Dentistry Commons^™

Global Public Health Feasibility: Digital Dentistry In Geriatric Population, Merna Amr Saleh

Theses and Dissertations

Oral health is a critical yet often overlooked determinant of well-being among older adults in Egypt, where mobility limitations, geographic barriers, and low awareness of preventive practices exacerbate dental disparities. DentalPal, a teledentistry-based mobile application, was developed to provide older adults with remote dental consultations, oral hygiene advice, and triage guidance. The platform enables users to submit oral photographs or radiographs for assessment, seek second opinions, and initiate follow-up chats directly with the healthcare provider. This flexible design allows users to access dental consultations on demand while ensuring continuity of care The question that guided this study was how older …

A Virtual-Reality-Based Dental Simulator For Endodontics With Automated Formative Feedback, Yousef Salah Abo El Ela

Theses and Dissertations

Advancements in virtual reality (VR) and haptic technology are transforming the landscape of medical and dental education, offering new avenues for safe, immersive, and repeatable training experiences. Within dentistry, endodontics presents unique challenges for preclinical education due to anatomical complexity, limited access to extracted teeth, ethical concerns, and the shortcomings of conventional plastic models. Despite endodontics specific plastic teeth being available, they fall short of replicating the hardness of real extracted teeth, are relatively costly compared to generic plastic teeth, and are ultimately a disposable item which makes them inadequate as a sustainable long-term solution. Extracted teeth do a much …

Comparison Of Artificial Intelligence Vs Human Observer For Periapical Radiolucency Detection, Adam J. Pink

Theses and Dissertations

Objective: The aim of this study was to assess the performance of an Artificial Intelligence (AI) program (OverJet AI) with that of experienced endodontic residents, endodontists, a radiologist, and dental students in detecting periapical radiolucencies using radiographic images.

Methods: One hundred and fifty periapical radiographic images were analyzed using the OverJet AI software to determine the presence/absence of a periapical radiolucency as well as the size (small 1-3mm, medium 4-6mm, and large 6+mm). The unaltered images were also evaluated by two endodontic residents, two practicing endodontists, an oral radiologist and two 4th year dental students.

Results: Agreement between the AI …

Endodontic Access Through Zirconia Crowns: A Comparative Evaluation Of 3d Guided Versus Free-Handed Techniques, Maryam Alrughaib

Theses and Dissertations

Objective:

Accessing canals through full-coverage zirconia crowns is challenging and may increase the risk of misdirection, excessive dentin removal, and prolonged chair time. Guided endodontic access has been proposed to improve efficiency and precision. This study compared the accuracy and time efficiency of guided versus free-hand endodontic access through zirconia restorations. The hypothesis was that guided access would enhance canal localization precision and significantly reduce access time.

Methods:

Thirty-two extracted maxillary premolars were restored with 1-mm–reduced monolithic zirconia crowns (3Y-TZP, Katana HTML, Kuraray, Japan) and mounted in Modupro models. Teeth were assigned to two groups (n = 16 each): guided …

Development Of Preventive Dental Guidelines In The Primary Healthcare Setting In Egypt: A Delphi Method, Basant Mehriz

Theses and Dissertations

This study addresses the critical need for standardized preventive dental care guidelines within Egypt's primary healthcare system amid the rising burden of oral diseases. Through a systematic two-phase methodology combining a comprehensive literature review and a Delphi consensus-building process engaging 35 dental professionals, the research established priorities for contextually appropriate preventive measures. The consensus framework revealed strong support for clinical interventions (mean of 83% agreement), particularly fluoride-based prevention; community initiatives (mean of 83%), especially school-based programs; policy measures (mean of 77%) such as workforce and educational development, though with variable support for taxation and social determinants approaches. Statistical analysis demonstrated …

Effects Of Different Blue Light Conditions On Saos-2 Cell Viability, Differentiation, And Mineralization, Jamielyn Alcantara Jarvis

Theses and Dissertations

Photobiomodulation (PBM) is a low-intensity light therapy that uses non-ionizing forms of energy to induce a directed cellular response. Prior work has investigated the effects of blue light exposure at energy densities ranging from 1 J/cm2 to 10 J/cm2 on osteogenic differentiation of human gingival mesenchymal stem cells (hGMSCs), human dental pulp stem cells (hDPSCs), and stem cells from the apical papilla (SCAPs) and shown promising outcomes at 4 J/cm2 and then having a detrimental impact at higher energy densities. One key caveat in prior studies is that the blue light energy density was modulated by changing the light exposure …

Smear Layer Removal By Irrigation Adjuncts: A Scanning Electron Microscopy Study, Triet D. Vuong

Theses and Dissertations

Purpose: This study aimed to compare the intracanal smear layer removal ability of two adjunctive irrigation modalities: the AdvErL EVO laser, the GentleWave^® Procedure, and their combination, after minimally invasive canal instrumentation.

Methods: Forty molars were accessed, the mesiobuccal canals of maxillary and mandibular molars were prepared up to apical size 25.04 using rotary instrumentation, then irrigated using: conventional needle irrigation (CNI), laser-assisted irrigation (LAI), the GentleWave^® Procedure (GWP), and LAI followed by GWP (LAI+GWP). The teeth were then decoronated and split longitudinally. One-half of each root was selected for preparation and analysis under scanning electron microscope. Blinded …

Comparative Evaluation Of Three Endodontic Rotary File Systems In S-Shaped Root Canals: An In-Depth Analysis, Mudher Bahar

Theses and Dissertations

Objective: This study compares three endodontic file systems—XP‐3D Shaper⁺, EdgeFile X7 and WaveOne Gold in S‐shaped simulated canals in resin blocks. It aimed to quantify canals volumetric changes post‐instrumentation to guide clinical selection of a system that preserves tooth structure while efficiently shaping root canals.

Methods: Thirty S‐shaped canals in resin blocks were divided into three groups (n=10) for instrumentation with XP‐3D Shaper⁺, EdgeFile X7 or WaveOne Gold using the crown‐down technique and manufacturers recommended settings. A no‐treatment control provided a baseline for volumetric changes measured via CBCT scans analyzed with ITK‐SNAP. Data were analyzed using ANOVA and Tukey’s test …

Subgingival Microbiomes Of Healthy And Periodontitis Subjects, Tareq Abdulrasoul

Theses and Dissertations

Background: Periodontitis is a common chronic inflammatory disease triggered by the dysbiosis of the subgingival microbiome. 16s rRNA sequencing has been used to profile the subgingival plaque samples in healthy and periodontitis subjects. Here, we have collected subgingival plaque samples from subjects and analyzed the microbiome profile from 16s rRNA sequencing. We hypothesized that periodontitis patients will have a different subgingival microbiome profile than that of healthy subjects.

Methods: Subgingival plaque samples were collected from periodontitis and healthy subjects who were indicated for periodontal surgeries (osseous resective and regenerative surgery for periodontitis patients or crown lengthening for healthy …

The Role Of Hdac6 In Periodontal Inflammation, Hannah S. Lohner

Theses and Dissertations

Periodontal disease is a polymicrobial infection-induced chronic inflammatory disease and results in irreversible tissue damage and bone loss. While bacteria play a large role in the initiation of this disease, excessive and prolonged inflammatory immune responses are fundamental for its progression, making host directed therapy (HDT) a possible and potentially valuable treatment. Histone Deacetylase 6 (HDAC6) is an enzyme that removes acetyl groups from both histone and non-histone proteins, giving it a potential role in regulating inflammation initiated by pathogenic oral bacteria. Previous studies indicated that HDACs act as a bivalent regulator in inflammatory responses; however, the role that HDAC6 …

The Effect Of Local Anesthesia When Used In Dental Restorative Cases Under General Anesthesia On Control Of Postoperative Comfort, Elizabeth S. Kleefisch Dds

Theses and Dissertations

Purpose:

To determine the effect of local anesthesia on postoperative comfort in patients undergoing dental care under general anesthesia.

Methods:

This study was modeled as a double-blinded randomized control trial. Patients included healthy children under the age of 6 years scheduled for restorative dental treatment under general anesthesia (GA). Patient behavior was evaluated preoperatively and postoperatively using the Faces, Legs, Activity, Cry and Consolability (FLACC) or other pain score and postoperatively using the Parent’s Postoperative Pain Measure (PPPM). Intraoperatively, participants followed a standardized general anesthesia protocol and were given either local anesthetic (LA) infiltration using 2% Lidocaine 1:100,000 Epinephrine by …

An Examination Of Hiring Practices And Employee Retention Today Compared With Pre-Pandemic Characteristics In Orthodontics, Logan Passey

Theses and Dissertations

Purpose: Evaluate current hiring practices and employee retention characteristics in orthodontic private practices.

Methods: Orthodontists (n=1000) were surveyed regarding their hiring methods and outcomes. Responses were summarized with descriptive statistics. Chi-square tests were used to compare hiring practices and perceptions. Nonparametric Kruskal-Wallis tests were utilized in analysis of retention thresholds.

Results: Survey response rate was 7.2% (72 responses). When comparing thresholds previous to, and after the COVID-19 pandemic, there was an increase in open clinical positions compared with non-clinical and managerial positions (p=.0008). 68% of orthodontists reported a decrease in qualified applications for clinical positions compared with non-clinical and managerial …

A Retrospective Chart Review Of Avulsion Injuries Treated At Virginia Commonwealth University., Ryan Hediger

Theses and Dissertations

A RETROSPECTIVE CHART REVIEW OF AVULSION INJURIES TREATED AT VIRGINIA COMMONWEALTH UNIVERSITY. By: Ryan Hediger, DMD

Objective: Outcomes related to healing following an avulsion injury are multifactorial. However, contemporary literature suggests that tooth survival can be enhanced after such injuries by promptly replanting the tooth and adhering to proper management guidelines. Despite the abundance of resources available, the actions taken immediately after the avulsion injury play a pivotal role in determining the fate of an avulsed tooth. The primary objective of the current investigation is to unveil prognostic factors associated with the survival of avulsed teeth.

Methods: A chart review …

Intersectionality, Racial Discrimination And Oral Healthcare Utilization Among Black Adults In Baltimore City, Maryland, Briona M. Phillips

Theses and Dissertations

INTRODUCTION: Oral health is essential for overall well-being, yet disparities persist, particularly among marginalized populations including Black adults. Limited access to and underutilization of oral healthcare services exacerbate these disparities. Discrimination, both individual and systemic, acts as a significant barrier to accessing care, contributing to disparities in oral health outcomes. Individuals facing discrimination experience mistrust and fear within oral healthcare settings, leading to delayed or avoided care. Therefore, investigating and addressing discrimination among Black adults is essential for promoting equitable access to oral healthcare, improving overall oral health outcomes, and lessening existing disparities.

PURPOSE: The purpose of this dissertation was …

Outcomes Of Anterior Crossbite Correction On Alveolar Bone Morphology In Patients With Cleft Lip And Palate, Katherine J. Hayes

Theses and Dissertations

Objective: To determine if patients with cleft lip and/or cleft palate (CLP) with dental correction of the anterior crossbite during growth display differences in alveolar bone thickness around the maxillary central incisors compared to patients without crossbite correction.

Methods: This retrospective study evaluated post-treatment cone beam computed tomography (CBCT) images of growing patients with CLP with anterior crossbites who underwent Phase I orthodontic treatment (n=32). CBCTs were sorted by whether the crossbite was corrected (n=16) or not corrected (n=16) during Phase I. Alveolar bone thickness was measured on the buccal and palatal aspects of the central incisors at 3 mm, …

Validation Of A Screening Tool For Sleep Apnea In Children, Brandon Khor

Theses and Dissertations

Objective: The aims of this study were to (1) determine the ability of a pediatric obstructive sleep apnea (POSA) questionnaire to identify high-risk patients through confirmation with an at-home sleep apnea test (HSAT) and (2) to evaluate the correlation between high-risk patients as identified by the questionnaire (PM-STOP-Bang) and an already validated POSA screening tool.

Methods: Orthodontic patients aged 12-17 who met the inclusion criteria were consecutively enrolled in the study (n=16). At the initial orthodontic appointment, the clinician filled out the PM-STOP-Bang questionnaire. Subsequently, participants were invited to complete a one-night HSAT (WatchPat, WP-Itamar-Medical, Caesarea, Israel), which recorded diagnostic …

Factors Important To Underrepresented Minority Applicants In Ranking Orthodontic Programs, Alyssa Patterson

Theses and Dissertations

Purpose: To determine if there was a difference in desirability of various factors used by applicants ranking orthodontic programs depending on their racial or ethnic background.

Method: A survey was distributed to orthodontic residents to assess overall preferences, and differences in desirability of various factors between underrepresented minority (URM) and non-URM applicants.

Results: For applicants overall, “clear aligner therapy training”, “good quality of clinical faculty” and “high number of cases started” had the highest mean desirability. “Racial and ethnic diversity among current and former residents”, “racial and ethnic diversity among faculty” and “participation in care of Medicaid patients” were significantly …

A Radiographic Analysis Of Teeth With Carrier-Based Obturation Requiring Retreatment, Robert W. Rudnicki

Theses and Dissertations

Objective: The purpose of this study was to determine observer accuracy and agreement in detecting carriers using preoperative radiographs, as well as to identify potential radiographic indicators for the presence of carriers.

Methods: A chart review was conducted for patients seen at the VCU graduate endodontic clinic. Eligible cases included previously treated teeth that were nonsurgically retreated, with and without identified carriers. 100 cases were identified, including 61 carrier and 39 non-carrier cases. Preoperative radiographs were randomized, and evaluators assessed each case for the presence of carrier-based obturation. Evaluators included three endodontists, one general dentist, and four endodontic residents. Statistical …

Characteristics Of Permanent Teeth Diagnosed With Pulpal Necrosis: A Retrospective Study, William Lee

Theses and Dissertations

Objective: To determine associations of pulpally necrotic teeth with demographics, clinical findings, radiographic presentation, and periapical status.

Methods: Virginia Commonwealth University uses AxiUm software to record dental treatment and treatment notes. The current study involves a keyword search using the term “pulpal necrosis”. Factors compiled and evaluated included but not limited to patient demographics, location in the dental arch, clinical findings, radiographic presentation, and periapical status.

Results: Data has revealed that teeth with pulpal necrosis can present with a variety of different clinical findings. All of the following were observations of teeth with pulpal necrosis. A total of 325 teeth …

Age Of First Dental Visit And Early Childhood Oral Health Quality Of Life, Richard Greene

Theses and Dissertations

Objective: This project aims to examine the association between the age of a child's first dental visit and their Early Childhood Oral Health Impact Scale (ECOHIS) score.

Methods: A 22-item cross-sectional survey was distributed to caregivers of healthy children aged 5 years and younger with an American Society of Anesthesiology (ASA) I and II status who presented for new patient exams.

Results: In total, 117 caregivers participated in the survey. The ECOHIS was assessed on a 5-point Likert scale and scores ranged from 0-52; higher values indicate poor oral health having a greater impact on the child and family. Those …

Assessment Of Maxillary Sinus Pneumatization In Dentate And Edentulous Areas Using Cone Beam Computed Tomography, Catherine Ramundo

Theses and Dissertations

Objectives: The primary goal of this retrospective analysis is to analyze the morphologic changes that occur following extraction in regards to sinus pneumatization.

Methods: The patient population was selected from the VCU School of Dentistry Graduate Periodontics Department. Cone Beam Computed Tomography scans (CBCT) was obtained from patients that had a posterior tooth extracted. A horizontal tangent line was drawn to the inferior border of the nasal cavity, acting as a constant reference point for measuring the extent of maxillary sinus pneumatization. Radiographic measurements were performed from a horizontal line at this fixed anatomical marker to the deepest level of …

The Value Of Educating Teachers, Coaches, And Athletic Trainers On The Management Of Dental Trauma., Darlene W. Jean

Theses and Dissertations

Purpose: To investigate the benefit of educating teachers, coaches, and athletic trainers about dental trauma to prevent incidents and improve the management of students/athletes with dental trauma.

Methods: Teachers, coaches, and athletic trainers throughout the greater Richmond metro area were recruited via email. Participants answered a pre-seminar survey to evaluate their baseline knowledge and determine whether they have experienced dental trauma with their students/athletes previously. The participants were given the option to attend an in-person or virtual seminar educating them on the basic management of traumatic dental injuries and how to guide affected students/athletes and their families to obtain optimal …

Clinical Outcomes Of Primary Anterior Esthetic Crowns In Pediatric Dentistry, Jenan Alahmad

Theses and Dissertations

Clinical Outcomes of Primary Anterior Esthetic Crowns in Pediatric Dentistry - A Prospective Cohort Study

By: Jenan Alahmad, BDS

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, 2024

Thesis Advisor: Parthasarathy Madurantakam, DDS, MDS, PhD

Department of Pediatric Dentistry

BODY

Purpose: This prospective cohort study aimed to compare the effectiveness of restoring maxillary anterior teeth in children (aged 3-6 years) with three different materials: Zirconia Crowns (ZC), Resin Composite Crowns (RC), and Pre-veneered Stainless-Steel Crowns (PVSSC). The study aims to assess the Oral …

A Preliminary Report Of A Randomized Controlled Clinical Trial Comparing Ferric Sulfate With Zin Oxide Eugenol And Non-Eugenol Based Material For Pulpotomy In Primary Molar Teeth, Sarah Balal

Theses and Dissertations

Purpose: This study aimed to evaluate the effect of eugenol and non-eugenol-based Zinc Oxide Eugenol (ZOE) cements on primary tooth pulpotomies where Ferric Sulfate (FS) is used as a medicament.

Methods: Children aged 3-7 years with dental caries in their primary molars that have clinical and radiographic diagnosis of reversible pulpitis and undergoing dental treatment under Oral Conscious Sedation (OCS) or General Anesthesia (GA) were recruited. Children were randomly assigned to receive either FS and ZOE (IRM) or FS and non-eugenol based (CAVIT). The outcomes were assessed based on failure rates of the materials separately for clinical or radiographic evidence …

Transforming Children's Oral Health: The Impact Of Oral Healthcare Policies On Virginia Medicaid Dental Health Outcomes., Anita M. Kumar

Theses and Dissertations

Abstract: Transforming Children's Oral Health: The Impact of Oral Healthcare Policies on Virginia Medicaid Dental Health Outcomes.

Objectives: This dissertation uses Department of Medical Assistance Services (DMAS) administrative files at the individual and provider level from fiscal years (FY) 2011 to 2021 to systematically study the effect of recently implemented oral health policies (EBD guidelines on sealants, CMS updated quality measures, expansion of Medicaid oral healthcare for qualifying pregnant women) on oral health outcomes of Virginia Medicaid-enrolled children.

Methods: The studies employ a difference in differences regression methods (negative binomial, Poisson, and logistic) to examine the effects of oral health …

Feasibility Of Using Somatosensory Input On Pediatric Patients Receiving Dental Treatment, Liara D. Vinson

Theses and Dissertations

Purpose: The aim of this randomized, cross-over designed feasibility study is to evaluate patient anxiety, patient cooperation, and patient acceptance of a vibrating weighted vest used during the restorative treatment compared to when no device is used.

Methods: Children aged 5 to 15 years, needing at least two appointments for restorative treatment requiring local anesthesia under basic behavior guidance techniques were recruited. Patients were randomly allocated to wearing a vibrating weighted vest at one of the appointments. At both appointments, behavior was evaluated using Frankl scores and anxiety was evaluated at the beginning and at the end of …

Utilization Of Intraoral Scanners For Fabrication Of Obturators For Patients Born With Cleft Lip/ Palate (Clp), Swara Fadnis

Theses and Dissertations

Objective: The goal of this cross-sectional study was to assess the knowledge and attitude of providers regarding incorporating a digital scanner for impression taking in children born with cleft lip and/or palate (CLP). Methods: A survey was sent out to members of the American Association of Pediatric Dentistry (AAPD). The survey included questions regarding the providers’ perception of incorporating digital intraoral scanners for impressions for fabrication of obturators. The survey also included questions about the providers’ reservations in using this technology in practice, what their experience has been with the incorporation of this technology into practice, and what is …

A Six-Month Comparison Of Orthodontic Pain Associated With Fixed Edgewise Appliances And Clear Aligners, Victor Chan

Theses and Dissertations

Title: A Six-Month Comparison of Orthodontic Pain Associated with Clear Aligners and Fixed Edgewise Appliances

Objective: To document and compare pain perception, intensity, and analgesic use over a sixmonth period between patients treated with fixed appliances (FA) and clear aligners (CA).

Methods: A prospective, parallel, two-arm, multi-center, longitudinal cohort study was conducted with 87 adults treated with CA (n=59) or FA (n=28). Subjects were selected according to inclusion and exclusion criteria. A seven-item, digital survey was sent at three timepoints (preappointment, 2-days post-appointment, and 7-days post-appointment) at each adjustment over a six-month period. The variables measured included pain experience, pain …

How Stromal Interactions Play A Role In The Quest For Human Papillomavirus Specific Cancer Therapeutics, Alexis-Leigh A. Fakunmoju

Theses and Dissertations

High-risk human papillomaviruses (HPV), like HPV16 and HPV18, are associated with malignant cancer growth within the oropharynx and cervix. Globally, HPV-induced cancers, including oropharyngeal and cervical cancers, contribute 5% to the overwhelming burden of all cancers. HPV is highly transmissible by sexual contact via micro abrasions to the mucosa. Once exposure occurs, the virus begins replication and creates an intimate relationship with the host’s cellular proteins. While most HPV is cleared quickly by our immune system, persistent infections, or infections in immune compromised individuals, are susceptible to transformation and tumor progression. Early detection measures like PAP smears and preventable measures …

Probing The Porphyromonas Gingivalis Nitrosative Stress Response Network, Alexandra Galina

Theses and Dissertations

Objective: To persist in the oral cavity, the perio-pathogen Porphyromonas gingivalis must have an efficient nitrosative stress response mechanism. To better understand how P. gingivalis responds to nitrite (NO₂^-) we must determine what genes are involved in the nitrosative stress response network.

Methods: Through genomic screening, a list of genes was generated that were hypothesized to be part of the nitrosative stress response network and believed to be involved in nitrate/nitrite metabolism or redox state of the cells. Protein coding regions were replaced with the ermF sequence by allelic exchange mutagenesis. 15 mutants were created …