UIC Clinic & Research Day 2014

1. UICClinic&ResearchDay2014 CriticallyAppraisedTopics Anapproachtopre-doctoralresearchopportunities FifthAnnualCompetition

2. L&LAgenda Objectives Parameters Howtofindcases CaseCATPosterTemplate CaseCATWorksheet CaseCATLiteratureWorksheet JudgingCriteria Onceyouhaveidentifiedacase Contactinformation         

3. Objectives Toprovideanopportunityforpre-doctoral studentstoengageinapatientbasedstudyto thelevelofscientificinquiry Tofacilitatethetransformationofapatient basedstudytoacasepresentationthatcanbe presentedatClinicandResearchDay  

4. Parameters Howweretreatmentplansoroutcomesforyour patientaffectedby: Treatmentprocedure Patienthealthconcerns Therapeuticproblemsconcerningpatient Unusualmedications Treatmentconsiderationformedically compromisedorpatientswithdisabilities Example:Bloodpressuremedicationthat causesxerostomia What arecauses,howdoyouevaluate,howdoyoutreat?

5. WheredoIfindcases? Portfolio 1. Onmedicallycompromisedpatientsi.e.diabetes, hypertension Patientson3ormoremedicallysignificanttherapeutic medications   ScreeningClinic/UrgentCare 2. Diagnosisofaninterestingpatientissue  Rotationswithspecialtyclinics 3. Workingwithresidents Examplesinclude:Ortho(craniofacialanomaly),Perio (diabetes),Endo(implants)  

6. ImportantElements toConsider Patientissueexemplifiesproblem Thoughtfuldescriptionofcase AdequateDocumentation(mustbede-identified)    Photosandradiographs Axiumpagewithcharting Patientmedical,dentalhistory,chiefcomplaint    DifferentialDiagnosis  Inmanycasesalreadypreexistingdiagnosis  DevelopcasetolevelofCAT  Faculty,journalsandinternetasresources  IRBIssues  Mustbesinglecase,caseseriesnotacceptable 

8. CaseCAT Worksheet

9. CaseCATWorksheet

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. PeriapicalRadiolucencies 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 PercPalp 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.

12. CaseCATWorksheet

14. CaseCATWorksheet

16. DirectPulpCapping:MineralTrioxideAggregate(MTA)or CalciumHydroxide(Dycal)? Student:AndreaVenizelos Advisors:SatishAlapati,BDS,MS,PhD;BradfordJohnson,DDS,MHPE,UICDepartmentofEndodontics CASESCENARIO Duringcariesexcavationonamatureadulttoothapinpointpulpexposureisnoticedandpulp cappingisindicated. P…Adultwithpinpointpulpexposure(<1mm) I…Directpulpcapping C…Material((MineralTrioxideAggregate(MTA)or CalciumHydroxide(Dycal)) O…Increasedsurvivaloftooth Exam:EOEWNL.IOErevealslargeDBILcariouslesion. Diagnosis:#8NormalPulpwithNormalPeriapical TreatmentPlan:Excavatecariesandrestore.RCTnotindicated MESHTerms: DentalPulpCapping;Pulpal Response;MineralTrioxide Aggregate;Calcium Hydroxide CRITICALQUESTION Duringcariesexcavationonamatureadulttoothapinpointpulpexposure(<1mm)isnoticed,for increasedsurvivalofthetooth,whichmaterialshouldbeusedforpulpcapping:MTA(Mineral TrioxideAggregate)orCalciumHydroxide(Dycal)? CASESIGNIFICANCE StudentSummary Fewinvivostudiesareavailableonthistopic. However,fromtheavailableevidencethe followingconclusionscanbedrawn: 1.Calciumhydroxidedoesnotadheretothe dentinandlackstheabilitytoseal.Seepageof materialintothepulpisprobable.Hardtissue bridgesthatformareincompleteandpresent withtunneldefectsthatactasapathwayfor microleakage. 2.PulpdefectstreatedwithMTAhaveless inflammation,lesshyperemia,morestablehard tissuebridgeswithincreasedthickness,andare freefromtunneldefects.MTAshowsgreater abilitytoprovideafluid-tightseal. 3.MTAhasamuchgreatercostthancalcium hydroxide. 4.Thereisaneedformorehigh-qualitystudies forMTAtodefinitivelybethematerialofchoice fordirectpulpcapping. CAT2 Aeinehchietal.“MineralTrioxideAggregate (MTA)andCalciumHydroxideasPulp-Capping AgentsinHumanTeeth:APreliminaryReport.” InternationalEndodonticJournal36pp225-231. 2003. Methods:22maxillarythirdmolarswere subjectedtomechanicalpulpexposure.Pulp cappingmaterialwaseitherMTAorcalcium hydroxide,coveredwithZOEandrestoredwith amalgam.Extractionswereafterperiodsof1 week,2months,and6months. Results/Conclusion:Lessinflammation, hyperemiaandnecrosisplusthickerdentinal bridgeandmorecommonodontoblastlayer formationwithMTAwasfoundthanwith calciumhydroxide. Validity:Directpulpcappingmaterialwas randomlyassigned.Smallsamplesize,large drop-outofpatients. LOE:2(RandomizedControlledTrial) CAT1 Olssonetal.“FormationofaHardTissue BarrierAfterPulpCappinginHumans.A SystematicReview.”InternationalEndodontic Journal36pp429-442.2006. Methods:APubMedandCentralliterature searchwithspecifictermsweremade.Levelof evidenceofthepublicationswasassessed. Results/Conclusion:21publicationsremained afterinterpretation.Nonehadahighlevelof evidence,onehadmoderatelevelofevidence, and20hadalowlevelofevidence.Evidence gradewasdeterminedtobeinsufficient.Does notimplythatthereisnoeffectofapulp cappingprocedure,butratheraneedforhigh- qualitystudies.Cappingmaterialincluded calciumhydroxide,bondingmaterials, Vitrebond,synthetichydroxyapatite,isobutyl cyanoacrylate,andMTA. Validity:Hadvalidinclusioncriteria,and evaluatedLOE. LOE:1(SystematicReview) CAT3 Nairetal.“Histological,Ultrastructuraland QuantitativeInvestigationsontheResponseof HealthyHumanPulpstoexperimentalCapping withMineralTrioxideAggregate:A RandomizedControlledTrial.”International EndodonticJournal42pp422-444.2009. Methods:Apulpalexposurewasmadein35 healthymaxillarythirdmolarsfrom23 patients.PulpcappingmaterialwaseitherMTA orDycal.33oftheseteethwerehisto- morphologicallyprocessed.Cavitieswere restoredwithIRM.Extractionswereafter periodsof1week,1month,and3months. Results/Conclusion:Pulpexposurestreated withMTAwereessentiallyfreefrom inflammationandcoveredwithhardtissue bridges.TeethtreatedwithDycalhadlesshard tissueformation,morepulpalinflammation, andseepageofmaterialintothepulp. Validity:Directpulpcappingmaterialwas randomlyassigned.Followupwas100% LOE:2(RandomizedControlledTrial)

17. IdealLutingAgentforaZirconiaAbutment Student:ShivamPatel Advisor:Dr.SatishAlapati CASESCENARIO P–Patientreceivingazirconiaimplantabutment I–Resinbasedlutingcement 24y/ohispanicfemalepresentsaftertraumaticavulsion#25.Shewouldliketohaveafixedrestoration, preferablyadentalimplant.Estheticsandfunctionareherprimaryconcern.IOErevealsathinsofttissue biotypewhichmayhaveanadverseoutcomeifstock/titaniumabutmentisutilized. Mean(standarddeviation)ofdislodginingforcesofthe studiedcement(N)groups. C–Conventionalcement O–Adequatebondstrengthbetweenfinalrestorationandabutment Meanmicrotensilebondstrengthsforceramicbondedto compositegroups. CRITICALQUESTION ForapatientreceivinganimlpantinanestheticzonewithaZirconiabasedabutment, whatistheideallutingagentthatwillprovideadequateretentiontopreventdislodgement? MESHTerms: Zirconiaabutment LutingAgent CASESIGNIFICANCE StudentSummary Implant Bonding CAT3 EkfeldtA,FürstB,CarlssonGE.“Zirconia abutmentsforsingle-toothimplantrestorations: aretrospectiveandclinicalfollow-upstudy.” ClinOralImplantsRes.2011Nov;22(11):1308-14. Methods:Part1–Retrospectiveevaluationof 130patientsw/185STIrestorationsw/ZrO2 abutments.Part2–Clinicalexamof25patients w/40restorationsplaced>3yrsago.93 cementedw/zincphosphate,1w/resincement, 1w/TempBond Results/Conclusion:ZrO2abutmentshadlow rateoftechnicalandbiologicalcomplications, softtissuerespondedwell. Validity/Applicability:Multiplefocus parametersw/shortfollowupbutvastdata collection.Protocolforsurgeryandrestoration standardizedandpositive3-5yearsuccess. LevelofEvidence:LowLevel3–Retrospecitve analysisandclinicalfollowupstudy ManystudieshavebeenconductedonZrO2 plates/discsandthevastmajorityofsearch resultswereinvitrostudies.Systematicreviews werenotavailableasthematerialinquestionis stillfairlynewinthescopeofdentalpractice. Thetopichashelpedmerealizetheimportance ofmaterialscienceanditsplaceindentistry. Bondingconcepts,biocompatibility,and physical/chemicalpropertiesarefactorsthat contributeagreatdealtosuccesswithinthe oralcavity. Basedonmyresearchresinbasedlutingagents arethebestcandidatesforcementationontoa ZrO2substratesuchasanimplantabutment.Air abrasion,priming,andtrebochemical treatmentsareallareasforfutureresearchto determinethebestalternativetoincreasebond strengthsinthezirconiamaterialwithout compromisingitsphysical/chemicalintegrity. CAT1 NejatidaneshF,SavabiO,ShahtoosiM. “Retentionofimplant-supportedzirconium oxideceramicrestorationsusingdifferent lutingagents.”ClinOralImplantsRes.2011Nov 14. Methods:20ITIabutments(5.5mmheight)and ITIimplantanalogsmountedtoacrylicblocks. 90ZrO2copings(Al2O3abraded).Copings conditionedinartificialsalivaandthermocycled andcementedw/variouscements. Results/Conclusion:ResinbasedandRMGI lutingagentsaremostretentive.Cement selectionshouldbebaseduponsiteaswellas optionforretrievability. Validity/Applicability:Studylimitationswere monotonicstaticload,invivoforceshave dynamicloading.Fatigueofcementsunderload notanalyzedbutdatapresentedandeach specimenonlysubjectedtoonevariable(luting agent). LevelofEvidence:Level5–Benchtopresearch CAT2 Kim,Min-Jeong,etal."ShearBondStrengthsof variousLutingCementstoZirconiaCeramic: SurfaceChemicalAspects."Journalofdentistry 39.11(2011):795-803.. Methods:Mutiplecementtypeswerebonded tosandblastedZrO2(Lava).Specimenswere storedinwaterat37degreesCandother½ thermocycled.Shearbondstrengthsand surfaceenergyparameterswererecorded. Results/Conclusion:PanaviaF2.0andPrinciple producedhigherbondstrengthsthanother cementsw/nosignificantdifferencesbeforeor afterthermocycling. Validity/Applicability:Thestudysuggeststhat surfaceenergyparametersshouldbe importantconsiderationsindeterminingwhich lutingagentshouldbeutilizedforproper adhesion.Varioussurfacetreatmentsshould beincorporatedforcomparison LevelofEvidence:Level5–Benchtopresearch

18. CaseCAT Literature Worksheet

19. EvaluationSheet

20. Onceyouhaveidentifiedacase: Identifyamentor PrimaryContact:GroupPracticeManager AllprojectTitlesshouldturnedinto KatherineLongatlongka@uic.edu ASAP Talktopreviousparticipants    

21. Questions? CaseCATcontacts: Dr.Crowe Dr.Knight Elizabeth Razdolsky dlcrowe@uic.edu gwknight@uic.edu erazdo2@uic.edu