Monish Bhola

University of Detroit Mercy, Detroit, MI, United States

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Publications (25)15.07 Total impact

  • Clinical Advances in Periodontics. 11/2013;
  • Clinical Advances in Periodontics. 11/2012; 2(4):250-255.
  • Monish Bhola
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    ABSTRACT: La stabilité primaire d'un implant dentaire est essentielle à la réussite de l'ostéointégration. La macro-géométrie d'un implant et sa nano-surface, influencent respectivement le degré de stabilité de l'implant et le taux d'ostéointégration. Ces deux caractéristiques influent sur le délai de mise en charge d'un implant dentaire et donc la restauration définitive. Le succès de l'ostéointégration d'un implant est assuré par sa stabilité primaire [1], ce qui représente un défi dans de l'os de type IV, en particulier dans la région maxillaire postérieure, En dehors des considérations liées à l'hôte, la conception de l'implant joue un rôle essentiel pour obtenir une bonne stabilité primaire. Des recherches ont été effectuées par les fabricants d'implants dentaires sur l'état de surface et le design de l'implant (forme, diamètre, longueur, spires) et les techniques chirurgicales ont évolué afin d'obtenir la meilleure stabilité primaire possible [2].
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    ABSTRACT: Individuals with human immunodeficiency virus (HIV) have an increased risk of developing health problems, including some that are life threatening. Today, dental treatment for the population with a positive HIV diagnosis (HIV+) is comprehensive. There are limited reports on the outcomes of intraoral surgical therapy in patients with HIV, such as crown lengthening surgery (CLS) with osseous recontouring. This report investigates the outcome of CLS procedures performed at an urban dental school in a population of individuals with HIV. Specifically, this retrospective clinical analysis evaluates the healing response after CLS. Paper and electronic records were examined from the year 2000 to the present. Twenty-one individuals with HIV and immunosuppression, ranging from insignificant to severe, underwent CLS. Pertinent details, including laboratory values, medications, smoking history/status, and postoperative outcomes, were recorded. One such surgery is described in detail with radiographs, photographs, and a videoclip. Of the 21 patients with HIV examined after CLS, none had postoperative complications, such as delayed healing, infection, or prolonged bleeding. Variations in viral load (<48 to 40,000 copies/mL), CD4 cell count (126 to 1,260 cells/mm(3)), smoking (6 of 21 patients), platelets (130,000 to 369,000 cells/mm(3)), and neutrophils (1.1 to 4.5 × 103 /mm(3)) did not impact surgical healing. In addition, variations in medication regimens (highly active anti-retroviral therapy [18]; on protease inhibitors [1]; no medications [2]) did not have an impact. The results of this retrospective analysis show the absence of postoperative complications after CLS in this population with HIV. Additional investigation into this area will help health care practitioners increase the range of surgical services provided to this group of patients.
    Journal of Periodontology 07/2011; 83(3):344-53. · 2.40 Impact Factor
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    ABSTRACT: Implant placement in the posterior maxillary region is often compromised due to anatomic limitations. Often, factors like inadequate vertical dimension, poor bone quality, and undercuts result in placement of shorter and/or angled implants. The bone-added osteotome sinus floor elevation technique can be employed in many clinical situations that involve minimal bone height, resulting in increased bone height and placement of longer implants. This article will briefly review the literature and provide a detailed description of the technique as well as present multiple cases in which this procedure was used.
    Compendium of continuing education in dentistry (Jamesburg, N.J.: 1995) 06/2011; 32(1):E4-9.
  • Source
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    ABSTRACT: Excessive gingival display is a frequent finding that can occur because of various intraoral or extraoral etiologies. This report describes the use of a mucosal coronally positioned flap for the management of a gummy smile associated with vertical maxillary excess and hypermobility of the upper lip. A 24-year-old female presented for consultation regarding a gummy smile. At full smile the average gingival display ranged from 2 to 4 mm. A clinical examination revealed hypermobility of the upper lip and absence of generalized altered passive eruption. A cephalometric analysis pointed to the presence of vertical maxillary excess. The surgical procedure consisted of an elliptical mucosal excision followed by coronal advancement of the flap. This procedure aimed to limit the activity of the elevator muscles and reestablish the depth of the vestibule. Rapid surgical healing with minimal postoperative sequelae was observed. The patient reported significant reduction of gingival display at 1 week, which was maintained at the 1-year postoperative visit. Reduction in the amount of gingival display at the 1-year follow-up visit was stable. For patients desiring a less invasive alternative to orthognathic surgery, the mucosal coronally positioned flap is a viable alternative. We demonstrate short-term successful use of this technique for the management of excessive gingival display in the presence of slight vertical maxillary excess and hypermobility of the upper lip. Long-term follow-up studies are needed to determine stability of the results.
    Journal of Periodontology 12/2010; 81(12):1858-63. · 2.40 Impact Factor
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    ABSTRACT: When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone-added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone-added osteotome sinus floor elevation technique. We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone-implant gap when indicated. All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months. Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.
    Journal of Periodontology 11/2010; 82(6):820-8. · 2.40 Impact Factor
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    ABSTRACT: There are numerous reports of oral surgical procedures in patients undergoing highly active antiretroviral therapy. In the general population, the success of immediate implant placement for replacing teeth is well documented. The number of human immunodeficiency virus (HIV)-positive patients seeking comprehensive dental care, including implant therapy, continues to increase. Aside from a solitary case report published 12 years ago, there is very limited evidence describing immediate implant placement in the HIV-positive population. The two cases described herein demonstrate successful immediate implant placement in this population. Two white male patients aged 48 and 55 were scheduled to undergo extraction of a mandibular premolar. Both patients were HIV-positive, receiving highly active antiretroviral therapy, and were closely monitored by their physicians. On the day of the surgical procedure, atraumatic extractions were completed, osteotomies prepared in the ideal orientation, and implants placed. The bone-to-implant gap was >1.5 mm in Case 2, which required particulate bone graft placement. Case 1 did not need additional bone grafting. In Case 1, the healing abutment was placed at the time of implant placement, whereas a second-stage surgical procedure was performed for Case 2. Patients were seen at 2 and 4 weeks for postoperative assessment. No adverse postoperative sequelae were observed, and both implants integrated and were successfully restored. Immediate implant placement in HIV-positive patients is a viable and successful treatment option. To our knowledge, only one other similar report exists. It is hoped that this case report adds to the body of evidence supporting immediate implant placement in the HIV-positive population.
    Journal of Periodontology 11/2010; 82(3):505-11. · 2.40 Impact Factor
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    ABSTRACT: Predictable regeneration of lost periodontal tissues in furcations is difficult to achieve. This paper investigates the efficacy of different treatment modalities for Class II molar furcations. Publications in English were searched using PubMed, Medline, and Cochrane Library databases combined with hand searching from January 1, 1966 to October 1, 2007. The search included randomized controlled human trials in molar Class II furcations with over 6 months of surgical reentry follow-up. Changes in vertical probing depths, vertical attachment levels, and vertical and horizontal bone levels were compared. The search identified 801 articles of which 34 of 108 randomized clinical trials met the criteria. Thirteen trials had test and control arms allowing three meta-analyses: 1) five comparing non-resorbable versus resorbable membranes, 2) five comparing non-resorbable membranes versus open flap debridement and 3) three comparing resorbable membranes versus open flap debridement. There was significant improvement for resorbable versus non-resorbable membranes mainly in vertical bone fill (0.77 ± 0.33 mm; [95% CI; 0.13, 1.41]). Non-resorbable membranes showed significant improvement in vertical probing reduction (0.75 ± 0.31 mm; [95% CI; 0.14, 1.35]), attachment gain (1.41 ± 0.46 mm; [95% CI; 0.50, 2.31]), horizontal bone fill (1.16 ± 0.29 mm; [95% CI; 0.59, 1.73]), and vertical bone fill (0.58 ± 0.11 mm; [95% CI; 0.35, 0.80]) over open flap debridement. Resorbable membranes showed significant improvement in vertical probing reduction (0.73 ± 0.16 mm; [95% CI; 0.42, 1.05]), attachment gain (0.88 ± 0.16 mm; [95% CI; 0.55, 1.20]), horizontal bone fill (0.98 ± 0.12 mm; [95% CI; 0.74, 1.21]) and vertical bone fill (0.78 ± 0.19 mm; [95% CI; 0.42, 1.15]) over open flap debridement. Guided tissue regeneration with the use of resorbable membranes was superior to non-resorbable membranes in vertical bone fill. Both types of membranes were more effective than open flap debridement in reducing vertical probing depths and gaining vertical attachment levels and in gaining vertical and horizontal bone.
    Journal of Periodontology 11/2010; 82(3):413-28. · 2.40 Impact Factor
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    ABSTRACT: Gingival recession is a frequent clinical finding in the general population. Exposed root surfaces are more likely to develop root sensitivity and root caries and pose esthetic concerns for the patient. Most root coverage procedures have been described on non-restored root surfaces. Limited data are available that describe root coverage procedures on restored root surfaces. To our knowledge, this is the first case report in which a severe recession defect and its associated carious lesion were managed using the combination of a lateral sliding flap and a resin-modified glass ionomer restoration in an HIV-positive individual. A 53-year-old male patient with a 25-year history of HIV infection presented for comprehensive care. The facial surface of tooth #22 had a fractured composite restoration, recurrent decay, and a Miller Class III recession defect. The lesion was restored with resin-modified glass ionomer and root coverage was obtained by a lateral sliding flap mobilized from the adjacent edentulous ridge. After 8 weeks, surgical access was used to correct a previously undetected void in the restoration. Uneventful healing was observed at the 1-, 4-, 8-, 10-, 12-, and 24-week postoperative visits. Root coverage of 5 mm along with a 2-mm band of keratinized tissue was obtained at 24 weeks. The gingiva displayed no signs of inflammation and was tightly adapted to the root surface with minimal probing depths circumferentially. Successful root coverage was obtained on a resin-modified glass ionomer-restored surface in an HIV-positive individual.
    Journal of Periodontology 04/2010; 81(4):632-40. · 2.40 Impact Factor
  • Nomahn Humayun, Junu Ojha, Monish Bhola
    The Journal of the Michigan Dental Association 12/2009; 91(12):38, 40, 42-3.
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    ABSTRACT: The dental treatment of HIV-positive individuals has undergone a change from the management of HIV-associated oral lesions to routine comprehensive dental care. To the authors' knowledge, this is the first report in which palatal soft tissue grafts were used for vestibuloplasty in an HIV-positive patient with a shallow mandibular vestibule. No adverse sequelae were seen during follow-up.
    Journal of the California Dental Association 08/2009; 37(7):467-70.
  • Russell Thaler, Junu Ojha, Monish Bhola
    The Journal of the Michigan Dental Association 05/2009; 91(4):44, 46-7.
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    ABSTRACT: The purpose of this report is to provide a brief literature review of the bone-added osteotome sinus floor elevation (BAOSFE) procedure and to present a case utilizing this technique. Implant placement in the posterior maxillary region is often compromised due to anatomic limitations. In clinical situations where there is inadequate vertical bone dimension, the BAOSFE technique can be employed to increase bone height and allow placement of implants with an appropriate length dimension. A case of a 60-year-old female with inadequate vertical bone dimension in the area of an extracted #13 is presented. The BAOSFE technique was performed which facilitated the placement of a 3.75 X 13 mm implant. Anatomic limitations such as inadequate vertical bone dimension in the posterior maxillary region may result in placement of shorter implants. Sinus floor elevation (SFE) procedures using a crestal approach such as the BAOSFE, in certain selected cases, can effectively and predictably increase bone height. The BAOSFE technique is an excellent procedure that can overcome limitations associated with the posterior maxillary region.
    The journal of contemporary dental practice 02/2009; 10(3):81-8.
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    ABSTRACT: ABSTRACT The role of occlusion in periodontal disease has always been a challenging topic. A good understanding of the current status of the relationship of occlusion and periodontitis is of paramount importance in order for dental clinicians to provide adequate and comprehensive periodontal treatment in patients presenting with traumatic occlusion. This article reviews the literature regarding the relationship between occlusion and periodontitis and presents recommendations for clinical practice based on available evidence. Clinical cases illustrating the complexity of this relationship and their management are presented.
    Journal of the California Dental Association 01/2009; 36(12):924-30.
  • Jacob Steiger, Aaron Zeevi, Monish Bhola
    The Journal of the Michigan Dental Association 01/2009; 90(12):40-6.
  • Monish Bhola, Bassam M Kinaia, Katy Chahine
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    ABSTRACT: Post extraction sites may have residual ridge deformities with insufficient bone present for future implant placement. This presents a challenge to the clinician attempting to obtain optimum results. To predictably augment these areas and obtain aesthetically pleasing results, bone grafting may be required. Guided bone regeneration with an allograft material is a predictable means by which to solve this challenge. This article describes three case presentations utilizing on allograft material for bone regeneration prior to implant placement.
    Practical procedures & aesthetic dentistry: PPAD 11/2008; 20(9):551-7; quiz 558.
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    ABSTRACT: Root coverage using the lateral sliding flap technique presents many potential benefits to patients with localized recession defects. By using the tissue adjacent to the recession defect, the lateral sliding flap allows for correction of the defect without the discomfort encountered during other grafting techniques associated with palatal donor sites. This procedure is a time efficient, less invasive, and highly aesthetic treatment option for managing isolated recession defects. The following case series describes this technique and demonstrates its efficacy in various clinical settings.
    Practical procedures & aesthetic dentistry: PPAD 09/2008; 20(7):437-43; quiz 444, 432.
  • Holly Halliday, Sara Gordon, Monish Bhola
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    ABSTRACT: A 24-year-old woman had a red mass (2.4 x 1.4 cm) on her left maxillary gingiva (between teeth No. 11 and 12) that interfered with normal occlusion and speech. Although pyogenic granuloma was the clinical diagnosis, histopathologic examination revealed that the lesion was actually focal fibrous hyperplasia with focal mucinosis degeneration. This article illustrates the role of the oral and maxillofacial pathologist in establishing an accurate diagnosis of oral lesions and discusses the differential diagnosis of gingival enlargements.
    General dentistry 01/2007; 55(3):232-5.
  • Jeremy Michaelson, Monish Bhola
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    ABSTRACT: A case report of the oral manifestations of sickle cell anemia is presented, with emphasis on the radiographic features of the disease and the surgical management of periodontal defects. The pathogenesis and clinical course of the disease are discussed, along with a review of clinical characteristics and management protocols. Recommendations for genetic counseling and an update of research in gene therapy of sickle cell anemia are also presented.
    The Journal of the Michigan Dental Association 10/2004; 86(9):32-5.