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

ParametersHow 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

CAT 1 CAT 2 CAT 3

CRITICAL QUESTION CASE SIGNIFICANCEStudent Summary

Place the critical elements of your case here… e.g., Chief Complaint, Hx, AXIUM data, photos, etc. (preferably in font Calibri - minimum size 20)

Type your searchable question here… (preferably in font Calibri - minimum size 20)

Type your CAT here… (preferably in font Calibri - minimum size 20)

Type your CAT here… (preferably in font Calibri - minimum size 20)

Type your CAT here… (preferably in font Calibri - minimum size 20)

Type your bottom line here… (preferably in font Calibri - minimum size 20)

MESH Terms:

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…

Terms…

FUTURE DIRECTIONSWrite 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

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 (see arrows below).

MESH Terms:

Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both teeth. The following clinical tests were performed:

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

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

Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis

Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

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?

FUTURE DIRECTIONSWrite 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

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 (see arrows below).

Beach et al. “Clinical Evaluation of Bacterial Leakage of Endodontic Temporary Filling Materials.” Journal of Endodontics 22:9 pp459-462. 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)

MESH Terms:

Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both teeth. The following clinical tests were performed:

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

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

Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis

Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

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?

Root Canal Therapy; Dental Restoration, Temporary; Leakage

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).

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 DIRECTIONSWrite 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

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 (see arrows below).

Beach et al. “Clinical Evaluation of Bacterial Leakage of Endodontic Temporary Filling Materials.” Journal of Endodontics 22:9 pp459-462. 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)

MESH Terms:

Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both teeth. The following clinical tests were performed:

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

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

Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis

Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

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?

Root Canal Therapy; Dental Restoration, Temporary; Leakage

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).

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)

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 longka@uic.edu by January 9th 2012

•Talk to previous participants

Questions?

Additional ContactsDr. Marucha- marucha@uic.eduDr. Knight- gwknight@uic.edu Kaitrin Baloue kbaloue2@uic.edu