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

P: P…

I: I…

C: C…

O: 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)

CRITICAL QUESTION MESH Terms: CASE SIGNIFICANCE

Type your searchable question here… (preferably in font Calibri - minimum size 20) Terms…
Student Summary
Type your bottom line here… (preferably in font
Calibri - minimum size 20)

CAT 1 CAT 2 CAT 3

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

FUTURE DIRECTIONS
Write 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
29 y/o healthy female has full mouth radiographs taken as part of comprehensive Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both
oral examination. Periapical Radiolucencies are seen on teeth #4 and #5 (see teeth. The following clinical tests were performed:
arrows below).
Tooth Cold EPT Perc Palp Probing Mobility

P- Patients receiving root canal therapy 3 WNL 31/80 WNL WNL 323B 323L 0

4 NR 80/80 WNL WNL 323B 323L 0

I- Temporary restorative material
(Cavit, IRM, or KetacFill [GI]) 5 NR 80/80 WNL WNL 323B 323L 0

6 WNL 26/80 WNL WNL 323B 323L 0

C- Definitive restoration

O- Durability and resistance to coronal Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis
microleakage Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

CRITICAL QUESTION MESH Terms: CASE SIGNIFICANCE

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?

CAT (1) CAT (2) CAT (3)

FUTURE DIRECTIONS
Write 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
29 y/o healthy female has full mouth radiographs taken as part of comprehensive Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both
oral examination. Periapical Radiolucencies are seen on teeth #4 and #5 (see teeth. The following clinical tests were performed:
arrows below).
Tooth Cold EPT Perc Palp Probing Mobility

P- Patients receiving root canal therapy 3 WNL 31/80 WNL WNL 323B 323L 0

4 NR 80/80 WNL WNL 323B 323L 0

I- Temporary restorative material
(Cavit, IRM, or KetacFill [GI]) 5 NR 80/80 WNL WNL 323B 323L 0

6 WNL 26/80 WNL WNL 323B 323L 0

C- Definitive restoration

O- Durability and resistance to coronal Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis
microleakage Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

CRITICAL QUESTION MESH Terms: CASE SIGNIFICANCE

For patients receiving root canal therapy, which temporary restorative material (Cavit, IRM, or Root Canal Therapy;
KetacFill GI) compares most favorably to the properties of the definitive restoration as measured Dental Restoration,
by durability and resistance to coronal microleakage? Temporary; Leakage

CAT (1) CAT (2) CAT (3)

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)
Barthel et al. “Leakage in Roots Coronally
Naoum & Chandler. “Temporization for
Sealed with Different Temporary Fillings.”
Endodontics.” International Endodontic Journal
Journal of Endodontics 25:11 pp 731-734. 1999.
35:pp 964-978. 2002.
Methods: 103 extracted single-rooted teeth
Methods: A literature review was performed
received RCT and were then filled with either
using MEDLINE and contemporary textbooks to
Cavit, IRM, GI, Cavit/GI, or IRM/GI. Teeth were
assess various endodontic temporary filling
then immersed into a two-chamber system
materials and to make clinical recommendations.
which was inspected daily over a 30-day period
Results/Conclusion: Cavit possesses favorable
for bacterial microleakage.
marginal seal but inferior mechanical properties
Results/Conclusion: GI gave the best seal
compared to IRM. Studies have shown that IRM
against bacteria (1/20 samples leaked),
also provides a favorable marginal seal,
whereas Cavit gave the poorest seal (13/20
especially when the powder: liquid ratio is
samples leaked). 11 out of 20 IRM samples
leaked.
decreased. GI is more costly, but has been found FUTURE DIRECTIONS
to be antibacterial and to have a superior seal; Write future directions here… (preferably in font
Validity/Applicability: Results of in vitro studies
thus it may be used for cases of long-term Calibri - minimum size 20)
cannot directly be applied to clinical practice.
temporization.
However, all available filling materials to UIC
Validity/Applicability: Authors did not provide a
COD students were tested.
detailed selection criteria for articles reviewed.
Level of Evidence: 6 (Preclinical study)
Level of Evidence: 5 (Expert Opinion)
.
CaseCAT Worksheet
 Should I use CavitTM, IRMTM, or KetacFillTM?
Student: Michael P. Munaretto
Advisor: Bradford Johnson, DDS MHPE, UIC Department of Endodontics

CASE SCENARIO
29 y/o healthy female has full mouth radiographs taken as part of comprehensive Exam: EOE WNL. IOE reveals large DO amalgam restorations present on both
oral examination. Periapical Radiolucencies are seen on teeth #4 and #5 (see teeth. The following clinical tests were performed:
arrows below).
Tooth Cold EPT Perc Palp Probing Mobility

P- Patients receiving root canal therapy 3 WNL 31/80 WNL WNL 323B 323L 0

4 NR 80/80 WNL WNL 323B 323L 0

I- Temporary restorative material
(Cavit, IRM, or KetacFill [GI]) 5 NR 80/80 WNL WNL 323B 323L 0

6 WNL 26/80 WNL WNL 323B 323L 0

C- Definitive restoration

O- Durability and resistance to coronal Diagnosis: #4 and #5 Necrotic Pulp, Asymptomatic (Chronic) Apical Periodontitis
microleakage Treatment Plan: Non-surgical RCT #4 and #5. Multiple visits will be required.

CRITICAL QUESTION MESH Terms: CASE SIGNIFICANCE

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?
CAT (1)
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)
CAT (2)
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)
.
Root Canal Therapy; Few in vivo studies and no systematic reviews
Dental Restoration, exist studying this topic. However, from the
Temporary; Leakage available evidence the following conclusions can
be drawn:
CAT (3) 1. Cavit provides an adequate seal over at least 3
weeks as revealed by an in vivo study (1).
Naoum & Chandler. “Temporization for
However, due to its poor mechanical properties,
Endodontics.” International Endodontic Journal
its use should be reserved only for conservative
35:pp 964-978. 2002.
accesses where occlusal forces are minimal (3).
2. IRM provides an adequate seal over at least 3
Methods: A literature review was performed
weeks as revealed by an in vivo study (1). Its
using MEDLINE and contemporary textbooks to
mechanical properties are superior to Cavit and it
assess various endodontic temporary filling
is therefore indicated for whenever the tooth will
materials and to make clinical recommendations.
be regularly subjected to occlusal forces. As the
Results/Conclusion: Cavit possesses favorable
powder: liquid ratio is decreased, the seal
marginal seal but inferior mechanical properties
improves (at the expense of mechanical
compared to IRM. Studies have shown that IRM
properties). (3)
also provides a favorable marginal seal,
especially when the powder: liquid ratio is
3. GI has been found in an in vitro study to have a
decreased. GI is more costly, but has been found
superior seal to Cavit and IRM (2). Because of
to be antibacterial and to have a superior seal;
this, GI has been recommended for longer term
thus it may be used for cases of long-term
temporization (3).
temporization.
4. Studies have recommended that a definitive
Validity/Applicability: Authors did not provide a
restoration be placed as soon as possible
detailed selection criteria for articles reviewed.
following obturation (2, 3).
Level of Evidence: 5 (Expert Opinion)
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 Contacts
Dr. Marucha- marucha@uic.edu
Dr. Knight- gwknight@uic.edu
Kaitrin Baloue kbaloue2@uic.edu