Transcript CaseCATs

CaseCATs
(Critically Appraised Topics)
An approach to pre-doctoral
research opportunities
Lunch and Learn Agenda
•
•
•
•
•
•
•
Objectives
Parameters
How to find cases
CaseCAT Worksheet
CaseCAT Literature Worksheet
CaseCAT Poster Template
Judging Criteria
Objectives
• To provide an opportunity for 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
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?
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
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
Situation of Concern (Calibri font size 60)
Student Name
Advisor
CASE
SCENARIO
P:
I:
C:
O:
Place the critical elements of your case here… e.g., Chief Complaint, Hx, AXIUM data, photos, etc.
(preferably in font Calibri - minimum size 20)
P…
I…
C…
O…
Place the critical elements of your case here… e.g., Chief Complaint, Hx, AXIUM data, photos, etc.
(preferably in font Calibri - minimum size 20)
MESH Terms:
CRITICAL QUESTION
Terms…
Type your searchable question here… (preferably in font Calibri - minimum size 20)
CASE SIGNIFICANCE
Student Summary
Type your bottom line here… (preferably in font
Calibri - minimum size 20)
CAT 1
Type your CAT here… (preferably in font Calibri minimum size 20)
CAT 2
Type your CAT here… (preferably in font Calibri minimum size 20)
CAT 3
Type your CAT here… (preferably in font Calibri minimum size 20)
FUTURE DIRECTIONS
Write future directions here… (preferably in font
Calibri - minimum size 20)
CaseCAT
Worksheet
CaseCAT Worksheet
Should I use CavitTM, IRMTM, or KetacFillTM?
Student: Michael P. Munaretto
Advisor: Bradford Johnson, DDS MHPE, UIC Department of Endodontics
CASE SCENARIO
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 (see
arrows below).
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
P- Patients receiving root canal therapy
3
WNL
31/80
WNL
WNL
323B 323L
0
I- Temporary restorative material
(Cavit, IRM, or KetacFill [GI])
4
NR
80/80
WNL
WNL
323B 323L
0
5
NR
80/80
WNL
WNL
323B 323L
0
C- Definitive restoration
6
WNL
26/80
WNL
WNL
323B 323L
0
Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis
O- Durability and resistance to coronal
microleakage
Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.
MESH Terms:
CRITICAL QUESTION
For patients receiving root canal therapy, which temporary restorative material (Cavit, IRM, or
KetacFill GI) compares most favorably to the properties of the definitive restoration as measured
by durability and resistance to coronal microleakage?
CAT (1)
CAT (2)
CASE SIGNIFICANCE
CAT (3)
FUTURE DIRECTIONS
Write future directions here… (preferably in font
Calibri - minimum size 20)
CaseCAT Worksheet
Should I use CavitTM, IRMTM, or KetacFillTM?
Student: Michael P. Munaretto
Advisor: Bradford Johnson, DDS MHPE, UIC Department of Endodontics
CASE SCENARIO
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 (see
arrows below).
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
P- Patients receiving root canal therapy
3
WNL
31/80
WNL
WNL
323B 323L
0
I- Temporary restorative material
(Cavit, IRM, or KetacFill [GI])
4
NR
80/80
WNL
WNL
323B 323L
0
5
NR
80/80
WNL
WNL
323B 323L
0
C- Definitive restoration
6
WNL
26/80
WNL
WNL
323B 323L
0
Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis
O- Durability and resistance to coronal
microleakage
Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.
MESH Terms:
CRITICAL QUESTION
For patients receiving root canal therapy, which temporary restorative material (Cavit, IRM, or
KetacFill GI) compares most favorably to the properties of the definitive restoration as measured
by durability and resistance to coronal microleakage?
CAT (1)
Beach et al. “Clinical Evaluation of Bacterial
Leakage of Endodontic Temporary Filling
Materials.” Journal of Endodontics 22:9 pp459462. 1996.
Methods: 51 human teeth received RCT in vivo.
After obturation a sterile paper disk was placed
below a 4 mm filling of Cavit, IRM, or TERM.
Three weeks later the patients were recalled, the
fillings were removed, and the paper disks were
analyzed for bacterial growth.
Results/Conclusion: 1/18 IRM samples showed
bacterial growth, whereas 0/19 Cavit samples
showed growth. No significant difference was
found between IRM and Cavit.
Validity/Applicability: Restoration type was
randomly assigned. Follow up was 100%. in vivo
study. 3 week follow-up realistic at UIC COD.
Level of Evidence: 2 (Randomized Controlled Trial)
CAT (2)
Barthel et al. “Leakage in Roots Coronally
Sealed with Different Temporary Fillings.”
Journal of Endodontics 25:11 pp 731-734. 1999.
Methods: 103 extracted single-rooted teeth
received RCT and were then filled with either
Cavit, IRM, GI, Cavit/GI, or IRM/GI. Teeth were
then immersed into a two-chamber system
which was inspected daily over a 30-day period
for bacterial microleakage.
Results/Conclusion: GI gave the best seal
against bacteria (1/20 samples leaked),
whereas Cavit gave the poorest seal (13/20
samples leaked). 11 out of 20 IRM samples
leaked.
Validity/Applicability: Results of in vitro studies
cannot directly be applied to clinical practice.
However, all available filling materials to UIC
COD students were tested.
Level of Evidence: 6 (Preclinical study)
.
Root Canal Therapy;
Dental Restoration,
Temporary; Leakage
CASE SIGNIFICANCE
CAT (3)
Naoum & Chandler. “Temporization for
Endodontics.” International Endodontic Journal
35:pp 964-978. 2002.
Methods: A literature review was performed
using MEDLINE and contemporary textbooks to
assess various endodontic temporary filling
materials and to make clinical recommendations.
Results/Conclusion: Cavit possesses favorable
marginal seal but inferior mechanical properties
compared to IRM. Studies have shown that IRM
also provides a favorable marginal seal,
especially when the powder: liquid ratio is
decreased. GI is more costly, but has been found
to be antibacterial and to have a superior seal;
thus it may be used for cases of long-term
temporization.
Validity/Applicability: Authors did not provide a
detailed selection criteria for articles reviewed.
Level of Evidence: 5 (Expert Opinion)
FUTURE DIRECTIONS
Write future directions here… (preferably in font
Calibri - minimum size 20)
CaseCAT Worksheet
Should I use CavitTM, IRMTM, or KetacFillTM?
Student: Michael P. Munaretto
Advisor: Bradford Johnson, DDS MHPE, UIC Department of Endodontics
CASE SCENARIO
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 (see
arrows below).
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
P- Patients receiving root canal therapy
3
WNL
31/80
WNL
WNL
323B 323L
0
I- Temporary restorative material
(Cavit, IRM, or KetacFill [GI])
4
NR
80/80
WNL
WNL
323B 323L
0
5
NR
80/80
WNL
WNL
323B 323L
0
C- Definitive restoration
6
WNL
26/80
WNL
WNL
323B 323L
0
Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis
O- Durability and resistance to coronal
microleakage
Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.
MESH Terms:
CRITICAL QUESTION
For patients receiving root canal therapy, which temporary restorative material (Cavit, IRM, or
KetacFill GI) compares most favorably to the properties of the definitive restoration as measured
by durability and resistance to coronal microleakage?
CAT (1)
Beach et al. “Clinical Evaluation of Bacterial
Leakage of Endodontic Temporary Filling
Materials.” Journal of Endodontics 22:9 pp459462. 1996.
Methods: 51 human teeth received RCT in vivo.
After obturation a sterile paper disk was placed
below a 4 mm filling of Cavit, IRM, or TERM.
Three weeks later the patients were recalled, the
fillings were removed, and the paper disks were
analyzed for bacterial growth.
Results/Conclusion: 1/18 IRM samples showed
bacterial growth, whereas 0/19 Cavit samples
showed growth. No significant difference was
found between IRM and Cavit.
Validity/Applicability: Restoration type was
randomly assigned. Follow up was 100%. in vivo
study. 3 week follow-up realistic at UIC COD.
Level of Evidence: 2 (Randomized Controlled Trial)
CAT (2)
Barthel et al. “Leakage in Roots Coronally
Sealed with Different Temporary Fillings.”
Journal of Endodontics 25:11 pp 731-734. 1999.
Methods: 103 extracted single-rooted teeth
received RCT and were then filled with either
Cavit, IRM, GI, Cavit/GI, or IRM/GI. Teeth were
then immersed into a two-chamber system
which was inspected daily over a 30-day period
for bacterial microleakage.
Results/Conclusion: GI gave the best seal
against bacteria (1/20 samples leaked),
whereas Cavit gave the poorest seal (13/20
samples leaked). 11 out of 20 IRM samples
leaked.
Validity/Applicability: Results of in vitro studies
cannot directly be applied to clinical practice.
However, all available filling materials to UIC
COD students were tested.
Level of Evidence: 6 (Preclinical study)
.
Root Canal Therapy;
Dental Restoration,
Temporary; Leakage
CAT (3)
Naoum & Chandler. “Temporization for
Endodontics.” International Endodontic Journal
35:pp 964-978. 2002.
Methods: A literature review was performed
using MEDLINE and contemporary textbooks to
assess various endodontic temporary filling
materials and to make clinical recommendations.
Results/Conclusion: Cavit possesses favorable
marginal seal but inferior mechanical properties
compared to IRM. Studies have shown that IRM
also provides a favorable marginal seal,
especially when the powder: liquid ratio is
decreased. GI is more costly, but has been found
to be antibacterial and to have a superior seal;
thus it may be used for cases of long-term
temporization.
Validity/Applicability: Authors did not provide a
detailed selection criteria for articles reviewed.
Level of Evidence: 5 (Expert Opinion)
CASE SIGNIFICANCE
Few in vivo studies and no systematic reviews
exist studying this topic. However, from the
available evidence the following conclusions can
be drawn:
1. Cavit provides an adequate seal over at least 3
weeks as revealed by an in vivo study (1).
However, due to its poor mechanical properties,
its use should be reserved only for conservative
accesses where occlusal forces are minimal (3).
2. IRM provides an adequate seal over at least 3
weeks as revealed by an in vivo study (1). Its
mechanical properties are superior to Cavit and it
is therefore indicated for whenever the tooth will
be regularly subjected to occlusal forces. As the
powder: liquid ratio is decreased, the seal
improves (at the expense of mechanical
properties). (3)
3. GI has been found in an in vitro study to have a
superior seal to Cavit and IRM (2). Because of
this, GI has been recommended for longer term
temporization (3).
4. Studies have recommended that a definitive
restoration be placed as soon as possible
following obturation (2, 3).
CaseCAT
Literature
Worksheet
Once you have identified a case:
• Identify a mentor
• Primary Contact: Group Practice Manager
• All project Titles should be emailed or turned
into Katherine Long at [email protected] by
January 9th 2012
• Talk to previous participants
Questions?
Additional Contacts
Dr. Marucha- [email protected]
Dr. Knight- [email protected]
Kaitrin Baloue [email protected]