone allograft with collagen plug vs. L-PRF clot
(2019) Bouwer, Jonathan; Atout, Reem; Pesun, I.; Cholakis, Anastasia
A randomized study examining the effect of Leukocytic Platelet Rich Fibrin (L-PRF) clot on the hard and soft tissue volumetric changes in ridge preservation procedures when compared to freeze dried bone block allografts (FDBA) covered by d-PTFE non-absorbable membrane.
Open Access
The Efficacy of Adjunctive Antimicrobial Photodynamic Therapy for Residual Pockets in Previously Surgically Treated Teeth: A Randomized Clinical Trial
(2020) Cabrales, Javier; Atout, Reem; Benhamou, Veronique; Price, D.; Cholakis, Anastasia
Purpose. The aim of this study was to assess the clinical effects of antimicrobial photodynamic therapy (aPDT) delivered as an adjunct to maintenance therapy, specifically in patients with residual pockets at previously surgically treated teeth and compare it with patients receiving mechanical debridement only. Methods and Materials. Twenty-three patients on a regular maintenance schedule who had previously received periodontal surgical care were randomly assigned to receive aPDT or a placebo at their first debridement appointment. The teeth selected had to have at least one site with bleeding on probing and a probing depth of >5mm. One week later, patients received the same treatment according to their group allocation. These teeth were simultaneously reassessed at their three- and six-month maintenance appointments. The primary outcome measure was bleeding on probing (BOP) and secondary outcome measures were plaque index (PI), probing depth (PD), and clinical attachment level (CAL). Results. There were statistically significant (SS) improvements for both groups in mean BOP, PD, and CAL. Individual sites in both groups showed SS improvements in BOP, PD, and CAL as well. When comparing the two groups directly, there was a SS increased mean PD reduction and CAL gain in the adjunctive aPDT treatment over debridement only at 6 months. There were no significant differences between the groups for BOP and PI comparisons. Conclusion. Adjunctive aPDT significantly improves PD and CAL at previously surgically treated teeth in maintenance care, when compared to mechanical debridement alone.
Open Access
Effects of Er:YAG Photobiomodulation Therapy on Wound Healing of Human Palatal Mucosa After Connective Tissue Graft Harvesting: A Pilot Study
(2020) Wiens, Brian; Cholakis, Anastasia; Schroth, Robert; Todescan, Sylvia; Atout, Reem
Objective: The purpose of this pilot study was to evaluate the effects of photobiomodulation (PBM) with a 2940-nm Er:YAG laser on post-operative pain and wound healing at the palatal donor site of subepithelial connective tissue grafts (CTGs). Methods: Ten systemically healthy patients who required CTG surgery completed this randomized clinical trial. Participants were assigned to receive PBM therapy or sham laser treatment of the palate following harvest of the graft. Analgesic consumption was recorded, and a visual analogue scale (VAS) pain questionnaires completed for the first post-operative week. At one week, patients completed an Oral Impact on Daily Performance (OIDP) questionnaire. At one and two weeks, healing was evaluated according to a modified early wound-healing index (MEHI) and the healing index of Landry, Turnbull and Howley (HI). Patients returned at six weeks for assessment of tissue thickness and for collection of a tissue sample. Results: There were no significant differences in VAS scores, analgesic intake, or healing of the palate between the Test and Control groups. The Test group reported more frequent disruptions to doing light work, going out, sleeping, smiling, and interacting with others. Conclusions: Within the limitations of this study, PBM therapy with an Er:YAG laser did not impart any beneficial effects.
Open Access
A COMPARISON OF THE EFFICACY OF WATER FLOSSER TO INTERDENTAL FLOSS AROUND DENTAL IMPLANTS: A RANDOMIZED CONTROLLED TRIAL AND A QUALITATIVE STUDY OF PATIENTS' PERCEPTIONS
(2021) Sgarbanti, Carlo; Halas, Gayle; Stavropoulou, Chrysi; Cholakis, Anastasia
AIM The aim of this study was to determine the effectiveness of a water flosser device compared to flossing around implants in several clinical parameters and to investigate patients’ perceptions and experiences of implant maintenance. METHODS This study comprised an initial quantitative study and follow-up qualitative study. Patients were randomly divided in two groups, group 1 (experiment) with water flosser and group 2 (control) with dental floss. At each appointment five clinical parameters were recorded: Full Mouth Plaque Score (FMPS), Quigley-Hein plaque index (QHI), Probing Depth (PD), Bleeding on Probing (BOP) and width of Keratinized Tissue (KT) around implants. Patients were then interviewed to investigate perceptions of implant care and maintenance. RESULTS Twenty-four patients with a total of 76 implants completed at least one follow-up appointment. No statistically significant differences were found for any of the investigated parameters. The qualitative data collected with the interviews were reorganized into main themes: implant versus natural tooth care routines and the ‘impact’ of the study intervention. CONCLUSIONS Based on this study, dental floss and water flosser are equally effective in maintaining peri-implant health. The majority of the patients in water flosser group were in favour of this device and willing to continue using it. Longer term follow-up with a larger sample size could help to demonstrate impact in oral hygiene behaviour and clinical outcomes.
Open Access
Role of oral microbiota and intrinsic host factors in peri-implantitis – a pilot study
(2022-04-26) Enghiad, Setareh; Stavropoulou, Chrysi (Dr. Gerald Niznick College of Dentistry); Cholakis, Anastasia (Dr. Gerald Niznick College of Dentistry); Chelikani, Prashen (Dr. Gerald Niznick College of Dentistry); Bhullar, Raj
Introduction: Although many studies have evaluated microbial composition of peri-implant pockets, the role of mycobiome on peri-implantitis is not well established. Objectives: The aim of this study is to characterize the role of oral microbiota in peri-implant health and disease by determining the composition of the oral bacteriome and mycobiome from subgingival dental plaque, cytokine profile in the crevicular fluid, and to determine if there are any relationships between the oral microbiota, cytokine profile and peri-implant health and disease. Methods: Gingival crevicular fluid and subgingival plaque samples were collected from 20 periodontally healthy patients with healthy implants [Group H] and 9 periodontally healthy patients with peri-implantitis [Group P]. Eight IL-1β, IFN-γ, IL-2, IL-4, IL-6, IL-8, IL-10, and TNF-α were analyzed in crevicular fluid samples isolated from both groups. 16S rRNA and ITS rRNA amplicon sequencing was performed to detect bacterial and fungal species. Results: No statistically significant difference was found in concentrations of IL-2, IL-8, IL-10, and TNF-α. However, statistically significant differences were observed for IL-4 and IL-6. Alpha diversity analysis showed a significant difference between the groups H - Implant vs. P - Tooth and P - Implant vs. P - Tooth. Significant differences in species abundances were also observed between Group H and Group P. Candida parapsilosis and Aspergillus restrictus were significantly enriched in the Group P. Conclusions: To the best of our knowledge, this is the first time Aspergillus restrictus is related to peri-implantitis. Moreover, we found that the relative abundance of Candida parapsilosis is significantly higher in peri-implantitis sites. Our findings further challenge the concept that peri- implantitis is a bacterial disease with specific bacterial pathogens and strengthens the idea that bacterial invasion happens secondary to bone loss because of not very well understood processes such as foreign body reaction.
Open Access
Videoscope-assisted lateral maxillary sinus floor elevation: evaluation of the Schneiderian membrane for micro-perforations
(2022-06-30) Ohnander, Sarah; Stavropoulou, Chrysi (Dentistry); Kelekis-Cholakis, Anastasia (Dentistry); Harrel, Stephen (Texas A&M University); Stavropoulou, Chrysi
Introduction: Sinus floor elevation procedures are of a moderate to high complexity, entailing a significant risk of complications. The most frequent and common intra-operative complication is perforation of the sinus membrane. For the lateral window technique, perforation rates of 10% to 20% have been documented. Several studies have reported a correlation between perforation of the membrane and failure of the graft, as well as post-operative infection. In order to help identify perforations early, the authors evaluated the Schneiderian membrane for micro-perforations. The purpose of this case series was to identify the incidence of micro- perforations during lateral maxillary sinus elevation surgery. Case Series: Lateral maxillary sinus floor elevation was performed on 8 patients. A surfactant solution was applied topically to the exposed Schneiderian membrane. The presence of micro- perforations was assessed by observing for a bubbling effect after slight positive pressure. Evaluations were recorded using a videoscope, which provided magnification and additional lighting at the surgical site. Data was collected after evaluation of the membrane intra- operatively; post-operatively, the recordings of the procedure were randomised and evaluated by three periodontists. Conclusion: Use of a surfactant solution and videoscope evaluation did not reveal any incidence of micro-perforations on the Schneiderian membrane during lateral sinus lift.
Open Access
A Prospective Quality Control Study on Methods Used for the Treatment of Non-Complicated Mandibular Angle Fractures by Open Reduction and Internal Fixation in Manitoba
(2022-07-14) Howard, Ryan; Shah, Adnan (Dentistry); Elgazzar, Reda (Dentistry); Franca, Rodrigo (Dentistry); Shah, Adnan
Mandibular fracture is a common diagnosis that the Oral and Maxillofacial Surgeon is presented with, and its management is a critical skill for a competent trauma surgeon. One of the most commonly fractured regions of the mandible is that of the mandibular angle, found where the tooth-bearing corpus of the mandible meets the ascending ramus. While the mandibular angle fracture is a particularly common injury, there remains some openness in the interpretation of the best manner in which to establish fixation in these cases. The Oral and Maxillofacial Surgery Department at the University of Manitoba treats mandibular angle fractures by open reduction internal fixation using one of two typical plating orientations. The first method positions a miniplate angled along the superolateral aspect of the external oblique ridge spanning the fracture site, while the second method positions a miniplate strictly on the lateral aspect of the mandible across the fracture site. The purpose of this study was to compare the post-operative outcomes of these two plating methods. The study consisted of eighteen patients with mandibular angle fractures eligible for treatment by open reduction internal fixation that were randomly assigned to two treatment groups: Group A (N=8) with the miniplate oriented at the superolateral aspect of the mandible, and Group B (N=10) with the miniplate oriented on the lateral aspect of the mandible. Patients in each group were followed prospectively at 1-week, 4-week and 6-month post- operative time intervals for outcomes that included post-operative malocclusion, maximal interincisal opening, paresthesia, pain, swelling, development of infection, and surgical site dehiscence. There was no statistically significant difference found between the two plating orientation methods in each of the aforementioned outcomes.
Open Access
Efficacy of maxillary tuberosity connective tissue grafts in periodontal and peri-implant soft tissue procedures: a systematic review
(2023-03-21) Chung, Katie; Shah, Adnan (Dentistry); Soloman, Charlene (Dentistry); Cholakis, Anastasia (Dentistry); Stavropoulou, Chrysi
The objective of this systematic review was to assess the efficacy of maxillary tuberosity connective tissue grafts (MT-CTGs) in periodontal plastic surgeries at tooth and implant sites. An electronic search of literature in OVID, Embase, Cochrane and Scopus databases and a manual search up to August 2022 were performed to identify clinical studies at all levels of evidence with a minimum 3 month follow-up. Out of 880 potential publications, 10 studies were included, which included randomized controlled trials (RCTs), cohort studies and case reports. Due to study heterogeneity, a meta-analysis was not performed. Risk of bias was assessed with the Cochrane Risk of Bias 2 tool, the Newcastle-Ottawa Scale and the JBI Critical Appraisal checklist. MT- CTGs were more commonly utilized for peri-implant soft tissue augmentation, with keratinized mucosa thickness gain of 3-4 mm. Favourable gingival recession and mucosal dehiscence coverage outcomes, and satisfactory aesthetic ratings were reported though untoward hyperplastic tissue reactions at treated sites have also been documented. The limited evidence suggests MT-CTGs to be a sound soft tissue graft choice which may perform as well as lateral palate CTGs in periodontal soft tissue surgeries. Their true effect is yet to be determined with more well-designed long-term RCTs.
Open Access
A prospective evaluation of peri-operative glucocorticoid use in the management of cervicofacial infections of odontogenic origin
(2023-07-12) McCoy, Ryan; Shah, Adnan (Dentistry); Elgazzar, Reda (Dentistry); Mutalik, Sunil (Dentistry); Bhullar, Raj (Dentistry); Shah, Adnan; Elgazzar, Reda
Odontogenic cervicofacial infections requiring inpatient management are treated in a routine manner by oral and maxillofacial surgeons in Manitoba. After a standardized pre-operative workup, patients undergo surgical intervention including extraction of necessary teeth and incision and drainage of associated abscess(es). Patients are treated post-operatively with antibiotics, steroids, and medications for supportive care until appropriate for discharge. Benefits of intravenous corticosteroids in patients undergoing dentoalveolar and maxillofacial surgery include improved comfort, reduced post-operative edema, and shortened time to recovery. Corticosteroids also aid in reducing the risk of morbidity by limiting mass effect from edema and associated airway obstruction. In addition, their anti-inflammatory effect limits further swelling from manipulation of soft tissues during surgical procedures. Current literature supports the use of corticosteroids in the management of primary and deep space neck infections. However, corticosteroid dosing regimens are currently determined by the clinical judgment of the attending surgeon and are not standardized. The purpose of this study was to provide guidance for optimal dosing of methylprednisolone in the management of odontogenic cervicofacial infections. This prospective study followed the inpatient course of 28 patients with various cervicofacial infections of odontogenic origin. All patients were treated with a standardized surgical protocol, antibiotics, and steroids. Patients were randomized to receive one of two methylprednisolone dosing regimens. 14 patients were assigned to receive one dose of methylprednisolone 125mg IV at the time of surgery. The remaining 14 patients received one dose of methylprednisolone 125mg IV at the time of surgery and three consecutive doses of methylprednisolone 125mg IV every six hours post-operatively. Patients were evaluated at the time of hospital presentation and daily throughout admission. Outcomes evaluated included C-reactive protein (CRP) levels, white blood cell (WBC) count, length of hospital admission, and trismus. By examining differences in outcome success variables, the goal of this study was to support future evidence-based dosing decisions in the peri-operative treatment of inpatients in Manitoba. Data analysis showed a greater reduction in CRP throughout admission in the four-dose methylprednisolone group that was statistically significant. No significant difference in daily WBC count or trismus was found.
Open Access
Prevalence of neurovascular structures in the anterior mandible and differences based on dentition, age and sex; a retrospective cone-beam computed tomography study
(2023-07-13) Demers, Xavier; Huen, Galvin; Sunil, Mutalik (Dentistry); Kelekis-Cholakis, Anastasia (Dentistry); Hryniuk, Alexa (Human Anatomy and Cell Science); Bhuller, Raj (Dentistry); Stavropoulou, Chrysi
Objective: To assess the prevalence of lingual and incisive vascular structures in the anterior aspect of the mandible and to see the effect sex, age and dentition status may have. Methods: A total of 191 anonymized cone-beam computed tomography (CBCT) scans were assessed by a single calibrated operator. Incisive canals and lingual canals present between the mental foramina were counted, with location, size, dentition status in the lower anterior mandibular sextant, as well as the distance between the alveolar crest for the most coronal centered lingual canal being noted. Results: Lingual canals were present in the midline area in 96% and in the lateral areas in about 25% of cases. Incisive canals had a prevalence under 10% for a given area in the mandible. Most canals observed were below 1 mm in diameter. The most coronal lingual canal in the center was 2 mm closer to the alveolar crest in females and in patients showing a degree of edentulism in the anterior mandible, with dentate patients also showing an increased number of lingual canals below 1 mm in size at the midline. Furthermore, aging appeared to impact the presence of lateral lingual canals. Although unclear, the dentition status could also affect the presence of larger incisive canals. Conclusions: The anterior mandible features several structures visible on CBCT scans. The present findings suggest that sex, age and dentition status could have an effect on their presence. As such, the previous variables should be considered when planning surgical interventions in the area.
Open Access
The role of the oral microbiota and intrinsic host factors in peri-implant diseases: peri-implant mucositis versus peri-implantitis
(2024-08-11) Rozenblit, Amit; Kelekis-Cholakis, Anastasia (Dentistry); Chelikani, Prashen (Oral Biology); Bhullar, Raj (Dentistry); Stavropoulou, Chrysi
Aim: To characterize and compare the role of the oral microbiota and host biomarkers in patients with peri-implant mucositis and peri-implantitis. Methods: Patients diagnosed with either peri-implant mucositis (N=13) or peri-implantitis (N=20) were recruited from the Dr. Sam Borden Graduate Periodontics Clinic at the University of Manitoba. Subgingival plaque samples and crevicular fluid samples were collected from diseased implant sites and healthy natural teeth to study the local microbiome and host biomarker profiles, respectively. 16 rRNA and ITS rRNA amplicon sequencing were performed to detect bacterial and fungal species. Eight different cytokines were isolated and analyzed: IL-1β, IL-2, IL-4, IL-6, IL8, IL-10, IFN-γ, TNF-α. Results: Bacterial differential abundance analysis indicated statistically significant differences in the abundance of 17 different bacterial taxa and species between sites with peri-implant mucositis and peri-implantitis, most notably Tannerella forsythia was significantly more abundant at sites with peri-implantitis compared to sites with peri-implant mucositis. Fungal differential abundance analysis indicated that Malassezia species were significantly reduced in sites with peri-implant mucositis compared to sites with peri-implantitis. Cytokine analysis indicated no statistically significant differences in the crevicular concentrations of any cytokines analyzed between the peri-implant mucositis and peri-implantitis groups. Conclusion: Peri-implant mucositis and peri-implantitis have similar microbial communities and cytokine profiles; however, the presence of certain bacterial and fungal species may play a role in the transition between peri-implant diseases.
Open Access
Assessing the Biomechanical Impact of Dentition Types and Craniofacial Forms on Intact and Fractured Mandibles
(2024-08-26) Zakeri, Mahdi; Elgazzar, Reda (Dept. Oral and Maxillofacial Surgery); Bhullar, Rajinder (Dept. of Oral Biology); Todescan, Reynold (Dept of Prosthodontics); Rickey, Daniel (Dept of Radiology); Shah, Adnan
Currency, Oral and maxillofacial surgeon globally dealing with some challenges in Management of Mandibular fracture. It is imperative for clinician to have in depth understanding of biomechanic of the intact and fractured mandible to be able to improve the quality care and prevent further complications associated with the effectiveness of the open reduction and internal fixation of mandibular fracture. It is also important for clinician to have a thorough understanding of bone biology and the healing process, and how it is directly affected by mechanical and biological factors.

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