Transcript CaseCAT Overview (PowerPoint)

UIC Clinic & Research Day
Mar 5th, 2015
Critically Appraised Topics
Sixth Annual Competition
5 Easy Steps:
• Identify a Mentor
• Identify a Patient Case
• Perform a Literature Search
• Make a Poster
• Present Your Poster
STEP 1:
Identify a Mentor
• Work with faculty or resident to identify a case
STEP 2:
Identify a Case
• Patient has interesting presentation with basis in dental
literature
• Medically compromised
• Diabetes, hypertension
• On 3 or more medications
• Unusual pathology or treatment needs
• Adequate Documentation (patient must be de-identified)
• Photos and Radiographs
• Axium page with charting
• Patient medical, dental history, chief complaint
Where Do I Find Cases?
• Personal Portfolio
• Screening Clinic/Urgent Care
• Diagnosis of an interesting or unusual pathology
• Rotations with Specialty Clinics
• Working with residents
• Examples include:
• Orthodontics (craniofacial anomalies)
• Periodontics (diabetes)
• Endodontics (implants)
STEP 3:
Perform a Lit Search
• Find 3 published reports that relate to management
of the case
• Relate reports back to the case in order to make a
more informed treatment decision
STEP 4:
Make Poster!
• Scott Czarnik
• Carolyn Cronin
Sealing Resin Composite Restorations Margins:
To Bevel or Not to Bevel
Student: Scott Czarnik
Advisor: Dr. Ana Bedran-Russo DDS, MS, PhD
CASE
SCENARIO
35 y/o male treatment planned for Class I and II restorations & requests no amalgam. Patient alarmed
at marginal staining and failing restorations but still insists on Composite Resin.
P:
I:
C:
O:
Adults in need of a resin composite restoration involving the
occlusal surface of teeth
Beveled cavosurface margin
Buttjoint cavosurface margin
Reduction in microleakage
MESH Terms:
CRITICAL QUESTION
Does placing a cavosurface bevel on the occlusal surface of a cavity preparation decrease microleakage in resin composite
restorations when compared to a buttjoint preparation for the same material?
CAT 1
Isenberg BP, Leinfelder KF. Efficacy of beveling
posterior composite resin preparations. J Esthetic
Dent 1990;2:70-73.
Methods: 43 Class 1 and 2 preparations generated
in adult population. Etched, bonded, filled with
Macrofil Resin. Color matching, Interfacial
Staining, Secondary Caries, Anatomic Form,
Marginal Adaption, Surface Texture were
assessed at time of placement, 1 year, and 2
years.
Results: No statistical difference shown between
Bevel and Buttjoint margin.
Validity: Study done in 1990, no identifiable
adhesive system, duration only 2 years.
Level of Evidence: RCT (2) In Vivo
CAT 2
Coelho-De-souza, Fábio Herrmann et al. Influence
of adhesive system and bevel preparation on
fracture strength of teeth restored with composite
resin. Brazilian Dental Journal 2010; 21(4): 327-331.
Methods: 80 sound human premolars, teeth
allocated in 8 groups (control, margin design,
adhesive system) filled with Microhybrid resin.
Axial compression test for fracture strength (N).
Results: Etch and Rinse bond with beveled
preparation gave highest resistance to fracture:
1750.6 N versus 1034.6 N for Control Tooth
“Composite Resins”
“Dental Leakage”
“Dental Cavity Preparation”
CAT 3
Coelho-De-souza, Fábio Herrmann et al. A
randomized double-blind clinical trial of posterior
composite restorations with or without bevel: 1year follow-up. J. Appl. Oral Sci. 2012, vol.20, n.2,
pp. 174-179.
Methods: Split mouth design in 13 adult patients
(20-30yrs). Bevel and buttjoint design used, Adper
Single Bond, Fracture/Retention, Marginal
Adaption, Post-Op Hypersensitivity, assessed at
placement, 6 months and 1 year.
Results: Decreased marginal staining when
preparations had beveled cavosurface margin.
Validity: Teeth idealized – no contact directly on
restorative material.
Validity: Duration only 1 year.
Level of Evidence: RCT (2) In Vitro
Level of Evidence: RCT (2) In Vivo
CASE SIGNIFICANCE
Student Summary
The available studies, despite being high levels of
evidence, are short in duration with no long term
follow up.
-Findings vary depending on what type of adhesive
agent was used.
-Etch and Rinse Adhesive was shown to have most
favorable results when coupled with a beveled
cavosurface margin.
-Beveling preparations has the potential to
decrease marginal staining and chance of fracture.
FUTURE DIRECTIONS
-Long-term studies to further evaluate both
preparation designs are needed.
-Clinical surveys to gauge prevalence of bevel in
private practice.
Acupuncture as a Treatment Modality for Chronic
Myofascial Pain
Student: Carolyn Cronin
Advisor: Dr. Ales Obrez DMD, PhD; UIC Department of Restorative Dentistry
CASE
SCENARIO
P:
I:
C:
O:
30 year old healthy female presents with Chief Complaint:
”My jaw muscles have been aching for months. They feel stiff and I can’t always open my
mouth all the way. It is worse when I wake up. I’ve tried everything from pain meds, hot
compresses, jaw exercises, and even sleeping medication. My friend gets acupuncture.
Would it work for me? I need some relief.”
Adult patients with Chronic Myofascial Pain
Acupuncture
Pain Assessment:
Location: Bilateral masticatory muscles
Quality: Dull, aching, stiff
Intensity: 7 out of 10
Duration: 6+ months
Modifiers: Stress  Worse
Function  Worse
Sham Acupuncture
Pain reduction
MESH Terms:
CRITICAL QUESTION
Does acupuncture help relieve pain in patients with Chronic Myofascial Pain?
CAT 1
Jung, Aram, et al. “Acupuncture for treating
temporomandibular joint disorders: a systematic
review and meta-analysis of randomized, shamcontrolled trials.” Journal of Dentistry 39.5 (2011)
341-350.
Methods: Systematic searches on 13 electronic
databases. 7 RCTs : TMD subjects; Acupuncture
intervention; Sham control. Pain intensity
outcome: Visual Analog Scale: (VAS). Statistical
analysis of acupuncture vs sham using VAS.
Results/Conclusions: 5 RCTs showed significant
improvement in pain intensity (VAS). Real
acupuncture superior to non-penetrating sham
control in pain outcomes. No difference between
acupuncture and penetrating sham from
subgroup meta-analysis
Validity/Applicability:
Moderate
Cochrane
Quality of Study. All double blind RCTs.
Limitations- (mean sample size= 20). Variation in
duration and # acupuncture treatments.
LOE: (1) Systematic Review with Meta Analysis
“Acupuncture Therapy” “Acupuncture”
“Temporomandibular Joint Dysfunction Syndrome”
“Myofascial Pain Syndrome”
CAT 2
CAT 3
Clinical Exam:
Palpable tender “knots” in muscle
Limited mandibular opening
Diagnosis
Chronic Myofascial Pain
CASE SIGNIFICANCE
Student Summary
Double blind acupuncture trials are difficult to
execute due to the control: sham acupuncture not
being inert.
La Touche, Roy, et al. “Acupuncture in the
treatment of pain in temporomandibular
disorders: a systematic review and meta-analysis
of randomized controlled trials.” The Clinical
Journal of Pain 26.6 (2010): 541-550.
Cho, Seung-Hun, and Wei-Wan Whang.
“Acupuncture for temporomandibular disorders:
a systematic review.” Journal of Orofacial Pain
24.2 (2010).
Moderate evidence exists supporting acupuncture
as an effective pain management tool for patients
with TMD of muscular origin, Chronic Myofascial
Pain.
Methods: Electronic database systematic search.
9 RCTs- TMD muscular pain; Acupuncture
intervention; Sham/occlusal splint/no tx control.
Outcome: Pain in VAS. Systematic analysis: VAS.
Methods: Electronic database systematic search.
14 RCTs chosen that assessed efficacy of
acupuncture for TMD. Tradition/contemporary
acupuncture
vs
sham/ortho/splint/surgery
control. VAS pain outcome.
Penetrating sham acupuncture is shown to be as
effective as traditional acupuncture in pain relief.
Results/Conclusions: Acupuncture is effective in
short-term basis for reduction of TMD pain of
muscular origin. Meta analysis- Acupuncture is
more effective than sham in reducing pain
intensity.
Validity/Applicability:
5/9
RCTs
good
methodology quality (Jadad scale). LimitationsSmall sample size. TMD of muscular origin not
well defined in 4/9 RCTs
LOE: (1) Systematic Review with Meta Analysis
Results/Conclusions: Moderate evidence of
positive influence of acupuncture beyond
placebo. Both acupuncture and penetrating sham
showed significant reduction in VAS but no
difference between groups. Acupuncture
equivalent to current management tools.
Validity/Applicability: Heterogenous clinical
intervention/control. Acupuncture vs sham
studies fewer. Not all studies blinded.
LOE: (1) Systematic Review
Acupuncture is equivalent to current management
tools such as occlusal splints and physical therapy.
FUTURE DIRECTIONS
More double blind RCTs with larger sample sizes
and better long term evaluation needed.
The ethics of acupuncture as a pain management
tool need to be considered if current research
demonstrates the control penetrating sham to be
as effective in pain reduction.
STEP 5:
Present Poster
• Present Poster to Group Practice (early Feb 2015)
• Every poster will be presented at Clinic and Research
Day on (March 5, 2015)
Why do it?
• If you want a chance to better develop your ability
to make evidence-based decisions about new
treatments/discoveries/instruments under the
guidance of an advisor, and present your work!
• If you are interested in finding out how or why
clinical dentistry is changing !
• If you are planning on specializing and want to
find a mentor or project!
• CaseCAT competition… looks great on a
resume!
To get involved:
Please email CaseCAT contacts with any questions:
• Dr. Rynn-Howard ([email protected])
• Marybeth Francis ([email protected])
THANK YOU SO
MUCH FOR
COMING!