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INTRODUCTION: This thesis explores findings from three trials utilizing a mouse in-vitro calvarial model. The primary aim was to establish a reproducible in-vitro bone tissue model for testing the inductive and conductive potential of materials for bone regeneration. MATERIALS AND METHODS: Trial I: Assessed the behavior of normal calvarial bone under laboratory-standard conditions protocol with (DMEM). Histological examinations and micro-CT were analyzed on 10 specimens over 18 days. Trial II: Evaluated the effects of ascorbic acid (AA) in three different culture media formulae on a critical size defect repair. Histological examinations and alkaline phosphatase (ALP) activity were analyzed on 40 specimens over 21 days. Trial III: Explored the potential of "DAG" (dexamethasone, ascorbic acid, β-glycerophosphate) as an osteoinductive stimulus using (DMEM). Histological examinations and ALP activity were analyzed on 20 specimens over 36 days. Micro-CT scans were conducted on four samples, one selected from each group. RESULTS: Trial I: Histological observations demonstrated a significant reduction in cellular activity and thinning of the periosteal layer from day 0 to day 18. Micro-CT analysis indicated an increased bone mineral density over time (n=1 for each time period). Trial II: Treatment with α-MEM supplemented with 200 mg/L AA led to complete closure of a 2 mm defect, while treatment with α-MEM containing 50 mg/L AA resulted in a dramatic reduction in calvarial bone thickness and cellular density. DMEM with 150 mg/L AA preserved the defect size and bone structure with minimal changes. Trial III: Histological examinations, ALP activity, and micro-CT analysis revealed elevated levels of cell activity in DAG-treated groups relative to saline controls, with the highest cell proliferation and migration observed in Group 4, treated with OSSIX® Plus and DAG. CONCLUSIONS: Trial I: Our findings underscore the importance of timely intervention when using this model to test materials with osteogenic potential, to capitalize on the thick periosteal layers present at the time of harvest. Trial II: AA concentration in the culture medium profoundly impacted bone development. DMEM with 150 AA and a 2 mm defect can be defined as a reproducible critical size defect in an in-vitro mouse calvarial model. Trial III: DAG induced cell migration and proliferation and has potential for directed induction of bone cell migration. / 2026-05-28T00:00:00Z

INTRODUCTION: Effective diagnosis and treatment planning are necessary for attaining favorable results in immediate implant placement and restoration following tooth extraction. In assessing a patient's suitability for dental implants, a comprehensive approach is imperative, tailored to the needs of the individual. These may include detailed medical and dental histories, clinical imagery such as photographs, study casts, and radiographic assessments including periapical and panoramic views, along with linear or computerized tomography scans specifically targeted to the intended implant sites. Each of these components contributes crucial insights, guiding the treatment process towards optimal outcomes. AIM: The primary aim of this study was to analyze anatomic variations of the maxillary bicuspid root as a reflection of its socket for insight in immediate implant placement. The secondary goal was to assess the relationship of the immediate implant placement to the apices of maxillary bicuspid teeth and implant crown restoration. MATERIALS & METHODS: DICOM files from the periodontal department's CBCT library, containing de-identified data, were examined using Invivo 6 software to analyze the maxillary premolars anatomy. Root dimensions were assessed, as a reflection of the residual socket, assuming no bone loss post-extraction, with specific anatomic considerations reviewed and measured. A total of 83 CBCT files from adult patients treated at Boston University Henry M. Goldman School of Dental Medicine were randomly selected from the Periodontology database. Sixty-one of these patients were found to have intact premolar dentition. No demographic information was provided. In total, 200 maxillary first and second premolars from these patients were evaluated for root morphology, length, dimensions, and their distance from the maxillary sinus floor using Invivo CBCT software. Roots (sockets) were classified as Type 1, 2 or 3. RESULTS: Maxillary 1st premolar socket types: Amongst a total of 104 Maxillary 1st premolars, 67 were Type-1, 30 were Type-2 and 7 were Type-3. Maxillary 2nd premolar socket types: Amongst total of 97 Maxillary 2nd premolars, 12 of were Type-1, 38 were Type-2 and 47 were Type-3. The average root length of the maxillary 1st and 2nd Premolars were measured from CEJ to Apex in Mesial/Distal cross-section view on the Invivo CBCT Software. The average length of the Maxillary 1st Premolars was 14.01mm whereas the Maxillary 2nd premolar length was 12.60mm. Average distances from apex of Maxillary 1st Premolars to sinus floor were measured in both Buccal/Lingual and Mesial/Distal views in CBCT (Invivo software). The average distance from the apex to the floor of the sinus in M/D view was 5.28mm and in B/L view it was 7.44mm. The average distance from the apex of the Maxillary 2nd Premolars to the sinus floor were measured in both B/L and M/D views in CBCT (Invivo software). Distance from apex to floor of the sinus in M/D view was 2.66mm and in B/L view it was 3.73mm. CONCLUSION: To optimize esthetic and functional outcomes, treatment plans should be based on comprehensive knowledge of the root socket anatomy. Immediate implant placement in the maxillary premolars presents challenges due to variations in root morphology, anatomical landmarks, and alveolar bone availability and quality. Type I root form, predominantly found in first premolar sites, offers substantial alveolar bone support, making it suitable for immediate implant placement with high primary stability. The presence of a narrow palatal root in the first premolar Type I root with a corresponding narrow socket can enhance stability and facilitate proper prosthetically driven of the implant positioning. Conversely, the Type III root form, common in the maxillary second premolar sites, offers less alveolar support. The proposed root form classification system discussed in the current study enhances understanding and aids in treatment planning, emphasizing the importance of evaluating internal bone socket geometry during implant placement. Precise consideration of root anatomy and the root form classification presented in this study informs decision-making, and will foster effective communication among clinicians.

Objective: The mandibular canal, which houses the inferior alveolar neurovascular bundle, is a critical anatomic structure that needs to be accurately identified for mandibular dental procedures such as dental implant placement, extractions, and endodontic procedures. Damage to the mandibular neurovascular bundle can cause both neurologic damage and bleeding concerns. “Bifid” mandibular canals are a normal anatomic variation of mandibular canals. The purpose of this study is to identify the prevalence of bifid canals, use the Naitoh classification system to classify the bifid canals, and to measure the height of alveolar bone above the most superior portion of the mandibular canal. Other factors such as gender and ethnicity were evaluated for association with bifid canal prevalence.Methods: Retrospective analysis of 1,006 mandibular CBCT scans of patients treated at the Temple Kornberg School of dentistry were analyzed using Xelis software. Age, gender, ethnicity, and dentition status were recorded for each patient in the study. For each scan the right and left mandibular canals were identified as singular or bifid, and the height of alveolar bone above the most superior border of the mandibular canal at the right and left first molar position was recorded. Descriptive statistics, bivariate analyses, and multivariable regression analyses were performed using “R” statistical software. Results: After exclusion, 558 CBCT scans were included in the study. Of the 558 patients, 247 were male and 311 were female. Based on ethnicity: there were 170 African Americans, 53 Asians, 263 Caucasians, and 72 Hispanics. 76 of the patients had a complete mandibular dentition, and 482 were missing at least 1 tooth in the mandible. The prevalence of bifid mandibular canals in the study population was 12.54%. There was no significant difference in the prevalence of bifid canals in relation to gender or ethnicity. The height of alveolar bone above the most superior border of the mandibular canal at the first molar position ranged from (2.2mm to 28.4mm) with an average of 15.25mm. There was a significantly greater height of alveolar bone in fully dentate compared to partially edentulous patients (p < 0.001), and there was a significant negative correlation between alveolar bone height above the mandibular canal and age (p <0.045). Conclusions: Bifid mandibular canals are present in 12.54% the population studied, and the prevalence does not vary by gender, or ethnicity as past studies have proposed. Further, alveolar height above the mandibular canal decreases with age and tooth loss. Therefore, it is critically important to obtain CBCT imaging of the mandible before performing implant, oral surgical, or endodontic procedures to prevent neurosensory and/or bleeding complications and improve patient care. / Oral Biology

Introduction: Dental implant placement has become an increasingly popular method of tooth replacement. CBCT imaging has revolutionized dental implant planning by providing a three-dimensional view of intra-oral dental structures. The lingual concavity is a concave area located on the lingual surface of the posterior mandible. Perforation of the lingual concavity is associated with floor of the mouth bleeding and upper airway obstruction. A thorough understanding of the mandibular ridge morphology is critical to avoid surgical complications associated with lingual cortex perforations. The objective of this study was to assess the morphology of the anterior and posterior mandibular lingual ridges, determine the prevalence of the posterior lingual concavity, measure the average length and depth of the concavity, and investigate the influence of gender, ethnicity, smoking status, and history of periodontal disease on mandibular ridge morphology. Materials and Methods: The study was a retrospective analysis initially involving 1006 CBCT scans obtained from Temple University – Kornberg School of Dentistry from January 2020 to July 2022. Inclusion criteria included subjects who were above the age of 18. Exclusion criteria included subjects who were under the age of 18, subjects who received limited field of view CBCTs, and scans that were unintelligible due to scatter. 552 CBCT scans met the inclusion criteria and were included in the final analysis. Data was recorded on anterior and posterior mandibular lingual ridge shape, location, length, and depth. Results: The mean age of subjects at the time of CBCT scan acquisition was 55 years. The study included 310 females and 242 males. 545 subjects (99%) presented with a convex mandibular anterior lingual ridge morphology. The average length in millimeters of the anterior lingual convexity was 19.01mm. There was a significant relation between anterior ridge length and smoking status (ANOVA, F=4.819, p=0.016). There was also a significant mean difference in anterior ridge length based on the history of periodontal disease (t-test, t=8.683, p<2.2e-16). The most prominent location of the mandibular lingual anterior convexity was at the central incisor site in 514 subjects. 332 subjects presented with a lingual concavity in the right posterior mandible (60.1%). 330 subjects presented with a lingual concavity in the left posterior mandible (59.8%). The average length in millimeters of the lingual concavity was 12.73mm and 12.35mm for the right and left posterior mandible. The average depth in millimeters of the lingual concavity was 2.03mm and 1.96mm for the right and left posterior mandible respectively. The most common location of the posterior mandible lingual concavity was found at the right first molar site in 184 subjects (52%) followed by right second molar in 165 subjects (46%) and the right second premolar in 6 subjects (2%). Conclusion: CBCT imaging can improve the ability of practitioners to identify the mandibular lingual concavity and pre-plan dental implants of adequate dimensions. This may prevent complications associated with lingual concavity perforations, including potentially life-threatening hemorrhages and airway obstruction. Further research should incorporate a broader range of confounding variables (systemic conditions, medication usage), to better understand their impact on mandibular lingual ridge morphology. / Oral Biology

Purpose: Empathy is a critical component of patient-centered care, and research has shown that itpositively impacts patient outcomes. This study examined the relationship between patient-rated provider empathy following a dental visit and subsequent adherence to follow-up visits. Method: Participants were recruited through outreach phone calls. Participants completed the Consultation and Relational Empathy (CARE) measure and the Modified Dental Anxiety Scale (MDAS). Univariate analyses (e.g., mean, percentages) and bivariate analyses (e.g., correlation and t-tests) were used. Logistic regression was used to determine the relationship between patient-rated empathy and attendance at follow-up appointments while controlling for potential confounding factors. Results: Participants included 148 patients seeking dental care at Temple University Kornberg School of Dentistry (TUKSoD). Participants were 43% male and 57% female, predominantly comprising Black or African American race (57%), and with a mean age of 50 years (SD=17.2). Participants had minimal dental anxiety based on MDAS scores (M=9.36, SD=4.47). Patients rated their providers highly empathic (M=46.67, SD=6.47, Range = 16-50). Based on the CARE measure, the participants who rated their dentists lower on empathy had significantly higher rates of cancelations (0.51 vs. 0.29, t=1.99, p=.049). Conclusion: Patients who perceive lower provider empathy cancel appointments more frequently, thus requiring a higher number of scheduled apportionments to complete treatment. Dentists who utilize empathy skills are likely to reduce scheduling disruptions. / Oral Biology

ABSTRACTObjective: This study aimed to evaluate the satisfaction levels of different materials used for the fabrication of dental veneers. Furthermore, it intended to fill a gap in the current literature by helping both participants and dentists to make a more informed decision when it comes to veneers selection. Methods: The study recruited participants from Temple University School of Dentistry. Participants received information about the study's purpose, risks, and benefits and provided verbal consent before completing a phone evaluation. A brief questionnaire composed of 20 questions assessed satisfaction with dental veneers in areas such as aesthetics, functionality, longevity, and overall satisfaction. The survey applied descriptive statistics, such as mean, standard deviation, and frequencies, to evaluate the characteristics of the sample. Results: A total of 288 patients were screened for the study and 61 participants agreed to participate. Participants were primarily female (68%). When asked to evaluate their satisfaction, participants reported high levels of satisfaction, with an average score of 4.51 out of 5, denoting a positive experience. Those with porcelain veneers reported slightly higher satisfaction levels (M=4.63). However, there were non-significant differences in satisfaction with aesthetics, functionality, longevity, and overall satisfaction between the two types of veneers. Conclusions: The study mainly aimed to compare participants’ satisfaction levels with porcelain and composite dental veneers and revealed high overall satisfaction levels with both materials. Demographic factors like age and gender did not predict satisfaction levels. These outcomes may have been restricted by multiple factors, such as the small sample size and limited range of satisfaction scores. / Oral Biology

Objectives: The oral cavity floor encompasses critical anatomical structures such as veins, arteries, nerves and glands. Life threatening hemorrhage and hematoma formation in the floor of the mouth may occur when injury to such vessels occur during dental surgery in the mandibular anterior region. Lingual foramina are located at the lingual surface of the mandible, which are often observed in the central and lateral incisors regions. Identification of mandibular median (MLF) and lateral (LLF) lingual foramina are important to avoid bleeding complications during dental implant site development and placement. Cone beam computed tomography (CBCT) is indicated to provide 3 dimensional images to evaluate anatomical structures. To assist our dental patients and dental practitioners, knowledge of clinical anatomy and frequency of finding vital structures is important and has clinical significances to achieve best treatment outcome and minimize health and procedure risk. The purpose of the study is to evaluate the prevalence of mandibular median and lateral lingual foramina in dental school population using cone beam computed tomography. Other variables such as gender, age, ethnicity, dentition status, number of canals, distance from lower border of mandible will also be evaluated.Methods: This study conducted a retrospective cross-sectional analysis using 558 CBCT scans from patients over 18 years, selected from a total of 1009 scans taken between January 2020 and July 2022 at the Temple University School of Dentistry, Philadelphia. The research aimed to identify the prevalence and characteristics of mandibular median and lateral lingual foramina, focusing on their number and distances from the base of the mandible and alveolar crest. Exclusions were applied to scans not meeting the study criteria. The primary outcomes, including the presence and specifics of the lingual foramen, were measured through CBCT imaging and categorized by location and presence percentages. Independent variables analyzed were gender, ethnicity, age, and dentition status. Results: This study included 558 patients subdivided by gender into 312 females and 244 males; by ethnicity into 266 Caucasians, 165 African Americans, 53 Asians and 72 Hispanics and by dentition status with 467 partial, 71 complete and 18 edentulous dentitions. Overall, 84.23% scans presented with median lingual foramen and 11.83% scans exhibited lateral lingual foramina. Average number of median lingual foramina per scan was found to be 1.11 located at central incisor region. Anatomical position of median foramen on average was 16.61 mm from alveolar crest to the foramen and 11.19 mm from foramen to the base of the mandible. Bivariate analysis indicated no significant associations between the presence and frequency of foramina and patient ages, genders, or ethnicities. However, status of the dentition whether edentulous, complete or partial significantly influenced the distance from the alveolar crest to the foramen with p=0.000017, emphasizing the importance of dentition in surgical planning and risk assessment. Conclusions: Our study confirms current consensus in prevalence of median and lateral lingual foramina in the mandibular anterior lingual region. Generalized prevalence across genders, ethnicities and age groups highlights the necessity for thorough pre-operative CBCT imaging and careful evaluation prior to planning implant surgeries. This study emphasizes the role of CBCT in identifying these anatomical structures, thereby aiding dental practitioners avoiding potentially life threatening risks associated with surgical procedures in anterior mandibular region. Awareness and understanding of prevalence and location of lingual foramina can significantly contribute to the patient safety and enhance success of dental procedures. / Oral Biology