Medicine and Health Sciences Commons^™

Outcome Of Vital Pulp Therapy On Immature Permanent Teeth With Calcium Silicate-Based Materials: Retrospective Cohort Study, Brian I. Hone

Theses and Dissertations

Introduction: The purpose of vital pulp therapy is to maintain pulp viability by eliminating bacteria from the dentin-pulp complex and to establish an environment in which apexogenesis can occur. The aim of this retrospective cohort study was to evaluate the clinical and radiographic outcomes of vital pulp therapy on immature permanent teeth using different calcium silicate-based materials. Methods: This study was carried out in the Virginia Commonwealth University Graduate Endodontics department in Richmond, Virginia. Vital pulp therapy cases performed by graduate endodontic residents were retrospectively searched and charts were reviewed to determine inclusion into this study. All cases …

Outcome Of Endodontic Microsurgery: Success And Survival Rates At Virginia Commonwealth University, Abdullah Alawadhi

Theses and Dissertations

Introduction: Endodontic microsurgery treatment is an option for teeth with apical periodontitis and may be indicated for teeth with previous endodontic treatment that have not healed, teeth with canal obstructions which would impede a non-surgical approach, and where a biopsy is needed. The purpose of this study is to evaluate healing after endodontic microsurgery in 2-dimensional PA radiographs and 3 dimensional CBCT imaging. Methods: Patient records were pooled from graduate resident cases completed at Virginia Commonwealth University in the Graduate Endodontic Clinic between the years 2010 to 2020. Cases were identified using the CDT codes and a key word search …

Characteristics Of Posterior Permanent Teeth With A Periradicular Diagnosis Of Symptomatic Apical Periodontitis: A Retrospective Study, Christina A. Martin

Theses and Dissertations

The diagnosis of apical periodontitis is based on radiographic manifestations and the results of the various clinical tests that can be performed as part of a routine dental examination. Apical periodontitis producing clinical symptoms involving a painful response to biting and/or percussion or palpation is given the diagnosis of symptomatic apical periodontitis (SAP). This study aimed to determine associations of SAP with gender, age, radiographic findings, diagnostic testing, pulpal diagnosis, and location of the tooth in the arch. Data for this study were obtained from patients of record treated at Virginia Commonwealth University School of Dentistry in the Department of …

Radiographic Comparison Using Cbct-Pai And Volumetric Analysis Of Endodontically Treated Teeth: A Retrospective Cohort Study, Jeremy Hargrove

Theses and Dissertations

Purpose: To assess the changes in CBCT-PAI score as well as 3-D volume of periapical findings associated with endodontically treated roots and to see how these findings change over time.

Methods: Retrospective chart review with the following inclusion criteria: 1. At least one tooth was endodontically treated at the endodontic private practice; 2. Patient had a recall examination and the treated tooth was asymptomatic, functional and a CBCT was exposed; 3. CBCT interpretation found a periapical finding associated with the treated tooth; 4. A follow-up recall examination was completed and CBCT exposed. Cases that fulfilled the inclusion criteria had the …

In Vitro Evaluation Of The Solubility Of Endosequence Bc Sealer In Acidic Solutions, Inderpal S. Sappal

Theses and Dissertations

Purpose: In recent years, bioceramic sealers (BCS), such as EndoSequence BC Sealer, have gained popularity in endodontic practices. Previous research has found BCS difficult to remove from canals during retreatments when compared with other endodontic sealers. Acidic solutions have been found to inhibit the set of BCS and increase their solubility. The purpose of this study was to evaluate the efficacy of acidic solutions in the removal of BCS as compared with a traditional retreatment solvent.

Methods: Roots of extracted human single rooted teeth (N=15) were prepared into 17 mm sections, then instrumented with ProTaper Gold (PTG) rotary files up …

Achieving Dentin Conservation Using Dynamic Navigation Technology For Locating Calcified Canals, Madison W. Saunders

Theses and Dissertations

Purpose: Pulp canal obliteration (PCO) is a common sequela of dental trauma, caries, restorations and vital pulp therapy procedures. Despite the application of high magnification and CBCT imaging, access cavity preparation for such cases is prone to procedural errors that may lead to substantial loss of dentin structure thereby reducing the long-term prognosis. This study aimed to achieve dentin conservation using a novel computer assisted dynamic navigation system (Navident) in comparison to freehand access preparation for locating calcified canals.

Methods: Forty maxillary and mandibular central incisors (tooth #9 and tooth #25) were 3-D printed to simulate PCO. They were randomly …

Comparison Of Endodontic Treatment Planning Decisions Using Cone Beam Computed Tomography Versus Periapical Radiography In Previously Endodontically Treated Molars, Sarah Alkanderi

Theses and Dissertations

Objectives: The aim of this study was to determine if treatment plans differ when evaluating previously endodontically treated molars using periapical images (PA’s) alone versus PA’s and CBCT.

Methods: A retrospective cohort chart review was conducted including 67 previously treated molars that had a CBCT taken. Two calibrated board-certified endodontists evaluated standard PA’s. A data sheet questionnaire regarding radiographic findings and treatment plan decisions was completed. Two weeks later, the same steps were repeated but the examiners evaluated both PA’s and CBCT images and again arrived at a recommended treatment plan.

Results: Agreement between raters was assessed with Cohen’s Kappa …

Current Trends In The Management Of Invasive Cervical Resorption, Erik J. Foisy

Theses and Dissertations

Purpose: To determine how endodontic practitioners are currently managing cases of invasive cervical resorption. Also, to analyze how invasive cervical resorption (ICR) has been managed at Virginia Commonwealth University (VCU) over the past ten years.

Methods: Both domestic and international endodontists were invited to participate in a 14-question survey developed and administered via REDCap. Survey invitations were sent via email to currently practicing endodontists. Electronic dental records were queried for patients diagnosed with ICR at VCU in the preceding ten years. Results of both were summarized using descriptive statistics (counts and percentages). Fisher’s exact test was used to compare survey …

Management Of The Open Apex Using A Bioceramic Apical Barrier: Success And Survival Rates At Virginia Commonwealth University, Adam Sarnowski

Theses and Dissertations

Purpose: The aim of this study was to assess the outcome of treatment of teeth with open apices managed by the orthograde placement of a bioceramic apical barrier as well as to identify potential outcome factors for this type of treatment. Methods: Patient records were pooled from graduate resident cases completed at Virginia Commonwealth University between January 1, 2010 and May 31, 2018. A total of 515 patients were identified using relevant ADA codes and a key word search within the patient record database. A total of 104 patients (119 teeth) had an open apex that had NSRCT utilizing a …

Impact On Bacterial Micro-Leakage In Exposed Root Canal Obturation Material In Teeth Irrigated With Different Solutions, Khalifa W. Alhaddad

Theses and Dissertations

Purpose: Determine the timeframe of bacterial penetration that occurs to the apex when obturation material (gutta percha) is exposed to bacteria for a set period of time (45 days) and to determine if bacterial penetration of the obturated root is influenced by the type of irrigant used during the final rinse (17% EDTA vs 2% Chlorhexidine vs full strength 5.25% NaOCl). Methods: Thirty-six extracted teeth, including six controls, were instrumented and irrigated with 5.25% NaOCl followed by a final rinse of either: 17% EDTA, 2% Chlorhexidine, or 5.25% NaOCl, and then obturated. Each root was suspended between two chambers: the …

Antibiotics And Antimicrobial Resistance: An Evaluation Of The Knowledge, Attitude And Perception Among Dental Students And Academic Deans And Department Chairs Within U.S. Dental Schools, Magdalena S. Holz

Theses and Dissertations

Purpose: This study aimed to survey current 3^rd and 4^th year dental students, academic deans, and department chairs within U.S. dental schools to analyze the level of understanding; education; guidelines; and overall awareness regarding antibiotic use within dentistry and antimicrobial resistance.

Methods: A 25-question survey intended for 3^rd and 4^th year dental students and a 20-question survey intended for academic deans and various department chairs of U.S dental schools were each developed utilizing REDCap. The survey invitations were sent via e-mail to the current academic dean of each U.S. dental school for distribution.

Results: There were …

Evaluation And Comparison Of Periapical Healing Using Periapical Films And Cone Beam Computed Tomography: Post-Treatment Follow Up, Adam S. Polinsky

Theses and Dissertations

Purpose: The purpose of this study was to assess the radiographic changes in periapical status and analysis of healing determined using periapical radiographs (PA) versus cone beam computed tomography (CBCT) pre-operatively and at 3-64 months following endodontic treatment.

Methods: Pre/post treatment radiograph and CBCT scans of patients who had NSRCT, NSReTx, or SRCT from July 2011-December 2018 at VCU Graduate Endodontic clinic were included in this study. Volumetric and linear measurements of periapical lesions on initial and recall PA and CBCT images were performed using three calibrated examiners. Changes and differences in the estimated area from PA to CBCT were …

Change In Working Length At Different Stages Of Instrumentation As A Function Of Canal Curvature, Mei Tang, Garry L. Myers, Richard D. Archer, Al M. Best

Graduate Research Posters

The aim of this study was to determine the change in working length (∆WL) before and after coronal flaring and after complete rotary instrumentation as a function of canal curvature. One mesiobuccal or mesiolingual canal from each of 43 extracted molars had coronal standardization and access performed. Once the access was completed, canal preparation was accomplished using Gates Glidden drills for coronal flaring and EndoSequence files for rotary instrumentation. WLs were obtained at 3 time points: pre-instrumentation (unflared), mid-instrumentation (flared) and post-instrumentation (concluded). Measurements were made via direct visualization (DV) and the CanalPro apex locator (EM) in triplicate by a …

The Effect Of Instrumentation Taper On Dentin Conservation, Megan E. Green

Theses and Dissertations

Introduction: The aim of this in vitro study was two part. The first being to assess and compare the amount of dentin removed by an instrument with a taper of 0.04 versus an instrument with a taper of 0.06 using the Edge Evolve® file system at different increments within the canal system. Secondly, this study evaluated whether instrumentation with either taper resulted in a remaining dentin thickness (RDT) of less than 0.3mm. If this RDT was imposed upon, fracture resistance was compromised. Both pre and post instrumentation measurements were taken of samples instrumented with the 0.04 and 0.06 tapered files. …

Change In Working Length At Different Stages Of Instrumentation As A Function Of Canal Curvature, Mei Tang

Theses and Dissertations

The aim of this study was to determine the change in working length (∆WL) before and after coronal flaring and after complete rotary instrumentation as a function of canal curvature. One mesiobuccal or mesiolingual canal from each of 43 extracted molars had coronal standardization and access performed. Once the access was completed, canal preparation was accomplished using Gates Glidden drills for coronal flaring and EndoSequence files for rotary instrumentation. WLs were obtained at 3 time points: pre-instrumentation (unflared), mid-instrumentation (flared) and post-instrumentation (concluded). Measurements were made via direct visualization (DV) and the CanalPro apex locator (EM) in triplicate by a …

Observations Of Trends And Successes Of Revascularization Therapy At Virginia Commonwealth University: A Retrospective Study, Richard W. Sedwick

Theses and Dissertations

The aim of this study was to determine the trends in protocol, success rates, and consistency in follow up of revascularization procedures in a controlled environment. Patients of the Virginia Commonwealth University School of Dentistry were identified who were offered revascularization therapy as a treatment option on immature permanent teeth from January 1, 2010 to May 31, 2017. A total of 77 patients and 78 teeth were evaluated for revascularization therapy. For patients accepting treatment, records were reviewed for outcome assessment and consistency of follow up. A total of 30 patients (31 teeth) were treated following revascularization protocols, with only …

Potential Antimicrobial Methods For Provisionalizing Teeth After Endodontic Treatment, Laura T. Garden

Theses and Dissertations

POTENTIAL ANTIMICROBIAL METHODS FOR PROVISIONALIZING TEETH AFTER ENDODONTIC TREATMENT

By Laura T. Garden, DDS

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University.

Virginia Commonwealth University, 2018

Thesis Advisor: Garry Myers, DDS

Department of Endodontics

Objective:To evaluate the effectiveness of a Chlorhexidine soaked cotton pellet on bacterial leakage.

Methods: Fifty-one extracted teeth, including six controls, were instrumented, obturated, and sealed with either a cotton pellet (CP), 2% Chlorhexidine soaked cotton pellet (CHX), or a Permaflo orifice barrier (OB). Each root was suspended between two chambers: the …

The Prevalence, Predictive Factors, And Classification Of Intrapulpal Cracks In Maxillary Molars Requiring Endodontic Treatment, Husain Karashi

Theses and Dissertations

Diagnosis and treatment of teeth with longitudinal fractures is challenging. Cracks are usually not visible radiographically; they require a thorough evaluation to aid in diagnosis. Patients may be asymptomatic, demanding the dentist rely on clinical findings to make a diagnosis. Early diagnosis of the presence and extent of a crack is essential for the successful management of a cracked tooth. There is limited information in the literature regarding the prevalence or predictive factors of cracks extending into the pulp chamber of teeth. The purpose of this study was to determine the prevalence of intrapulpal cracks in maxillary molars and to …

Prevalence And Clinical Characteristics Of Teeth Extracted With A Diagnosis Of Cracked Tooth: A Retrospective Study, Riley B. Sturgill

Theses and Dissertations

The body of knowledge that exists regarding cracked teeth is limited. The purpose of this study was to determine the prevalence of cracks among extracted teeth. This retrospective longitudinal cohort study included patients of the Virginia Commonwealth University School of Dentistry that underwent extraction procedures over a 6 year period. The sample consisted of 20,408 patients and 40,870 teeth. Statistical analysis software was used to identify diagnoses of a crack, fracture, or split tooth prior to extraction of the tooth by analyzing the Electronic Health Record (EHR) (axiUm™, Version 6.03.03.1035, Exan Corporation, Vancouver, BC, Canada). There were 3,228 teeth …

Evaluation Of Volumetric Change Of Periapical Lesions After Apicoectomy As A Measure Of Postsurgical Healing Utilizing Cone Beam Computed Tomography, Eshwar Arasu

Theses and Dissertations

The aim of this study was to evaluate whether volumetric changes in persistent periapical lesions can be detected in follow-ups six months to five years after apicoectomy using cone-beam computed tomography. Patients with a previous treatment history of apicoectomy and for whom a pre-surgical CBCT scan was taken between November 2010 and December 2015 were invited to participate in the study. A post-surgical CBCT image of the treated tooth was obtained at the recall visit. Volumetric and linear measurements of periapical lesions on initial and postoperative CBCT images were performed using DiThreshGUI software and two calibrated examiners—a board-certified endodontist and …

A Comparative Study Of Intraradicular Enterococcus Faecalis Biofilm Removal With Three Root Canal Treatment Systems: A Scanning Electron Microscopy Evaluation, Cyrous Ardalan

Theses and Dissertations

The objective of this study was to evaluate the biofilm removal efficacy of three root canal treatment systems: ProUltra® PiezoFlow™, traditional needle irrigation, and the GentleWave® system in an ex-vivo benchtop study. Twenty-four extracted maxillary and mandibular molars were selected. Teeth were all instrumented to a master apical file size #25 with 4% taper. Teeth were then randomly divided into four experimental groups and two control groups. The root canals were inoculated with a culture of Enterococcus faecalis and incubated for five weeks to form a biofilm. Each group was then treated with one of the different root canal treatment …

Comparison Of Treatment Planning Decisions When Combining Cbct And Digital Radiography Verses Digital Radiography Alone, Mckay Barlow Packer

Theses and Dissertations

Cone beam computed tomography (CBCT) is the recommended imaging modality of choice for evaluating previous endodontic treatment (1). The aim of this study was to compare treatment planning decisions made when evaluating previous endodontic treatment to determine if treatment planned and projected prognosis differs when digital radiography is used alone or in combination with CBCT. A retrospective chart review was conducted. Patients for whom a CBCT was taken were included in the study. Twenty-eight patients qualified. Patient’s periapical digital radiographs (Dexis©) were evaluated by 2 calibrated endodontists, a treatment plan was identified and a prognosis was projected. Later the same …

The Incidence Of Root Dentinal Micro-Cracks Caused By Reciprocating And Continuous Rotary Instrumentation, Stephen N. Schroeder

Theses and Dissertations

The aim of this study was to compare the incidence of root canal dentinal micro-cracks after canal instrumentation using reciprocating files (WaveOne Gold® and Twisted Adaptive®) and continuous rotation files (Edge Evolve® and EndoSequence®) in an ex-vivo benchtop study. This project used a novel methodology of finding dentinal defects using the “K-cube”, which allows evaluators to visualize sectioned root surfaces before instrumentation and after instrumentation. Mesial roots from 40 human mandibular first molars were divided into 4 groups of 10 for each file type. Root section pictures were taken with a Zeiss Discovery V20 stereomicroscope before and after canal instrumentation. …

Analysis Of Radiographic Changes Associated With The Periradicular Diagnosis Of Symptomatic Apical Periodontitis, Preeti Batra

Theses and Dissertations

Symptomatic apical periodontitis (SAP) is indicative of inflammation of the periodontal ligament. It may or may not be accompanied by radiographic changes and may occur with vital or necrotic pulpal diagnosis. Purpose of this study was to analyze clinical and radiographic presentations of SAP in a retrospective electronic dental chart and digital radiograph review utilizing the endodontic diagnostic template note of predoctoral dental school patients presenting with SAP. The aim was to determine prevalence of periapical radiolucencies (PARLs) in SAP, association of SAP to pulpal diagnosis, and define associated radiographic changes. Most prevalent pulpal diagnosis with SAP was symptomatic irreversible …

Assessment Of Changes In The Size Of Periapical Radiolucencies 3-12 Months Post Non-Surgical Root Canal Treatment Using Cbct Imaging: A Pilot Study, Jeremy W. Fike Dds

Theses and Dissertations

The purpose of this study was to assess the changes in size of periapical lesions 3-12 months following root canal treatment using CBCT. Patients who had non-surgical root canal therapy (NSRCT) or non-surgical retreatment (ReTx) from July 30,2014 to August 19, 2015 with a periapical lesion of endodontic origin and received NSRCT or ReTx and had a pre-treatment or intra-treatment CBCT were invited to participate. Volumetric and linear measurements of periapical lesions on initial and post- treatment CBCT images were performed. A total of 20 patients with 23 treated teeth with 30 separate periapical radiolucent lesions returned for follow up …

Treatment Decisions Involving Teeth With Intrapulpal Cracks: A Survey Of Endodontists, Sheldon M. Sealey

Theses and Dissertations

There is no universal protocol for diagnosing, treating and managing cracked teeth. The purpose of this survey was to investigate the use of traditional methods of crack detection and to explore how treatment decisions were made using an intrapulpal crack classification. The electronic survey was sent to 1115 active members of the American Association of Endodontists (AAE) and The Digital Office (TDO^™) community. Comparisons were assessed using logistic or repeated-measures regression. The most often used diagnostic method was probing. When the crack involved one wall, 85% of respondents would complete root canal therapy > 50% of the time or …

Restorative Characteristics Of Intrapulpally Cracked Teeth, Charles M. Beavers

Theses and Dissertations

Cracked teeth have long presented a diagnostic challenge. Previous investigators have considered possible predictive factors, many of which revolve around the tooth’s restorative characteristics. Few have investigated the restorative status of teeth with cracks extending into the pulp chamber. The purpose of this investigation was to determine the prevalence of the different types of restorations present in intrapulpally cracked teeth and determine any other restorative factors that may aid in predicting the presence or extent of an intrapulpal crack. Intrapulpally cracked molars requiring endodontic therapy at the VCU Graduate Endodontic Practice were included in this study. For each tooth, the …

The Prevalence, Predictive Factors, And Classification Of Intrapulpal Cracks In Maxillary Premolars Requiring Endodontic Treatment, Sarah Krygowski

Theses and Dissertations

Cracked teeth may be difficult to diagnose. Craze lines rarely become symptomatic or require treatment. Cracks in the enamel and dentin alone may or may not become symptomatic and require restorative treatment. However, cracks extending into the enamel, dentin, and pulp chamber provide an avenue for bacteria to establish infection and this commonly results in symptoms and the need for endodontic and restorative treatment. The published endodontic literature has limited information regarding the prevalence or predictive factors for cracks extending into the pulp chamber of teeth. The purpose of this study was to determine the prevalence and classification of intrapulpal …

Lowering The Number Of False Positive Responses To Electric Pulp Tests By Qualifying Patient Response, Katherine Js Lee

Theses and Dissertations

The electric pulp test (EPT) has been shown to be a valuable tool in assessing pulp vitality. One of its drawbacks, however, is its high number of false positives. The purpose of this study was to determine if qualifying the type of sensation elicited by the test could lower the percentage of false positive responses. A retrospective chart review of an eleven-month period was conducted, examining all patients with necrotic teeth tested with the EPT. Of 189 teeth, when the patient responded to EPT at first sensation 23.3% of teeth were incorrectly identified as vital. When the patient was asked …

Use Of Cone Beam Computed Tomography In The Determination Of Mental Foramen Location In Relation To Mandibular 1st And 2nd Premolars, Sanjay Bhagchandani

Theses and Dissertations

The purpose of this study was to use existing Cone Beam Computer Tomography images to determine the vertical and horizontal location of the mental foramen in relation to the mandibular first and second premolars, as well as the distance in millimeters from the apex of each. The distance from the inferior border of the foramen to the inferior border of the mandible was also recorded. The average distance from the apices of the mandibular first and second premolars to the mental foramen was 7.43mm (SD= 1.97) and 5.30mm (SD=1.65) respectively. The foramen was located 11.44mm (SD=1.49) from the inferior border …