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UIC Clinic & Research Day 2014 Critically Appraised Topics An approach to pre-doctoral research opportunities Fifth Annual Competition.

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Presentation on theme: "UIC Clinic & Research Day 2014 Critically Appraised Topics An approach to pre-doctoral research opportunities Fifth Annual Competition."— Presentation transcript:

1 UIC Clinic & Research Day 2014 Critically Appraised Topics An approach to pre-doctoral research opportunities Fifth Annual Competition

2 L&L Agenda  Objectives Parameters How to find cases CaseCAT Poster Template CaseCAT Worksheet CaseCAT Literature Worksheet Judging Criteria Once you have identified a case Contact information

3 Objectives  To provide an opportunity for pre-doctoral students to engage in a patient based study to the level of scientific inquiry To facilitate the transformation of a patient based study to a case presentation that can be presented at Clinic and Research Day

4 Parameters How were treatment plans or outcomes for your patient affected by:  Treatment procedure  Patient health concerns  Therapeutic problems concerning patient  Unusual medications  Treatment consideration for medically compromised or patients with disabilities Example: Blood pressure medication that causes xerostomia  What are causes, how do you evaluate, how do you treat?

5 Where do I find cases? 1. Portfolio On medically compromised patients i.e. diabetes, hypertension Patients on 3 or more medically significant therapeutic medications 2. Screening Clinic/Urgent Care Diagnosis of an interesting patient issue 3. Rotations with specialty clinics Working with residents Examples include: Ortho (craniofacial anomaly), Perio (diabetes), Endo (implants)

6 Important Elements to Consider  Patient issue exemplifies problem Thoughtful description of case Adequate Documentation (must be de-identified) Photos and radiographs Axium page with charting Patient medical, dental history, chief complaint  Differential Diagnosis In many cases already preexisting diagnosis  Develop case to level of CAT Faculty, journals and internet as resources  IRB Issues Must be single case, case series not acceptable

7 SituationofConcern(Calibrifontsize60) StudentName Advisor CASE Placethecriticalelementsofyourcasehere…e.g.,ChiefComplaint,Hx,AXIUMdata,photos,etc. SCENARIO (preferablyinfontCalibri-minimumsize20) P… P: I… I: C… C: O… O: Placethecriticalelementsofyourcasehere…e.g.,ChiefComplaint,Hx,AXIUMdata,photos,etc. (preferablyinfontCalibri-minimumsize20) MESHTerms: CRITICALQUESTION Terms… Typeyoursearchablequestionhere…(preferablyinfontCalibri-minimumsize20) CASESIGNIFICANCE StudentSummary Typeyourbottomlinehere…(preferablyinfont Calibri-minimumsize20) CAT1 TypeyourCAThere…(preferablyinfontCalibri- minimumsize20) CAT2 TypeyourCAThere…(preferablyinfontCalibri- minimumsize20) CAT3 TypeyourCAThere…(preferablyinfontCalibri- minimumsize20) FUTUREDIRECTIONS Writefuturedirectionshere…(preferablyinfont Calibri-minimumsize20)

8 CaseCAT Worksheet

9 CaseCAT Worksheet

10 Should I use CavitTM, IRMTM, or KetacFillTM? Student: Michael P. Munaretto Advisor: Bradford Johnson, DDS MHPE, UIC Department of Endodontics CASE SCENARIO CAT (1) CAT (2) CAT (3) CRITICAL QUESTION CASE SIGNIFICANCE 29 y/o healthy female has full mouth radiographs taken as part of comprehensive oral examination. Periapical Radiolucencies are seen on teeth #4 and #5. Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both teeth. The following clinical tests were performed: Tooth Cold EPT Perc Palp Probing Mobility 3 WNL 31/80 WNL WNL 323B 323L 0 4 NR 80/80 WNL WNL 323B 323L 0 5 NR 80/80 WNL WNL 323B 323L 0 6 WNL 26/80 WNL WNL 323B 323L 0 P- Patients receiving root canal therapy I- Temporary restorative material (Cavit, IRM, or KetacFill [GI]) C- Definitive restoration O- Durability and resistance to coronal microleakage Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

11 ToothColdEPTPercPalpProbingMobility 3WNL31/80WNL 323B323L0 4NR80/80WNL 323B323L0 5NR80/80WNL 323B323L0 6WNL26/80WNL 323B323L0

12 CaseCAT Worksheet

13 TMTMTM ShouldIuseCavit,IRM,orKetacFill? Student:MichaelP.Munaretto Advisor:BradfordJohnson,DDSMHPE,UICDepartmentofEndodontics CASESCENARIO 29y/ohealthyfemalehasfullmouthradiographstakenaspartofcomprehensive Exam:EOEWNL.IOErevealslargeDOamalgamrestorationspresentonboth oralexamination.PeriapicalRadiolucenciesareseenonteeth#4and#5(see teeth.Thefollowingclinicaltestswereperformed: arrowsbelow). P-Patientsreceivingrootcanaltherapy I-Temporaryrestorativematerial (Cavit,IRM,orKetacFill[GI]) C-Definitiverestoration Diagnosis:#4and#5NecroticPulp,Asymptomatic(Chronic)ApicalPeriodontitis O-Durabilityandresistancetocoronal microleakage Treatment Plan:Non-surgicalRCT#4and#5.Multiplevisitswillberequired. CRITICALQUESTION MESHTerms: Forpatientsreceivingrootcanaltherapy,whichtemporaryrestorativematerial(Cavit,IRM,orRootCanalTherapy; KetacFillGI)comparesmostfavorablytothepropertiesofthedefinitiverestorationasmeasuredDentalRestoration, bydurabilityandresistancetocoronalmicroleakage?Temporary;Leakage CASESIGNIFICANCE FUTUREDIRECTIONS Writefuturedirectionshere…(preferablyinfont Calibri-minimumsize20) CAT(1) Beachetal.“ClinicalEvaluationofBacterial LeakageofEndodonticTemporaryFilling Materials.”JournalofEndodontics22:9pp Methods:51humanteethreceivedRCTinvivo. Afterobturationasterilepaperdiskwasplaced belowa4mmfillingofCavit,IRM,orTERM. Threeweekslaterthepatientswererecalled,the fillingswereremoved,andthepaperdiskswere analyzedforbacterialgrowth. Results/Conclusion:1/18IRMsamplesshowed bacterialgrowth,whereas0/19Cavitsamples showedgrowth.Nosignificantdifferencewas foundbetweenIRMandCavit. Validity/Applicability:Restorationtypewas randomlyassigned.Followupwas100%.invivo study.3weekfollow-uprealisticatUICCOD. LevelofEvidence:2(RandomizedControlledTrial) CAT(2) Bartheletal.“LeakageinRootsCoronally SealedwithDifferentTemporaryFillings.” JournalofEndodontics25:11pp Methods:103extractedsingle-rootedteeth receivedRCTandwerethenfilledwitheither Cavit,IRM,GI,Cavit/GI,orIRM/GI.Teethwere thenimmersedintoatwo-chambersystem whichwasinspecteddailyovera30-dayperiod forbacterialmicroleakage. Results/Conclusion:GIgavethebestseal againstbacteria(1/20samplesleaked), whereasCavitgavethepoorestseal(13/20 samplesleaked).11outof20IRMsamples leaked. Validity/Applicability:Resultsofinvitrostudies cannotdirectlybeappliedtoclinicalpractice. However,allavailablefillingmaterialstoUIC CODstudentsweretested. LevelofEvidence:6(Preclinicalstudy). CAT(3) Naoum&Chandler.“Temporizationfor Endodontics.”InternationalEndodonticJournal 35:pp Methods:Aliteraturereviewwasperformed usingMEDLINEandcontemporarytextbooksto assessvariousendodontictemporaryfilling materialsandtomakeclinicalrecommendations. Results/Conclusion:Cavitpossessesfavorable marginalsealbutinferiormechanicalproperties comparedtoIRM.StudieshaveshownthatIRM alsoprovidesafavorablemarginalseal, especiallywhenthepowder:liquidratiois decreased.GIismorecostly,buthasbeenfound tobeantibacterialandtohaveasuperiorseal; thusitmaybeusedforcasesoflong-term temporization. Validity/Applicability:Authorsdidnotprovidea detailedselectioncriteriaforarticlesreviewed. LevelofEvidence:5(ExpertOpinion) ToothColdEPTPercPalpProbingMobility 3WNL31/80WNL 323B323L0 4NR80/80WNL 323B323L0 5NR80/80WNL 323B323L0 6WNL26/80WNL 323B323L0

14 CaseCAT Worksheet

15 TMTMTM ShouldIuseCavit,IRM,orKetacFill? Student:MichaelP.Munaretto Advisor:BradfordJohnson,DDSMHPE,UICDepartmentofEndodontics CASESCENARIO 29y/ohealthyfemalehasfullmouthradiographstakenaspartofcomprehensiveExam:EOEWNL.IOErevealslargeDOamalgamrestorationspresentonboth oralexamination.PeriapicalRadiolucenciesareseenonteeth#4and#5(see teeth.Thefollowingclinicaltestswereperformed: arrowsbelow). P-Patientsreceivingrootcanaltherapy I-Temporaryrestorativematerial (Cavit,IRM,orKetacFill[GI]) C-Definitiverestoration Diagnosis:#4and#5NecroticPulp,Asymptomatic(Chronic)ApicalPeriodontitis O-Durabilityandresistancetocoronal microleakage Treatment Plan:Non-surgicalRCT#4and#5.Multiplevisitswillberequired. CRITICALQUESTION MESHTerms: Forpatientsreceivingrootcanaltherapy,whichtemporaryrestorativematerial(Cavit,IRM,orRootCanalTherapy; KetacFillGI)comparesmostfavorablytothepropertiesofthedefinitiverestorationasmeasuredDentalRestoration, bydurabilityandresistancetocoronalmicroleakage?Temporary;Leakage CASESIGNIFICANCE Fewinvivostudiesandnosystematicreviews existstudyingthistopic.However,fromthe availableevidencethefollowingconclusionscan bedrawn: 1.Cavitprovidesanadequatesealoveratleast3 weeksasrevealedbyaninvivostudy(1). However,duetoitspoormechanicalproperties, itsuseshouldbereservedonlyforconservative accesseswhereocclusalforcesareminimal(3). 2.IRMprovidesanadequatesealoveratleast3 weeksasrevealedbyaninvivostudy(1).Its mechanicalpropertiesaresuperiortoCavitandit isthereforeindicatedforwheneverthetoothwill beregularlysubjectedtoocclusalforces.Asthe powder:liquidratioisdecreased,theseal improves(attheexpenseofmechanical properties).(3) 3.GIhasbeenfoundinaninvitrostudytohavea superiorsealtoCavitandIRM(2).Becauseof this,GIhasbeenrecommendedforlongerterm temporization(3). 4.Studieshaverecommendedthatadefinitive restorationbeplacedassoonaspossible followingobturation(2,3). CAT(1) Beachetal.“ClinicalEvaluationofBacterial LeakageofEndodonticTemporaryFilling Materials.”JournalofEndodontics22:9pp Methods:51humanteethreceivedRCTinvivo. Afterobturationasterilepaperdiskwasplaced belowa4mmfillingofCavit,IRM,orTERM. Threeweekslaterthepatientswererecalled,the fillingswereremoved,andthepaperdiskswere analyzedforbacterialgrowth. Results/Conclusion:1/18IRMsamplesshowed bacterialgrowth,whereas0/19Cavitsamples showedgrowth.Nosignificantdifferencewas foundbetweenIRMandCavit. Validity/Applicability:Restorationtypewas randomlyassigned.Followupwas100%.invivo study.3weekfollow-uprealisticatUICCOD. LevelofEvidence:2(RandomizedControlledTrial) CAT(2) Bartheletal.“LeakageinRootsCoronally SealedwithDifferentTemporaryFillings.” JournalofEndodontics25:11pp Methods:103extractedsingle-rootedteeth receivedRCTandwerethenfilledwitheither Cavit,IRM,GI,Cavit/GI,orIRM/GI.Teethwere thenimmersedintoatwo-chambersystem whichwasinspecteddailyovera30-dayperiod forbacterialmicroleakage. Results/Conclusion:GIgavethebestseal againstbacteria(1/20samplesleaked), whereasCavitgavethepoorestseal(13/20 samplesleaked).11outof20IRMsamples leaked. Validity/Applicability:Resultsofinvitrostudies cannotdirectlybeappliedtoclinicalpractice. However,allavailablefillingmaterialstoUIC CODstudentsweretested. LevelofEvidence:6(Preclinicalstudy). CAT(3) Naoum&Chandler.“Temporizationfor Endodontics.”InternationalEndodonticJournal 35:pp Methods:Aliteraturereviewwasperformed usingMEDLINEandcontemporarytextbooksto assessvariousendodontictemporaryfilling materialsandtomakeclinicalrecommendations. Results/Conclusion:Cavitpossessesfavorable marginalsealbutinferiormechanicalproperties comparedtoIRM.StudieshaveshownthatIRM alsoprovidesafavorablemarginalseal, especiallywhenthepowder:liquidratiois decreased.GIismorecostly,buthasbeenfound tobeantibacterialandtohaveasuperiorseal; thusitmaybeusedforcasesoflong-term temporization. Validity/Applicability:Authorsdidnotprovidea detailedselectioncriteriaforarticlesreviewed. LevelofEvidence:5(ExpertOpinion) ToothColdEPTPercPalpProbingMobility 3WNL31/80WNL 323B323L0 4NR80/80WNL 323B323L0 5NR80/80WNL 323B323L0 6WNL26/80WNL 323B323L0

16 To oth ColdEPTPercPalpProbingMobility 7WNL35/ B/32 3L 0 8WNL24/ B/42 3L 0 9WNL36/ B/32 3L 0 10WNL32/ B/32 3L 0 Direct Pulp Capping: Mineral Trioxide Aggregate (MTA) or Calcium Hydroxide (Dycal)? Student: Andrea Venizelos Advisors:Satish Alapati, BDS,MS,PhD; BradfordJohnson, DDS, MHPE, UIC Department of Endodontics CRITICAL QUESTION During caries excavation on a mature adult tooth a pinpoint pulp exposure (<1mm) is noticed, for increased survival of the tooth, which material should be used for pulp capping: MTA (Mineral Trioxide Aggregate) or Calcium Hydroxide (Dycal)? CAT 1 Olsson et al. “Formation of a Hard Tissue Barrier After Pulp Capping in Humans. A Systematic Review.” International Endodontic Journal 36pp Methods: A PubMed and Central literature search with specific terms were made. Level of evidenceof the publications was assessed. Results/Conclusion: 21 publications remained after interpretation. None had a high level of evidence, one had moderate level of evidence, and 20 had a low level of evidence. Evidence grade was determined to be insufficient. Does not imply that there is no effect of a pulp capping procedure, but rather a need for high- quality studies. Capping material included calcium hydroxide, bonding materials, Vitrebond, synthetic hydroxyapatite, isobutyl cyanoacrylate, andMTA. Validity: Had valid inclusion criteria, and evaluated LOE. LOE: 1(Systematic Review) CAT 2 Aeinehchi et al. “Mineral Trioxide Aggregate (MTA) and Calcium Hydroxide as Pulp-Capping Agents in Human Teeth: A Preliminary Report.” International Endodontic Journal 36 pp Methods: 22 maxillary third molars were subjected to mechanical pulp exposure. Pulp capping material was either MTA or calcium hydroxide, covered with ZOE and restored with amalgam. Extractions were after periods of 1 week, 2 months,and 6 months. Results/Conclusion: Less inflammation, hyperemia and necrosis plus thicker dentinal bridge and more common odontoblast layer formation with MTA was found than with calcium hydroxide. Validity: Direct pulp capping material was randomly assigned. Small sample size, large drop-outof patients. LOE: 2(RandomizedControlledTrial) CAT 3 Nair et al. “Histological, Ultrastructural and Quantitative Investigations on the Response of Healthy Human Pulps to experimental Capping with Mineral Trioxide Aggregate: A Randomized Controlled Trial.” International EndodonticJournal 42pp Methods: A pulpal exposure was made in 35 healthy maxillary third molars from 23 patients. Pulp capping material was either MTA or Dycal. 33 of these teeth were histo- morphologically processed. Cavities were restored with IRM. Extractions were after periodsof 1 week, 1 month,and 3 months. Results/Conclusion: Pulp exposures treated with MTA were essentially free from inflammation and covered with hard tissue bridges. Teeth treated with Dycal had less hard tissue formation, more pulpal inflammation, and seepageof material into thepulp. Validity: Direct pulp capping material was randomlyassigned.Follow upwas 100% LOE: 2(RandomizedControlledTrial) CASE SIGNIFICANCE Student Summary Few in vivo studies are available on this topic. However, from the available evidence the following conclusionscan bedrawn: 1. Calcium hydroxide does not adhere to the dentin and lacks the ability to seal. Seepage of material into the pulp is probable. Hard tissue bridges that form are incomplete and present with tunnel defects that act as a pathway for microleakage. 2. Pulp defects treated with MTA have less inflammation, less hyperemia, more stable hard tissue bridges with increased thickness, and are free from tunnel defects. MTA shows greater ability to providea fluid-tight seal. 3. MTA has a much greater cost than calcium hydroxide. 4. There is a need for more high-quality studies for MTA to definitively be the material of choice for direct pulpcapping. CASE SCENARIO Duringcaries excavationona mature adult tootha pinpointpulpexposureis noticedand pulp cappingis indicated. P… Adult with pinpointpulp exposure(<1mm) I…Direct pulpcapping C…Material ((Mineral Trioxide Aggregate(MTA)or Calcium Hydroxide(Dycal)) O…Increasedsurvival of tooth MESH Terms: Dental Pulp Capping; Pulpal Response; Mineral Trioxide Aggregate; Calcium Hydroxide Exam:EOEWNL. IOEreveals large DBIL carious lesion. Diagnosis: #8 Normal Pulp with NormalPeriapical TreatmentPlan: Excavatecaries and restore.RCT notindicated

17 Ideal Luting Agent for a Zirconia Abutment Student: Shivam Patel Advisor: Dr. Satish Alapati CASE SIGNIFICANCE Student Summary CRITICAL QUESTION Fora patient receivingan imlpant in an estheticzonewith a Zirconia basedabutment, what is theideal luting agentthat will provideadequateretentionto preventdislodgement? CAT 1 NejatidaneshF, Savabi O, ShahtoosiM. “Retentionofimplant-supportedzirconium oxideceramic restorationsusingdifferent luting agents.”Clin Oral Implants Res.2011Nov 14. Methods:20ITI abutments(5.5mmheight)and ITI implant analogs mountedto acrylic blocks. 90ZrO 2 copings(Al 2 O 3 abraded).Copings conditionedin artificial saliva and thermocycled and cementedw/ various cements. Results/Conclusion: Resinbasedand RMGI luting agentsare mostretentive.Cement selection shouldbebaseduponsite as well as optionfor retrievability. Validity/Applicability: Studylimitations were monotonicstatic load, in vivo forceshave dynamicloading.Fatigueof cementsunderload notanalyzedbutdata presentedand each specimenonlysubjectedto onevariable (luting agent). Levelof Evidence:Level 5 – Benchtopresearch CAT 2 Kim, Min-Jeong,et al. "ShearBondStrengthsof various LutingCementsto Zirconia Ceramic: SurfaceChemical Aspects." Journalof dentistry 39.11(2011): Methods:Mutiple cementtypeswerebonded to sandblastedZrO 2 (Lava). Specimenswere storedin water at 37 degreesC and other½ thermocycled.Shearbondstrengthsand surface energyparameterswererecorded. Results/Conclusion: Panavia F 2.0andPrinciple producedhigherbondstrengthsthan other cementsw/ nosignificant differencesbeforeor after thermocycling. Validity/Applicability: Thestudysuggeststhat surface energyparametersshouldbe importantconsiderationsin determiningwhich luting agentshouldbeutilized for proper adhesion.Various surface treatmentsshould beincorporatedfor comparison Levelof Evidence:Level 5 – Benchtopresearch CAT 3 EkfeldtA, FürstB, Carlsson GE. “Zirconia abutmentsforsingle-toothimplant restorations: a retrospectiveand clinical follow-upstudy.” Clin Oral Implants Res. 2011Nov;22(11): Methods:Part 1 – Retrospectiveevaluationof 130patientsw/ 185STIrestorations w/ ZrO 2 abutments.Part 2 – Clinical examof 25 patients w/ 40restorationsplaced >3 yrs ago.93 cementedw/ zinc phosphate,1 w/ resin cement, 1 w/ TempBond Results/Conclusion: ZrO 2 abutmentshad low rate of technical andbiological complications, soft tissue respondedwell. Validity/Applicability: Multiple focus parametersw/ short follow up butvast data collection. Protocolfor surgeryandrestoration standardizedand positive3-5year success. Levelof Evidence:Low Level 3 – Retrospecitve analysis and clinical follow upstudy Many studies have been conducted on ZrO 2 plates/discs and the vast majority of search results were in vitro studies. Systematic reviews were not available as the material in question is still fairly newin thescopeof dental practice. The topic has helped me realize the importance of material science and its place in dentistry. Bonding concepts, biocompatibility, and physical/chemical properties are factors that contribute a great deal to success within the oral cavity. Based on my research resin based luting agents are the best candidates for cementation onto a ZrO 2 substrate such as an implant abutment. Air abrasion, priming, and trebochemical treatments are all areas for future research to determine the best alternative to increase bond strengths in the zirconia material without compromisingits physical/chemical integrity. CASE SCENARIO P – Patientreceivinga zirconia implant abutment I – Resin basedluting cement C – Conventionalcement O – Adequatebondstrengthbetweenfinal restoration andabutment MESH Terms: Zirconia abutment LutingAgent Implant Bonding Meanmicrotensile bondstrengthsforceramic bondedto compositegroups. 24 y/o hispanic female presents after traumatic avulsion #25. She would like to have a fixed restoration, preferably a dental implant. Esthetics and function are her primary concern. IOE reveals a thin soft tissue biotypewhich may havean adverseoutcomeif stock/titanium abutmentis utilized. Mean(standarddeviation)of dislodgining forcesof the studiedcement(N) groups.

18 CaseCAT Literature Worksheet

19 Evaluation Sheet

20 Once you have identified a case:  Identify a mentor Primary Contact: Group Practice Manager All project Titles should turned in to Katherine Long at ASAP Talk to previous participants

21 Questions? CaseCAT contacts: Dr. Crowe Dr. Knight Elizabeth Razdolsky


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