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 to respond only if they felt an uncomfortable sensation, the false positive rate was lowered to 8.5%, a statistically significant difference. No association was found between the teeth reclassified as necrotic and age, gender, type of tooth, or number of canals.

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 always. For two or more walls, the percentage dropped to 44%. When the crack involved the floor or orifices, 60% would not complete treatment. For necrotic teeth, 36% of respondents preferred extraction as opposed to 3% if vital. This survey illustrated the anecdotal nature of detection, diagnosis and management of cracked teeth.

The purpose of this study was to test the number of rotations to fracture of the M-Wire GT® Series X(TM) rotary files compared to the original ProFile® GT® rotary files in a simulated curved canal. Eighty GT® Series X(TM) files of 25mm length were divided into eight groups of ten, one for each of the new GT® Series X(TM) files. Eighty original ProFile® GT® files of 25mm length were divided into eight groups of the same tip and taper sizes consistent with the GT® Series X(TM) file groups. Files were rotated at 300 rpm. While the angle may have slightly changed due to the flexure property of the file, the angle was the same for each file with the same tip and taper. The time to fracture was recorded and rotations to fracture were calculated. The data collected was analyzed using a two-way ANOVA, followed by specific post-hoc contrasts comparing the two brands for each tip and taper combination. The results show the M-Wire GT® Series X(TM) files were significantly more resistant to fracture by cyclic fatigue than the ProFile® GT® rotary instruments for the following tip and taper sizes: 20/.04, 30/.04, 30/.06, 30/.08, and 40/.08. The following tip and taper sizes: 20/.06, 40/.04, and 40/.06 were not statistically significant.

The purpose of this study was to determine what factors influence dentists when deciding whether to place an implant or perform endodontic retreatment. Null hypothesis: Dentists today are no more likely to place an implant than to perform endodontic retreatment. A twelve-item questionnaire was mailed to 525 general dentists and specialists who are members of the Richmond Dental Society. Response rate was 61.9%. The questionnaire included items on demographics, practice profile and cases of failing endodontic therapy which participants were asked to consider and chose between endodontic retreatment or implant placement. The relationship between the treatment choices and the characteristics of each dentist was assessed using a chi-square analyses and logistic regression analyses. Generally practitioners preferred retreatment (66%). This preference for retreatment varied between 25.5% and 85.9%. Associations were found between years of experience and implant use. In those practitioners with 10 years or less experience the odds of choosing an implant were higher than practitioners with more than 10 years of experience. Associations were also found between those who place implants vs. those who do not. The odds of choosing an implant verses retreatment were lower in those who did not place implants versus those who did. In conclusion, it appears that clinicians participating in this study in general still consider endodontic retreatment to be a viable treatment option prior to implant placement. However, this varies greatly with years of experience and the use of implants in practice.

AbstractTHE PLACEMENT OF MINERAL TRIOXIDE AGGREGATE USING TWO DIFFERENT TECHNIQUESBy Anita Aminoshariae, D.D.S.A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth UniversityVirginia Commonwealth University, 2003Major Director: Gary R. Hartwell, D.D.S., M.S.Chairman and Professor, Department of EndodonticsThe purpose of this study was to determine if the adaptation of Mineral Trioxide Aggregate (MTA) to the walls of the samples would differ when placed into simulated root canals of varying length using two different placement and condensation methods. Hand condensation was compared to ultrasonic condensation. Eighty polyethylene tubes were divided into four groups of twenty tubes each. The tubes in the four groups were prepared to receive 3, 5, 7 and 10-mm lengths of MTA respectively. Each group of twenty tubes was then subdivided so that ten samples of each length would have MTA placed and condensed by the hand method and the other ten by the ultrasonic method. After condensation the samples were evaluated with a light microscope and radiographs for the degree of adaptation of the MTA to the tube walls and for the presence of voids within the MTA material itself. The results demonstrated an 80% agreement for findings between the light microscopy and radiographic evaluation. Hand condensation resulted in better adaptation to the tube walls and less voids than the ultrasonic method. There was no significant difference in the results for any of the four lengths of MTA placed by the hand method (p> 0.9). At this time hand condensation should be considered the preferred method for placement of MTA.

The purpose of this study was evaluate the interobserver reliability of endodontists in the diagnosis the presence or absence of pulpal and/or periradicular disease. The study used 47 patients presenting to the VCU School of Dentistry for screening appointments as a test population under the rules and regulations of the VCU IRB. The patients were examined separately by two endodontists, using a thorough patient history, clinical exam, and radiographs. The answer to the question was then answered, does the patient have pulpal and/or periradicular disease, and compared. The data was analyzed using Kappa and the standard error was determined to test for statistical significance. Observers agreed 88% of the time with a Kappa of 0.74. This was determined to represent a bona fide reliability with p<.0001. The results indicate that agreement among endodontists is very good when patients are evaluated for pulpal and/or periradicular disease.

The purpose of this study was to determine the prevalence and demographic predictors of pulpal and/or periradicular disease in an urban population. A total of 210 subjects were recruited from a population of patients that were screened for acceptance to the dental school clinics. The diagnosis of pulpal and/or periradicular disease was made using the following data: radiographic interpretation, patient's history of previous pain and chief complaint, and objective pulpal testing. Objective pulpal testing included percussion, palpation, electric pulp test, and cold. The unit of observation was the individual, not the tooth. The overall prevalence of endodontic disease among the study sample of the screening patient population was 39.52%. Controlling for gender, patients in the 30-39 age group were 3.05 times more likely to have pulpal disease than patients in the 18-29 age group (OR=3.05, 95%CI 1.04-8.9). Controlling for age, men were 1.82 times more likely to have pulpal disease than women (OR=1.82, 95%CI 1.01-3.26). Non-white patients were 2.69 times more likely to have pulpal disease than white patients (OR=2.69, 95%CI 1.51-4.81). Patients who earned less than $25,000 were 2.06 times more likely to have pulpal disease compared to those who earned more than $25,000 (OR=2.06, 95% CI 1.15-3.69). Overall, this data provides valuable information for identifying vulnerable populations and addressing the policy goals of the U.S. Surgeon General.

The purpose of this study was to examine the number of rotations to failure of two different rotary file systems, EndoSquence Brassler USA (Savannah, GA) and GT(TM) series X(TM). Files sizes 20,30,40 with 0.04, 0.06 tapers of GT series X and Endo Sequence files size and taper used were 20, 30, 40 with 0.04 and 0.06 taper. Like tip and tapers were compared between systems. All files tested were 25mm in length. Files were allocated into 12 groups of 10 files each, and mounted to a universal testing machine. Each file was rotated at 300 rpms until fractured occurred. The number of rotations to fracture were calculated. A two-way ANOVA indicated that each of the 12 groups were significantly different (p < .0001). The Brand Tip/Taper interaction indicated that the differences between the brands varied by Tip/Taper combination (p < .0001). The tip/taper combination 20/.04, the GT series X file rotated 1.4 times longer than the EndoSequence (p = 0.0027). The tip/taper combination 20/.06, the GT series X file rotated 1.61 times longer than the EndoSequence (p = <.0001). The tip/taper combination 30/.04, the GT series X file rotated 3.67 times longer, than the EndoSequence (p = <.0001). For the tip/taper combination 30/.06, the GT series X file rotated 2.63 times longer than the EndoSequence (p = <.0001). For the tip/taper combination 40/.06, the GT series X file rotated 4.05 times longer than the EndoSequence (p = <.0001). In comparing all these tip and taper combinations GT series X was significantly higher rotations to failure. Comparing tip/taper combination 40/.04, the GT series X file rotated 1.22 times longer, however, this was not significantly different than the Sequence (p = 0.0707). The results suggested that the number of rotations to failure for GT series X files were greater than the EndoSequence file of the same tip and taper combination.

The purpose of this study was to compare the resistance to fracture by the twisting of two nickel titanium (NiTi) rotary file systems. The Profile® GT® (GT) and the GT® Series X(TM) (GTX) files were tested to analyze the maximum torsional strength and the maximum angular deflection at the time of separation of the files. For each system, ten new files were tested at each of the following eight taper/size designations for a total of 160 files: 20/0.04, 20/0.06, 30/0.04, 30/0.06, 30/0.08, 40/0.04, 40/0.06, and 40/0.08. The American National Standards Institute / American Dental Association Specification No. 28 was implemented to evaluate torsional limits for these intruments. Files were mounted in a Maillefer Torsiometre machine, which records maximum torsional strength and angular deflection at separation for each file. A two-way ANOVA revealed significant differences after comparing the size and type of file. The GT files required significantly more torque to separate than the GTX files in all groups tested except the GTX file size 20/0.06, which required significantly more maximum torque than the GT file, with no significant difference between the GT and GTX files for size 30/0.04. The GT files exhibited values for angular deflection at separation that were significantly higher than those for the GTX files at sizes 30/0.04 and 40/0.08 and the GTX files exhibited higher values at size 30/0.08 with no significant difference between the brands at the remaining five file sizes. In summary, the GT files required significantly more torque to fracture and exhibited values for angular deflection at separation that were significantly higher than the GTX files for in 6 of 8 and 2 of 8 file sizes, respectively.

Endodontic residents must keep current with clinical information to practice evidence- based dentistry. To do so, endodontic residents must access research papers and interpret results. This requires a knowledge of biostatistics. However, the biostatistical knowledge of endodontic residents is relatively unknown. The purpose of the study was to assess the biostatistical knowledge of endodontic residents using a survey instrument to prove or reject the hypothesis that there exists a lack of understanding of biostatistic principles among endodontic residents. A survey consisting of 29 questions querying attitudes and biostatistical knowledge was distributed to 230 endodontic residents and returned with a 32% response rate. The overall mean resident knowledge score was 42.3% (SD, 17.5%; range, 10% to 90%). Only 39% stated they understood all of the statistical terms encountered in journal articles. This data supports the hypothesis that there exists a lack of understanding of biostatistical principles and would suggest that more effective training in biostatistics in residency education is desirable.