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 BevelStudent: Scott Czarnik

Advisor: Dr. Ana Bedran-Russo DDS, MS, PhD

CASE SCENARIO

CAT 1 CAT 2 CAT 3

CRITICAL QUESTION CASE SIGNIFICANCEStudent Summary

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.

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?

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

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

Validity: Teeth idealized – no contact directly on restorative material.

Level of Evidence: RCT (2) In Vitro

Coelho-De-souza, Fábio Herrmann et al. A randomized double-blind clinical trial of posterior composite restorations with or without bevel: 1-year 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: Duration only 1 year.

Level of Evidence: RCT (2) In Vivo

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.

MESH Terms:

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

“Composite Resins”“Dental Leakage”“Dental Cavity Preparation”

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

CAT 1 CAT 2 CAT 3

CRITICAL QUESTION CASE SIGNIFICANCEStudent Summary

Does acupuncture help relieve pain in patients with Chronic Myofascial Pain?

Jung, Aram, et al. “Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled 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

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.

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.

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). Limitations- Small sample size. TMD of muscular origin not well defined in 4/9 RCTs

LOE: (1) Systematic Review with Meta Analysis

Cho, Seung-Hun, and Wei-Wan Whang. “Acupuncture for temporomandibular disorders: a systematic review.” Journal of Orofacial Pain 24.2 (2010).

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.

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

Double blind acupuncture trials are difficult to execute due to the control: sham acupuncture not being inert.

Moderate evidence exists supporting acupuncture as an effective pain management tool for patients with TMD of muscular origin, Chronic Myofascial Pain.

Penetrating sham acupuncture is shown to be as effective as traditional acupuncture in pain relief.

Acupuncture is equivalent to current management tools such as occlusal splints and physical therapy.

MESH Terms:

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.”

Pain Assessment: Clinical Exam:Location: Bilateral masticatory muscles Palpable tender “knots” in muscleQuality: Dull, aching, stiff Limited mandibular openingIntensity: 7 out of 10Duration: 6+ months DiagnosisModifiers: Stress Worse Chronic Myofascial Pain Function Worse

Adult patients with Chronic Myofascial Pain

Acupuncture

Sham Acupuncture

Pain reduction

“Acupuncture Therapy” “Acupuncture”“Temporomandibular Joint Dysfunction Syndrome”“Myofascial Pain Syndrome”

FUTURE DIRECTIONSMore 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 ResearchDay 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 (mhowar20@uic.edu)• Marybeth Francis (mfranc28@uic.edu)

THANK YOU SO MUCH FOR COMING!