published_or_final_version / Dentistry / Master / Master of Dental Surgery

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 identify factors that may aid in diagnosing the existence of a crack. All maxillary molar teeth requiring non- surgical root canal therapy or retreatment at the Virginia Commonwealth University graduate endodontic clinic from June 2016 through December 2016 were included in the study after obtaining patient consent. Teeth were examined visually, transilluminated, stained, and examined microscopically for the presence of an intrapulpal crack. Demographic information, subjective data associated with the chief complaint, objective results of diagnostic testing (percussion, palpation, bite stick test, transillumination, probing depths, existing restorations, and diagnosis) were analyzed using chi-square and logistic regression (p<0.05) to identify associations of these findings with the existence of a crack. A total of 18% (15/82 teeth) of maxillary molars that were evaluated and had endodontic treatment initiated were cracked. There was a significant association between cracked teeth and pain on biting (P<.0001) and with probing depths greater than 4 millimeters (mm) (P < 0.003). Those positive on a tooth slooth test were more likely to have an intrapulpal crack (P<.001) and teeth with a positive transillumination test were also found to be associated with the presence of a crack(P < .001).

Few studies have reported the incidence or prevalence of cracked teeth with pulpal involvement. No attempts have been made to evaluate the prevalence or clinical predictors for intrapulpal cracks. The purpose of this study was to investigate the prevalence of intrapulpal cracks in first and second mandibular molars and to determine if clinical findings are predictive for the existence of intrapulpal cracks. First and second mandibular molars (190) requiring non-surgical root canal treatment at the VCU Graduate Endodontic Practice between February 15, 2013 and August 15, 2013 were analyzed retrospectively. Teeth were transilluminated, stained, and inspected for intrapulpal cracks using a dental microscope. Data gathered included: demographics, subjective and objective information regarding the chief complaint to include bite stick test, transillumination, probing depths greater than 4mm, existing restorations, and diagnosis. Chi-square and logistic regression were performed (p<0.05). The prevalence of intrapulpal cracks in first and second mandibular molars combined was 9% (17/190, 95%CI= 5.7% to 13.9%). The prevalence was 7% for 1st molars and 13% for 2nd molars. There was no statically significant difference in the prevalence between first and second mandibular molars. Individual characteristics predictive for the existence of intrapulpal cracks were age, probing depth greater than 4mm, transillumination and a positive Tooth Slooth™ test (all p<0.05). Staining of the pulp chamber after access identified only one of 17 intrapulpal cracks. Staining of the pulp chamber did not significantly increase the ability to identify intrapulpal cracks. Neither diagnosis, sex, nor existing restorations were significant predictors for intrapulpal cracks. Probing depth greater than 4mm, age over 40 and a positive Tooth Slooth™ test were conjointly significant for predicting intrapulpal cracks.

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 type of restorative material present and surfaces involved were recorded. The Restoration Volume Proportion (RVP) was calculated to accurately quantify the size of the restoration present. Pulpal and periapical diagnoses, and intrapulpal crack classification were also recorded. Chi squared analysis and logistic regression were used to determine any significant associations. This study included 43 teeth. The study population was 65% female and the average age was 56. Of the various restoration types evaluated, 73% of teeth presented with amalgams, 12% with composites. Class I restorations were 61% of the sample. The most frequently occurring restoration size by volume was a “small” restoration. The most commonly involved teeth were the maxillary 1st molar and mandibular 2nd molar. A significant association was found between restoration size and crack classification suggesting that teeth with larger restorations had a higher incidence of coronal cracks while those with smaller restorations had a higher incidence of radicular cracks. Restoration classification and pulpal walls involved were also significantly associated suggesting that Class II restorations were most frequently associated with cracks involving a single pulpal wall while Class I restorations were evenly associated with one and two wall cracks. Other significant associations were found between tooth type and pulpal walls involved and between restoration surfaces and pulpal wall classification. This study found several significant associations between restoration characteristics and intrapulpal cracks. Further research may continue to reveal how a tooth’s restorative status may influence its risk for the presence of an intrapulpal crack.

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.

Purpose: The purpose of this retrospective chart review was to determine how primary molars needing vital pulp therapy have been treated in the past four years at Virginia Commonwealth University (VCU) and to determine which treatments: indirect pulp therapy (IPT), formocresol pulpotomy, and ferric sulfate pulpotomy have been successful. Methods: AxiUm records that contained the procedure codes D3120 (Pulp Cap – Indirect) or D3220 (Therapeutic Pulpotomy) were totaled by year. Visit records were queried again to identify treatment failures i.e. extractions or pulpectomy. Results: In 2010, 52% of vital pulp therapies were ferric sulfate pulpotomies and in 2014 over 90% were indirect pulp therapy. Indirect pulp therapy had a 96.2% success rate, formocresol pulpotomy had a 65.8% success rate and ferric sulfate had a 62.9% success rate at three years (PConclusions:Indirect pulp therapy is a successful treatment option for the primary tooth with deep caries approaching the pulp

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A dissertation submitted to the Faculty of Science, University of the Witwatersrand, Johannesburg, in fulfilment of requirements for the degree of Master of Science. Johannesburg, October 29, 2014. / Teeth are the most common element in the fossil record and play a critical role in taxonomic assessments. Size, relative width and cusp arrangements on enamel crown surfaces are used to help assess relationships between specimens. In this exploratory study, a model is developed for the placement of landmarks on images of lower first molars to maximise key information from crown surfaces of molars of African Plio-Pleistocene hominin fossils representing species of Australopithecus, Paranthropus and Homo. Lower first molar data of four extant species (Pan paniscus, Pan troglodytes, Gorilla and Homo sapiens) are visualised in a principal components analysis to detect whether landmark placements are adequate to identify species groupings and overlaps and patterns indicative of sexual dimorphism. The role of size as a differentiator between extant species is visualised using Procrustes Form Space as the basis for the analysis. A series of analyses, including linear diameter plots, Procrustes averaging, principal components analyses, discriminant function analyses and log sem (based on regression analyses) are used to test whether species groupings agree with currently accepted taxonomic classifications of thirty-six African Plio-Pleistocene hominin lower 2 first molars. Specimens in the sample that consistently fail to group with current species designations are flagged as “anomalous”. Six specimens are identified as anomalous and these are ultimately removed from the analyses. The resultant principal components plot of the fossil specimens appears to show distinctions between currently accepted species groups. The statistical regression analyses (log sem) confirm the results from the geometric morphometric analyses, and are associated with an average log sem value of -1.61 for conspecific pairwise comparisons. The log sem value of -1.61 has been proposed by Thackeray (2007a) as an approximation of a biological species constant (T), based on pairwise comparisons of modern vertebrate taxa, using cranial data. The anomalies confirm the hypothesis that certain specimens from the sample may have been misclassified, and that certain species groups as currently defined may comprise more than one morphotype.

The aim of this study was to compare the size of the teeth of a sample of small-bodied fossil humans from the island of Palau, Micronesia, with modern and fossil human populations from mainland southern Africa. Four modern human population groups and a sample of Holocene human remains were examined for comparison. These included Zulus, Tswanas, Khoisan and Europeans, from the Dart Collection, University of the Witwatersrand. Several measurements of the different tooth classes were obtained from the modern population groups and compared to the Palauan sample using Univariate and Bivariate statistical methods. In addition, frequencies of anomalies were recorded for the entire modern human Dart Collection (n. 3000), and a sample of Holocene human skeletons (n. 69) for comparison with the Palauan material. The Palauans have been found to have absolutely and relatively very large teeth compared to modern and Holocene population groups. Their mesiodistal diameter (MD) and buccolingual diameter (BL) exceed the normal range of modern human populations, whereas the same measurements at the cervical enamel junction are smaller. Total root length and crown height of the Palauans are equal to those of modern humans. Estimating body size from tooth size is thus shown to be unreliable, indicating that tooth size should be viewed in relation to other factors, such as diet, which may lead to phenomena like island dwarfism. Frequencies of third molar agenesis, incisiform canines, caniniform premolars and rotated premolars were very high in the Palauan sample: third molar agenesis, incisiform canines, caniniform premolars and rotated premolars. These anomalies are mostly due to crowding, which results in erupting teeth looking like their neighbours, or failing to develop at all, as in the case of third molars, which free up space for the remaining teeth to develop.

EVOLUTIONARY AND DEVELOPMENTAL ASPECTS OF DENTITION OF SQUAMATE REPTILES Summary of the PhD. thesis Dentition and its evolutionary modifications played important roles during the radiation of reptiles. It is generally accepted that a plesiomorphic state for reptiles is represented by homodont, polyphyodont dentition with conical or cylindroconical teeth. However, in contrast to mammalian dentition which is the object of intensive research, reptilian dentition is studied only rarely. I therefore focused on developmental and evolutionary aspects of squamate dentition and used histological, immunohistochemical and in situ hybridization methods, computerised tomography, rentgenography and scanning electron microskopy. The goals of this work were as following: (a) to choose the model taxa representing squamate lineages relevant from a phylogenetic position as well as possessing dissimilar types of dental adaptations; (b) to evaluate using of these taxa as model species; (c) in these taxa describe basic odontogenic features. As a species with generalized dentition gecko Paroedura picta was chosen, the up coming reptilian model species with features also present in a wide spectrum of other lizards. I focused mainly on the developmental differences between teeth of the null and functional generations, development...