December 2011. A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: This study aimed to investigate the influence of anteroposterior lip position on male and female facial profile attractiveness rankings among three groups of judges (orthodontists, general dentists, lay people) and to determine if these rankings might be influenced by demographic variables such as race, gender, and profession. Methods: Two serial sets of digitally constructed male and female profile images were employed to assess the rank order of preference in profile attractiveness as a function of anteroposterior lip position. A defined image area of the composite profiles, including superior and inferior lips, was "morphed" to produce a "base-line" image defined according to Ricketts esthetic ideal with the lower lip 2mm posterior to the E-plane. The area of the lips were "morphed" in 1mm increments from the "base line" image, six increments anteriorly and six increments posteriorly resulting in a total of thirteen images for both the male and female. The images were then segregated into two sets of 7 for both the male and female. Each set included the base-line image plus 3 images morphed anterior and 3 images morphed posterior relative to the base line image. The Set 1 images were morphed in 1 mm increments, and the Set 2 images were morphed in 2mm increments. Utilizing an online survey, three-hundred and forty-eight adult judges (116 orthodontists, 126 dentists and 106 laypeople) were asked to sort and then rank order the seven images in each set from most attractive to least attractive profile appearance. Results: Relative to the historical norms of the lower lip positioned 2mm posterior to the E-plane, for male profile preference, a more concave profile was most preferred in Set 1 by orthodontists and general dentists while a more convex was preferred by lay people. A more convex profile was preferred in Set 2 by all groups of judges. For female profile preference, the opposite was found, as a slightly convex profile was preferred in Set 1, while a more concave profile was preferred in Set 2 by all groups of judges. Conclusion: Preference for facial profile attractiveness can be significantly influenced by the anteroposterior lip position, and that while orthodontists, general dentists, and lay people were shown to be in general agreement in their profile preferences, there was considerable variability in their esthetic preference between male and female images and across morphs.

December 2011. A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: The nasoalveolar molding appliance is used pre-surgically in cleft lip and palate patients as a method of bringing together the lip and alveolus by applying force to direct desired growth.1 It is used in the infant to reduce the pre-surgical severity of the initial cleft and to improve alignment of the base of the nose and lip segments.1 The purpose of this study was to examine the long-term effect of nasoalveolar molding on facial growth and nasolabial esthetics in complete unilateral cleft lip and palate patients. Methods: Sixteen (N=16) post-surgical cleft lip and palate patients who had undergone nasoalveolar molding as infants and twelve (N=12) control patients, treated surgically without nasoalveolar molding, were recalled for a clinical examination including impressions, photographs, and a lateral cephalogram. Dental models were analyzed using the Goslon Yardstick, developed by Mars et al. in 1987.2¬ Photographs were analyzed using the Asher-McDade method for rating the nasolabial appearance in patients with cleft lip and palate.3 Finally, lateral cephalograms were digitized and analyzed using Dolphin Imaging software. Results: Separate ordinal logistic regression models indicated no significant difference between the molding and non-molding groups in Goslon score, nasal form, nose symmetry, vermilion border or nasolabial profile assessments. Generalized linear models revealed one cephalometric variable to be statistically significant between the two groups. The ANB angle was decreased by 2.34 degrees on average in the group who underwent nasoalveolar molding prior to cheiloplasty. Intra-rater and inter-rater weighted kappa statistics were calculated for each variable. Conclusion: Short-term benefits of nasoalveolar molding have been documented in the literature. However, more long-term studies are needed in order to demonstrate the longitudinal effects of the appliance on esthetics and midfacial growth. Due to the limitations of cleft lip and palate studies, it is often difficult to accurately assess treatment effects. Through inter-center studies such as the Eurocleft and Americleft projects, some limitations and biases can be overcome in order to compare various protocols and outcomes.4 In the future, it is the desire of the investigators to include the current sample of nasoalveolar molding patients in the future efforts and expansion of the Americleft study.

December 2011. A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Background: Temporary anchorage devices (TADs) provide a versatile means by which orthodontic anchorage can be established without the need for patient compliance and complex force systems. Their use is predicated on their ability to remain stable throughout the course of treatment in which they are needed. This has been shown to be the result of "primary stability" which is achieved through mechanical interlocking of the screw threads with the surrounding bone immediately upon placement. Therefore, evaluating the factors that can either enhance or detract from the primary stability of TADs can serve to improve the predictability of their success. Objectives: The objectives of this study were to describe how variations in synthetic cortical bone thickness and the angle of force applied in relation to the long axis of TADs affects their stability in terms of pull-out strength, and to ascertain the perspectives of practicing orthodontists in the state of Florida on their experiences with temporary anchorage devices with regards to success and failure. Methods: For the bench top study, 90 1.5x8mm long neck Orthotechnology Spider Screws were randomly allocated to 9 groups of 10 TADs each. The 9 groups were established based on both the thickness of synthetic cortical bone (1.0, 1.5, and 2.0mm) and the angle of force vector applied relative to the long axis of the TADs (45, 90, and 1800). Pull-out testing was carried out by applying a force to the TADs via a universal testing machine (Instron, Canton, MA) at a rate of 2.0mm/minute. Real-time graphical and digital readings were recorded, with the forces being recorded in Newtons (N). Each miniscrew was subjected to the pull force until peak force values were obtained. For the 450 and 1800 tests, the force registered at the time-point of pull-out, or screw head movement of 1.5mm within the synthetic bone blocks. The determination of 1.5mm of movement was made due the dramatically erratic deflection observed by the digital and graphical readouts at precisely this point. For the survey portion of this study, A customized survey was developed for this study. The survey was composed of 12 questions, some of which were obtained from a questionnaire that was created by Buschang et al.54 The additional questions were devised by the members of this research project, with the aim of answering questions regarding the clinical experiences that practicing orthodontists experienced with TADs. Results: For the bench top study: Implants placed in 2.0mm of synthetic cortical bone and pulled at an angle of 1800 had the highest pull-out strength among all groups (258.38N), while those placed in 1.0mm of synthetic cortical bone and pulled at an angle of 900 exhibited the lowest (67.11N). When evaluated separately, a cortical bone thickness of 2.0 mm displayed the highest pull-out forces for the three angles of force application, and 1800 angle of force displayed the highest-pull-out forces for the three cortical bone thicknesses. Conversely, 1.0mm of cortical bone thickness displayed the lowest pull-out forces for the three angles of force application, and 900 angle of force displayed the highest-pull-out forces for the three cortical bone thicknesses. For the survey: The most important factor associated with TAD failure was cited as placement location by 45.7% (n=16) of respondents, while root proximity was cited as the least important factor by 35.3% (n=12) of respondents. For the site from which practitioners indicated that they experience the greatest success, 81.8% cited the palate, while 51.9% responded that they experience the highest failure rates for the posterior maxilla (distal to the cuspids). Conclusions: A synthetic cortical bone thickness of 2mm and pull forces applied parallel to the long axis of TADs resulted in the greatest resistance to pull-out.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objectives: To determine the amount of initial fluoride release from four orthodontic bonding systems over a period of four weeks, and then to subject these materials to an external source of fluoride for recharge in order to measure the amount of fluoride re-release over another four-week interval. Additionally the surface morphology of these materials was analyzed under the scanning electron microscope in order to identify microscopic changes in the materials that may have occurred during the experiment. Methods: Four orthodontic adhesives: Fuji Ortho LC (GC America, Alsip, IL), Transbond XT (3M Unitek, Monrovia, CA), Illuminate Light Cure (Ortho Organizers, Carlsbad, CA), and Opal Seal with Opal Bond MV (Ultradent, South Jordan, UT), n=120 (30/material) were tested for fluoride release at 1 hour, 24 hours, 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks. Samples (10/subgroup/material) were then recharged with an external source of fluoride (toothpaste, foam, or varnish), and retested for fluoride re-release at 1 hour, 24 hours, 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks. The scanning electron microscope was utilized in order to assess each material's surface morphology before testing and after completion of the experiment (n=16). Descriptive statistics, means and standard deviations were calculated for all four materials and their subgroups at each time interval. A mixed model two-way ANOVA was run, using a level of significance of 0.05. Bonferroni multiple comparison tests were conducted using if groups were found to be statistically significantly different. To determine significant differences between fluoride release and re-release for each recharge subgroup within each material group, paired t-tests were performed for the time intervals of 24 hours, 2 weeks, and 4 weeks. For the paired t-tests, the level of significance used was 0.02 to allow for Bonferroni correction. Results: During the initial 24 hours the fluoride measurements (in mg/L or ppm) were as follows: Fuji 9.78±0.65, Illuminate 7.83±1.49, Opal 0.05±0.02, and Transbond 0.01±0.0. At the initial four weeks time point, the readings were as follows: Fuji 6.68±0.79, Illuminate 3.82±1.84, Opal 0.06±0.01, and Transbond 0.01±0.01. The greatest fluoride release came from the varnish subgroups from each of the materials at 2 weeks post re-charge: Fuji 9.16±1.53, Illuminate 7.5±3.1 (tied with foam subgroup 7.5±4.4), Opal 5.3±2.45, and Transbond 3.75±1.67. The greatest fluoride measurement for each material at the final week post-recharge was: Fuji varnish subgroup 8.3±3.58, Illuminate foam subgroup 6.5±3.5, Opal varnish subgroup 2.50±1.1, and Transbond varnish subgroup 1.72±1.82. SEM results showed an observable difference between the materials pre-experiment and post-experiment at a magnification of 50X and 500X. The Fuji foam and paste subgroups displayed surface crackling patterns at both magnifications when compared to the control and varnish samples. The Illuminate control, foam, and paste specimens all had a roughened grainy appearance, while the varnish specimen seemed to be smoothed over by the varnish material. The Transbond samples appeared to have observable differences in surface morphology at 50X, but not at 500X. The Opal paste and foam specimens appeared to have a smoother surface than both the control and the varnish samples. Conclusions: There were significant differences in release and re-release of fluoride among all four adhesives at different time intervals over a period of eight weeks. Significant increase in fluoride re-release was seen for all three of the recharge subgroups for both Opal and Transbond at each time interval. A significant increase in fluoride re-release for the Illuminate group was mainly observed at the end of second and fourth week. Though no significant increase in fluoride re-release was observed, Fuji released highest amount of fluoride during release and re-release, at all different time intervals. Fluoride varnish was the superior recharge material, as it provided the greatest fluoride measurements, followed by foam and toothpaste. There were observable changes in the surface morphology of the materials pre-experiment and post-experiment at a magnification of 50X and 500X, which may have an affect on the fluoride releasing capabilities of the materials.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objective: This study was conducted to examine the changes in the inclination of mandibular incisors and their alveolar bone dimensions between pre- and post- non-extraction orthodontic treatment, measured using cone beam computed tomography (CBCT) images. The study measured the association of the pre- and post- labial and lingual bone measurements with the pre- and post- treatment incisor inclination by comparing the incisor-mandibular plane angle (IMPA). Background: Teeth move through bone by extensive osseous adaptation within the alveolar process. It is a common belief in orthodontics that alveolar bone follows tooth movement. As a tooth moves, bone will remodel around the alveolar socket usually in a 1:1 ratio of bone resorption to bone apposition. However, conflicting evidence in the orthodontic literature questions whether the anterior alveolar bone is able to remodel and follow the direction and quantity of tooth movement. Many studies have shown that the width of the alveolar bone and the lingual and labial cortical plates set limitations on how much anterior tooth movement can be accomplished without negative effects such as periodontal problems, root resorption or fenestrations. Methods: Pre- and post- non-extraction orthodontic treatment CBCT scans of twenty Class I molar patients with mild to moderate crowding were used to observe the buccal and lingual width and incisor inclination of each of the patient's four mandibular incisors. The labial and lingual alveolar bone dimensions were measured pre-treatment and post-treatment at 6 mm apical to the CEJ and at the apex of each tooth. The inclination of the incisors (using IMPA) of both time points was also documented. Results: A Fisher's exact test and a Cramer's V test were performed. The results showed statistical significance between the change in bone of the incisors and the change in their inclination at the buccal 6mm, buccal apex, lingual 6mm and lingual apex. There was also statistical significance found between the change in bone between the buccal apex and lingual apex of the LR1, LR2, LL1, and LL2. Conclusion: Our results showed that the change in bone of the lower incisors is correlated to the change in their inclination. This suggests that incisors were tipped within the confines of the mandibular anterior alveolar process, or the alveolar process bent and remodeled around the incisors in the same direction of tooth movement or a combination of the two.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. ABSTRACT The significance of this research was to identify the optimal techniques to remove ceramic orthodontic appliances in order to prevent tooth-enamel fracture, pain, and esthetic complications. Discomfort and pain are common occurrences during orthodontic appliance removal. In debonding (bracket removal) appointments, less force, measured as reduced shear bond strength (SBS) is preferable because greater force creates more discomfort and pain. In a previous study, 24.3% of patients reported pain when metallic brackets were removed using a ligature-cutting plier, compared to 12.8% of patients reporting pain when a lift-off instrument was employed. These previous findings demonstrate the need to investigate new debonding removal methods which have less SBS to help reduce the pain experienced by orthodontic patients. Some recent studies have reported that orthodontic bracket debonding causes inevitable damage to the enamel surface. The debonding of ceramic orthodontic brackets can increase the risk of enamel damage. The application of heat to help debond a bracket can increase the temperature of the pulp chamber; this could injure pulp cells and threaten the long term vitality of the affected tooth. The purpose of this in-vitro study was to evaluate the safety and effectiveness of using a diode laser for the debonding of ceramic brackets in relation to the amount of debonding force required, the risk of direct force impact on enamel, and the risk of causing an adverse temperature increase inside the pulp chamber. The central hypothesis I investigated was that using a diode laser would facilitate the debonding of ceramic brackets by decreasing the SBS, increase the adhesive remnant index (ARI), and avoid causing an adverse temperature increase in the pulp chamber. I investigated these parameters with the goal of establishing an effective and safe protocol for debonding ceramic brackets. At present no guidelines exist, I recognized that guidelines are needed for using a diode laser to debond brackets in relation to the power level and duration of lasing. This study tested two types of ceramic brackets; a monocrystalline bracket called Radiance and polycrystalline ceramic bracket called Clarity. These brackets were selected because they are widely available and in common use. The experimental brackets were monocrystalline and polycrystalline: the laser power settings and lasing times were; negative control (not lased), lased at 2.5 watts for 3 and 6 seconds, and lased at 5.0 watts for 3 and 6 seconds. The diode laser treatments had little effect on the debonding SBSs for the removal of the Radiance monocrystalline brackets. Alternatively, the debonding of the Clarity polycrystalline brackets with laser treatment using 2.5 watts for 6 seconds, 5.0 watts for either 3 seconds or 6 seconds reduced the SBS. The debonding of the Radiance monocrystalline brackets with laser treatment using 2.5 watts for 3 seconds, and 5.0 watts for 6 seconds increased the ARI. The debonding of the Clarity polycrystalline brackets with laser treatment using 2.5 watts for 6 seconds, 5.0 watts for 3 seconds and 6 seconds increased the ARI. The increase in pulp chamber temperature likely to cause thermal injury to the pulp cells was measured against Zack and Cohen¡¯s in vivo standards (2.2¢ªC and, 5.5¢ªC).30 When compared to the 2.2¢ªC standard; the debonding of Radiance monocrystalline brackets with laser treatment using 2.5 watts for 3 seconds were within the standard, and the debonding of Clarity polycrystalline brackets using 2.5 watts for 3 seconds was cooler. When compared to the 5.5¢ªC standard, the debonding of Clarity polycrystalline brackets using 2.5 watts for 6 seconds was cooler. The research results showed that using a diode laser for debonding at 2.5 watts for 6 seconds decreased the SBS for Clarity polycrystalline brackets (reduced the force needed for debonding), increased ARI for Clarity polycrystalline brackets (increased adhesive on enamel), and did not increase the pulp chamber temperature by an injurious amount. The difference in the debonding SBS, ARI and pulp chamber temperatures of the two bracket types probably arose because of the difference in the designs of the two bracket pads. My research results demonstrate the long-term need to design brackets with pads which can be removed easily with a diode laser, leave more adhesive on enamel, and that do not cause injurious temperature increases within the pulp chamber. My research results also demonstrate why guidelines for bracket debonding using diode lasers are needed, which limit the power setting and lasing times. The debonding of brackets using diode lasers could benefit orthodontic patients and become more common if it can reduce the risk of tooth fracture, lower the sensation of pain, reduce the amount of enamel damage, and maintain the vitality of teeth in future studies.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objectives: The purpose of this study was to evaluate clinical outcomes based on the American Board of Orthodontics Objective Grading System (ABO-OGS) in a 30-month postgraduate orthodontic residency and to determine what factors affected these treatment outcomes. Methods: Consecutively debonded cases from July 1, 2010 to June 30, 2011 treated by residents in the Orthodontics Department at Nova Southeastern University were graded using the ABO-OGS. The age and sex of the patient, the treatment time, the missed appointments and the number of providers were documented. Discrepancy indices were calculated for each patient. These variables were assessed and their associations with the obtained treatment outcome scores were evaluated. Results: The average OGS score of the debonded cases was 33.87. There was no significant correlation between total OGS score and the demographic or explanatory variables. There were significant correlations found between the discrepancy index (DI) and the treatment time, the number of providers, but not the OGS. Significant correlations were also identified between treatment time and the number of failed appointments and the number of providers. Extraction cases were shown to have a significantly longer treatment time. Out of the eight objective measurements of the OGS, occlusal contacts, marginal ridges, buccolingual inclination and alignment/rotations scored the highest points in our evaluation with an average of 7.81, 6.37, 5.04, and 5.01 respectively. Conclusions: This study indicated the Nova Southeastern University Orthodontic Department average OGS score is about 6 points higher than the ABO clinical exam passing score. The initial complexity of a case was not a pre-determined factor for the final treatment results. This study identified several aspects of treatment outcomes that need improvement including, occlusal contacts, marginal ridges, correcting buccolingual inclination and improving the alignment.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Introduction: One of the challenges in orthodontics is obtaining desired tooth movement. A recent development in orthodontics offers patients more comfort by minimizing pain, and shortening the treatment time. Low level laser therapy (LLLT) emerged as a technology that may accelerate the velocity of tooth movement and shorten the orthodontic treatment period. LLLT (630-1000nm) has been shown to modulate various biological processes including wound healing and bone remodeling. Bone remodeling is one of the biological processes that ensue during tooth movement. Bone remodeling is a continuous process characterized by bone deposition at sites of tension and bone resorption on the pressure sites. At cellular level bone remodeling is regulated by receptor activator of NF-κB (RANK) and receptor activator of NF-κB ligand (RANKL) and Osteoprotegrin (OPG). RANK and RANKL promotes osteoclastic differentiation and promotes bone resorption. OPG is a soluble decoy receptor that competes with RANK for binding to RANKL and inhibits the osteoclastic activity. The goal of the research is to understand the regulatory effects of LLLT on bone metabolism at the cellular level. Furthermore, the purpose of this study is to evaluate the critical parameters of low level lasers on the early stage of ostegenic regulation of human osteoblast cells. In this study, CRL-1427 cells derived from human osteosarcoma which have an osteoblast phenotype were used as cell model. Methods: Human osteoblast cells CRL1427(ATCC, Manassas, VA) were cultured in minimum essential medium supplemented with 10% fetal bovine serum and 1% antibiotics and incubated in at 37°C with 5% CO2. The monolayer of cells after reaching 70-80% confluency were irradiated with a single dose of Galium Aluminum Arsenide (Ga-Al-As) laser, with a wave length of 830nm and output power of 85mW with 0.6, 1.5, 1.8 Joules/cm2 energy exposure regimes. The mRNA expressions of Alkaline phosphatase (ALP), Osteoprotegerin (OPG), RANKL and RANK were compared after seven days by quantitative real time PCR. Results: We observed that treatment of CRL 1427 cells with LLLT (1.5, 1.8 Joules/cm2) irradiation significantly increased the expression of ALP, OPG, RANKL and RANK mRNAs compared to the control group (P≤0.05). There was no significant difference between the control group and mRNA expression of ALP, OPG, RANK, or RANKL at 0.6J/cm2of irradiation. Conclusion: LLLT irradiation can directly influence the expression of genes associated with bone metabolism and potentially represents a mechanism that facilitates rapid bone remodeling.

A thesis submitted to the College of Dental Medicine of Nova Southeastern University of the degree of Master of Science in Dentistry. Objective: This study was conducted to determine the resistance to wear and effectiveness of Opal®Seal (Opal Orthodontics by Ultradent, South Jordan, UT, USA) against enamel demineralization in comparison to L.E.D. Pro Seal® (Reliance Orthodontic Products, Itasca, IL, USA). Background: Development of white spot lesions (WSL) is a primary concern during fixed orthodontic treatment. With poor oral hygiene during orthodontic therapy, it is almost inevitable that enamel demineralization will occur and WSLs will be seen clinically. Numerous materials have demonstrated successful prevention of WSLs, including topical varnishes and sealants, gels, pastes and bonding agents. The newly developed sealant Opal Seal is claimed by the manufacturer to prevent demineralization and subsequent WSLs from forming during orthodontic treatment. To evaluate the effectiveness of Opal Seal, we tested and compared it to Pro Seal, which has proven to be successful at WSL prevention and is, like Opal Seal, a fluoride-releasing, light-cured, low viscosity filled resin sealant. Methods: A total of 48 non-carious extracted human premolar teeth were divided into 3 groups representing one of the following topical treatments: no treatment (C), Opal Seal (OS) or L.E.D. Pro Seal (PS). Each group was subdivided into either T1 or T2 time interval groups (C1, C2, OS1, OS2, PS1 and PS2) and teeth were subjected to 10,000 or 20,000 simulated brush strokes, respectively, followed by exposure to an acidic solution for 96 hours. Teeth were examined macroscopically for product wear and assessment of WSL development and then sectioned for quantitative examination with polarized light microscopy. Results: Visual assessment revealed wear of L.E.D. Pro Seal in 62.5% of the PS2 teeth following exposure to toothbrush abrasion and acidic challenge. No L.E.D. Pro Seal or Opal Seal wear was found in any PS1 or OS teeth, respectively. WSLs involving 50-100% of the exposed enamel surface developed in all control teeth and 37.5% of PS teeth had WSLs involving less than 50% of their enamel surface. These WSLs were visible as small, white, isolated points. No visible WSLs were found in any teeth in the OS group. A Fisher's Exact test was used to evaluate any differences in demineralization within groups over time. The results indicate a significant difference in the number of lesions found at T1 compared to T2 in the PS group (p = 0.003). A non-parametric Kruskal-Wallis test using a Wilcoxon test for all multiple comparisons was conducted to evaluate any differences among the treatment groups for change in depth of demineralization (µm) at two different time points. PS and OS groups were found to have significant differences in average lesion depth compared to the control groups at T1 and T2 (pConclusions: Our results showed that both Opal Seal and L.E.D. Pro Seal reduce enamel demineralization when teeth are subjected to simulated toothbrush abrasion and an acidic environment over time. Opal Seal provided superior protection of the enamel surface and demonstrated complete wear resistance and prevention of demineralized lesion development in our experimental groups.

Purpose: The aims of this study were to: (1) evaluate the prevalence of compliance of Postgraduate Pediatric Dentistry Programs (PPDPs) in the United States with the current American Academy of Pediatric Dentistry (AAPD) sedation guidelines and Commission On Dental Accreditation (CODA) sedation curriculum requirements and identify barriers to and facilitators for implementation of such guidelines; (2) identify changes to-date in sedation practices of PPDP since the previously published AAPD sedation guidelines (2011); and (3) determine the independent association of compliance of PPDP with program setting. Methods: A 40-item questionnaire was emailed to all postgraduate pediatric dentistry program directors (PPDPDs) of CODA accredited programs in the U.S. (n=74). Bivariate analysis, chi-square, Monte Carlo simulation and Kruskal-Wallis tests were used to analyze the data. Results: 70% of surveyed participants responded (n=52). On average, PPDPs were found to be compliant with both AAPD and CODA sedation standards. The bivariate analysis showed that both current setting of PPDPs and PPDPDs training setting did not affect the compliance of the program with the AAPD and the CODA sedation guidelines. Directors that stated receiving an “excellent sedation training” were more likely to be compliant with the CODA sedation standards (p=0.01). In this study, a major perceived barrier for increasing the number of non-IV conscious sedation cases per residents was a lack of patient pool (37%). When comparing changes in the sedation practice of PPDPs between 2009 and 2011, more sedation emergency drills were found to be performed in 2015 (p=0.05). Conclusion: Most PPDPs were compliant with both the AAPD and CODA sedation standards. Most PPDPDs were in favor of the 2013 increase number of sedation required by CODA. Both PPDPD training setting and PPDP setting did not affect the compliance of the programs with the AAPD sedation guidelines and the CODA sedation standards. PPDPs with PPDPDs who reported an excellent sedation training were more likely to be more compliant with the CODA sedation guidelines. Finally, PPDP setting did not affect the number of patients receiving non-IV conscious sedation or the number of sedation ER experienced per year.