Objectives: Human bone density varies between areas of the maxilla and mandible. Orthodontists place Temporary Anchorage Devices (TADs) in all parts, guided by bone porosity and intra-oral location. These decisions may influence TAD stability, defined as the amount of interlocking between the TAD and bone immediately after insertion. The aim of the study was to evaluate the effect of bone mineral density (BMD) on TAD stability in vitro.Methods: Porcine jawbone samples were collected from a local slaughterhouse and maintained hydrated. Samples were created by sectioning rectangular blocks of approximately 1.5×1.5×3 cm3 from different jaw locations and scanned using SkyScan 1127 with appropriate settings (16 mm pixel size, large camera, 100Kv, 100mA, 10W, 180° rotation, and 0.5Al filter). The BMD of the samples was quantified by converting the x-ray attenuation coefficients to BMD. Twenty (n=20) Rocky Mountain TADs of 1.6 mm × 8 mm were inserted perpendicular to the surface of the bone samples. To evaluate TAD stability, all TADs were subjected to a tangential force on an Instron machine until the TADs were displaced 2.5 mm. The force required to displace the TADs overtime was recorded, and the slope was calculated to determine resistance to displacement. Results: The mean BMD, resistance to displacement and yield point were 1.20 g/cm3 ± 0.12, 95.57 N/mm ± 29.14, and 29.04 N ± 10.78. Our results indicate no significant relationship between BMD and TAD resistance to displacement, and between BMD and yield point, as determined by Pearson correlation test (0.109, -0.188) and a two-tailed significance test (p = 0.647, p = 0.428), respectively. Conclusion: Data from this study design did not reveal any association between BMD and TAD stability. Changes in the study protocol such as, bone harvesting from jaw sites with lower BMD, or alterations in TAD length might provide different results. / Oral Biology

Objectives: Temporary anchorage devices (TADs) provide skeletal anchorage for orthodontic tooth movement. TAD stability is defined as device retention during treatment. Insertion of TADs can either be hand-driven, relying on tactile sensation, or electric-driven, with established presets with specific torque and speed. Although device manufacturers claim that electric-driven insertion provides greater stability, this is currently unsubstantiated. The aim of this study was to compare stability, as measured by resistance to deflection, and insertion time of TADs placed using these two methods.Methods: Twenty TADs (Rocky Mountain Orthodontics; 1.6mm x 8mm) were inserted into synthetic bone blocks mimicking palatal bone: 20 PCF with a 1mm cortical plate of 40 PCF (Sawbones USA). TADs were inserted by two methods, hand-driven (n=10) and electric-driven (n=10; at 10 N•cm, 15 RPM) perpendicular to the surface of the bone blocks. All TADs were subjected to a tangential force using an Instron machine until their deflection measured 2.5mm. The force versus displacement over time was recorded and the slope was calculated to determine resistance to deflection. The insertion time was recorded for each TAD. Results: Hand-driven TADs had a mean resistance to deflection (76.30 N/mm ± 11.70), yield point (43.61 N ± 4.34), and insertion time (28.929 s ± 3.47). Electric-driven TADs had a mean resistance to deflection (79.34N/mm ± 17.95), yield point (40.81N ± 4.58), and insertion time (77.642 s ± 7.21). An independent samples t-test revealed no significant difference in TAD resistance to deflection (p=0.658) or yield point (p=0.177) between the two groups. Hand insertion time was on average 2.68 times faster (p=0.000) than electric insertion time. Individual measurements had small standard deviations, indicating reliability to the experimental approach. Conclusion: There are no significant differences in stability between hand-driven and electric-driven TADs when studied by this method. These results indicate that electric drivers may require more operating time and do not necessarily provide more TAD stability. / Oral Biology

Objectives: Medicaid Insurance Provider funding decisions often differ from the orthodontic clinician, assessed by malocclusion indices used for approvals. This study analyzed differences between clinician and insurance, insurance providers, and time of year for funding approval of orthodontic treatment. Since many American orthodontic graduate programs utilize Medicaid access to care as their predominant source, our sample evaluated Temple’s University Orthodontic cohort, between January 1st, 2018 and Dec 31st, 2019. Methods: The sample included 1,576 individuals, with 926 insured by Company 2 or Company 3 and the remaining 207 insured by either Company 1, Company 4, Company 5, or Company 6. Malocclusion severity evaluation had an inter-examiner reliability ≥90%, using the Salzmann Evaluation Index, with a score of ≥25 determining treatment need. These scores along with intra and extra oral photographs, a cephalogram and panorex, and an intra oral scan were sent to the Insurance Provider, an employee of the insurance provider received the records submitted and made a funding decision. Results: Company 3 displayed the highest similarity to the orthodontic clinician’s assessment, agreeing 69.7% of the time. Company 2 and Company 4 showed the lowest similarity at 39.8% and 33.3% agreement respectively. Company 2 and Company 3 were significantly different from each other in the way they determined eligibility for funding with a P-value of <0.000. The time of year was significant, p-value <0.01, only for Company 3, with the highest agreement similarity in May at 73.2% and the lowest in November at 30.3%. Conclusions: Company 2 funds a significantly lower percentage of individuals submitted with a SEI score of ≥25 than all other Providers, excluding Company 4. These findings suggest that Company 2 is evaluating individuals significantly different from orthodontic clinicians, raising potential access to care concerns. The time of year was significant only for Company 3, although no overall trend was observed.

Objectives: Various indices exist to determine priority for orthodontic treatment need. The American Association of Orthodontists (AAO) Auto-Qualifiers (AQs) are proposed criteria to standardize treatment priority. We investigated how the AAO Auto-Qualifier criteria compares to the Salzmann Index (SI) for determining treatment need, and thus Medicaid funding for orthodontic treatment. Methods: 81 subjects were previously screened, with completed SI scores, at Temple University Kornberg School of Dentistry (TUKSoD) between December 2019 and February 2020. Records were analyzed using the AAO Auto-Qualifier criteria. AQ results were compared to funding decisions by Insurance Company A, one of the primary Medicaid insurance companies for patients seeking treatment at TUKSoD. Malocclusion characteristics for transverse (presence of posterior crossbite), vertical (presence of open bite or deep bite) and sagittal (Class I, II, or III or presence of anterior crossbite) dimensions were recorded when funding decisions were discrepant between Insurance Company A and the AQs. Results: Funding approval by Insurance Company A and potential approval based on the AAO AQs was found to be 37.04% and 44.44%, respectively. Funding agreement between the two assessments was 77.7% (Cohen’s kappa = 0.56). Disagreement occurred with malocclusion characteristics identified in all three dimensions, most often sagittal. Crowding or spacing ≥10mm (in either arch) and impinging overbite with evidence of occlusal contact into the opposing soft tissue were the two most common Auto-Qualifiers that resulted in funding approval. Crowding or spacing ≥10mm (in either arch) and anterior and/or posterior crossbite of ≥3 teeth per arch were the most common AAO AQs that disagreed with SI scores. Conclusions: There is a moderate level of agreement for determining Medicaid funding for orthodontic treatment between Insurance Company A (based on SI scores) and the proposed AAO AQs. Adopting the proposed AAO Auto-Qualifiers nationally may result in a greater number of approvals for Medicaid funding for patients seeking orthodontic treatment in states that utilize Salzmann Index scores for determining funding decisions. / Oral Biology

Background: Dental implants have become a standard of care in dentistry in order to replace missing teeth. The high success rates of implant placement have been reported in the literature. However, in the last decade there is an increasing evidence of implant failure. Thus, there has been huge emphasis in the prevention, management and treatment of peri-implantitis. Periodontal pathogens such as P. gingivalis play major role in peri-implantitis. Nonsurgical and surgical intervention with adjunctive use of antimicrobials and laser disinfection to treat peri-implantitis are not always successful in complete decontamination of the pathogens. There is a need to develop minimal invasive therapies that remove pathogens and promote the regeneration of periodontal tissues. Moreover, hydrogels have found applications in dentistry for periodontal and pulpal tissue regeneration in conjunction with the nonsurgical and surgical therapies in dentistry. Currently, the Smart Biomaterials Lab is developing a piezoelectric hydrogel incorporated with barium titanate (BTO) fillers that offer antibacterial effects. The light curable hydrogel can be injected in the periodontal/peri-implant pockets to provide antimicrobial effects against periodontal pathogen. Objective: The aim of this study is to evaluate the antimicrobial effects of piezoelectric hydrogel against P. gingivalis for the treatment of peri-implantitis. Materials and methods: Two groups of biomaterials were tested. Group 1 consisted of BTO (GelMA hydrogel with piezoelectric fillers BTO), Group 2 consisted of GelMA only (hydrogel with no fillers), and control group (biofilms were grown in an empty well) called Empty well. Hydrogel samples were tested under two conditions including static and cyclic loading (1 N and 2 Hz) to activate the antibacterial effects. The antibacterial activity was evaluated by measuring metabolic activity (via MMT) and colony-forming unit. Results: the mean metabolic activity showed no statistically significant difference between BTO, GelMA and control under static and cyclic loading conditions. Log CFU of the 3 groups showed same results under static and cyclic loading condition however, the small sample size for CFU assay made it hard to obtain conclusive results. Conclusions: with the limitations of this study, there was no antimicrobial effect of BTO against P. gingivalis at magnitude 1 N and frequency of 2 Hz. Further studies will be conducted to investigate the antimicrobial effect of BTO against P. gingivalis when the magnitude is 2 N and frequency is 10 Hz for piezoelectric charge production / Oral Biology

Objective: The aim of this study was to research the efficacy of Povidone (PVP) Iodine as an adjunct to scaling and root planing (SRP) in reducing periodontal pocket depth (PPD) compared to scaling and root planing with water, saline, or no rinse in the treatment of chronic periodontitis among adult patients. Material and methods: An electronic search of the databases PubMed, EMBASE, Cochrane Library, Medline, and Dentistry & Oral Sciences Source (DOSS) were performed from 2010 up to January 2022. A single reviewer identified and selected screened abstracts and titles for possible inclusion, and assessed randomized, controlled clinical trials comparing the additional benefit of PVP-Iodine in the treatment of chronic periodontitis in adult patients. A meta-analysis was conducted to analyze the eight studies included. Results: The pool effects for split mouth design and randomized control trials was significant in favoring the control group. A mean reduction of periodontal pocket depth (PPD) favoring the control group was observed, this reduction was 0.93 mm, (95% CI: 0.66–1.2) (p = 0.00, fig. 2a) for split mouth design studies and a reduction of 0.61 mm, (95% CI: 0.2-1.02) (p=0.004, fig. 2b) for randomized controlled trials (RCTs). There was significant heterogeneity between the split mouth studies and RCTs, i2 = 89.7 and i2 = 83.9, respectively. The studies included administered different concentrations and irrigation frequencies of PVP-iodine, presented with different baseline pocket depths, and evaluated different teeth. Based on the studies included, there was no additional benefit of adjunct use of PVP-iodine with SRP in improving PPD reduction. Conclusion: The adjunctive use of PVP-iodine during scaling and root planing does not improvement pocket depth reduction. However, due to the high heterogeneity between studies more clinical trials should be conducted to evaluate PVP-iodine efficacy in deeper pockets. / Oral Biology

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