Le développement rapide des nouvelles technologies numériques est en passe de révolutionner l’enseignement classique de l’odontologie comme dans de nombreuses spécialités médicales. En effet, l’avènement de nouveaux dispositifs alliant réalité virtuelle et dispositif haptique permettant de simuler au plus juste les gestes techniques de l’odontologie, laisse entrevoir la possibilité d’évaluer plus objectivement les compétences des futurs Chirurgiens-Dentistes et de renforcer la formation traditionnelle. Au travers de différentes expérimentations pédagogiques dans les domaines de l’implantologie, de la dentisterie restauratrice et de la chirurgie orale, nous avons voulu : (i) évaluer l’impact de la simulation haptique sur la formation en odontologie en nous focalisant sur l’implantologie et la dentisterie restauratrice ; (ii) définir de nouveaux paramètres pédagogiques pour essayer de les évaluer objectivement et estimer l’importance de la vision 3D en simulation / The rapid development of new digital technologies is revolutionizing the classical teaching of dentistry as in many medical specialties. Indeed, the advent of new devices combining virtual reality with a haptic device allowing to simulate the technical gestures of odontology, suggests the possibility to evaluate the skills of future Dentists more objectively and to strengthen traditional training. Through various educational experiments in the fields of implantology, restorative dentistry and oral surgery, we wanted to: (i) assess the impact of haptic simulation on odontology training by focusing on implantology and restorative dentistry ; (ii) define new objectively evaluable pedagogical parameters and to estimate the importance of 3D vision in simulation

In Zeiten einer wachsenden Zahl jährlich inserierter dentaler Implantate rückt der Erhalt von Zähnen mit unsicherer Prognose oftmals in den Hintergrund. Dies betrifft u. a. furkationsbefallene Zähne, im Speziellen, wenn der Befall fortgeschritten ist und/oder Molaren des Oberkiefers betrifft. Die in der Vergangenheit angewandte Therapie dieser Zähne mittels Entfernung einer oder mehrerer Wurzeln mitsamt des koronalen Anteils, der Hemisektion bzw. Trisektion, wird seltener genutzt. Nicht nur gegenüber der Extraktion und der darauffolgenden implantatbasierten prothetischen Versorgung hat sie ihren Wert eingebüßt, auch jüngere Behandlungsformen, wie z. B. die Guided Tissue Regeneration, konkurrieren mit ihr. Die vorliegende Arbeit befasst sich mit der Frage, welche Stellung die Hemisektion/Trisektion gegenüber Implantaten auf Grund der heutigen Datenlage einnimmt. Daneben werden weitere mögliche Behandlungsoptionen analysiert und der Hemisektion/Trisektion gegenübergestellt. Der zweite Teil dieser Arbeit beinhaltet die Anleitung zur Hemisektion/Trisektion und ihre Anwendung in einem dokumentierten Patientenfall. Schlüsselartikel der vorliegenden Arbeit war die Veröffentlichung von Fugazotto (2001). Um zusätzliche Informationen zu beschaffen, wurden verschiedene Institutionen und Fachgesellschaften konsultiert. Hierunter fielen u. a. die Kassenzahnärztliche Bundesvereinigung (KZBV 2018), die Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde e. V. (Deutsche Gesellschaft für Zahn- Mund- und Kieferheilkunde (DGZMK) 2005) und das Statistische Bundesamt (Destatis) in Zusammenarbeit mit dem Robert Koch-Institut (RKI) (GBE des Bundes 2020). Der theoretische Part des zweitens Teils basiert maßgeblich auf Yuodelis Erkenntnissen, publiziert in dem Lehrbuch „Periodontal Disease“ (Schluger et al. op. 1977).

Atherosclerosis is an insidious disease with serious morbidity and mortality including ischemic heart disease, stroke, and myocardial infarction. This condition is progressive and can start early in life eventually leading to large plaques and arterial occlusion. Two key components of this process are the immune system and lipids; in particular, LDL which accumulates within the arterial walls and macrophages which recognize and engulf oxidized-LDL (oxLDL) to form foam cells. Knowing that certain antibodies directed against bacterial antigens such as phosphorylcholine (PC) and cardiolipin (CL) show opsonizing cross-reactivity with oxLDL it can be proposed that there is a link between immune responses to periodontal bacteria and atherosclerosis. The aim of this investigation was to determine whether periodontal bacteria are capable of inducing serum antibodies potentially involved in cardiovascular diseases; specifically, IgG anti-PC, IgG anti-CL, and IgM anti-CL. To test this, 17 subjects with chronic periodontitis received scaling and root planing in conjunction with blood sample analysis to determine if periodontal instrumentation resulted in changes in these serum antibodies. If plaque bacteria are responsible for an immune response then serum levels of these antibodies should decrease following periodontal therapy. We found that serum levels of IgG anti-PC, IgG anti-CL, and IgM anti-CL decreased following periodontal scaling and root planing but the change was significant only for IgG anti-PC (P 0.045). Serum levels of IgM anti-CL approached significance (P 0.054). The results support the hypothesis that the immune response to periodontal bacterial microflora contributes to serum concentrations of antiphospholipid antibodies.

AIM: The aim of this investigation is to determine the prevalence of maxillary altered passive eruption in a dental school population. METHODS: 100 subjects were examined clinically and had models fabricated of their maxilla. Demographic, periodontal, cast measurements were recorded for each subject. Demographic variables recorded included age, gender, and ethnicity, history of orthodontic treatment, presence of incisal /occlusal wear, appearance of gingival excess, and presence of gingival asymmetry. Measurements made on cast included clinical crown length, clinical crown width, papillary height, and distance from the lateral gingival zenith to the gingival aesthetic line. Clinical crown width-to-length ratio was calculated. These measurements were compared to previously published standards. RESULTS: 83% of the subjects had central incisors with a clinical W:L ratio greater than .80. Logistical regression analysis determined that subjects with central incisors with an appearance of gingival excess were more likely to have a clinical W:L ratio greater than .80 (P<.0007; OR=79). ANOVA demonstrated that clinical crown length had a statistically significant relationship with gender (P<.0001), tooth type (P<.0001) and biotype (P<0.0026). Clinical crown width and clinical crown W:L ratio had a statistically significant relationship with gender (P<0.0007, P<.0001) and tooth type (P<0.0026, P<.0001). The average clinical crown length was 0.5-1.5 mm shorter than established ideal measurements. CONCLUSION: 83% of the subject population had central incisors that displayed altered passive eruption. Subjects who exceeded the clinical W:L ratio of .80 were more likely to have been classified as having the appearance of gingival excess or “gummy smile”. Esthetic crown lengthening should be considered to achieve desired esthetics in these subjects.

A radiografia é uma das ferramentas primárias de auxílio ao diagnóstico e monitoração do tratamento das doenças periodontais. Porém, a análise subjetiva dessas radiografias feita pelo dentista só consegue identificar lesões quando o quadro clínico apresenta perda acima de 30% do conteúdo mineral do osso, levando um sério desafio ao exercício da odontologia. Em muitas situações clínicas, o dentista também precisa ser capaz de quantificar o tamanho de uma lesão para determinar a taxa de progressão ou cura da doença. A técnica de subtração digital de radiografias provê a detecção de mudanças ósseas sutis, de cerca de 5%, levando ao diagnóstico precoce da doença e aumentando assim o sucesso de seu tratamento. Desta forma, o esquema de auxílio ao diagnóstico de reabsorção óssea periodontal através de subtração digital de radiografias odontológicas proposto no presente trabalho emprega a técnica de subtração digital de radiografias, onde duas radiografias odontológicas, tiradas em intervalos de tempos planejados, são subtraídas para obter uma nova imagem onde serão visíveis somente estruturas que mudaram de uma imagem em relação à outra. Será gerada uma imagem que auxiliará o dentista a efetuar um diagnóstico precoce e instituir o melhor plano de tratamento, e assim acompanhar a resposta do tratamento a partir de novas imagens subtraídas. Na fase anterior à subtração, é necessário o alinhamento, para garantir que estruturas idênticas em ambas imagens estejam no mesmo local, e evitando que o resultado da subtração seja errôneo. O alinhamento consiste na marcação de 4 pontos em regiões de alto contraste em ambas as imagens para que a imagem subseqüente seja alinhada em translação e em rotação em relação à primeira. Posteriormente, uma técnica de correção de contraste é utilizada para corrigir eventuais diferenças de contraste. A subtração fornecerá três formas de visualização, na imagem subtraída, da área onde ocorreu uma reabsorção ou ganho ósseo. Uma delas é a subtração qualitativa, cujas áreas onde as imagens se mantiveram idênticas são mostradas em preto, e áreas onde ocorreram mudanças, em branco. A segunda é a subtração quantitativa, que gera a imagem subtraída em níveis de cinza, mostrando em tons de cinza uniformes áreas onde as imagens se mantiveram idênticas; em tons de cinza escuros, onde ocorreu reabsorção óssea; e em tons de cinza claros, onde ocorreu ganho ósseo. Além destas duas subtrações, há uma terceira subtração, a subtração quantitativa porcentagem-colorida, que mostrará a porcentagem de reabsorção ou ganho ósseo através de áreas coloridas na imagem. O intervalo de porcentagens poderá ser escolhido pelo dentista e a este intervalo poderá ser atribuída uma cor para visualização. Intervalos de porcentagens negativas indicam reabsorção óssea e intervalos de porcentagens positivas, ganho ósseo. Os testes realizados encontraram um erro médio de 7,5% no resultado da subtração, sendo que deste total, 3,5% é o erro introduzido pelo digitalizador. É importante ressaltar que esta taxa representa o erro não somente do algoritmo desenvolvido, mas também a propagação do erro em todas as etapas do processo, ou seja, aquisição, digitalização, alinhamento e subtração. Portanto, o erro da subtração deduzido do erro do digitalizador é de somente 4,0%. / Radiography is one of the primary features to help diagnose and monitor the treatment of periodontal diseases. However, the subjective analysis of these radiographs by the dentist only can identify lesions above 30% of mineral bone loss, leading to a serious challenge for the practice of odontology. In many clinical situations, the dentist needs to quantify the size of a lesion to determine the rate of progression or healing the disease. The digital subtraction radiography technique provides the detection of subtle bone changes, i.e., changes of around 5%, leading to an early diagnosis and enlarging the success of its treatment. The aided diagnosis scheme for periodontal bone resorption through odontological digital subtraction radiography proposed in this work employees the digital subtraction radiography technique, where two odontologic radiographs taken at intervals of planned times are subtracted to obtain a new image where only structures that have been changed from one image to the other will be visible. It will generate an image to help the dentist make an early diagnosis and establish the best treatment plan, besides accompanying the treatment’s response starting from new subtracted images. In the stage previous to the subtraction, the lining up is necessary to assure that identical structures on both images are in the same place, avoiding an erroneous result of the subtraction. It consists in marking 4 points in places with high contrast on both images for the subsequent image to be first lined up in translation and then in rotation in relation to the first one. Then, a contrast correction technique is used to correct possible contrast differences. The subtraction will provide three ways of visualization in the subtracted image of the area where a bone resorption or gain occurred. One of them is the qualitative subtraction, where areas kept identical are showed in black and areas where changes occurred are showed white. The second is the quantitative subtraction, which generates a subtracted image in gray levels, showing in uniform gray levels the areas where the images remained identical, in dark gray levels the areas where there was bone resorption and in light gray levels the area with bone gain. The third subtraction is called colored-percentage quantitative subtraction, which shows the percentage of bone resorption or gain through colored areas on the radiograph. The intervals of percentage can be chosen by the dentist and he/she can attribute a color for visualization to this interval. Negative percentage intervals indicate bone resorption and positive percentage intervals correspond to bone gain. The tests performed found a mean error of 7.5% in the result of the subtraction, of which 3.5% correspond to the error introduced by the digitalizer. It is important to stress that this rate represents the error not only for the algorithm developed, but the spreading of the error to all process stages, such as acquisition, digitalization, lining up and subtraction. Therefore, the subtraction error deduced from the digitalizer error is only 4,0%.

A radiografia é uma das ferramentas primárias de auxílio ao diagnóstico e monitoração do tratamento das doenças periodontais. Porém, a análise subjetiva dessas radiografias feita pelo dentista só consegue identificar lesões quando o quadro clínico apresenta perda acima de 30% do conteúdo mineral do osso, levando um sério desafio ao exercício da odontologia. Em muitas situações clínicas, o dentista também precisa ser capaz de quantificar o tamanho de uma lesão para determinar a taxa de progressão ou cura da doença. A técnica de subtração digital de radiografias provê a detecção de mudanças ósseas sutis, de cerca de 5%, levando ao diagnóstico precoce da doença e aumentando assim o sucesso de seu tratamento. Desta forma, o esquema de auxílio ao diagnóstico de reabsorção óssea periodontal através de subtração digital de radiografias odontológicas proposto no presente trabalho emprega a técnica de subtração digital de radiografias, onde duas radiografias odontológicas, tiradas em intervalos de tempos planejados, são subtraídas para obter uma nova imagem onde serão visíveis somente estruturas que mudaram de uma imagem em relação à outra. Será gerada uma imagem que auxiliará o dentista a efetuar um diagnóstico precoce e instituir o melhor plano de tratamento, e assim acompanhar a resposta do tratamento a partir de novas imagens subtraídas. Na fase anterior à subtração, é necessário o alinhamento, para garantir que estruturas idênticas em ambas imagens estejam no mesmo local, e evitando que o resultado da subtração seja errôneo. O alinhamento consiste na marcação de 4 pontos em regiões de alto contraste em ambas as imagens para que a imagem subseqüente seja alinhada em translação e em rotação em relação à primeira. Posteriormente, uma técnica de correção de contraste é utilizada para corrigir eventuais diferenças de contraste. A subtração fornecerá três formas de visualização, na imagem subtraída, da área onde ocorreu uma reabsorção ou ganho ósseo. Uma delas é a subtração qualitativa, cujas áreas onde as imagens se mantiveram idênticas são mostradas em preto, e áreas onde ocorreram mudanças, em branco. A segunda é a subtração quantitativa, que gera a imagem subtraída em níveis de cinza, mostrando em tons de cinza uniformes áreas onde as imagens se mantiveram idênticas; em tons de cinza escuros, onde ocorreu reabsorção óssea; e em tons de cinza claros, onde ocorreu ganho ósseo. Além destas duas subtrações, há uma terceira subtração, a subtração quantitativa porcentagem-colorida, que mostrará a porcentagem de reabsorção ou ganho ósseo através de áreas coloridas na imagem. O intervalo de porcentagens poderá ser escolhido pelo dentista e a este intervalo poderá ser atribuída uma cor para visualização. Intervalos de porcentagens negativas indicam reabsorção óssea e intervalos de porcentagens positivas, ganho ósseo. Os testes realizados encontraram um erro médio de 7,5% no resultado da subtração, sendo que deste total, 3,5% é o erro introduzido pelo digitalizador. É importante ressaltar que esta taxa representa o erro não somente do algoritmo desenvolvido, mas também a propagação do erro em todas as etapas do processo, ou seja, aquisição, digitalização, alinhamento e subtração. Portanto, o erro da subtração deduzido do erro do digitalizador é de somente 4,0%. / Radiography is one of the primary features to help diagnose and monitor the treatment of periodontal diseases. However, the subjective analysis of these radiographs by the dentist only can identify lesions above 30% of mineral bone loss, leading to a serious challenge for the practice of odontology. In many clinical situations, the dentist needs to quantify the size of a lesion to determine the rate of progression or healing the disease. The digital subtraction radiography technique provides the detection of subtle bone changes, i.e., changes of around 5%, leading to an early diagnosis and enlarging the success of its treatment. The aided diagnosis scheme for periodontal bone resorption through odontological digital subtraction radiography proposed in this work employees the digital subtraction radiography technique, where two odontologic radiographs taken at intervals of planned times are subtracted to obtain a new image where only structures that have been changed from one image to the other will be visible. It will generate an image to help the dentist make an early diagnosis and establish the best treatment plan, besides accompanying the treatment’s response starting from new subtracted images. In the stage previous to the subtraction, the lining up is necessary to assure that identical structures on both images are in the same place, avoiding an erroneous result of the subtraction. It consists in marking 4 points in places with high contrast on both images for the subsequent image to be first lined up in translation and then in rotation in relation to the first one. Then, a contrast correction technique is used to correct possible contrast differences. The subtraction will provide three ways of visualization in the subtracted image of the area where a bone resorption or gain occurred. One of them is the qualitative subtraction, where areas kept identical are showed in black and areas where changes occurred are showed white. The second is the quantitative subtraction, which generates a subtracted image in gray levels, showing in uniform gray levels the areas where the images remained identical, in dark gray levels the areas where there was bone resorption and in light gray levels the area with bone gain. The third subtraction is called colored-percentage quantitative subtraction, which shows the percentage of bone resorption or gain through colored areas on the radiograph. The intervals of percentage can be chosen by the dentist and he/she can attribute a color for visualization to this interval. Negative percentage intervals indicate bone resorption and positive percentage intervals correspond to bone gain. The tests performed found a mean error of 7.5% in the result of the subtraction, of which 3.5% correspond to the error introduced by the digitalizer. It is important to stress that this rate represents the error not only for the algorithm developed, but the spreading of the error to all process stages, such as acquisition, digitalization, lining up and subtraction. Therefore, the subtraction error deduced from the digitalizer error is only 4,0%.

Bone regeneration or augmentation is often required prior to or concomitant with implant placement. With the limitations of many existing technologies, a biologically compatible synthetic bone grafting substitute that is osteogenic, bioerodible, and provides spacing-making functionality while acting as a drug delivery vehicle for bioactive molecules could provide an alternative to ‘gold standard’ techniques. In the first part of this work, calcium sulfate (CS) space-making synthetic bone grafts with uniformly embedded poly(β-amino ester) (PBAE) biodegradable hydrogel particles was developed to allow controlled release of bioactive agents. The embedded gel particles’ influence on the physical and chemical characteristics of CS was tested. Namely, the compressive strength and modulus, dissolution, and morphology, were studied. All CS samples dissolved via zero-order surface erosion consistent to one another. Compression testing concluded that the amount, but not size, of embedded gel particles significantly decreased (up to 75%) the overall mechanical strength of the composite. Release studies were conducted to explore this system’s ability to deliver a broad range of drug types and sizes. Lysozyme (model protein for larger growth factors like bone morphogenic protein [BMP]) was loaded into PBAE particles embedded in CS matrix. The release of simvastatin, a small molecule drug capable of up regulating BMP production, was also examined. The release of both lysozyme and simvastatin was governed by dissolution of CS. The second part of this work proposed a bilayered CS implant. The physical and chemical properties were characterized similarly to the CS composites above. Release kinetics of directly loaded simvastatin in either the shell, core, or both were investigated. A sequential release of simvastatin was witnessed giving foresight of the composite’s tunability. The sequential release of an antibacterial, metronidazole, loaded into poly(lactic-co-glycolic acid) (PLGA) particles embedded into the shell along with directly loaded simvastatin either in the shell, core, or both layers was also observed. Through controlled release of bioactive agents, as well as a tunable layered geometry, CS-based implants have the potential to be optimized in order to help streamline the steps required for the healing and regeneration of compromised bone tissue.

La cicatrisation parodontale est un processus complexe, composé de quatre phases hautement intégrées (hémostase, inflammation, prolifération, remodelage), qui nécessite une interaction complexe entre les différents types tissulaires (épithélium, conjonctif, os) ainsi que la synthèse de médiateurs, tels que les hormones et les facteurs de croissance. La difficulté à pouvoir obtenir une régénération des tissus parodontaux est en partie due à la réponse inflammatoire qui interfère avec le processus de cicatrisation, via la surexpression des cytokines pro-inflammatoires, ainsi qu’à la croissance rapide des cellules épithéliales le long de la surface de la racine qui porte atteinte à la vraie organisation des tissus, essentielle à la régénération parodontale. Notre objectif a été de mettre au point des membranes nanofibreuses implantables à base de polycaprolactone (PCL) fonctionnalisés par plusieurs molécules actives (Alpha-Melanocyte Stimulating Hormone (α-MSH)), ibuprofène, atorvastatine) et implantables, permettant à la fois un contrôle physique et biochimique de la cicatrisation parodontale. En d’autres termes, nous avons cherché à ralentir la colonisation de la surface radiculaire par les cellules épithéliales et à moduler l’inflammation de la phase post-chirurgicale afin de promouvoir la cicatrisation parodontale. Pour cela, nous avons mis au point un modèle d’inflammation in vitro mimant le tissu superficiel du parodonte en utilisant des cellules parodontales, à savoir des kératinocytes et fibroblastes gingivaux humains, stimulées par du lipopolysaccharide de Porphyromonas gingivalis (LPS-Pg). Les résultats obtenus ont montré une bonne biocompatibilité des systèmes (α-MSH, ibuprofène) ainsi qu’une diminution de la prolifération, migration des kératinocytes, fibroblastes gingivaux humains et une diminution significative de l’expression des marqueurs pro- ou anti-inflammatoires (TNF-α, TGF-β, IL-6, IL-8), des marqueurs d’adhérence, de prolifération (Intégrine, Laminine, Fibronectine) et de remodelage (COL-IV). En conclusion, les stratégies développées (α-MSH, ibuprofène) au sein de notre laboratoire ont permis de mettre en évidence l’intérêt de délivrer une molécule anti-inflammatoire à partir d’un biomatériau et représentent un fort potentiel d’application clinique pour la parodontologie mais aussi pour la médecine de demain. / Periodontal wound healing is a process involving hemostasis, inflammatory phase, proliferation and maturation/matrix remodeling. These phases require cell-to-cell interaction of different cell types (epithelial cells, fibroblasts, osteoblasts, and cementoblasts) orchestrated by growth factors, cytokines and extracellular matrix components. After conventional periodontal therapy, wound healing corresponds more to tissue reparation than regeneration. This absence of true regeneration is considered to be mainly due to the competition between the different periodontal tissues (gingiva, cementum, alveolar bone) and the differential rate of proliferation, migration and differentiation of periodontal cells during wound healing. Therefore, the inflammatory response could interfere with the healing process depending on the secretion/activity level of matrix metalloproteinase (MMPs), cytokines, chemokines and also the imbalance with their antagonists/inhibitors, which leads to fibrosis and excessive scarring. Our aim was to develop implantable nano-fibrous membranes based on polycaprolactone (PCL) and functionalized by several active molecules (Alpha-melanocyte stimulating hormone (α-MSH)), ibuprofen, atorvastatin) allowing both physical control and biochemical periodontal healing features. Furthermore, we developed an in vitro inflammatory model mimicking the periodontal tissue surface, using periodontal cells ; keratinocytes and human gingival fibroblasts stimulated with lipopolysaccharide of Porphyromonas gingivalis (Pg-LPS). The results obtained showed good biocompatibility systems (α-MSH, ibuprofen) and a decrease in the proliferation and migration of keratinocytes, human gingival fibroblasts. Moreover, a significant decrease of pro- or anti-inflammatory markers expression (TNF-α, TGF-β, IL-6, IL-8), adhesion markers of proliferation (Integrin, laminin, fibronectin) and remodeling (COL-IV) could be achieved. In conclusion, the strategies developed in our laboratory (α-MSH, ibuprofen), have helped to highlight the interest of the release of an anti-inflammatory molecule from a biomaterial, and represented a strong potential for clinical application not only in periodontics but also in general medicine.

No description available.

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall health. A total of 66 NPs were included in the study, primarily female (91%) with master’s degrees (77%). While knowledge and education were not significantly associated, this research found significant associations between confidence and assessments, less than one-third (30.3%) were confident in their knowledge and ability to evaluate oral abnormalities.