- ItemOpen AccessRole 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, RajIntroduction: 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.
- ItemOpen AccessPrevalence 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, ChrysiObjective: 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.
- ItemOpen AccessA 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, RedaOdontogenic 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.
- ItemOpen AccessEfficacy 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, ChrysiThe 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.
- ItemOpen AccessA 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, AdnanMandibular 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.