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Celebrating Excellence and
Achievement in Research
2013 –2014 Research Abstracts
2
Student and Faculty Research Abstracts 2013 –2014
Table of Contents
History of Bates-Andrews Day | Message from Dean Thomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Message from Dr. Kugel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Acknowledgements: Corporate Partners | Special Thanks to Faculty and Students. . . . . . . . . . 6
Bates-Andrews Day Proceedings | Keynote Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Bates-Andrews Day 2014 Awards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Predoctoral Student Presentations by Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Postdoctoral Student Presentations by Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Faculty Abstracts by Subject Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5
Student Presentations And Abstracts
Predoctoral Student Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Postdoctoral Student Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Faculty Abstracts
Behavioral, Epidemiologic, and Health Services Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Cancer Biology and Tissue Engineering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Cariology Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Craniofacial Biology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Dental Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Diagnostic Sciences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Education Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Endodontics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Implantology Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Methodology and Clinical Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Mineralized Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Neuroscience / TMJ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Oral Health Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Oral Surgery Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Orthodontics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Pediatric Dentistry Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Periodontal Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Pharmacology, Therapeutics, and Toxicology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Prosthodontics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Salivary and Lacrimal Gland Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Statistics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Index of Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Tufts University School of Dental Medicine
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History of Bates-Andrews Day
Since the 1930s, this day is held annually to honor George A. Bates, an alumnus of Tufts University
School of Dental Medicine, who taught Tufts medical and dental students. He was regarded by his
students as an inspiring instructor in histology. Bates Day at TUSDM helps to promote student
research and thereby enhance the opportunities for professional growth of our students, alumni,
and faculty.
The Robert R. Andrews Society is a student-run organization formed in 1921 in honor of Dr.
Andrews, an outstanding researcher and distinguished dental surgeon. The Andrews Society seeks to
promote dental research and to honor those who excel in it.
Message From the Dean
Welcome to Bates-Andrews Day 2014, a showcase of our predoctoral and postgraduate students’
research activities. This year’s event will be the largest yet, with 78 student poster presentations! We
appreciate your attendance and support of our students’ efforts.
We are very pleased to have Dr. Carroll Ann Trotman, professor and chair of Tufts Department of
Orthodontics, as our keynote speaker. Her address was on “Restoration of Soft Tissue Dynamics and
Form in the Cleft Patient.”
Bates-Andrews Day gives our students the opportunity to share with the rest of the Tufts
community their accomplishments in fields of special interest. I applaud them for their initiative
and achievements.
Strengthening and increasing research activity and creating an environment that encourages and
supports student participation in research are integral parts of the School’s strategic plan. Student
research is also a key accreditation standard for dental education programs.
I appreciate the dedication of the faculty advisors to their mentorship. Special thanks go to the
judges and the participation of the commercial exhibitors who help make this event possible.
Finally, Eileen Doherty’s guidance as director of predoctoral student research and Dr. Gerard Kugel’s
leadership as associate dean for research are highly valued in enhancing our students’ research
experiences.
Huw F. Thomas, B.D.S., M.S., Ph.D.
Dean and Professor of Pediatric Dentistry
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Student and Faculty Research Abstracts 2013 –2014
Message From Dr. Kugel
The research mission of Tufts University School of Dental Medicine promotes integration of
innovative studies in basic science, clinical practice, and public health. This book is evidence of
the progress we have made and will continue to make at the Dental School.
TUSDM welcomes the valuable partnerships and contributions of corporations, foundations,
NIH, and NIDCR to our mission. Working together, we have the means to perform ethical,
meaningful research in oral and general health care that can be applied for the benefit of the
scientific community and the public at large.
Researchers at TUSDM conduct studies in many areas, including bench and clinical studies
in dental materials, devices, and pharmaceuticals. We are presently engaged in developing
innovative techniques in tissue engineering, bone remodeling, and Sjögren’s Syndrome.
Tufts also provides extensive opportunities for interdisciplinary research with our schools of
medicine, biomedical sciences, veterinary medicine, and engineering.
The combination of disciplines and talent at Tufts University provides the ideal environment
for collaborative research and materials testing. Our record of contributions to the sciences and
our potential to influence the future of dental medicine are extensive.
As we work to continually promote oral health and improve the quality of life for the general
population, we remain aware that strategic partnerships are vital to our efforts. We recognize
the power of shared knowledge and are always looking to share resources and ideas. The pages
ahead reveal just a sample of our achievements thus far.
Gerard Kugel, D.M.D., M.S., Ph.D.
Professor and Associate Dean for Research
Tufts University School of Dental Medicine
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Acknowledgements
Corporate Partners
The following commercial exhibitors and contributors helped to make this year’s
Bates-Andrews Day successful:
3M ESPE
Great Expressions Dental Centers
Dr. Chad Anderson, D04
Hu-Friedy
Aspen Dental Management, Inc.
Johnson & Johnson Healthcare Products
Benco Dental Company
Natick Dental Partners
Brasseler USA
Living Legacy Financial Group
Colgate Oral Pharmaceuticals, Inc.
Massachusetts Dental Society
DENTSLPY
Dr. Kistama Naidu, D02
Designs for Vision
NCDR, LLC for Kool Smiles
Door to Door Dental
Patterson Dental
Eastern Dentists Insurance Company
The Procter & Gamble Company
General Scientific Corporation
Shofu Dental Corporation
Gentle Communications, LLC
Sullivan-Schein Dental
GlaxoSmithKline
Ultradent Inc.
Tufts University acknowledges the support of these sponsors and corporate attendees, but does not necessarily share their views
and does not endorse, support, or promote any of the sponsors, corporate attendees, or their services or products.
Special thanks to the following Tufts faculty and students
Research Committee
Dr. Tofool Alghanem
Dr. John Morgan
Dr. Addy Alt-Holland
Dr. Athena Papas
Dr. Jake Chen
Dr. Alfred Rich
Dr. Wai Cheung
Dr. Naomi Rosenberg
Prof. Eileen Doherty
Dr. Paul Stark
Dr. Diana Esshaki
Ms. Jennifer Towers
Dr. Michael Kahn
Dr. Archana Viswanath
Dr. Gerard Kugel
Dr. Pamela Yelick
Dr. Driss Zoukhri
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Bates Student Research Group
and Andrews Society Officers
Courtney Michelson, President
Shruti Pore, Vice President
Kelly Kimiko Leong, Secretary
Lindsay Fox, Treasurer
Student and Faculty Research Abstracts 2013 –2014
Bates-Andrews Day 2014
Wednesday, March 5, 2014
Schedule of events
11:00 am – 3:00 pm
Predoctoral and postdoctoral student posters on display
Commercial Exhibitors
3:30 pm – 4:30 pmKeynote Speech
4:30 pm
Awards Presentation and Reception
Keynote Address
Restoration of Soft Tissue Dynamics and Form in the Cleft Patient
Carroll Ann Trotman, B.D.S., M.A., M.S.
Professor and Chair
Department of Orthodontics
Dr. Trotman received her Bachelor of Dental Surgery from the University
of Dundee, Scotland; a certificate in Orthodontics and Masters in Oral
Biology from Columbia University, New York; and a Masters in Clinical
Research and Statistics from the University of Michigan. She has also
completed fellowships in craniofacial anomalies and clinical research
design, and is a diplomate of the American Board of Orthodontics. Prior
to her position at Tufts, she was an assistant professor at the University of
Michigan Ann Arbor, professor and assistant dean for graduate education
and academic development at the University of North Carolina, Chapel
Hill, and professor and associate dean for academic and student affairs at
the University of Maryland. Dr. Trotman has maintained an active research program throughout her
career. Her currently NIDCR-funded research efforts are focused on the functional outcomes of cleft
lip surgery and decision making for surgeons. She has published extensively and has served on several
NIDCR panels and study sections.
Tufts University School of Dental Medicine
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Bates-Andrews research Day 2014
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Student and Faculty Research Abstracts 2013 –2014
Bates-ANdrews Day 2014 Awards
Best Postgraduate Poster Presentation
Dr. Daniel Coleman —“Accuracy of Periodontal Probing Depth and Calculus Detection through the Use of
Kinoshita Nissin Periodontal Dental Model”
Best Scientific Research Presentation by a Senior (Andrews Society Award)
Kyler McEwen —“Shear Bond Strength of Different Dentin and Zirconia Treatments”
First Place ADA/DENTSPLY Student Clinician Award for Best Overall Predoctoral
Table Clinic
Elizabeth Bingham —“Dab2 Depletion Modifies E-cadherin Expression in Squamous Cell Carcinoma Cells”
Second Place Award for Predoctoral Table Clinic
Jonathan Bishop —“Effect of Phosphoric Acid on Vitrebond Plus Resin-Modified Glass Ionomer”
Third Place Award for Predoctoral Table Clinic
John Constantine —“Properties of Silk Electrogels: Functional Vehicles for Drug Delivery”
Research Committee Award for Basic Science Research
Jacqueline Servais —“Anti-VEGF Therapy Inhibits Hypothyroidism Associated with Infantile Hemangioma”
Massachusetts Dental Society and ASDA Public Health Award
Douglas Kim —“Retrospective Study of Oral Health Program in a Rural Zambian Community”
Omicron Kappa Upsilon (OKU) Hilde Tillman Award
Stephanie Brue —“Comparing Microabrasion Techniques for In Vitro White Spot Lesion Removal”
Procter & Gamble Traveling Fellowship Award
Shruti Pore —“Microenvironmental Cues Affect Dab2 Expression in Squamous Cell Carcinoma Development”
Dr. Chad Anderson Family Award for Innovative Methodology and
Research Design
Christina Penn —“Thermal Effect Due to Laser and Handpiece Usage on Pulp”
Multicultural Award for the Advancement of Dental Research
Vishavjeet Girn —“Comparison of Mechanical Properties of Dental Restorative Material”
Oral Health Disparities Award
Christina Piacquadio —“Occupational Therapy and Oral Health of Individuals with
Developmental/Acquired Disabilities”
Bates Student Research Group “Peer-Reviewed” Award
Taylor Newman —“Assessing the Level of Evidence in Post-Graduate Experience at TUSDM,”
with Dr. Irina Dragan
ADEA Student Group Educational Research Award
Lauren Marzouca —“Student Self-Evaluation Versus Faculty Assessment of Operative Competencies:
An Analysis of Calibration”
Tufts University School of Dental Medicine
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Predoctoral Student Presentations by Author
PREdoctoral STUDENT PresentationS
Ivy Ahluwalia, D14 (p. 23)
Flexural Loading Strength of Provisional Restorative Material
Riley Baldwin, D16 (p. 24)
Survey of Special Education Teachers’ Knowledge of Oral Health Principles
Christopher Beninati, D16 (p. 25)
Effect of Instruction on Energy Delivered to Simulated Restorations
Christian Benitez, D14 (p. 26)
Evidence Based Study: The Correlation between Diabetes and Periodontitis and
the Importance of Incorporating Blood Glucose Tests in the Dental Setting
Elizabeth Bingham, D15 (p. 27)
Dab2 Depletion Modifies E-cadherin Expression in Squamous Cell Carcinoma Cells
Jonathan Bishop, D16 (p. 28)
Effect of Phosphoric Acid on Vitrebond Plus Resin-Modified Glass Ionomer
William Brown, D16 (p. 29)
Measuring the Dimensional Accuracy of Ceramic Orthodontic Brackets
Stephanie Brue, D14 (p. 31)
Comparing Microabrasion Techniques for In Vitro White Spot Lesion Removal
Minh Bui, D15 (p. 32)
Gluma Antimicrobial Effect on Five Strains of Cariogenic Bacteria
Matthew Cannavo, D14 (p. 34)
Microleakage of Dental Bulk Fill, Conventional, and Self-Adhesive Composites
William Chao, D16 (p. 35)
Effects of Storage Conditions on the Hardness of Nanocomposite
Jimmy Chen, D16 (p. 36)
Characterization of the Novel Zebrafish Helicase Craniofacial Mutant
Dave Cho, D14 (p. 37)
Student and Faculty Perception on Use of Objective Clinical Structured Examination
in Preclinical Removable Partial Denture Course
Elena Ciciolla, D15 (p. 38)
Comparing Immediate Tear Strength of Elastomeric Impression Materials
Rachel Cohen, D16 (p. 40)
Endodontic Treatment Outcomes in Patients with Sjögren’s Syndrome
John Constantine, D16 (p. 41)
Properties of Silk Electrogels: Functional Vehicles for Drug Delivery
Matthew Devine, D16 (p. 43)
Adiponectin Attenuates Inflammation by Regulating the Jmjd3-Irf4 Axis in Macrophages
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Student and Faculty Research Abstracts 2013 –2014
Predoctoral Student Presentations by Author
Daniel Dooley, D16 (p. 45)
Depth of Cure and Radiopacity of Select Composites
Lindsay Fox, D15 (p. 46)
Elastic Recovery of Light-Bodied Impression Materials at Different Working Times
Ryan George, D15 (p. 47)
Pilot Study Analysis of Four Types of Digitally Processed Models
Vishavjeet Girn, D15 (p. 48)
Comparison of Mechanical Properties of Dental Restorative Material
Jasmine Jenkins, D15 (p. 49)
Association between Cumulative Grade Percent and Dental Licensure Exam Results
Rajvir Jutla, D14 (p. 50)
Paracrine Effects of Diabetic-Foot Ulcer Fibroblasts on Keratinocytes In Vitro
Elaina Kazes, D14 (p. 51)
A Comparison of Conventional Intraoral Radiography and Sectional CBCT Imaging
Samantha Keck, D16 (p. 53)
Oral Health Related Quality of Life in Primary Sjögren’s Syndrome
Douglas Kim, D16 (p. 54)
Retrospective Study of Oral Health Program in a Rural Zambian Community
Julia Kim, D16 (p. 55)
Microleakage Evaluation of Beveling Cavosurface Margins in Composite Class-II Restorations
Alice Ko, D15 (p. 56)
Assessment of Participants in Oral Health Project in Rural Zambia
Michael Kreitzer, D14 (p. 57)
Strength Testing of Various Cements and Restorative Materials
Hemanth Kunduru, D14 (p. 59)
Effect of Mold Type on Depth of Cure
Chase Larsen, D14 (p. 60)
All Ceramic Restorations: A Clinical Case
Judyth Lee, D14 (p. 61)
Effect of Curing Light on Depth of Cure
Jennie Leikin, D15 (p. 62)
Tufts University School of Dental Medicine Geriatric Patients Oral Quality of Life
Heather Leung, D16 (p. 63)
The Relationship between Learning Modality and Academic Performance
Wei Liu, D14 (p. 64)
Penetration Depths of Different Retraction Pastes
Tufts University School of Dental Medicine
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Predoctoral Student Presentations by Author
Maryam Mahdavi, D16 (p. 65)
Demographic/Utilization Information for an Oral Health Program in Rural Zambia
Alissa Mariano, D16 (p. 66)
Microleakage Evaluation of Restorations Sealed with a CO2 Laser
Lauren Marzouca, D16, and Bradley Belous, D16 (p. 68)
Student Self-Evaluation vs. Faculty Assessment of Operative Competencies: An Analysis of Calibration
Kyler McEwen, D14 (p. 70)
Shear Bond Strength of Different Dentin and Zirconia Treatments
Sharod McKinney, D16 (p. 72)
Characterization and Mapping of Two Novel Zebrafish Mineralized Tissue Mutants
Amanda Merikas, D15 (p. 73)
Shear Bond Strength Tests of Different Types of Silane Primers after Stress and Aging
Courtney Michelson, D14 (p. 74)
Comparing Compressive Strengths of New Self-Adhesive Bulk Fill Material to Restorative Materials
Joann O’Brien, D15 (p. 76)
Growth Factors Secreted from Diabetic Foot Ulcer Fibroblasts
Khusbu Patel, D16 (p. 77)
Oral Health Quality of Life in Intellectually/Developmental Disabled Individuals
Christina Penn, D16 (p. 78)
Thermal Effect Due to Laser and Handpiece Usage on Pulp
Christina Piacquadio, D16 (p. 79)
Occupational Therapy and Oral Health of Individuals with Developmental/Acquired Disabilities
Shruti Pore, D14 (p. 80)
Microenvironmental Cues Affect Dab2 Expression in Squamous Cell Carcinoma Development
Jessie Reisig, D16 (p. 81)
Effect of Contouring with Mylar on Composite Shear Bond Strength
Justin Richer, D16 (p. 82)
Comparing Publication Characteristics between Successful and Unsuccessful Dental Materials
Courtney Robinson, D16, and David Frantz, D15 (p. 83)
Ergonomic Prevention before Intervention: Early Education for Musculoskeletal Wellness
Sepideh Sabooree, D15, and Alireza Ashrafi (Oral Surgery) (p. 84)
Post Discharge Nausea/Vomiting after Ambulatory Anesthesia in Oral Surgery
Shawheen Saffari, D16 (p. 85)
Tumor-Stromal Interactions Alter the Metabolism of Squamous Cell Carcinoma Cells
Sara Samaha, D16 (p. 86)
Energy Delivery Based on Restoration Location and Light Curing Unit
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Student and Faculty Research Abstracts 2013 –2014
Predoctoral & Postdoctoral Student Presentations by Author
Jacqueline Servais, D15 (p. 87)
Anti-VEGF Therapy Inhibits Hypothyroidism Associated with Infantile Hemangioma
Laura Shim, D16 (p. 88)
Comparison of Flipped and Standard Classrooms in a Dental School Setting
Leslie Slowikowski, D14 (p. 89)
Fluoride Ion Penetration on Ionic Resin Materials
Jesse Small, D15 (p. 90)
Polyvinyl-Siloxane Impression Materials Performance in a Tensile Strength Test
Kyle Smith, D16 (p. 91)
Epigenetically Modified BMSCs in Regenerating Dental and Craniofacial Bone Tissues
Ronney Tay, D16 (p. 92)
Delineating Regulatory Mechanisms of Nasopharyngeal Carcinoma Development by
Comparative Metabolomics
Michelle Tsao, D14 (p. 93)
Influence of Air/Vinylpolysiloxane on Residual Layers of Temporization Materials
Michelle Webb, D14 (p. 94)
The Impact of Training Pre-School Teachers as Ambassadors of the Give Kids a Smile Program
to Improve Children’s Oral Health Disparities
Esther Yun, D14 (p. 95)
Association between Sleepiness and Stress and Simulated Clinical Performance
POSTDoctoral STUDENT PRESENTATIONS
C. Marissa Alikpala (General Practice Residency), and Jennifer Logigian (General Practice Residency)
(p. 96)
Long-Term Success Rates of Ketac and Photec in the Posterior Dentition
Ola Alshuhail (Craniofacial Pain) (p. 97)
Case Report: Management of Obstructive Sleep Apnea and Insomnia in a Patient with
Complete and Partial Removable Dentures
Alireza Ashrafi (Oral and Maxillofacial Surgery) (p. 98)
The Evaluation of a Non-Invasive Respiratory Volume Monitor in Patients Undergoing
Dental Extractions during Moderate Sedation
Andras Balint (Oral and Maxillofacial Surgery) (p. 99)
Survey about the Use of Ambulatory Oral and Maxillofacial Surgery Safety Checklist among
Oral Surgeons in AAOMS Database
Ranju Bhasin (General Practice Residency) and Brianne McGuinness (General Practice Residency) (p. 100)
Special Considerations for the Dental Management of Patients with Osteogenesis Imperfecta
Tufts University School of Dental Medicine
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Daniel Coleman (Periodontology) (p. 101)
Accuracy of Periodontal Probing Depth and Calculus Detection through the Use of
Kinoshita Nissan Periodontal Dental Model
Irina Dragan (Periodontology) and Taylor Newman, D15 (p. 102)
Assessing the Level of Evidence in Post-Graduate Experience at TUSDM
Jennifer Guidry (Pediatric Dentistry) (p. 103)
Repeat Dental Treatment under General Anesthesia: A Retrospective Study
Aditi Jindal (Pediatric Dentistry) (p. 104)
Effect of Carbonated/Non-Carbonated and Sugary Drinks on Microleakage of Pit-Fissure Sealants
Rami Muadab (Implant Fellowship) (p. 105)
Shear Bond Strength of Acrylic Denture Teeth to Denture Base of Metal-Resin Implant-Supported
Fixed Prosthesis: In Vitro Study
Hubert Park (Pediatric Dentistry) (p. 106)
BabySteps: Innovative Obesity and Caries Prevention Pilot for Young Children
Devina Shah (Pediatric Dentistry) (p. 107)
Effectiveness of an Oral Health Education Program for Obstetrician/Gynecologist Residents at
Tufts Medical Center
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Student and Faculty Research Abstracts 2013 –2014
Faculty Abstracts by Subject Area
Faculty AbstractS
Note: Names marked with an asterisk denote presenter of paper.
BEHAVIORAL, EPIDEMIOLOGIC, AND HEALTH SERVICES RESEARCH
Characterization of Cognitive Dysfunction in Sjögren’s Syndrome Patients (p. 108)
Lynn Epstein, Gina Masse, Jerold Harmatz, Tammy Scott, Athena Papas, and David Greenblatt
Relationship between Duration of Treatment and Oral Health in Adults with Intellectual and
Developmental Disabilities (p. 108)
Matthew Finkelman, Paul Stark, Wen Tao, and John Morgan
Personal Oral Health Practices: Caregivers of Adults with Developmental Disabilities (p. 109)
John Morgan, Angel Park, and Paula Minihan
Is Periodontal Health in the Elderly More Sensitive to the Effects of Chronic Diseases, Medications,
and Smoking? (p. 109)
Zuhair Natto and Athena Papas
Exploring HIV-Testing Intentions in Young Asian/Pacific Islander Women as It Relates to Acculturation,
Theory of Gender and Power, and the AIDS Risk-Reduction Model (p. 110)
Margaret Salud, Helen Hopp Marshak, Zuhair Natto, and Susanne Montgomery
Cotinine Levels among Betel Quid Users and Cigarette Smokers in Cambodia (p. 110)
Pramil Singh, Zuhair Natto, Rituraj Saxena, Hiya Banerjee, Daravuth Yel, Sothy Khieng, and Jayakaran Job
Adverse Drug and Device Reactions in the Oral Cavity: Surveillance and Reporting (p. 111)
Athanasios Zavras, Gregory Rosenberg, Jared Danielson, Vassiliki Cartsos
CANCER BIOLOGY AND TISSUE ENGINEERING
Tooth Tissue Engineering: The Influence of Hydrophilic Surface on Nanocrystalline Diamond Films for
Human Dental Stem Cells (p. 112)
Silvio Duailibi, Monica Duailibi, Lydia Ferreira, Karina Salmazi, Maria Salvadori,
Fernanda de Sá Teixeira, Alberto Pasquarelli, Joseph Vacanti, and Pamela Yelick
Metabolic Models of Nasopharyngeal Carcinoma Invasion and Metastasis (p. 112)
Sam Kamlartz, Addy Alt-Holland, Pamela Smith, and James Baleja
Delineating the Metabolic Profiles of Skin Cancer Cells and Stromal Fibroblasts In Vitro (p. 113)
Shawheen Saffari, Ronney Tay, John Nolan, James Baleja, and Addy Alt-Holland
Fibroblasts Derived from Human Pluripotent Stem Cells Activate Angiogenic Responses In Vitro and
In Vivo (p. 113)
Yulia Shamis, E.A. Silva, Kyle Hewitt, Y. Brudno, S. Levenberg, D.J. Mooney, and Jonathan Garlick
The Influence of Electrospun Fibre Scaffold Orientation and Nano-Hydroxyapatite Content on the
Development of Tooth Bud Stem Cells In Vitro (p. 114)
Elisabeth van Manen, Weibo Zhang, X. Frank Walboomers, Betsy Vazquez, Fang Yang, Wei Ji, Na Yu,
Daisy Spear, John Jansen, and Pamela Yelick
CARIOLOGY RESEARCH
Bridging the Gap between Preventive and Restorative Dentistry: Identification of Caries Risk Factors
and Strategies for Minimizing Risk (p. 115)
Pamela Maragliano-Muniz
Tufts University School of Dental Medicine
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Faculty Abstracts by Subject Area
CRANIOFACIAL BIOLOGY
The Novel Zebrafish Mutant fantome/wdr43 as a Human Craniofacial Ribosomopathy Model (p. 116)
Melissa LaBonty, Chengtian Zhao, K. McCann, Viktoria Andreeva, S.J. Baserga, and Pamela Yelick
Roles for wdr43 in Craniofacial Development (p. 116)
Pamela Yelick, Viktoria Andreeva, Chengtian Zhao, Yann Gibert, Shubhangi Prabhudesai, Yi Zhou, Leonard Zon,
and Susan Baserga
Tissue Specific Roles for the Ribosome Biogenesis Factor wdr43 in Zebrafish Development (p. 117)
Chengtian Zhao, Viktoria Andreeva, Yann Gibert, Melissa LaBonty, Victoria Lattanzi, Shubhangi Prabhudesai,
Yi Zhou, Leonard Zon, Kathleen L. McCann, Susan Baserga, and Pamela Yelick
DENTAL MATERIALS
Effect of Chlorhexidine-Gluconate on Microleakage of Different Bonding Agents (p. 118)
Laila Aldeeb, David Bardwell, Ronald Perry, Hiroshi Hirayama, and Matthew Finkelman
Erosion of Conventional Glass Ionomer Cements in Lactic Acid Solution (p. 119)
Sapan Bhatt, Michael Kreitzer, Ronald Perry, and Gerard Kugel
Assessing Surface Roughness on Composite Restorations Using Different Abrasive Products (p. 120)
Stephanie John, James Vlahakis, Masly Harsono, and Ronald Perry
Comparative Response of Whitening Strips Versus In-Office Light-Assisted Whitening (p. 121)
Gerard Kugel, Ronald Perry, Britta Magnuson, Masly Harsono, M.K. Anastasia, Robert Gerlach, and S. Farrell
Effects of Surface Treatments and Cement Types on the Bond Strength of Porcelain-to-Porcelain Repair
(p. 122)
F.F. Mohamed, Matthew Finkelman, Roya Zandparsa, Hiroshi Hirayama, and Gerard Kugel
Comparative Performance of Two Whitening Systems in a Dental Practice (p. 123)
Ronald Perry, E. Conde, S. Farrell, Robert Gerlach, and Jennifer Towers
Dental Imaging and Fabrication (p. 123)
Roya Zandparsa
Latest Biomaterials and Technology in Dentistry (p. 123)
Roya Zandparsa
DIAGNOSTIC SCIENCES
Systematic Interpretation of CBCT Scans: Why Do It? (p. 124)
Rumpa Ganguly and Aruna Ramesh
Coincidence of Calcified Carotid Atheromatous Plaque, Osteoporosis, and Periodontal Bone Loss in Dental
Panoramic Radiographs (p. 124)
Aruna Ramesh, Sheila Soroushian, and Rumpa Ganguly
Education Research
Pioneering Toolkit Pilot Course Enhances Student Research and Learning Experience (p. 125)
Addy Alt-Holland and Eileen Doherty
Online, Interactive Discussion Boards Enhance Student Research and Learning Experience. (p. 126)
Addy Alt-Holland, Eileen Doherty, and Jennipher Murphy
16
Student and Faculty Research Abstracts 2013 –2014
Faculty Abstracts by Subject Area
Problem-Based Learning in Dental Education: A Systematic Review of the Literature (p. 126)
Seyed H. Bassir, Pooyan Sadr-Eshkevari, Shaden Amirikhorheh, and Nadeem Karimbux
MedEdPORTAL: A Report on Oral Health Resources for Health Professions Educators (p. 127)
Nithya Chickmagalur, Veerasathpurush Allareddy, Sue Sandmeyer, Richard Valachovic, Christopher Candler,
Michael Saleh, Emily Cahill, and Nadeem Karimbux
Perceptions and Practices of U.S. Dental Schools Regarding Curriculum Integrated Format and Traditional
Format Licensure Exams (p. 128)
Shamik Desai, Veerasathpurush Allareddy, R. Bruce Donoff, T. Howard Howell, and Nadeem Karimbux
Criteria Considered by the Program Directors in the AGEP Admission Process (p. 128)
Irina Dragan, Noshir Mehta, and E. Anderson
Assessing the Level of Evidence in the Postgraduate Experience at TUSDM (p. 129)
Irina Dragan, Taylor Newman, Nadeem Karimbux, and Paul Stark
Valuable Tips for Designing a Successful Research Project (p. 129)
Irina Dragan and Paul Stark
Interprofessional Teams: Collaborative Management of the Medically Complex Patient (p. 130)
Diana Esshaki, Kanchan Ganda, Sanjay Chand, and Wai-Choong Foong
Performance of Dental Students Versus Prosthodontists Residents on a 3D Immersive Haptic Simulator
(p. 130)
Elizabeth Eve, Samuel Koo, Abdulmonem Alshihri, Jeremy Cormier, Maria Kozhenikov, R. Bruce Donoff, and
Nadeem Karimbux
Science Literacy for Civic Engagement: Bringing Science to Life (p. 130)
Jonathan Garlick
Use of Lecture Recordings in Dental Education: Assessment of Status Quo and Recommendations (p. 131)
Zsuzsa Horvath, Jean A. O’Donnell, Lynn A. Johnson, Nadeem Karimbux, Charles Shuler, and Heiko Spallek
An Initial Assessment of Haptics in Preclinical Operative Dentistry Training (p. 132)
Samuel Koo, A. Kim, R. Bruce Donoff, and Nadeem Karimbux
Using Dental Students’ Preclinical Performance as an Indicator of Clinical Success (p. 132)
Bianca Velayo, Paul Stark, Steven Eisen, and Gerard Kugel
The Need for Dentists with Formal Training in Public Health: The Development of the DMD/MPH Program
(p. 133)
Wanda Wright and Jennifer Au
Endodontics RESEARCH
Rubber Dam Use During Post Placement Influences the Success of Root Canal-Treated Teeth (p. 134)
Joshua Goldfein, Chad Speirs, Matthew Finkelman, and Robert Amato
A Survey of Root Canal Treatment in Saudi Arabia: A Pilot Study (p. 134)
Zuhair Natto
Tufts University School of Dental Medicine
17
Faculty Abstracts by Subject Area
IMPLANTOLOGY RESEARCH
An In Vitro Comparison of the Accuracy of Implant Impressions with Coded Healing Abutments and
Different Implant Angulations (p. 135)
Khaled Al-Abdullah, Roya Zandparsa, Matthew Finkelman, and Hiroshi Hirayama
Effect of Different Implant Heights and Angulations on Overdenture Retention (p. 136)
Ekaterini Antonellou, Nopsaran Chaimattayompol, Gerard Kugel, Matthew Finkelman, and Samia Elhamdy
Titanium-Zirconium Narrow-Diameter Versus Titanium Regular-Diameter Implants for Anterior and
Premolar Single Crowns: One-Year Results of a Randomized Controlled Clinical Study (p. 137)
G. Benic, G.O. Gallucci, M. Mokti, C. Hämmerle, Hans-Peter Weber, and R. Jung
A Five- to Six-Year Radiological Evaluation of Titanium Plasma Sprayed/Sandblasted and Acid-Etched
Implants: Results from Private Practice (p. 137)
Hamasat Gheddaf Dam, Semaan Abi Najm, Nathalie Nurdin, Mark Bischof, Matthew Finkelman, and
Rabah Nedir
The Effect of Keratinized Mucosa Width on Peri-Implant Health: A Systematic Review (p. 138)
Luca Gobbato, Gustavo Avila-Ortiz, Keyvan Sohrabi, C.W. Wang, and Nadeem Karimbux
Comparison of the Effect of Two Interdental Cleaning Devices around Implants on the Reduction of
Bleeding: A Thirty-Day Randomized Clinical Trial (p. 138)
Britta Magnuson, Masly Harsono, Paul Stark, D. Lyle, Gerard Kugel, and Ronald Perry
The Effect of Different Implant-Abutment Connections on Screw Joint Stability (p. 139)
Konstantinos Michalakis, Pasquale Calvani, S. Muftu, A. Pissiotis, and Hiroshi Hirayama
Human Histologic Value of Platform-Switched Osseointegrated Dental Implant (p. 139)
Myron Nevins, Marcelo Camelo, Samuel Koo, Richard Lazzara, and David Kim
Implant Loading Protocols for Edentulous Patients with Fixed Prostheses:
A Systematic Review and Meta-Analysis (p. 140)
Panos Papaspyridakos, C.J. Chen, S.K. Chuang, and Hans-Peter Weber
Accuracy of Implant Impressions for Partially and Completely Edentulous Patients:
A Systematic Review (p. 140)
Panos Papaspyridakos, C.J. Chen, G.O. Galluci, A. Doukoudakis, Hans-Peter Weber, and V. Chronopoulos
Transcription Factor and Bone Marrow Stromal Cells in Osseointegration of Dental Implants (p. 141)
S.G. Yan, Jin Zhang, Qisheng Tu, J.H. Ye, E. Luo, M. Schuler, M.M. Dard, Y. Yu, Dana Murray, David Cochran,
Sung-Hoon Kim, P. Yang, and Jake Chen
Effect of Chronic Kidney Disease on the Healing of Titanium Implants (p. 142)
H. Zou, X. Zhao, N. Sun, S. Zhang, T. Sato, H.Yu, Q. Chen, Hans-Peter Weber, M. Dard, Q. Yuan, and B. Lanske
Methodology and clinical trials
Outcomes of Implants and Restorations Placed in General Dental Practices: A Retrospective Study by the
Practitioners Engaged in Applied Research and Learning Network (p. 143)
John DaSilva, Julie Kazimiroff, Athena Papas, Frederick Curro, Van Thompson, Donald Vena, Hongyu Wu,
Damon Collie, and Ronald Craig
What You Need to Know about Data Management: Special SIVB Workshop at the World Forum (p. 144)
Kathryn Houk, and Addy Alt-Holland
18
Student and Faculty Research Abstracts 2013 –2014
Faculty Abstracts by Subject Area
MINERALIZED TISSUE
BET Inhibitor JQ1 Blocks Inflammation and Bone Destruction (p. 145)
Shu Meng, Lan Zhang, Yin Tang, Qisheng Tu, L. Zheng, Liming Yu, Dana Murray, Jessica Cheng, Sung-Hoon
Kim, Xuedong Zhou, and Jake Chen
Central Adiponectin Administration Reveals New Regulatory Mechanisms of Bone Metabolism in Mice
(p. 145)
Yuwei Wu, Qisheng Tu, Paloma Valverde, Jin Zhang, Dana Murray, Lily Dong, Jessica Cheng, Hua Jiang,
Maribel Rios, Elise Morgan, Zhihui Tang, and Jake Chen
NEUROSCIENCE/TMJ
Temporomandibular Joint Osteoarthritis: Diagnosis and Long-Term Conservative Management:
A Topic Review (p. 147)
M. Kalladka, S. Quek, G. Heir, E. Eliav, M. Mupparapu, and Archana Viswanath
The Effect of Dental Occlusal Disturbances on the Curvature of the Vertebral Spine in Rats (p. 147)
German Ramirez-Yanez, Laxmi Mehta, and Noshir Mehta
ORAL HEALTH RESEARCH
A Survey of Dentists’ Knowledge and Attitudes with Respect to the Treatment of Scleroderma Patients
(p. 148)
David Leader, Athena Papas, and Matthew Finkelman
Mycobacterial Pseudotumor of the Skin (p. 148)
M. Rahmani, J. Alroy, Driss Zoukhri, R.O. Wein, and A.S. Tischler
Effect of Sialagogue on Bleeding on Probing in Sjögren’s Syndrome (p. 149)
Mabi Singh and Athena Papas
Use of Pre-operative Mouthwash in Dental Treatment: A Literature Review (p. 149)
Wael Yaghmoor, Yumi Ogata, James Hanley, Matthew Finkelman, T. Kawai, and Yong Hur
ORAL SURGERY RESEARCH
The Use of a Transcutaneous CO2 Monitor during Moderate Sedation in Oral and Maxillofacial Surgery
(p. 150)
Sanjeet Chaudhary, Ruba Khader, Matthew Finkelman, Daniel Oreadi, Marcin Jarmoc, Roman Schumann, and
Morton Rosenberg
Prosthetic Dental Rehabilitation with Implants Status Post Segmental Resection of the Anterior Mandible
(p. 150)
Sanjeet Chaudhary and Daniel Oreadi
Immediate Mandibular Implants for Hybrid Prosthesis in a Patient Taking Bisphosphonates (p. 151)
Ghassan Darwish, Andras Balint, and David-Joey Chang
Adult Airway Evaluation in Oral Surgery (p. 152)
James Phero, Morton Rosenberg, and Joseph Giovannitti Jr.
Management of Allergy and Anaphylaxis during Oral Surgery (p. 152)
Morton Rosenberg, James Phero, and Joseph Giovannitti Jr.
Tufts University School of Dental Medicine
19
Faculty Abstracts by Subject Area
ORTHODONTICS
Fully Customized Placement of Orthodontic Miniplates: A Novel Clinical Technique (p. 153)
Jan Hourfar, Georgios Kanavakis, Peter Goellner, and Björn Ludwig
Newly Defined Landmarks for a Three-Dimensionally Based Cephalometric Analysis: A Retrospective ConeBeam Computed Tomography Scan Review (p. 153)
Moonyoung Lee, Georgios Kanavakis, and R. Matthew Miner
The Effects of Lip Revision Surgery on Nasolabial Esthetics in Patients with Cleft Lip (p. 154)
A.M. Mercado, C. Phillips, K.W. Vig, and Carroll Ann Trotman
Influence of Objective Three-Dimensional Measures and Movement Images on Surgeon Treatment Planning
for Lip Revision Surgery (p. 154)
Carroll Ann Trotman, C. Phillips, J.J. Faraway, T. Hartman, and J.A. van Aalst
The Role of Mandibular Third Molars on Lower Anterior Teeth Crowding and Relapse after Orthodontic
Treatment: A Systematic Review (p. 155)
K.H. Zawawi and Marcello Melis
PEDIATRIC DENTISTRY RESEARCH
Effect of the DentalVibe Injection System on Pain during Local Anesthesia Injections in Adolescent Patients
(p. 156)
David Ching, Matthew Finkelman, and Cheen Loo
PERIODONTAL RESEARCH
Recent Systematic Reviews Comparing Growth Factors in Periodontal Regeneration (p. 157)
Shatha Al Harthi, Yong Hur, Rory O’Neill, Andreas Paraschis, and Yumi Ogata
A Survey: How Periodontists and Other Dental Professionals View the Scope of Periodontics (p. 157)
Peter Chang, Joshua Hall, Matthew Finkelman, Angel Park, and Paul Levi Jr.
Growth Factor-Mediated Vertical Mandibular Ridge Augmentation: A Case Report (p. 158)
Kevin Guze, Emilio Arguello, David Kim, Myron Nevins, and Nadeem Karimbux
Modified Periosteal Releasing Incision for Flap Advancement: A Practical Technique for Tensionless Closure
(p. 158)
Yong Hur, Minh Bui, Terrence Griffin, and Yumi Ogata
Popularity of Suture Materials among Residents and Faculty Members of Postdoctoral Periodontology
Program (p. 159)
Mohamed Maksoud, Samuel Koo, Kasumi Barouch, and Nadeem Karimbux
Restoration of Gingival and Esthetic Deformities following Flap Advancement: The Physiologically
Pigmented Gingival Graft, A Case Report (p. 159)
Eduardo Marcuschamer, T. Tsukiyama, H. Moroi, Charles Hawley, and Terrence Griffin
Bio-Absorbable and Non-Absorbable Membrane in Lateral GBR: A Literature Review (p. 160)
Lorenzo Mordini, Yumi Ogata, Hans-Peter Weber, Paul Stark, and Yong Hur
Factors Associated with Tooth Loss following Periodontal Regenerative Therapy (p. 160)
Yumi Ogata, Minh Bui, Zuhair Natto, James Hanley, and Yong Hur
Use of Polyphenols in Periodontal Inflammation (p. 161)
Iro Palaska, Evangelos Papathanasiou, and Theoharis Theoharides
20
Student and Faculty Research Abstracts 2013 –2014
Faculty Abstracts by Subject Area
Stress Hormones Regulate Periodontal Inflammation (p. 161)
Evangelos Papathanasiou, Iro Palaska, and Theoharis Theoharides
Centipeda periodontii in Human Periodontitis (p. 162)
Thomas Rams, Charles Hawley, Eugene Whitaker, John Degener, Arie van Winkelhoff
Negotiating the Severely Resorbed Extraction Site: A Clinical Case Report with Histologic Sample (p. 162)
Chin-wei Wang, Samuel Koo, David Kim, and Eli Machtei
Adiponectin Ameliorates Experimental Periodontitis in Diet-Induced Obesity Mice (p. 163)
Lan Zhang, Shu Meng, Qisheng Tu, Liming Yu, Yin Tang, Michel M. Dard, Sung-Hoon Kim, Paloma Valverde,
Xuedong Zhou, and Jake Chen
PHARMACOLOGY, THERAPEUTICS, AND TOXICOLOGY
Benefits of Thrombolytics in Prolonged Cardiac Arrest and Hypothermia over Its Bleeding Risk (p. 164)
R. Gupta, Aditi Jindal, and H. Cranston-D’Amato
PROSTHODONTICS RESEARCH
An In Vitro Comparison of Fracture Load of Zirconia Custom Abutments with Internal Connection and
Different Angulations and Thickness: Part I (p. 165)
Abdalah Albosefi, Matthew Finkelman, and Roya Zandparsa
The Effect of Variations in Translucency and Background on Color Differences in CAD/CAM Lithium
Disilicate Glass Ceramics (p. 165)
Abdulaziz Al Ben Ali, Kiho Kang, Matthew Finkelman, Roya Zandparsa, and Hiroshi Hirayama
An In Vitro Comparison of the Shear Bond Strengths of Two Different Gingiva-Colored Materials Bonded to
Commercially Pure Titanium and Acrylic Artificial Teeth (p. 166)
Yahya Elzarug, Roger Galburt, Matthew Finkelman, and Hamasat Gheddaf Dam
Conversion of an Existing Metal Ceramic Crown to an Interim Restoration and Nonfunctional Loading of a
Single Implant in the Maxillary Esthetic Zone: A Clinical Report (p. 167)
Konstantinos Michalakis, C.D. Kalpidis, and Hiroshi Hirayama
Immediate Provisionalization and Nonfunctional Loading of a Single Implant in the Maxillary Esthetic
Zone: A Clinical Presentation and Parameters for Consideration (p. 167)
Konstantinos Michalakis, C.D.R. Kalpidis, Y. Kirmanidou, Hiroshi Hirayama, Pasquale Calvani, and
A.L. Pissiotis
Marginal Adaptation of Four Inlay Casting Waxes on Stone, Titanium, and Zirconia Dies (p. 167)
Konstantinos Michalakis, V. Kapsampeli, A. Kitsou, Y. Kirmanidou, A. Fotiou, A.L. Pissiotis, Pasquale Calvani,
Hiroshi Hirayama, and Yukio Kudara
Marginal and Internal Adaptation of Ceramic Crown Restorations Fabricated with CAD/CAM Technology
and the Heat-Press Technique (p. 168)
Hisham Mously, Matthew Finkelman, Roya Zandparsa, and Hiroshi Hirayama
Influence of Coping Design on the Cervical Color of Ceramic Crowns (p. 169)
Gianluca Paniz, Kiho Kang, Yong Jeong Kim, Naota Kumagai, and Hiroshi Hirayama
Transition from Failing Dentition to Complete-Arch Implant Rehabilitation with a Staged Approach:
A Three-Year Clinical Report (p. 169)
Panos Papaspyridakos and V. Chronopoulos
Tufts University School of Dental Medicine
21
Faculty Abstracts by Subject Area
An In Vitro Comparison of Shear Bond Strength of Zirconia to Enamel Using Different Surface Treatments
(p. 170)
Roya Zandparsa, Nayrouz Talua, Matthew Finkelman, and Scott Schaus
SALIVARY AND LACRIMAL GLAND RESEARCH
Salivary Cortisol, Salivary Alpha Amylase, and the Dental Anxiety Scale (p. 171)
Hana Sadi, Matthew Finkelman, and Morton Rosenberg
STATISTICS RESEARCH
Shortening the Current Opioid Misuse Measure via Computer-Based Testing:
A Retrospective Proof-of-Concept Study (p. 172)
Matthew Finkelman, Ronald Kulich, Driss Zoukhri, Niels Smits, and Stephen Butler
Curtailment: A Method to Reduce the Length of Self-Report Questionnaires While Maintaining
Diagnostic Accuracy (p. 172)
Marjolein Fokkema, Niels Smits, Matthew Finkelman, Henk Kelderman, and Pim Cuijpers
Variable Length Testing Using the Ordinal Regression Model (p. 173)
Niels Smits and Matthew Finkelman
22
Student and Faculty Research Abstracts 2013 –2014
Student Presentations and Abstracts
Note: Names marked with an asterisk denote presenter of paper.
PREDOCTORAL STUDENT PRESENTATIONS
Flexural Loading Strength of Provisional Restorative Material
Lindsay Kovary, Ivy Ahluwalia,* Stephanie John, Ruby Ghaffari, Masly Harsono, and
Ronald Perry
Objective: To compare in vitro four commercial provisional
restorative materials under flexural loading conditions.
Methods: Sixty provisional bridges were made (n=15 each
group) using: Group 1, Protemp™ Plus (3M ESPE); Group 2,
Luxatemp® Solar (DMG); Group 3, Integrity® (DENTSPLY
Caulk); and Group 4, Visalys® Temp (Kettenbach). Teeth #19
and #21 were prepared as abutments for the 3-unit bridge
on Typodont (Columbia, New York). Approximate reduction
amount was 2–2.5 mm on buccal, lingual, and proximal walls,
1–1.5 mm full deep chamfer margin, and 15–20 degrees total
occlusal convergence. A metal cast duplicate was made from the
Typodont as a template for provisional bridge restorations.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Polyvinyl-siloxane impression material was used as a template for fabricating the provisional bridge. The pontic
design for missing tooth #20 was a modified ridge lap. All samples were polished with pumice and cemented
using TempBond® (Kerr) on a metal template prior to testing.
The modified 3-point bending test was carried out using a universal testing machine (Instron 5566A, crosshead
speed 1.0 mm/min). The initial crack was recorded and testing stopped when it hit a catastrophic failure of the
bridge. Data was recorded in Newtons. Statistical analysis was conducted using a one-way ANOVA with post
hoc Tukey HSD Test for pairwise comparison. Statistical difference was predetermined at p<0.05.
Results:
Group (n=15)
1
2
3
4
Mean Flexural Loading Strength (N)
573.94
296.22
307.38
458.35
Standard Deviation
198.11
92.13
106.79
132.71
Groups 2 and 3 were statistically lower than groups 1 and 4. There was no statistical difference between groups 2
and 3 (p=1), nor between groups 1 and 4 (p=0.11).
Conclusion: Strength testing resulted in group 1 being comparable to group 4. Both groups 1 and 4
were significantly higher than groups 2 and 3. Initial mode of failure was observed on the junctions between
abutment crowns and pontics. Fracture resistance in provisional bridges may have clinical implications in the
success of final restorations.
Sponsored in part by Kettenbach LP. Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina.
Abstract #300.
Tufts University School of Dental Medicine
23
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Survey of Special Education Teachers’ Knowledge of Oral
Health Principles
Riley Baldwin,* Wanda Wright, Angel Park, and John Morgan
Objective: Adults and children with intellectual and developmental disabilities (IDD) face significant
challenges in maintaining good oral health. Little is known of the exposure of special needs children to
oral health education and prevention programs while in school. A survey was conducted to investigate the
knowledge and attitudes of special education teachers regarding oral health.
Methods: A 22-item questionnaire was adapted from two existing validated surveys. Qualitative interviews
and field-testing among dentists, dental hygienists, and special education teachers were conducted to ascertain
a high degree of face and content validity of the questionnaire. The survey included questions regarding the
training and education, current curriculum, and knowledge and attitudes about oral health of individuals with
disabilities of special education teachers. Likert scales were used for ordinal and count responses.
Results: Preliminary data from 28 teachers who responded to the online survey indicated 76% had received
inadequate training and 67% had received no continuing education regarding the teaching of oral health. Of the
teachers responding, 44% reported that their current curriculum was already overloaded and did not have room
for oral health care education. However, 80% replied that they would like to teach oral health care, with 60%
saying it should be formally addressed, similarly to other school subjects.
Conclusions: Based on preliminary data, special education teachers responding to an online survey were
underprepared to teach oral health and, further, did not have enough time to do so in the classroom. However,
it was perceived as an important gap in their students’ education and as something that they hope to address in
the future.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1493.
24
Student and Faculty Research Abstracts 2013 –2014
Effect of Instruction on Energy Delivered to Simulated Restorations
Sara Samaha,1 Sapan Bhatt,1 Christopher Beninati,1* Ronald Perry,1 Richard Price,2 and
Howard Strassler3
1Tufts
University School of Dental Medicine, Boston; 2Faculty of Dentistry, Dalhousie University,
Halifax, Nova Scotia, Canada; 3University of Maryland School of Dentistry, Baltimore, Maryland
Objectives: Delivering an adequate amount of energy to resin-based restorations is of critical importance.
This study used a patient simulator to determine if dental students delivered more energy to simulated
restorations after they received instructions using the simulator on how to improve their light curing technique.
Methods: Thirty dental students light-cured two simulated restorations (1-mm deep anterior and 4-mm
deep posterior) using three light-curing units (LCUs): VALO® (Ultradent Products, South Jordan, Utah);
Bluephase G2® (Ivoclar Vivadent, Amherst, New York), and Optilux 401® (Kerr Corporation, Orange,
California). A MARC Patient Simulator® (Bluelight Analytics, Halifax, Nova Scotia, Canada) measured the
irradiance (mW/cm2) received by the restorations in real-time to calculate the energy (J/cm2) delivered during a
20-second cure. At first, students were asked to use their own light curing technique. They were then given five
minutes of combined verbal instructions and a demonstration on proper curing technique using the MARC-PS,
and asked to cure the restorations again. Based on a literature review, 16 J/cm2 was considered the minimum
amount of energy an average resin-based restoration should receive to be considered adequately cured.
Results: Paired t-tests were used to
determine significance in the amount
of energy delivered before versus after
instruction (Table 1). A McNemar test
compared energy delivery before and after
instruction in relation to the 16 J/cm2
minimum requirement. Eighteen students
improved from delivering below 16 J/cm2
before instruction to delivering above
16 J/cm2 after instruction when using the
Optilux 401 (p<0.001). Twenty-seven
students delivered above 16 J/cm2 both
before and after instruction when using
both the VALO and Bluephase G2 LCUs;
the remaining three students all delivered
16 J/cm2 after instruction.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Table 1: Increase in energy delivered after instruction by LCU used
LCU
VALO
Bluephase G2
Optilux 401
Increase in energy delivered
5.918 J/cm2
3.503 J/cm2
4.990 J/cm2
p-value
<0.001
<0.001
<0.001
Conclusion: Using a patient simulator to teach proper curing technique markedly and significantly
improved the amount of energy delivered by dental students using three different LCUs.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #350.
Tufts University School of Dental Medicine
25
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Evidence Based Study: The Correlation between Diabetes and
Periodontitis and the Importance of Incorporating Blood Glucose
Tests in the Dental Setting
Christian Benitez,* Alyssa Benitez, and Aidee Nieto-Herman
Background: Diabetes has been
demonstrated through investigative research
to have multiple deleterious effects on the
human body, including its debilitating effect
on the body’s natural response to periodontal
pathogens and their associated inflammatory
mediators. Studies have also established the
correlation of a patient’s glycemic and metabolic
control to periodontal disease, specifically
in terms of the body’s resistance to insulin,
in patients who present with periodontal
inflammation. Epidemiological data confirms
that diabetic patients are at a major risk of
periodontal disease. It has recently been
suggested that blood glucose testing (BGT) in the dental setting/office may help to improve glycemic and
metabolic control in patients with chronic periodontitis (CP) and diabetes mellitus. This systematic review
assesses the importance of establishing BGT in the dental setting/office in order to provide dental practitioners
with comprehensive health information in their efforts to treat a diabetic patient with periodontal disease.
Methods: In order to determine the need for glucose testing in the dental setting, a systematic review of the
current literature on periodontitis, diabetes, and glycemic control tests was performed. After identifying 90
research articles through both a database and manual search, the scientific papers were screened more closely
in order to select articles that cited a relationship between diabetes and periodontitis and/or gingivitis and
were published in the United States within the past ten years. The inclusion criteria and research strategy was
focused on the hypothesis of whether the inclusion of BGT in the dental setting will influence the success rate of
periodontal therapy for patients suffering from diabetes and periodontal disease.
Results: After screening the databases and journals, a total of seven articles were chosen to be included in the
study. The results of the systematic review revealed the importance of BGT in the dental setting, which will be
effective in improving both diagnosis and treatment of diabetic patients with periodontal disease.
Conclusion: The systematic review of the articles supports the relationship between glycemic and metabolic
control to the severity of periodontal disease. Although the mechanism of this link is still not completely
understood, it has been demonstrated that the severity of both periodontitis and diabetes, more specifically
Type 2 diabetes, is bidirectional. As a result, the implementation of BGT in the dental setting/office may assist in
treating patients with diabetes and periodontal disease. However, future studies are needed to demonstrate the
overall results of BGT in the dental setting/office. As a consequence of the silent progression of diabetes, which
now encompasses over 25.8 million Americans, approximately 7 million of these individuals with diabetes are
currently unaware of their current condition. Due to the outstanding number of people afflicted with diabetes
in the United States, whether clinically detected or undiagnosed, the relationship between the two diseases is a
paramount public health concern and may also have considerable economic implications.
26
Student and Faculty Research Abstracts 2013 –2014
Dab2 Depletion Modifies E-cadherin Expression in Squamous Cell
Carcinoma Cells
Elizabeth Bingham,* Shruti Pore, A. Chau, James Baleja, and Addy Alt-Holland
Objective: Loss of E-cadherin-mediated cell-cell adhesion is associated with squamous cell carcinoma (SCC)
progression, but the molecular mechanisms that direct E-cadherin loss and regulate SCC cell motility and
invasion are only partially known. Disabled-2 (Dab2) is an adaptor protein that is involved in endocytosis of cell
surface proteins, cell adhesion, and migration. Here we determined the effect of Dab2 depletion, under different
small interfering RNA (si-RNA) transfection conditions, on SCC cell morphology and E-cadherin expression
level.
Methods: E-cadherin and Dab2 protein expression levels were determined in lysates of E-cadherin
competent (II-4) and E-cadherin suppressed (II-4-Ecad-) skin SCC cells by Western blotting. Cultures were
transfected with si-Dab2 under serum-starved and non-starved conditions, and imaged by bright field and
fluorescent microscopy.
Results: Under non-starved transfection
conditions, Dab2 depletion resulted
in reduced E-cadherin expression and
increased cell spread within compact II-4
cell colonies, similarly to the spread of
II-4-Ecad- cells. However, under serumstarved transfection conditions, while less
cell spread was observed, si-Dab2-mediated
depletion resulted in an opposing, marked
increase in E-cadherin level. Whereas
in II-4-Ecad- SCC cells the endogenous
E-cadherin level is initially low, under
non-starved transfection conditions Dab2
depletion decreased E-cadherin expression
even further. Under serum-starved
transfection conditions, similarly to Dab2 depleted II-4 cultures, Dab2 loss increased E-cadherin expression
level in II-4-Ecad- SCC cells.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: Dab2 depletion in SCC cells is associated with E-cadherin down regulation and consequent
abrogation of cell-cell adhesion. Using short-term stress conditions revealed the existence of a compensatory
mechanism that enables SCC cells to overcome the effect of Dab2 depletion on cell-cell contact by increasing
E-cadherin protein levels. Thus, Dab2 plays a key role in the behavior of SCC cells, and may serve as a potential
biomarker for epithelial cancers, such as skin and oral cancers.
“Tufts Collaborates!” grant awarded to Drs. Alt-Holland and Baleja funded this study. Also presented at the 2014
AADR Annual Session in Charlotte, North Carolina. Abstract #748.
Tufts University School of Dental Medicine
27
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Effect of Phosphoric Acid on Vitrebond Plus Resin-Modified Glass Ionomer
Jonathan Bishop,* William Chao, Melissa Ing, Steven Eisen, and Gerard Kugel
Objective: Despite numerous tests assessing phosphoric acid pre-treatment on dental materials, there is
little research testing the positive/negative effects of phosphoric acid on resin-modified glass ionomer (RMGI)
surface and its influence on shear bond strength of the RMGI-composite resin interface. This study sought
to determine whether phosphoric acid etching of the RMGI surface affects the shear bond strength between
Vitrebond™ Plus RMGI and Filtek™ Supreme Ultra nanocomposite when using the closed sandwich technique.
Methods: Cylindrical molds sized 3 mm x 6 mm were filled with Vitrebond Plus RMGI. Samples were then
treated in one of two ways: 1) RMGI surfaces were treated with 35% phosphoric acid (N=27); or 2) RMGI
surfaces were not treated with phosphoric acid (N=26). Within each category, all samples were treated with
ExciTE® F total-etch bonding agent. Separate cylindrical molds (8 mm x 3 mm) were then placed over the
RMGI samples and 3 mm of Filtek Supreme Ultra was added to each sample. The composite resin side of
the buttons were embedded in acrylic molds and these molds were kept at room temperature for 24 hours.
All experimental samples were created following manufacturers’ instructions. The shear bond strength of
each button was determined using a universal testing machine (Instron® 5566A) at a crosshead speed of 1.0
mm/min. Data was analyzed via the independent-samples t-test. A p-value <0.05 was considered statistically
significant.
Results:
Group statistics
Group
Etched
Non-etched
N
27
26
Mean (MPa)
3.17
3.22
SD (MPa)
1.97
1.84
No statistically significant difference was observed between the acid-etched and non-etched groups (p=0.918).
Conclusions: Literature review shows some clinicians selectively etch RMGI, and this study shows there is
no statistically significant effect on the bond strength between Vitrebond Plus and Filtek Supreme Ultra. Further
research is warranted to ensure etching
RMGI does not increase microleakage
when using these two products.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #249.
28
Student and Faculty Research Abstracts 2013 –2014
Measuring the Dimensional Accuracy of Ceramic Orthodontic Brackets
William Brown,* Gerard Kugel, Matthew Finkelman, Kane Ramsey, and Georgios Kanavakis
Objectives: To measure internal slot-dimensions of ceramic/esthetic orthodontic brackets of three different
manufacturers and compare them to each other and to nominal stated manufacturing value (0.018 inches).
Methods: American Orthodontics (Radiance model, n=60), Ormco (Ice model, n=60), and 3M Unitek
(Clarity model, n=60) were included. Bracket slots were imaged from the distal using an Olympus SZX16
(Olympus Corporation; Tokyo, Japan) microscope with mounted camera. Digital images were imported and
all measurements were made with the Buehler Omninet 9.0 software program (Buehler, Lake Bluff, Illinois).
Bracket measurements were taken from gingival and occlusal sides at two points equidistant between slot
base and top. Mean slot-dimension for each tooth/manufacturer combination was recorded. Six teeth per
manufacturer were examined and results compared between companies using a set of 6 one-way ANOVAs.
Mean of each bracket set (18 total sets) was compared to the manufacturing standard of 0.018, using a set of 18
one-way ANOVAs. Bonferroni correction adjusted for multiple comparisons.
Results: For all teeth, there were statistically significant differences in slot-dimensions between the three
companies (p<0.001). American brackets were statistically insignificant when compared to the manufacturing
standard (p-values ranging between 0.026 and 0.441). The majority of Ormco and 3M Unitek brackets were
statistically significant when compared to the manufacturing standard (all p-values <0.001), with the exception
of the Ormco left central incisor (p=0.003). Significance was indicated when p-value is <0.0028 after application
of Bonferroni correction.
Company
Tooth
N (number
of samples)
Min.
Max.
Mean
Standard Dev.
P-value
American
Right Cuspid
Right Lateral
Right Central
Left Central
Left Lateral
Left Cuspid
10
10
10
10
10
10
0.0173
0.0175
0.0175
0.0176
0.0172
0.0172
0.0181
0.0189
0.0183
0.0183
0.0184
0.0185
0.0177
0.0179
0.0178
0.0179
0.0177
0.0177
0.00031
0.00043
0.00027
0.00021
0.00041
0.00043
0.026
0.441
0.046
0.264
0.036
0.038
Ormco
Right Cuspid
Right Lateral
Right Central
Left Central
Left Lateral
Left Cuspid
10
10
10
10
10
10
0.0174
0.0170
0.0175
0.0166
0.0170
0.0173
0.0177
0.0179
0.0177
0.0179
0.0177
0.0179
0.0175
0.0176
0.0176
0.0175
0.0175
0.0177
0.00009
0.00025
0.00007
0.00037
0.00019
0.00017
<0.001
0.001
<0.001
0.003
<0.001
0.001
3M
Right Cuspid
Right Lateral
Right Central
Left Central
Left Lateral
Left Cuspid
10
10
10
10
10
10
0.0190
0.0196
0.0189
0.0187
0.0198
0.0191
0.0195
0.0203
0.1092
0.0192
0.021
0.0195
0.0193
0.0200
0.0190
0.0189
0.0204
0.0193
0.00015
0.00023
0.00009
0.00015
0.00041
0.00013
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: Results revealed that three tested bracket manufacturing companies consistently manufacture
brackets with undersized or oversized slot-dimensions. Slot sizes varied from 0.0166 (7.78%) undersized to
Tufts University School of Dental Medicine
29
Bates-Andrews Day Abstracts
30
Predoctoral Student Presentations
0.021 (16.67%) oversized. Variations
of this magnitude directly impact fit of
the wire and amount of contact surface
between wire and bracket slot resulting
in unintended treatment effects. Products
supplied by American Orthodontics and
Ormco.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #499.
Student and Faculty Research Abstracts 2013 –2014
Comparing Microabrasion Techniques for In Vitro White Spot
Lesion Removal
Stephanie Brue,* Angel Park, and Gerard Kugel
Objective: This study serves to analyze the effect of technique variations for enamel depth removed on
normal and early demineralization of enamel (white spots). It is hypothesized that microabrasion with rotary
and greater time will remove a greater depth of enamel.
Methods: Intact non-carious human teeth were obtained. Teeth were sectioned into approximately 3 mm
x 3 mm squares and embedded in resin. Samples were polished using 600-grit SiC paper to obtain a flattened
enamel surface (Ecomet®, Buehler). Samples were randomly assigned to two groups (n=20): normal enamel
(NE) and demineralized enamel (DE). The DE group was immersed in a demineralizing solution (Queiroz,
et al., 2008) for 32 hrs at 37°C to create artificial demineralized lesions. Each group was randomly divided
into four subgroups (n=5) and treated with microabrasion material (Opalustre®, Ultradent) with variation of
techniques: cotton swab for 30 or 60 sec or rotary prophy cup for 30 or 60 sec. All samples were abraded using
a light pressure determined by a digital scale. Samples were cross-sectioned (Isomet®, Buehler). The removal
depths were measured under stereo microscope (Olympus SZX16®) with analysis software (Omninet 9.0,
Buehler). Statistical analysis was done using independent samples t-test.
Results:
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Depth of Enamel Removal Based on Technique
Time=30
Rotary (n=5)
Swab (n=5)
95% CL
95% CL
Mean mean (µm) Mean mean (µm)
DE 105.9 28.8–183.1 41.2 34.4–47.9
NE 53.6 47.9–59.2
35.7 27.1–44.3
p-value
0.049
0.002
Time=60
Rotary (n=5)
Swab (n=5)
95% CL
95% CL
Mean mean (µm) Mean mean (µm)
216.5 153.2–279.7 74.1 59.0–89.1
55.3 40.7–69.9
53.3 44.9–61.7
p-value
0.0003
0.759
Conclusion: Results from all groups were
normally distributed (Shapiro-Wilk test). On DE,
the focus of treatment, at t=30, enamel removal
using swab had a mean (95% CL) of 41.2 µm
(34.3–47.9), and rotary was greater at 105.9 µm
(28.8–183.1) (p=0.049). DE depth at t=60 using
swab had a mean (95% CL) of 74.1 µm (59.0–
89.1), and rotary was again greater at 216.5 µm
(153.2–279.7) (p=0.003). Small sample size limited
comparison between time points. Greatest enamel
removal was observed using rotary and after greater
time (t=60). By referencing these techniques based
on time and instrument used, a more efficient and
accurate microabrasion procedure can be clinically
accomplished.
Also presented at the 2014 AADR Annual Session in
Charlotte, North Carolina. Abstract #891.
Tufts University School of Dental Medicine
31
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Gluma Antimicrobial Effect on Five Strains of Cariogenic Bacteria
Minh Bui,1* Brian Klein,2 and Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Tufts University Sackler School of Graduate
Biomedical Sciences, Boston
Objectives: Gluma® desensitizer is one of many topical agents used to prevent post-operative
hypersensitivity. This project aimed to see if Gluma could have an additional antimicrobial effect on five strains
of common bacteria associated with caries by assessing the zone of inhibition.
Methods: Three experiments were conducted using prepared plates (either MRS or blood agar) with strains
of Streptococcus mutans (ATCC 25175 [S. mutans]), Porphymonas gingivalis (BAA-308 [PG W83]), Porphymonas
gingivalis (ATCC 33277 [PG 33277]), Lactobacillus rhamnosus GG (ATC 53103 [LGG]), and Lactococcus lactic
(CMB8). In the first test, Gluma was pipetted directly onto plates; in the second test, Whatman and Fisher
filter paper discs were impregnated with Gluma then placed on plates; in the third test, 1 µl and 0.5 µl Gluma
was filled into wells punched out using tips of a micropipette and a Pasteur pipette. Plates were packaged in
pouches, incubated anaerobically at 37°C for at least 48 hours, then retrieved. Zones of inhibitions were assessed
and measured. Statistics were not done because the aim was to verify the presence or absence of the zones of
inhibition.
Results:
Strains
S. mutans
CMB8
LGG
PG W83
PG 33277
Zones of Inhibition (mm) for Gluma pipetted onto plate
10
11
12
13
9
11
12
12
8
10
10
11
12
13
14
16
5
5
6
10
All five strains demonstrated susceptibility by having the zones of inhibition with clear borders of antimicrobial
capability up to a certain point where the Gluma could not diffuse out. Results were listed from smallest to
largest values.
Strains
S. mutans
CMB8
LGG
PG W83
PG 33277
Strains
S. mutans
CMB8
LGG
PG W83
PG 33277
32
9
8
7
9
9
Zones of inhibition (mm) for Fisher filter paper
10
10
10
9
9
10
9
9
10
9
10
10
9
10
10
11
10
11
11
12
8
5*
7
5*
9
Zones of inhibition (mm) for Whatman filter paper
9
10
10
10
10
11
9
9
9
9
9
10
10
12
12
10
13
10
10
14
Student and Faculty Research Abstracts 2013 –2014
All discs but two (noted with an asterisk) demonstrated clear inhibition zones. Fisher filter paper discs created
zones of similar diameters, whereas Whatman discs had a larger range.
Strains
CMB8
LGG
S. mutans
Zones of inhibition (mm) for prepared wells filled with Gluma
Micropipette tip well Micropipette tip well Pasteur tip well Pasteur tip well
+ 1 μl
+ 0.5 μl
+ 1 μl
+ 0.5 μl
19
20
13
16
15
15
9
10
15
17
9
10
Plates yielded results with distinct borders only for three species. Zones were bigger for the wells created by the
micropipette than the Pasteur pipette.
Conclusions: From the results of all three experiments, Gluma demonstrated an antimicrobial effect on the
bacteria tested regardless of the approach used to introduce the desensitizer.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #269.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
33
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Microleakage of Dental Bulk Fill, Conventional, and Self-Adhesive
Composites
Matthew Cannavo,* Masly Harsono, Matthew Finkelman, and Gerard Kugel
Objective: To compare microleakage among bulk
fill (BF) composite, a conventional (CV) composite,
and bioactive self-adhesive (SAC) restorative material.
Method: One-hundred forty standard Class II
preparations were prepared on sound extracted
human third molar teeth by the same operator.
Preparations were approximately 2.0 mm deep at the
occlusal floor and 4.0 mm deep at the gingival floor.
Samples were randomly assigned into seven groups
(n=20). Four composite systems were tested: Filtek™
Supreme Ultra (3M, ESPE/CV), SonicFill™ (Kerr/
BF), Tetric EvoCeram® (Ivoclar/BF), and ACTIVA
(Pulpdent Corporation/SAC). Scotchbond™ universal
adhesive (3M, ESPE) was used as a bonding agent
in groups 1–6. In three groups the bonding agent was used as total etch (TE) and in three groups it was used
as self-etch (SE). ACTIVA is a self-adhesive bioactive restorative with 5 second etch. All materials were used
according to manufacturer’s instructions. Samples were cured for 40 seconds with LED lights (DEMI, Kerr) and
thermocycled for 5,000 cycles between 5°C and 50°C with a dwell time of 30 seconds. Samples were immersed
in a 50% ammoniacal silver nitrate solution for three hours and exposed to a photodeveloping solution for
six hours. Samples were embedded into acrylic and sectioned in the mesio-distal direction (Isomet, Buehler).
Microleakage was evaluated with analyzer software (Omnimet 9.0, Buehler). A penetration score was used on
the Axial (A) and Gingival (G) walls; 0=no microleakage, 1=microleakage less than half-way to axial/pulpal
wall, 2=more than half-way to axial/pulpal wall, 3=at or beyond the axial/pulpal wall. Statistical analysis
completed using generalized estimating equations (GEE) comparing the 7 groups in terms of microleakage;
p-value=0.1492.
Result:
Group n=20
1 (CV TE)
2 (CV SE)
3 (BF TE)
4 (BF SE)
5 (BF TE)
6 (BF SE)
7 (SAC)
Microleakage=0
(G/A)
14/17
11/15
16/17
13/14
16/17
15/18
16/18
Microleakage=1
(G/A)
3/0
1/2
2/0
1/0
4/1
1/0
0/0
Microleakage=2
(G/A)
0/0
2/1
0/0
0/0
0/0
0/0
0/0
Microleakage=3
(G/A)
3/3
6/2
2/3
6/6
0/0
4/2
4/2
Conclusion: Microleakage difference was not statistically significant between CV, BF, and SAC groups tested
(p-value=0.1492).
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #847.
34
Student and Faculty Research Abstracts 2013 –2014
Effects of Storage Conditions on the Hardness of Nanocomposite
William Chao,* Jonathan Bishop, Melissa Ing, Matthew Finkelman, Angel Park, and
Gerard Kugel
Objective: The aim of this study is to evaluate the effects of air, distilled water, and artificial saliva storage
conditions on the hardness of nanocomposite.
Methods: Cylindrical molds of 2 mm x 6 mm were filled with 3M Filtek Supreme Ultra® nanocomposite
and light cured from the top for 20 seconds (per manufacturer’s instructions). Thirty-six samples were made
for each of the four time intervals (n=144): 15 minute, 1 hour, 12 hours, and 24 hours. Samples were randomly
divided into three groups: air, distilled water, and artificial saliva. Using an Instron® testing machine, three
indentations were made on the bottom side of each sample with a 1000 g pre-load, and a mean Vicker’s
Hardness Number (VHN) was calculated. One-way ANOVA was used to assess statistical significance between
the groups at each time interval, with Tukey’s HSD as post-hoc tests (SPSS, v.19). Using the Bonferroni
correction, a p-value of 0.0125 was considered statistically significant for the ANOVA.
Results: At 15 minutes, saliva had the lowest mean (SD) VHN, 58.3(2.6), and air the highest, 63.9(3.1). At
24-hours, saliva had the highest value at 86.3(3.7).
Table 1. Comparison of mean Vickers Hardness Number for nanocomposite in three storage conditions
15 min
1 hour
12 hour
24 hour
Air (N=12)
Mean
63.9a,b
68.2c
75.0d,e
83.9
SD
3.1
2.2
2.8
5.5
Distilled water (N=12)
Mean
SD
60.2a
4.8
65.1c
3.1
72.1d
2.7
81.4
3.5
Artificial saliva (N=12)
Mean
SD
58.3b
2.6
61.6c
3.4
70.15e
2.3
86.3
3.7
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
*Similar letters denote statistical significance between the two groups
At the 15-minute and 12-hour time intervals, there was significance between air and water and air and saliva.
Moreover, at the 1-hour interval, there was significance between all three conditions. At the 24-hour interval, all
groups had results at the p-value (0.0125).
Conclusions: Storage conditions
appear to have an effect on hardness of
nanocomposite at 15-minute, 1-hour, and
12-hour time intervals. However, this effect
is less pronounced at the 24-hour time
interval where the nanocomposite may
be approaching its maximum hardness.
Further research is suggested to explore the
effects of storage conditions on hardness
between time intervals.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #1460.
Tufts University School of Dental Medicine
35
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Characterization of the Novel Zebrafish Helicase Craniofacial Mutant
Jimmy Chen,* David Cheng, Viktoria Andreeva, and Pamela Yelick
Objectives: Our goal was to characterize the developmental expression of the 9N helicase gene and define
9N craniofacial cartilage defects.
Methods: An Alcian blue/Alizarin Red developmental staging series was generated to characterize cartilage
and bone, respectively, in age-matched 9N mutant and wild-type sibling zebrafish. We used in situ hybridization
(ISH) to examine the tissue specific developmental expression of the 9N helicase gene.
Results: The 9N mutant neurocranium presented with an underdeveloped notochord, an expanded otic
capsule, a malformed Trabeculae Cranii, and a trilobed Ethmoid plate. In humans, these deformities can
be associated with possible vertebral disc, otic capsule, and sella turcica dysplasia, and bilateral cleft palate,
respectively. The 9N mutant pharyngeal skeleton presented with underdeveloped dentition, inverted Ceratohyal
and underdeveloped Basihyal, shortened Meckel’s cartilage, and fused joints between the Meckel’s cartilage and
the Palatoquadrate. In humans, these defects correspond to an under-calcified dentition, hyoid arch dysplasia, a
shortened mandible, and a possible fusion between the mandible and temporo-mandibular joint. ISH revealed
that the 9N helicase mRNA is expressed in 16 cell stage zebrafish on the cell surface, in 14 somite stage zebrafish
along the neurocranium, and from 1–5 days post fertilization in the notochord, otic capsule, ceratohyal,
basihyal, and Meckel’s cartilage. The 9N helicase mRNA expression pattern is consistent with the deformities
observed in 9N mutant zebrafish.
Conclusions: Our data suggest
an important role for the 9N helicase
in craniofacial development. Future
functional characterizations of the 9N
helicase mutant will be used to improve
our understanding of human craniofacial
development, and provide new inroads for
more effective therapies for the prevention
and repair of craniofacial defects.
These studies were supported by NIH/
NIDCR R01 DE and Tufts University School
of Dental Medicine, Boston. Also presented at
the 2014 AADR Annual Session in Charlotte,
North Carolina. Abstract #1043.
36
Student and Faculty Research Abstracts 2013 –2014
Student and Faculty Perception on Use of Objective Clinical Structured
Examination in Preclinical Removable Partial Denture Course
Dave Cho,* Paul Stark, and Yun Saksena
Objectives: The aim of this research is to determine the usefulness of objective structured clinical
examination (OSCE) as perceived by students and faculty in a pre-clinical removable partial denture (RPD)
course compared to a practical exam that is currently used.
Methods: Students from the 2015
Class at Tufts University School of Dental
Medicine and the faculty involved in
teaching the course were surveyed. The
survey was anonymous and on paper and
asked the students and faculty about their
perception of the value of OSCE and the
practical. The questions on the surveys
were answered on a Likert Scale. Utilizing
SPSS software, perceptions of OSCE and
the practical exam were compared using
the Wilcoxon Signed Rank Test.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: There were strong correlations
for each pair of questions that compared
student perception of the OSCE and the
practical. The practical scored higher in each category of the student survey. Due to the low number of total
faculty surveys completed, analysis was not performed for faculty perception.
Q12 − Q1 Q13 − Q2 Q14 − Q3 Q15 − Q4 Q16 − Q5 Q17 − Q6 Q18 − Q8 Q19 − Q9
Z
Asymp. Sig.
(2-tailed)
−6.053b
−5.001b
−7.473b
−6.282b
−5.896b
−3.797b
−5.376c
−6.988b
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Conclusion: Compared to the practical, students found the OSCE to be a more negative experience. The
students thought that the OSCE was not as relevant to the course material; the OSCE was not as well organized;
they received less feedback; it did not motivate them to study harder; the experience was more stressful; and the
exam was less fair. Comments from the survey showed that students thought the OSCE was a good idea, but
time per station was limited. Student perceptions may have been affected by scheduling conflicts and changes,
cancellation of the debriefing, and students tampering with the stations (the tampered station scores were
adjusted). When the scores were combined with the practical, the OSCE helped some students pass the course,
while no one failed the course because of the OSCE. Further research may involve investigating how students
actually scored on the OSCE given the negative perception. It may also involve changing the OSCE in order to
turn the exam into a positive learning experience.
Also presented at the 2014 ADEA Annual Session in San Antonio, Texas.
Tufts University School of Dental Medicine
37
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparing Immediate Tear Strength of Elastomeric Impression Materials
Elena Ciciolla,* Jesse Small, Masly Harsono, and Ronald Perry
Objectives: This study examines the immediate tear strengths (MPa) of elastomeric impression materials
using the Boghosian and Lautenschlager Tear Strength Test Method and following the manufacturer minimum
recommended setting time (MRST).
Methods: Seven sample groups (n=20 each group) were created using a stainless steel mold (101.6 mm
long, 19.05 mm wide, and 2.7 mm thick) and different elastomeric impression materials. A notch was created
in the central region of each sample using a stainless steel insert that created either a 0.30 mm (n=10) or 0.50
mm thick (n=10) notch. Each mold was
immersed in a water bath of 35±1°C for
five minutes and removed. The elastomeric
impression materials were loaded into the
mold and immersed after 20 seconds for
the manufacturer minimum recommended
setting time. Specimen was removed
from water bath, immediately placed into
universal testing machine (Instron® 5582),
and subjected to tensile force at a crosshead
speed of 500 mm/min until failure.
Statistical analysis was conducted using
one-way ANOVA with a post hoc Tukey
HSD for pair wise analysis among groups.
Statistical differences were predetermined
at p<0.05.
Results:
Average Stress MPa
Average Stress MPa
(Psi/mean±SD)
(Psi/mean±SD)
Mold 338 (0.50 mm thickness) Mold 348 (0.30 mm thickness)
Groups Material
1
2
3
4
5
6
7
AquasilTM Monophase
(DENTSPLY Caulk)
Tissue Management Impression
Material (DENTSPLY Caulk)
Tissue Management Impression
Material Tray (DENTSPLY Caulk)
ImprintTM 4 Light
(3M ESPE)
Take 1® Advanced (Kerr)
Flexitime®
(Heraeus)
ImpregumTM Soft Lightbody
(3M ESPE)
607.541±39.013A
462.585±49.221F
534.072±28.980B
493.367±28.320F
533.654±55.597B
497.955±58.582F
349.668±31.245C
287.535±55.853G
288.123±37.414D
253.665±22.578G
268.576±33.100D
256.620±9.212G
175.791±21.673E
183.210±34.355H
Groups with the same letter superscript are not statistically different from one another.
38
Student and Faculty Research Abstracts 2013 –2014
Group 1 yielded statistically higher tensile strength compared to the other groups in the 0.5 mm thickness. For
the 0.3 mm thickness, group 3 showed statistically higher tear strengths compared to groups 4, 5, 6, and 7.
Conclusion: Capturing crown and bridge margins accurately is critical for a well-fitting prosthesis.
Impression materials should exhibit high tear strengths to avoid tearing in thin areas, such as those within the
sulcus, when impression trays are removed from the mouth.
Sponsored in part by DENTSPLY Caulk. Also presented at the 2014 AADR Annual Session in Charlotte, North
Carolina. Abstract #501.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
39
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Endodontic Treatment Outcomes in Patients with Sjögren’s Syndrome
Rachel Cohen,* Angel Park, Mabi Singh, and Athena Papas
Objective: In patients with Sjögren’s Syndrome (SSP), hyposalivation has severe implications due to loss of
the protective effects of saliva. Xerostomia promotes cariogenic bacteria, which attack tooth structure, often
leading to root canal therapy (RCT). SSP report having 2.2 restorations/yr. vs. 0.8 restorations/yr. in peer
controls despite spending on average $1,335.16/yr. vs. $503.57/yr. on dental work annually. We investigated the
failure rate and factors associated with RCT in female SSP treated at Tufts University School of Dental Medicine
in an effort to determine how best to manage treatment of SSP, all of whom have salivary hypofunction (<1.5
ml/min) and use preventive fluoride therapy.
Methods: This retrospective study reviewed dental records from 115 SSP with radiographic evidence of
RCT. RCT success and failure were assessed by evaluating radiographs and clinical notes. Failure was defined
as missing RCT tooth on follow-up radiograph, periapical radiolucency, or documented pain on percussion.
Salivary flow rates (SFR) and treatment information were collected from patient charts and activity status was
determined. Association between SFR and endodontic failure was assessed using the Wilcoxon-Mann-Whitney
test (SAS 9.2).
Results: We were able to assess treatment outcomes in 79/115 active subjects with regular follow-up visits.
Within these 79, 37.97% had at least one failure. Both unstimulated and stimulated SFRs between the success
and failure groups were not statistically significantly different.
Table 1: Stimulated Salivary Flow (ml/min) Values by RCT Success or Failure
N
IQR
Median
Mode
RCT Success
49
0.147–1.676
0.632
0.000
RCT Failure
30
0.024–1.128
0.385
0.000
p-value
0.276
Conclusions: A higher rate of endodontic failure in SSP compared to the general population was found.
The SSP failure rate was almost double that reported in the literature for the general population, which ranges
from 3.0–19.1%. Though not statistically
significant, SSP with lower SFR have
increased rates of RCT failure, despite
prevention. Study limitations include
small sample size due to missing followup radiographs where we were unable to
determine RCT outcome. This high rate of
RCT failure warrants further study.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #1597.
40
Student and Faculty Research Abstracts 2013 –2014
Properties of Silk Electrogels: Functional Vehicles for Drug Delivery
John Constantine,1* Tyler Brady,1 Roberto Elia,2 Gerard Kugel,1 and David Kaplan2
1Tufts
University School of Dental Medicine, Boston; 2Tufts University Department of Biomedical
Engineering, Medford, Massachusetts
Objective: To verify that dental implants coated with silk-based electrogels are capable of delivering
therapeutic pharmaceuticals.
Methods: Silk-based electrogels were grown directly on titanium studs for 20 seconds, generating a uniform
coating. The silk solution was laced with pharmaceuticals prior to electrogelation. Pharmaceuticals included
BMP-2, Streptomycin, and penicillin in differing combinations and concentrations. The resulting implants were
tested for antibiotic release, BMP-2 release, and strength of attachment. For antibiotic release testing, electrogels
were placed on fully prepared bacterial lawns of E. coli. The zone of inhibition was measured after 3 days. For
measurement of BMP-2 release, BMP-2-treated electrogels were placed in phosphate buffered saline (PBS)
and samples were taken at 0, 1, 3, and 6 hours. BMP-2 was also introduced directly onto mesenchymal stem
cells (MSCs). Changes to MSCs were determined using ALP staining (a sign of osteogenic differentiation). The
tensile strength of the electrogel adhesion was measured using an Instron®.
Treatment
Silk/Titanium
Penicillin
Penicillin/Streptomycin
Zone of Inhibition
0.0±0.0
4.8 mm±0.79
6.5 mm±1.51
8.2 mm±0.86
10.4 mm±0.77
11.5 mm±1.04
11.7 mm±1.91
1 µg/ml
2 µg/ml
3 µg/ml
1 µg/ml
2 µg/ml
3 µg/ml
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: Penicillin Streptomycin created a larger zone of inhibition than did penicillin alone at all
concentrations tested.
BMP-2 was released from electrogels and measured at 1 hour, 3 hours, and 6 hours.
Treatment
Silk/Titanium
BMP-2 (1.5 µg/ml)
BMP-2 (3.0 µg/ml)
BMP-2 (6.0 µg/ml)
BMP-2 + Pen/Streptomycin (6.0 µg & 6% Pen/Strep/ml)
BMP-2 Alone (6.0 µg/ml PBS)
BMP-2 Silk (no gel) (6.0 µg/ml)
BMP Cumulative Concentration (ng/ml)
1 hr
3 hr
6 hr
0
0
0
0
0
0.33
0
0.17
0.17
0.54
0.54
0.59
0.57
0.76
0.76
0.54
0.91
0.91
0.88
1.19
1.19
There was no significant difference in adhesive strength between the different treatments (p 0.566).
Treatment
Silk
Silk Penicillin/Streptomycin
Silk BMP-2
Silk Penicillin/Streptomycin + BMP-2
Adhesive Strength (MPa±SD)
0.50±0.11
0.40±0.14
0.51±0.28
0.57±0.23
Tufts University School of Dental Medicine
41
Bates-Andrews Day Abstracts
42
Predoctoral Student Presentations
Conclusions: Silk electrogels
are capable of absorbing, storing,
and releasing therapeutic drugs.
Adhesion testing found incorporation
of pharmaceuticals does not
compromise strength. The results
show promise for dental implants.
Also presented at the 2014 AADR
Annual Session in Charlotte, North
Carolina. Abstract #489.
Student and Faculty Research Abstracts 2013 –2014
Adiponectin Attenuates Inflammation by Regulating the Jmjd3-Irf4 Axis
in Macrophages
Donying Xuan,1 Matthew Devine,1* Lan Zhang,1 Qianqian Han,1 Yin Tang,1 Qisheng Tu,1 and
Jake Chen1,2
1Division
of Oral Biology, Tufts University School of Dental Medicine, Boston; 2Department of
Anatomy and Cell Biology, Tufts University School of Medicine and Sackler School of Biomedical
Sciences, Boston
Objective: Polarization of macrophages between inflammatory (M1) and anti-inflammatory (M2)
phenotypes plays a crucial role in wound healing and the systemic inflammatory state. Adiponectin, a factor
secreted by adipose tissue (AT) and down-regulated in obesity, functions to switch macrophage polarization
from M1 to M2, thereby attenuating
chronic inflammation. However, little is
known about the epigenetic mechanism
underlying how adiponectin affects the
macrophage state. In this study, we aimed
to examine the relationship between
adiponectin and the H3K27 demethylase
Jmjd3 in regards to the Jmjd3-Irf4 axis,
which is required for M2 polarization in
macrophages.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Methods: An established P. gingivalisinduced periodontal bone loss model
was utilized with wild-type mice and
adiponectin knockout (APN-/-) mice, then
exogenous adiponectin was administrated
to APN-/- mice. Jmjd3 and Irf4 expression
was analyzed by RT-PCR and immunohistochemistry from collected gingival and AT (n=5). To analyze the
possible molecular mechanism in vitro, bone marrow-derived macrophages were isolated from wild-type and
APN-/- mice, then challenged with Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) ± adiponectin. Jmjd3
and Irf4 expression was determined by RT-PCR (n=3).
Results: The results exhibited that exogenous administration of adiponectin can abrogate periodontal bone
loss, and cause reduction of macrophage infiltration into AT. RT-PCR results demonstrated that adiponectin
can rescue the up-regulation of Jmjd3 and Irf4 expression in vivo in gingiva tissue and AT. Also, upregulation
of Jmjd3 and RNA expression was mitigated in bone marrow-derived macrophages from APN-/- mice upon
challenge with Pg-LPS. Moreover, this reduction in expression could be restored by pretreatment with
adiponectin.
Tufts University School of Dental Medicine
43
Bates-Andrews Day Abstracts
44
Predoctoral Student Presentations
Bone marrow-derived macrophage mRNA expression
APN-/-
APN-/- +adiponectin
Jmjd3/GAPDH
1.31±0.662
5.92±1.75*
IRF4/GAPDH
1.21±0.370
3.10±0.500**
Asterisk indicates significance over
APN-/- group. *p<0.05; **p<0.005
APN-/- +Pg-LPS
APN-/- +Pg-LPS +adiponectin
0.833±0.202
2.56±0.194***
1.08±0.186
2.78±0.437**
Asterisk indicates significance over
APN-/- +Pg-LPS group. **p<0.005; ***p<0.0005
Conclusions: Our results demonstrate by gain- and loss-of-function approaches that adiponectin abrogates
periodontal bone loss by regulating the Jmjd3-Irf4 axis to M2 polarization in macrophages. Understanding of
epigenetic changes underlying the effect of adiponectin on macrophages may provide the basis for macrophagecentered epigenetic therapeutic strategies to control inflammation and promote wound healing.
Supported by NIH/NIDCR grant DE21464 and National Natural Science Foundation of China (grant 81271160)
and an award from IADR/Academy of Osseointegration (AO) to JC. Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina. Abstract #1262.
Student and Faculty Research Abstracts 2013 –2014
Depth of Cure and Radiopacity of Select Composites
Sapan Bhatt, Michael Kreitzer, Daniel Dooley,* Ronald Perry, and Gerard Kugel
Objectives: To investigate the relationship between depth of cure and radiopacity for select composite
materials.
Methods: Four composite materials were tested: group 1, AuraTM (SDI, Australia); group 2, LunaTM (SDI);
group 3, LlisTM (FGM, Brazil); and group 4, OpallisTM (FGM). Samples (n=6 for each group) were prepared in
stainless steel tubular molds (8 mm x 4 mm internal diameter) according to the depth of cure protocol specified
in ISO 4049. Half of the samples were cured for 10 seconds with a Radii Plus (SDI) curing light and the other
half were cured for 20 seconds. Uncured composite was removed from the bottom of the sample, and the
remaining composite height was measured with a caliper. Sample heights were then divided by two according to
ISO 4049. Mean depth of cure and standard deviation were calculated for each sample. To measure radiopacity,
one 1 mm x 15 mm diameter disc was prepared for each composite material and radiographs were taken
using a 2200 digital radiograph machine set at 70kV, 4mA, 0.09s exposure time connected to a RVG6100TM
digital imaging sensor. Radiopacity levels were determined from a 0.5 mm stepped aluminum wedge. One-way
ANOVA and Tukey tests were conducted on depths of cure for each composite for both cure time (p<0.05, CI=
95%).
Results:
Composite
Group 1
Group 2
Group 3
Group 4
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Avg. Depth of Cure (mm)
10 sec
20 sec
2.38A
2.76A
2.76B
3.16B
1.67C
2.06C
A
2.29
2.94A,B
1Materials
with the same letter are not significantly different
from each other.
Composite
Group 1
Group 2
Group 3
Group 4
Radiopacity (mm Al)
3.00
1.84
2.73
3.12
Conclusion: While no relationship exists between radiopacity and depth of cure, the composites did vary
significantly in depth of cure. For both the 10- and 20-second cure times, group 3 was the shallowest depth of
cure and group 2 was the deepest. Group 1 and group 4 had similar cure depths.
Supported in part by SDI. Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract
#1160.
Tufts University School of Dental Medicine
45
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Elastic Recovery of Light-Bodied Impression Materials at Different
Working Times
Lindsay Fox,* Ronald Perry, and Gerard Kugel
Objective: To compare the elastic recovery behavior of five commercially available quick setting impression
materials with a newly introduced Super-Quick vinylpolysiloxane (VPS) material Imprint 4™ (3M ESPE) and
evaluate the effect of varied working times.
Method: Six groups (n=10 each group) of quick setting light body materials were analyzed for elastic
recovery according to ISO4823:2000 standards (ADA No.19, 2004). Materials: 3M-ESPE-Imprint4™ (IP4),
DENTSPLY-AquasilUltraXLV® (XLV) , Heraeus-Flexitime®XtremeCorrectFlow (FTX), Kerr-Take1Advanced™
(T1A), Panasil-Initial-X-lightFast® (XLF), and GC-America-EXA’lence-LightBody™ (EXA). After a working
time of 1:00 minute (according to ISO), the mold was placed into a 35°C water bath and allowed to set
according to manufacturer’s directions; total set time (XLV, T1A, XLF, EXA) or fixed intraoral set time (IP4,
FTX). A second experiment was performed with a shortened working time of 30 seconds (non-ISO standard).
Results:
One-way ANOVA and Tukey tests were performed on percent recovery (p≤0.05).
Working time
1:00 min
0:30 min
Material
Value (%
recovery)
Std. Dev.
Stat.
Group
Value (%
recovery)
IP4
XLV
T1A
XLF
EXA
FTX
99.65
99.41
99.70
99.61
99.11
99.40
±0.033
±0.064
±0.081
±0.077
±0.140
±0.160
AB
D
AB
ABC
E
D
99.59
99.55
99.72
99.73
99.16
N/A
Std. Dev.
Stat.
Group
±0.044
±0.086
±0.048
±0.033
±0.110
BC
C
AB
A
E
SIG diff
Difference b/w time
points
−0.06
No
0.14
Yes
0.02
No
0.12
No
0.05
No
N/A
Conclusion: All materials performed above the minimum (96.5%) ISO standards for recovery. At 1:00 min,
IP4 showed similar elastic recovery to T1A and XLF. At 30 seconds, IP4 showed similar recovery to only T1A.
Within the materials with fixed intraoral
set time, IP4 showed no significant
difference between the two working times,
while FTX was immeasurable at reduced
working time. Within the materials with
total set time, XLV showed a statistical
improvement of elastic recovery with
shorter working time while all other groups
showed no significant difference.
Supported in part by 3M ESPE. Also
presented at the 2014 AADR Annual Session
in Charlotte, North Carolina. Abstract #280.
46
Student and Faculty Research Abstracts 2013 –2014
Pilot Study Analysis of Four Types of Digitally Processed Models
Ryan George,*1 Judyth Lee,1 M. Beyari,2 H. Lamfon,2 John Orfanidis,1 Matthew Finkelman,1
Masly Harsono,1 and Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Umm Al-Qura University, Makkah, Saudi
Arabia
Objective: To perform a pilot study to test efficacy of using a three-dimensional (3D) evaluation of digitallyprocessed models to compare accuracy in fabrication methods using a conventional model as a control.
Methods: A die of Tooth #3 was fabricated using four methods (N=3 each group): conventional analog
model (CAM) (Impression: Heraeus Flextime; Die: GC America, Fuji Rock); scanned impression material
(SIM) (Impression: Heraeus Flextime; Die: inverted using MeshLab software); extracted die from scanned
impression material (EXSIM) (Heraeus Flextime); intraoral digitally-processed model (IO) (MHT). A typodont
(Kilgore) was used as the master comparison model/control. The master model and all models from each
group were scanned using Smart Optics 880 to create a digital sample. The scanner was calibrated according to
manufacturer’s specifications before each use. Using Exocad software, each digital sample was digitally matched
to the master model digital sample at the highest and lowest points on each, creating superimposed test samples
(N=12). All superimposed test samples were imported into Geomagic Qualify 2012 software and analyzed using
3D analysis to collect data about size/shape differences (in the overall models and specifically in each upper and
lower arch) between the digitally-processed models and the conventional model. Average maximum deviation
and average minimum deviation were analyzed using Geomagic.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Group
CAM
SIM
EXSIM
IO
3D Average
Maximum
Deviation
0.0293
0.0267
0.1076
0.0433
3D Average
Minimum
Deviation (µ)
−0.0196
−0.0236
−0.0236
−0.0326
3D Standard
Deviation (µ)
0.0480
0.0390
0.1513
0.0796
Maximum
Maximum Lower
Upper Deviation
Deviation (µ)
(µ)
0.4867
−0.4220
0.4930
−0.4990
0.6600
−0.1180
0.6570
−0.6563
Conclusion: 3D analysis of all
superimposed test samples resulted in
comparable results. Further testing is
necessary to determine if this method of
evaluation is effective in testing accuracy of
digitally processed models.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #502.
Tufts University School of Dental Medicine
47
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparison of Mechanical Properties of Dental Restorative Material
Vishavjeet Girn,* William Chao, Masly Harsono, Angel Park, and Gerard Kugel
Objective: This study aims to evaluate and compare the
compressive strength, diametric tensile strength, and flexural
strength of four commercial tooth-colored restorative materials.
Methods: Four groups (n=10 each) of restorative materials were
tested. Samples were prepared according to DIN 53454 (ISO 9917
2001) and ISO Standard 4049 for compressive testing (CS), flexural
strength (FS) and diametric tensile strength (DTS): a 4 x 8-mm2
mold for CS; a 6 x 3.5-mm2 mold for diametric tensile strength
(DTS); a 2 x 2 x 2-mm3 mold for FS. The samples in groups 1 to 3
were cured with a halogen light from top and bottom surfaces for 40
seconds. Group 4 was self-polymerized according to manufacturer’s
directions. Samples were then stored in distilled water for 24 hours
to ensure polymerization of the material. All tests were performed
using a universal testing machine (UTM) with 1 K load cell (Instron
5566A, Norwood, Massachusetts). For CS and DTS testing, a 4 mm/
min cross head speed was used, while FS testing used a three-point
bending fixture attach on a UTM machine at a 0.5 mm/min cross head. The distance between the two supports
was set at 20 mm. The radius of each support was 1 mm. Differences among groups was tested with one way
ANOVA and post hoc tests using Tukey’s HSD. Statistical significance was predetermined at level p<0.05.
Results:
Mean values of four measurements of strength in four restorative materials
Compressive
Strength
(MPa±SD)
Diametric
Tensile Strength
(MPa±SD)
Flexural Strength
(MPa±SD)
Modulus of
Elasticity
(GPa±SD)
286.89±63.72a
48.97±10.78d
126.67±12.73f
9.53±1.00i
270.71±14.67a
44.44±4.43d
3
Ketac™ Nano (3M
ESPE) RMGI
201.89±46.61b
12.85±5.71e
4
Fuji IX™ (GC
America) GI
73.74±24.36c
6.00±1.49e
Group
1
2
Material
Filtek™ Supreme
Ultra (3M ESPE)
Resin
ACTIVA BioActive
Restorative
(Pulpdent)
108.41±14.73g
16.84±2.66h
8.58±4.61h
4.45±0.29j
2.89±0.54k
2.57±1.40k
Means with the same superscript letter are not statistically different from one another.
Conclusion: Bioactive restorative group 2 demonstrates mechanical properties similar to a composite resin
restorative material group 1. This study suggests that this new bioactive material has promising attributes as a
dental restorative material comparable to resin composites and superior to RMGIs and GIs.
Research sponsored in part by Pulpdent. Also presented at the 2014 AADR Annual Session in Charlotte, North
Carolina. Abstract #1163.
48
Student and Faculty Research Abstracts 2013 –2014
Association between Cumulative Grade Percent and Dental Licensure
Exam Results
Jasmine Jenkins,* Paul Stark, and Yun Saksena
Many factors, some unrelated to academic performance, can impact whether a student passes a licensure
examination. Considering the importance of these examinations on the careers of future dentists, it is
valuable to study the relationships between performance in educational programs and the outcomes of such
examinations. Thus, the purpose of this study was to compare the relationship between selected measures of
academic performance and the outcomes on the North East Regional Board of Dental Examiners (NERB) and
Western Regional Examining Board (WREB) licensing examinations. The dental students’ cumulative grade
percentage served as the primary predictor when evaluating this relationship. Data were collected on three
graduating classes at Tufts University School of Dental Medicine (2010–2012). Mean grades were compared
between those who passed and those who failed their licensure examinations using t-tests. All analyses were
performed using SPSS, Version 19. The Tufts Medical Center/Tufts University Health Sciences institutional
Review Board approved this study. There were 416 students in the combined group who took one of the exams:
280 took the NERB and 136 took the WREB. Of the 416, the 112 failures had a mean (SD) GPA of 86.04 (3.93),
and the 304 who passed had a mean (SD) GPA of 87.66 (3.80), p<0.001, indicating a statistically significant
difference in GPA depending on licensure exam results.
Conclusion: The study found that
students who passed the licensure
examination had a statistically significantly
higher cumulative GPA than those who
did not, although the difference was only
1.6 percentage points. Though statistically
significant, this is a very small difference
practically. Such differences may not be
discernable when grades are converted to
a 4-point GPA. Further work needs to be
conducted to determine whether academic
performance is a good predictor of passing
the licensure examinations.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Also presented at the 2014 ADEA Annual
Session in San Antonio, Texas.
Tufts University School of Dental Medicine
49
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Paracrine Effects of Diabetic-Foot Ulcer Fibroblasts on Keratinocytes
In Vitro
Rajvir Jutla,1* Anna Maione,1 Avi Smith,1 Behzad Gerami-Naini,1 A. Veves,2 L. Pradhans,2
Marjana Tomic-Canic,3 and Jonathan Garlick1
1Department
of Oral and Maxillofacial Pathology, Tufts University School of Dental Medicine,
Boston; 2Beth Israel Deaconess Medical Center, Boston; 3University of Miami, Miami, Florida
Objectives: Signaling between fibroblasts and keratinocytes is essential for proper wound healing but is
thought to be dysregulated in the diabetic foot ulcer (DFU) environment. An engineered 3D human skin model
was used to examine differences in the ability of DFU fibroblasts to support the differentiation and proliferation
of human keratinocytes. The long-term goal is to develop improved therapeutic approaches for DFU repair.
Methods: Fibroblasts were harvested from diabetic foot ulcers (DFU) and non-ulcerated diabetic feet
(DFF) from Type II diabetic patients as well as from site-matched non-diabetic feet (NFF). DFU, DFF, or
NFF fibroblasts were embedded in collagen gels, normal human keratinocytes (NHKs) were seeded on them,
and tissues grown at air-liquid interface.
Tissues were pulsed with BrdU for 6 hours,
formalin-fixed, and paraffin embedded.
Sections of these tissues were stained by
H&E to visualize tissue development and
for BrdU to identify proliferating cells.
The number of BrdU-positive, basal
keratinocytes were counted and expressed
as a percentage of the total number of basal
keratinocytes per 20x image.
Results: H&E staining showed that all
three fibroblast types (DFU, DFF, and
NFF) were able to support keratinocyte
development into a fully differentiated
epidermal layer. However, keratinocytes
grown on DFU fibroblasts were more
proliferative than those grown on DFF fibroblasts (p<0.05). The number of proliferating keratinocytes grown
on NFF fibroblasts was less than DFUs and greater than DFFs, although not statistically significant.
Conclusions: Our findings indicate that DFU fibroblasts stimulated increased keratinocyte proliferation
in 3D tissues when compared with DFF fibroblasts, suggesting that the ulcer environment may direct paracrine
signaling between fibroblasts and keratinocytes. This suggests a possible mechanism for the hyperproliferative
keratinocytes found in the callus surrounding DFUs. This marks an important step towards understanding
mechanisms that will help develop future regenerative therapies to treat oral and cutaneous wounds.
Supported by NIH Grant #RO1 DK98055-06A1 and the TUSDM Dean’s Scholars Program. Also presented at the
2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1038.
50
Student and Faculty Research Abstracts 2013 –2014
A Comparison of Conventional Intraoral Radiography and Sectional
CBCT Imaging
Elaina Kazes,* Angel Park, Aruna Ramesh, and Virginia Karapanou
Objectives: This study measured
agreement between conventional periapical
(PA) radiographic images versus sectional
CBCT images in identifying the position
of maxillary molar root tips relative to
maxillary sinus floor.
Methods: The primary observer (OB1)
categorized 130 tooth roots of posterior
maxillary teeth into 4 groups based on the
relationship of root tips to the maxillary
sinus floor using CBCT images (Planmeca
Romexis® Viewer) and corresponding PA
images (MiPACS®). A second observer
(OB2) categorized 40 random roots from
the same sample as OB1 in both image
modalities for observer comparison.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
The images were classified as follows:
A: Root tips below the sinus floor
B: Root tips in contact with the sinus floor without sinus floor elevation
BB: Root tips in contact with the sinus floor in a lateral position, without sinus floor elevation
C: Root tips protruding within the sinus
Results: Bowker’s test of symmetry and Cohen’s kappa tests were used to determine the level of agreement
between the observers (OB1 and OB2), and between PA and CBCT.
Table 1: Level of Agreement between Observers
Image Type
OB1 PA + OB2 PA
OB1 CBCT + OB2 CBCT
Sample
Size
40
40
Bowker’s Test of
Symmetry
S=5.3, p=0.50
S=3.3, p=0.77
Cohen’s Kappa Test Notes:
K=0.70
K=0.53
Strong agreement
Moderate agreement
Table 2: Level of Agreement between CBCT and PA
Image Type
OB1 PA + OB1 CBCT
OB2 PA + OB2 CBCT
Sample
Size
130
40
Bowker’s Test of
Symmetry
S=69.3, p<0.01
S=22.0, p≤0.01
Tufts University School of Dental Medicine
Cohen’s Kappa Test Notes:
K=0.23
K=0.21
Weak agreement
Weak agreement
51
Bates-Andrews Day Abstracts
52
Predoctoral Student Presentations
Table 3: Percentage of Agreement between CBCT and PA
Group
% Agreement
A (Root tips below the sinus floor)
68.6
B (Root tips in contact with the sinus floor without sinus floor elevation)
23.6
BB (Root tips in contact with the sinus floor in a lateral position, without sinus floor elevation)
12.1
C (Root tips protruding within the sinus)
0.0
Conclusions: Statistical analysis shows agreement between the two observers in categorizing the PA and
CBCT. As expected, the Kappa statistic was in low agreement when comparing PA and CBCT, the percentage of
agreement being highest in group A (when the root tips are below the sinus floor) and lowest in group C (when
the root tips protrude within the sinus).
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1420.
Student and Faculty Research Abstracts 2013 –2014
Oral Health Related Quality of Life in Primary Sjögren’s Syndrome
Samantha Keck,* Athena Papas, Matthew Finkelman, Britta Magnuson, and Mabi Singh
Objective: This study investigated oral health
related quality of life (OHRQoL) in patients with
primary Sjögren’s Syndrome (PSS) using a webbased questionnaire.
Methods: A comprehensive web-based
questionnaire (Qualtrics) was created using the
OHIP-14 Questionnaire and questions from
the Harrison Interactive Survey on Sjögren’s
Syndrome. After IRB review, the questionnaire
was sent out by the Sjögren’s Syndrome
Foundation (SSF) to their email list. Members
of SSF were asked to forward the questionnaire
to someone of similar age and same gender
that had not been diagnosed with Sjögren’s
Syndrome, which served as the comparison
population. All data were de-identified.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: There were 1,336 PSS and 165 comparison responses. All participants did not respond to every
question. Demographics were: PSS, average age (range) 59.2 years (17–89), 96% female; comparison, average
age (range) 58.4 years (18–83); 95.6% female. OHIP-14 responses were on a coded scale: never=0, hardly
ever=1, occasionally= 2, fairly often=3, and very often=4. The maximum additive OHIP-14 score was 56. A
lower score indicated better OHRQoL. Each of the 14 questions of OHIP-14 was compared between the PSS
population and the non-Sjögren’s Syndrome comparison population using Mann-Whitney U tests with the
Bonferroni Correction for multiple testing. For each question, a higher frequency of “never” was reported in the
comparison population, and a higher frequency of “very often” was reported in PSS. All 14 tests had a p-value
of <0.001. The results were statistically significant. The additive OHIP-14 was also analyzed for PSS and the
comparison population (Table 1). The p-value was <0.001, and the results were statistically significant.
Table 1
PSS (n=807)
Comparison (n=134)
Additive OHIP-14
Inter-quartile range
18
2
19
7
Conclusions: The OHRQoL in PSS population was significantly decreased in all measures in comparison to
a non-Sjögren’s population. PSS patients are reported to have poor oral health measures, and the results of this
study may be a result of poor oral health affecting oral quality of life.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1599.
Tufts University School of Dental Medicine
53
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Retrospective Study of Oral Health Program in a Rural
Zambian Community
Douglas Kim,* Wanda Wright, Alice Ko, Maryam Mahdavi, Angel Park, and John Morgan
Objective: Oral health interventions and services in developing nations often focus on curative and
emergency procedures. The aim of this study was to describe and assess the impact of an oral health program
provided in a rural Zambian community. Elements of the program included oral health education, screening
examinations, fluoride application and pain relieving extractions.
Methods: Data was collected from screening examinations and treatment records during annual visits to a
rural health center in Zambia from 2007–2012. Screening examinations were performed by qualified oral health
providers and included treatment urgency scores (TU) as defined by the Association of State and Territorial
Dental Directors (0=no obvious problem; 1=early dental problem; 2=urgent dental care required). Patient
information was de-identified, entered into an Access database, and analyses completed in SAS (Version 9.2).
Results: Preliminary results indicated that 2,375 individual patients were screened from 2007–2012. The least
number of screening visits (192) was in 2007, the most (720) in 2012. Of the patients who were recommended
curative treatments each year, an average of 42.7% required extractions. The percentage of patient visits with
TU=0 was 27.8% in 2007 and 52.1% in 2012. From 2007 to 2011, the percentage of TU=2 visits was consistently
about 1/2 of the total visits. The lowest percentage of TU=2 visits (32.1%) was reported in 2012.
Conclusion: Although most oral health intervention programs in developing nations focus on curative and
emergency procedures such as extractions, the oral health program in this study also focused on prevention and
education. In 2012, although the percentage for TU=2 was the lowest compared to previous years, the number
of patients was greatest. These results are consistent with the program’s focus on prevention with an increase
over time in the utilization of the program for preventive services.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1076.
54
Student and Faculty Research Abstracts 2013 –2014
Microleakage Evaluation of Beveling Cavosurface Margins in Composite
Class-II Restorations
Julia Kim,* Stephanie John, Matthew Finkelman, Gerard Kugel, and Masly Harsono
Objective: To observe the microleakage of Class-II composite restorations with or without beveled enamel
cavosurface margins.
Methods: A total of eighty Class-II preparations were prepared on caries-free extracted human molars by
a single operator. All preparations were approximately 1.5 mm in depth at the pulpal floor and 2.5 mm at the
gingival floor. Samples were randomly assigned into four groups, n=20 each, two groups with bevel (B), two
groups without bevel (WB). Beveled
groups had cavosurface margins of
the occlusal and proximal walls of the
preparations beveled approximately 1
mm at 45° angle. Two adhesive systems
were used: Adper™ Scotchbond™ MultiPurpose Plus Adhesive total etch-system
(TE, 3M ESPE) and Adper™ Easy Bond
Self-Etch Adhesive (SE, 3M ESPE).
Adhesives were applied according to
manufacturer’s instructions. Samples
were filled with Filtek Supreme Ultra
(3M ESPE) and cured for 30 seconds
with an LED light (DEMI, Kerr).
After restorations were completed, samples were thermocycled for 10,000 cycles between 5°C and 50°C with a
dwell time of 15 seconds and immersed in 50% ammoniacal silver nitrate solution for 3 hours and in a photo
developing solution for 24 hours. Samples were embedded into acrylic and sectioned in the mesio-distal
direction (Isomet, Buehler). Microleakage scores towards pulpal floor (P) and axial wall (A) were recorded
under a light microscope (Olympus SZX16). Statistical analysis was conducted using an ordinal regression test.
Statistical significance was predetermined at p<0.05.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: The following table shows the number of samples in each scoring group.
Microleakage score towards Pulpal Floor
(P) / Axial wall (A)
0 = no microleakage
1 = 25% towards (P)/(A)
2 = 50% towards (P)/(A)
3 = 75% towards (P)/(A)
4 = 100% towards (P)/(A)
Group 1
WB, TE
4/6
13/11
1/2
2/1
0/0
Group 2
WB, SE
1/1
11/7
6/8
0/1
2/3
Group 3
B, TE
13/11
5/8
2/1
0/0
0/0
Group 4
B, SE
4/4
12/6
3/8
1/1
0/1
WB=without bevel, B=bevel, TE=total etch, SE=self-etch.
Conclusions: Effect of beveling enamel cavosurface margins and using total etch adhesive systems on
microleakage was statistically significant, and group 3 had the lowest microleakage in Class II composite
restorations.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #841.
Tufts University School of Dental Medicine
55
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Assessment of Participants in Oral Health Project in Rural Zambia
Alice Ko,* Wanda Wright, Douglas Kim, Maryam Mahdavi, Angel Park, and John Morgan
Objective: Effective design and implementation of preventive oral health programs in developing nations is
challenging. Based on the proposed strategy of the World Health Organization (WHO), a prevention-focused
oral health program has been implemented at a health center in a rural Zambian community. The aim of this
study was to assess whether patients who had visits in successive years had less oral health urgency than those
who attended only an initial visit.
Methods: Data was collected from screening forms of yearly visits to the program from 2007–2012. All
records were de-identified, exported to Access, and double entered, and crude bivariate analyses were completed
in SAS. Treatment urgency (TU) of each patient visit was recorded as 0=no obvious problem; 1=early dental
problem (restoration); 2=urgent care (toothache, infection). A total of 2,375 patients were screened. Of those,
212 were patients with multiple visits.
Results: The number of patients seen in multiple years was 212, attending 479 visits. Of the 212 subjects,
81.1% visited twice, 12.7% three times, 5.2% four times, and 0.9% five times. Preliminary data analysis of the
total visits indicates 174 (36.9%) were
TU=0, 101 (21.4%) were TU=1, and
196 (41.6%) were TU=2. In 2007 the
proportion of TU=0 was 25.0% and in
2012 it was 55.7%. The TU=2 decreased
from 46.9% in 2007 to 25.5% in 2012.
Conclusion: Preliminary results
indicate that the proportion of visits with
TU=0 increased, while that of TU=2 scores
decreased over the six-year period. This
is consistent with a population seeking
preventive oral health and not returning
solely for urgent care. Although further
investigation is needed, this evaluation
suggests a promising method to determine
if the oral health program implemented in
a rural community of Zambia is working toward and supports WHO’s proposed strategy.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1077.
56
Student and Faculty Research Abstracts 2013 –2014
Strength Testing of Various Cements and Restorative Materials
Michael Kreitzer,* Sapan Bhatt, Ronald Perry, and Gerard Kugel
Objectives: Evaluate shear-bond-strength (SBS), compressive-strength (CS) and flexural-strength (FS) for
select glass-ionomer (GI) cements and restorative-materials; CS and FS for select composites.
Methods: Six GI-cements, five GI-restorative-materials, and four composites were tested (n=5). To test SBS,
extracted human teeth embedded in epoxy-resin were sectioned with a diamond saw to remove enamel on the
occlusal surface. After conditioning the dentin surface per manufacturer’s instructions (MI), a 6-mm plastic
ring was centered over the bonding area and filled with test GI material. SBS was measured using a universal
testing machine (Instron®, crosshead-speed: 0.75 mm/min), and results (MPa) were analyzed. CS samples were
mixed per MI and placed into (3 x 5 mm) metal cylindrical molds on top of a Mylar strip resting on a glass
slab. The mold was filled, all excess removed, and another Mylar strip on a glass slab was placed on top and
secured with a paperclip. Samples were stored for 24 hours, removed from molds and broken using an Instronmachine (crosshead speed: 1.0 mm/min), and results analyzed. FS samples were mixed per MI and placed into
metal rectangular molds (2 x 2 x 30 mm) on top of a Mylar strip resting on a glass slab. Samples were secured,
stored for 24-hours, removed from molds, then broken using a 4-point bending ring with an Instron machine
(crosshead speed: 1.0 mm/min), and results analyzed. Upon completion of all preparations, each sample was
stored for 1 hour at 37°C (100%RH), removed, and immersed in deionized-water at 37°C for 23 hours before
testing.
Group
1
2
3
4
5
6
GI Cements
riva luting (SDI)
Ionomaster C (Wilcos)
Ionomaster F (Wilcos)
Maxxion C (FGM)
Vidrion C (SS White)
Vitro Cem (Nova DFL)
Group
1
2
3
4
5
GI Restorative Materials
riva self-cure (SDI)
Maxxion R (FGM)
Vitro Fil (Nova DFL)
Vitro Molar (Nova DFL)
Ionomaster R (Wilcos)
Group
1
2
3
4
Composites
Aura MC (SDI)
Luna (SDI)
Llis (FGM)
Opallis (FGM)
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: One-way ANOVA test and Tukey-post-hoc tests were used to find significant difference for each
individual strength by material (p<0.05, CI=95%). All tests for GI cements, GI restorative materials, and
composites showed statistical significance.
Tufts University School of Dental Medicine
57
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
GI Cements (n=5)
riva luting
Ionomaster C
Ionomaster F
Maxxion C
Vidrion C
Vitro Cem
Avg. SBS (MPa±Std Dev)
4.13±0.77*
3.87±1.35*
5.49±0.55*
4.25±0.89*
10.2±3.10*
4.53±2.32*
Avg. CS (MPa±Std Dev)
100.1±7.11*
62.5±5.28*
96.1±11.5*
56.1±5.18*
136.6±14.5*
61.3±8.99*
Avg. Fs (MPa±Std Dev)
5.93±1.09*
5.63±0.96*
7.80±0.76*
7.96±1.67
11.7±2.90*
5.60±1.55*
GI Restorative (n=5)
riva self cure
Maxxion R
Vitro Fil
Vitro Molar
Ionomaster R
Avg. SBS (MPa±Std Dev)
6.79±1.38*
5.72±0.52*
3.49±1.55*
5.58±2.69*
1.48±0.87*
Avg. CS (MPa±Std Dev)
158.1±18.8*
82.2±2.06*
62.5±2.68*
103.2±19.3*
30.2±3.43*
Avg. FS (MPa±Std Dev)
13.1±1.85*
7.84±1.01*
8.57±1.63*
6.76±0.88*
Composites (n=5)
Aura MC
Luna
Llis
Opallis
Avg. CS (MPa±Std Dev)
354.7±25.5
360.6±23.9
313.2±28.9*
369.1±28.8*
Avg. FS (MPa±Std Dev)
103.9±8.1*
128.6±12.3*
87.5±6.7*
102.9±10.9*
1Results
*Samples not measured
with an asterisk (*) are statistically different (p<0.05).
Conclusions: Riva self-cure GI restorative material showed the highest SBS, CS, and FS, while Vidrion
C had the highest SBS, CS, and FS for a GI cement. Luna composite had the highest FS value and Llis was
significantly different from Opallis for CS testing.
Sponsored in part by SDI. Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract
#1124.
58
Student and Faculty Research Abstracts 2013 –2014
Effect of Mold Type on Depth of Cure
Hemanth Kunduru,1* Richard Price,2 and Ronald Perry 1
1Tufts
University School of Dental Medicine, Boston; 2Dalhousie University, Halifax, Nova Scotia,
Canada
Objectives: The ISO 4049 standard for determining depth of cure uses a metal mold with a 4-mm diameter
internal round hole. This mold design may not be clinically relevant (Flury et al. 2012). This study evaluated the
effect of three different mold designs on the depth of cure of dental resin.
Methods: Three resin composites from Ivoclar-Vivadent were measured: Tetric® Bulk fill IVA (A); Tetric
Evoceram® A2 (B); and Heliomolar A2 (C). These composites were packed into a 10-mm deep metal or semitransparent white Delrin mold with a 4-mm internal diameter circular hole, or a 10-mm deep metal mold with
a 2-mm radius semi-circular hole. The top and bottom surfaces were covered with Mylar strips and pressed
flat using a glass slide, which was then removed. Composites A and B were exposed to a Bluephase® G2 curing
light for 10 s on high, and C was exposed for 15 s. Immediately after light curing, the specimens were removed
from the molds and the soft composite scraped away with a plastic spatula. The remaining hard composite was
measured with a digital micrometer and divided by two. Ten specimens of each composite were made in each
mold. ANOVA and Fishers post-hoc multiple comparison tests were used to compare the mold effect on the
depth of cure.
Results: The depth of cure ranged from 1.3 to 4.9 mm depending on the composite and mold used.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Depth of Cure
Thickness/2
Mold
Composite Depth of Cure (mm) S.D. mm Difference from ISO Mold
Circular Semi-Transparent Delrin
A
4.9
0.1
+81%
Circular Semi-Transparent Delrin
B
4.2
0.2
+83%
Circular Semi-Transparent Delrin
C
3.4
0.2
+127%
Circular Metal
A
2.7
0.1
0
Circular Metal
B
2.3
0.1
0
Semi-Circular Metal
A
2.2
0.1
−19%
Semi-Circular Metal
B
1.9
0.2
−17%
Circular Metal
C
1.5
0.1
0
Semi-Circular Metal
C
1.3
0.1
−13%
Conclusions: Mold design had a significant effect on the depth of cure for all three composites. Composite
A cured to a greater depth compared to B or C (p<0.05). Composite A did not achieve a 4 mm depth of cure in
either metal mold when the Bluephase G2 was used for 10 seconds. Composite B did achieve a 2 mm depth of
cure in the circular metal mold.
This study was supported by Ivoclar-Vivadent and by Tufts and Dalhousie Universities. Also presented at the 2014
AADR Annual Session in Charlotte, North Carolina. Abstract #1152.
Tufts University School of Dental Medicine
59
Bates-Andrews Day Abstracts
60
Predoctoral Student Presentations
All Ceramic Restorations: A Clinical Case
Chase Larsen,* Guilherme Valverde, William Lobel, Nopsaran Chaimattayompol, and
Hans-Peter Weber
Over the past few decades, ceramic materials have been widely used in prosthetic dentistry because of their
excellent esthetics and biocompatibility. Associated with improved microstructure and physical properties,
all-ceramic crowns and their use have expanded in the field of dentistry as an alternative treatment for dental
defects. Clinical data and years of experience suggest that they may be as reliable as metal-ceramic crowns
in appropriate situations. The present work depicts a clinical case where six anterior IPS e.max® crowns
(Ivoclar Vivadent) were fabricated for a patient in the pre-doctoral clinic at Tufts University. A 46-year-old
woman presented in July 2012 with a desire to enhance the esthetics of her smile. A clinical and radiographic
examination revealed extensive composite restorations on her maxillary incisors with poor contour,
inconsistent color, and recurrent decay. Overhanging margins and inadequate plaque removal had contributed
to periodontal inflammation with moderate loss of attachment but limited mobility in the maxillary anterior
sextant. The treatment plan included periodontal therapy, endodontic therapy, the placement of direct
restorations for carious lesions in posterior teeth, and the placement of six all-ceramic full-coverage crowns on
the maxillary anterior teeth. Upon completion of the first two phases of treatment, the maxillary anterior teeth
were prepared for all-ceramic crowns. As an alternative to a traditional wax mock-up, the desired position and
contour of the crowns was determined by fabricating provisional crowns directly on the tooth preparations
using BlueLine® DCL denture teeth (Ivoclar Vivadent) and acrylic. The occlusion, profile of emergence, crown
length, and lip support could all be adjusted and verified intraorally using this technique. A stone model of the
provisional restorations was sent, along with the final impression, to aid the lab technician in the fabrication of
the final crowns. All-ceramic restorations are designed to provide clinicians with a reliable option for treating
dental defects in areas of esthetic concerns
while maintaining the advantages of
indirect restorations. This case provides
interested clinicians with one technique
by which to begin integrating all-ceramic
restorations into their routine practice.
Student and Faculty Research Abstracts 2013 –2014
Effect of Curing Light on Depth of Cure
Hemanth Kunduru,1 Richard Price,2 Judyth Lee,1* and Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Dalhousie University, Halifax,
Nova Scotia, Canada
Objectives: To evaluate the effect of three different curing lights on the depth of cure of one bulk fill resin
composite.
Methods: One Ivoclar-Vivadent
resin composite Tetric® bulk fill IVA
(TBF) was light cured for 10 seconds
in a 10-mm deep metal mold with a
2-mm radius semi-circular hole. The
top and bottom surfaces were covered
with Mylar strips and pressed flat using
a glass slide, which was then removed.
Three different curing lights were used
for 10 seconds each: Bluephase®G2 (BP),
Demi Plus (DP), and Woodpecker® LED
D (WP). Immediately after light curing,
the specimens were removed from the
molds and the remaining soft composite
scraped away with a plastic spatula. The
length of the remaining hard composite was measured with a digital micrometer. This number was then divided
by two. Ten specimens of composite were made for use with each curing light. An ANOVA and Fisher post-hoc
multiple comparison test was used to compare the effect of the curing lights on the depth of cure.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: The depth of cure ranged from 2.5 mm to 2.6 mm depending on the curing light used.
Depth of Cure
Thickness/2
Curing Light
Depth of Cure (mm)
S.D. (mm)
DP
2.6
0.07
BP
2.5
0.60
WP
2.5
0.10
No significant difference between curing lights (p<0.01)
Conclusions: When tested immediately after light curing, the choice of curing light had no effect on the
depth of cure (p<0.01). In this metal mold, the bulk filling resin composite TBF did not achieve the 4-mm
depth of cure stated by the manufacturer when these lights were used for 10 s.
This study was supported by Ivoclar-Vivadent and by Tufts and Dalhousie Universities. Also presented at the 2014
AADR Annual Session in Charlotte, North Carolina. Abstract #313.
Tufts University School of Dental Medicine
61
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Tufts University School of Dental Medicine Geriatric Patients Oral Quality
of Life
Jennie Leikin,* Matthew Finkelman, Britta Magnuson
Objective: To take a sample of geriatric patients at Tufts University School of Dental Medicine (TUSDM)
to examine geriatric patient’s quality of life (as measured by the Geriatric Oral Health Assessment Index
(GOHAI)) and oral health status (as measured by periodontal status, number of missing teeth, presence of
decay, and presence of restorations).
Methods: IRB approval was obtained
and 35 geriatric patients (aged ≥65) at
TUSDM were consented for participation
in this study. They were each surveyed
using the GOHAI questionnaire,
demographic information was collected,
and periodontal status was recorded.
AxiUm records were reviewed for dental
status information. Descriptive statistics
were reported. The Kruskal-Wallis test was
used to assess the statistical significance of
the association between periodontal status
and GOHAI score. P-values less than 0.05
were considered significant. SPSS Version
19 was used.
Results: The patients surveyed included 19 females and 16 males. They included 33 white subjects, 1
black/African American subject, and 1 Asian subject. Of these, 24 subjects were aged 65–74 years, 9 subjects
were aged 75–84 years, and 2 subjects were aged 85–94 years. Scoring of GOHAI was on a scale of 0–60.
The GOHAI median for this population was 18, with a range of 9 to 34. Five subjects were diagnosed with
clinical periodontal health; 13 subjects were diagnosed with gingivitis; and 17 subjects were diagnosed with
periodontitis. The healthy subjects had a median GOHAI score of 18.00, with an interquartile range of 2.00. The
gingivitis subjects had a median GOHAI score of 16.00, with an interquartile range of 9.00. The periodontitis
subjects had a median GOHAI score of 19.00, with an interquartile range of 8.00. The p-value was 0.163.
Conclusion: This study showed insufficient evidence that periodontal status is associated with the GOHAI
score in geriatric patients at TUSDM. Further analysis of the number of missing teeth, the presence of decay,
and the presence of restorations is necessary to qualify oral health status of geriatric patients and its association
with the GOHAI score at TUSDM.
62
Student and Faculty Research Abstracts 2013 –2014
The Relationship between Learning Modality and Academic Performance
Heather Leung,* Paul Stark, and Yun Saksena
Background: A majority of dental faculty teach in a single mode, the lecture. However the mode by which
students assimilate information varies depending on age, gender, experience, and personality. This study aimed
to explore the possible relationship between the dominant learning sensory modalities of undergraduate dental
students at Tufts University School of Dental Medicine (TUSDM) and their academic performance in the
following three first-year didactic courses: Biochemistry, Gross Anatomy, and Operative Dentistry (practical
component).
Materials and Methods: Student preferences in learning were assessed by a learning preferences
instrument called the VARK (visual, aural, read/write, kinesthetic) survey. Following approval from the
Institutional Review Board, the sixteen-item questionnaire was emailed via Qualtrics to 380 pre-doctoral
students of the 2015 and 2016 classes at TUSDM. An overall 15.3% response rate was obtained. Due to a
relatively small sample size (n=58), the non-parametric Kruskal-Wallis test was used to compare the grades
of three courses (Gross Anatomy, Biochemistry, and Operative Dentistry) across the four sensory modality
groups (V, A, R, K). Pairs of modalities were compared using Mann-Whitney U tests. All statistical analyses were
performed using SPSS Version 21.
Results: Biochemistry grades differed across the learning modalities (p=0.017). The read/write modality had
the highest median (range) GPA, 3.7 (1.0), followed by kinesthetic, 3.3 (1.7), then visual, 3.2 (1.3), and aural, 3.0
(1.7). There was a statistically significant difference between modality groups A and R (p=0.003) and modality
groups R and K (p=0.020). No statistically significant differences were found in Gross Anatomy (p=0.071) or
Operative Dentistry (p=0.495) between the four learning modalities.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: This study found that median grades differed across learning modalities for Biochemistry, but
not Gross Anatomy or Operative Dentistry. This might suggest that different learning styles process information
differently. However, due to our low response rate, more work needs to be done before meaningful conclusions
can be drawn.
Also presented at the 2014 ADEA Annual
Session in San Antonio, Texas.
Tufts University School of Dental Medicine
63
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Penetration Depths of Different Retraction Pastes
Wei Liu,* Masly Harsono, Ronald Perry, and Gerard Kugel
Objective: To measure the depth of gingival penetration for three retraction paste materials.
Methods: In a polystyrene mold (30 mm x 30 mm x 12 mm), Post-It® Index Notes (3M™) were used as
placeholders to create a simulated gingival sulcus 8 mm deep with widths of 0.06 mm, 0.13 mm, and 0.19 mm.
The mold was filled with Permadyne™ (3M ESPE™) automixed polyether impression material (Pentamix™
3M) to simulate the gingiva. After setting, the elastomeric block was removed from the mold and the upper edge
cut at 45°, replaced in the mold, and mass measured. Three retraction pastes were added to the sulci according
to manufacturer’s instructions. Depth measurements were taken. Each material was measured 8 times at each
sulcus width. Statistical analysis was done by one-way ANOVA with post-hoc analysis conducted via Tukey’s
HSD. Significance differences were predetermined at p<0.05.
Results: The average and standard deviation of three retraction pastes with three different sulcus widths were
calculated.
Depth
(mm)
Sulcus Width
Experimental
Product 1
Experimental
Product 2
Experimental
Product 3
0.06
2.291±0.825
3.553±0.853
3.493±0.584
0.13
6.657±1.248
6.055±0.799
6.931±1.162
0.19
7.350±1.017
6.702±0.789
7.685±1.096
Conclusion: At all sulcus width (0.06 mm, 0.13 mm), Experimental Product 1 paste was inserted to
deeper depths than Experimental Product 2 paste. At two narrower sulcus widths (0.06 mm and 0.13 mm),
Experimental Product 1 paste was able to penetrate deeper than Experimental Product 3 paste. Yet at those
sulcus widths, Experimental Product 2 paste did not penetrate significantly deeper than Experimental Product
3 paste. However, at the widest sulcus width (0.19 mm), Experimental Product 2 paste demonstrated better
penetration comparing to Experimental Product 3 paste. In addition, Experimental Product 1 paste is not
significantly better in 0.19 mm sulcus width than Experimental Product 3 paste.
Sponsored in part by DENTSPLY Caulk. Also
presented at the 2014 AADR Annual Session
in Charlotte, North Carolina. Abstract
#1175.
64
Student and Faculty Research Abstracts 2013 –2014
Demographic/Utilization Information for an Oral Health Program in
Rural Zambia
Maryam Mahdavi,* Wanda Wright, Douglas Kim, Alice Ko, Angel Park, and John Morgan
Objective: According to the World Health Organization, limited literature exists on outcomes of dental aid
organizations (DAOs). This study provided demographic and utilization information regarding participants for
a preventive focused oral health project in rural Zambia.
Methods: From 2007 to 2012, oral health personnel screened 2,375 individuals attending an oral health
program based at a rural Zambian health center. Program elements included dental education, prevention
including fluoride application, and
pain relieving extractions. A screening
instrument based on the Association of
State and Territorial Dental Directors was
used. Age, gender, untreated caries (UCs),
and pain were recorded for each visit. Data
were de-identified, entered into an Access
database, and analyzed using SAS (Version
9.2).
Results: Preliminary results indicated
participants ranged in age from 2 to 92
[mean age (SD) = 26.4 (17)] and 62.1%
were female. Of the study population,
41.3% were aged 19 or younger, 54.3% were
between 20 and 59 years, and 4.3% were
over 60 years. At the first recorded visit,
pain was reported by 51.7% of participants
and UCs identified in 64.2%. For those ≤19 years, 22.0% reported pain and 34.3% had UCs. In the 20- to 59year age range, 72.6% reported pain and 84.9% had UCs. For those ≥60 years, 68.9% reported pain and 94.2%
had UCs. Pain was reported by 56.2% of the females and 44.8% of the males respectively (p<0.01).
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: High disease prevalence was reported in the study population. Over half of the participants
were aged 20–59. Prevalence of pain and UCs was highest in the older age groups. Less pain was reported by
men than women, with men underrepresented in the study population. This study demonstrated a method of
program outcomes assessment. Project enhancement strategies include improved recruitment for those under
20, community mobilization to reach those over 60, and outreach activities to achieve more participation
by men.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1078.
Tufts University School of Dental Medicine
65
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Microleakage Evaluation of Restorations Sealed with a CO2 Laser
Alissa Mariano,* Christopher Beninati, Christina Penn, Daniel Dooley, Ronald Perry,
Gerard Kugel, and Masly Harsono
Objective: To evaluate microleakage of restorations
sealed with the 9.3 μm Solea™ Dental Laser System
(Convergent Dental) at 3 outputs.
Methods: Thirty-six non-carious extracted human
molars were prepared with Class V restorations on
the buccal and lingual surfaces. The preparations
were completed in the cervical 1/3 using a Midwest
Tradition L Hand Piece (DENTSPLY) with a #330 bur.
The restorations were approximately 1.5 mm deep and
trapezoid shaped, with flat/straight occlusal and gingival
outlines and axial walls following the tooth contours.
Both buccal and lingual restorations were total etched
and coated with Peak® LC Bond (Ultradent Products)
and filled with FilkTek™ shade A4 (3M ESPE) according
to manufacturers’ instructions. The samples were randomly assigned to three treatment groups:
Sample Group
Sample Size
Solea Laser System Soft Tissue Setting Power Output
Spot Size
Cutting Speeding Pulse Duration µs
Water Setting
Group 1: High Power
12
1.00 mm
100%
20
12
Group 2: Medium Power
12
1.00 mm
100%
15
12
Group 3: Low Power
12
1.00 mm
50%
10
12
The lingual margins were laser-irradiated with a single pass along the margin with the laser 4–7 mm from the
lingual/cervical surface. Restorations were finished and polished using Super-Snap® Finishing and Polishing
(Shofu). Microleakage evaluation was completed after 2,000 thermocycles followed by immersion in 50%
ammoniacal silver nitrate and photo developing solutions. Samples were sectioned longitudinally and silver
dye penetration was observed with a stereo microscope (Olympus SZX 16). Two independent readers recorded
microleakage scores on the cervical margin of both restorations based on a whole number scale from 0 to 4:
Score 0 = 0%
No evidence of dye penetration at the tooth/restoration interface.
Score 1 = 25%
Dye penetration less than half the length of the cervical floor.
Score 2 = 50%
Dye penetration up to the full length of the cervical floor.
Score 3 = 75%
Dye penetration up to half the length of the axial wall.
Score 4 = 100%
Dye penetration greater than half the length of the axial wall.
Analysis was conducted using Wilcoxon Signed Rank test (p<0.05).
Results: Group 1 demonstrated the lowest mean score on the lingual surface. Group 3 demonstrated the
highest mean score on the lingual surface. Group 3 resulted in a statistically higher microleakage score on the
lingual surface.
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Student and Faculty Research Abstracts 2013 –2014
Microleakage Score of Microleakage Score of
Lingual Lased Surface Buccal Control Surface
Group 1
Group 2
Group 3
Mean±Std Dev (n=24) Mean±Std Dev (n=24)
p-value
0.54167±0.64415
0.58333±0.86201
1.29167±1.27407
0.7188
0.66667±0.94281
0.95833±1.05984
0.25000±0.82916
0.2189
0.0015
Conclusions: Varying the power at higher intensity demonstrates lower average microleakage scores and
appears to show marginal sealing; however, the laser may etch or discolor the margin as it seals at high powers.
Other studies are required to determine optimal power outputs.
Sponsored in part by Convergent Dental. Also presented at the 2014 AADR Annual Session in Charlotte, North
Carolina. Abstract #855.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
67
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Student Self-Evaluation vs. Faculty Assessment of Operative
Competencies: An Analysis of Calibration
Lauren Marzouca,* Bradley Belous,* Christopher Paolino, Steven Eisen, Gerard Kugel, and
Matthew Finkelman
Objective: Practicing dentists rely heavily on their ability to self-evaluate their work in order to provide
the highest level of oral health care. Accordingly, a comprehensive goal of dental education is to foster a selfcritiquing mind. Although many academic research studies have examined clinical aptitude, few studies have
examined the effectiveness of student self-evaluation in the preclinical setting. We aim to determine if students
truly comprehend how to objectively assess their own operative dentistry preparations and restorations by
comparing and contrasting calibrated professor scoring and first-year dental student self-evaluation.
Methods and Results: The Tufts
University School of Dental Medicine
(TUSDM) class of 2016 took their regularly
scheduled operative dentistry preclinical
practical examination on April 20, 2013,
and May 2, 2013 (half of the class at a
time). The class was told about the study
prior to the practical examination, IRB
approval was achieved, and the students
were shown an information sheet
describing the study. Upon completion of
the #3 MO amalgam restoration practical
examination, students self-evaluated
their own work. The students left their
self-assessment forms at their simulation
clinic seats, and the forms were collected
after all students left the examination room. Finally, the professors evaluated the amalgam restorations using
normal grading procedures. Two randomized and calibrated instructors collaboratively scored each student’s
practical on a 10-point scale, with the lowest passing score being a 7. The scale also included half-points (e.g.
7.5, 9.5, etc.). All students and faculty used identical grading forms. The student score and the professor score
were linked using only the simulation clinic chair number. The study data were not linked to any identifiable
information.
Conclusion: Based on a #3 amalgam MO restorative operative dentistry practical whereby the entire
TUSDM class of 2016 was asked to volunteer in a self-assessment, it was found that there was a significant
difference between student self-evaluation and professor generated scores. One hundred fifty-eight (n=158)
students chose to participate: roughly 85% of the class. Twenty-three point four percent (23.45%) of students
graded themselves exactly the same as the professors. Of the student grades that differed from the professors’
grades, 53.1% scored themselves higher; the largest percentage of students scored themselves higher by only 0.5
points (21.5%). Of the remaining students’ scores that differed from the professors’ scores, 23.4% of students
graded themselves lower. Of this 23.4%, the majority of students graded themselves lower by only 0.5 points
(14.6%). These data demonstrate that students tended to score themselves higher, rather than lower, by a ratio
of 25:11. A paired samples t-test also revealed that students (M=8.38, SD=0.92) scored themselves higher than
68
Student and Faculty Research Abstracts 2013 –2014
professors (M=8.04, SD=1.06) overall (p<0.001). A Spearman correlation revealed a statistically significant
weak negative correlation of −0.304 (p<0.001), when students’ grades and the absolute difference between
students’ grades and professor grades were compared. Hence, as a student scored himself or herself higher,
the numerical absolute difference between the student grade and the professor grade decreased. Conversely,
as students’ grades decreased, the absolute difference between the two grades became greater. This finding
alludes to the fact that students with lower grades are not as familiar with an ideal preparation or restoration
when compared to the higher-scoring subset of students. Perhaps, then, the lower scoring students’ inability
to perform well during operative dentistry preclinical practical examinations could be attributed to a lack of
calibration, rather than inherently poor hand skills. This lack of calibration could be attributed to low class
attendance, lack of attention during calibration sessions, or disconnect between faculty instruction and student
interpretation. Given the significant findings of this study, it may be appropriate to experiment further with
blind student grading on a larger scale and with a wider scope to retest the hypothesis. Therefore, this study will
be replicated with the TUSDM class of 2017 during the 2013–2014 academic year. Six varied operative dentistry
practicals will be included.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
69
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Shear Bond Strength of Different Dentin and Zirconia Treatments
Kyler McEwen,1* Masly Harsono,1 R. Tuttle,2 and Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Ultradent Products, Inc., South Jordan, Utah
Objective: To compare shear bond strength (SBS) values on dentin with differently treated dentin and
zirconia.
Methods: One hundred sixty-eight 3.5-mm
diameter zirconia buttons were sintered, airabraded, and set aside. Each zirconia button has four
25-micron-high feet to ensure even and uniform
cement thickness. Eighty-four de-identified, noncarious, extracted human molars were sectioned
longitudinally to produce 168 specimens; each were
embedded in acrylic resin and polished with 600-grit
grinder to expose clean, smooth dentin. Specimens
were randomly divided into 7 groups. In groups 1–3,
the zirconia was air-abraded only. In groups 4–7,
zirconia was air-abraded and treated with Peak™ Z
Primer (PZ), bonded, and light cured. Information is
listed in Table 1. Each group was incubated in water
for 24 hours at 40°C. SBS testing was performed on
an Ultra Tester machine (Ultradent™, 91043/KB3) at
a crosshead speed of 1 mm/min. Mode of failure was
observed at the bond-bond interface using a stereo microscope.
A one-way ANOVA was used to test the SBS among the different treatments. Pairwise differences were
determined using post-hoc Fisher LSD tests. Statistical significance was determined at p<0.05.
Table 1:
Zirconia: Air-abraded Only*
Zirconia: Air-abrasion + PZ + PUB†
Zirconia: Air-abrasion + PZ + EVP‡
Group
(n=24/group)
1*
2*
3*
4†
5†
6†
7‡
Etchant
UE
NONE
TE
UE
NONE
TE
TE
Bond
PUB
PSE + PUB
EVP
PUB
PSE + PUB
EVP
EVP
Cement
UC
UC
UC
UC
UC
UC
UC
Ultradent™ Products: 35% UltraEtch™ (UC), Peak™ Universal Bond (PUB), UltraCem™ (UC), Peak Z (PZ)
Ivoclar™ Products: 37% Total Etch™ (TE), ExcITE™F Viva Pen (EVP)
70
Student and Faculty Research Abstracts 2013 –2014
Results:
1*
UE + PUB + UC
Mean Shear Bond Strength
(MPa±SD)
10.21±5.77 b
2*
PSE + PUB + UC
14.08±8.11 a
3*
TE + EVP + UC
8.09±4.36 b
4†
UE + PUB + UC
5.34±2.75 c
5†
PSE + PUB + UC
9.56±4.25 b
6†
TE + EVP + UC
9.39±4.57 b
7‡
TE + EVP + UC
6.70±3.26 c
Group
(n=24/group)
Adhesive System
Conclusions: Shear bond strength of group 2 was statistically higher than all other groups. Therefore, using
PSE and PUB on air-abraded zirconia could increase clinical bond strength of zirconia to dentin. This could
eliminate the need for a zirconia primer. Further testing is needed.
Research sponsored by Ultradent. Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina.
Abstract #1127.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
71
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Characterization and Mapping of Two Novel Zebrafish Mineralized
Tissue Mutants
Sharod McKinney,* Azadeh Zadmehr, and Pamela Yelick
Objectives: Mineralized tissue defects in developmentally staged 152N and 156N zebrafish mutants were
characterized, and DNA was collected from 40 individual 152N/156N mutants and 40 individual wild-type
(WT) sibling zebrafish for next generation mapping. The goal of these studies is to better understand the
growth patterns of mineralized tissue in WT and 152N/156N mutant zebrafish.
Methods: Zebrafish bred and raised from heterozygous 152N and 156N parents were monitored and imaged
for several weeks using bright field and fluorescent microscopy. Mineralized tissue formation was assessed by
vital staining with 2% Calcein solution for one hour at room temperature, followed by a one-hour rinse in
zebrafish system water. Bright field and fluorescent images were then obtained on anesthetized zebrafish using a
Zeiss M2Bio microscope.
Results: At 9 weeks post-fertilization
(wpf), 152N mutants were identified by
eye and exhibited abnormal growth of
all fins, appearing thicker and brittle as
compared to age matched WT siblings.
Calcein staining revealed increased
mineralized tissue formation relative to
WT siblings. The 156N mutants were
examined over a 4-week period from 4 to 8
wpf. Homozygous 156N mutants were not
easily identified by eye, but were found to
exhibit delayed fin ray mineralization and
segmented calcification of fin rays when
stained.
Conclusions: Both 152N and 156N mutations result in abnormal growth of mineralized fin ray tissue in
zebrafish. The 152N mutation results in atypically thick and brittle bone growth in the fins. In contrast, the
156N mutation results in retarded mineralized fin ray growth as compared with age-matched WT siblings. In
addition, 156N mutants exhibited discontinuous mineralized fin ray growth as compared to the continuous fin
ray mineralization pattern observed in WT siblings. We anticipate that further elucidation of the genes mutated
in each mutant will identify novel regulators of bone growth to facilitate bone regeneration and repair.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1568.
72
Student and Faculty Research Abstracts 2013 –2014
Shear Bond Strength Tests of Different Types of Silane Primers after Stress
and Aging
Amanda Merikas* and Liang Chen
Objectives: The study is to investigate the long-term priming efficacy of different types of commercial silane
primers using shear bond strength test methods after stress and aging.
Methods: Five silane-containing primers were used in this study, including Porcelain Primer (Bisco), RelyX
Ceramic Primer (3M ESPE), Monobond Plus (Ivoclar Vivadent), Kerr Silane (Kerr), and Scotchbond Universal
(3M ESPE). Silica-based ceramics (Lithium Disilicate, IPS e. Max) were wet-polished by 320-grit SiC paper and
etched with Porcelain Etchant (4% HF, 25 seconds, Bisco). The silane primer was applied to the etched lithium
disilicate and left undisturbed for 5 minutes. The primed ceramics were cleaned by ultrasonication in ethanol
bath for 2 minutes and dried. A shear bond strength test was done on polished lithium disilicate using a dualcure resin cement (Duolink, Bisco) in light-cure mode (40 sec/500 mW/cm2) using an ultradent jig method
(bonding area 4.5 mm2). The cured specimens were stored in de-ionized water for 6 months at 37°C, thermal
cycled for 1000 cycles, then tested until failure using a universal tester (Instron 4466) at a speed of 1 mm/min.
Results:
Shear Bond Strength on Primed Lithium Disilicate
Primer Types
Control
Silane/No Additive
Silane/Extra Resin
Silane/Acidic Monomer
Silane / Universal Adhesive
Primer Name
No primer
Bisco Porcelain Primer
RelyX Ceramic Primer
Kerr Silane
Monobond Plus
ScotchBond Universal
Shear Bond Strength, MPa (SD), n=16
7.15 (1.97)
25.81 (4.20)
25.34 (5.10)
14.86 (6.61)
17.31 (7.25)
5.58 (3.66)
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: The silane primer with no additives (BISCO Porcelain Primer, RelyX Ceramic Primer)
demonstrated the highest shear bond strengths. The silanes tested with additives (extra resin in Kerr Silane,
Scotchbond Universal, and Monobond Plus with acidic monomer) demonstrated bond strengths that were
significantly lower than the silane primers
with no additives. This data is consistent
with the previous data collected and aged
for only a period of 24 hours. Aged samples
that have been stressed through the use of
a thermal cycler are more representative
of the ability of a primer to withstand
conditions present in the oral cavity.
Tufts University School of Dental Medicine
73
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparing Compressive Strengths of New Self-Adhesive Bulk Fill Material
to Restorative Materials
Courtney Michelson,* Ronald Perry, and Gerard Kugel
Objectives: Amalgams are being phased out of modern-day dentistry; a need for an easy use over bulk fill
material has developed. The following study tests a new product that has potential to meet those objectives.
Evaluate the compressive strength of a new self-adhesive bulk fill material (DO-UC, 3M ESPE) to glass ionomer
(GI), resin-modified glass ionomer (RMGI), and composite materials.
Methods: Materials tested (n=8 per group): Group A, Dyract® (DENTSPLY); Group B, Heliomolar® (Ivoclar
Vivadent); Group C, DO-UC Capsule (3M ESPE); Group D, DO-UC Handmix (3M ESPE); Group E, Fuji II™
LC (GC America); Group F, Vitremer™ (3M ESPE); Group G, Kentac™ N100 (3M ESPE); Group H, Ketac™
Nano (3M ESPE); Group I, Fuji IX™ GP Capsule (GC America); Group J, Fuji IX™ GP Handmix (GC America);
Group K, Chemfil® Rock (DENTSPLY). All samples were made using polyoxymethylene (Delrin®) molds with
3 x 3 x 5 mm for light-cured specimens and 4 x 6 mm for self-cured specimens. Samples were fabricated and
cured according to manufacturers’ instructions. Self-cured specimens were put in 37°C water bath for 1 hr after
preparation. All samples sat in distilled water (37°C/24hrs) to complete cure. A universal Zwick machine loaded
(10kN; crosshead speed 1.0 mm/min) measured compressive strengths until fracture. One-way ANOVA and
Fisher method tests showed a p<0.05.
Results:
Light-Cured (n=8 for each group):
Group
A
B
C
D
E
F
G
H
Mix System
Compule
Compule
Capsule
Handmix
Handmix
Handmix
Clicker
Compule
Type of Material Results Mean±SD (MPa)
Composite
313.9±33.4
Composite
309.5±17.8
New
292.4±23.4
New
26.6±22.0
RMGI
229.0±15.0
RMGI
195.5±14.6
RMGI
195.5±47.3
RMGI
223.4±5.2
Self-Cured (n=8 for each group):
Group
C
D
I
J
K
Mix System
Capsule
Handmix
Capsule
Handmix
Capsule
Type of Material Results Mean±SD (MPa)
New
273.3±12.2
New
272.0±19.4
GI
199.5±37.1
GI
187.0±21.2
GI
191.5±6.4
For light-cured groups, both composites and the DO-UC capsule were significantly higher than the GI and
RMGIs. For self-cured, the DO-UC materials performed significantly higher than the GI materials.
74
Student and Faculty Research Abstracts 2013 –2014
Conclusions: The compressive
strength of the DO-UC was significantly
higher in comparison to the tested GI and
RMGI materials. Values for DO-UC were
comparable to the composites, and there was
no statistically significant difference between
these groups. Further testing is required; this
new material shows potential for use as a selfadhesive bulk fill product.
Research funded in part by a grant from 3M
ESPE. Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina. Abstract
#1149.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
75
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Growth Factors Secreted from Diabetic Foot Ulcer Fibroblasts
Joanne O’Brien,1* Anna Maione,1 Avi Smith,1 Julia Caine,1 A. Veves,2 L. Pradhans,2 D.
Mooney3, and Jonathan Garlick1
1Department
of Oral and Maxillofacial Pathology, Tufts University School of Dental Medicine,
Boston; 2 Beth Israel Deaconess Medical Center, Boston; 3School of Engineering and Applied
Sciences, Harvard University, Cambridge, Massachusetts
Objectives: Altered growth factor-mediated communication between fibroblasts and other cell types in
chronic wounds are linked to a failure to heal. The aim of our study was to characterize growth factor secretion
in 3D tissues harboring chronic wound fibroblasts grown with and without keratinocytes. The long-term
objective of this study is to develop stem cell therapies that can effectively treat non-healing, diabetic foot
ulcers (DFU).
Methods: Biopsies were obtained from
DFUs and site-matched normal skin (NFF).
Fibroblasts were isolated and 3D, skin-like
tissues were generated. Tissues grown with
fibroblasts in collagen gel were compared
to those grown with fibroblasts and
keratinocytes (NHKs). Supernatants were
collected and growth factor secretion was
measured from tissues on a per cell basis.
Results: Both NFF and DFU fibroblasts
increased in number when co-cultured
with NHKs compared to fibroblasts alone.
NFFs were more responsive than DFU in
secretion of HGF and IL-8. DFUs showed
an 8- to 10-fold increase in IL-8 versus a 20-fold increase in NFF. Similarly, HGF showed a 6- to 10-fold increase
in NFF. In contrast, IL-6 did not show a conclusive pattern while KGF secretion was below detection range. In
general, growth factor secretion was increased in tissues harboring NFF when compared to those harboring
NFF fibroblasts.
Conclusion: This study determined that DFU fibroblasts were deficient in secretion of growth factors in 3D
skin like tissues. This helps explain why these cells are repair-deficient. Our next step will be to reprogram these
cells to induced pluripotent stem cells, in the hope that this may improve healing through enhanced growth
factor signaling.
Supported by NIH Grant #RO1 DK98055-06A1 and the TUSDM Dean’s Scholars Program. Also presented at the
2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1088.
76
Student and Faculty Research Abstracts 2013 –2014
Oral Health Quality of Life in Intellectually/Developmental
Disabled Individuals
Khusbu Patel,* Wanda Wright, Matthew Finkelman, and John Morgan
Objective: Little is known about the functional, physical, social and psychological impacts of oral conditions
as perceived by adults with intellectual and developmental disabilities (IDD). The aim of this study was to
develop an instrument to measure oral health related quality of life (OHQOL) in the adults with IDD.
Methods: A 25-item OHQOL instrument designed for adults with ID was developed through a review of
the literature and existing QOL questionnaires. Written informed consent was obtained from the subject/
guardian as appropriate. Two subjects with mild to moderate intellectual disability were asked to complete the
survey. A series of 8 questions was asked of each subject to assess the clarity of the questions and the ability of
the respondent to understand each question. Each subject was then asked to complete the survey again and the
responses to the surveys for each subject were compared.
Results: Based on the field test (pilot)
of the survey questionnaire, two subjects
were able to successfully complete the
survey. One subject recommended minor
alteration of one question that was either
unclear or confusing. The question asked,
“Have you felt that life in general was less
satisfying because of problems with your
teeth or mouth?”
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: The field test of this
survey indicated that this is a potentially
useful instrument for use with IDD adults
to better understand oral quality of life
in this population. Further testing and
development is warranted.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #904.
Tufts University School of Dental Medicine
77
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Thermal Effect Due to Laser and Handpiece Usage on Pulp
Christina Penn,* Christopher Beninati, Alissa Mariano, Daniel Dooley, Ronald Perry,
Gerard Kugel, and Masly Harsono
Objectives: The purpose of this study was to
determine the thermal effect of the Solea™ (SL)
CO2 Laser (Convergent Dental) on the pulp of
extracted human teeth compared to other lasers on
the market and a high-speed handpiece.
Methods: Four groups, each containing 20
extracted non-carious human molars, were
established to collect thermal data: SL (group 1);
Lightwalker® DT (LW-DT) Laser (Fotona) (group
2); Waterlase® MD (W-MD) Laser (Biolase)
(group 3); and Midwest® (MW) High Speed
Handpiece (DENTSPLY) (group 4). Each molar
was digitally radiographed to locate pulp chamber
for thermocouple placement to detect temperature
changes created by the instruments during hard
tissue removal. A hole at CEJ was drilled to create
a space for insertion of the thermocouple; thermal
epoxy was placed into the hole to secure the
thermocouple once it was inserted. Another radiograph was taken to confirm thermocouple placement. Samples
were instrumented for 60 seconds and temperatures were recorded within the pulp chamber of each tooth using
an Apollo IV DT304 Digital Temperature Logger (UEI Test Instruments) over a period of 60 seconds as dental
hard tissue was removed from the occlusal surface of each molar. Four thousand eight hundred temperatures
(20 samples x 60 seconds x 4 groups; 1 temp record per second) were recorded. One-way ANOVA and post hoc
two-sample t-tests were calculated to pairwise analyze among groups (95% confidence level).
Results: The average start, mean maximum and average temperature change for each device was calculated
(Table 1).
Table 1.
Sample Group
Group 1 (SL)
Group 2 (LW-DT)
Group 3 (W-MD)
Group 4 (MW)
Average Start Temp (°C) Mean Maximum Temp (°C)±SD Average Temp Change (°C)
23.14
26.44±1.40
3.30
21.84
25.04±1.51
3.20
21.78
25.34±0.90
3.56
22.59
24.16±1.28
1.57
Conclusion: None of the average temperature changes exceeded 5.5°C for pulpal safety. The thermal effect
of groups 1, 2, and 3 (lasers) demonstrated a relatively higher temperature increase compared to group 4
(handpiece). However, the thermal effect of group 1 is similar to other lasers tested.
Sponsored in part by Convergent Dental. Also presented at the 2014 AADR Annual Session in Charlotte, North
Carolina. Abstract #1416.
78
Student and Faculty Research Abstracts 2013 –2014
Occupational Therapy and Oral Health of Individuals with Developmental/
Acquired Disabilities
Christina Piacquadio,* Wanda Wright, Matthew Finkelman, Angel Park, and John Morgan
Objective: To explore occupational therapists’ knowledge of oral health for persons with disabilities and the
extent to which they implement this knowledge into practice.
Methods: A 35-item questionnaire was modeled on two validated questionnaires of health care providers.
Prior to using the questionnaire, an 18-member review panel comprised of dentists, dental hygienists, and
occupational therapists were asked to complete the survey to ensure face and content validity. The survey
included questions regarding occupational therapy practices as they pertained to the oral health of individuals
with disabilities as well as their attitudes toward and knowledge of oral health. Likert scales were used for
ordinal and count responses.
Results: Preliminary data showed most
respondents (85%) agreed that they can
play a useful role in improving the oral
health of individuals with disabilities.
Over half (67%) did not feel as confident
providing recommendations regarding
oral health as with other forms of personal
health care, and 61% reported limited
information and knowledge specifically
regarding the oral health of individuals
with intellectual and physical disabilities
(IDD). A majority (71%) would like
more information regarding how OT
professionals and dentists can work
together.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: It was found that OTs
believe there is an important role for them in the oral health care of individuals with developmental and
acquired disabilities. Most respondents agreed that there is an opportunity for inter-professional education to
assist the OT and dental professions to improve oral health of individuals with disabilities.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #340.
Tufts University School of Dental Medicine
79
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Microenvironmental Cues Affect Dab2 Expression in Squamous Cell
Carcinoma Development
Shruti Pore,* Elizabeth Bingham, James Baleja, and Addy Alt-Holland
Objectives: Suppression of E-cadherin-mediated cell-cell contact is concomitant with advanced stages of
squamous cell carcinoma (SCC), but the mechanisms that control the incipient stages of this disease are poorly
understood. The adaptor protein Disabled-2 (Dab2) can potentially contribute to SCC development via its role
in regulating the trafficking of surface proteins involved in cell adhesion and migration. Here we examined the
effect of the microenvironmental context on Dab2 expression in SCC tumor cells.
Methods: Bioengineered, three-dimensional (3D) tissues were fabricated by seeding human E-cadherincompetent (II-4) or E-cadherin-suppressed (II-4-Ecad-) skin SCC cells onto fibroblast-populated collagen
scaffolds. Dab2 expression was analyzed by immunohistochemistry and immunofluorescence staining of these
tissues and SCC tumors that developed from them after their transplantation to mice. Dab2 expression in cell
cultures grown on coverslips was determined by immunofluorescence analysis.
Results: In cell cultures, II-4 cells demonstrated intense Dab2 staining in comparison to faint Dab2 staining
of II-4-Ecad- cells. II-4 tissues showed intense epithelial Dab2 staining whereas II-4-Ecad- tissues revealed faint
Dab2 staining at the superficial layers of the epithelium and evident Dab2 staining at the basal and immediate
basal cell layers, specifically in cells that invaded into the underlying matrix. II-4 tumors demonstrated intense
Dab2 staining of well-differentiated sheets of tumor cells. However, high-grade II-4-Ecad- tumors showed faint
Dab2 staining throughout the tumor mass but noticeable Dab2 at the invasive front of the tumors.
Conclusions: Dab2 expression level that is markedly reduced upon E-cadherin suppression can be modified
by microenvironmental cues, depending on the location of the tumor cells and their interactions with adjacent
tumor cells and stromal compartments. Thus, delineating mechanisms that regulate Dab2 levels can reveal
potential therapeutic targets for skin SCC and life-threatening epithelial cancers, such as oral cancer.
A “Tufts Collaborates!” grant awarded to Drs. Alt-Holland and Baleja funded this study. Also presented at the 2014
AADR Annual Session in Charlotte, North Carolina. Abstract #444.
Photo of Jessie Reisig
accompanies abstract on opposite page
80
Student and Faculty Research Abstracts 2013 –2014
Effect of Contouring with Mylar on Composite Shear Bond Strength
Jessie Reisig,* Stephanie John, Steven Eisen, Angel Park, and Gerard Kugel
Objective: Mylar strip placed against composite during curing is used to achieve contour in class IV
restorations. Due to possible changes with composite surface’s oxygen-inhibited layer or surface roughness, the
goal of this pilot study was to test for difference in SBS with or without the Mylar-treatment.
Methods: Composite (Filtek™ Supreme Ultra, 3M) 4 mm width x 7 mm depth samples were made by curing
(Demi, Kerr) for 20 s with a Mylar strip (n=79; Matrix Mylar Strips, Benco Dental) against the superficial
surface or without a Mylar strip (n=97). Additionally the deep sides of samples were cured for 20 s, labeled by
treatment, and further divided into 5 duration groups for distilled water storage: 5 min, 30 min, 1 hr, 24 hrs, or
72 hrs. Adhesive (ExciTE®F, Ivoclar Vivadent) was added, it was cured for 10 s, 4 mm3 composite was added, and
it was cured for an additional 20 s. The samples were tested for SBS at a crosshead speed of 1mm/min (Instron™
5566A, Norwood, Massachusetts). After testing for normality using a Shapiro-Wilk test, an independent samples
t-test was performed to test difference between the means. Data was analyzed using SAS 9.2. A non-parametric
test, Wilcoxon-Mann-Whitney U test was used to test the hypothesis (p<0.05).
Results: SBS values from each group indicated normality (except for the 5 min untreated values). Statistical
analysis failed to reject the null hypothesis for all time points except at 30 min (p=0.002, statistically significant)
where median values were 6.02 MPa (Mylar-treated) and 14.82 MPa (untreated) (Table 1).
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Table 1
Sample
Treatment
Time
None
Mylar
None
Mylar
None
Mylar
None
Mylar
None
Mylar
5 min
5 min
30 min
30 min
1 hr
1 hr
24 hrs
24 hrs
72 hrs
72 hrs
N
Mean Shearbond strength
(MPa)
Standard
Deviation
Median Shearbond strength
(MPa)
ShapiroWilk
p-value
23
15
16
15
18
15
20
15
20
19
9.06
8.11
6.98
15.13
13.72
15.17
9.45
12.06
9.99
10.70
5.77
4.37
4.33
6.27
6.54
7.47
5.54
4.47
5.95
4.72
6.70
7.06
6.02
14.82
14.48
13.97
7.97
11.83
9.78
10.63
0.0200
0.3910
0.0480
0.7628
0.8552
0.3460
0.1360
0.9240
0.4010
0.2060
Wilcoxon-MannWhitney U
p-value
0.8126
0.0020
0.7070
0.1390
0.7270
Conclusion: In all groups but the 30 min time, there were no statistically significant differences between
the presence of and absence of the Mylar treatment, suggesting that Mylar treatment does not affect SBS. Larger
sample sizes and focused time points may help explore the difference at the 30 min time. Larger sample sizes
would provide greater power and statistical support.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #464.
Tufts University School of Dental Medicine
81
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparing Publication Characteristics between Successful and
Unsuccessful Dental Materials
Justin Richer,1* Gerard Kugel,1 Paul Stark,1 and Amy Bauer2
1Tufts
University School of Dental Medicine, Boston; 2New York University, New York, New York
Objective: Failed dental products pose a risk to patients and are costly to manufacturers. Therefore,
benefit exists in being able to predict whether a product will be successful. This study attempted to identify
fundamental differences in publications existing between successful and unsuccessful dental materials.
Methods: Seven dental materials were chosen based upon their clinical performance and defined as either
“unsuccessful” or “successful.” Unsuccessful products have been taken off the market due to failures or lack of
success. Unsuccessful group consisted of ARTglass (Heraeus Kulzer, Germany), Dicor©, Empress II® Bridge
material (ivoclarvivadent) and Fibrekor/Skulpture (smithsterling). The successful group consisted of Empress®
(ivoclarvivadent), Lithium Disilicate, and Zirconia® (BruxZir). Using selective criteria, a literature review
on these materials yielded 24 articles (12 “successful,” 12 “unsuccessful”). A scoring algorithm (Table 1) was
developed and applied to each article to evaluate the strength of each study design. After review, each article’s
data was combined into an Excel file and the scores were totaled. Independent samples t-tests, chi-square, and
Fisher’s exact tests were performed using SPSS to compare continuous and categorical values between the
successful and unsuccessful materials.
Results: Unsuccessful materials yielded a statistically significantly lower mean (SD) total score of 10.51 than
the successful materials (23.29, p<0.001). The study design criterion showed a statistically significant difference
(p=0.014) indicating successful materials were more likely to be clinical studies than unsuccessful (100% vs.
50%). Successful materials were more likely to evaluate inclusion criteria (p<0.001), consider a sample size
calculation (p=0.011), and assess marginal breakdown (p<0.001).
Conclusion: Articles published on
dental products that were ineffective or
unsafe on the open market demonstrated
lower quality than articles published on
comparable materials still in use today.
More work must be done to develop
methodology for using publications as
predictive factors for success or failure of
dental materials.
Also presented at the 2014 AADR Annual
Session in Charlotte, North Carolina.
Abstract #457.
82
Student and Faculty Research Abstracts 2013 –2014
Ergonomic Prevention before Intervention: Early Education for
Musculoskeletal Wellness
Melissa Ing,1 David Frantz III,1* Courtney Robinson,1* Vishavjeet Girn,1 Adam Paggi,2
Sage Yoo,1 Paul Shamirian,1 and Sheeva Ahmadian1
1Tufts
University School of Dental Medicine; 2Northeastern University
Since dental providers are at risk for musculoskeletal injury, it is beneficial to provide ergonomic training and
implementation of daily exercises as early as possible while in the educational setting, starting with the preclinic.
The purpose of this video production is to provide schools with a tool to help promote more productive and
longer careers through musculoskeletal health. Hopefully by administering injury prevention education, the
next generation of dentists will report fewer occupational injuries. Injury prevention education includes three
important areas: proper seated and standing dentistry ergonomics, dynamic movements to perform at key
points throughout the day, and strengthening exercises to augment daily activity. Demonstrating these three
facets of musculoskeletal health in a video is thorough, consistent, and gives students a resource to reference.
The paramount reason for utilizing videography is it can be utilized as part of the curriculum at many dental
schools, thus having a broad, positive effect. The dental ergonomics video provides instruction on both proper
ergonomics, good and bad positioning, and stretching and strengthening exercises to promote musculoskeletal
health while working. Although dentists take courses in anatomy and physiology, it is imperative to ask for
help from experts of that field. The video
utilizes the expertise of a doctor of physical
therapy (DPT) who is versed in the injuries
with which dentists commonly present.
The video shows the DPT instructing
actual dental students in a preclinical and
clinical setting. The DPT demonstrates
proper chair-side ergonomic positioning,
daily warm-up, mid-day and cool down
stretches, and strength exercises to perform
outside of the clinical setting. By addressing
the risk of musculoskeletal disorders in the
preclinic setting and providing students
with skills to maintain musculoskeletal
health, this video production will help
dental educators play a proactive role in the
overall health of the profession.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
83
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Post Discharge Nausea/Vomiting after Ambulatory Anesthesia in
Oral Surgery
Sepideh Sabooree,* Alireza Ashrafi,* Matthew Finkelman, Britta Magnuson,
Maria Papageorge, and Archana Viswanath
Aim/Objective: One of the most
common ambulatory oral surgical
procedures done today is removal of
third molar teeth. However, as with any
other surgeries, there are complications
associated with oral surgeries. Post
discharge nausea and vomiting (PDNV) is
one of the complications commonly seen
in ambulatory surgeries. While the overall
incidence of PDNV after general anesthesia
is well established to be about 25%, data on
the incidence of PDNV after ambulatory
surgery patients are limited and conflicting.
Therefore, this study sought to measure the
incidence of PDNV in patients undergoing
third molar extractions under ambulatory
anesthesia and, if clinically relevant, identify independent risk factors.
Methods: A prospective study was conducted to obtain postoperative data from 25 adults who underwent
third molar surgery under ambulatory anesthesia. The primary endpoint was the incidence of nausea and/or
vomiting after discharge from the clinic until the second postoperative day. Fisher’s exact test was performed to
identify predictors for PDNV: female gender, history of motion sickness, opioid consumption, antibiotic usage,
and smoking status; a p<0.05 was considered significant.
Results: Patient characteristics were: age 24.2±5.18 years, 44% females, 48% non-smokers, 32% current
smokers, 16% former smokers, and 12% had a history of motion sickness. Sixteen patients completed the study.
By 48 hours after discharge, 43.8% experienced nausea, 25% severe nausea. None of the predictors listed above
were found to be significant predictors for PDNV (Table 1).
Table 1
Variables
Sex and nausea
Smoking and nausea
Motion sickness and nausea
Antibiotic usage and nausea
Oxycodone usage and nausea
P-value (2 sided)
0.36
0.37
0.55
1.00
1.00
Conclusions: These preliminary results show the incidence of PDNV after third molar extraction. This is an
ongoing study and the initial data did not show significant predictors.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #1254.
84
Student and Faculty Research Abstracts 2013 –2014
Tumor-Stromal Interactions Alter the Metabolism of Squamous Cell
Carcinoma Cells
Shawheen Saffari,* Ronney Tay, John Nolan, James Baleja, and Addy Alt-Holland
Objective: Loss of E-cadherin-mediated cell-cell contact is critical for the development of aggressive
squamous cell carcinoma (SCC). Whereas alterations in cellular metabolism are associated with cancer
progression, the metabolic profile of E-cadherin-competent or E-cadherin-suppressed SCC cells and its
contribution to tumor-stromal interactions has not been addressed. Here we determined the metabolic profile
of these cells in the presence or absence of human dermal fibroblasts.
Method: Individual cell cultures or co-cultures of 2 x 105 E-cadherin-competent (II-4) or E-cadherinsuppressed (II-4-Ecad-) skin SCC cells and 5 x 104 fibroblasts were grown for 48 hours. 1H NMR was used to
analyze metabolites that were secreted into or consumed from the culture media. Morphological analysis was
performed by bright field microscopy.
Results: II-4 SCC cultures demonstrated well-organized colonies, consumed more glutamine, valine,
phenylalanine, and choline, and secreted more pyruvate than II-4-Ecad- SCC cultures in which random
spread of individual cells was observed.
In co-cultures, streams of fibroblasts
closely surrounded compact II-4 colonies,
whereas fibroblasts stretched in different
directions between individual II-4-Ecadcells. Unexpectedly, a significant decline
in the overall metabolic rate, indicated
by decreased consumption of glucose
and various amino acids, was revealed in
co-cultures of both SCC cell lines with
fibroblasts. II-4 SCC co-cultures showed
greater production of lactate and alanine as
well as increased consumption of choline,
glutamine and leucine compared to II-4Ecad- SCC co-cultures.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: This study provides new insights into tumor-stromal interactions and modulation of cell
behavior via metabolites. The decline in overall energy metabolism in SCC cells-fibroblast co-cultures indicates
the existing of a mechanism that enables fibroblasts to alter the metabolism of SCC cells, possibly by interfering
with the spread of tumor cells. Thus, delineating alterations in the metabolic profile of skin and oral SCC cells
can help identify new biomarkers of cancer progression and the base for developing novel targeted therapies.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #822.
Tufts University School of Dental Medicine
85
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Energy Delivery Based on Restoration Location and Light Curing Unit
Sara Samaha,1* Sapan Bhatt,1 Ronald Perry,1 Richard Price,2 and Howard Strassler3
1Tufts
University School of Dental Medicine, Boston; 2Department of Dental Clinical Sciences,
Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada; 3University of Maryland
School of Dentistry, Baltimore, Maryland
Objective: The clinical setting poses
complications for LCU use, such as location
of a restoration, LCU size and shape, and
size of the patient’s mouth. The purpose
of this study was to examine the difference
in energy delivered by three LCUs to two
simulated restorations, and the difference
in energy received by a restoration based on
location in the mouth.
Methods: Thirty dental students cured
one 1-mm simulated anterior restoration
and one 4-mm simulated posterior
restoration twice using an Optilux 401®
(Kerr Corporation, Orange, California),
VALO® (Ultradent Products, South Jordan,
Utah); and Bluephase G2® (Ivoclar Vivadent, Amherst, New York), for a total of twelve cures per student. LCUs
were stabilized perpendicular to, and 1 mm off of, each restoration for one second then moved directly over
the restoration for the remainder of the cure. Twenty-second cure times were used for all three lights for both
restoration locations. A MARC-PS® (BlueLight Analytics, Halifax, Nova Scotia, Canada) dental mannequin
containing the two simulated restorations collected data on irradiance (mW/cm2) in real time to determine
energy delivered to the restorations.
Results: A mixed model test determined energy delivered to the anterior restoration was significantly
greater than that delivered to the posterior restoration (p=0.0009). The same analysis determined no statistical
significance between energy delivered by the Bluephase G2 and VALO LCUs, although both delivered
significantly more energy to the restorations than the Optilux 401 (p<0.0001). Table 1 shows the energy
delivered by the three LCUs.
Table 1: Difference in energy based on LCU used
LCU
VALO
Bluephase G2
Optilux 401
Average energy delivered
25.713 J/cm2
25.532 J/cm2
17.649 J/cm2
Discussion: Three LCUs delivered statistically different amounts of energy to two simulated restorations and
to the restorations based on location in the mouth. Dental professionals should be aware of these discrepancies
to avoid failure due to under-cured restorations.
Sponsored in part by Ivoclar Vivodent (Amherst, New York). Also presented at the 2014 AADR Annual Session in
Charlotte, North Carolina. Abstract #314.
86
Student and Faculty Research Abstracts 2013 –2014
Anti-VEGF Therapy Inhibits Hypothyroidism Associated with
Infantile Hemangioma
Jacqueline Servais,* Diana Ramirez, Melissa Ramirez, Olin Liang, and Damian Medici
Objective: Hemangiomas are the most common tumors of infancy and form by uncontrolled proliferation
of vascular endothelial cells. Hemangiomas have also been shown to cause hypothyroidism by producing
type III iodothyronine deiodinase (D3), an enzyme that catalyzes the inactivation of thyroid hormones T3
and T4. Hemangiomas form by genetic mutations that induce hyperactive vascular endothelial growth factor
(VEGF) signaling, which stimulates tumor growth, but nothing is known about how D3 enzyme is produced by
hemangiomas. Our goal was to determine whether the constitutive VEGF signaling in hemangioma endothelial
cells (HemECs) promotes D3 expression and whether anti-VEGF therapy will inhibit the hypothyroidism
associated with infantile hemangioma.
Methods: Cultured primary HemECs isolated from surgically resected hemangiomas were exposed to
VEGF neutralizing antibodies or a non-specific IgG control. Their effects on D3 expression were determined
by immunoblotting. Resected proliferating hemangioma tissues were cut into pieces and surgically implanted
under the skin of immunodeficient
mice. The mice were itraperitoneally
injected twice per week with bevicizumab
(pharmaceutical grade VEGF neutralizing
antibodies) or a non-specific IgG control
to determine their effects on tumor growth
and hypothyroidism. Blood samples were
collected once per week for multiplex
quantitative immunoassay analysis of D3,
T3, and T4 levels.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: Our data show that VEGF
neutralizing antibodies inhibit D3
expression in cultured HemECs.
Bevacizumab inhibited hemangioma tumor
growth in vivo and also reduced the levels
of D3 enzyme produced by the tumors.
Furthermore, blood serum levels of D3 were reduced and thyroid hormone levels were increased in mice
injected with bevacizumab.
Conclusion: Our results suggest that inhibition of the constitutive VEGF signaling with a drug such as
bevacizumab should be sufficient to inhibit hypothyroidism in patients with infantile hemangiomas.
Tufts University School of Dental Medicine
87
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparison of Flipped and Standard Classrooms in a Dental
School Setting
Laura Shim,* Paul Stark, and Yun Saksena
As there are many different styles of teaching and learning, it is sometimes
difficult to know if students are more receptive to one method over another. The
purpose of this study was to compare student performance and overall student
experience between a flipped and a standard classroom setting in a pre-clinical
course at Tufts University School of Dental Medicine (TUSDM). In standard
classrooms, students usually attend a lecture in order to become introduced to
a topic. After class, students are responsible for reviewing the material that was
covered by studying the lecture slides, their notes, and reading the associated text.
In a flipped classroom, students watch a video-captured lecture before class and
spend class time in a more interactive and engaging fashion where students delve
more deeply into the material. This study was conducted in the second year dental
students’ Removable Partial Dentures course at TUSDM. Four flipped classroom
sessions were preceded by available lecture slides and lecture video for students to
watch online before class. Actual class time mainly consisted of students applying
their knowledge by discussing case studies in small groups. The other nine
classroom sessions were taught in a standard classroom setting. These standard
classes were lecture-based, with some interactive elements (i.e., group discussions, clicker questions, etc.). Some
designated material was covered only in the flipped classroom and other designated material was covered only
in the standard classroom to facilitate the comparison of the two teaching methods. Student performance was
assessed by both midterm and final examinations. On each exam, the questions used for this study were preselected with the criteria that the material was covered in either a flipped or standard classroom, but not both.
Comparison of the percentages of correct answers in the two categories of questions was used to determine if
students learned better from one teaching method over the other. The exact test for two proportions was used
for the comparisons. In addition, online surveys were given to students at the end of the course. The responses
to the surveys were used to assess student attitudes and overall student experience towards flipped classrooms.
This study was approved by the Tufts Medical Center/Tufts University Health Sciences Institutional Review
Board. In the midterm exam, 84.25% of students answered the flipped classroom questions correctly. The
percentage was lower at 82.41% for the standard classroom questions. The p-value of the midterm exam was
0.0444. In the final exam, 83.56% of students answered the flipped classroom questions correctly. Again, a lower
percentage of 82.13% answered the standard classroom questions correctly. The p-value for the final exam
was 0.0701. Overall, 83.90% of students answered flipped classroom questions correctly while 82.27% of the
standard classroom questions were answered correctly. The p-value for the combined midterm and the final was
0.0045. The p-value of 0.0045 suggests that the difference in the percentage of correct answers of the flipped and
standard classrooms was statistically significant. This evidence indicates that students had better performance
in flipped classrooms as compared with standard classrooms. In the surveys, students thought that flipped
classrooms were a good idea in theory. However, the majority did not consistently listen to the lectures before
the flipped classroom sessions and agreed that the concept of flipped classrooms was not practical or useful with
their busy dental school schedules. The discrepancy between student performance and overall attitude towards
flipped classrooms should be an area of further study.
Also presented at the 2014 ADEA Annual Session in San Antonio, Texas.
88
Student and Faculty Research Abstracts 2013 –2014
Fluoride Ion Penetration on Ionic Resin Materials
Leslie Slowikowski,* Stephanie John, Matthew Finkelman, Ronald Perry, Masly Harsono,
and Gerard Kugel
Objective: To observe the release and recharge of fluoride ions from
a new therapeutic bioactive material using fluoride ion concentration
gradient diffusion methodology.
Methods: Three groups (n=10 each group) were tested: Group 1,
ACTIVA BioActive Restorative (Pulpdent); Group 2, Ketac™ Nano
Lightcuring Glass Ionomer (RMGI) (3M ESPE); Group 3, GC Fuji
Triage® (GI) (GC America). Sample tabs were created according to
manufacturers’ specifications for each group using a Teflon® mold
(13 mm diameter by 2 mm depth). Tabs were placed as filters within a
Swinnex® syringe filter holder. The upper chamber was filled with 0.5 mL
of a 5% NaF solution, and the lower was filled with 0.5 mL of de-ionized
water. The upper chamber was recharged and the lower chamber was
refreshed daily. Fluoride ion release was measured after each recharge
using a fluoride ion electrode after 1, 2, 24, and 72 hours and 1, 2, and 3 weeks.
Results: Values for the median and interquartile range were tabulated. Kruskal-Wallis test using the
Bonferroni correction (p-value approximately 0.007) found statistical significance at 3 time points: 24 hours, 1
week, and 3 weeks with p-values 0.001, 0.002, and <0.001 respectively. Further analysis using the Mann-Whitney
U for significant comparison with the Bonferroni correction (p-value=0.017) determined that statistical
difference at 24 hours between groups 1 and 3 (p-value<0.001) and groups 2 and 3 (p-value=0.015) but not
between groups 1 and 2. At 1 week, there was statistical difference between groups 1 and 3 (p-value=0.001) and
at 3 weeks between groups 1 and 3 (p-value=0.001) and groups 2 and 3 (p-value<0.001).
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Median fluoride release:
Group 1
Group 2
Group 3
1 hr
ppm
2 hrs
ppm
24 hrs
ppm
72 hrs
ppm
1 wk
ppm
2 wks
ppm
3 wks
ppm
Median
799.00
883.00
842.50
910.50
1004.00
902.00
842.00
Interquartile range
118.50
162.75
191.75
181.86
417.00
330.00
554.75
Median
744.50
809.50
723.50
802.00
776.50
689.00
652.50
Interquartile range
110.25
213.00
264.25
337.25
499.50
436.75
456.50
Median
715.50
562.50
462.00
643.50
546.00
663.00
68.45
Interquartile range
173.75
423.00
310.50
614.75
431.25
436.25
168.40
Conclusions: At the seven time points tested, the new therapeutic bioactive material has statistically greater
fluoride release after recharge at 24 hours, 1 week, and 3 weeks compared to the other groups tested.
This study was supported in part by Pulpdent. Also presented at the 2014 AADR Annual Session in Charlotte, North
Carolina. Abstract #268.
Tufts University School of Dental Medicine
89
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Polyvinyl-Siloxane Impression Materials Performance in a Tensile
Strength Test
Jesse Small,* Elena Ciciolla, Ronald Perry, and
Masly Harsono
Objectives: To compare the tear strengths of eight polyvinylsiloxane impression materials under tensile force, mimicking the
clinical settings of a final impression.
Method: A total of 8 groups (n=20) of impression material
were tested using the Boghosian and Lautenschlager Methodology.
Stainless steel molds of 101.6 mm long x 19.05 mm wide x 2.7 mm
thick were used to produce specimens with a V-notch in the center,
measuring either 0.30 mm or 0.50 mm (n=10 each thickness).
The impression material was injected into the mold and placed in
a water bath with a temperature of 35±1°C at T=20 seconds. Materials were set according to manufacturer’s
specified set time. The samples were placed into the Instron® machine (model 5582) and tested at T=90 seconds
after removal from the water bath. Tensile force was applied at a cross-head speed of 500 mm/min. Average
tensile strength was recorded for each of the molds. Statistical analysis was conducted using One-way ANOVA
with a post hoc Tukey HSD for pairwise analysis among groups. P-value<0.05.
Results:
Group
1
2
3
4
5
6
7
8
Material
AquasilTM Monophase
(DENTSPLY Caulk)
Tissue Management Impression
Material (DENTSPLY Caulk)
TMIM Tray (DENTSPLY Caulk)
AquasilTM XLV
Sultan Genie® (DENTSPLY)
3M ImprintTM 4 Ultralight (3M
ESPE)
Flexitime® (Heraeus)
Take 1® Advanced (Kerr)
Average Tensile Strength
Force, MPa±SD
Mold 338 (0.50 mm)
Average Tensile Strength
Force, MPa±SD
Mold 348 (0.30 mm)
541.42±34.52A
520.4±45.98D
540.03±83.59A
514.6±57.57D
527.97±74.03A
426.54±51.4B
369.19±46.52B
532.04±60.2D
388.38±51.4E
342.03±37.89E
273.81±19.58C
220.92±36.96F
257.96±32.98C
257.31±31.41C
248.24±21.05F
229.35±42.28F
Means that are statistically the same are represented by the same superscript letters (A, B, or C for 0.50 mm thickness and D, E, F for 0.30
mm thickness).
Conclusion: For both mold thickness, groups 1, 2, and 3 had statistically significant higher tensile strength
values when compared to the other groups. The specified notch thicknesses of 0.50 mm and 0.30 mm estimate
the sulcus width around the margin of a preparation and thus indicate that these materials may perform better
in a clinical setting.
Sponsored in part by DENTSPLY Caulk. Also presented at the 2014 AADR Annual Session in Charlotte, North
Carolina. Abstract #283.
90
Student and Faculty Research Abstracts 2013 –2014
Epigenetically Modified BMSCs in Regenerating Dental and Craniofacial
Bone Tissues
Qianqian Han, Kyle Smith,* Yuwei Wu, Qisheng Tu, and Jake Chen
Objective: Epigenetic regulation of gene expression is a central mechanism that governs cell stemness,
determination, commitment, and differentiation. It has been recently found that PHF8, a major H4K20/H3K9
demethylase, plays a critical role in craniofacial and bone development. As a nuclear matrix protein, special
AT-rich sequence-binding protein 2 (SATB2) is expressed in branchial arches and in cells of the osteoblast
lineage, therefore it is required for bone development and formation. However, our previous understanding of
the modulation of SATB2 impedes our further insight into this important osteogenic transcription factor. In
this study, we hypothesize that PHF8 promotes osteoblastogenesis by epigenetically regulating the expression of
master gene SATB2.
Methods: Our design consisted of treating preosteoblasts (MC3T3-E1) and bone marrow stromal cells
(BMSCs) with an osteogenic medium. Once treated, we performed real time PCR, Western blot, gain and loss
functions, and chromatin immunoprecipitation (ChIP) assays.
Results: Our results showed that
expression levels of PHF8 and SATB2
in MC3T3-E1 and BMSCs increased
simultaneously during osteogenic
induction. Overexpressing PHF8 in BMSCs
and MC3T3-E1 cells with wild type PHF8
upregulated the expression of SATB2,
Runx2 and osterix, and bone matrix
proteins. Conversely, knockdown of PHF8
reduced the expression of SATB2 and
other bone marker genes. Furthermore,
using ChIP assays, we found that PHF8
specifically bound to the transcription start
site (TSS) of the SATB2 promoter.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: Taken together, our results
suggest, for the first time, that PHF8 enhances osteogenic differentiation via modulating histone methylation
states of the master gene SATB2 and subsequently converting its chromatin into a transcriptionally active
conformation. We expect that epigenetic regulation of BMSCs during osteogenic differentiation will promote
SATB2-dependent activation and facilitate bone regeneration in tissue engineering.
Tufts University School of Dental Medicine
91
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Delineating Regulatory Mechanisms of Nasopharyngeal Carcinoma
Development by Comparative Metabolomics
Ronney Tay,* Shawheen Saffari, Samuel Kamlarz, Leah Leahy, Pamela Smith, James Baleja,
and Addy Alt-Holland
Objective: Among epithelial tumors of the head and neck, nasopharyngeal carcinoma (NPC) is associated
with the highest rate of metastasis, a catastrophic development with a median survival of less than one year.
Thus, there is an unmet medical need for development of new therapeutics that relies on understanding the
regulatory mechanisms of NPC cell behavior that drive metastasis. As altered metabolism is associated with
cancer progression, we determined the metabolic profiles of human NPC cell lines and bona fide tumor spheres.
Methods: 1H NMR was used to analyze
metabolites that were secreted into or
consumed from the media of cultures of
human NPC C666-1 cell line, metastatic
C666-1 sub-line, cisplatin-treated C6661 cells, and NPC tumor spheres isolated
from a mediastinal lymph node metastasis.
Additionally, 8 months following
subcutaneous injection of these spheres
to mice, animals were sacrificed and
examined for cancer development. Cultures
were routinely imaged by bright field
microscopy.
Results: Elevated arginine, glutamate,
and lactate levels and decreased pyruvate,
glutamine, and glucose levels were detected in media samples from the cell lines in comparison to those of the
spheres. Conversely, elevated alanine and glutamine levels were detected in media samples of sphere cultures.
Importantly, the tumor spheres maintained their metastatic potential in vivo. Following their subcutaneous
injection to mice, sphere-like structures were found in microscopic examination of the lung tissue, a common
site of metastasis of this cancer. These structures, likely representing NPC metastases, continued to develop in
dissected lung tissues in vitro.
Conclusions: Using comparative metabolomics, this study revealed distinct metabolic profiles of NPC
cell lines and tumor spheres that may correlate with the culture growth state and metastatic capabilities. These
data provide new insights into potential metabolites and corresponding biochemical pathways that can serve as
biomarkers for NPC progression or as targets for novel mechanism-based intervention strategies.
Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina. Abstract #821.
92
Student and Faculty Research Abstracts 2013 –2014
Influence of Air/Vinylpolysiloxane on Residual
Layers of Temporization Materials
Michelle Tsao,1* Ronald Perry,1 B. Hofmann,2 and J. Farr2
1Tufts
University School of Dental Medicine, Boston; 23M ESPE,
Seefeld, Germany
Objectives: To compare the thickness of residual layers created
by temporization crown and bridge materials against air and two
experimental vinylpolysiloxane (VPS) materials via PentaTM or
GarantTM delivery systems. Less residual layer may translate to a product
with better handling characteristics and more aesthetic provisionals.
Methods: Seven temporary materials were selected to test the thickness of residual layers against air and
VPS impression materials dispensed with either a PentamixTM3 (3M-ESPE) or GarantTM Dispenser. Temporary
materials tested were: Integrity® Fluorescence-IN (DENTSPLY), LuxatempStar-LU (DMG), Protemp™4-PR
(3M-ESPE), Visalys Temp-VI (Kettenbach), PreVISION®-PV (Heraeus), Structur 3-VO (VOCO), and Structur
Premium-ST (VOCO). Six samples per group (N=6) of impression material tiles 3 cm x 3 cm x 3 mm were
created. Each temporary material was dispensed according to manufacturers’ directions into Delrin-rings (d=20
mm; h=3.5 mm) and mounted on either impression tiles or glass slides (for air). Samples were removed from
tiles, slides, and ring after setting 15 minutes at room temperature. Samples were weighed, first with the residual
layer and again after removing residual layer with isopropranol. For VPS materials, impression tiles were also
weighed before and after removing residual layers. Weight differences were calculated.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: Data was analyzed using one-way ANOVA with Fischer test, achieving 95% confidence interval.
Summary of results, mean values, and standard deviations calculated. Means in each column with same letters
(A–E) are statistically the same.
Material
Air (mg/cm²)
Exp. Mat. w/ Pentamix™ (mg/cm²)
Exp. Mat. Garant™ (mg/cm²)
IN
2.66[±0.28]E
1.80[±0.21]D
1.19[±0.45]E
LU
4.00[±0.19]D
2.33[±0.32]C
1.77[±0.34]D
PR
2.59[±0.16]E
1.49[±0.20]D
1.28[±0.14]D,E
VI
4.34[±0.32]C
3.52[±0.59]B
2.69[±0.44]C
PV
4.96[±0.18]B
5.33[±0.53]A
5.02[±0.79*]A
VO
4.32[±0.26]C
3.29[±0.45]B
2.44[±0.32]C
ST
6.18[±0.27]A
4.99[±0.57]A
3.82[±0.20]B
*PreVISION VPS-Garant samples tested twice due to a high standard deviation, but yielded same results. Second group results used for
statistical analyses.
Conclusion: Across all seven provisional materials, thicknesses of residual layers were lowest against PVSGarant, then VPS-Pentamix, and highest against air. PreVISION had thickest residual layer on VPS materials.
StructurPremium had thickest residual layer against air and with VPS-Pentamix. Protemp and Integrity
produced the least amount of residual layer at all conditions.
Sponsored by 3M ESPE. Also presented at the 2014 AADR Annual Session in Charlotte, North Carolina.
Abstract #279
Tufts University School of Dental Medicine
93
Bates-Andrews Day Abstracts
94
Predoctoral Student Presentations
The Impact of Training Pre-School Teachers as Ambassadors of the Give
Kids a Smile Program to Improve Children’s Oral Health Disparities
Michelle Webb,* Zuzana Mendez, Arlene Pimentel, Sheina Jean-Marie, Ana Tonet-Wescott,
Elimin Tejada, Andrea Lugo, and Aidee Nieto-Herman
This descriptive analysis research examines the importance of the incorporation of pre-school teachers as
ambassadors of the program Give Kids a Smile (GKAS). It was done in partnership with the Massachusetts
Hispanic Dental Association (MHDA) and Tufts Student Hispanic Dental Association (TSHDA). This study
examines current children oral health disparities and assesses the level of parents’ and pre-school teachers’
dental knowledge following their training sessions in oral health and evaluates if the parents have an established
dental home for their pre-school children. The GKAS program is well described as a successful U.S. oral
health program that was created in 2002. A survey was conducted of parents and pre-school teachers at the
Neighborhood Involvement of Children
Education (NICE) pre-school to
determine their familiarity with oral
health. A total of 41 parents and 10
pre-school teachers participated. The
majority of the surveyed parents, 39/41
(90%) responded, and 100% considered
it important that their children receive
oral health care instructions from their
pre-school teachers. The majority of
the surveyed parents (72%) expressed
that a dental home existed and after
training, the number of dental homes
increased to 78%. However, in regards
to 10 teachers’ and parents’ oral health
knowledge, the majority of them have
correct basic oral health knowledge but
some discrepancies exist. The ambassador program can help to eliminate this gap, while reinforcing correct oral
health information. The findings of this study indicate that there is great value in utilizing pre-school teachers
as oral health care ambassadors of the GKAS program. Furthermore, the GKAS program offers students and
volunteer dentists from MHDA the opportunity to partner with the community and to be a constructive part of
the solution to reduce children oral health disparities.
Student and Faculty Research Abstracts 2013 –2014
Association between Sleepiness and Stress and Simulated
Clinical Performance
Esther Yun
Purpose: The goal of this project was to assess whether there is an association between students’ sleepiness
and stress and their performance in a simulated clinical setting.
Method: The study was a cross-sectional study conducted at Tufts University School of Dental Medicine
(TUSDM) using students in their third year. Students were asked to keep a sleep diary starting one week before
their practice licensure competency exam. On the day of the exam, the participants were given two short
questionnaires: the Epworth Sleepiness Scale (ESS) and the Perceived Stress Scale (PSS). After the grades from
the clinical competency exam were obtained, correlations and t-tests were used for evaluations. All statistical
analysis was conducted using IBM SPSS Version 19.
Findings: In total, 68 students volunteered to participate in the study, but only 22 students completed the
study. No significant associations were found between total grade and gender (p=0.929), average hours of sleep
(p=0.533), ESS score (p=0.218), or PSS score (p=0.301). However, the negative correlation between grade and
age was found to be significant (r = −0.43, p=0.048). In addition, there was a significant positive correlation
between grade and the average time students took to fall asleep (r=0.53, p=0.011), how refreshed students
felt in the morning (r=0.46, p=0.032), and the amount of exercise that students had during the week (r=0.42,
p=0.049). When isolating data from only the night before the exam, the only significant correlation found from
the isolated data was between total grade and the time it took the students to fall asleep (r=0.58, p=0.006).
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: These findings from the
ESS and PSS questionnaires suggest that
there is no association between sleepiness
and stress and performance in a clinical
setting. However, it was interesting to
note that as age increased in the students,
the grades significantly decreased. This
study had many limitations in terms of
sample size and grading structure, but
was important in acknowledging that
sleepiness and stress could impact clinical
performance. Future studies on the effects
of sleepiness and stress and the effects of
possible interventional studies for stress
reduction are required to understand
how to better improve dental students’
educational environment.
Tufts University School of Dental Medicine
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Bates-Andrews Day Abstracts
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Postdoctoral Student Presentations
PostDOCTORAL STUDENT PRESENTATIONS
Long-Term Success Rates of Ketac and Photec in the Posterior Dentition
C. Marissa Alikpala* and Jennifer Logigian*
When working with medically complex and special needs patients, in many cases a dentist may have to forgo
the more “ideal” restorations due to low patient cooperation. This includes the use of amalgam or composite
in conjunction with a rubber dam. As a result, it is necessary to utilize quicker-setting materials or those that
are less sensitive to moisture contamination. Two such materials that are being used with increased frequency
are Photec and Ketac Molar. Photec is a light cured, radiopaque, fluoride-releasing resin glass ionomer. It is
self-adhesive as well as biocompatible. It comes in 8 esthetic shades. With its user-friendly properties, it is
ideal for those who are unable to undergo
the ideal restoration. Ketac Molar is a
chemically cured radiopaque restorative
glass ionomer material that, like Photec,
comes in 8 shades for improved aesthetics.
It has a high fluoride release as well as
an expansion coefficient similar to tooth
structure. It has a number of clinical
applications, including primary teeth
fillings, single surface (non-occlusal) areas,
cervical fillings in the posterior dentition
and as a core build-up material. Because
it does not need to be light cured, it is also
useful in challenging clinical situations
such as when working with patients with
behavioral issues or when the provider has
limited working time. Because these materials can be considered a definitive restoration in these latter cases, it
is important to determine their wear resistance, particularly in the posterior dentition. The aim of this study
is to better understand the long-term success of Ketac and Photec as a permanent restoration in the posterior
dentition.
Student and Faculty Research Abstracts 2013 –2014
Case Report: Management of Obstructive Sleep Apnea and Insomnia in a
Patient with Complete and Partial Removable Dentures
Ola Alshuhail* and Leopoldo Correa
Introduction: The American Academy of Sleep Medicine (AASM) last update of its guidelines indicated
that oral appliance therapy is for individuals with primary snoring and upper airway resistance syndrome,
mild to moderate obstructive sleep apnea (OSA) preferring oral appliance (OA) therapy to continuous positive
airway pressure (CPAP), and severe OSA refusing CPAP.
Objectives and Importance: We assessed the feasibility of managing OSA with an oral appliance for
an edentulous patient. Patient compliance with CPAP is challenging and OA therapy could improve patient
adherence and quality of life.
Clinical Presentation: A 56-yearold American male with a medical
history of moderate OSA and insomnia
was referred to our center from a sleep
physician for OA therapy. He reported
intolerance to using CPAP with different
types of masks and nasal pads. Upon the
clinical examination, the patient was fully
edentulous in the maxilla and had three
healthy abutment teeth in the mandible.
He wore an upper complete denture and a
lower partial denture during day and night.
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Intervention and Technique:
We used a custom-made adjustable OA
(semi-edentulous design) for over both
dentures. In the last follow up visit, there was a significant improvement of OSA indexes. The apnea-hypopnea
index (AHI) decreased from 11.8/hour to 6.8/hour and the nadir oxygen saturation increased from 83% to 92%.
The rapid eye movement (REM) stage of sleep drastically improved from 15.7% to 26.6% and the respiratory
disturbance index (RDI) decreased from 40/hour to 15.8/hour at REM stage.
Conclusion: In this case, OA therapy was an effective alternative to a tongue retainer device for a complete
and partial edentulous patient refusing the use of CPAP and not able to tolerate the tongue retainer device.
Further studies with larger sample sizes using different oral appliances are required in this field.
Tufts University School of Dental Medicine
97
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
The Evaluation of a Non-Invasive Respiratory Volume Monitor in Patients
Undergoing Dental Extractions during Moderate Sedation
Alireza Ashrafi,* Sepideh Sabooree, Maria Papageorge, Morton Rosenberg,
Roman Schumann, and Archana Viswanath
Purpose: This study examines the clinical utility of the ExSpiron Respiratory Volume Monitor (RVM,
ExSpiron™, Respiratory Motion, Inc., Waltham, Massachusetts) in oral surgery patients during moderate
sedation. Previous work demonstrated the ability of this novel technology to provide non-invasive, realtime, continuous measurements of respiratory parameters including tidal volume (TV), minute ventilation
(MV), and respiratory rate (RR) in spontaneously breathing patients. Current respiratory monitoring in nonintubated oral surgery patients relies mostly on oximetry, capnography, and subjective clinical assessment. We
studied the changes in ventilator rates and volumes during moderate sedation with this device.
Method: Following IRB approval and written informed consent, subjects were enrolled in this prospective,
observational study. TV and vital capacity were measured with a hand-held spirometer for baseline comparison
to the RVM that uses an impedance-based technology and proprietary algorithms to obtain respiratory
values. MV, TV, and RR measurements were collected from the RVM ExSpiron™ prior and during moderate
sedation until discharge. Sedations were carried out using Midazolam, Fentanyl, and Diazepam. Age, sex, BMI,
and sedatives (timing, type, and dose)
along with vital signs were recorded and
correlated with the device data. For each
subject we determined an MV change to a
threshold value of 80% from their baseline
(10 minutes prior to sedation) at 2 time
points; Sedation start and 10 minutes post
drug administration. Paired t-test and
ANOVA were utilized for comparison of
the groups and dependent variable.
Results: Of the total, 32 subjects (14
male, 18 female) completed the study for
this analysis. For all patients, MV decreased
to below 80% from baseline immediately
after drug administration. At 10 minutes
following initial drug administration,
MV of 14 subjects remained below 80% of baseline and the other 18 had recovered to above this limit. The
demographics and sedation variables between these two groups were not independently significantly different;
all p-values were >0.05.
Conclusions: Our study demonstrated an early decline of MV to below 80% of baseline immediately
following sedative administration. Of the total, 18 out of 32 patients recovered to above this threshold within
10 minutes. It is not clear from these preliminary data which factors influence this outcome. Further study is
needed to determine how this new technology could improve monitoring and patient safety outcomes in this
setting.
98
Student and Faculty Research Abstracts 2013 –2014
Survey about the Use of Ambulatory Oral and Maxillofacial Surgery Safety
Checklists among Oral Surgeons in AAOMS Database
Andras Balint,* Archana Viswanath, Morton Rosenberg, William Gilmore, and
Maria Papageorge
Objective: The overall objective of this study is to determine the attitudes and prevalence of the usage of an
ambulatory oral and maxillofacial surgery safety checklist among oral surgeons.
Background: Patient safety has emerged as an important topic in recent years. Improving surgical safety
has become a high priority in order to reduce adverse events in patients. In 2008 the WHO World Alliance
for Patient Safety developed a “Surgical Safety Checklist” and published data on the efficacy of it. The
implementation manual, published in
parallel with the WHO Surgical Safety
Checklist, suggests that the checklist should
be adapted to fit in with local practice. The
checklist is a powerful and inexpensive tool
that will facilitate effective communication
and teamwork.
Methods: Recruitment for the survey
consisted of emailing 500 oral surgeons
with a valid email address published
in the American Association of Oral
and Maxillofacial Surgeons (AAOMS)
directory. Since the response rate was less
than 50%, another email was sent to 500
oral surgeons. Up to 1,000 surgeons were
contacted. There was no bias in subject
selection since the email addresses were randomly selected by a person not involved in the study. Qualtrics
(Tufts University survey tool) was used to facilitate the distribution and completion of surveys.
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Results: A total of 110 oral surgeons responded to the survey. Of the responders, 94% were male, 82% were in
private practice, and among them only 37% reported using a checklist in their practice. Of the participants, 60%
(n=66) reported that they were not using a surgical safety checklist for ambulatory surgery; 93% reported that
if provided they would consider implementing a surgical safety checklist in their practice. Of the oral surgeons,
26% reported that they were not using a safety checklist although they reported that they were performing more
than 30 procedures a week. Although not statistically significant, the majority of the oral surgeons who had
completed OMFS training for longer than 20 years reported not using a checklist in their practice.
Conclusion: According to our survey, the majority of practicing oral and maxillofacial surgeons do not
currently use surgical safety checklists. Although the response rate was 11%, the survey does reflect a clear lack
of use of checklists amongs practicing oral and maxillofacial surgeons despite the widespread acceptance in the
medical community.
Tufts University School of Dental Medicine
99
Bates-Andrews Day Abstracts
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Postdoctoral Student Presentations
Special Considerations for the Dental Management of Patients with
Osteogenesis Imperfecta
Ranju Bhasin* and Brianne McGuinness*
Osteogenesis Imperfecta
(OI) is a genetic disorder
characterized by bones
that break easily, often
from little or no apparent
cause. There are special
considerations that are
necessary when caring
for the health of patients
diagnosed with OI,
including oral health. Due
to altered composition of
bone, along with dental
anomalies, management
of dental needs in patients
with OI may follow an
alternative approach.
Student and Faculty Research Abstracts 2013 –2014
Accuracy of Periodontal Probing Depth and Calculus Detection through
the Use of Kinoshita Nissin Periodontal Dental Model
Daniel Coleman,* Paul Levi Jr., and Matthew Finkelman
Dental education is a continually evolving process. This study seeks to develop evidence-based practices for the
instruction of dental students to properly probe periodontal pockets and detect dental calculus.
The purpose of this study will be to evaluate the effectiveness of the Kinoshita dental model (KDM) as a preclinical training tool for pre-doctoral education in periodontal probing and calculus detection.
Prior to this study, students at Tufts University (TUSDM) were trained primarily through lecture in techniques
for periodontal pocket probing and calculus detection. The KDM has been specifically designed by the authors
of this study to facilitate hands-on instruction of probing depth measurement and calculus detection.
Study participants were second-year TUSDM students. Participants were given a hands-on lecture and
workshop on proper techniques for periodontal probing and calculus detection using one of three KDM
models. Three workshops were given. In
each workshop, participants received a
KDM with different simulated gingiva. The
three preclinical groups were translucent
gingiva, opaque gingiva, and both
translucent and opaque gingiva. At the end
of each workshop students were tested on
opaque models to determine their accuracy
in both periodontal probing and calculus
detection.
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Data from the pre-clinical study showed
no significant difference in mean absolute
difference between groups for accuracy in
probing depth measurement. This indicates
that both translucent and opaque model
types are equally effective as teaching aids.
When determining differences in calculus detection, it was found that there was a significant difference (p<0.05)
in the number of correctly identified surfaces with calculus between the opaque group and the group trained
with both translucent and opaque models. Those trained with opaque models alone were able to correctly
identify calculus more accurately than those trained using both model types. Results of this study bring insight
into the effectiveness of each KDM as a teaching tool for periodontal probing and calculus detection.
Tufts University School of Dental Medicine
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Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Assessing the Level of Evidence in Post-Graduate Experience at TUSDM
Irina Dragan,* Taylor Newman,* Nadeem Karimbux, and Paul Stark
Aim: The aim of this project was to assess the format used in the literature review classes offered in the postgraduate (PG) programs at Tufts University School of Dental Medicine (TUSDM). A secondary aim was to
evaluate the differences in how the course format and objectives are perceived by the students vs. the course
directors.
Material and Methods: The proposed research study was an observational cross-sectional study. The
subjects of the study, the PG students and the course directors of the literature review classes, received the same
survey on the day of the literature review class. Two co-investigators (TN, ID) explained to all the subjects
the purpose of the study and helped with the data collection. The survey consisted of multiple choice and
short answer response questions regarding the format of the literature review class, as well as the role of EBD
in these classes. The same two
co-investigators reviewed and
compared the written responses of
both groups (course directors and
students) for each literature review
class, evaluating the agreement
between the groups. Counts and
percentages were reported for
categorical data. SAS, Version
9.2 (SAS Institute, Cary, North
Carolina) was used for all statistical
analyses. This study was approved
by the Tufts Health Sciences
Institutional Review Board.
Results: A total of seven
course directors and 74 students
completed the survey for seven literature review courses offered in the PG programs. Courses included four
accredited advanced education programs (Endodontics, Orthodontics, Periodontology, Prosthodontics) and
one advanced education program (Esthetic Dentistry). Endodontics and Periodontology offer both current
and classic literature review courses. All of the classes meet at least once per week to discuss articles ultimately
chosen by the course directors, except Orthodontics, which uses American Board of Orthodontics (ABO)
criteria. The majority of the students were in partial agreement with the course directors’ stated objectives,
except Orthodontics residents, which were in complete agreement, and Prosthodontics residents, which did not
match at all. Only one of the seven classes, Periodontology Current, utilized a recognized way of evaluating the
level of evidence.
Conclusion: PG literature review courses should adopt a more consistent format, while still adhering
to each discipline’s accreditation or governing body requirements. More emphasis should be placed on
incorporating EBD in the PG literature review curriculum.
102
Student and Faculty Research Abstracts 2013 –2014
Repeat Dental Treatment under General Anesthesia:
A Retrospective Study
Jennifer Guidry,* Angel Park, Alfred Rich, and Cheen Loo
Purpose: The purpose of this retrospective chart review of pediatric dental patients who had at least one
general anesthesia (GA1) visit was to evaluate whether there is an association between those who returned for a
second GA (GA2) visit and attendance at their post GA1 follow-up (FU) appointment.
Methods: A review of charts of patients treated at Tufts University School of Dental Medicine from 2004 to
2013 identified 541 subjects who met the inclusion criteria. Subjects were categorized as: group 1, those who
did not have GA2; group 2, those who had GA2. The following were recorded: age, gender, payment type, dmfs,
recall frequency, procedures done, and emergency appointments. Chi-square and t-tests were used to assess
associations between variables. Data was analyzed using SAS 9.2 (Cary, North Carolina).
Results: Out of 541 subjects, 27 (5%) had a GA2. The mean time difference between GA1 and GA2 was 2.7
years. At GA1, group 1’s mean age at their initial GA visit was 4.8 years compared to group 2’s 2.7 (p=0.06). Of
GA2, 93% were Medicaid (p=0.013). Mean dmfs score prior to GA1 was 29.7 for group 1 and 35.7 for group 2
(p=0.02). In group 1, 57% attended their FU compared to 56% of those with GA2 (p=0.87).
Conclusion: Subjects
who were younger, covered by
Medicaid, or had a higher dmfs
score at GA1 were more likely to
need a repeat dental treatment
under GA. There was no
association between attendance
at the GA FU appointment and
the need for a second GA visit.
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Research supported by DHHSHRSA #D84HP1995.
Tufts University School of Dental Medicine
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Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Effect of Carbonated/Non-Carbonated and Sugary Drinks on Microleakage
of Pit-Fissure Sealants
Aditi Jindal,* Matthew Finkelman, Sarah Bagher, Alfred Rich, Cheen Loo, and
Masly Harsono
Purpose: The aim of this in vitro study is to determine the effects of different colas, sugary drinks, and similar
acidic soft drinks on the microleakage of pit and fissure sealant after thermo-cycling.
Materials and Methods: Fifty human molar teeth were obtained for this study. Embrace wetbond
sealant was used for all samples. The samples were randomly divided into five groups with ten teeth each. Teeth
in the treatment group were immersed into milk, cola, water (control), orange juice, and carbonated water
respectively for 2 hours, three times a day for 14 days, under agitation. Samples were thermocycled for 10,000
cycles between 5°C and 55°C, immersed in 50% w/v amoniacal silver nitrate for three hours, then exposed
in photo developing solution for sixteen hours. Each tooth was sectioned into two halves. Microleakage was
examined under Olympus SZX16 stereomicroscope for each section.
Results: Using the Kruskal-Wallis test significant difference was found between groups. Water and milk were
significantly lower than other groups using the posthoc Mann-Whitney U-test with the Boneferroni correction.
Microleakage*
% Microleakage
Group
Median**
IQR***
Milk
00.09a
7.03
Cola
26.80c
19.48
Water
00.00a
2.03
30.33b,c
24.29
12.06b
9.25
Orange Juice
Carbonated Water
* p-value of Kruskal-Wallis test <0.001
** Groups sharing a letter do not exhibit a statistically significant difference
*** IQR= Interquartile range
Conclusion: Based on statistical
analysis, results showed that
microleakage was higher for groups
immersed in orange juice and cola as
compared to groups immersed in milk,
carbonated water, and plain water.
104
Student and Faculty Research Abstracts 2013 –2014
Shear Bond Strength of Acrylic Denture Teeth to Denture Base of MetalResin Implant-Supported Fixed Prosthesis: In Vitro Study
Rabie El Huni, Rami Muadab,* Xueying Wu, Khadiga Elfallah, and Roger Galburt
Objectives: The purpose of this in vitro study was to evaluate whither the high hardness of the acrylic teeth
would decrease the bond strength of the acrylic teeth to the denture base material.
Materials and Methods: Two groups of acrylic denture teeth with different hardnesses were used in
the study. A total of 16 maxillary first molar denture teeth in each group were tested and analyzed. To provide a
uniform surface for bonding, the teeth were embedded in a block of wax within a silicone mold. Subsequently
all the denture teeth were ground with AL2O3 paper and the ground surfaces were thoroughly cleaned with air/
water spray and ethanol (70%). All denture teeth were processed with heat- curing injection system (SR Ivocap
Plus, Ivoclar-Vivadent, Florida). After processing, all the ride-labs were flattened with AL2O3 paper, and then all
samples were cut into rod-shape of 4 mm diameter using a trephine bur in drill press. The specimens were then
subjected to a shear bond strength test using an Instron universal testing machine (model 5566A, Norwood,
Massachusetts). The load was applied to the interface between the acrylic teeth and denture base material a
crosshead speed of 1.0 mm/min until failure. The mean shear bond strength for each specimen was measured
and analyzed.
Results: Descriptive statistics are shown in table 2 and as side-by-side box-plots in Figure 3. A power
calculation was conducted using nQuery Advisor (Version 7.0). Assuming a difference in means of 8.34
between the two groups, a standard deviation of 3.34 in the Zahn group, and a standard deviation of 2.09 in
the Ivoclar group (the effect size that was observed in a pilot study using 5 samples per group), a sample size
of n=15 per group was adequate to obtain a Type I error rate of 5% and a power greater than 99%. Descriptive
statistics analysis (means, SDs) was calculated for each group. An independent sample t-test was used to assess
statistical significance. All analyses were conducted using the software package IBM SPSS Statistics version 19.0
(SPSS). P-values less than 0.05 were considered statistically significant. The independent sample t-test showed
significant difference between the two groups in terms of shear bond strength to the denture base (p=0.001)
(Table 2). The limitations of the study include: 1. Pre-treatment of the bonding surface. 2. Artificial aging. 3.
Screw holes and the magnitude of occlusal forces.
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Conclusion: Within the limitations
of this investigation, the following
conclusions can be made:
1. Denture teeth with lower hardness
show significantly higher shear bond
strength to heat-polymerized denture
base compared to higher hardness
denture teeth.
2. Furthermore laboratory and clinical
studies should be conducted to evaluate
the shear bond strength between
different types of denture teeth and heat
polymerized denture base.
Tufts University School of Dental Medicine
105
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
BabySteps: Innovative Obesity and Caries Prevention Pilot for Young
Children
Hubert Park,* Cheen Loo, Carole Palmer, Susan Koch-Weser, Aviva Must, Lingxia Sun, and
Virginia Rall Chomitz
Purpose: High rates of obesity and dental caries among very young children make prevention a national
priority. Dental/nutrition partnerships show promise given that key dietary behaviors that prevent obesity can
also improve oral health. We describe preliminary feasibility and short-term efficacy results from BabySteps, an
obesity and dental caries primary prevention pilot program for very young children in a pediatric dental clinic
setting.
Methods: BabySteps used behavior change theory and behavioral motivation strategies to develop a program
for participants 6–24 months of age and their caregivers at Tufts Dental Baby Clinic in Boston. Parents/
guardians completed a dietary practice assessment in the waiting room. They then received customized dietary
behavior guidance and goal setting from dental staff during an initial pediatric dental exam. Provider guidance
comprises synergistic messages for early
dietary practices and caries prevention.
Implementation feasibility is assessed
by tracking additional clinic visit time
and staff satisfaction with the program.
Short-term efficacy of BabySteps on
obesogenic/cariogenic behavior goals
is assessed at a one-month, post-visit
phone interview with parent/guardian.
Results: Data collection and analysis
were ongoing through April 2014.
Initial findings suggest the BabySteps
intervention adds approximately 12
minutes to the routine baby dental
exam. The majority of parents/guardians
report that the customized behavior
guidance and goal setting has positive impact on facilitating the targeted behavior change.
Conclusions: Pediatric dental settings hold promise for positively influencing healthy eating behaviors that
also promote oral health. The final results of this pilot study will inform future efficacy trials.
Research supported by the Tufts Clinical and Translational Science Institute (CTSI) #UL1 TR000073.
106
Student and Faculty Research Abstracts 2013 –2014
Effectiveness of an Oral Health Education Program for Obstetrician/
Gynecologist Residents at Tufts Medical Center
Devina Shah,* Angel Park, Ester Kim, Alfred Rich, and Cheen Loo
Purpose: The purpose of the study was to assess obstetrician/gynecologist (OB/GYN) residents’ knowledge
and training in oral health and the effectiveness of an educational program for OB/GYN residents at Tufts
Medical Center. An informational seminar session on oral health was used to determine how beneficial such
training would be in improving OB/GYN residents’ dental knowledge.
Methods: A pre/post test design with
a three-month follow-up was used to
evaluate the effectiveness of a seminar
session given to OB/GYN residents at
Tufts Medical Center. Knowledge-based
and belief-based questions were used to
determine the level of knowledge of oral
health.
Results: The study included 18
subjects who participated in oral health
awareness sessions and completed
the questionnaire. The mean age of
participants was 29 years old. Results
show that for the knowledge-based
questions, there was an increase in scores
between the pre- and post-tests with a
slight decrease in scores during the 3-month follow-up. Further statistical analysis is necessary after collection of
data is completed.
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Conclusions: Pregnancy affords a unique opportunity to educate women on the importance of oral health.
The study showed that many benefit from an oral health educational session for OB/GYN residents at Tufts
Medical Center. Therefore, a similar training module can be brought to other OB/GYN residencies and OB/
GYNs.
Tufts University School of Dental Medicine
107
Behavioral, Epidemiologic, and Health Services
Faculty Abstracts
Note: Names marked with an asterisk denote presenter of paper.
BEHAVIORAL, EPIDEMIOLOGIC, AND
HEALTH SERVICES RESEARCH
Characterization of Cognitive Dysfunction in Sjögren’s Syndrome Patients
2013 –2014 Faculty Abstracts
Lynn Epstein, Gina Masse, Jerold Harmatz, Tammy Scott, Athena Papas, and
David Greenblatt
108
Sjögren’s syndrome is an autoimmune disorder primarily affecting women, with decreased saliva and
tear production as the principal characteristic. Cognitive, neurological, and psychiatric disorders also are
associated with Sjögren’s. The present study addressed the hypothesis that patients with Sjögren’s syndrome
differ significantly from matched controls in the prevalence and impact of a number of neuropsychiatric
abnormalities. Sjögren’s patients and controls (n=37 per group) underwent medical and psychiatric evaluation,
demographic assessments, quality of life and symptom evaluation, and extensive testing of cognitive function
and memory. Patients and controls were closely matched for age, gender distribution, verbal IQ, marital status,
educational level, employment status, and current/past medical or psychiatric history. On most subjective
self-ratings, Sjögren’s patients reported greater fatigue, impaired physical functioning, feeling depressed,
and autonomic symptomatology compared to controls. Impaired memory was described mainly as loss of
thought continuity in the midst of a task or activity. However, the majority of objective measures of cognition,
psychomotor function, and memory showed minimal differences between groups. Sjögren’s patients rate
themselves as impaired on multiple ratings of emotional, cognitive, and physical function, but objective
measures of cognition reveal fewer substantive differences between patients and matched controls. Sjögren’s
patients perceive deteriorated physical function over time, but they achieve a level of functioning comparable to
controls despite the burden of their illness.
Published in Clin Rheumatol. 2014 Apr;33(4):511-21. doi: 10.1007/s10067-013-2453-6. Epub 2013 Dec 15.
Relationship between Duration of Treatment and Oral Health in Adults
with Intellectual and Developmental Disabilities
Matthew Finkelman, Paul Stark, Wen Tao, and John Morgan
The purpose of this study was to evaluate how dental outcomes changed over time among subjects with
intellectual and developmental disabilities (IDD) who were under treatment. This retrospective study included
107 subjects who were treated at a Tufts Dental Facilities clinic. Data from each subject were collected at three
time points: initial visit, midpoint visit, and most recent visit. Generalized estimating equations were used to
assess the relationship between time in treatment and several outcome variables (cooperation level, hygiene
rating, presence of caries, periodontitis, dental pain, and infection). Statistically significant decreases in caries
(p<0.001) and increases in periodontitis (p=0.002) were found over time. Associations between time and other
outcome variables were not statistically significant. The prevalence of caries decreased and the prevalence of
periodontitis increased over time among patients with IDDs receiving regular comprehensive dental care. Even
among patients under routine maintenance, significant oral health problems remain.
Published in Special Care in Dentistry, 34, 171-175.
Student and Faculty Research Abstracts 2013 –2014
Behavioral, Epidemiologic, and Health Services
Personal Oral Health Practices: Caregivers of Adults with
Developmental Disabilities
John Morgan, Angel Park, and Paula Minihan
Objective: Adults with developmental disabilities (DD) have a high risk for dental disease and rely on their
caregivers to assist with daily oral home care and dental visits. Information about the oral health (OH) practices
of caregivers and the impact of these practices on the individuals they care for is limited. A survey conducted to
learn about the role of caregivers in promoting the OH of adults with DD included questions about their own
OH practices.
Method: A convenience sample of English-speaking caregivers who accompanied DD adults (>20 years)
to dental appointments in four dental clinics in a specialized statewide dental care system in Massachusetts
completed computer-assisted interview surveys from September 2011 to May 2012. Exploratory analyses
including chi-square tests were completed using SAS 9.2.
Result: A total of 808 caregivers (84.5% paid; 15.5% family) completed surveys. More family than paid
caregivers were aged ≥50 years (79.2% to 33.0%; p<0.01) and were edentulous (8.0% to 3.8%, p=0.04). Overall
60.1% visited the dentist at least twice/year; 23.2% once/every year-two years; and 16.7% only when they had
a problem. Among dentate caregivers, 86.4% brushed more than twice/day and 50.4% flossed once/day; 24.7%
flossed less than once/week or never. Reasons cited by the 33.1% who did not visit the dentist as often as desired
included cost (54.6%) and lack of dental insurance (34.7%).
The objective of this research was to evaluate whether or not there is an interaction in a sample of the elderly
between the clinical attachment level (CAL) or probing depth (PD) of teeth with the number of medications,
smoking, or major causes of death, such as cardiovascular disease (CVD) and diabetes mellitus. Dental
examinations were conducted on 284 patients by one examiner. Periodontal assessments were performed by
probing with a manual UNC-15 periodontal probe to measure PD and CAL at 6 sites. Complete lists of the
patients’ medications were obtained during the examination and causes of death of some of these patients
were abstracted from death certificates. Statistical analyses involved ANOVA/Kruskal Wallis, chi-square, and
multivariate logistic regression analysis. Our results demonstrated that patients in our sample who died of CVD
had higher CAL than the group still living (OR=2.16, 95% CI: 1.47–3.17) and this effect persisted even after
2013 –2014 Faculty Abstracts
Conclusion: Daily oral hygiene and regular dental care help prevent dental disease. Findings suggest that
many but not all caregivers visited the dentist and brushed their teeth at recommended frequencies; only about
half flossed as often as recommended. It is unclear if caregivers who do not brush or floss at recommended
frequencies or visit the dentist regularly support these behaviors in others. Further research into the links
between caregivers’ OH behaviors and the OH supports they provide for adults with DD is needed.
Tufts University School of Dental Medicine
109
Supported in part by NIH 1RC1DE020396. Presented at the 2014 AADR General Session in Charlotte, North
Carolina. Abstract #909.
Is Periodontal Health in the Elderly More Sensitive to the Effects of
Chronic Diseases, Medications, and Smoking?
Zuhair Natto and Athena Papas
Behavioral, Epidemiologic, and Health Services
controlling several variables (OR=2.03, 95% CI: 1.35–3.03). The number of medications had a greater effect
on CAL and the attachment loss increased after 4 medications; it did not have any effect on periodontal PD. In
multivariate logistic regression analyses, 6 or more medications led to a higher risk of attachment loss (>3 mm)
compared with no medication in crude odds ratio (OR=1.20, 95% CI: 0.22–6.64), and age adjusted (OR=1.16,
95% CI: 0.21–6.45), but not with a multivariate model (OR=0.71, 95% CI: 0.11–4.39). Smoking showed the
same dose response pattern on CAL by comparison with PD. We concluded that, when compared with PD,
attachment level seemed to be more sensitive to chronic diseases, number of medications and smoking. Among
those factors, CVD and smoking had the strongest effects. However, it was not possible to discriminate exactly
what number of combined drugs led to the breakdown in CAL.
Source of Funding: USDA Human Nutrition Research Center on Aging (HNRCA) and Educational Foundation of
America. Presented at the National Oral Health Conference and the 15th joint meeting of the Association of State
and Territorial Dental Directors (ASTDD) and the American Association of Public Health Dentistry (AAPHD).
Fort Worth, Texas, April 28–30, 2014.
Exploring HIV-Testing Intentions in Young Asian/Pacific Islander Women
as It Relates to Acculturation, Theory of Gender and Power, and the AIDS
Risk-Reduction Model
2013 –2014 Faculty Abstracts
Margaret Salud, Helen Hopp Marshak, Zuhair Natto, and Susanne Montgomery
110
While HIV rates are low for Asian/Pacific Islanders (APIs), they have been increasing, especially for API women
in the United States. We conducted a cross-sectional study with 299 young API women (18–24 years old) in
the Inland Empire region of Southern California to better understand their intention for HIV testing and their
perceptions about HIV/AIDS. Data analyses included descriptive statistics, bivariate exploration for model
building, and multivariate analyses to determine variables associated with HIV-testing intentions. Results
suggest that more lifetime sexual partners, greater perceived gender susceptibility, higher HIV/AIDS knowledge,
sexual activity, more positive attitudes about HIV testing, and higher self-perceptions/experiences related
to risk contribute to stronger intentions for HIV testing in young API women. Findings from this study will
contribute to the limited literature on HIV/AIDS in API women and provide information that can be used for
developing and implementing culturally appropriate programs that encourage HIV prevention and testing in
this population.
Published in AIDS Care, 26(5):642-647.
Cotinine Levels among Betel Quid Users and Cigarette Smokers in
Cambodia
Pramil Singh, Zuhair Natto, Rituraj Saxena, Hiya Banerjee, Daravuth Yel, Sothy Khieng, and
Jayakaran Job
Smokeless tobacco use in the form of the betel quid is common in the Western Pacific Region, and yet few
studies have determined the nicotine delivery of this habit. During a validation sub-study, we randomly sampled
201 adults from a rural province of Cambodia and determined nonparametric (bootstrapped) confidence
intervals (CIs) for salivary cotinine levels in tobacco users. We found that cotinine levels for daily betel quid use
among women (95% CI=218.6–350.0 ng/mL) were (1) similar to the levels for daily cigarette smoking in men
(95% CI=240.2–317.1 ng/mL) and (2) significantly higher than the levels for daily cigarette smoking in women
Student and Faculty Research Abstracts 2013 –2014
Behavioral, Epidemiologic, and Health Services
(95% CI=71.8–202.7 ng/mL). The 95% confidence range for these habits exceeded the threshold for addiction.
Our findings from rural Cambodia indicate that the typical betel quid habit among women supports the same
level of nicotine addiction as the typical cigarette habit in men.
Published in Asia Pac J Public Health. 2013 Sep;25(5 Suppl):84S-91S. doi: 10.1177/1010539513493459.
Adverse Drug and Device Reactions in the Oral Cavity:
Surveillance and Reporting
Athanasios Zavras, Gregory Rosenberg, Jared Danielson, and Vassiliki Cartsos
Background: According to the U.S. Centers for Disease Control and Prevention, 48% of Americans
(roughly 144 million people) used at least one prescribed medication in the preceding month; 11% used five or
more. The authors describe the U.S. Food and Drug Administration’s (FDA’s) MedWatch program, the safety
surveillance system for drugs and devices in the United States, and the dentist’s role with regard to voluntary
reporting of adverse effects (AEs). They also identify the most frequent AEs in the oral cavity as reported in the
FDA Adverse Event Reporting System (FAERS).
Methods: The authors reviewed the literature regarding MedWatch, and they mined data in the FAERS
public database for the 100 most commonly prescribed medications and their associated AEs.
Results: Pharyngitis was the most common AE. Cough, dysgeusia, and dysphagia also were common.
Conclusion: The MedWatch program and its related databases contain useful information about AEs of
pharmaceuticals and devices manifested in the oral cavity. Increased participation in the reporting of suspected
adverse reactions will improve the national surveillance system and ultimately will protect patients’ safety.
Published in J Am Dent Assoc. 2013 Sep;144(9):1014-21.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Practical Implications: As pharmaceutical consumption increases exponentially for a growing segment
of the population, and as innovation in dental technology and devices flourishes, dentists have a distinct role
in safeguarding patients’ well-being. Promptly reporting AEs in the oral cavity improves quality of care and
protects patients’ well-being.
111
Cancer Biology and Tissue Engineering
CANCER BIOLOGY AND TISSUE ENGINEERING
Tooth Tissue Engineering: The Influence of Hydrophilic Surface on
Nanocrystalline Diamond Films for Human Dental Stem Cells
Silvio E. Duailibi,1,2 Monica T. Duailibi,1,2 Lydia M. Ferreira,1 Karina I. Salmazi,1
Maria C. Salvadori,1 Fernanda de Sá Teixeira,1 Alberto Pasquarelli,3 Joseph P. Vacanti,4,5
and Pamela Yelick6
of São Paulo, São Paulo, Brazil; 2INCT-Biofabris, São Paulo; 3University of Ulm, Ulm,
Germany; 4Massachusetts General Hospital, Boston; 5Harvard Medical School, Boston; 6Tufts
University School of Dental Medicine, Boston
2013 –2014 Faculty Abstracts
1University
112
New techniques for tissue engineering (TE) are rapidly emerging. The basic concept of autologous TE is to
isolate cells from small biopsy specimens, and to expand these cells in culture for subsequent seeding onto
biodegradable scaffolds. Nanocrystalline diamond films have attracted the attention of researchers from a
variety of different areas in recent years, due to their unique and exceptional properties. In this approach,
human dental stem cells (hDSCs) were characterized by flow cytometry and grown on diamond films with
hydrogen (H)-terminated and oxygen (O)-terminated surfaces for 28 days, and then removed by lysis and
washing with distilled water. Energy dispersive spectroscopy analysis was performed, showing that the regions
with O-terminated surfaces contained much higher levels of deposited calcium, oxygen, and phosphorus.
These results suggest that the extracellular matrix was considerably more developed in the O-terminated
regions, as compared with the H-terminated regions. In addition, optical microscopy of hDSCs cultured on the
diamond substrate with H- and O-terminated surfaces, before washing with distilled water, showed preferential
directions of the cells arrangement, where orthogonal lines suggest that the cells appeared to be following
the O-terminated regions or hydrophilic surface. These findings suggest that O-terminated diamond surfaces
prepared on biodegradable scaffolds can be useful for mineralized dental tissue formation.
Published in Tissue Engineering Part A. December 2013, 19(23-24): 2537-2543.
Metabolic Models of Nasopharyngeal Carcinoma Invasion and Metastasis
Sam Kamlartz,1 Addy Alt-Holland,2 Pamela Smith,3 and James Beleja3
1University
of Massachusetts Amherst; 2School of Dental Medicine, Tufts University; and 3School of
Medicine, Tufts University
The goal of this project is to find out new ways to target nasopharyngeal carcinoma (NPC) and discover new
therapies through an in vitro metabolic analysis of tumor cells. Our collaborator, Dr. Alt-Holland, supplied
twenty-nine media samples from cell lines derived from patient tumors. We used nuclear magnetic resonance
spectroscopy in order to determine what metabolites can be found in our samples and at what concentrations
these metabolites are found. We compared the concentrations of the metabolites in the samples grown in
different conditions such as different cell lines, different media, location of tumor, and whether co-culturing the
cells with fibroblasts alters the concentration of the metabolites. The cell lines used in this study are all derived
from a single patient infected with NPC. The patient underwent cisplatinin treatment to combat the cancer.
The treatment seemed to work but after five years the patient’s cancer came back with tumors in his lungs. In
this study cells from different stages of the cancer were assessed, including a knee metastasis of a mouse injected
with the parental cell line. We found that even within a particular cancer there is great metabolic heterogeneity
Student and Faculty Research Abstracts 2013 –2014
Cancer Biology and Tissue Engineering
alluding to the fact that it is important to study particular cancer types in order to discover better therapeutic
drug targets.
Presented at the Building Diversity in Biological Sciences Poster Presentation and Competition, Tufts University,
August 2013.
Delineating the Metabolic Profiles of Skin Cancer Cells and Stromal
Fibroblasts In Vitro
Shawheen Saffari,1 Ronney Tay,1 John Nolan,2 James Baleja,2 and Addy Alt-Holland 1*
1School
of Dental Medicine and 2School of Medicine, Tufts University
Presented at the World Forum on Biology, the Society for In Vitro Biology, Savannah, GA, May, 2014.
Fibroblasts Derived from Human Pluripotent Stem Cells Activate
Angiogenic Responses In Vitro and In Vivo
Yulia Shamis,1 E.A. Silva,2 Kyle Hewitt,1 Y. Brudno,2 S. Levenberg,3 D.J. Mooney,2,3 and
Jonathan Garlick1
1Tufts
University, Boston; 2Harvard University, Cambridge, Massachusetts; 3Technion—Israel Institute
of Technology, Haifa, Israel
Human embryonic and induced pluripotent stem cells (hESC/hiPSC) are promising cell sources for the
derivation of large numbers of specific cell types for tissue engineering and cell therapy applications. We
have describe a directed differentiation protocol that generates fibroblasts from both hESC and hiPSC (EDK/
iPDK) that support the repair and regeneration of epithelial tissue in engineered, 3D skin equivalents. In
the current study, we analyzed the secretory profiles of EDK and iPDK cells to investigate the production of
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
E-cadherin loss is one of the hallmarks of squamous-cell carcinoma (SCC) development. However, how loss
of E-cadherin in cancer cells and how tumor-stromal interactions between cancer cells and fibroblasts affect
cellular metabolic pathways that can promote SCC or basal-cell carcinoma (BCC) development in the human
skin remain elusive. To that end, individual cell cultures and co-cultures of human E-cadherin-competent (II4) or E-cadherin-suppressed (II-4-Ecad-) SCC cells and dermal fibroblasts were cultured for 24 to 48 hours.
Extracellular metabolites in the growth medium were analyzed by nuclear magnetic resonance (1H-NMR).
Microscopy analysis showed that in individual monolayer cell cultures, fibroblasts presented elongated cell
morphology, II-4 cells grew as compact colonies, and II-4-Ecad- cells grew as single and randomly spread cells.
In co-cultures, II-4 colonies were tightly surrounded by streams of fibroblasts, whereas in co-cultures of II-4Ecad- cells and fibroblasts, the tumor cells spread around the latter. NMR revealed that II-4 cultures consumed
more glutamine, valine, and leucine and secreted more pyruvate than II-4-Ecad- cultures that showed less
metabolic activity. Notably, the overall energy metabolism of co-cultures of fibroblasts with either II-4 or II-4Ecad- cells was lower than that of individual SCC cell cultures. This was evident by the decrease in consumption
of glucose and production of lactate in co-cultures of SCC cells and fibroblasts. Thus, the cross-talk between
epithelial tumor cells and dermal fibroblasts can alter the metabolic profile of these cell types upon their
interaction with each other. These findings can shed light on the behavior of these cells in vivo during cancer
progression. Furthermore, metabolites or their corresponding biochemical pathways can serve as targets for new
mechanism-based therapeutic strategies or as biomarkers to monitor the progression of SCC, and potentially
of BCC.
113
Cancer Biology and Tissue Engineering
factors that activate and promote angiogenesis. Analysis of in vitro secretion profiles from EDK and iPDK cells
demonstrated the elevated secretion of pro-angiogenic soluble mediators, including VEGF, HGF, IL-8, PDGFAA, and Ang-1, that stimulated endothelial cell sprouting in a 3D model of angiogenesis in vitro. Phenotypic
analysis of EDK and iPDK cells during the course of differentiation from hESCs and iPSCs revealed that both
cell types progressively acquired pericyte lineage markers NG2, PDGFRβ, CD105, and CD73 and demonstrated
transient induction of pericyte progenitor markers CD31, CD34, and Flk1/VEGFR2. Furthermore, when cocultured with endothelial cells in 3D fibrin-based constructs, EDK and iPDK cells promoted self-assembly of
vascular networks and vascular basement membrane deposition. Finally, transplantation of EDK cells into mice
with hindlimb ischemia significantly reduced tissue necrosis and improved blood perfusion, demonstrating
the potential of these cells to stimulate angiogenic responses in vivo. These findings demonstrate that stable
populations of pericyte-like angiogenic cells can be generated with high efficiency from hESC and hiPSC
using a directed differentiation approach. This provides new cell sources and opportunities for vascular tissue
engineering and for the development of novel strategies in regenerative medicine.
Published in PLoS One. 2013 Dec 30;8(12):e83755. doi: 10.1371/journal.pone.0083755. eCollection 2013.
The Influence of Electrospun Fibre Scaffold Orientation and
Nano-Hydroxyapatite Content on the Development of Tooth Bud
Stem Cells In Vitro
Elisabeth H. C. van Manen,1 Weibo Zhang,2 X. Frank Walboomers,1 Betsy Vazquez,2
Fang Yang,1 Wei Ji,1 Na Yu,1 Daisy Spear,2 John A. Jansen,1 and Pamela Yelick2
University Nijmegen Medical Centre, Nijmegen, The Netherlands; 2Tufts University School
of Dental Medicine, Boston
2013 –2014 Faculty Abstracts
1Radboud
114
In stem-cell-based dental tissue engineering, the goal is to create tooth-like structures using scaffold materials
to guide the dental stem cells. In this study, the effect of fiber alignment and hydroxyapatite content in
biodegradable electrospun PLGA scaffolds have been investigated. Fiber orientation of the scaffolds was
random or aligned in bundles. For scaffolds with prefabricated orientation, scaffolds were fabricated from
PLGA polymer solution containing 0%, 10%, or 20% nano-hydroxyapatite. The scaffolds were seeded with
porcine cells isolated from tooth buds (dental mesenchymal, dental epithelial, and mixed dental mesenchymal/
epithelial cells). Samples were collected at 1, 3, and 6 weeks. Analyses were performed for cell proliferation, ALP
activity, and cell morphology. Fiber alignment showed an effect on cell orientation in the first week after cell
seeding, but had no long-term effect on cell alignment or organized calcified matrix deposition once the cells
reach confluency. Scaffold porosity was sufficient to allow migration of mesenchymal cells. Hydroxyapatite
incorporation did not have a positive effect on cell proliferation, especially of epithelial cells, but seemed to
promote differentiation.
Conclusion: Scaffold architecture is important to mesenchymal cell morphology, but has no longterm effect on cell alignment or organized ECM deposition. nHA incorporation does have an effect on cell
proliferation, differentiation and ECM production, and should be regarded as a bioactive component of dental
bioengineered scaffolds.
Published in Odontology 2014 Jan;102(1):14-21.
Student and Faculty Research Abstracts 2013 –2014
Cariology Research
CARIOLOGY RESEARCH
Bridging the Gap between Preventive and Restorative Dentistry:
Identification of Caries Risk Factors and Strategies for Minimizing Risk
Pamela Maragliano-Muniz
Following the introduction of caries management by risk assessment (CAMBRA) in 2007, a number of
recommendations for office protocols were introduced, and many companies have formulated products and
procedures for implementing CAMBRA. As a result, the implementation of a caries management program can
be confounding and overwhelming to a dental practitioner. Understanding risk factors as they contribute to the
caries process can help mitigate confusion and guide the practitioner when selecting materials for their practice.
Ultimately, knowing how the risk factors play a role in the progression of dental caries will lead to appropriate
risk management and product recommendations. The purpose of this article is to discuss the contribution of
risk factors to the caries process and to introduce strategies that restorative dentists can utilize to minimize
caries risk.
Published in Compend Contin Educ Dent. 2013 Oct;34(9):664-8; quiz 669.
2013 –2014 Faculty Abstracts
Tufts University School of Dental Medicine
115
Craniofacial Biology
CRANIOFACIAL BIOLOGY
The Novel Zebrafish Mutant fantome/wdr43 as a Human Craniofacial
Ribosomopathy Model
Melissa LaBonty,1 Chengtian Zhao,1 K. McCann,2 Viktoria Andreeva,1 S.J. Baserga,2 and
Pamela Yelick1
1Tufts
University, Boston; 2Yale Medical School, New Haven, Connecticut
Introduction: The zebrafish mutant fantome (fan) exhibits severe pharyngeal arch cartilage defects.
Positional cloning was used to map the fan allele to a premature stop codon in wdr43, which encodes a t-Utp
ribosomal protein characterized in yeast to function in rRNA biogenesis. The objective of this study is to use the
fantome/wdr43 mutant to define roles for wdr43 in craniofacial development.
Methods: WISH, Alcian blue stain, Y2H, IF histochemistry, shRNA targeted knock-down, qRT-PCR,
antisense morpholino oligomer (MO), mRNA injections, Western and Northern blot analyses.
Results: The fan/wdr43 mutation was confirmed by rescue with single cell wdr43 mRNA injections and
by anti-sense wdr43 MO phenocopy. WISH analyses revealed reduced neural crest cell populations, and
qRT-PCR revealed upregulated p53 signaling in fan mutants. In vitro subcellular localization studies showed
that full length wdr43 localized to nucleoli, while truncated fan mutant wdr43 did not. Stable cell lines
expressing shRNAs targeting wdr43 are being used to examine the subcellular localization of other nucleolar
phosphoproteins including t-Utps and TCOF1/Treacle, commonly mutated in Treacher Collins Syndrome.
2013 –2014 Faculty Abstracts
Conclusions: The fantome/wdr43 mutant exhibits features similar to TCS, and may be an informative
model for human neurocristopathies, including TCS.
116
Presented at the AAA/Experimental Biology Meeting in Boston, MA, April 2013. Abstract 319.1.
Roles for wdr43 in Craniofacial Development
Pamela Yelick,1 Viktoria Andreeva,1 Chengtian Zhao,2 Yann Gibert,3
Shubhangi Prabhudesai,3 Yi Zhou,4 Leonard Zon,4 and Susan Baserga5
1Tufts
University School of Dental Medicine, Boston; 2Institute of Evolution and Marine Biodiversity,
Ocean University of China, Qingdao, China; 3Tufts University, Boston; 4Children’s Hospital, Boston;
5Yale University, New Haven, Connecticut
Neural crest cells (NCCs), a unique cell population originating from the dorsal side of the embryonic neural
tube, contribute to a significant portion of the craniofacial skeleton. Aberrant NCC specification, migration, and
differentiation can lead to craniofacial defects. In recent years, it has become evident that mutations in a variety
of ribosome biogenesis proteins result in distinct craniofacial defects.
Objective: Here we investigate the function of the ribosome biogenesis protein wdr43 in craniofacial
development.
Method: A forward genetic chemical mutagenesis screen combined with Alcian blue/Alizarin Red staining
was used to identify zebrafish mineralized tissue mutants.
Result: We identified the zebrafish mutant, fantome (fan), which exhibits severe craniofacial cartilage defects.
Positional cloning was used to identify a premature stop codon mutation at amino acid 356 in zebrafish Wdr43,
Student and Faculty Research Abstracts 2013 –2014
Craniofacial Biology
the ortholog to yeast Utp5 known to function in ribosome biogenesis. The fan mutants exhibit increased
apoptosis, reduced cell proliferation, and reduced craniofacial cartilage formation, all of which are partially
relieved by targeted depletion of p53. In vitro and in vivo studies were used to demonstrate that wdr43 is
required for the proper subnucleolar localization of a variety of nucleolar proteins including TCOF1, the gene
commonly mutated in Treacher-Collins Syndrome.
Conclusion: We reveal, for the first time, roles for the ribosome biogenesis gene Wdr43 in craniofacial
development. We anticipate that the zebrafish fan mutant will be a useful tool for devising effective methods to
prevent and/or treat a variety of craniofacial ribosomopathy mutations, including Treacher-Collins Syndrome.
This research was supported by NIH/NIDCR R01DE018043 (PCY), NIH/NIGMS R01GM52581 (SJB) and Tufts
University School of Dental Medicine, Boston. Presented at the 2014 AADR General Session in Charlotte, North
Carolina. Abstract #163.
Tissue Specific Roles for the Ribosome Biogenesis Factor wdr43 in
Zebrafish Development
Chengtian Zhao,1,2 Viktoria Andreeva,1 Yann Gibert,1 Melissa LaBonty,1 Victoria Lattanzi,1
Shubhangi Prabhudesai,1 Yi Zhou,3 Leonard Zon,3 Kathleen L. McCann,4 Susan Baserga,4
and Pamela Yelick 1
1Tufts
University School of Dental Medicine, Boston; 2Ocean University of China, Qingdao, China,
3Children’s Hospital Boston and Harvard Medical School, Boston; 4Yale School of Medicine, New
Haven, Connecticut
Published in PLoS Genetics 2014 Jan;10(1).
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
During vertebrate craniofacial development, neural crest cells (NCCs) contribute to most of the craniofacial
pharyngeal skeleton. Defects in NCC specification, migration, and differentiation resulting in malformations
in the craniofacial complex are associated with human craniofacial disorders including Treacher-Collins
Syndrome, caused by mutations in TCOF1. It has been hypothesized that perturbed ribosome biogenesis
and resulting p53 mediated neuroepithelial apoptosis results in NCC hypoplasia in mouse TCOF1 mutants.
However, the underlying mechanisms linking ribosome biogenesis and NCC development remain poorly
understood. Here we report a new zebrafish mutant, fantome (fan), which harbors a point mutation and
predicted premature stop codon in zebrafish wdr43, the ortholog to yeast UTP5. Although wdr43 mRNA is
widely expressed during early zebrafish development, and its deficiency triggers early neural, eye, heart, and
pharyngeal arch defects, later defects appear fairly restricted to NCC derived craniofacial cartilages. Here we
show that the C-terminus of wdr43, which is absent in fan mutant protein, is both necessary and sufficient to
mediate its nucleolar localization and protein interactions in metazoans. We demonstrate that wdr43 functions
in ribosome biogenesis, and that defects observed in fan mutants are mediated by a p53 dependent pathway.
Finally, we show that proper localization of a variety of nucleolar proteins, including TCOF1, is dependent
on that of wdr43. Together, our findings provide new insight into roles for wdr43 in development, ribosome
biogenesis, and also ribosomopathy-induced craniofacial phenotypes including Treacher-Collins Syndrome.
117
Dental Materials
DENTAL MATERIALS
Effect of Chlorhexidine-Gluconate on Microleakage of Different
Bonding Agents
Laila Aldeeb, David Bardwell, Ronald Perry, Hiroshi Hirayama, and Matthew Finkelman
Objective: The primary aim was to compare the microleakage between total-etch, self-etch, and selectiveetch adhesive systems, both with and without 2% chlorhexidine. Secondary aim was to compare the
microleakage between the chlorhexidine and the non-chlorhexidine groups.
Method: Standardized Class II preparations were set on 105 extracted molars, and randomized into seven
groups (n=15): group 1, total-etch adhesive; group 2, self-etch adhesive; group 3, selective-etch adhesive; group
4, total-etch adhesive with 2% chlorhexidine; group 5, self-etch adhesive then 2% chlorhexidine; group 6, 2%
chlorhexidine then self-etch adhesive; group 7, selective-etch adhesive with 2% chlorhexidine. After restoring
with the assigned system, samples were thermocycled. Samples were immersed in ammoniacal silver nitrate for
24 hours, followed by 8 hours in a photo-developing solution. Finally, they were sectioned and analyzed by two
raters and scored according to the degree of dye penetration: score 0, no marginal leakage; score 1, silver nitrate
(SN) penetrates up to half the gingival wall length; score 2, SN penetrates beyond half the gingival wall length;
score 3, SN penetrates along the gingival and axial walls toward the pulp.
2013 –2014 Faculty Abstracts
Result: There was a statistically significant difference between group 1 and 2 (p-value<0.0001), and between
group 2 and 3 (p-value<0.0001). There was no significant difference between group 5 and 6 (p-value=0.681).
When the groups were compared based on the type of adhesive system used, the results revealed no statistically
significant difference.
118
Table 1: Microleakage scores in counts and percentages for groups 1–7 as rated by two evaluators.
Group
1
2
3
4
5
6
7
Total
Microleakage Score
0
1
2
3
Total
N
Percentage
N
Percentage
N
Percentage
N
Percentage
N
Percentage
N
Percentage
N
Percentage
N
Percentage
25
83.3%
5
16.7%
24
80.0%
23
76.7%
9
30.0%
6
20.0%
25
83.3%
117
55.7%
5
16.7%
13
43.3%
6
20.0%
4
13.3%
11
36.7%
15
50.0%
5
16.7%
59
28.1%
0
0.0%
8
26.7%
0
0.0%
2
6.7%
9
30.0%
6
20.0%
0
0.0%
25
11.9%
0
0.0%
4
13.3%
0
0.0%
1
3.3%
1
3.3%
3
10.0%
0
0.0%
9
4.3%
30
100.0%
30
100.0%
30
100.0%
30
100.0%
30
100.0%
30
100.0%
30
100.0%
210
100.0%
Conclusion: Total-etch and selective-etch adhesive systems have superior results over self-etch adhesive
Student and Faculty Research Abstracts 2013 –2014
Dental Materials
systems, with or without the use of chlorhexidine. Chlorhexidine did not adversely affect the marginal
adaptation of either of the adhesive systems. Applying chlorhexidine, either before the self-etch adhesive or after,
did not have a statistically significant effect on the microleakage scores.
Presented at the 2014 AADR General Session in Charlotte, North Carolina. Abstract #849.
Erosion of Conventional Glass Ionomer Cements in Lactic Acid Solution
Sapan Bhatt, Michael Kreitzer, Ronald Perry, and Gerard Kugel
Objectives: To investigate the amount of erosion of glass ionomer cements (GICs) when placed in a lactic
acid solution as compared to ISO standard compared to ISO standard 9917-1:2007.
Methods: Eleven GIC groups were prepared in PMMA sample molds (30 x 30 x 5 mm) with a central
perforation of 5 mm in diameter and 2 mm depth. Samples (n=5) were then submerged in vials of distilled
water and incubated at 37°C for 1 hour. Measurements comparing the height of the sample to the sample holder
were taken with a micrometer (Digimatic Mitutoyo Corporation). Samples were then submerged in jars each
containing 30 mL of lactic acid/sodium lactate buffer solution with pH 2.74 and incubated at 37°C for 24 hours.
Sample height was measured again in comparison to the sample holder. Average difference in the sample height
(sample erosion) and standard deviation were calculated for each GIC.
Results: One-way ANOVA and Tukey test were conducted to compare the mean erosion for each GIC.
GIC
SD
0.116
0.004
Maxxion RTM (FGM)C
0.349
0.019
VitroFilTM
0.300
0.052
VitroMolarTM (Nova DFL)B
0.199
0.008
RTM
0.214
0.009
0.155
0.021
0.207
0.058
0.169
0.014
0.200
0.033
0.132
0.006
0.308
0.017
Riva
(SDI)A
(Nova
Ionomaster
DFL)C
(Wilcos)B
Riva LutingTM (SDI)A,B
Ionomaster
CTM
(Wilcos)B
Ionomaster FTM (Wilcos)A,B
Maxxion
CTM
(FGM)B
Vidrion CTM (SS White)A
VitroFil
1Materials
CTM
(Nova
DFL)C
with the same letter are not significantly different from each other.
Conclusion: There was a significant difference (p<0.05) in the amount of erosion sustained by the selected
GICs. Samples in group A showed the least acid erosion and had mean erosion values below the ISO standard
9917-1:2007 maximum for GICs, 0.170 mm. Samples in group C showed the most acid erosion, all having mean
erosion values greater than 0.170 mm. This data suggests that there are GICs on the market that do not meet
ISO specifications for acid erosion.
Supported in part by SDI. Presented at the 2014 AADR General Session in Charlotte, North Carolina. Abstract #488.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Mean Erosion (mm)
SCTM
119
Dental Materials
Assessing Surface Roughness on Composite Restorations Using Different
Abrasive Products
Stephanie John, James Vlahakis, Masly Harsono, and Ronald Perry
Objective: To evaluate the effect of different abrasive discs products on surface roughness of composite
restorations.
Methods: Nine composite groups (n=5 each group listed in Table 1) were prepared by packing uncured
composite into a stainless steel mold (20 mm x 10 mm x 5mm). Mylar sheets were placed over each surface of
uncured composite. Glass plates were placed over the Mylar sheets and pressed down to extrude excess material.
Specimens were then light-cured in a TRIAD 2000 visible light-curing unit (DENTSPLY) for two minutes each
side. Specimens were taken from the mold, and one side of each specimen was polished down with a #320 sand
paper using light pressure to remove the initial shiny surface resulting from curing against the Mylar. Specimens
were then paired with the finishing and polishing systems described in Table 1. To standardize finishing/
polishing, one operator treated all samples, each polishing device was used only once, and polishing motion was
kept circular and constant. Polishing devices were used dry and the same slow speed hand piece (NSK EX-6)
was used for all samples. Average surface roughness (Ra, µm) was measured with a contact surface profilometer
(Vecco Dektak 6 m) using a tracing area of 3 mm x 3 mm and a cutoff value of 0.8 mm to filter surface waviness.
The effectiveness of various polishing systems was evaluated based on the mean percentage difference of surface
roughness before and after polishing procedures. Statistical analysis was conducted using one-way ANOVA with
post hoc Tukey HSD test for pair wise analysis. Statistical significance was predetermined at p<0.05.
2013 –2014 Faculty Abstracts
Results:
120
Group
Resin Composite
(n=5)
1
2
3
4
5
Polishing Systems
Finishing (F) and Polishing (P)
Mean (Ra, µm)
Before polish After polish
(µm±SD)
(µm±SD)
Percentage
difference
(%±SD)
Sof-Lex discs (3M ESPE)
F: Coarse + Medium
0.515±0.162 0.052±0.012 89.28±3.87a
P: Fine + Superfine
OptiDisc (Kerr)
Herculite® Ultra A2
F: Extra coarse + Coarse/Medium 0.296±0.025 0.056±0.012 80.97±4.15a
(Kerr)
P: Fine + Extrafine
F: Enhance finishing discs
GrandioSo®
(DENTSPLY Caulk)
0.328±0.028 0.064±0.013 80.24±4.51a
(Voco)
P: Diamanto polishing lens
(Voco)
F: Enhance finishing discs
TPH3®
(DENTSPLY Caulk)
0.885±0.165 0.083±0.046 90.47±5.85a
(DENTSPLY Caulk) P: PoGo polishing discs
(DENTSPLY Caulk)
F: Enhance finishing discs
TPH3®
(DENTSPLY Caulk)
0.885±0.165 0.166±0.072 80.99±8.36a
(DENTSPLY Caulk) P: Prisma gloss + Prisma gloss
extra fine (DENTSPLY Caulk)
Filtek™ Supreme
Plus A2 (3M ESPE)
Student and Faculty Research Abstracts 2013 –2014
Dental Materials
Group
Resin Composite
(n=5)
6
7
8
9
Polishing Systems
Finishing (F) and Polishing (P)
F: Enhance finishing discs
(DENTSPLY Caulk)
TPH4® Cream
(DENTSPLY Caulk) P: PoGo polishing discs
(DENTSPLY Caulk)
F: Enhance finishing discs
TPH4® Cream
(DENTSPLY Caulk)
(DENTSPLY Caulk) P: P
risma gloss + Prisma gloss
extra fine (DENTSPLY Caulk)
F: Enhance finishing discs
Experimental
(DENTSPLY Caulk)
Composite 1 (stiff) P: P
oGo polishing discs
(DENTSPLY Caulk)
F: Enhance finishing discs
Experimental
(DENTSPLY Caulk)
Composite 1 (stiff) P: P
risma gloss + Prisma gloss
extra fine (DENTSPLY Caulk)
Mean (Ra, µm)
Before polish After polish
(µm±SD)
(µm±SD)
Percentage
difference
(%±SD)
0.742±0.116
0.061±0.034 91.22±12.82a
0.742±0.116
0.350±0.065 51.77±12.82b
0.600±0.082
0.061±0.038
0.600±0.082
0.244±0.040 58.14±12.47b
90.18±5.29a
Conclusion: All groups evaluated showed a significant decrease in surface roughness with the exceptions of
groups 7 and 9.
Results: Mean (SD) age was 36.6 (11.8), 57% of subjects were female, and treatments were balanced (p>0.54)
on starting tooth color. At day 11, both groups exhibited significant (p<0.001) color improvement from
2013 –2014 Faculty Abstracts
Research sponsored in part by DENTSPLY. Presented at the 2014 AADR General Session in Charlotte, North
Carolina. Abstract #1456.
Tufts University School of Dental Medicine
121
Comparative Response of Whitening Strips Versus In-Office
Light-Assisted Whitening
Gerard Kugel,1 Ronald Perry,1 Britta Magnuson,1 Masly Harsono,1 M.K. Anastasia,2
Robert Gerlach,2 and S. Farrell2
1Tufts
University School of Dental Medicine, Boston; 2Procter & Gamble Company, Mason, Ohio
Objective: This clinical study compared peroxide-based whitening with 10-day take-home whitening strips
to an immediate in-office light-enhanced whitening treatment.
Methods: After institutional review and informed consent, 49 adults with no history of previous bleaching
and a Vita shade of A2 or darker on maxillary anterior teeth were randomized (2:1) to at-home strips or
in-office whitening treatments. The experimental group was daily 2-hour application of 10% hydrogen
peroxide high-adhesion whitening strips (Crest® 3D White 2-Hour Express Whitestrips®) for at-home use
over 10 days. The positive control was professional light-assisted application of a 25% hydrogen peroxide gel
(Zoom!® Advanced Power Chairside Whitening System) after soft tissue isolation following manufacturer’s
recommendations. Efficacy was measured objectively as L*a*b* color change using digital images at baseline and
day 11, and safety was assessed by intraoral examination and subject report.
Dental Materials
baseline. After adjusting for baseline and age, day 11 Δb* means (SE) were −2.1 (0.14) for the strip group and
−1.8 (0.20) for the in-office group. Groups did not differ (p>0.22) on post-treatment Δb* or ΔL* whitening
at day 11. Tooth sensitivity and oral irritation were the most common adverse events, with the latter more
common (38% of subjects) in the professional control.
Conclusion: Daily use of take home whitening strips resulted in similar tooth whitening as a professional
light-assisted whitening treatment.
Sponsored in part by Procter & Gamble. Presented at the 2014 AADR General Session in Charlotte, North Carolina.
Abstract #518.
Effects of Surface Treatments and Cement Types on the Bond Strength of
Porcelain-to-Porcelain Repair
F.F. Mohamed,1 Matthew Finkelman,2 Roya Zandparsa,2 Hiroshi Hirayama,2 and
Gerard Kugel2
1School
of Dentistry, University of Michigan, Ann Arbor, Michigan; 2Tufts University School of Dental
Medicine, Boston
2013 –2014 Faculty Abstracts
Purpose: The purpose of this in vitro study was to evaluate the effects of four surface treatments and two
resin cements on the repair bond strength of a ceramic primer.
122
Materials and Methods: Eighty-eight pairs of disks (10 and 5 mm in diameter, 3 mm thickness) were
prepared from heat-pressed feldspar ceramics (GC Initial IQ). After being stored in mucin-artificial saliva for
2 weeks, the 10-mm disks were divided into four surface treatment groups (n=22) and then treated as follows:
(1) no treatment (control); (2) 40% phosphoric acid; (3) 5% hydrofluoric acid + acid neutralizer + 40%
phosphoric acid; (4) silica coating (CoJet-sand) + 40% phosphoric acid. The 5-mm disks were treated with 5%
hydrofluoric acid + 40% phosphoric acid. The two sizes of porcelain disks, excluding the control group, were
primed with Clearfil Ceramic Primer. The specimens in each group were further divided into two subgroups of
11 each, and bonded with Clearfil Esthetic Cement (CEC) or Panavia F 2.0 Cement (PFC). The specimens were
stored in distilled water at 37°C for 24 hours, thermocycled for 3000 cycles at 5 to 55°C, and stored at 37°C for
an additional 7 days. Shear bond strength (SBS) was measured with a universal testing machine at a 0.5 mm/
min crosshead speed until fracture. Statistical analysis of the results was carried out with a two-way ANOVA
and Tukey HSD test (α=0.05). Debonded specimen surfaces were examined under an optical microscope to
determine the mode of failure.
Results: The statistical analysis showed that the SBS was significantly affected by surface treatment and
resin cement (p<0.05). For treatment groups bonded with CEC, the SBS (MPa) values were (1) 2.64±1.1; (2)
13.31±3.6; (3) 18.88±2.6; (4) 14.27±2.7; while for treatment groups cemented with PFC, the SBS (MPa) values
were (1) 3.04±1.1; (2) 16.44±3.3; (3) 20.52±2.2; and (4) 16.24±2.9. All control specimens exhibited adhesive
failures, while mixed types of failures were observed in phosphoric acid-treated groups. The other groups
revealed mainly cohesive and mixed failures.
Conclusions: Combined surface treatment of etching with hydrofluoric acid and phosphoric acid provides
the highest bond strengths to porcelain. Also, PFC exhibited higher SBS than CEC did.
Published in J Prosthodont. 2014 Jul 27. doi: 10.1111/jopr.12194. [Epub ahead of print]
Student and Faculty Research Abstracts 2013 –2014
Dental Materials
Comparative Performance of Two Whitening Systems in a Dental Practice
Ronald Perry,1 E. Conde,2 S. Farrell,2 Robert Gerlach,2 and Jennifer Towers1
1Tufts
University School of Dental Medicine, Boston; 2The Procter and Gamble Company, Mason Ohio
Objective: A randomized, controlled clinical trial was conducted to compare the safety and whitening
efficacy of high-adhesion tooth-whitening strips with a marketed in-office professional tooth-whitening system.
Methods and Materials: This open-label study was conducted in a private dental practice, and adult
volunteers were assigned (2:1) to either 9.5% hydrogen-peroxide whitening strips (strip group) or an in-office
light plus 25% hydrogen-peroxide whitening gel treatment (in-office group). The strip group was instructed
to treat the maxillary arch once daily for 30 minutes over a 20-day period, while the in-office group underwent
professional application of light plus whitening gel in a single office visit. Whitening response was measured
as change in yellowness (b*) and lightness (L*) at Day 21 using standardized digital images of the maxillary
anterior teeth, while safety was assessed as tooth sensitivity and oral irritation occurrence. A total of 45 subjects
enrolled, were randomized, and received treatment; 44 completed the study.
Results: At day 21, significant improvement in b* and L* was noted in both groups (p≤0.001). The adjusted
mean (SE) ΔL* in the strip group (1.72 (0.104)) was significantly greater than that in the in-office group (1.17
(0.153)) (p=0.005). Both test products were well tolerated. Overall, both the strip and in-office treatments
resulted in significant tooth whitening.
Published in Compend Contin Educ Dent. 2013 Nov-Dec;34 Spec No 8:15-8.
Dental Imaging and Fabrication
Bioceramics have been adopted in dental restorations for implants, bridges, inlays, onlays, and all-ceramic
crowns. Dental bioceramics include glass ceramics, reinforced porcelains, zirconias, aluminas, fiber-reinforced
ceramic composites, and multilayered ceramic structures. The process of additive manufacturing is ideally
suited to dentistry. Models are designed using data from a computed tomography scan or magnetic resonance
imaging. Since its development in 2001, direct ceramic machining of presintered yttria tetragonal zirconia
polycrystal has become increasingly popular in dentistry. There are wide variety of commercially available
cements for luting all-ceramic restorations. However, resin cements have lower solubility and better aesthetic
characteristics.
Published in Dental Clinics of North America 2014 Jan;58(1):135-58
Latest Biomaterials and Technology in Dentistry
Roya Zandparsa
Navigation technology is applied successfully in oral and maxillofacial surgery. Laser beams are used for caries
removal. With nanodentistry, it is possible to maintain comprehensive oral health care. Nanorobots induce
oral analgesia, desensitize teeth, and manipulate the tissue. They can also be used for preventive, restorative,
and curative procedures. Strategies to engineer tissue can be categorized into three major classes: conductive,
inductive, and cell transplantation approaches. Several populations of cells with stem cell properties have been
isolated from different parts of the tooth.
2013 –2014 Faculty Abstracts
Roya Zandparsa
Published in Dental Clinics of North America 2014 Jan;58(1):113-34
Tufts University School of Dental Medicine
123
Diagnostic Sciences
DIAGNOSTIC SCIENCES
Systematic Interpretation of CBCT Scans: Why Do It?
Rumpa Ganguly and Aruna Ramesh
Cone beam computed tomography (CBCT) is being extensively used by dentists and dental specialists.
Although the advantages of using this modality are enormous, with information comes responsibility. Most
dental clinicians are not maxillofacial radiologists and are generally not familiar with interpretation of anatomy
and pathosis in the head-and-neck area outside their immediate area of clinical interest. This leaves a larger
part of extragnathic anatomy unassessed in a CBCT volume that is prescribed for specific dental diagnosis and
treatment planning. This is critical because literature shows that most often, incidental findings—those that
are found unrelated to immediate clinical interest—are found in the extragnathic areas. Incidental findings are
abnormal findings that are unrelated to the initial purpose of the CBCT study. The failure to identify and report
these findings, especially if these findings are pathological in nature, can lead to medical complications in the
patient and have potential medicolegal ramifications for the dentist/specialist.
Published in J Mass Dent Soc. 2014 Winter;62(4):68-70.
Coincidence of Calcified Carotid Atheromatous Plaque, Osteoporosis, and
Periodontal Bone Loss in Dental Panoramic Radiographs
Aruna Ramesh, Sheila Soroushian, and Rumpa Ganguly
2013 –2014 Faculty Abstracts
Purpose: This study was performed to assess the correlation of calcified carotid atheromatous plaque
(CCAP), the mandibular cortical index, and periodontal bone loss in panoramic radiographs.
124
Materials and Methods: One hundred eighty-five panoramic radiographs with CCAP and 234 without
this finding were evaluated by three observers for the presence of osseous changes related to osteoporosis and
periodontal bone loss. Chi-squared and Mann-Whitney U tests were used to compare the two groups for an
association of CCAP with the mandibular cortical index and periodontal bone loss, respectively.
Results: There was a statistically significant coincidence of CCAP and osseous changes related to osteopenia/
osteoporosis, with a p-value<0.001. There was no statistically significant coincidence of CCAP and periodontal
bone loss. When comparing the 2 groups, “with CCAP” and “without CCAP,” there was a statistically significant
association with the mean body mass index (BMI), number of remaining teeth, positive history of diabetes
mellitus, and vascular accidents. There was no statistically significant association with gender or a history of
smoking.
Conclusion: This study identified a possible concurrence of CCAP and mandibular cortical changes
secondary to osteopenia/osteoporosis in panoramic radiographs. This could demonstrate the important role
of dental professionals in screening for these systemic conditions, leading to timely and appropriate referrals
resulting in early interventions and thus improving overall health.
Published in Imaging Sci Dent. 2013 Dec;43(4):235-43. doi: 10.5624/isd.2013.43.4.235. Epub 2013 Dec 12.
Student and Faculty Research Abstracts 2013 –2014
Education Research
Education Research
Pioneering Toolkit Pilot Course Enhances Student Research and
Learning Experience
Addy Alt-Holland and Eileen Doherty
Purpose: Facilitating the involvement of dental students in basic, clinical or educational research is essential
for the future of dental education, and for over two decades Tufts University School of Dental Medicine
(TUSDM) has offered a student summer research program. This program encourages dental students to
conduct research primarily during the summer and offer stipends on a competitive basis to support this activity.
Enrolled students are mentored by faculty members and are expected to write a research proposal, perform
the research, submit a research abstract, and present their research at the school’s Bates-Andrews Research Day
and in various conferences. Students who participate in this program do so for a variety of reasons, including
the quest for knowledge, increased resume visibility, supplementary stipend, travel opportunity, and building a
stronger relationship with faculty members. However, the experiences that students have under various research
mentors and projects are wide-ranging. A faculty-driven effort to provide comprehensive research guidelines
for dental students and to promote camaraderie between them, regardless their perspective research areas, was
needed. To address these shortcomings, a pioneering pilot course was designed to enhance the learning and
teaching experience, provide life-long learning tools, and broaden the students’ skills, scientific thinking, and
satisfaction in their research experience and accomplishments.
Findings: The lectures provided the students with an overview on institutional personnel, managing the
advisor-advisee relationship, critical aspects of scientific research, the basics of good study design, and the
methods for an effective literature search and writing successful scientific abstracts. Students’ feedback was
positive for the round-table discussions as it allowed them to introduce their research plan to their group
members, reflect on their progress, achievements, and frustrations, and listen to their peers’ input. We found
that the weekly TUSK online board discussions enabled them to continuously share their research progress,
success and obstacles, and support each other in their research journey. However, out of the course’s 53 students,
the first-year students were most inclined to take advantage of the online discussion board. Out of the 24 firstyear students, 12 students (50%) participated on a regular basis and provided weekly research updates at least
3 times during the summer. Of these, 9 students posted once or twice during the summer, and 3 students did
not participate. Second- and third-year students seemed to be less enthusiastic about the online tool; 16 of
them (55%) participated once or twice in the online discussions and 16 students (30%) did not participate in
the online discussion board. Throughout the course, students were prompted to give feedback on the course
structure and content. Currently an assessment online survey of the effectiveness of this pilot course on
students’ research and learning experience is underway and will be presented in the poster.
2013 –2014 Faculty Abstracts
Methods: Our pilot course was offered to 53 research students during the 2013 summer. The course included
educational and practical sections and was designed to be fun, interactive and informative. The educational
section consisted of four lectures given by faculty members and staff aimed to orient the students as they
become involved in research and to provide them with comprehensive guidelines that are applicable to any
research discipline in which they are engaged. In the course’s practical section, students were assigned to four
groups, each encompassing basic science research, clinical research, dental materials, and population data
analysis, and were encouraged to participate in round-table discussions and online discussion boards through
the Tufts University Sciences Knowledgebase (TUSK) internet site.
Tufts University School of Dental Medicine
125
Education Research
Conclusion: This pioneering “Student Summer Research Toolkit” pilot course aimed to “plant the seeds of
research” in dental students, introduce them to teamwork concepts, and provide them with diverse educational
and scientific tools to support and enhance their learning experience. We found that the course was more
effective for first-year students as they began their research experience at TUSDM. We anticipate that overall the
course increased the students’ research experience, the ways they write about it, and the confidence with which
they present it. The online survey will allow us to assess the students’ overall learning outcomes, revise and
improve the course, and respond to the students’ learning needs. We intend to disseminate the course concept
and assessment plan to other schools that involve student research in their programs.
Presented at the annual meeting of the American Dental Education Association in San Antonio, Texas.
Online, Interactive Discussion Boards Enhance Student Research and
Learning Experience
2013 –2014 Faculty Abstracts
Addy Alt-Holland, Eileen Doherty, and Jennipher Murphy
126
Tufts University School of Dental Medicine offers a student summer research program that fosters the
involvement of its students in basic, clinical, and educational research. We created a pilot course with
educational and practical sections that aimed to be fun, interactive, and informative. This course was designed
to enhance learning and teaching, broaden the students’ skills, scientific thinking, and satisfaction in their
research experience, and promote camaraderie between them. One of the course’s unique aspects was the
participation of the students in online discussion boards through the Tufts University Sciences Knowledgebase
(TUSK) internet site. We generated discussion groups that included students that were involved in diverse
research areas as a means to introduce them to teamwork concepts and to support each other in their research
journey by sharing their research progress, success, and obstacles in an open, interactive online weekly journal.
We found that the first-year students were willing to take advantage of the online discussion board; half of them
participated on a regular basis and provided weekly research updates, questions and self-reflections. In general,
second- and third-year students seemed to be less enthusiastic about the new online tool. An assessment survey
of the effectiveness of this pilot course on students’ research and learning experience is underway and the results
will be discussed in our presentation.
Presented at the annual meeting of the American Dental Education Association, San Antonio, Texas.
Problem-Based Learning in Dental Education:
A Systematic Review of the Literature
Seyed H. Bassir,1 Pooyan Sadr-Eshkevari,2 Shaden Amirikhorheh,3 and Nadeem Karimbux4
1Harvard
School of Dental Medicine, Boston; 2School of Dentistry, University of California, Los
Angeles; 3Guilan University of Medical Sciences, Rasht, Iran; 4Tufts University School of Dental
Medicine, Boston
The purpose of this systematic review was to compare the effectiveness of problem-based learning (PBL) with
that of traditional (non-PBL) approaches in dental education. The search strategy included electronic and
manual searches of studies published up to October 2012. The population, intervention, comparator, and
outcome (PICO) framework was utilized to guide the inclusion or exclusion of studies. The search strategy
identified 436 articles, 17 of which met the inclusion criteria. No randomized controlled trial was found
comparing the effectiveness of PBL with that of lecture-based approach at the level of an entire curriculum.
Student and Faculty Research Abstracts 2013 –2014
Education Research
Three randomized controlled trials had evaluated the effectiveness of PBL at a single course level. The quality
assessment rated four studies as being of moderate quality, while the other studies were assessed as being of
weak quality. This review concludes that there are a very limited number of well-designed controlled studies
evaluating the effectiveness of PBL in dental education. The data in those studies reveal that PBL does not
negatively influence the acquisition of factual knowledge in dental students and PBL enhances the ability of
students in applying their knowledge to clinical situations. In addition, PBL positively affects students’ perceived
preparedness.
Published in J Dent Educ. 2014 Jan;78(1):98-109.
MedEdPORTAL: A Report on Oral Health Resources for Health
Professions Educators
Nithya Chickmagalur,1 Veerasathpurush Allareddy,1 Sue Sandmeyer,2
Richard W. Valachovic,2 Christopher S. Candler,3 Michael Saleh,3 Emily Cahill,3
and Nadeem Karimbux4
1Harvard
School of Dental Medicine, Boston; 2American Dental Education Association, Washington,
D.C., 3Association of American Medical Colleges, Washington, D.C., 4Tufts University School of
Dental Medicine, Boston
Published in J Dent Educ. 2013 Sep;77(9):1122-8
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
MedEdPORTAL is a unique web-based peer-reviewed publication venue for clinical health educators sponsored
by the Association of American Medical Colleges (AAMC). The open exchange of educational resources
promotes professional collaboration across health professions. In 2008, the American Dental Education
Association (ADEA) collaborated with AAMC to allow dental educators to use the platform to publish
dental curriculum resources. Oral health is integral to general health; hence, collaboration among healthcare
professionals brings enormous value to patient-centered care. The aim of this study was to conduct a current
survey of metrics and submission statistics of MedEdPORTAL resources. The data were collected using the
MedEdPORTAL search engine and ADEA and AAMC staff. The data collected were categorized and reported
in tables and charts. Results showed that at the time of this study there were over 2,000 medical and dental
resources available to anyone worldwide. Oral health resources constituted approximately 30% of the total
resources, which included cross-indexing with information relevant to both medical and dental audiences.
There were several types of dental resources available; the most common were the ones focusing on critical
thinking. The usage of MedEdPORTAL has been growing, with participation from over 190 countries and
10,000 educational institutions around the world. The findings of this report suggest that MedEdPORTAL
is succeeding in its aim to foster global collaborative education, professional education, and educational
scholarship. As such, MedEdPORTAL is providing a new forum for collaboration and opens venues for
promising future work in professional education.
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Education Research
Perceptions and Practices of U.S. Dental Schools Regarding Curriculum
Integrated Format and Traditional Format Licensure Exams
Shamik Desai,1 Veerasathpurush Allareddy,2 R. Bruce Donoff,1 T. Howard Howell,1 and
Nadeem Karimbux3
1Harvard
School of Dental Medicine, Boston; 2Boston Children’s Hospital, Boston; 3Tufts University
School of Dental Medicine, Boston
2013 –2014 Faculty Abstracts
The dental licensure exam in the United States has evolved over the past ten years, and two formats—the
traditional format and curriculum-integrated format—are now available for students to satisfy licensure
requirements. The objective of this study was to examine the differences and relative merits of the two formats.
A 25-question survey was distributed to the 57 U.S. dental schools at the time. The survey included both
quantitative and discrete variables and followed a strategic sequential order. The first set of questions sought to
determine what type of board preparatory/mock exam each dental school offered, and the next set of questions
asked which licensure exam each school formally offered. The final questions were qualitative in nature and
aimed to determine the school representatives’ opinions about the curriculum-integrated format versus
traditional format. Of the 57 schools contacted, 37 agreed to participate (response rate=64.9%). Of these, 14
schools reported that they administer the traditional format only and 12 administer the curriculum integrated
format only, while 11 offer both. Also, 32 schools offered mock board exams to their graduating students, and
24 of those said their mock exams were identical in format to the actual qualifying clinical exams offered at
their institution. The respondents reported no significant advantage to preparing for the curriculum-integrated
format examination as compared to the traditional format examination with regards to number of clock hours
taken from regular curriculum time. In reporting on this study, this article provides an overview of the relative
advantages and disadvantages of the two examination formats used for the dental licensure process in the
United States.
128
Published in J Dent Educ. 2013 Aug;77(8):1052-62.
Criteria Considered by Program Directors in the AGEP Admission Process
Irina Dragan, Noshir Mehta, and E. Anderson
Throughout the history of higher education, the method for selecting students has changed as
attitudes among faculty and administrators changed and as scientists developed new instruments of
measurement. Colleges and universities have altered what they are by changing whom they admit.
Information regarding the postgraduate selection process in dentistry is sparse and available only
for certain specialties. The aim of this presentation is to describe and discuss the results of a survey
distributed among the advanced dental education program directors in the United States, in order to
review and compare the criteria considered to select the candidates for their programs.
Presented at the 6th Dental Students’ Scientific Meeting in Saudi Arabia, February 2014.
Student and Faculty Research Abstracts 2013 –2014
Education Research
Assessing the Level of Evidence in the Postgraduate Experience at TUSDM
Irina Dragan, Taylor Newman, Nadeem Karimbux, and Paul Stark
Aim: The aim of this project was to assess the format used in the literature review classes offered in the postgraduate (PG) programs at Tufts University School of Dental Medicine (TUSDM). A secondary aim was to evaluate
the differences in how the course format and objectives are perceived by the students vs. the course directors.
Material and Methods: The proposed research study was an observational cross-sectional study.
The subjects of the study, the PG students and the course directors of the literature review classes, received
the same survey on the day of the literature review class. Two co-investigators (TN, ID) explained to all the
subjects the purpose of the study and helped with the data collection. The survey consisted of multiple choice
and short answer response questions regarding the format of the literature review class, as well as the role of
evidence-based dentistry (EBD) in these classes. The same two co-investigators reviewed and compared the
written responses of both groups (course directors and students) for each literature review class, evaluating the
agreement between the groups. Counts and percentages were reported for categorical data. SAS, Version 9.2
(SAS Institute, Cary, North Carolina) was used for all statistical analyses. This study was approved by the Tufts
Health Sciences Institutional Review Board.
Presented at the XXII Portuguese Dental Association Annual Meeting, Portugal, November 2013.
2013 –2014 Faculty Abstracts
Results: A total of 7 course directors and 74 students completed the survey for 7 literature review courses
offered in the PG programs. Courses included 4 accredited advanced education programs (endodontics,
orthodontics, periodontology, prosthodontics) and 1 advanced education program (esthetic dentistry).
Endodontics and periodontology offer both current and classic literature review courses. All of the classes meet
at least once per week to discuss articles ultimately chosen by the course directors, except orthodontics, which
uses American Board of Orthodontics (ABO) criteria. The majority of the students were in partial agreement
with the course directors stated objectives, except orthodontics residents, which were in complete agreement,
and prosthodontics residents, which did not match at all. Only 1 of the 7 classes, periodontology current,
utilizes a recognized way of evaluating the level of evidence.
Tufts University School of Dental Medicine
129
Conclusion: PG literature review courses should adopt a more consistent format, while still adhering
to each discipline’s accreditation or governing body requirements. More emphasis should be placed on
incorporating EBD in the PG literature review curriculum.
Presented at the annual meeting of the American Dental Education Association, San Antonio, Texas.
Valuable Tips for Designing a Successful Research Project
Irina Dragan and Paul Stark
Research methodology, biostatistics, and epidemiology are seldom part of the dental school’s curriculum. The
number of research studies currently developed in the dental field and the manuscripts published have steadily
increased. Multiple studies have revealed the poor quality of the dental literature and mentioned the need for
more training for dentists interested in conducting research projects. For clinicians who are not interested in
developing new projects, a basic understanding about the study design and statistical analyses is required for
evaluating the literature. The current presentation will summarize the basic concepts that should be considered
for developing a successful research project and highlight important aspects commonly lacking in dental
research projects.
Education Research
Interprofessional Teams: Collaborative Management of the Medically
Complex Patient
Diana Esshaki,* Kanchan Ganda, Sanjay Chand, and Wai-Choong Foong
Dental accreditation standards emphasize the need for medical science instruction in dentistry. Tufts University
School of Dental Medicine and University of Detroit Mercy School of Dentistry have introduced two models
of chair-side medical education in the undergraduate dental clinic. These unique programs enable students to
become confident in treating medically complex patients, learn about the work of other healthcare practitioners,
enhance the role of the dentist as a partner in interprofessional healthcare delivery, and improve patient
outcomes. Participants will learn two teaching models about the care of the medically complex patient to dental
students on the clinic floor.
Presented at the ADEA Annual Session and Exhibition in San Antonio, Texas.
Performance of Dental Students Versus Prosthodontists Residents on a 3D
Immersive Haptic Simulator
Elizabeth J. Eve,1 Samuel Koo,1,2 Abdulmonem A. Alshihri,1 Jeremy Cormier,3
Maria Kozhenikov,4 R. Bruce Donoff,1 and Nadeem Karimbux2
School of Dental Medicine; 2Tufts University School of Dental Medicine; 3European
University of Britain; 4Harvard Medical School and Massachusetts General Hospital
2013 –2014 Faculty Abstracts
1Harvard
130
This study evaluated the performance of dental students versus prosthodontics residents on a simulated caries
removal exercise using a newly designed, 3D immersive haptic simulator. The intent of this study was to provide
an initial assessment of the simulator’s construct validity, which in the context of this experiment was defined
as its ability to detect a statistically significant performance difference between novice dental students (n=12)
and experienced prosthodontics residents (n=14). Both groups received equivalent calibration training on the
simulator and repeated the same caries removal exercise three times. Novice and experienced subjects’ average
performance differed significantly on the caries removal exercise with respect to the percentage of a carious
lesion removed and volume of surrounding sound tooth structure removed (p<0.05). Experienced subjects
removed a greater portion of the carious lesion, but also a greater volume of the surrounding tooth structure.
Efficiency, defined as percentage of carious lesion removed over drilling time, improved significantly over the
course of the experiment for both novice and experienced subjects (p<0.001). Within the limitations of this
study, experienced subjects removed a greater portion of carious lesion on a 3D immersive haptic simulator.
These results are a first step in establishing the validity of this device.
Published in J Dent Ed 2014;78:630-637.
Science Literacy for Civic Engagement: Bringing Science to Life
Jonathan Garlick
Our goal is to bring the world of science to life by allowing students to reflect on, explore, and assess its personal
relevance and meaning, so they can thoughtfully engage to solve big problems facing the world. To do this, our
educational initiative, “Science Literacy for Civic Engagement,” links foundational science literacy to “public
learning” as a process of inquiry through which a civil and democratic society searches for solutions to problems
at the interface of science and the public interest. Our students tell us that to learn the value and consequences
of science is to learn what it means to be human. This initiative is designed to help our students engage in
Student and Faculty Research Abstracts 2013 –2014
Education Research
an open-minded discussion about the impact of science in their lives and to make this public conversation
more open and accessible. To accomplish this, we have implemented several undergraduate courses and smallgroup seminars to help students with interests in the humanities and social sciences better understand the
broad socio-cultural impacts of science and medicine through an interdisciplinary lens. We create teaching
teams that bridge disciplines and expertise in medicine, dentistry, veterinary medicine, occupational therapy,
biology, anthropology, policy, literature, philosophy, law, and ethics. These freshman seminars, “Science and the
Human Experience,” have helped Tufts students discover a compelling, personal rationale to explore sciencebased citizenry issues that lie at the interface of science and society. Our goal is to ensure that all students, both
science and non-science majors, gain the tools to understand, assess, analyze, and evaluate the social, moral,
philosophical, political, and ethical issues that are grounded in science and play an increasingly larger role in
contemporary life. This includes end-of-life and reproductive issues, as well as stem-cell research. Students
grapple with multiple points of view about how science-based issues dramatically impact their lives. Addressing
these issues requires the tools to interpret scientific content including skepticism, critical thinking, and the
ability to recognize and deal with the many gray areas—the unexplored spaces between the “facts” postulated
by traditional scientific inquiry. We have developed pedagogy termed “ensemble learning”—an approach where
students don’t merely talk about issues that are important to them, but also seriously consider and weigh the
worth of opinions other than their own. Faculty model this conversation for their students, as class discussions
became personal and poignant when students entertain a spectrum of views related to diversity, inclusion,
and social justice. Ultimately, the goal of “Science Literacy for Civic Engagement” is to create a forum in which
citizens have a voice and can find common ground in the science conversation that impacts their lives.
Presented at the Annual IALS Life Science University Network U.S./Canada, BMEP Student Yearbook, 2014.
Zsuzsa Horvath,1 Jean A. O’Donnell,1 Lynn A. Johnson,2 Nadeem Karimbux,3
Charles F. Shuler,4 and Heiko Spallek1
1University
of Pittsburgh School of Dental Medicine, Pittsburgh; 2University of Michigan School of
Dentistry, Ann Arbor, Michigan; 3Tufts University School of Dental Medicine, Boston; 4University of
British Columbia Faculty of Dentistry, Vancouver, British Columbia, Canada
This research project was part of a planned initiative at the University of Pittsburgh School of Dental Medicine
to incorporate lecture recordings as standard educational support technologies. The goal of an institutional
survey was 1) to gather current data about how dental educators across the United States and Canada use lecture
recordings; 2) determine dental educators’ perceived value and outcomes of using lecture recordings; and 3)
develop recommendations based on #1 and #2 for the dental education community. Of the 66 North American
dental schools at the time of the study, 45 schools responded to the survey, for a 68% response rate. Of the
respondents, 28 schools were found to currently conduct lecture recording; these comprised the study sample.
This study focused on the dental schools’ past experiences with lecture recording; thus, those not currently
engaged in lecture recording were excluded from further analysis. The survey questions covered a wide range of
topics, such as the scope of the lecture recording, logistics, instructional design considerations, outcomes related
to student learning, evaluation and reception, barriers to lecture recording, and issues related to copyright and
intellectual property. The literature review and results from the survey showed that no common guidelines for
best practice were available regarding lecture recordings in dental education. The article concludes with some
preliminary recommendations based on this study.
2013 –2014 Faculty Abstracts
Use of Lecture Recordings in Dental Education: Assessment of Status Quo
and Recommendations
Published in J Dent Educ. 2013 Nov;77(11):1431-42
Tufts University School of Dental Medicine
131
Education Research
An Initial Assessment of Haptics in Preclinical Operative Dentistry Training
Samuel Koo,1,2 A. Kim,2 R. Bruce Donoff,2 and Nadeem Karimbux1
1Tufts
University School of Dental Medicine; 2Harvard School of Dental Medicine
The purpose of this study was to assess novice student perception of haptic-based manual dexterity training.
The short-term impact of haptic training in the early phase of preclinical operative dentistry education was also
investigated. Dental students performed a class II amalgam and a class III resin tooth preparation in a typodont
model at baseline. The experimental group performed exercises on the manual dexterity module of the IDEA™
software using a haptic device. The exercises required removing the maximum amount of three-dimensional
geometric shapes within a predetermined width and depth. Tooth preparations were repeated 2 weeks
later. A questionnaire survey was given to assess the subjective evaluation of the haptic simulation exercise.
Tooth preparations were scored regarding external outline, internal form, and integrity of adjacent tooth.
Improvement of overall tooth preparation scores post-haptic use was not statistically significant compared to
controls (p>0.05). However, students found the game-feature of the haptic device made the learning experience
more fun and interesting. The haptic exercises with the manual dexterity module software were not superior in
improving the dexterity of students for tooth cavity preparations in short-term. Benefits of ease of use and fun
learning experience can be further investigated in future studies.
Published in J Investig Clin Dent. 2013 Aug 15. doi: 10.1111/jicd.12065. [Epub ahead of print]
Using Dental Students’ Preclinical Performance as an Indicator of
Clinical Success
2013 –2014 Faculty Abstracts
Bianca Velayo, Paul Stark, Steven Eisen, and Gerard Kugel
132
The purpose of this study was to evaluate part of one dental school’s predoctoral curriculum by investigating
correlations between students’ final grades in two preclinical courses and their performance in the related
clinical courses. The sample consisted of 301 students at Tufts University School of Dental Medicine who
graduated in 2010 and 2011. All final grades used as data were obtained from the Registrar’s Office and
evaluated anonymously. The average preclinical final grades differed significantly for students in the 2010
(M=84.92, SD=3.35) and 2011 (M=79.67, SD=4.67) classes, as did their average clinical final grades (2010:
M=88.38, SD=2.13; 2011: M=87.45, SD=2.06). The data for each class were therefore examined separately.
Results showed that the correlation between students’ preclinical grades and clinical grades in operative
dentistry and fixed prosthodontics was statistically significant (2010: r2=0.144, p<0.001; 2011: r2=0.261,
p<0.001). This finding suggests there may be a positive relationship between preclinical and clinical
performance of these students; however, the discrete factors contributing to that relationship were not
investigated in this study and require further research.
Published in J Dent Educ. 2014 Jun;78(6):823-8.
Student and Faculty Research Abstracts 2013 –2014
Education Research
The Need for Dentists with Formal Training in Public Health:
The Development of the DMD/MPH Program
Wanda Wright and Jennifer Au
Many graduate programs in public health offer students the opportunity to enroll in combined degree
programs. The most frequent dual degrees offered at member schools of the Association of Schools of Public
Health are: MD/MPH, JD/MPH, MSN/MPH, MSW/MPH, and MBA/MPH. Dentistry and public health have
traditionally not worked as synergistic disciplines because they are based on different care models. However, a
number of different imperatives emphasize the need for this type of combined expertise to address oral-health
problems and workforce shortages. As a recognized specialty by the American Dental Association, dental public
health remains a very small group with less than 200 diplomats credentialed in dental public health. Most
advanced degree programs in public health do not offer a specialty in dental public health, and those dental
professionals receiving masters or doctoral public health degrees may have had no specific coursework related
to dental public health. In response to this need, a new option at Tufts University School of Dental Medicine
(TUSDM) was initiated to offer a combined DMD/MPH program. We describe the development process, which
includes the philosophy guiding the program, initiation of the program, setting goals and objectives, identifying
course content, funding, and selecting applicants, as well as first-year challenges and successes. The program
was successfully funded and participant selection, registration, and enrollment procedures have been developed.
Course content and performance standards have been established. The experience at TUSDM can help guide
others contemplating a combined dental/MPH program.
Presented at the 141st APHA Annual Meeting in Boston, Massachusetts. Abstract #282286.
2013 –2014 Faculty Abstracts
Tufts University School of Dental Medicine
133
Endodontics Research
Endodontics Research
Rubber Dam Use During Post Placement Influences the Success of Root
Canal-Treated Teeth
Joshua Goldfein, Chad Speirs, Matthew Finkelman, and Robert Amato
Introduction: Salivary leakage after root canal therapy is of great concern and can lead to failure of the
endodontic therapy. The aim of this study was to investigate whether the use of a rubber dam (RD) during post
placement impacts the success of root-canal-treated teeth.
Methods: Retrospective chart reviews of 185 patients with an average recall of 2.7 years were assessed for
the incidence of a new periapical lesion (periapical index score>2) after root canal therapy and post placement.
The patients were divided into 2 groups based on the presence or absence of an RD clamp in the verification
radiograph during post placement.
Results: In the study, 26 patients (30 teeth) had a post placed with the use of an RD and 159 patients (174
teeth) had a post placed without an RD. In the non-RD group, 128 (73.6%) teeth were considered successful at
follow-up. In the RD group, 28 (93.3%) teeth were considered successful at follow-up. Based on the bivariate
GEE model, the difference in success between these 2 groups was statistically significant (p=0.035).
Conclusions: The use of an RD during prefabricated post placement provides a significantly higher success
rate of root-canal-treated teeth. Using an RD is already considered a standard of care for nonsurgical root canal
therapy; in addition, using an RD during restorative procedures that involve open teeth should also become a
standard of care.
2013 –2014 Faculty Abstracts
Published in Journal of Endodontics 39(12), 1481-1484.
A Survey of Root Canal Treatment in Saudi Arabia: A Pilot Study
Zuhair Natto
Objective: To characterize the methods and practices used in root canal treatment in Saudi Arabia.
Methods: A questionnaire was developed and distributed in 2010–2011 to a simple random sample of 205
dental practitioners and distributed among private and governmental sectors in 8 different Saudi Arabian
cities. The questions were designed to provide understanding of the awareness and knowledge of dentists
regarding the new instruments and modern techniques that exist in the practice of endodontics. Completed
questionnaires were analyzed in terms of a simple summary statistic.
Results: A total of 85.9% of the practitioners responded. The majority of respondents reported using stepback instrumentation as their main root canal preparation technique (79%) and K-type files as intracanal
instruments (75%). Overall, 47% of respondents did not use intracanal medications in their practice. Cold
lateral compaction was the method of choice for 86% of respondents. Only 3%, however, used magnification
devices and only 20% used electronic apex locators. Among those who indicated using rotary nickel titanium
files, 80% use a ProFile system.
Conclusions: In Saudi Arabia, there are traditional trends in practice that do not appear to be supported by
scientific evidence. The results of this survey demonstrate the importance of integrating evidence-based practice
concepts into teaching curriculums, continuous education courses, and postgraduate studies. However, further
studies are necessary to evaluate this trend.
Published in Oral Health Dent Manag. 2014 Jun;13(2):354-8.
134
Student and Faculty Research Abstracts 2013 –2014
Implantology Research
IMPLANTOLOGY RESEARCH
An In Vitro Comparison of the Accuracy of Implant Impressions with
Coded Healing Abutments and Different Implant Angulations
Khaled Al-Abdullah, Roya Zandparsa, Matthew Finkelman, and Hiroshi Hirayama
Statement of Problem: Fabricating implant definitive casts with CAD/CAM technology (Robocasts)
from coded healing abutment impressions represents a simpler and innovative alternative to conventional
implant impression techniques. However, information about the accuracy of the impressions and the resultant
definitive casts is limited.
Purpose: The purpose of the study was to evaluate the accuracy of the Robocasts and compare them to those
definitive casts fabricated with conventional implant impression techniques (open tray with splinted impression
copings technique).
Results: The median vertical discrepancy of each coded healing abutment impression group was higher than
the corresponding median of the control group (OTSC) for every combination of angulation and position.
Kruskal-Wallis tests indicated a statistically significant difference (p<0.001) between groups for each angulation/
position combination. All post hoc Mann-Whitney U tests indicated statistically significant differences (all
p≤0.002) between OTSC and the other groups. Differences between the angulations and positions were not
statistically significant when accounting for multiple comparisons.
Conclusions: The implant definitive casts fabricated from the coded healing abutment impressions were
found to be less accurate than those fabricated from the open tray with splinted impression copings technique
for restoring 2 paired (10 or 30 degrees) convergent internal connection implants with nonengaging screwretained splinted 2-unit implant restorations. Accuracy of fit was not influenced by the implant angulation or
position for either impression technique or by the Encode healing abutment height for the Encode impression
technique.
Published in Journal of Prosthetic Dentistry, 110, 90-100.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Material and Methods: A reference epoxy resin cast was fabricated and shaped to simulate a dental
arch. Two regular platform implant replicas (Biomet 3i Certain, 4.1 mm diameter and 15 mm length) with
internal connections were placed 10 mm apart with a 10-degree convergence for one side of the reference resin
cast and a 30-degree convergence for the other. Coded healing abutments (Encode) were placed at 3 different
heights above the level of the soft tissue replication material (approximately 1, 2, and 4 mm) and served as test
groups (E1, E2, and E4), and open trays with splinted impression copings (OTSC) served as a control group.
The control group was compared to the impressions of the coded healing abutments by using a standardized
measurement protocol. Impressions were made for each group (n=18) and poured with vacuum mixed (100 g
powder/20 mL water) Type IV dental stone. The vertical discrepancy (Z axis) between 2 prefabricated passively
fitting titanium reference frameworks and the platforms of the implant replicas was measured with an optical
comparator applying the 1 screw test. Data were analyzed with Kruskal-Wallis and post-hoc Mann-Whitney
U tests, as well as the Wilcoxon signed-rank tests. The Bonferroni correction was used to account for multiple
comparisons. The significance level (α) used in a given set of tests was equal to 0.05 divided by the number of
tests performed in that set.
135
Implantology Research
Effect of Different Implant Heights and Angulations on
Overdenture Retention
Ekaterini Antonellou,* Nopsaran Chaimattayompol, Gerard Kugel, Matthew Finkelman, and
Samia Elhamdy
Objective: The aim of this in vitro study was to evaluate the retentive properties of an overdenture
attachment system when two implants were placed at different heights and/or different buccal-lingual
angulations.
Method: In this study, 40 sets of 2 implant-supported overdenture models were evaluated (N=10 per group).
An acrylic resin block was used to house the overdenture Locator® attachments, while an artificial bone block
was used to house two implants. The groups consisted of the following: group A (control group), implants were
placed parallel to each other at same height; group B, implants were placed parallel to each other at different
heights (3 mm difference); group C, implants were placed at different angulations (20°) at same height; and
group D, implants were placed at different angulations (20°) at different heights (3 mm difference). The height
was pre-determined by the bone block, and different abutment heights were used to compensate for the
difference. The angulations were determined by a digital goniometer; all angled implants were lingually tilted.
Retention loss was defined as the number of cycles required for the dislodgement force to drop below 20 N. A
texture analyzer was programmed to apply dislodgment force to the attachment system in a wet condition and
to stop cycling when retentive forces drop below 20 N. Two-way ANOVA and four independent-samples t-tests
(α=0.05) between each group were used to analyze the difference in retention loss.
2013 –2014 Faculty Abstracts
Result: Results of two-way ANOVA were significant. Results of independent sample t-tests (α=0.05) revealed
significant differences between groups C and D, A and C, and B and D, while there was no significant difference
between groups A and B.
136
Table 1: Two-way ANOVA results.
Source
F
P-Level
Heights
7.502
0.010
65.067
<0.001
Angulations
Table 2: Independent samples t-test results.
Group Comparison
T
P-value P-Level
Group A, B
−0.726
0.477
Group C, D
5.887
<0.001
Group A, C
2.656
0.016
Group B, D
9.543
<0.001
Conclusion: Results of this study demonstrated that implants placed at different heights and angulations
resulted in a significant difference in the retention of the attachments of implant supported overdentures.
Sponsored in part by Nobel Biocare. Presented at the 2014 AADR General Session in Charlotte, North Carolina.
Abstract #389.
Student and Faculty Research Abstracts 2013 –2014
Implantology Research
Titanium-Zirconium Narrow-Diameter Versus Titanium Regular-Diameter
Implants for Anterior and Premolar Single Crowns: One-Year Results of a
Randomized Controlled Clinical Study
G. Benic,1 G.O. Gallucci,2 M. Mokti,2 C. Hämmerle,1 Hans-Peter Weber,3 and R. Jung1
1University
of Zurich, Zurich, Switzerland; 2Harvard School of Dental Medicine, Boston; 3Tufts
University School of Dental Medicine, Boston
Aim: To test whether titanium-zirconium (TiZr) 3.3-mm diameter implants perform differently from titanium
(Ti) 4.1-mm diameter implants with respect to marginal bone level (MBL) and clinical parameters.
Material and Methods: Forty subjects in need of a single implant-supported crown in the anterior
or premolar regions were recruited in two centers. After random allocation, either a Ti or a TiZr implant was
placed. Definitive crowns were inserted 6 months after implant placement. Implant survival, change in MBL,
clinical parameters and occurrence of adverse events were assessed at the 1-year examination.
Results: At 1 year, 38 of the 40 included patients were examined (18 Ti and 20 TiZr implants). All the
implants were in place and stable. From the implant placement to the 1-year examination, the change of MBL
amounted to −0.40 mm in the Ti group and −0.41 mm in the TiZr group. There were no significant differences
between the groups regarding the change in MBL, the clinical parameters, and the occurrence of adverse events.
Conclusions: The use of TiZr implants with narrow diameter for the support of single crowns in the
anterior and premolar regions leads to successful tissue integration and clinical performance over a 1-year
period.
Published in J Clin Periodontol. 2013 Nov;40(11):1052-61. doi: 10.1111/jcpe.12156. Epub 2013 Sep 8.
Hamasat Gheddaf Dam, Semaan Abi Najm, Nathalie Nurdin, Mark Bischof,
Matthew Finkelman, and Rabah Nedir
Objectives: This study aimed to determine bone level changes after 5 to 6 years of follow-up for a large
group of one-stage dental implants consecutively placed in private practice. Potential confounding factors
influencing crestal bone loss (CBL) were also assessed.
Materials and Methods: A total of 378 transmucosal Straumann implants in 174 patients were
examined radiographically. Half of the study population’s implants (189 implants) had a titanium plasma
sprayed (TPS) surface, and the other half (189 implants) were sandblasted and acid-etched (SLA). Mean
CBL was measured from 5 to 6 years post-operative radiographs on the basis of known implant landmarks.
Correlations of increased CBL with various independent variables were also investigated. Statistical analyses
were performed using generalized estimating equations.
Results: Radiographic measurements showed a CBL≤1.5 mm for 65% of studied implants. A CBL>1.5 mm
was found for 28% of implants, while 7% of implants had a CBL≥3 mm. Three factors significantly influenced
CBL (p<0.05): implant surface texture (TPS>SLA), smoking status (smokers>non-smokers), and implant
location (anterior>posterior).
Conclusions: CBL was ≤1.5 mm after 5 to 6 years for the majority of followed implants. For implants with a
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
A Five- to Six-Year Radiological Evaluation of Titanium Plasma Sprayed/
Sandblasted and Acid-Etched Implants: Results from Private Practice
137
Implantology Research
CBL > 1.5 mm, statistically significant correlations were found for TPS surface type, anterior jaw locations, and
smoking. Implant length did not influence CBL.
Published in Clinical Oral Implants Research 25(2):e159-e165.
The Effect of Keratinized Mucosa Width on Peri-Implant Health:
A Systematic Review
Luca Gobbato, Gustavo Avila-Ortiz, Keyvan Sohrabi, C.W. Wang, and Nadeem Karimbux
Purpose: The aim of this systematic review was to investigate the effect of keratinized mucosa width (KMW)
on clinical parameters of peri-implant health and stability.
Materials and Methods: Two independent reviewers conducted a comprehensive search to identify
studies on human subjects reporting KMW as a bivariate factor (≥2 mm and <2 mm), along with mean pocket
depth (PD), bleeding on probing (BOP), modified bleeding index (mBI), gingival index (GI), plaque index (PI),
modified PI (mPI), and implant survival with a minimum follow-up of 6 months after implant loading. Eight
studies were included in the systematic review and seven in the meta-analyses to ascertain summary effects for
differences in the aforementioned parameters among groups of KMW.
2013 –2014 Faculty Abstracts
Results: Pooled analyses showed that GI, PI, and mPI were significantly higher in the group with KMW of <2
mm, while mBI was also higher but only marginally significant. In contrast, PD was not significantly different
between the two groups. Differences in BOP and implant survival rate could not be analyzed because of limited
data availability. Heterogeneity was highly significant among the pooled studies for all investigated variables.
138
Conclusion: Reduced KMW around implants appears to be associated with clinical parameters indicative of
inflammation and poor oral hygiene. However, based on the selected evidence, the predictive value of KMW is
limited.
Published in Int J Oral Maxillofac Implants. 2013 Nov-Dec;28(6):1536-45. doi: 10.11607/jomi.3244.
Comparison of the Effect of Two Interdental Cleaning Devices
around Implants on the Reduction of Bleeding:
A Thirty-Day Randomized Clinical Trial
Britta Magnuson,1 Masly Harsono,1 Paul Stark,1 D. Lyle,2 Gerard Kugel,1 and Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Water-Pik Inc., Fort Collins, Colorado
Objective: To determine the effectiveness of a water flosser in reducing the bleeding on probing (BOP) index
around dental implants as compared to flossing.
Methods and Materials: Patients with implants were randomly assigned to one of two groups in this
examiner-masked, single-center study. The study compared the efficacy of a manual toothbrush paired with
either traditional string floss or a water flosser.
Results: The primary outcome was the reduction in the incidence of BOP after 30 days. There were no
differences in the percent of bleeding sites between the groups at baseline. At 30 days, 18 of the 22 (81.8%)
implants in the water flosser group showed a reduction in BOP compared to 6 of the 18 (33.3%) in the floss
group (p=0.0018).
Conclusions: These results demonstrate that the water flosser group had statistically significantly greater
Student and Faculty Research Abstracts 2013 –2014
Implantology Research
bleeding reduction than the string floss group. The authors concluded that water flossing may be a useful
adjuvant for implant hygiene maintenance.
Published in Compend Contin Educ Dent. 2013 Nov-Dec;34 Spec No 8:2-7.
The Effect of Different Implant-Abutment Connections on Screw
Joint Stability
Konstantinos Michalakis,1,2 Pasquale Calvani,1 S. Muftu,3 A. Pissiotis,2 and Hiroshi Hirayama1
1Tufts
University School of Dental Medicine, Boston; 2Aristotle University of Thessaloniki, School of
Dentistry, Thessaloniki, Greece; 3Northeastern University, Boston
Published in Int J Periodontics Restorative Dent 2014 ;34 Suppl 3:s71-3.
2013 –2014 Faculty Abstracts
Dental implants with an internal connection have been designed to establish a better stress distribution
when lateral external forces act on the prosthesis and minimize the forces transmitted to the fastening screw.
In the present study, 10 externally and 10 internally hexed implants were tested with a compressive force
applied with an Instron Universal machine. Four cycles of loading-unloading were applied to each specimen
to achieve displacements of 0.5, 1, 2, and 2.5 mm. The mean loads for the first cycle were 256.70 N for the
external connection and 256 N for the internal connection implants. The independent t-test did not reveal any
significant differences among the 2 tested groups (p=0.780). For the second cycle, the mean loads needed for
a displacement of 1 mm were 818.19 N and 780.20 N for the external connection and the internal connection
implants, respectively. The independent t-test revealed significant differences among the 2 tested groups
(p<0.001). In the third cycle, the mean load values for a 2-mm displacement were 1394.10 N and 1225.00 N.
The independent t-test revealed significant differences among the 2 tested groups (p<0.001). The mean loads
for the fourth cycle were 1488.00 N for the external connection and 1029.00 N for the internal connection
implants. These loads were required for a displacement of 2.5 mm. The independent t-test revealed significant
differences among the 2 tested groups (p<0.001). The results of this in vitro study suggest that the internal
connection design of the examined implant system could not prevent screw loosening during overloading. No
implant or prosthesis failure was noticed in either group.
Tufts University School of Dental Medicine
139
Published in J Oral Implantol. 2014 Apr;40(2):146-52. doi: 10.1563/AAID-JOI-D-11-00032.
Human Histologic Value of Platform-Switched Osseointegrated
Dental Implant
Myron Nevins,1 Marcelo Camelo,1 Samuel Koo,1,2 Richard J. Lazzara,3 and David M. Kim1
1Harvard
School of Dental Medicine; 2Tufts University School of Dental Medicine; 3Private Practice
This case report examined crestal bone level maintenance surrounding a platform-switched implant that
was retrieved due to prosthetic difficulty. The retrieved platform-switched implant threads demonstrated
tight contact with the surrounding bone and demonstrated both radiographic and histologic features that
were indicative of successful osseointegration. Very high bone-to-implant contact (BIC) without epithelial
downgrowth to the implant thread was noted. The BIC consisted of a combination of newly formed bone and
native bone. The buccal and lingual bone levels coincided with the original platform position noted at the
time of the surgery, and did not appear to resorb at all. The result of the present investigation confirms the
maintenance of the crestal bone level for platform-switched implants.
Implantology Research
Implant Loading Protocols for Edentulous Patients with Fixed Prostheses:
A Systematic Review and Meta-Analysis
Panos Papaspyridakos, C.J. Chen, S.K. Chuang, and Hans-Peter Weber
Purpose: To report on the effect of immediate implant loading with fixed prostheses compared to early and
conventional loading on implant and prosthesis survival, failure, and complications.
Materials and Methods: An electronic and manual search was conducted to identify randomized
controlled clinical trials (RCTs) as well as prospective and retrospective studies involving rough surface implants
and implant fixed complete dental prostheses for edentulous patients.
2013 –2014 Faculty Abstracts
Results: The 62 studies that fulfilled the inclusion criteria featured 4 RCTs, 2 prospective case-control
studies, 34 prospective cohort studies, and 22 retrospective cohort studies. These studies yielded data from
2,695 patients (2,757 edentulous arches) with 13,653 implants. Studies were grouped according to the loading
protocol applied: 45 studies reported on immediate loading; 8 on early loading; and 11 on conventional loading.
For the immediate loading protocol with flap surgery, the implant and prosthesis survival rates ranged from
90.1% to 100% and 93.75% to 100%, respectively (range of follow-up, 1 to 10 years). When immediate loading
was combined with guided flapless implant placement, the implant survival rates ranged from 90% to 99.4%.
For the early loading protocol, the implant and prosthesis survival rates ranged from 94.74% to 100% and
93.75% to 100%, respectively (range of follow-up, 1 to 10 years). For the conventional loading protocol, the
implant and prosthesis survival rates ranged from 94.95% to 100% and 87.5% to 100%, respectively (range of
follow-up, 2 to 15 years). No difference was identified between maxilla and mandible.
140
Conclusions: When selecting cases carefully and using dental implants with a rough surface, immediate
loading with fixed prostheses in edentulous patients results in similar implant and prosthesis survival and
failure rates as early and conventional loading. For immediate loading, most of the studies recommended a
minimal insertion torque of 30 Ncm. The estimated 1-year implant survival was above 99% with all three
loading protocols. Caution is necessary when interpreting these results, as there are many confounding factors
that affect treatment outcomes with each of the loading protocols.
Published in Int J Oral Maxillofac Implants. 2014;29 Suppl:256-70. doi: 10.11607/jomi.2014suppl.g4.3.
Accuracy of Implant Impressions for Partially and Completely Edentulous
Patients: A Systematic Review
Panos Papaspyridakos, C.J. Chen, G.O. Galluci, A. Doukoudakis, Hans-Peter Weber, and
V. Chronopoulos
Purpose: To compare the accuracy of digital and conventional impression techniques for partially and
completely edentulous patients and to determine the effect of different variables on the accuracy outcomes.
Materials and Methods: An electronic and manual search was conducted to identify studies reporting
on the accuracy of implant impressions. Pooled data were descriptively analyzed. Factors affecting the accuracy
were identified, and their impact on accuracy outcomes was assessed.
Results: The 76 studies that fulfilled the inclusion criteria featured 4 clinical studies and 72 in vitro studies.
Studies were grouped according to edentulism; 41 reported on completely edentulous and 35 on partially
edentulous patients. For completely edentulous patients, most in vitro studies and all three clinical studies
Student and Faculty Research Abstracts 2013 –2014
Implantology Research
demonstrated better accuracy with the splinted vs. the nonsplinted technique (15 studies, splint; 1, nonsplint;
9, no difference). One clinical study and half of the in vitro studies reported better accuracy with the opentray vs. the closed-tray technique (10 studies, open-tray; 1, closed-tray; 10, no difference). For partially
edentulous patients, one clinical study and most in vitro studies showed better accuracy with the splinted vs. the
nonsplinted technique (8 studies, splint; 2, nonsplint; 3, no difference). The majority of in vitro studies showed
better accuracy with the open-tray vs. the closed-tray technique (10 studies, open-tray; 1, closed-tray; 7, no
difference), but the only clinical study reported no difference.
Conclusion: The splinted impression technique is more accurate for both partially and completely
edentulous patients. The open-tray technique is more accurate than the closed-tray for completely edentulous
patients, but for partially edentulous patients there seems to be no difference. The impression material
(polyether or polyvinylsiloxane) has no effect on the accuracy. The implant angulation affects the accuracy
of implant impressions, while there are insufficient studies for the effect of implant connection type. Further
accuracy studies are needed regarding digital implant impressions.
Published in Int J Oral Maxillofac Implants. 2014 Jul-Aug;29(4):836-45. doi: 10.11607/jomi.3625.
Transcription Factor and Bone Marrow Stromal Cells in Osseointegration
of Dental Implants
Shi-guo Yan,1,2,3 Jin Zhang,1,2 Qisheng Tu,1 Jin-Hai Ye,1,4 En Luo,1,5 M. Schuler,6 M.M. Dard,7
Y. Yu,8 Dana Murray,1 David L. Cochran,9 Sung-Hoon Kim,10 P. Yang,2 and Jake Chen1
1Tufts
Titanium implants are widely used in dental clinics and orthopaedic surgery. However, bone formation
surrounding the implant is relatively slow after inserting the implant. The current study assessed the effects
of bone marrow stromal cells (BMSCs) with forced expression of special AT-rich sequence-binding protein 2
(SATB2) on the osseointegration of titanium implants. To determine whether SATB2 overexpression in BMSCs
can enhance the osseointegration of implants, BMSCs were infected with the retrovirus encoding SATB2
(pBABE-SATB2) and were locally applied to bone defects before implanting the titanium implants in the mouse
femur. Seven and twenty-one days after implantation, the femora were isolated for immunohistochemical
(IHC) staining, haematoxylin eosin (H&E) staining, real-time quantitative reverse transcription polymerase
chain reaction (qRT-PCR), and micro-computed tomography (μCT) analysis. IHC staining analysis revealed
that SATB2-overexpressing BMSCs were intensely distributed in the bone tissue surrounding the implant.
Histological analysis showed that SATB2-overexpressing BMSCs significantly enhanced new bone formation
and bone-to-implant contact 3 weeks after implantation. Real-time qRT-PCR results showed that the local
delivery of SATB2-overexpressing BMSCs enhanced expression levels of potent osteogenic transcription factors
and bone matrix proteins in the implantation sites. μCT analysis demonstrated that SATB2-overexpressing
BMSCs significantly increased the density of the newly formed bone surrounding the implant 3 weeks postoperatively. These results conclude that local delivery of SATB2-overexpressing BMSCs significantly accelerates
osseointegration of titanium implants. These results provide support for future pharmacological and clinical
2013 –2014 Faculty Abstracts
University School of Dental Medicine, Boston; 2School of Stomatology, Shandong University,
Jinan, China; 3Shandong Academy of Medical Sciences, Jinan, China; 4School of Stomatology,
Nanjing Medical University, Nanjing, China; 5School of Stomatology, Sichuan University, Chengdu,
China; 6Institute Straumann AG, Basel, Switzerland; 7New York University College of Dentistry, New
York, New York; 8Fudan University, Shanghai, China; 9University of Texas Health Science Centre at
San Antonio, San Antonio; 10College of Oriental Medicine, Kyunghee University, Seoul, South Korea
Tufts University School of Dental Medicine
141
Implantology Research
applications of SATB2, which accelerates bone regeneration around titanium implants.
Published in Eur Cell Mater. 2013 Dec 19;26:263-70; discussion 270-1.
Effect of Chronic Kidney Disease on the Healing of Titanium Implants
H. Zou1, X. Zhao,1 N. Sun,1 S. Zhang,1 T. Sato,2 H. Yu,1 Q. Chen,1 Hans-Peter Weber,3 M. Dard,4
Q. Yuan,1,2 and B. Lanske2
1Sichuan
University, Chengdu, China; 2Harvard School of Dental Medicine, Boston; 3Tufts University
School of Dental Medicine, Boston; 4New York University College of Dentistry, New York, New York
Chronic kidney disease (CKD) has become a worldwide public health problem. However, its effect on
osseointegration of dental implants is largely unknown. The aim of this study is to investigate whether CKD
impairs the quality of the osseointegration of titanium implants. Uremia was induced by 5/6 nephrectomy
in mice, and serum levels of BUN, FGF23, PTH, and ALP were significantly increased. For in vitro tests, bone
marrow mesenchymal stem cells (BMMSCs) were obtained and cultured on titanium discs. There was no
significant difference in term of expression of osteogenic marker genes including Osx, Col-1, Ocn, and Opn,
as quantified by qPCR. Moreover, Alizarin Red S staining showed comparable mineralized nodules formation.
Histomorphometrical analysis of experimental implants inserted in the femurs of CKD mice revealed a trend
of decreased BIC ratio at 2-week healing. The strength of bone-implant integration, as measured by a push-in
method, was significantly lower for the CKD group at 2 weeks, although a comparable level was reached at 4
weeks. These results demonstrated that CKD only negatively affects the osseointegration of titanium implants at
the early stage.
2013 –2014 Faculty Abstracts
Published in Bone. 2013 Oct;56(2):410-5. doi: 10.1016/j.bone.2013.07.014. Epub 2013 Jul 19.
142
Student and Faculty Research Abstracts 2013 –2014
Methodology and Clinical Trials
Methodology and clinical trials
Outcomes of Implants and Restorations Placed in General Dental
Practices: A Retrospective Study by the Practitioners Engaged in
Applied Research and Learning Network
John D. DaSilva,1 Julie Kazimiroff,2 Athena Papas,3 Frederick A. Curro,4 Van P. Thompson,5
Donald A. Vena,6 Hongyu Wu,6 Damon Collie,6 and Ronald G. Craig4
1Harvard
School of Dental Medicine, Boston; 2The University Hospital of the Albert Einstein College
of Medicine, New York, New York; 3Tufts University School of Dental Medicine, Boston; 4New York
University College of Dentistry, New York, New York; 5King’s College London Dental Institute, Guy
Hospital, London; 6The EMMES Corporation, Rockville, Maryland
Objectives: The authors conducted a study to determine the types, outcomes, risk factors and esthetic
assessment of implants and their restorations placed in the general practices of a practice-based research
network.
Results: The authors enrolled 922 implants and patients from 87 practices, with a mean (standard deviation)
follow-up of 4.2 (0.6) years. Of the 920 implants for which complete data records were available, 64 (7.0%)
were classified as failures when excessive bone loss was excluded from the analysis. When excessive bone loss
was included, 172 implants (18.7%) were classified as failures. According to the results of univariate analysis, a
history of severe periodontitis, sites with preexisting inflammation or type IV bone, cases of immediate implant
placement and placement in the incisor or canine region were associated with implant failure. According to the
results of multivariate analysis, sites with preexisting inflammation (odds ratio [OR]=2.17; 95% confidence
interval [CI], 1.41–3.34]) or type IV bone (OR=1.99; 95% CI, 1.12–3.55) were associated with a greater risk of
implant failure. Of the 908 surviving implants, 20 (2.2%) had restorations replaced or judged as needing to be
replaced. The majority of P-Is and patients were satisfied with the esthetic outcomes for both the implant and
restoration.
Conclusions: These results suggest that implant survival and success rates in general dental practices may
be lower than those reported in studies conducted in academic or specialty settings.
Practical Implications: The results of this study, generated in the private general practice setting, add to
the evidence base to facilitate implant treatment planning.
Published in J Am Dent Assoc. 2014 Jul;145(7):704-13. doi: 10.14219/jada.2014.27.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Methods: All patients who visited network practices three to five years previously and underwent placement
of an implant and restoration within the practice were invited to enroll. Practitioner-investigators (P-Is)
recorded the status of the implant and restoration, characteristics of the implant site and restoration, presence
of peri-implant pathology, and an esthetic assessment by the P-I and patient. The P-Is classified implants as
failures if the original implant was missing or had been replaced, the implant was mobile or elicited pain on
percussion, or there was overt clinical or radiographic evidence of pathology or excessive bone loss (>0.2
millimeter per year after an initial bone loss of 2 mm). They classified restorations as failures if they had been
replaced or if there was abutment or restoration fracture.
143
Methodology and Clinical Trials
What You Need to Know about Data Management: Special SIVB Workshop
at the World Forum
Kathryn Houk and Addy Alt-Holland
Today, the world’s hottest commodities are technology and information, and as scientists and researchers,
we not only use technology to consume information, but we are also major users and producers of this
information. When so much information is being produced, how is an information consumer supposed
to: 1) find the relevant information, 2) determine its quality, and 3) build and test hypotheses based on this
data? The answer to all these questions is fairly straightforward: academic librarians. Academic librarians are
expertly trained in information organization, retrieval, and evaluation of information in physical and digital
formats. The librarians who work at academic and health sciences libraries are what make the difference
between researchers using a “satisficing” versus an “optimal decision” approach to their literature searches.
The interactive workshop titled “Conquering Chaos in the Age of Networked Science: The Importance of Data
Management” at the SIVB’s 2014 World Forum of Biology will be focusing on data management. New mandates
from the Office of Science and Technology Policy, the bipartisan Fair Access to Science and Technology
Research Act (FASTR) introduced in 2013, points to a new focus on providing access to research data used in
publications. This workshop will be using a real lab’s research project as an example to cover the steps for good
data management, the seven common issues you will likely encounter, and resources to assist you along the way.
It aims to provide you with the knowledge and tools to better manage your data and to create the 2-page data
management plan required by NSF and NIH grants.
2013 –2014 Faculty Abstracts
Published in In Vitro Report, Issue 48.2, April-June 2014.
144
Student and Faculty Research Abstracts 2013 –2014
Mineralized Tissue
MINERALIZED TISSUE
BET Inhibitor JQ1 Blocks Inflammation and Bone Destruction
Shu Meng,1,2 Lan Zhang,1,2 Yin Tang,1,2 Qisheng Tu,1 Leilei Zheng,1 Liming Yu,1 Dana Murray,1
Jessica Cheng,1 Sung-Hoon Kim,3 Xuedong Zhou,2 and Jake Chen1
1Tufts
University School of Dental Medicine; 2West China School of Stomatology, Sichuan University,
China; 3College of Oriental Medicine, Kyunghee University, South Korea
Adiponectin (APN), the most abundant adipocyte-secreted adipokine, regulates energy homeostasis and exerts
well-characterized insulin-sensitizing properties. The peripheral or central effects of APN regulating bone
metabolism are beginning to be explored but are still not clearly understood. In the present study, we found that
APN-knockout (APN-KO) mice fed a normal diet exhibited decreased trabecular structure and mineralization
and increased bone marrow adiposity compared with wild-type (WT) mice. APN intracerebroventricular
infusions decreased uncoupling protein 1 (UCP1) expression in brown adipose tissue, epinephrine and
norepinephrine serum levels, and osteoclast numbers, whereas osteoblast osteogenic marker expression
and trabecular bone mass increased in APN-KO and WT mice. In addition, centrally administered APN
2013 –2014 Faculty Abstracts
BET proteins are a group of epigenetic regulators controlling transcription through reading acetylated histone
tails and recruiting transcription complexes. They are considered as potential therapeutic targets in many
distinct diseases. A novel synthetic bromodomain and extraterminal domain (BET) inhibitor, JQ1, was proved
to suppress oncogene transcription and inflammatory responses. The present study was aimed to investigate
the effects of JQ1 on inflammatory response and bone destruction in experimental periodontitis. We found
that JQ1 significantly suppressed lipopolysaccharide (LPS)-stimulated inflammatory cytokine transcription,
including interleukin (IL)-1β, IL-6, and tumor necrosis factor alpha (TNF-α), as well as receptor activator of
nuclear factor kappa-B ligand (RANKL)-induced osteoclast markers, such as c-Fos, nuclear factor of activated
T-cells, cytoplasmic, calcineurin-dependent 1 (NFATc1), tartrate-resistant acid phosphatase (TRAP), and
cathepsin K in vitro. JQ1 also inhibited toll-like receptors 2/4 (TLR2/4) expression and nuclear factor kappalight-chain-enhancer of activated B cells (NF-κB) phosphorylation and nuclear translocation. Chromatin
immunoprecipitation and quantitative polymerase chain reaction (ChIP-qPCR) revealed that JQ1 neutralized
BRD4 enrichment at several gene promoter regions, including NF-κB, TNF-α, c-Fos, and NFATc1. In a murine
periodontitis model, systemic administration of JQ1 significantly inhibited inflammatory cytokine expression in
diseased gingival tissues. Alveolar bone loss was alleviated in JQ1-treated mice because of reduced osteoclasts in
periodontal tissues. These unprecedented results suggest the BET inhibitor JQ1 as a prospective new approach
for treating periodontitis.
Tufts University School of Dental Medicine
145
Published in J Dent Res. 2014 May 5;93(7):657-662. [Epub ahead of print]
Central Adiponectin Administration Reveals New Regulatory Mechanisms
of Bone Metabolism in Mice
Yuwei Wu,1,2 Qisheng Tu,1 Paloma Valverde,3 Jin Zhang,1 Dana Murray,1 Lily Q. Dong,4
Jessica Cheng,1 Hua Jiang,1 Maribel Rios,5 Elise Morgan,6 Zhihui Tang,2 and Jake Chen1
1Tufts
University School of Dental Medicine; 2Peking University School and Hospital of Stomatology,
China; 3Wentworth Institute of Technology, Boston; 4University of Texas Health Science Center at
San Antonio, San Antonio; 5Tufts University School of Medicine, Boston; 6Boston University, Boston
Mineralized Tissue
increased hypothalamic tryptophan hydroxylase 2 (TPH2), cocaine- and amphetamine-regulated transcript
(CART), and 5-hydroxytryptamine (serotonin) receptor 2C (Htr2C) expressions but decreased hypothalamic
cannabinoid receptor-1 expression. Treatment of immortalized mouse neurons with APN demonstrated
that APN-mediated effects on TPH2, CART, and Htr2C expression levels were abolished by downregulating
adaptor protein containing pleckstrin homology domain, phosphotyrosine domain, and leucine zipper motif
(APPL)-1 expression. Pharmacological increase in sympathetic activity stimulated adipogenic differentiation of
bone marrow stromal cells (BMSC) and reversed APN-induced expression of the lysine-specific demethylases
involved in regulating their commitment to the osteoblastic lineage. In conclusion, we found that APN regulates
bone metabolism via central and peripheral mechanisms to decrease sympathetic tone, inhibit osteoclastic
differentiation, and promote osteoblastic commitment of BMSC.
2013 –2014 Faculty Abstracts
Published in Am J Physiol Endocrinol Metab. 2014 Jun 15;306(12):E1418-30. doi: 10.1152/ajpendo.00048.2014.
Epub 2014 Apr 29.
146
Student and Faculty Research Abstracts 2013 –2014
Neuroscience /TMJ
NEUROSCIENCE / TMJ
Temporomandibular Joint Osteoarthritis: Diagnosis and Long-Term
Conservative Management: A Topic Review
M. Kalladka,1 S. Quek,2 G. Heir,2 E. Eliav,3 M. Mupparapu,4 and Archana Viswanath5
1Mallya
Hospital, Bangalore, India; 2Rutgers University School of Dental Medicine, Newark, New
Jersey; 3University of Rochester Medical Center, Rochester, New York; 4University of Pennsylvania
School of Dental Medicine, Philadelphia; 5Tufts University School of Dental Medicine, Boston
Degenerative joint disease (DJD), a common osteoarthritic problem encountered in clinical practice presents
as a chronic debilitating disease resulting in altered joint structure due to degradation and loss of articular
cartilage, along with changes in the subchondral bone and other soft tissues. DJD is a frequent finding in the
temporomandibular joints (TMJs). Consequently, a good understanding of the use of a diagnostic algorithm
will lead to a better control of DJD in the TMJ. The etiopathogenesis of osteoarthritis is complex, and it is
associated with multiple risk factors. The condition progresses slowly through different phases with periods of
remission and activity finally reaching the burnout phase. Conservative management forms the cornerstone
for the treatment of most of these cases. This review attempts to acquaint the dentist with the diagnosis,
pathogenesis and general characteristics of the disease while highlighting and updating them with the current
conservative treatment algorithms in order to assist in the formulation of a treatment plan for these patients.
Published in J Indian Prosthodont Soc. 2014 Mar;14(1):6-15. doi: 10.1007/s13191-013-0321-3. Epub 2013 Sep 22.
German O. Ramirez-Yanez,1 Laxmi Mehta,1 and Noshir Mehta2
1Faculty
of Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada; 2Tufts University School
of Dental Medicine, Boston
Objective: To determine whether a unilateral increase or decrease in the bite affects the curvatures of the
vertebral spine in rats.
Methods: The study included 25 male Sprague Dawley rats. Of these, 5 animals received no alteration on
their bite. Bite was increased on 10 animals, and molar teeth were extracted on 10 other animals. Frontal and
lateral radiographs were taken on days 0, 7, 14, and 21. Distances from landmarks to a true vertical line were
measured on both radiographs.
Results: Repeated measures analysis showed statistically significant differences between the amount of
the curvature at the cervical and thoracic spines on frontal and lateral radiographs over time (p<0.05 and
p<0.0001). One-way ANOVA computed significant differences (p<0.05) at D14 at the cervical and thoracic
spines on both increased and decreased vertical dimension.
Conclusion: Alterations in the dental occlusion affects the normal curvatures of the vertebral spine in rats.
Published in Cranio. 2014 Jul 22:2151090314Y0000000017. [Epub ahead of print]
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
The Effect of Dental Occlusal Disturbances on the Curvature of the
Vertebral Spine in Rats
147
Oral Health Research
ORAL HEALTH RESEARCH
A Survey of Dentists’ Knowledge and Attitudes with Respect to the
Treatment of Scleroderma Patients
David Leader, Athena Papas, and Matthew Finkelman
Objective: Scleroderma or systemic sclerosis causes dry mouth, a major risk factor for tooth decay, and
shrinks the mouth opening, complicating care. A 2011 survey determined that 28% of systemic sclerosis patients
have difficulty finding dentists prepared to treat them, and 63% do not recommend their current dentist to
other systemic sclerosis patients. We use a survey to gauge dentists’ knowledge and attitudes regarding the care
of scleroderma patients.
Methods: We conducted an Internet-based survey of all 4,465 members of the Massachusetts Dental Society
to determine their knowledge and attitudes of treating systemic sclerosis patients. Data were analyzed using
SPSS and Qualtrics research suite.
2013 –2014 Faculty Abstracts
Results: Surveys were accessed by 351 dentists and completed by 269. Responses were primarily from Eastern
Massachusetts (80%), but represented the Boston area less than expected. Most dentists believed they have an
ethical responsibility to treat patients who have scleroderma (93%). More than half of dentists believed that
in not knowing about systemic sclerosis they might harm a patient (51%). If contacted by a patient who has
scleroderma, 50% of dentists would gather information on the disease or the patient’s condition. Dentists who
felt prepared (71%) were more likely to correctly answer questions related to diagnosis and classification of
scleroderma than those who felt unprepared (p=0.004, Mann-Whitney U test).
148
Conclusion: Results indicate the potential value of creating a health communication effort targeting oral
health providers to improve scleroderma patient satisfaction and access to care.
Published in Journal of Clinical Rheumatology 2014 Jun;20(4):189-94
Mycobacterial Pseudotumor of the Skin
M. Rahmani, J. Alroy, Driss Zoukhri, R.O. Wein, and A.S. Tischler
Inflammatory pseudotumors have a diverse etiology, mycobacterial pseudotumor (MP) being one of them. MP
is a rare entity; it has been reported infrequently in various organs and is extremely rare in the skin. We report
a cutaneous MP in an immunosuppressed liver transplant recipient. The lesion consisted mostly of spindle
cells, with small numbers of lymphocytes. Conventional acid-fast bacilli (AFB) stain revealed a large number
of acid-fast bacilli within spindled histiocytes and the presence of Mycobacterium avium was determined by
polymerase chain reaction. Given that the patient had a prior history of cutaneous squamous-cell carcinoma
resected and reconstructed in the same area, establishing the diagnosis was challenging. Immunohistochemical
staining for lysosome-associated membrane protein was strongly positive, suggesting the presence of numerous
mature lysosomes within infected spindle cells. Mycobacterial spindle cell pseudotumors can mimic malignant
or benign neoplasms and should be considered in differential diagnosis of spindle-cell lesions, especially in
immunocompromised patients. Further studies are needed to determine mechanisms that permit the survival
of mycobacteria within the lesions and that cause this unusual manifestation of infection.
Published in Virchows Arch. 2013 Dec;463(6):843-6. doi: 10.1007/s00428-013-1491-4. Epub 2013 Oct 11.
Student and Faculty Research Abstracts 2013 –2014
Oral Health Research
Effect of Sialagogue on Bleeding on Probing in Sjögren’s Syndrome
Mabi Singh and Athena Papas
Background: Bleeding on probing (BOP) is a frequent observation in patients with Sjögren’s syndrome and
a sialagogue is routinely prescribed for these patients.
Objective: The objective of this study was to evaluate the effect of sialagogue (muscarinic cholinergic
agonists) on BOP in patients with Sjögren’s syndrome.
Materials and Methods: This observational study included 57 subjects. Study population was divided
into two groups: subjects on sialagogue (n=32), and subjects not on sialagogue due to its side-effects (nonsialagogue, n=25). The number of sites with BOP was recorded on all teeth.
Results: The subjects on sialagogue had a significantly lower mean (standard error) number of sites with BOP
22.97 (2.65) as compared with the non-sialagogue group 46.59 (6.20), p<0.001. After adjusting for the use of
remineralizing rinse the subjects on sialagogue had a significantly lower number of sites with BOP (p<0.001).
Conclusion: In this observational study, treatment with sialagogue may prevent BOP in patients with
Sjögren’s syndrome.
Published in Indian J Dent Res. 2013 Sep-Oct;24(5):567-70. doi: 10.4103/0970-9290.123371.
Use of Pre-operative Mouthwash in Dental Treatment: A Literature Review
Wael Yaghmoor,* Yumi Ogata, James Hanley, Matthew Finkelman, T. Kawai, and Yong Hur
Method: PubMed/MEDLINE search and hand search for relevant articles were done from August 1960
through August 2013 to identify appropriate studies. A comprehensive search was designed and the studies
were reviewed by 2 reviewers independently to evaluate the eligibility criteria. Clinical trials and randomized
controlled clinical trials in English that evaluated the effect of pre-operative use of different mouthwashes on
bacterial contamination during different dental procedures were selected. The total reduction of the bacterial
load after the use of the mouthwashes was the primary outcome.
Result: A total of 10 out of 1,544 articles met the inclusion criteria and were included in the review.
Chlorhexidine (CHX) was tested in 8 articles, povidone iodine in 3 articles, and Listerine® in 3 articles. After
evaluating samples from saliva, CHX, Listerine, and povidone-iodine mouthwashes showed a significant
reduction of aerobic and anaerobic bacteria (99.4%, 65.0%, 71.5% respectively) compared to control. CHX had
the most persistent effect (up to 7 hours in one study). All three rinses showed a significant reduction of the
incidence of bacteremia in blood samples following invasive dental procedures (e.g., scaling/root planing, intraligamental injections, and teeth extraction) as compared to control (55.0%, 90.1%, 72.5.0% respectively).
Conclusion: Studies showed varying amounts of reduction in bacterial load in both saliva and blood after
rinsing with different mouth rinses. The limited number of the available studies about the pre-operative use and
the heterogeneity of the studies and the products used made it difficult to come to a definite conclusion about
the effect on bacterial counts. Additional clinical trials with various mouthwashes and studies to confirm the
association between the quantitative oral flora counts and post-operative complications are recommended.
2013 –2014 Faculty Abstracts
Objective: The aim of this study was to review and evaluate the use of pre-operative mouthwashes on
reduction of bacterial count during different invasive dental procedures.
Presented at the 2014 AADR General Session in Charlotte, North Carolina. Abstract #1365.
Tufts University School of Dental Medicine
149
Oral Surgery Research
ORAL SURGERY RESEARCH
The Use of a Transcutaneous CO2 Monitor during Moderate Sedation in
Oral and Maxillofacial Surgery
Sanjeet Chaudhary,* Ruba Khader, Matthew Finkelman, Daniel Oreadi, Marcin Jarmoc,
Roman Schumann, and Morton Rosenberg
Purpose: Continuous monitoring of end-tidal CO2 (ETCO2) is a requirement for deep sedation and general
anesthesia during oral and maxillofacial surgery (OMFS) in 2014 and may be expanded to moderate sedation
in the future. In intubated patients, the ETCO2 measurement usually closely resembles the arterial partial
pressure of CO2 (PaCO2). In non-intubated OMFS patients, ETCO2 measurements are unreliable with respect to
the PaCO2 due to technical limitations in capturing exhaled gases. Transcutaneous CO2 monitors measure the
PtCO2 with electrochemical technology independent of expired breaths. This technology closely reflects PaCO2
and captures the end-result of clinical breathing patterns including respiratory efficiency in non-intubated
patients by continuous PtCO2 assessment and its trend during sedation. We conducted this pilot study to
determine the possible clinical utility of a transcutaneous pCO2 monitor during OMFS procedural sedation.
2013 –2014 Faculty Abstracts
Methods: Following IRB approval and written informed consent, we prospectively collected demographic,
anesthetic, and outcome data in patients undergoing moderate Fentanyl and Midazolam sedation for third
molar removal. All patients were monitored using a transcutaneous pCO2 monitor (SenTec DMS, Therwil,
Switzerland) that employs a simple earclip. A bispectral index (BIS) monitor (BIS™, Covidien, Mansfield,
Massachusetts) assessed the depth of sedation. We correlated the sedation depth with the PtCO2 using the
Pearson correlation. A p<0.05 was significant.
150
Results: Eighteen adult subjects completed the study. During moderate sedation the PtCO2 increased with
an increasing sedation level. PtCO2 and level of sedation were negatively correlated (Pearson Correlation −0.3);
however, this correlation was not statistically significantly different (p=0.072).
Conclusions: Transcutaneous CO2 monitoring may be attractive during moderate sedation for OMFS
procedures, because its location on the ear does not interfere with the surgical field and the CO2 monitoring
is not affected by the need to capture expiration. Our data show an inverse correlation between PtCO2 and
sedation level. This trend did not reach statistical significance in our small cohort. PtCO2 monitoring may have
a role as an additional safety monitor to reliably assess ventilation during sedation in non-intubated patients. A
larger study with an increased variety of sedation techniques is warranted.
Abstract accepted for presentation at the Second Annual ACOMS Resident meeting (November 9–10, 2013) at the
Jefferson Medical College in Philadelphia.
Prosthetic Dental Rehabilitation with Implants Status Post Segmental
Resection of the Anterior Mandible
Sanjeet Chaudhary* and Daniel Oreadi
A 40-year-old female was referred to our Oral and Maxillofacial Surgery Department by her oral surgeon
after a history of pain and swelling on the left parasymphyseal region. The patient’s past medical history is
significant for anemia. She is allergic to penicillin and has a social history of smoking ½ PPD for 20 years.
The patient underwent multiple surgical interventions including extraction of teeth #20 and #21, as well as an
Student and Faculty Research Abstracts 2013 –2014
Oral Surgery Research
incision and drainage of the affected area. She was refractory to medical and surgical therapy. After an extensive
workup and biopsy of the affected area by her oral surgeon, the patient was diagnosed with acute suppurative
osteomyelitis of the left anterior mandible. She was then referred to us for definitive treatment. The patient
underwent segmental resection of the left anterior mandible with placement of a reconstruction plate and
long-term antibiotics. Her post-operative healing period was uneventful. Four months after her initial surgery,
the left mandibular defect was reconstructed with a posterior iliac crest bone graft with an interim period of
four months for consolidation of the bone graft. The prosthodontic treatment plan includes restoration of
mandibular dentition with a 4 implant over denture with placement of implants at areas # 20, 22, 29, and 31.
Her remaining teeth 26, 27, and 28 remain periodontally stable. Due to the questionable restorability of the
maxillary teeth and poor long-term prognosis, the remaining teeth in the maxilla were planned for extractions.
The upper arch was planned for implant supported over denture utilizing 4 implants after adequate healing.
The patient underwent IV sedation with extraction on all remaining maxillary teeth and placement of four
implants on the mandible. The patient’s follow-up was uneventful. A 4-month period will be given for the
osseointegration of the mandibular implants, and future placement of maxillary implants on the upper arch for
full mouth rehabilitation.
Abstract accepted for presentation at Robert Schoor Northeast Postgraduate Implant Symposium (October 3–4,
2013)
Immediate Mandibular Implants for Hybrid Prosthesis in a Patient
Taking Bisphosphonates
Ghassan Darwish,* Andras Balint, and David-Joey Chang
Abstract accepted for presentation at Robert Schoor Northeast Postgraduate Implant Symposium (October 3–4,
2013.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
A 64-year-old female presents to our clinic with a chief complaint: “I want new lower teeth.” She has a past
medical history significant for depression, hypothyroidism, hypercholesterolemia, hypertension, GERD,
osteoporosis, breast cancer, and kidney cancer. Her current medication list includes fluoxetine, budeprion,
levothyroxine, simvastatin, atenolol, lisinopril, omeprazole, and vitamin D. She has no known drug allergies
and quit smoking 30 years ago. She recalls taking alendronate for the past 2 years; however, she has been noncompliant with the medication for the past 6 months. She is fully edentulous on the maxilla with a complete
maxillary denture and has remaining teeth 22–28 with significant periodontal disease. She was planned for
extraction of her remaining teeth and a hybrid mandibular prosthesis. The patient underwent extraction of her
remaining teeth with placement of 5 immediate implants in her anterior mandible and bone graft of labial bone
under IV sedation. Her post-operative recovery was complicated by dehiscence of the soft tissue. After 5 months
of healing, she returned with deficient bone over the labial alveolar ridge. In order to salvage the existing
implants, she underwent additional bone grafting using demineralized freeze-dried bone allograft with a nonresorbable, titanium reinforced PTFE membrane under IV sedation. Extensive undermining of the periosteum
was performed to facilitate closure without tension. Her postoperative recovery revealed appropriate healing
with no evidence of soft-tissue dehiscence. After adequate healing, she will be ready for second-stage surgery
followed by hybrid prosthetic reconstruction.
151
Oral Surgery Research
Adult Airway Evaluation in Oral Surgery
James C. Phero,1 Morton Rosenberg,2 and Joseph A. Giovannitti Jr.3
1University
of Cincinnati Academic Medical Center, Cincinnati; 2Tufts University School of Dental
Medicine, Boston; 3University of Pittsburgh School of Dental Medicine, Pittsburgh
Patients with a history of difficult intubation or with conditions associated with difficult airway should be
approached with organized primary and secondary plans for airway management. When these potential
problems are detected, patient safety may be improved with use of advanced airway management techniques
and equipment. Additionally, patient referral for consultation and/or management at facilities where advanced
airway management practitioners and equipment are available may be beneficial in some cases.
Published in Oral Maxillofac Surg Clin North Am. 2013 Aug;25(3):385-399.
Management of Allergy and Anaphylaxis during Oral Surgery
Morton Rosenberg,1 James C. Phero,2 and Joseph A. Giovannitti Jr.3
1Tufts
University School of Dental Medicine, Boston; 2University of Cincinnati Academic Medical
Center, Cincinnati; 3University of Pittsburgh School of Dental Medicine, Pittsburgh
Minor and major allergic reactions occur during oral and maxillofacial treatment. Immediate diagnosis and
pharmacologic intervention are imperative. Signs and symptoms may be variable. The early administration of
epinephrine is critical.
2013 –2014 Faculty Abstracts
Published in Oral Maxillofac Surg Clin North Am. 2013 Aug;25(3):401-406,
152
Student and Faculty Research Abstracts 2013 –2014
Orthodontics
Orthodontics
Fully Customized Placement of Orthodontic Miniplates:
A Novel Clinical Technique
Jan Hourfar,1 Georgios Kanavakis,2 Peter Goellner,3 and Björn Ludwig4
1University
of Heidelberg, Heidelberg, Germany; 2Tufts University School of Dental Medicine,
Boston; 3Private Practice, Bern, Switzerland; 4University of Saarland, Homburg/Saar, Germany
Introduction: The initial stability and survival rate of orthodontic mini-implants are highly dependent
on the amount of cortical bone at their insertion site. In areas with limited bone availability, mini-plates
are preferred to provide effective skeletal anchorage. The purpose of this paper was to present a new clinical
technique for the insertion of mini-plates.
Methods: In order to apply this new technique, a cone-beam image of the insertion area is required. Software
(Galaxy Sirona, Bensheim, Germany) is used to construct a three-dimensional image of the scanned area and
to virtually determine the exact location of the mini-plate as well as the position of the fixation screws. A
stereolithographic model (STL) is then created by means of a three-dimensional scanner. Prior to its surgical
insertion, the bone plate is adapted to the stereo-lithographic model. Finally, a custom transfer jig is fabricated
in order to assist with accurate placement of the mini-plate intra-operatively.
Results: The presented technique minimizes intra-operative decision making, because the final position of
the bone plate is determined pre-surgically. This significantly reduces the duration of the surgical procedure and
improves its outcome.
Published in Head Face Med. 2014 May 3;10(1):14. doi: 10.1186/1746-160X-10-14.
Newly Defined Landmarks for a Three-Dimensionally Based
Cephalometric Analysis: A Retrospective Cone-Beam Computed
Tomography Scan Review
Moonyoung Lee,1 Georgios Kanavakis,1 and R. Matthew Miner2
1Tufts
University School of Dental Medicine, Boston; 2Boston University Goldman School of Dental
Medicine, Boston
Objectives: To identify two novel three-dimensional (3D) cephalometric landmarks and create a novel
three-dimensionally based anteroposterior skeletal measurement that can be compared with traditional twodimensional (2D) cephalometric measurements in patients with Class I and Class II skeletal patterns.
Materials and Methods: Full head cone-beam computed tomography (CBCT) scans of 100 patients
with all first molars in occlusion were obtained from a private practice. InvivoDental 3D (version 5.1.6,
Anatomage, San Jose, California) was used to analyze the CBCT scans in the sagittal and axial planes to create
new landmarks and a linear 3D analysis (M measurement) based on maxillary and mandibular centroids. An
independent samples t-test was used to compare the mean M measurement to traditional 2D cephalometric
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Conclusions: A novel method for surgical placement of orthodontic mini-plates is presented. The
technique facilitates accurate adaptation of mini-plates and insertion of retaining surgical screws, thereby
enabling clinicians to more confidently increase the use of bone plates, especially in anatomical areas where the
success of non-osseointegrated mini-screws is less favorable.
153
Orthodontics
measurements, ANB, and APDI. Interexaminer and intraexaminer reliability were evaluated using 2D and 3D
scatterplots.
Results: The M measurement, ANB, and APDI could statistically differentiate between patients with Class I
and Class II skeletal patterns (p<0.001). The M measurement exhibited a correlation coefficient (r) of −0.79 and
0.88 with APDI and ANB, respectively.
Conclusions: The overall centroid landmarks and the M measurement combine 2D and 3D methods of
imaging; the measurement itself can distinguish between patients with Class I and Class II skeletal patterns
and can serve as a potential substitute for ANB and APDI. The new three-dimensionally based landmarks and
measurements are reliable, and there is great potential for future use of 3D analyses for diagnosis and research.
Published in Angle Orthod. 2014 May 27. [Epub ahead of print]
The Effects of Lip Revision Surgery on Nasolabial Esthetics in Patients
with Cleft Lip
A.M. Mercado,1 C. Phillips,2 K.W. Vig,1 and Carroll Ann Trotman3
1The
Ohio State University, Columbus, Ohio; 2University of North Carolina, Chapel Hill, North
Carolina; 3Tufts University School of Dental Medicine, Boston
Objectives: 1) To determine the concordance among surgeons on subjective assessments of nasolabial
esthetics in children with repaired cleft lip; and 2) to evaluate longitudinal changes in nasolabial esthetics in
relation to cleft lip revision surgery.
2013 –2014 Faculty Abstracts
Setting and Sample Population: School of Dentistry at University of North Carolina, Chapel Hill.
Children with repaired unilateral cleft lip: 32 had lip revision surgery and 27 did not have surgery.
154
Materials and Methods: Retrospective observational study from a non-randomized clinical trial.
Ratings of nasolabial esthetics performed by 6 surgeons using the Asher-McDade scale at baseline and
12-month follow-up.
Results: Concordance among surgeons ranged from poor to acceptable. Nasolabial ratings at follow-up were
better in the revision group than in the non-revision group, although differences were small. The most prevalent
change in the revision group was improvement in one or more units on the scale, while “no change” was most
prevalent in the non-revision group. Participants in the revision group were more likely to receive a “no” in
relation to the need for lip or nose revision at the follow-up visit.
Conclusion: There were mild esthetic improvements observed in relation to lip revision surgery, which
should be interpreted with caution given the subjectivity of the rating method used.
Published in Orthod Craniofac Res. 2014 May 20. doi: 10.1111/ocr.12046. [Epub ahead of print]
Influence of Objective Three-Dimensional Measures and Movement Images
on Surgeon Treatment Planning for Lip Revision Surgery
Carroll Ann Trotman,1 C. Phillips,2 J.J. Faraway,3 T. Hartman,2 and J.A. van Aalst2
1Tufts
University School of Dental Medicine, Boston; 2University of North Carolina, Chapel Hill, North
Carolina; 3University of Bath, Bath, England
Objective: To determine whether a systematic evaluation of facial soft tissues of patients with cleft lip and
palate, using facial video images and objective three-dimensional measurements of movement, change surgeons’
Student and Faculty Research Abstracts 2013 –2014
Orthodontics
treatment plans for lip revision surgery.
Design: Prospective longitudinal study.
Setting: The University of North Carolina School of Dentistry.
Patients, Participants: A group of patients with repaired cleft lip and palate (n=21), a noncleft control
group (n=37), and surgeons experienced in cleft care.
Interventions: Lip revision.
Main Outcome Measures: (1) facial photographic images; (2) facial video images during animations; (3)
objective three-dimensional measurements of upper lip movement based on z scores; and (4) objective dynamic
and visual three-dimensional measurement of facial soft tissue movement.
Results: With the use of the video images plus objective three-dimensional measures, the operating surgeon
changed the problem list of the surgical treatment plan for 86% of the patients (95% confidence interval, 0.64
to 0.97) and the surgical goals for 71% of the patients (95% confidence interval, 0.48 to 0.89). The surgeon
group varied in the percentage of patients for whom the problem list was modified, ranging from 24% (95%
confidence interval, 8% to 47%) to 48% (95% confidence interval, 26% to 70%) of patients, and the percentage
for whom the surgical goals were modified, ranging from 14% (94% confidence interval, 3% to 36%) to 48%
(95% confidence interval, 26% to 70%) of patients.
Conclusions: For all surgeons, the additional assessment components of the systematic valuation resulted
in a change in clinical decision making for some patients.
Published in Cleft Palate Craniofac J. 2013 Nov;50(6):684-95. doi: 10.1597/12-191. Epub 2013 Jul 15.
K.H. Zawawi1 and Marcello Melis2
1King
Abdulaziz University, Jeddah, Saudi Arabia; 2Tufts University School of Dental
Medicine, Boston
Aims: To evaluate the role of third molars in the development of crowding or relapse after orthodontic
treatment in the anterior segment of the dental arch.
Methods: PubMed search of the literature was performed selecting all the articles relevant to the topic and
limiting the studies to controlled trials on humans and written in English. Systematic review was conducted
according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.
Results: A total of 12 clinical studies were included in the review. A high risk of bias was found in most of the
articles, either because the relative items assessed were inadequate or because they were unclearly described. The
third molars were not correlated with more severe anterior tooth crowding in most of the studies. However, four
of them described a different outcome.
Conclusion: Definitive conclusions on the role of the third molars in the development of anterior tooth
crowding cannot be drawn. A high risk of bias was found in most of the trials, and the outcomes were not
consistent. However, most of the studies do not support a cause-and-effect relationship; therefore, third molar
extraction to prevent anterior tooth crowding or postorthodontic relapse is not justified.
2013 –2014 Faculty Abstracts
The Role of Mandibular Third Molars on Lower Anterior Teeth Crowding
and Relapse after Orthodontic Treatment: A Systematic Review
Published in ScientificWorldJournal. 2014;2014:615429. doi: 10.1155/2014/615429. Epub 2014 Apr 30.
Tufts University School of Dental Medicine
155
Pediatric Dentistry Research
PEdiatric Dentistry RESEARCH
Effect of the DentalVibe Injection System on Pain during Local Anesthesia
Injections in Adolescent Patients
David Ching, Matthew Finkelman, and Cheen Loo
Purpose: The purpose of this study was to compare the pain rating scale measurements from an exposure
group (injections with the aid of DentalVibe Injection Comfort System) and control group (traditional
injection without the aid of the DentalVibe) in adolescent patients using self-reported pain during
administration of local anesthetic injections.
Methods: This was a randomized, controlled study. Subjects consisted of 36 10- to 17-year-old patients who
required local anesthesia for dental treatment on both sides of the maxilla or mandible. All subjects received
a conventional injection (control) and an injection using DentalVibe (experimental). A pain rating for each
injection was obtained from subjects using the Wong-Baker FACES Pain Rating Scale.
Results: Statistical analysis using a Wilcoxon signed rank test found a significant reduction in pain ratings for
injections with the DentalVibe when compared to control injections. There was a positive correlation between
the pain rating for control injection and the difference between the two types of injection, indicating that
subjects who reported a higher pain score with the control injection had a greater reduction when DentalVibe
was used.
Conclusion: When compared to a conventional approach, DentalVibe significantly lowered self-reported
pain during local anesthesia injection for adolescent subjects in this study.
2013 –2014 Faculty Abstracts
Published in Pediatric Dentistry 36(1):51-55.
156
Student and Faculty Research Abstracts 2013 –2014
Periodontal Research
PERIODONTAL RESEARCH
Recent Systematic Reviews Comparing Growth Factors in Periodontal
Regeneration
Shatha Al Harthi, Yong Hur, Rory O’Neill, Andreas Paraschis, and Yumi Ogata
Objective: A systematic review was performed to reveal the current consensus in the field of dentistry
regarding which of the following treatment modalities is associated with the greatest periodontal regeneration
(as measured by clinical attachment level, CAL) in patients with intrabony defects: plasma-rich platelets (PRP),
platelet-derived growth factors (PDGF), or enamel-matrix derivative (EMD).
Method: Electronic search was conducted on PubMed, Google Scholar, and OVID for “systematic review,”
“periodontal,” “clinical attachment level,” “plasma-rich platelets,” “platelet-derived growth factors,” and “enamelmatrix derivative.” Articles were included if they were recent (since 2008), were a systematic review or a metaanalysis, focused on intrabony defects in periodontal disease, reviewed PRP, PDGF or EMD, and compared CAL.
Result: Eight articles meeting criteria were identified. In 2008–2009, only 3 articles met criteria, and these
focused on PRP only. For the other 5 articles, 2 focused exclusively on EMD, 1 on PRP, 1 on PDGF, and 1 on
both PRP and PDGF. Regardless of timeframe, authors were hesitant to declare PRP better than placebo or
competing treatments with respect to CAL gain in treatment of intrabony defects in periodontal patients.
PDGF and EMD were reviewed more favorably vs. placebo as well as competing treatments, but the paucity and
heterogeneity of studies prevented the authors from declaring superiority of these treatments.
Methods: In a pilot study, respondents were asked to list the answers to the question, “What is a
periodontist?” The results were consolidated into eight statements. The eight statements were placed into an
anonymous rank-order survey, and more than 1,200 responses were returned. The responses primarily came
from periodontists, hygienists, general practitioners, dental students, and dental hygiene students.
2013 –2014 Faculty Abstracts
Conclusion: There is no consensus on the superiority of PRP, PDGF, or EMD in periodontal regeneration
in periodontal patients with intrabony defects. Few studies exist focusing on PDGF or EMD, and those reported
have mixed results depending upon the comparison group. More studies exist on PRP, but the results suggest
either no effect to a slight superiority in efficacy. Future studies on PDGF and EMD could shed light on
whether, on balance, these treatments are superior to PRP or placebo.
Tufts University School of Dental Medicine
157
Presented at the 2014 AADR General Session in Charlotte, North Carolina. Abstract #654.
A Survey: How Periodontists and Other Dental Professionals View the
Scope of Periodontics
Peter Chang, Joshua Hall, Matthew Finkelman, Angel Park, and Paul Levi Jr.
Background: How do periodontists think of themselves when they define their practices? How do other
dental professionals view the scope of the specialty of periodontology? A strong component of periodontal
residency programs is extracting teeth and preserving or building bony ridges for the eventual placement of
implants. Has the discipline of periodontology moved away from retaining and treating the natural dentition?
By the use of a rank-order survey, the practice of periodontology was defined by periodontists and other dental
professionals.
Periodontal Research
Results: “Periodontists surgically treat advanced gum and bone infection problems” was considered the most
important statement in all of the cohorts. The least important statement considered by all was, “Periodontists
are educators promoting health.” Non-periodontist dentists (NPDs) ranked the statement, “Periodontists
perform dental implants and related procedures” less importantly (p<0.001) than the periodontists. The nonperiodontist cohort (NPC), which includes NPDs and dental hygienists, ranked the statement, “Periodontists’
treatments help general dentists and other specialists increase successful therapeutic outcomes” as second most
important.
Conclusions: The results of this survey indicate that periodontists ranked the placement of implants
and their related procedures higher than the NPC. NPDs appear to value periodontists in treating the natural
dentition for their patients. The NPC appreciates that periodontal therapy done by periodontists increases their
therapeutic success for their patients.
Published in Journal of Periodontology 2014 Jul;85(7):925-33
Growth Factor-Mediated Vertical Mandibular Ridge Augmentation:
A Case Report
Kevin A. Guze,1 Emilio Arguello,2 David Kim,1 Myron Nevins,1 and Nadeem Karimbux2
2013 –2014 Faculty Abstracts
1Harvard
158
School of Dental Medicine, Boston; 2Tufts University School of Dental Medicine, Boston
Posterior vertical alveolar ridge deficiencies are challenging defects to treat predictably and often require
autogenous bone-harvesting procedures. Traditional treatment modalities (e.g., guided bone regeneration,
distraction osteogenesis, and autogenous grafts) present with a number of potential complications and limited
success when used to restore vertical ridge height. Recent advances in recombinant growth factor technology
may provide viable, alternative therapies for the treatment of significant alveolar ridge deficiencies. This proofof-principle case report examines the utility and effectiveness of using a composite graft of freeze-dried bone
allograft and recombinant human platelet-derived growth factor BB in conjunction with an overlying titanium
mesh to regenerate well-vascularized bone in a significant posterior mandibular ridge defect prior to implant
placement. The important role of the overlying periosteum as a possible key source of osteogenic cells during
growth factor-enhanced regenerative procedures is emphasized.
Published in Int J Periodontics Restorative Dent. 2013 Sep-Oct;33(5):611-7. doi: 10.11607/prd.1518
Modified Periosteal Releasing Incision for Flap Advancement:
A Practical Technique for Tensionless Closure
Yong Hur, Minh Bui, Terrence Griffin, and Yumi Ogata
Introduction: Primary closure of a tensionless flap advancement is required following a guided bone
regeneration (GBR) procedure. The periosteal releasing incision (PRI) is a commonly used technique for flap
advancement. However, excessive use of the PRI technique to gain major flap advancement has consequences,
such as swelling, paresthesia, bleeding, and patient discomfort. This article describes a novel technique with
a shallow incision and lateral stretching approach, modified periosteal releasing incision (MPRI), for flap
advancement.
Case Presentation: A 63-year-old nonsmoking Caucasian male presented for implant placement in the
posterior mandibular area. Vertical and horizontal bone augmentation using GBR technique was planned prior
Student and Faculty Research Abstracts 2013 –2014
Periodontal Research
to implant placement due to ridge deficiency. MPRI was utilized for flap advancement. The flap advancement
achieved was greater than 10 mm. Using this technique, a major flap advancement was possible without mental
nerve complications.
Conclusion: MPRI technique introduced in this case report has been used successfully where major flap
advancement was needed to gain primary closure. The technique can be an alternative to the PRI technique
where there is a possibility of damaging the nerve or when flap advancement made by PRI is inadequate,
particularly around the mental foramen.
Published online in Clinical Advances in Periodontics, May 28, 2014 (doi:10.1902/cap.2014.140009).
Popularity of Suture Materials among Residents and Faculty Members of
Postdoctoral Periodontology Program
Mohamed Maksoud,1 Samuel Koo,1,2 Kasumi Barouch,1 and Nadeem Karimbux2
1Harvard
School of Dental Medicine; 2Tufts University School of Dental Medicine
Published in J Investig Clin Dent 2014 Feb 17;5(1):45-50. Epub 2013 Apr 17.
Restoration of Gingival and Esthetic Deformities
following Flap Advancement:
The Physiologically Pigmented Bingival Graft, A Case Report
Eduardo Marcuschamer, T. Tsukiyama, H. Moroi, Charles Hawley, and Terrence Griffin
The coronal advancement of surgical flaps and subsequent shift of the mucogingival junction during bone
augmentation procedures are common. These mucogingival alterations may become a challenge to manage
in the maxillary anterior region among patients with a high lip line upon smiling or high esthetic demands.
To further complicate matters, the presence of physiologic gingival pigmentation in the esthetic zone creates
challenges of its own. In this case, a free gingival graft from the buccal gingiva of the maxillary molars was used
to correct the mucogingival deformity created from a guided bone regeneration procedure.
Published in Int J Periodontics Restorative Dent. 2013 Sep-Oct;33(5):591-7. doi: 10.11607/prd.1252.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
The aim of the present study was to determine the favoritism of suture materials among a group of clinicians
at a teaching institution. The surveys included 11 absorbable and 9 non-absorbable sutures. The surveyor
was asked to select his or her suture preferences when it comes to using it in 13 different, commonlyperformed surgical procedures. The surveys showed overall preferences for non-absorbable versus absorbable
sutures. Chromic gut with a 4–0 diameter thread reverse cutting FS2 needle was the most favored suture. For
periodontal bone grafts and hard tissue ridge augmentation, polytetrafluoroethylene with a 4–0 thread and FS2
needle was preferred. For autogenous gingival grafts, gingival allografts, connective tissue grafts, frenectomy,
and frenoplasty, chromic gut with 5–0 diameter thread reverse cutting P3 needle was favored. For extraction
socket preservation, soft tissue canine exposure, ridge augmentation, and dental implants, chromic gut with
4–0 diameter thread reverse cutting FS2 needle was preferred, and for sinus augmentation, vicryl with a 4–0
diameter thread reverse cutting FS2 needle was favored. Absorbable sutures were preferred in the majority of
periodontal procedures; however, non-absorbable sutures were favored in procedures that required longer
healing or better stability of the flap edges in cases of periodontal and ridge augmentation.
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Periodontal Research
Bio-Absorbable and Non-Absorbable Membrane in Lateral GBR: A
Literature Review
Lorenzo Mordini, Yumi Ogata, Hans-Peter Weber, Paul Stark, and Yong Hur
Objective: Lateral guided bone regeneration (GBR) is a surgical procedure that utilizes absorbable and
non-absorbable barrier membranes for bone augmentation. It has been proven to be a reliable and predictable
procedure to augment bone in a horizontal direction at sites exhibiting insufficient bone volume for implant
placement. The aim of this study is to review literature to obtain evidence-based criteria that helps to elect one
of the two techniques currently used for lateral GBR.
Method: An electronic search on MEDLINE was conducted up to September 2013, supplemented by
cross-checking bibliographies of relevant review articles. The following keywords were used: “alveolar ridge
augmentation,” “lateral ridge augmentation,” “regeneration,” “bone regeneration,” “guided bone regeneration,”
“barrier membranes,” “membranes,” “graft,” “bone grafts,” “bone substitutes.” Only articles in English language
were selected. Animal studies were excluded.
2013 –2014 Faculty Abstracts
Result: A total of 28 articles met the requirements for the study objectives (oldest from 1965 and the most
recent 2012). Non-absorbable membrane showed different advantages towards the bio-absorbables. They
generally provided better time of barrier function and controlled resorption. Bone formation was usually
more favorable in situations of no membrane exposures. Human histologic studies confirmed these findings.
However, some authors have reported opposite results. Non-resorbable membranes resist to breakdown
processes and can maintain adequate defect space by not collapsing. However, they produce frequent postoperative complications (membrane exposure, infection, and soft-tissue dehiscence).
160
Conclusion: Non-absorbable membranes are considered the gold standard in bone augmentation
procedures. Choosing the right material for GBR procedures is crucial. However, the choice of membrane is
still a matter of personal choice based on experience and expert advice with limited scientific evidence. This
literature review failed to identify articles with evidence-based criteria to help in the selection of bio-absorbable
or non-absorbable membrane used for lateral GBR procedures in pristine edentulous areas.
Presented at the 2014 AADR General Session in Charlotte, North Carolina. Abstract #727.
Factors Associated with Tooth Loss following Periodontal
Regenerative Therapy
Yumi Ogata, Minh Bui, Zuhair Natto, James Hanley, and Yong Hur
Objectives: The efficacy of periodontal regenerative therapies has been proven by many animal and human
clinical studies. However, there is little evidence available to support long-term (greater than 5 years) success of
periodontal regenerative therapy. Past studies have demonstrated some patient factors adversely affecting the
outcome of periodontal therapy. The objective of this study was to systemically investigate factors associated
with tooth loss following periodontal regenerative therapy by a retrospective study using a dataset from the
electronic health records (EHR) of patients at Tufts University School of Dental Medicine (TUSDM).
Methods: Patients who have EHR and received periodontal regenerative therapy, including guided tissue
regeneration (GTR), bone replacement graft (BRG), enamel matrix derivative (EMD), and combinations of
these therapies, in the Department of Periodontology at TUSDM from July 2006 to June 2008 were identified
by record review and included in the study. Information regarding patient variables (demographic, systemic,
Student and Faculty Research Abstracts 2013 –2014
Periodontal Research
behavioral, dental, and surgical variables) were extracted from EHR for each patient and used as independent
variables for the analysis. Dental variables include furcation involvement and the numbers of walls of the bony
defects. Surgical variables include the type of membrane, bone graft and EMD used in the surgery.
Results: In the study, 64 teeth (59 patients) were available for data analysis. Results demonstrated that
5-year survival rate of the periodontal regenerative therapy is 91.2%. Defect types (p=0.0003) and furcation
involvement (p=0.002) were significantly related with tooth loss. Gender, location of the tooth, types of bone
graft materials, and types of barrier membrane (PLA/PGA membrane, collagen membrane, or non-resorbable
membrane) were not associated with the outcome.
Conclusions: The result of the study showed high long-term survival rate of periodontal regenerative
therapy. There are factors associated with tooth loss following the procedures.
Presented at the 2014 AADR General Session in Charlotte, North Carolina. Abstract #753.
Use of Polyphenols in Periodontal Inflammation
Iro Palaska, Evangelos Papathanasiou, and Theoharis Theoharides
Published in Eur J Pharmacol. 2013 Nov 15;720(1-3):77-83. doi: 10.1016/j.ejphar.2013.10.047. Epub 2013 Oct 31.
Stress Hormones Regulate Periodontal Inflammation
Evangelos Papathanasiou, Iro Palaska, and Theoharis Theoharides
Periodontal disease involves inflammation of the gingival tissues, caused by microbial pathogens. Recent papers
suggest that emotional stress worsens periodontal disease. Here we review the literature and propose that
corticotropin-releasing hormone (CRH) secreted under stress stimulates gingival mast cells together with other
neuropeptides and cytokines to secrete pro-inflammatory molecules that contribute to periodontal pathology.
Stress reduction and/or mast cell inhibition may provide additional therapeutic approaches.
Published in J Biol Regul Homeost Agents. 2013 Jul-Sep;27(3):621-6.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Periodontitis is an oral inflammatory disease of polymicrobial origin that causes the destruction of gingival
connective tissue and the alveolar bone supporting the teeth. Host immune and inflammatory responses due
to specific periodontopathogens and their metabolic products mediate local tissue destruction. Periodontal
disease affects as many as 30% of adults and it is one of the most common chronic human diseases. However,
traditional therapeutic modalities for periodontitis, including non-surgical or surgical periodontal therapy
and occasional adjunctive antimicrobial therapy, have been only partially successful. Moreover, the widespread
development of antibiotic resistance in pathogenic bacteria and unwanted effects on the gut flora necessitates
new strategies to better control periodontal inflammation. Recently, natural compounds capable of modulating
the host inflammatory response have received considerable attention. Here we review (Pubmed 1997 to 2013)
the orally-related anti-bacterial and anti-inflammatory actions of polyphenols, naturally occurring molecules,
capable of modulating the host inflammatory response. Of these, certain flavonoids appear to stand out because
of their beneficial profile and clinical evidence. Unique formulations of novel flavonoids may be useful for
further development as possible therapeutic agents for periodontal inflammation.
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Periodontal Research
Centipeda periodontii in Human Periodontitis
Thomas E. Rams,1 Charles Hawley,2 Eugene J. Whitaker,1 John E. Degener,3
Arie J. van Winkelhoff3
1Temple
University, Philadelphia; 2Tufts University School of Dental Medicine, Boston; 3University of
Groningen, Groningen, The Netherlands
2013 –2014 Faculty Abstracts
This study assessed the subgingival occurrence of the flagellated, gram-negative, anaerobic rod Centipeda
periodontii in chronic periodontitis and periodontal health/gingivitis with species-specific nucleic acid probes,
and evaluated the in vitro resistance of subgingival isolates to therapeutic levels of amoxicillin, metronidazole,
and doxycycline. Subgingival plaque biofilm specimens from 307 adults with chronic periodontitis and
48 adults with periodontal health/localized gingivitis were evaluated with digoxigenin-labeled, wholechromosomal, DNA probes to C. periodontii ATCC 35019 possessing a 104 cell detection threshold. Fifty-two
C. periodontii subgingival culture isolates were assessed on antibiotic-supplemented enriched Brucella blood
agar for in vitro resistance to either amoxicillin at 2 µg/ml, metronidazole at 4 µg/ml, or doxycycline at 2 µg/ml.
A significantly greater subgingival occurrence of C. periodontii was found in chronic periodontitis subjects as
compared to individuals with periodontal health/gingivitis (13.4 vs. 0%, p<0.003), although high subgingival
counts of the organism (≥106 cells) were rarely detected (1.3% of chronic periodontitis subjects). In vitro
resistance was not found to amoxicillin or metronidazole, and to doxycycline in only 2 (3.9%) of the 52 C.
periodontii clinical isolates studied. These findings indicate that C. periodontii is not a major constituent of the
subgingival microbiome in chronic periodontitis or periodontal health/gingivitis. The potential contribution of
C. periodontii to periodontal breakdown in the few chronic periodontitis subjects who yielded high subgingival
levels of the organism remains to be delineated. C. periodontii clinical isolates were susceptible in vitro to
therapeutic concentrations of three antibiotics frequently used in treatment of human periodontitis.
162
Published in Odontology. 2014 Jul 19. [Epub ahead of print]
Negotiating the Severely Resorbed Extraction Site: A Clinical Case Report
with Histologic Sample
Chin-wei Wang,1 Samuel Koo,1,2 David Kim,1 and Eli E. Machtei 1
1Harvard
School of Dental Medicine; 2Tufts University School of Dental Medicine
The treatment of an infected socket with a severe facial dehiscence/fenestration defect presents a therapeutic
dilemma to the dental team. Both implant-supported restoration and fixed partial denture are viable options to
restore function and occlusion, each with its benefits and disadvantages. In the present case report, a multi-stage
regenerative approach was selected to enable implant-supported single crown. The first phase of the treatment
after extraction of the maxillary central incisor was the stabilization of the blood clot with a collagen plug. After
6 weeks, the surgical site was re-entered and the socket was grafted with biphasic calcium sulfate (BCS). After 6
months, a dental implant was placed and a core biopsy taken. However, the central portion of the facial defect
demonstrated only partial regeneration, resulting in exposure of 6 implant threads. Freeze-dried bone allograft
(FDBA) and a collagen membrane were utilized to augment the ridge and cover the exposed threads. The
histology of the bone core showed a complete resorption of the grafted material with the presence of new woven
bone throughout the specimen. Clinically, complete defect regeneration and augmentation of the alveolar
ridge were attained after 4 months. Thus, the clinician should consider the pros and cons of this regenerative
approach along with other more conservative treatment alternatives when dealing with similar cases.
Published in Quintessence Int 2014;45:203-208.
Student and Faculty Research Abstracts 2013 –2014
Periodontal Research
Adiponectin Ameliorates Experimental Periodontitis in Diet-Induced
Obesity Mice
Lan Zhang,1,2 Shu Meng,1,2 Qisheng Tu,1 Liming Yu,1 Yin Tang,1,2 Michel M. Dard,3 Sung-Hoon
Kim,4 Paloma Valverde,5 Xuedong Zhou,2 and Jake Chen1
1Tufts
University School of Dental Medicine; 2West China Hospital of Stomatology, Sichuan
University, China; 3New York University College of Dentistry, New York, New York; 4College of
Oriental Medicine, Kyung Hee University, Korea; 5Wentworth Institute of Technology, Boston
Published in PLoS ONE 9(5): e97824. doi:10.1371/journal.pone.0097824
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Adiponectin is an adipokine that sensitizes the body to insulin. Low levels of adiponectin have been reported in
obesity, diabetes, and periodontitis. In this study we established experimental periodontitis in male adiponectin
knockout and diet-induced obesity mice, a model of obesity and type 2 diabetes, and aimed at evaluating the
therapeutic potential of adiponectin. We found that systemic adiponectin infusion reduced alveolar bone loss,
osteoclast activity, and infiltration of inflammatory cells in both periodontitis mouse models. Furthermore,
adiponectin treatment decreased the levels of pro-inflammatory cytokines in white adipose tissue of dietinduced obesity mice with experimental periodontitis. Our in vitro studies also revealed that forkhead box
O1, a key transcriptional regulator of energy metabolism, played an important role in the direct signaling of
adiponectin in osteoclasts. Thus, adiponectin increased forkhead box O1 mRNA expression and its nuclear
protein level in osteoclast-precursor cells undergoing differentiation. Inhibition of c-Jun N-terminal kinase
signaling decreased nuclear protein levels of forkhead box O1. Furthermore, over-expression of forkhead box
O1 inhibited osteoclastogenesis and led to decreased nuclear levels of nuclear factor of activated T cells c1.
Taken together, this study suggests that systemic adiponectin application may constitute a potential intervention
therapy to ameliorate type 2 diabetes-associated periodontitis. It also proposes that adiponectin inhibition of
osteoclastogenesis involves forkhead box O1.
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Pharmacology, Therapeutics, and Toxicology
PHARMACOLOGY, THERAPEUTICS, AND TOXICOLOGY
Benefits of Thrombolytics in Prolonged Cardiac Arrest and Hypothermia
over Its Bleeding Risk
R. Gupta,1 Aditi Jindal,2 and H. Cranston-D’Amato1
1St.
Luke’s Hospital, Chesterfield, Missouri; 2Tufts University School of Dental Medicine, Boston
A 52-year-old non-smoking Caucasian male, who was admitted to our emergency room after he was found
unconscious in a bathroom, went into cardiac arrest requiring prolonged cardiopulmonary resuscitation (CPR)
and hypothermia therapy. Cardiac catheterization showed non-obstructive coronary arteries, and further
bedside echocardiogram suggested probable pulmonary embolism (PE) as an underlying cause of cardiac arrest.
Although thrombolytic therapy is an effective therapy for PE, it is not routinely given during prolonged CPR
for its life-threatening bleeding complications. Many reported cases have suggested a beneficial effect of empiric
thrombolytic in cardiac arrest, but unrelated to duration of resuscitation and adjuvant treatments that imposes
bleeding risk. We suspect that tissue plasminogen activator (tPA) should be promptly given to prolonged cardiac
arrest patients, even when bleeding risk is high with the concurrent hypothermia treatment, keeping the benefits
over risk strategy. Our patient received thrombolytic, tPA and showed remarkable clinical, physiological and
radiographical improvement.
2013 –2014 Faculty Abstracts
Published in Int J Crit Illn Inj Sci. 2014 Jan;4(1):88-90. doi: 10.4103/2229-5151.128021.
164
Student and Faculty Research Abstracts 2013 –2014
Prosthodontics Research
PROSTHODONTICS RESEARCH
An In Vitro Comparison of Fracture Load of Zirconia Custom Abutments
with Internal Connection and Different Angulations and Thickness: Part I
Abdalah Albosefi, Matthew Finkelman, and Roya Zandparsa
Purpose: The purpose of this in vitro study was to compare the fracture load of one-piece zirconia custom
abutments with different thicknesses and angulations.
Materials and Methods: Forty zirconia custom abutments were divided into 4 groups. Group A-1 and
group B-1 simulated a clinical situation with an ideal implant position, which allows for the use of straight
zirconia custom abutments with two thicknesses (0.7 and 1 mm). Groups A-2 and B-2 simulated a situation
with a compromised implant position requiring 15° angulated abutments with different thicknesses (0.7 and
1 mm). Implant replicas were mounted in self-cure acrylic jigs to support the abutments in all groups. The
zirconia custom abutments were engaged in the implant replicas using a manual torque wrench. Each jig was
secured and mounted in a metallic vice 30° relative to a mechanical indenter. All groups were subjected to
shear stress until failure using a universal testing machine with a 0.5 mm/min crosshead speed with the force
transferred to the lingual surface of the zirconia custom abutments 2 mm below the top surface. The universal
testing machine was controlled via a computer software system that also completed the stress-strain diagram
and recorded the breaking fracture load. The fracture loads were recorded for comparison among the groups
and subjected to statistical analysis (two-way ANOVA).
Conclusions: There was no statistically significant difference in fracture strength between the 0.7 and 1.0
mm groups; however, angulated zirconia custom abutments had the lowest fracture load.
Clinical Implication: The results of this in vitro study will help dental practitioners with their decisionmaking process in selecting the type of custom abutment to be used clinically.
Published in Journal of Prosthodontics 2014 Jun;23(4):296-301
The Effect of Variations in Translucency and Background on Color
Differences in CAD/CAM Lithium Disilicate Glass Ceramics
Abdulaziz Al Ben Ali, Kiho Kang, Matthew Finkelman, Roya Zandparsa, and
Hiroshi Hirayama
Purpose: The purpose of this study was to compare the effect of variations in translucency and background
on color differences (ΔE) for different shades of computer-aided design and computer-aided manufacturing
(CAD/CAM) lithium disilicate glass ceramics.
Materials and Methods: A pilot study suggested n=10 as an appropriate sample size for the number
of lithium disilicate glass ceramic cylinders per group. High-transparency (HT) and low-transparency (LT)
cylinders (diameter, 12 mm; length, 13 mm) were fabricated in 3 ceramic shades (BL1, A2, C3) using CAD/CAM
technology and were cut into specimen disks (thickness, 1.2 mm; diameter, 12 mm) for placement on natural
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Results: The mean fracture load of zirconia custom abutments across the groups (A-1 through B-2) ranged
from 160±60 to 230±95 N. The straight zirconia custom abutment exhibited the highest fracture load among
the groups (p=0.009); however, the thickness of the zirconia custom abutment had no influence on the strength
of any of the specimens (p=0.827).
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Prosthodontics Research
die (ND1 and ND4) backgrounds. Four combinations of translucency and background color were evaluated
in terms of color differences for the 3 ceramic shades: group 1 (HT ND1, reference); group 2 (HT ND4);
group 3 (LT ND1); and group 4 (LT ND4). A spectrophotometer was used to measure the color differences.
Nonparametric tests (Kruskal-Wallis tests) were used to evaluate the color differences among the tested groups,
and Mann-Whitney U tests with Bonferroni correction were used as post hoc tests. Furthermore, for each
ceramic shade, the HT groups were compared to the LT groups using the Mann-Whitney U test.
Results: Significant differences were present among the tested groups of the same ceramic shade (p<0.001).
The highest ΔE values were observed in the HT ND4 group for BL1, while the lowest ΔE values were found in
the LT ND1 group for both A2 and C3. Further, the HT groups and the groups with a darker background (ND4)
showed increased ΔE values compared with the other groups (p<0.001).
Conclusions: Within the limitations of this study, the results suggested that the translucency and
background color significantly influenced the lithium disilicate glass ceramic color among the BL1, A2, and C3
ceramic shades. Changing the underlying color from a lighter background to a darker background resulted in
increased color differences.
Published in Journal of Prosthodontics 2014 Apr;23(3):213-20
An In Vitro Comparison of the Shear Bond Strengths of Two Different
Gingiva-Colored Materials Bonded to Commercially Pure Titanium and
Acrylic Artificial Teeth
2013 –2014 Faculty Abstracts
Yahya Elzarug, Roger Galburt, Matthew Finkelman, and Hamasat Gheddaf Dam
166
Purpose: The purpose of this study was to compare shear bond strengths between two different gingivacolored materials bonded to titanium alloy discs and acrylic resin artificial teeth.
Materials and Methods: For the first part of this study, 30 titanium alloy disc specimens were embedded
in autopolymerizing resin. These discs were then divided randomly into two groups: heat cure (HT1) and pink
composite (CT1). The discs were sandblasted with 100 μm aluminum oxide particles. For the HT1 group using
silicone molds, a wax-up was performed. After the wax removal step, heat-cured acrylic resin was applied and
processed according to the manufacturer’s recommendations. For the CT1 group using silicone molds, metal
primer II and gum opaque were applied and light cured; pink composite was then applied and light cured. For
the second part of the study, 30 artificial resin first molar teeth were completely embedded in autopolymerizing
resin. Teeth were then divided randomly into two groups: heat cure (HT2) and pink composite (CT2). For the
HT2 group using silicone molds, wax-up was performed. Specimens were then transferred to be processed in the
heat-cured acrylic resin according to the manufacturer’s recommendations. For the CT2 group using silicone
molds, composite primer followed by pink composite were applied and light cured. Shear bond tests were
performed using an Instron 3345 universal testing machine. The shear load at the point of failure was recorded
in Newtons. The force was calculated in MPa by calculating the failure load divided by the surface area. Two
independent-samples t-tests were performed. A significance level of p<0.05 was used for comparison.
Results: This study revealed that the difference in the shear bond strengths of two different gingiva-colored
materials bonded to titanium discs was statistically significant (p=0.012). The difference in the shear bond
strengths of two different gingiva-colored materials bonded to acrylic teeth was statistically significant (p<0.001).
Conclusion: In this in vitro study, heat-cured acrylic resins exhibited higher bonding strengths when
bonded to titanium discs or acrylic artificial teeth in comparison to pink composite resins.
Published in Journal of Prosthodontics, 23(4), 313-319, June 2014.
Student and Faculty Research Abstracts 2013 –2014
Prosthodontics Research
Conversion of an Existing Metal Ceramic Crown to an Interim Restoration
and Nonfunctional Loading of a Single Implant in the Maxillary Esthetic
Zone: A Clinical Report
Konstantinos Michalakis,1 C.D. Kalpidis,2 and Hiroshi Hirayama1
1Tufts
University School of Dental Medicine, Boston; 2Private Practice, Thessaloniki, Greece
Implant placement and immediate placement of an interim restoration can be a safe therapeutic approach with
high survival rates. The technique is often used in the anterior esthetic area because of the better preservation
of the peri-implant soft tissue contours. Traditionally this procedure involves the fabrication of an acrylic resin
implant-supported interim restoration. This clinical report describes the modification of an existing metal
ceramic crown to be used as an implant-supported interim restoration for immediate nonfunctional loading to
achieve an improved esthetic result and optimal support of the adjacent soft tissues.
Published in J Prosthet Dent. 2014 Jan;111(1):6-10. doi: 10.1016/j.prosdent.2013.06.001. Epub 2013 Nov 12.
Immediate Provisionalization and Nonfunctional Loading of a Single
Implant in the Maxillary Esthetic Zone: A Clinical Presentation and
Parameters for Consideration
Konstantinos Michalakis,1 C.D.R. Kalpidis,2 Y. Kirmanidou,2 Hiroshi Hirayama,1
Pasquale Calvani,1 and A.L. Pissiotis2
1Tufts
University School of Dental Medicine, Boston; 2Private Practice, Thessaloniki, Greece
Published in Case Rep Dent. 2013;2013:378062. doi: 10.1155/2013/378062. Epub 2013 Dec 8.
Marginal Adaptation of Four Inlay Casting Waxes on Stone, Titanium, and
Zirconia Dies
Konstantinos Michalakis,1 V. Kapsampeli,2 A. Kitsou,2 Y. Kirmanidou,3 A. Fotiou,2
A.L. Pissiotis,2 Pasquale Calvani,1 Hiroshi Hirayama,1 and Yukio Kudara1
1Tufts
University School of Dental Medicine, Boston; 2Aristotle University Faculty of Health
Sciences, School of Dentistry, Thessaloniki, Greece; 3Private Practice, Thessaloniki, Greece
Statement of Problem: Different inlay casting waxes do not produce copings with satisfactory marginal
accuracy when used on different die materials.
Purpose: The purpose of this study was to evaluate the marginal accuracy of 4 inlay casting waxes on stone
dies and titanium and zirconia abutments and to correlate the findings with the degree of wetting between the
die specimens and the inlay casting waxes.
Tufts University School of Dental Medicine
2013 –2014 Faculty Abstracts
Restoration of single tooth loss with implant supported prosthesis is now considered a highly predictable
treatment. However, the maxillary anterior region still presents a challenge for both the prosthodontist and
the periodontist because of the inherent difficulties encountered in the provisionalization and harmonic
incorporation of the definitive prosthesis into patient’s dentogingival complex. This paper presents a clinical
case of a single implant placed immediately after the extraction of a maxillary central incisor, followed by
immediate provisionalization and nonfunctional loading. The surgical and the restorative techniques are
described, and the parameters of consideration for this approach are presented.
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Prosthodontics Research
Material and Methods: The inlay casting waxes tested were Starwax (Dentaurum), Unterziehwachs
(Bredent), SU Esthetic wax (Schuler), and Sculpturing wax (Renfert). The marginal opening of the waxes
was measured with a stereomicroscope on high-strength stone dies and on titanium and zirconia abutments.
Photographic images were obtained, and the mean marginal opening for each specimen was calculated. A total
of 1,440 measurements were made. Wetting between die materials and waxes was determined after fabricating
stone, titanium, and zirconia rectangular specimens. A calibrated pipette was used to place a drop of molten
wax onto each specimen. The contact angle was calculated with software after an image of each specimen had
been made with a digital camera. Collected data were subjected to a two-way ANOVA (α=0.05). Any association
between marginal accuracy and wetting of different materials was found by using the Pearson correlation.
Results: The wax factor had a statistically significant effect both on the marginal discrepancy (f=158.31,
p<0.001) and contact-angle values (f=68.09, p<0.001). A statistically significant effect of the die material
factor both on the marginal adaptation (f=503.47, p<0.001) and contact-angle values (f=585.02, p<0.001) was
detected. A significant correlation between the marginal accuracy and the contact-angle values (Pearson=0.881,
p=0.01) was also found.
Conclusions: Stone dies provided wax copings with the best marginal integrity, followed by titanium and
zirconia abutments. Unterziehwachs (Bredent) wax produced the best marginal adaptation on different die
materials. A significant correlation was found between the marginal accuracy and the contact-angle values. As
the contact-angle value became smaller, the marginal accuracy improved. All combinations of waxes and stone
and titanium dies presented a high wettability.
2013 –2014 Faculty Abstracts
Published in J Prosthet Dent. 2014 Jul;112(1):70-8. doi: 10.1016/j.prosdent.2014.01.009. Epub 2014 Mar 24.
168
Marginal and Internal Adaptation of Ceramic Crown Restorations
Fabricated with CAD/CAM Technology and the Heat-Press Technique
Hisham Mously, Matthew Finkelman, Roya Zandparsa, and Hiroshi Hirayama
Statement of Problem: The accuracy of chairside computer-aided design and computer-aided
manufacturing (CAD/CAM) restorations is questionable, and the effect of the die spacer settings is not well
stated in the literature.
Purpose: The purpose of the study was to evaluate the marginal and internal adaptation of E4D crowns
fabricated with different spacer thicknesses and to compare these crowns with those fabricated with the heatpress technique.
Material and Methods: The E4D system was used to fabricate 30 crowns for the first 3 groups, with
different spacer thickness settings: 30 μm, 60 μm, and 100 μm. In the fourth group, 10 lithium disilicate crowns
were fabricated with the heat-press technique. The occlusal gap, axial gap, vertical marginal gap, and absolute
marginal discrepancy were evaluated by x-ray microtomography. Statistical significance was assessed with
the Kruskal-Wallis test (α=0.05). For post hoc analyses, the Mann-Whitney U test was used alongside the
Bonferroni correction for multiple comparisons (α=0.008).
Results: Within the CAD/CAM groups, the 30-μm spacer thickness resulted in the lowest median axial gap
(90.04 μm), whereas the 60-μm spacer thickness resulted in the lowest median occlusal gap (152.39 μm). The
median marginal gap values of the CAD/CAM-60 group (49.35 μm) and CAD/CAM-100 group (46.65 μm)
were lower than those of the CAD/CAM-30 group (55.18 μm). No significant differences among the CAD/CAM
groups were observed for absolute marginal discrepancy. The heat-press group had significantly different values
than those of the CAD/CAM groups.
Student and Faculty Research Abstracts 2013 –2014
Prosthodontics Research
Conclusion: The spacer thickness and fabrication technique affected the adaptation of ceramic crowns.
The heat-press group yielded the best marginal and internal crown adaptation results. The 30- or 60-μm spacer
settings are recommended for the E4D CAD/CAM system.
Published in J Prosthet Dent. 2014 Aug;112(2):249-56. doi: 10.1016/j.prosdent.2014.03.017. Epub 2014 Apr 29.
Influence of Coping Design on the Cervical Color of Ceramic Crowns
Gianluca Paniz, Kiho Kang, Yong Jeong Kim, Naota Kumagai, and Hiroshi Hirayama
Statement of Problem: The replication of natural teeth, especially with single-tooth restorations,
represents a challenge. Similar to metal ceramic crowns, different designs of zirconia substructures have been
suggested to improve the esthetic results of zirconia ceramic crowns.
Purpose of Study: The purpose of the study was to analyze the color of the cervical portion of single
zirconia ceramic crowns fabricated with different zirconia coping designs.
Material and Methods: The color, measured on the CIELAB color scale, of 3 different groups of
restorations (n=10) fabricated with zirconia coping (Lava) and feldspathic porcelain (Noritake Super Porcelain)
was analyzed with a spectrophotometer. Conventional zirconia crowns with zirconia facial margins were
compared with ceramic crowns with porcelain facial margins and either a horizontal reduction of the zirconia
coping (1.0 mm reduction) or an additional vertical reduction (1.0 mm additional reduction). The 3 groups,
each with a different coping extension, were examined with a one-way ANOVA and the Fisher exact test, and the
differences of the groups were evaluated by applying ΔE thresholds (α=0.05).
The transition of patients from failing dentition to complete-arch implant rehabilitation often means that
the patient is rendered edentulous and has to wear a removable complete denture for a time. Many patients
find this objectionable. A staged-treatment approach provides a fixed interim prosthesis for use throughout
the rehabilitation process, allowing patient comfort and prosthodontic control. This clinical report describes
a staged-approach protocol with a new type of interim prosthesis. The prosthesis is supported by hopeless
2013 –2014 Faculty Abstracts
Results: The mean color difference among all the groups was not clinically significant (ΔE<3.7). Reduced
color differences were present between the 2 porcelain butt margin groups of crowns (ΔE=1.06, between group
H and V). Increased differences were present between the zirconia margin group and the porcelain butt margin
group (ΔE=2.54 between group C and H; ΔE=2.41 between group C and V). L*a*b* values were examined in all
the groups of crowns to determine the clinical implications.
Tufts University School of Dental Medicine
169
Conclusions: Within the limitation of the study, no significant differences were present among the tested
groups of crowns. Nevertheless, although some differences were present between the zirconia margin group and
the porcelain butt margin group, reduced differences were present between the 2 different cutback designs.
Published in J Prosthet Dent. 2013 Dec;110(6):494-500. doi: 10.1016/j.prosdent.2013.08.005. Epub 2013 Oct 28
Transition from Failing Dentition to Complete-Arch Implant Rehabilitation
with a Staged Approach: A Three-Year Clinical Report
Panos Papaspyridakos 1,2 and V. Chronopoulos 2
1Tufts
University School of Dental Medicine, Boston; 2National and Kapodistrian University of
Athens, School of Dentistry, Athens, Greece
Prosthodontics Research
teeth and the soft tissues of the maxillary tuberosities and mandibular retromolar pads for the complete-arch
implant rehabilitation of a patient with failing dentition. This protocol allows for a fixed interim prosthesis with
combined tooth and mucosa or implant support during the entire rehabilitation process, thus avoiding the use
of complete dentures. The implants and prostheses were functioning successfully after 3 years of clinical service.
Published in J Prosthet Dent. 2014 Sep;112(3):423-8. doi: 10.1016/j.prosdent.2014.01.003. Epub 2014 Mar 14.
An In Vitro Comparison of Shear Bond Strength of Zirconia to Enamel
Using Different Surface Treatments
Roya Zandparsa, Nayrouz Talua, Matthew Finkelman, and Scott Schaus
2013 –2014 Faculty Abstracts
Purpose: The purpose of this in vitro study was to compare the shear bond strength of an airborne-particle
abraded zirconia, an acid-etched zirconia (piranha solution), an alloy primer-treated zirconia, and a silaned
zirconia to enamel, all bonded with a phosphate-methacrylate resin luting agent.
170
Materials and Methods: Seventy extracted intact human molars were collected, cleaned, and mounted
in autopolymerizing acrylic resin, with the experimental surface of the teeth exposed. The specimens were
randomly divided into seven groups of zirconia specimens (4 mm diameter, 2 mm thick): group 1, airborneparticle abrasion; group 2, airborne-particle abrasion and Z-PRIME Plus; group 3, airborne-particle abrasion
and alloy primer; group 4, piranha solution 7:1; group 5, piranha solution 7:1 and Z-PRIME Plus; group 6,
piranha solution 7:1 and alloy primer; group 7, CoJet and silane. All specimens were luted with a phosphatemethacrylate resin luting agent (Panavia F2.0) and stored in distilled water for 1 day, then thermocycled
(5°C and 55°C) for 500 cycles and tested for shear bond strength (SBS), measured in MPa, with a universal
testing machine at a 0.55 mm/min crosshead speed. All specimens were inspected under a scanning electron
microscope to determine mode of failure. The mean values and standard deviations of all specimens were
calculated for each group. A one-way ANOVA was performed, and multiple pairwise comparisons were then
completed with post hoc Tukey test (α = 0.05).
Results: The airborne-particle abrasion and Z-PRIME Plus group resulted in a significantly higher SBS
than the other groups (21.11±6.32 MPa) (p<0.001). The CoJet and silane group (15.99±8.92 MPa) and
airborne-particle abrasion and alloy primer group (11.07±4.34 MPa) showed high shear bond strength but
not statistically significant from the airborne-particle abrasion group (14.23±5.68 MPa). Failure mode was
predominately mixed in groups 1, 2, 3, and 7 with islands of retained resin on the zirconia and enamel surfaces;
however, groups 4, 5, and 6 showed mostly adhesive failures, which left the zirconia surface free of the adhesive
materials. No cohesive failures of the substrates (ceramic, resin, or enamel) were observed.
Conclusion: Airborne-particle abrasion followed by the application of a zirconia primer produced the
highest bond strength to enamel. Therefore, it can be recommended as a promising surface treatment method
to achieve a durable bond to densely sintered zirconia ceramics.
Published in Journal of Prosthodontics 2014 Feb;23(2):117-23
Student and Faculty Research Abstracts 2013 –2014
Salivary and Lacrimal Gland Research
SALIVARY AND LACRIMAL GLAND RESEARCH
Salivary Cortisol, Salivary Alpha Amylase, and the Dental Anxiety Scale
Hana Sadi, Matthew Finkelman, and Morton Rosenberg
The aim of this study was to investigate the correlation between dental anxiety, salivary cortisol, and salivary
alpha amylase (sAA) levels. Furthermore, the aim was to look into individual differences such as age, race,
gender, and any existing pain or traumatic dental experience and their effect on dental anxiety. This study
followed a cross-sectional design and included a convenience sample of 46. Every patient was asked to complete
the dental anxiety scale (DAS) and a basic demographic/dental history questionnaire. A saliva sample, utilizing
the method of passive drooling, was then collected in 2-mL cryovials. Samples were analyzed for salivary
cortisol and sAA levels by Salimetrics. Significant associations were observed between DAS scores and presence
of pain and history of traumatic dental experience. However, no significant correlations were observed between
DAS, cortisol, and sAA levels. Our study reconfirms that dental anxiety is associated with presence of pain and
a history of traumatic dental experience. On the other hand, our study was the first to our knowledge to test
the correlation between the DAS and sAA; nevertheless, our results failed to show any significant correlation
between dental anxiety, cortisol, and sAA levels.
Published in Anesthesia Progress, 60(2): 46-53.
2013 –2014 Faculty Abstracts
Tufts University School of Dental Medicine
171
Statistics Research
STATISTICS RESEARCH
Shortening the Current Opioid Misuse Measure via Computer-Based
Testing: A Retrospective Proof-of-Concept Study
Matthew Finkelman, Ronald Kulich, Driss Zoukhri, Niels Smits, and Stephen Butler
Background: The Current Opioid Misuse Measure (COMM) is a self-report questionnaire designed to help
identify aberrant drug-related behavior in respondents who have been prescribed opioids for chronic pain. The
full-length form of the COMM consists of 17 items. Some individuals, especially compromised individuals, may
be deterred from taking the full questionnaire due to its length. This study examined the use of curtailment
and stochastic curtailment, two computer-based testing approaches that sequentially determine the test length
for each individual, to reduce the respondent burden of the COMM without compromising sensitivity and
specificity.
Methods: Existing data from n=415 participants, all of whom had taken the full-length COMM and had
been classified via the Aberrant Drug Behavior Index (ADBI), were divided into training (n=214) and test
(n=201) sets. Post-hoc analysis of the test set was performed to evaluate the screening results and test lengths
that would have been obtained if curtailment or stochastic curtailment had been used. Sensitivity, specificity,
and average test length were calculated for each method and compared with the corresponding values of the
full-length test.
2013 –2014 Faculty Abstracts
Results: The full-length COMM had a sensitivity of 0.703 and a specificity of 0.701 for predicting the ADBI.
Curtailment reduced the average test length by 22% while maintaining the same sensitivity and specificity as
the full-length COMM. Stochastic curtailment reduced the average test length by as much as 59% while always
obtaining a sensitivity of at least 0.688 and a specificity of at least 0.701 for predicting the ADBI.
172
Conclusions: Curtailment and stochastic curtailment have the potential to achieve substantial reductions
in respondent burden without compromising sensitivity and specificity. The two sequential methods should be
considered for future computer-based administrations of the COMM.
Published in BMC Medical Research Methodology 13, 126.
Curtailment: A Method to Reduce the Length of Self-Report
Questionnaires While Maintaining Diagnostic Accuracy
Marjolein Fokkema, Niels Smits, Matthew Finkelman, Henk Kelderman, and Pim Cuijpers
Minimizing the respondent burden and maximizing the classification accuracy of tests is essential for efficacious
screening for common mental health disorders. In previous studies, curtailment of tests has been shown to
reduce average test length considerably without loss of accuracy. In the current study, we simulate deterministic
(DC) and stochastic (SC) curtailment for 3 self-report questionnaires for common mental health disorders,
to study the potential gains in efficiency that can be obtained in screening for these disorders. The curtailment
algorithms were applied in an existing dataset of item scores of 502 help-seeking participants. Results indicate
that DC reduces test length by up to 37% and SC reduces test length by up to 46%, with only very slight
decreases in diagnostic accuracy. Compared to an item response theory based adaptive test with similar test
length, SC provided better diagnostic accuracy. Consequently, curtailment may be useful in improving the
efficiency of mental health self-report questionnaires.
Published in Psychiatry Research, 215(2): 477-482.
Student and Faculty Research Abstracts 2013 –2014
Statistics Research
Variable Length Testing Using the Ordinal Regression Model
Niels Smits and Matthew Finkelman
Health questionnaires are often built up from sets of questions that are totaled to obtain a sum score. An
important consideration in designing questionnaires is to minimize respondent burden. An increasingly
popular method for efficient measurement is computerized adaptive testing; unfortunately, many health
questionnaires do not meet the requirements for this method. In this paper, a new sequential method for
efficiently obtaining sum scores via the computer is introduced that does not have such requirements and is
based on the ordinal regression model. In the assessment, future scores are predicted from past responses and
when an acceptable level of uncertainty is achieved, the procedure is terminated. Two simulation studies were
performed to illustrate the usefulness of the procedure. The first used artificially generated symptom scores, and
the second was a post-hoc simulation using real responses on the Center for Epidemiologic Studies Depression
scale. In both studies, the sequential method substantially reduced the respondent burden while maintaining a
high sum score quality. Benefits and limitations of this new methodology are discussed.
Published in Statistics in Medicine 33(3):488-499.
2013 –2014 Faculty Abstracts
Tufts University School of Dental Medicine
173
Index of Authors
A
C
F
Ahluwalia, Ivy, 23
Ahmadian, Sheeva, 83
Al-Abdullah, Khaled, 135
Albosefi, Abdalah, 165
Aldeeb, Laila, 118
Al Harthi, Shatha, 157
Ali, Abdulaziz Al Ben, 165
Alikpala, Marissa, 96
Alshuhail, Ola, 97
Alt-Holland, Addy, 27, 80, 85, 92,
112, 113, 125, 126, 144
Amato, Robert, 134
Andreeva, Viktoria, 36, 116, 117
Antonellou, Ekaterini, 136
Arguello, Emilio, 158
Ashrafi, Alireza, 84, 98
Au, Jennifer, 133
Avila-Ortiz, Gustavo, 138
Caine, Julia, 76
Calvani, Pasquale, 139, 167
Cannavo, Matthew, 34
Cartsos, Vassiliki, 111
Chaimattayompol, Nopsaran,
60, 136
Chand, Sanjay, 130
Chang, David-Joey, 151
Chang, Peter, 157
Chao, William, 28, 35, 48
Chaudhary, Sanjeet, 150
Cheng, David, 36
Cheng, Jessica, 145
Chen, Jake, 43, 91, 141, 145, 163
Chen, Jimmy, 36
Chen, Liang, 73
Ching, David, 156
Cho, Dave, 37
Chomitz, Virginia Rall, 106
Ciciolla, Elena, 38, 90
Cohen, Rachel, 40
Coleman, Daniel, 101
Constantine, John, 41
Correa, Leopoldo, 97
Cuijpers, Pim, 172
Finkelman, Matthew, 29, 34, 35, 47,
53, 55, 62, 68, 77, 79, 84, 89, 101,
104, 108, 118, 122, 134, 135, 136,
137, 148, 149, 150, 156, 157, 165,
166, 168, 170, 171, 172, 173
Fokkema, Marjolein, 172
Foong, Wai-Choong, 130
Fox, Lindsay, 46
Frantz III, David, 83
B
Bagher, Sarah, 104
Baldwin, Riley, 24
Baleja, James, 27, 80, 85, 92, 113
Balint, Andras, 99, 151
Banerjee, Hiya, 110
Bardwell, David, 118
Bauer, Amy, 82
Beleja, James, 112
Belous, Bradley, 68
Beninati, Christopher, 25, 66, 78
Benitez, Alyssa, 26
Benitez, Christian, 26
Bhasin, Ranju, 100
Bhatt, Sapan, 25, 45, 57, 86, 119
Bingham, Elizabeth, 27, 80
Bischof, Mark, 137
Bishop, Jonathan, 28, 35
Brady, Tyler, 41
Brown, William, 29
Brue, Stephanie, 31
Bui, Minh, 32, 158, 160
Butler, Stephen, 172
174
D
Danielson, Jared, 111
Darwish, Ghassan, 151
Devine, Matthew, 43
Doherty, Eileen, 125, 126
Dooley, Daniel, 45, 66, 78
Dragan, Irina, 102, 128, 129
E
Eisen, Steven, 28, 68, 81, 132
Elfallah, Khadiga, 105
Elhamdy, Samia, 136
El Huni, Rabie, 105
Elia, Roberto, 41
Elzarug, Yahya, 166
Epstein, Lynn, 108
Esshaki, Diana, 130
G
Galburt, Roger, 105, 166
Ganda, Kanchan, 130
Ganguly, Rumpa, 124
Garlick, Jonathan, 50, 76, 113, 130
George, Ryan, 47
Gerami-Naini, Behzad, 50
Ghaffari, Ruby, 23
Gheddaf Dam, Hamasat, 137, 166
Gibert, Yann, 116, 117
Gilmore, William, 99
Girn, Vishavjeet, 48, 83
Gobbato, Luca, 138
Goldfein, Joshua, 134
Greenblatt, David, 108
Griffin, Terrence, 158, 159
Guidry, Jennifer, 103
H
Hall, Joshua, 157
Hanley, James, 149, 160
Han, Qianqian, 43, 91
Harmatz, Jerold, 108
Harsono, Masly, 23, 34, 38, 47, 48,
55, 64, 66, 70, 78, 89, 90, 104, 120,
121, 138
Hawley, Charles, 159, 162
Hewitt, Kyle, 113
Hirayama, Hiroshi, 118, 122, 135,
139, 165, 167, 168, 169
Houk, Kathryn, 144
Hur, Yong, 149, 157, 158, 160
Student and Faculty Research Abstracts 2013 –2014
I
Ing, Melissa, 28, 35, 83
J
Jarmoc, Marcin, 150
Jean-Marie, Sheina, 94
Jenkins, Jasmine, 49
Jiang, Hua, 145
Jindal, Aditi, 104, 164
=Job, Jayakaran, 110
John, Stephanie, 23, 55, 81,
89, 120
Jutla, Rajvir, 50
K
Kamlarz, Samuel, 92
Kanavakis, Georgios, 29, 153
Kang, Kiho, 165, 169
Kaplan, David, 41
Karapanou, Virginia, 51
Karimbux, Nadeem, 102, 126,
127, 128, 129, 130, 131, 132,
138, 158, 159
Kazes, Elaina, 51
Keck, Samantha, 53
Kelderman, Henk, 172
Khader, Ruba, 150
Khieng, Sothy, 110
Kim, Douglas, 54, 56, 65
Kim, Ester, 107
Kim, Julia, 55
Kim, Yong Jeong, 169
Klein, Brian, 32
Ko, Alice, 54, 56, 65
Koch-Weser, Susan, 106
Koo, Samuel, 130, 132, 139,
159, 162
Kovary, Lindsay, 23
Kreitzer, Michael, 45, 57, 119
Kudara, Yukio, 167
Kugel, Gerard, 28, 29, 31, 34,
35, 41, 45, 46, 48, 55, 57, 64,
66, 68, 74, 78, 81, 82, 89, 119,
121, 122, 132, 136, 138
Kulich, Ronald, 172
Kumagai, Naota, 169
Kunduru, Hemanth, 59, 61
L
LaBonty, Melissa, 116, 117
Larsen, Chase, 60
Lattanzi, Victoria, 117
Leader, David, 148
Leahy, Leah, 92
Lee, Judyth, 47, 61
Lee, Moonyoung, 153
Leikin, Jennie, 62
Leung, Heather, 63
Levi Jr., Paul, 101, 157
Liang, Olin, 87
Liu, Wei, 64
Lobel, William, 60
Logigian, Jennifer, 96
Loo, Cheen, 103, 104, 106,
107, 156
Lugo, Andrea, 94
Luo, En, 141
M
Magnuson, Britta, 53, 62, 84,
121, 138
Mahdavi, Maryam, 54, 56, 65
Maione, Anna, 50, 76
Maragliano-Muniz, Pamela, 115
Marcuschamer, Eduardo, 159
Mariano, Alissa, 66, 78
Marshak, Helen Hopp, 110
Marzouca, Lauren, 68
Masse, Gina, 108
McEwen, Kyler, 70
McGuinness, Brianne, 100
McKinney, Sharod, 72
Medici, Damian, 87
Mehta, Noshir, 128, 147
Melis, Marcello, 155
Mendez, Zuzana, 94
Meng, Shu, 145, 163
Tufts University School of Dental Medicine
Merikas, Amanda, 73
Michalakis, Konstantinos, 139, 167
Michelson, Courtney, 74
Minihan, Paula, 109
Montgomery, Susanne, 110
Mordini, Lorenzo, 160
Morgan, John, 24, 54, 56, 65, 77,
79, 108, 109
Mously, Hisham, 168
Muadab, Rami, 105
Murphy, Jennipher, 126
Murray, Dana, 141, 145
Must, Aviva, 106
N
Najm, Semaan Abi, 137
Natto, Zuhair, 109, 110, 134, 160
Nedir, Rabah, 137
Newman, Taylor, 102, 129
Nieto-Herman, Aidee, 26, 94
Nolan, John, 85, 113
Nurdin, Nathalie, 137
O
O’Brien, Joanne, 76
Ogata, Yumi, 149, 157, 158, 160
O’Neill, Rory, 157
Oreadi, Daniel, 150
Orfanidis, John, 47
P
Palaska, Iro, 161
Palmer, Carole, 106
Paniz, Gianluca, 169
Paolino, Christopher, 68
Papageorge, Maria, 84, 98, 99
Papas, Athena, 40, 53, 108, 109,
143, 148, 149
Papaspyridakos, Panos, 140, 169
Papathanasiou, Evangelos, 161
Paraschis, Andreas, 157
Park, Angel, 24, 31, 35, 40, 48,
51, 54, 56, 65, 79, 81, 103, 107,
109, 157
175
Park, Hubert, 106
Patel, Khusbu, 77
Penn, Christina, 66, 78
Perry, Ronald, 23, 25, 32, 38, 45,
46, 47, 57, 59, 61, 64, 66, 70, 74,
78, 86, 89, 90, 93, 118, 119, 120,
121, 123, 138
Piacquadio, Christina, 79
Pimentel, Arlene, 94
Pore, Shruti, 27, 80
Prabhudesai, Shubhangi, 116, 117
R
Ramesh, Aruna, 51, 124
Ramirez, Diana, 87
Ramirez, Melissa, 87
Ramsey, Kane, 29
Reisig, Jessie, 81
Rich, Alfred, 103, 104, 107
Richer, Justin, 82
Rios, Maribel, 145
Robinson, Courtney, 83
Rosenberg, Gregory, 111
Rosenberg, Morton, 98, 99, 150,
152, 171
S
Sabooree, Sepideh, 84, 98
Sadi, Hana, 171
Saffari, Shawheen, 85, 92, 113
Saksena, Yun, 37, 49, 63, 88
Salud, Margaret, 110
Samaha, Sara, 25, 86
Saxena, Rituraj, 110
Schaus, Scott, 170
Schumann, Roman, 98, 150
Scott, Tammy, 108
Servais, Jacqueline, 87
Shah, Devina, 107
Shamirian, Paul, 83
Shamis, Yulia, 113
Shim, Laura, 88
Singh, Mabi, 40, 53, 149
Singh, Pramil, 110
176
Slowikowski, Leslie, 89
Small, Jesse, 38, 90
Smith, Avi, 50, 76
Smith, Kyle, 91
Smith, Pamela, 92, 112
Smits, Niels, 172, 173
Sohrabi, Keyvan, 138
Soroushian, Sheila, 124
Spear, Daisy, 114
Speirs, Chad, 134
Stark, Paul, 37, 49, 63, 82, 88,
102, 108, 129, 132, 138, 160
Sun, Lingxia, 106
X
T
Z
Talua, Nayrouz, 170
Tang, Yin, 43, 145, 163
Tao, Wen, 108
Tay, Ronney, 85, 92, 113
Tejada, Elimin, 94
Theoharides, Theoharis, 161
Tonet-Wescott, Ana, 94
Towers, Jennifer, 123
Trotman, Carroll Ann, 154
Tsao, Michelle, 93
Tu, Qisheng, 43, 91, 141, 145, 163
Zadmehr, Azadeh, 72
Zandparsa, Roya, 122, 123, 135,
165, 168, 170
Zavras, Athanasios, 111
Zhang, Jin, 141, 145
Zhang, Lan, 43, 145, 163
Zhang, Weibo, 114
Zhao, Chengtian, 116, 117
Zheng, Leilei, 145
Zoukhri, Driss, 148, 172
Xuan, Donying, 43
Y
Yaghmoor, Wael, 149
Yan, Shi-guo, 141
Ye, Jin-Hai, 141
Yel, Daravuth, 110
Yelick, Pamela, 36, 72, 112, 114,
116, 117
Yoo, Sage, 83
Yu, Liming, 145, 163
Yun, Esther, 95
V
Valverde, Guilherme, 60
Vazquez, Betsy, 114
Velayo, Bianca, 132
Viswanath, Archana, 84, 98, 99, 147
Vlahakis, James, 120
W
Webb, Michelle, 94
Weber, Hans-Peter, 60, 137, 140,
142, 160
Wright, Wanda, 24, 54, 56, 65, 77,
79, 133
Wu, Xueying, 105
Wu, Yuwei, 91, 145
Student and Faculty Research Abstracts 2013 –2014
NOTES
Dental Research Administration
Tufts University School of Dental Medicine
One Kneeland Street, DHS 1513
Boston, MA 02111
617-636 - 4045
Celebrating Excellence
and Achievement in Research
2014 –2015 Research Abstracts
2
Student and Faculty Research Abstracts 2014 –2015
Table of Contents
History of Bates-Andrews Day | Message from Dean Thomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Message from Dr. Kugel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Acknowledgements: Corporate Partners | Special Thanks to Faculty and Students. . . . . . . . . . . . . . . . . . . . 6
Bates-Andrews Day Proceedings | Keynote Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Bates-Andrews Day 2015 Awards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Predoctoral Student Presentations by Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Postdoctoral Student Presentations by Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Faculty Abstracts by Subject Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Student Presentations And Abstracts
Predoctoral Student Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Postdoctoral Student Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Faculty Abstracts
Behavioral, Epidemiologic, and Health Services Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Cancer Biology and Tissue Engineering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Craniofacial Biology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Dental Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Diagnostic Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Education Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Endodontics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Geriatric Oral Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Implantology Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Mineralized Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Neuroscience /TMJ/Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Oral Health Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Oral Surgery Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Orthodontics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Pediatric Dentistry Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Periodontal Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Prosthodontics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
Statistics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Tissue Engineering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Index of Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Tufts University School of Dental Medicine
3
History of Bates-Andrews Day
Since the 1930s, this day is held annually to honor George A. Bates, an alumnus of Tufts University
School of Dental Medicine, who taught Tufts medical and dental students. He was regarded by his
students as an inspiring instructor in histology. Bates Day at TUSDM helps to promote student
research and thereby enhance the opportunities for professional growth of our students, alumni, and
faculty.
The Robert R. Andrews Society is a student-run organization formed in 1921 in honor of Dr.
Andrews, an outstanding researcher and distinguished dental surgeon. The Andrews Society seeks
to promote dental research and to honor those who excel in it.
Message From the Dean
Welcome to Bates-Andrews Day 2015, a showcase of our predoctoral and postgraduate students’
research activities. This year’s event will be one of the largest, with 72 student poster presentations.
We appreciate your attendance and support of our students’ efforts.
We are very pleased to have as our Keynote Speaker, Dr. Ancy Verdier, A96, D03, DG06, who is
expected to present “The Complete Clinician: Evidence Based Research in the Dental Office.” Dr.
Verdier is a Bates-Andrews Day “veteran,” having presented his student research at the event in
2001.
Bates-Andrews Day gives our students the opportunity to share with the rest of the Tufts
community their accomplishments in fields of special interest. I applaud them for their initiative and
achievements.
Strengthening and increasing research activity and creating an environment that encourages and
supports student participation in research are integral parts of the School’s strategic plan. Student
research is also a key accreditation standard for dental education programs.
I appreciate the dedication of the faculty advisors for their mentorship. Special thanks go to the
judges and the participation of the commercial exhibitors who help make this event possible.
Finally, Eileen Doherty’s guidance as director of predoctoral student research and Dr. Gerard Kugel’s
leadership as associate dean for research are highly valued as they greatly enhance our students’
research experiences.
Huw F. Thomas, B.D.S., M.S., Ph.D.
Dean and Professor of Pediatric Dentistry
4
Student and Faculty Research Abstracts 2014 –2015
Message From Dr. Kugel
The research mission of Tufts University School of Dental Medicine promotes integration of
innovative studies in basic science, clinical practice, and public health. This book is evidence of
the progress we have made and will continue to make at the Dental School.
TUSDM welcomes the valuable partnerships and contributions of corporations, foundations,
NIH, and NIDCR tour mission. Working together, we have the means to perform ethical,
meaningful research in oral and general healthcare that can be applied for the benefit of the
scientific community and the public at large.
Researchers at TUSDM conduct studies in many areas, including bench and clinical studies
in dental materials, devices, and pharmaceuticals. We are presently pursuing groundbreaking
techniques in tissue engineering, bone remodeling, and Sjögren’s syndrome. Tufts also
provides a wealth of opportunities for interdisciplinary research with our schools of nutrition,
biomedical sciences, veterinary medicine, and engineering.
The combination of disciplines and talent at Tufts University provides the ideal environment
for collaborative research and materials testing. Our record of contributions to the sciences and
our potential to influence the future of dental medicine are extensive.
As we work to continually promote oral health and improve the quality of life for the general
population, we remain aware that strategic partnerships are vital to our efforts. We recognize
the power of shared knowledge and are always looking to share resources and ideas. The pages
ahead reveal a sample of our achievements thus far.
Gerard Kugel, D.M.D., M.S., Ph.D.
Professor and Associate Dean for Research
Tufts University School of Dental Medicine
5
Acknowledgements
Corporate Partners
The following commercial exhibitors and contributors helped to make this year’s
Bates-Andrews Day successful:
3M ESPE
Johnson & Johnson
American Dental Partners
Dr. Chad Anderson, D04
Drs. Kane, Tesini, Soporowski
& Associates LLP
Aspen Dental Management
Living Legacy Financial Group
Benco Dental Company
Massachusetts Dental Society
Brasseler USA
Dr. Kistama Naidu, D02
Colgate Oral Pharmaceuticals
OraPharma
DENTSPLY
Patterson Dental
Designs for Vision
The Procter & Gamble Company
Door to Door Dental
Shofu Dental Corp.
Eastern Dentists Insurance Company
Sullivan-Schein Dental
Gentle Communications, LLC
Surgitel Systems
GlaxoSmithKline
Ultradent Inc.
Great Expressions Dental Centers
Voco
Tufts University acknowledges the support of these sponsors and corporate attendees, but does not necessarily share their views
and does not endorse, support, or promote any of the sponsors, corporate attendees, or their services or products.
Special thanks to the following Tufts faculty and students
Research Committee
Dr. Tofool Alghanem
Dr. Addy Alt-Holland
Dr. Jake Chen
Dr. Wai Cheung
Prof. Eileen Doherty
Dr. Diana Esshaki
Dr. Michael Kahn
Dr. Gerard Kugel
6
Dr. Athena Papas
Dr. Alfred Rich
Dr. Naomi Rosenberg
Dr. Bjorn Steffensen
Ms. Jennifer Towers
Dr. Archana Viswanath
Dr. Pamela Yelick
Dr. Driss Zoukhri
Bates Student Research Group
and Andrews Society Officers
Lindsay Fox, President
Rachel Cohen, Vice President
Jessie Reisig, Secretary
Jonathan Bishop, Treasurer
Joann O’Brien, Public Relations
Student and Faculty Research Abstracts 2014 –2015
Bates-Andrews Day 2015
Wednesday, March 4, 2015
Schedule of events
11:00 am –3:00 pm
Predoctoral and Postdoctoral Student Posters on Display
Commercial Exhibitors
3:30 pm –4:30 pmKeynote Speech
4:30 pm
Awards Presentation and Reception
Keynote Address
The Complete Clinician:
Evidence-Based Research in the Dental Office
Ancy Verdier, D.M.D.
Diplomate American Board of Periodontology
Dr. Ancy Verdier is the founder of East End Periodontics and Worcester
Periodontics, periodontal dental practices with offices in Worcester,
Massachusetts, and East Hampton, New York, where he practices
periodontology and implant dentistry. He earned his B.A. in psychology
from Tufts University, where he served as student body president and was
the winner of the coveted Wendell Phillips Award (sole student speaker
at graduation). Following his graduation, Dr. Verdier completed the post
baccalaureate program at Harvard University then matriculated at Tufts
University School of Dental Medicine. After receiving his Doctor of Dental
Medicine, Dr. Verdier completed a prestigious three-year residency program in periodontology at Tufts
University School of Dental Medicine after which he was awarded Diplomate status by the American
Academy of Periodontology.
Dr. Verdier is a former clinical associate professor at NYU School of Dentistry, is currently an
attending at Interfaith Medical Center, and is a frequent speaker at national dental meetings and
oral-health seminars. He is the Young Alumni chair for Tufts University School of Dental Medicine,
ambassador of American Academy of Periodontology Foundation, and a trustee of Evidence, A
Dance Company. He has also been recognized by the trustees of the Southampton Library and
Bridgehampton Child Care/Recreational Center for his support of their organizations.
Tufts University School of Dental Medicine
7
Bates-Andrews research Day 2015
8
Student and Faculty Research Abstracts 2014 –2015
Bates-ANdrews Day 2015 Awards
Best Postgraduate Poster Presentation
Dr. Sage Yoo —“The Influence of Community Service Learning Externship on Pre-doctoral Dental Students’
Future Management of Pediatric Patients”
Best Scientific Research Presentation by a Senior (Andrews Society Award)
Elizabeth Bingham —“Dab2-E-cadherin Duo: A New Role in Squamous Cell Carcinoma Development”
ADA/DENTSPLY Student Clinician Award for Best Overall Predoctoral Table Clinic
Jason Berglund —“Manipulating Intracellular Pressure in Invading Oral Cancer Cells”
Second Place Award for Predoctoral Table Clinic
Maryam Mahdavi —“Oral-Health Status/Outcomes Assessment of Oral-Health Program in Zambia”
Third Place Award for Predoctoral Table Clinic
Ronney Tay —“Generation of Three-Dimensional Bioengineered Tissue Constructs of
Nasopharyngeal Carcinoma”
Research Committee Award for Basic Science Research
Grace Creech —“Regulation of Chondrogenesis and Osteogenesis by miRNA-342-3p Transduction in Mice”
Massachusetts Dental Society and ASDA Public Health Award
Justin Maillet —“Assessment of Dental Students’ Knowledge, Attitude, and Perception of HIV/HBV/HCV”
Omicron Kappa Upsilon (OKU) Hilde Tillman Award
Haomiao Wang —“Validation of Evidence-Based Dentistry and Critical Thinking Application Assessment Tool”
Bianca Velayo —“Evaluation of the Promotion of Critical Thinking and Integration of Evidence-Based
Dentistry in the Pre-doctoral Clinical Courses”
Dr. Chad Anderson Family Award for Innovative Methodology and Research
Jessie Reisig —“Direct Pairwise Comparison of Initial Hydrophilicity of Unset Impression Materials”
Dr. Aikaterini Papathanasiou Award for Promotion of Esthetic Dentistry
Kunal Dani —“Comparison of Two Different Delivery Techniques for the Placement of Bulk-Fill Composites”
Scientific Merit Award for First-Time Presenters
Kathryn Weber —“Optimization of Snai1 siRNA Transfection in Murine Bone Marrow Derived Mesenchymal
Stem Cells”
Oral Health Disparities Award
Christina Piacquadio —“Speech Pathology and Oral Health of Individuals with Developmental/
Acquired Disabilities”
Bates Student Research Group “Peer-Reviewed” Award
Mary Sayegh —“Caries Risk Correlates among Adults with Intellectual and Developmental Disabilities”
ADEA Student Group Educational Research Award
Ignacio De La Cruz —“Human Papillomavirus and Oropharyngeal Cancer: Dental Students’ Knowledge
and Attitudes”
Tufts University School of Dental Medicine
9
Predoctoral Student Presentations by Author
PREdoctoral STUDENT PresentationS
Anna Bak, D17 (p. 22)
The Benefit of a Switch: Answer-Changing on Computerized Dental Exams
Jason Berglund, D17 (p. 23)
Manipulating Intracellular Pressure in Invading Oral Cancer Cells
Elizabeth Bingham, D15 (p. 24)
Dab2-E-cadherin Duo: A New Role in Squamous Cell Carcinoma Development
Jonathan Bishop, D16 (p. 25)
In Vitro Adhesive Bond Strength of Three Universal Enamel-Dentin Bonding Agents
Charles Bond, D17, and Jacob Donohue, D17 (p. 26)
Ion Releasing Materials, Demineralization, and Shear Strength of Orthodontic Brackets
William Brown, D16 (p. 27)
Bond Strengths of Cements to Enamel and Dentin In Vitro
Minh Bui, D15 (p. 28)
Effect of Curing Distances on the Bulk-Fill Composites
William Chao, D16 (p. 29)
Comparison of Deflection at Break of Four Dental Restorative Materials
Jimmy Chen, D16 (p. 30)
Continued Characterization of the Novel Zebrafish Helicase Craniofacial Mutant
Elena Ciciolla, D15 (p. 31)
Dental Adhesive Shear Bond Strength: Comparing Human and Bovine Teeth
Rachel Cohen, D16 (p. 32)
Pilot SEM Analysis of Low pH Whitening Agents
John Constantine, D16 (p. 33)
A New Side-by-Side Initial Hydrophilicity of Impression Materials Technique
Grace Creech, D17 (p. 34)
Regulation of Chondrogenesis and Osteogenesis by miRNA-342-3p Transduction in Mice
Kunal Dani, IS16 (p. 35)
Comparison of Two Different Delivery Techniques for the Placement of Bulk-Fill Composites
Ignacio De La Cruz, D17 (p. 36)
Human Papillomavirus and Oropharyngeal Cancer: Dental Students’ Knowledge and Attitudes
Risha De Leon, IS16 (p. 37)
Comparison of Pre-clinical and Clinical Performance in Operative Dentistry and Fixed Prosthodontics
of the International Student Program
Lindsay Fox, D15 (p. 38)
Evaluating NaOCl Penetration into Dentinal Tubules Using GentleWave™ System
10
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations by Author
David Frantz, D15 (p. 39)
Comparing Two Teaching Methods: Virtual Patient Avatar vs. Traditional Lecture
Katharina Fung, D16, and Myles Clancy, D16 (p.40)
Effect of Elevated Temperatures on Fluoride Ion Release of Varnish
Yamila Garber, D16 (p. 41)
Demographic Comparison of TUSDM Research Participants vs. Massachusetts Census Data
Hannah Gilman, D16 (p. 42)
Select Characteristics of Developmentally Disabled Adults with No Untreated Caries
Vishavjeet Girn, D15 (p. 43)
Are We in the Dark: LED Headlamp Use at TUSDM
Daniel Gonzalez, D15 (p. 44)
The Prevalence of Global Service Programs in United States Dental Schools
Joshua Hall, D15 (p. 45)
Toothbrush Wear and Plaque Removal Efficacy over Time
Alexis Irby, D17 (p. 46)
Fluoride Content in Green Tea
Mansi Jailwala, D17 (p. 47)
Evaluating Dental Students’ Readiness in Managing the Domestic Violence Patient
Samantha Keck, D16 (p. 48)
Oral-Health Related Quality of Life in Sjögren’s Syndrome: A Continuation
Julia Kim, D16 (p. 50)
Comparison of Microleakage Evaluation Methodology of Beveled Composite Restorations
Yun Ae Kim, D16 (p. 51)
Analyzing the Prevalence of Hepatitis B in Asian American Patients and Non-Asian Americans with
a Medical Consult at TUSDM
Alice Ko, D15 (p. 52)
Rural Zambia Oral-Health Dental Services: Utilization Outcomes
Yujin Lee, D17 (p. 53)
Prevalence of Periodontal Bone Loss as a Function of Age
Heather Leung, D16 (p. 55)
Quantitative Admissions Criteria as Predictor of Academic Failure at TUSDM
James Leung, D17 (p. 56)
The Effect of Collagen I and Fibronectin on the Inflammatory Potential of THP-1 Macrophages:
Baseline Cytokine Measurements
Tufts University School of Dental Medicine
11
Predoctoral Student Presentations by Author
Maryam Mahdavi, D16 (p. 57)
Oral-Health Status/Outcomes Assessment of Oral-Health Program in Zambia
Justin Maillet, D17 (p. 58)
Assessment of Dental Students’ Knowledge, Attitude and Perception of HIV/HBV/HCV
Alissa Mariano, D16 (p. 59)
Shear Bond Evaluation of Bonding Agents on Enamel and Dentin
Matthew Marquis, D17 (p. 60)
Open Air Aging Effects on Enamel-Dentin Adhesive Systems In Vitro
Alexa Martin, D15 (p. 61)
Student Perspectives on Professionalism in Dentistry
Lauren Marzouca, D16, Bradley Belous, D16, and Jennifer Denike, D17 (p. 62)
Student Self-Assessment vs. Faculty Evaluation of Operative Dentistry Practical Examinations
Amanda Merikas, D15 (p. 63)
Effect of Coatings on Surface Hardness of Glass Ionomer Cements
Kathleen Molgaard, D17 (p. 64)
Checklist Intervention to Assess Dental Student Organization and Communication
Sahar Mostafavi, D17 (p. 65)
Preparing for Inferior Alveolar Nerve Block Using an Injection Simulation-Model
Zachary Neitzey, D17 (p. 66)
How Much Time Do Students Spend Answering Difficult Exam Questions?
Joann O’Brien, D15 (p. 67)
Diabetic Foot Ulcer Fibroblasts Proliferate and Produce Extracellular Matrix in Response to TGF-β
Felicia Patel, D16 (p. 68)
A Literature Review of the Extraction Decision in Orthodontics
Charles Pham, D16 (p. 69)
Screening Instrument for Opioid Risk in General Dentistry: Initial Questionnaire Construction
Stephanie Phillis, D17, and Sarah Schuback, D17 (p. 70)
Silk Fiber Implant Coatings for the Localized Release of Antibiotics
Christina Piacquadio, D16 (p. 71)
Speech Pathology and Oral Health of Individuals with Developmental/Acquired Disabilities
Jessie Reisig, D16 (p. 72)
Direct Pairwise Comparison of Initial Hydrophilicity of Unset Impression Materials
Sepideh Sabooree, D15 (p. 74)
Survey about Use of Checklist for Orthognathic Surgeries among Oral and Maxillofacial Surgeons
Shawheen Saffari, D16 (p. 75)
Dab2-Dependent Modulation of the Tumor Microenvironment Can Promote Cancer Development
12
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations by Author
Mary Sayegh, D15 (p. 76)
Caries Risk Correlates among Adults with Intellectual and Developmental Disabilities
Anjalee Shah, D16 (p. 77)
Analyzing the Impact and Perceptions of Medical Emergency Training for Faculty and Students at TUSDM
Tej Shah, D15 (p. 78)
Developing Software to Detect Incipient Caries in Radiographs
Paul Shamirian, D16 (p. 79)
Correlation between Mandibular Third Molar Inclination and Mandibular Divergence
Laura Shim, D16 (p. 80)
Impact of the “Fourth-Floor Initiative” at TUSDM on Clinical Efficiency
Shankeertha Sundaralingam, D16 (p. 81)
A Comparison Study: TUSDM Clinical Trial Participants vs. Clinic Patients
Michelle Ta, D17 (p. 82)
Microleakage Evaluation of Elevated Temperatures in Dental Restoratives
Ronney Tay, D16 (p. 84)
Generation of Three-Dimensional Bioengineered Tissue Constructs of Nasopharyngeal Carcinoma
Kanupriya Tewari, D17 (p. 85)
Effect of Elevated Temperature on Adhesive Microtensile Bond Strength
Jordan Thomas, D17 (p. 86)
Complications following Third Molar Extractions at TUSDM: A Case Control Study
Avanthi Tiruvadi, D16 (p. 87)
A Literature Review of Carotid Plaque Detection in Panoramic Radiographs
Bianca Velayo, D15 (p. 88)
Evaluation of the Promotion of Critical Thinking and Integration of Evidence-Based Dentistry in the
Pre-doctoral Clinical Courses
Haomiao Wang, D17 (p. 89)
Validation of Evidence-Based Dentistry and Critical Thinking Application Assessment Tool
Kathryn Weber, D17 (p. 90)
Optimization of Snai1 siRNA Transfection in Murine Bone Marrow Derived Mesenchymal Stem Cells
Fadi White, IS15 (p. 91)
Impact of an Interprofessional Teamwork and Communication Mini-course for Dental and Dental
Hygiene Students
Tufts University School of Dental Medicine
13
Postdoctoral Student Presentations by Author
POSTDoctoral STUDENT PRESENTATIONS
Faryn Berger and Jeffrey Graceffo (GPR) (p.92)
Effects of Operating Room Efficiency on the Dental Resident Experience
Sucheta Budania (Pediatric Dentistry) (p. 93)
Effectiveness of an Oral-Health Education Program for Pregnant Women at Tufts Medical Center
Irina Dragan (Periodontology) (p. 94)
Three-Dimensional Bone and Soft Tissue Reconstruction with Implant Placement in Esthetic Areas following
Severe Trauma: A Case Report
Kyle Dunmire, Ainslee Flavell, and Kiirsten Finn (AEGD) (p. 94)
Healthcare Providers Role in Decreasing Opioid Abuse
Osama Felemban (Pediatric Dentistry) (p. 95)
The Efficacy of CBCT and Extraoral Bitewings in Detection of Interproximal Caries
Marina Karnaukh, Neelam Shah, and Khoa Tran (AEGD) (p. 95)
Dental Management of Patients with Adrenal Insufficiency, Based on a Review of the Literature
Elaina Kazes and Amrita Singh (GPR) (p. 96)
Dental Management and Complications of Patients with Turner Syndrome
Gustavo Klein (Visiting Scholar) (p. 96)
Biomechanical Evaluation of Different Systems, Locking and Conventional, for Fixing Sagittal Osteotomy in
Major Advances with or without Anticlockwise Rotation
Sage Yoo (Pediatric Dentistry) (p. 97)
The Influence of Community Service Learning Externship on Pre-doctoral Dental Students’ Future Management
of Pediatric Patients
14
Student and Faculty Research Abstracts 2014 –2015
Faculty Abstracts by Subject Area
Faculty AbstractS
Note: Names marked with an asterisk denote presenter of paper.
Behavioral, Epidemiologic, and Health Ser vices Research
Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter Baumannii Complex Bacteremia:
A Retrospective Study in a Tertiary Hospital of West China (p. 98)
Quinquin Liu, Wenzhang Li, Xinmiao Du, Weijing Li, Taiqing Zhong, Yin Tang, Yulin Feng, Chuanmin Tao,
and Yi Xie
Engaging Hygienists in Meth Mouth Education: Qualitative Pilot (Phase II) (p. 99)
Jennifer Towers,* Susan Gallagher, and Gina Heideman
Cancer Biology
Maintenance of Functional Embryoid Bodies in Cryopreservable, Microfluidic Chips:
A Platform for Personalized Medicine (p. 100)
Raymond Anchan, Sinan Guven, Jennifer Lindsey, Michael Nickerson, Sireesha Chinthala,
Behzad Gerami-Naini, and Utkan Demirci
Craniofacial Biology
Functional Characterization of Retinoblastoma in Tooth Development (p. 101)
Weibo Zhang, Viktoria Andreeva, Betsy Vazquez, Jodie Pietruska, Philip Hinds, and Pamela Yelick
Dental Materials
Comparison of Microleakage between Bulk-fill Flowable and Nanofilled Resin-Based Composites (p. 102)
Eman AlSagob, David Bardwell, Samer Khayat, Paul Stark, and Ala Ali
Effect of Curing Light and Restoration Location on Energy Delivered (p. 102)
Sapan Bhatt, Coralie Ayer, Richard Price, and Ronald Perry
Change in Bond Strength of Selected Bonding Agents over Time (p. 103)
Sapan Bhatt, Richard Price, Ronald Perry, and Gerard Kugel
Effect of Phosphoric Acid on Vitrebond Plus Resin-Modified Glass Ionomer (p. 103)
Jonathan Bishop, William Chao, Melissa Ing, Steven Eisen, Aikaterini Papathanasiou, and Gerard Kugel
Composite Replacement of Amalgam Restorations: An In Vitro Examination (p. 104)
Hetaf Redwan, David Bardwell, Hans-Peter Weber, Ala Ali, Samer Khayat, and Matthew Finkelman
Diagnostic Sciences
Predictable Technique to Register Retruded Contact Position Using a Disposable Jaw Relation Recording
Device (p. 105
T. Daher, William Lobel, J. Massad, S. Ahuja, and Z. Danilov
CBCT Valuable for Diagnosis of Tooth Fracture (p. 105)
David Leader
Tufts University School of Dental Medicine
15
Faculty Abstracts by Subject Area
Education Research
Saudi and U.S. Dental Student Attitudes toward Treating Individuals with Developmental Disabilities
(p. 107)
Zuhair Alkahtani, Paul Stark, Cheen Loo, Wanda Wright, and John Morgan
A Virtual Patient Avatar: Enhancing Dental Education and Patient Care (p. 107)
David Frantz, Kanchan Ganda, Britta Magnuson, and Melissa Ing
Administrative Trends in U.S. Dental Schools (p. 108)
Martin Fu, Angel Rodriguez, Rebecca Chen, Earl Fu, Shu-Yi Liao, and Nadeem Karimbux
Evaluation of Student Research Environment and Intramural Research Database at Tufts
Kelly Leong, Minh Bui, Angel Park, and Yumi Ogata (p. 108)
Background, Training Experiences, and Career Plans of U.S. Periodontal Residents: Report of a WebBased Survey (p. 109)
Hani Mawardi, Ardavan Fateh, Lena Elbadawi, and Nadeem Karimbux
Comfort Levels among Predoctoral Dental and Dental Hygiene Students in Treating Patients at High-Risk
for HIV/AIDS (p. 110)
Zuhair Natto, Majdi Aladmawy, and Thomas Rogers
The Influence of Examiner Type on Dental Students’ OSCE Scores (p. 110)
Sang Park, Arthur Kim, Joshua Kristiansen, and Nadeem Karimbux
A Pilot Dental Teamwork Course Focused on Interprofessional Competencies (p. 111)
Ellen Patterson, Natalie Hagel, Kristeen Perry, Jennifer Bassett Midle, and Fadi White
An Interdisciplinary, Team-Based Design for an Oral and Maxillofacial Radiology Course for Postdoctoral
Dental Students (p. 111)
Aruna Ramesh, Rumpa Ganguly, and Donna Qualters
Endodontics Research
Root Fracture Resistance Evaluation Using Different Posts and Ferrule Heights (p. 113)
Ekaterini Antonellou,* Masly Harsono, Gerard Kugel, Matthew Finkelman, and Khadiga Elfallah
Geriatric Oral Research
Geriatric Patients’ Oral Quality of Life and Oral Health Status (p. 114)
Jennie Leikin, Matthew Finkelman, and Britta Magnuson
Factors Contributing to Tooth Loss among the Elderly: A Cross Sectional Study (p. 114)
Zuhair Natto, Majdi Aladmawy, Mohammed Alasqah, and Athena Papas
Oral Implications of Polypharmacy in the Elderly (p. 115)
Mabi Singh and Athena Papas
16
Student and Faculty Research Abstracts 2014 –2015
Faculty Abstracts by Subject Area
Implantology Research
Histomorphometric Results in Ridge Preservation Procedures Comparing Various Graft Materials in
Extraction Sockets with Nongrafted Sockets in Humans: A Systematic Review (p. 116)
Lucia Barallat, Vanessa Ruíz-Magaz, Paul Levi Jr., Santiago Mareque-Bueno, Pablo Galindo-Moreno, and
José Nart
Assessment of Atmospheric Pressure Plasma Treatment for Implant Osseointegration (p. 116)
Natalie Danna, Bryan Beutel, Nick Tovar, Lukasz Witek, Charles Marin, Estevam Bonfante, Rodrigo Granato,
Marcelo Suzuki, and Paulo Coelho
Full Mouth Implant Rehabilitation with Staged Approach: 6-Year Clinical Follow-Up (p. 117)
Panos Papaspyridakos
Digital vs. Conventional Implant Impressions for Edentulous Patients: Accuracy Outcomes (p. 117)
Panos Papaspyridakos, German Gallucci, Chun-Jung Chen, Stijn Hanssen, Ignace Naert, and
Bart Vandenberghe
A Retrospective Radiographic Study on the Effect of Natural Tooth/Implant Proximity and an Introduction
to the Concept of a Bone-Loading Platform Switch (p. 118)
Ranier Urdaneta, Rudolf Seemann, Irina Dragan, William Lubelski, Joseph Leary, and Sung-Kiang Chuang
Mineralized Tissue
Epigenetically Modified BMSCs in Regenerating Dental and Craniofacial Bone Tissues (p. 120)
Kyle Smith,* Jake Chen, Qisheng Tu, and Qianqian Han
Adiponectin Regulates Bone Marrow Mesenchymal Stem Cell Niche through a Unique Signal Transduction
Pathway: An Approach for Treating Bone Disease in Diabetes (p. 120)
Liming Yu, Qisheng Tu, Qianqian Han, Lan Zhang, Lei Sui, Leilei Zheng, Shu Meng, Yin Tang, Dongying Xuan,
Jin Zhang, Dana Murray, Q. Shen, Jessica Cheng, Sung-Hoon Kim, Lily Dong, Paloma Valverde, X. Cao, and
Jake Chen
Neuroscience/TMJ/Pain
A New Electronic Diary Tool for Mapping and Tracking Spatial and Temporal Head Pain Patterns
in Migraine (p. 122)
Gabi Barmettler, Jennifer Brawn, Nasim Maleki, Steven Scrivani, Rami Burstein, Lino Becerra, and
David Borsook
Safety and Efficacy of LY2951742, a Monoclonal Antibody to Calcitonin Gene-Related Peptide, for the
Prevention of Migraine: A Phase 2, Randomized, Double-Blind, Placebo-Controlled Study (p. 122)
David Dodick, Peter Goadsby, Egilius Spierings, Joel Scherer, Steven Sweeney, and David Grayzel
Sufficiency and Necessity in Migraine: How Do We Figure Out If Triggers are Absolute or Partial and,
If Partial, Additive or Potentiating? (p. 123)
Egilius Spierings, Stephen Donoghue, Alec Mian, and Christian Wöber
Nutrition
Effect of Dried California Mission Figs on Mineral Status and Food Replacement (p. 125)
Heba Alshaeri, Zuhair Natto, Serena Tonstad, Ella Haddad, and Karen Jaceldo-Siegl
Tufts University School of Dental Medicine
17
Faculty Abstracts by Subject Area
Oral Health Research
Seal Away Caries Risk (p. 126)
Natalie Hagel and Dorothy Vannah
Extended Efficacy of 1.5% Oxalate Strips on Dentinal Hypersensitivity (p. 126)
Britta Magnuson, Mabi Singh, Athena Papas, Elizabeth Tzavaras, Joseph Cimmino, Robert Gerlach, and
Melanie Miner
The Prevalence and Severity of Dental Caries in Chad: A Pilot Study (p. 127)
Zuhair Natto, Floyd Petersen, and Q. Niccola
The Oral Health Status and the Treatment Needs in Chad: A Pilot Study (p. 127)
Zuhair Natto, Floyd Petersen, and Q. Niccola
Safety and Effectiveness of Two-Step Paste/Gel Sequence with Medication Hyposalivation (p. 128)
Athena Papas,* Mabi Singh, Britta Magnuson, Elizabeth Tzavaras, Joseph Cimmino, Mary Kay Anastasia, and
Robert Gerlach
Randomized Controlled Trial Evaluating Use of Oxalates for Dentinal Hypersensitivity (p. 128)
Mabi Singh, Athena Papas, Britta Magnuson, Elizabeth Tzavaras, Joseph Cimmino, Melanie Miner, and
Robert Gerlach
Declining Treatment Clinical Trial to Assess Dentinal Hypersensitivity Relief (p. 129)
Mabi Singh, Athena Papas, Elizabeth Tzavaras, Matthew Barker, and Robert Gerlach
Oral Medicine Referrals at a Hospital-Based Practice in the United States (p. 130)
Alessandro Villa, Shannon Stock, Ali Aboalela, Mark Lerman, Sook-Bin Woo, Stephen Sonis, and
Nathaniel Treister
Oral Surgery Research
Surgical Safety Checklist Use among Oral Surgeons in AAOMS Database (p. 131)
Andras Balint, Archana Viswanath, Maria Papageorge, Daniel Oreadi, Morton Rosenberg, and William Gilmore
Essentials of Airway Management, Oxygenation, and Ventilation: Basic Equipment and Devices (p. 131)
Daniel Becker, Morton Rosenberg, and James Phero
Post Discharge Nausea and Vomiting following Third-Molar Extractions under Ambulatory Anesthesia
(p. 132)
Ray English III, Alireza Ashrafi, Sepideh Sabooree, Mina Boulos, and Archana Viswanath
Efficacy of HemCon Dental Dressing in Reducing Postsurgical Complications following Mandibular ThirdMolar Extractions (p. 133)
Ross Fahey, Daniel Oreadi, Ghassan Darwish, and Archana Viswanath
Crestal Bone Resorption an Augmented Bone Using Mineralized Freeze-Dried Bone Allograft or Pristine
Bone during Submerged Implant Healing: A Prospective Study in Humans (p. 134)
Hsiang-Yun Huang, Yumi Ogata, James Hanley, Matthew Finkelman, and Yong Hur
A Prospective Randomized Controlled Trial of Two Different Sedation Sequences for Third-Molar Removal
in Adults (p. 134)
Ruba Khader, Daniel Oreadi, Matthew Finkelman, Marcin Jarmoc, Sanjeet Chaudhary, Roman Schumann, and
Morton Rosenberg
18
Student and Faculty Research Abstracts 2014 –2015
Faculty Abstracts by Subject Area
Biomechanical Evaluation of Different Systems, Locking and Conventional, for Fixing Sagittal Osteotomy
in Major Advances with or without Counterclockwise Rotation (p. 135)
Gustavo Batista Grolli Klein, Corey Decoteau, Harshiv Vyas, Paulo Domingos Ribeiro Jr., Maria Papageorge,
and Archana Viswanath
Airway Assessment for Office Sedation/Anesthesia (p. 136)
Morton Rosenberg and James Phero
Orthodontics
An Active, Skeletally Anchored Transpalatal Appliance for Derotation, Distalization, and Vertical Control
of Maxillary First Molars (p. 137)
Jan Hourfar, Björn Ludwig, and Georgios Kanavakis
Morphology of Lateral Incisor Adjacent to Palatally Impacted Canines (p. 137)
Georgios Kanavakis,* Moonyoung Lee, and Sreedevi Srinivasan
Clinical Outcomes of Cases with Missing Lateral Incisors Treated with the “T”-Mesialslider (p. 138)
Georgios Kanavakis, Björn Ludwig, Marco Rosa, Bjorn Zachrisson, and Jan Hourfar
Comparison of Shear Bond Strength, Excess Adhesive Flash, and Bonding Time of Two Flash-Free Bonding
Techniques (p. 138)
Moonyoung Lee and Georgios Kanavakis
Newly Defined Landmarks for a Three-Dimensionally Based Cephalometric Analysis: A Retrospective
Cone-Beam Computed Tomography Scan Review (p. 139)
Moonyoung Lee, Georgios Kanavakis, and R. Matthew Miner
Interlot Variations of Transition Temperature Range and Force Delivery in Copper-Nickel-Titanium
Orthodontic Wires (p. 140)
Renée Pompei-Reynolds and Georgios Kanavakis
Surgeon Agreement/Bias When Evaluating Lip Surgery Outcomes in CL/P Patients (p. 140)
Carroll Trotman, Jing Yu, Ceib Phillips, and Gary Kotch
Pediatric Dentistry Research
Efficiency and Patient Satisfaction with the Isolite System vs. Rubber Dam for Sealant Placement in
Pediatric Patients (p. 142)
Muhanad Alhareky, Danya Mermelstein, Matthew Finkelman, Jehan Alhumaid, and Cheen Loo
Post-Traumatic Apexogenesis of an Immature Maxillary Central Incisor-A Case Report (p. 142)
Sonia Arevalo, Cheen Loo, and Mohammad Hassan
Anterior Crossbite Correction in Mixed Dentition: A Case Report (p. 142)
Ammar Asali and Marjan Askari
Full Mouth Rehabilitation for a Von Willebrand Disease Patient under General Anesthesia: A Case Report
(p. 143)
Ammar Asali and Cheen Loo
Effect of DentalVibe in Pain Perception during the Administration of Local Anesthetic in Pediatric
Dental Patients (p. 143)
Jason Ching, C. Brambila, Cheen Loo, Alfred Rich, and Angel Park
Tufts University School of Dental Medicine
19
Faculty Abstracts by Subject Area
The Efficacy of CBCT and Extraoral Bitewings in Detection of Interproximal Caries (p. 143)
Osama Felemban, Jennifer Bassett Midle, Cheen Loo, and Aruna Ramesh
Interceptive Orthodontic Treatment with Habit Breaking Appliance: A Case Report (p. 144)
David Juhn, Cheen Loo, and Marjan Askari
Effectiveness of an Oral Health Education Program for Obstetrician/Gynecologist Residents at Tufts
Medical Center (p. 144)
Lily Parsi, Matthew Finkelman, Devina Shah, E. Kim, Alfred Rich, and Cheen Loo
Effectiveness of Oral Health Education for Pediatric Nurse Practitioner Students at Northeastern
University (p. 145)
John Stark, Matthew Finkelman, Alfred Rich, M. Dolce, L. Malone, and Cheen Loo
Dental Externship and Influential Factors on Future Pediatric Care (p. 145)
Sage Yoo, Cheen Loo, Matthew Finkelman, Alfred Rich, and Wanda Wright
Periodontal Research
Impact of Patient Compliance on Tooth Loss during Supportive Periodontal Therapy: A Systematic Review
and Meta-analysis (p. 146)
C.T. Lee, H.Y. Huang, Teresa Sun, and Nadeem Karimbux
Is There a Relationship between Periodontal Disease and Causes of Death? A Cross Sectional Study (p. 146)
Zuhair Natto, Majdi Aladmawy, Mohammed Alasqah, and Athena Papas
Comparison of Different Lasers for the Treatment of Peri-implantitis: A Systematic Review (p. 147)
Zuhair Natto,* Majdi Aladmawy, Paul Levi, and Hom-Lay Wang
Prevalence of Peri-implant Diseases: A Cross-Sectional Study (p. 147)
Evangelos Papathanasiou, Natalie Jeong, Angel Park, James Hanley, and Andreas Parashis
Suppressor of Cytokine Signaling-3 Regulates Macrophage Response to Porphyromonas gingivalis (p. 148)
Evangelos Papathanasiou,* Alpdogan Kantarci, Antonios Konstantinidis, Danielle Stephens, Hongwei Gao, and
Thomas Van Dyke
Periodontal Treatment for Preventing Adverse Pregnancy Outcomes: A Meta- and Trial Sequential Analysis
(p. 149)
Falk Schwendicke, Nadeem Karimbux, Veerasathpurush Allareddy, and Christian Gluud
Prosthodontics Research
Marginal and Internal Fit of Five- and Three-Axis CAD/CAM Inlays (p. 150)
Norah Alajaji,* David Bardwell, Hiroshi Hirayama, Samer Khayat, Matthew Finkelman, and Ala Ali
Comparison of Candida Albicans Adhesion to Various Denture Base Materials (p. 150)
Alaa Makke,* Carol Kumamato, Amit Sachdeo, Matthew Finkelman, and Ali Muftu
Marginal and Internal Adaptation of Ceramic Crown Restorations Fabricated with CAD/CAM Technology
and the Heat-Press Technique (p. 151)
Hisham Mously, Matthew Finkelman, Roya Zandparsa, and Hiroshi Hirayama
Comparison of the Accuracy of Digital Impressions and Master Models (p. 152)
Rami Muadab,* Ali Muftu, Gerard Kugel, Matthew Finkelman, and Ala Ali
20
Student and Faculty Research Abstracts 2014 –2015
Faculty Abstracts by Subject Area
Transition from Failing Dentition to Complete-Arch Implant Rehabilitation with a Staged Approach:
A Three-Year Clinical Report (p. 152)
Panos Papaspyridakos and Vasilios Chronopoulos
Life-Changing Diastema Closure: Direct Composite Restorations with Minimal Intervention (p. 153)
Aikaterini Papathanasiou and Charilaos Asikis
Comparison of Marginal Adaptation Accuracy Using Different Impression Systems (p. 153)
Marwa Shembesh, Roya Zandparsa, Ala Ali, and Hans-Peter Weber
An In Vitro Comparison of Fracture Load of Zirconia Custom Abutments with Internal Connection and
Different Angulations and Thicknesses: Part II (p. 154)
Roya Zandparsa and Abdalah Albosefi
Statistics Research
Cognitive Diagnostic Models and Computerized Adaptive Testing: Two New Item-Selection Methods That
Incorporate Response Times (p. 155)
Matthew Finkelman, Wonsuk Kim, Alexander Weissman, and Robert Cook
Stochastic Curtailment in Adaptive Mastery Testing: Improving the Efficiency of Confidence IntervalBased Stopping Rules (p. 155)
Haskell Sie, Matthew Finkelman, Jay Bartroff, and Nathan Thompson
Utilizing Response Times in Computerized Classification Testing (p. 155)
Haskell Sie, Matthew Finkelman, Barth Riley, and Niels Smits
Tissue Engineering
Dental Epithelial-Mesenchymal 3D Cell Sheets for Tooth Regeneration (p. 157)
Nelson Monteiro, Elizabeth Smith, and Pamela Yelick
Silk Fibroin, a Functional Substrate for iPS-derived RPE Cells (p. 157)
Sheldon Rowan, Benjamin Chan, Waseem Khan Raja, Chiara Ghezzi, Avi Smith, Allen Taylor, David Kaplan,
Jonathan Garlick, and Behzad Gerami-Naini
Biomimetic Mineralized Tooth Constructs for Whole Tooth Bioengineering (p. 158)
Elizabeth Smith, Ali Khademhosseini, and Pamela Yelick
Tufts University School of Dental Medicine
21
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Student Presentations and Abstracts
Note: Names marked with an asterisk denote presenter of paper.
Predoctoral Student Presentations
The Benefit of a Switch: Answer-Changing on Computerized Dental Exams
Anna Bak,* Jennifer Bassett Midle, Steven Eisen, and Gerard Kugel
Objectives: Based on a notion that your “first instinct” is always right, instructors often advise their students
not to change their answers on exams. Yet existing literature overwhelmingly contradicts this belief and supports
the benefit that answer-changing has on exam scores. However, many of these studies utilized eraser marks on
written exams, small sample sizes, or voluntary
low-stakes exams as evidence. The purpose of
this study is to confirm the benefits of answerchanging by using detailed, reliable data from
high-stakes exams, administered electronically to
first-year dental students.
Methods: This study used computerized data
reports from a 24-item multiple-choice exam
(MCE) administered to 186 dental students in
the first-year biochemistry course. The results
will be expanded by ongoing research to include
6 additional first-year MCEs in biochemistry and
operative dentistry (N=192, 191, 193, 193, 194,
195), each with respective item numbers (y=45,
40, 45, 33, 33, 33).
Results: Consistent with previous studies in other fields, a majority of answer changes (69.9%) are from
wrong to right. An initially correct answer is changed to a wrong answer 10.3% of the time, while 19.9% of
answer changes results in no change. Of the latter, 15.2% are wrong-to-wrong changes and 4.6% are right-toright. While switching more commonly results in the correct answer, only a small proportion (6.8%) of answers
are actually reviewed and subsequently changed. In fact, 72.9% of questions are seen only once and never
reviewed, while 20.3% of questions are reviewed but an alternative answer is not selected.
Conclusions: Dental students should be encouraged to review their answers and reconsider alternative
choices. They should not be discouraged from changing their answers if upon careful reflection they have
reasonable doubt to select a different choice. The benefits of answer-changing should be recognized and adopted
as an exam-taking strategy.
22
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Jason Berglund,1,2 Ryan Petrie,2 and Kenneth Yamada2
1Tufts
University School of Dental Medicine, Boston; 2NIDCR, National Institutes of Health, Bethesda, Maryland
Invasive cancer cell migration is associated with transitions between amoeboid and lamellipodial migration
mechanisms along the RhoA-Rac1 signaling axis. RhoA controls pressure in primary fibroblasts migrating in 3D
matrix, with high and low pressure associated with lobopodia- and lamellipodia-based migration, respectively.
It is unclear if intracellular pressure plays a similar function in 3D cancer cell motility. Tropomyosins are actinbinding proteins that modulate actomyosin
contractility and cytoskeleton dynamics.
Expression of a specific tropomyosin
isoform is known to cause lamellipodiaindependent movement on a 2D surface.
To test the hypothesis that tropomyosin
expression regulates intracellular pressure
to govern the mechanism of cell movement,
two different isoforms of tropomyosin were
transfected into primary human fibroblasts
and oral cancer cells to determine if they
could alter intracellular pressure and cell
protrusion. We developed and validated
a method to measure the average size of
lamellipodia per cell based on distribution
of lamellipodial protein marker cortactin
and directly measured intracellular pressure
in individual cells with a 900A micropressure device. Tropomyosin isoform 3 (Tm3) significantly increased
intracellular pressure in primary dermal fibroblasts compared to positive controls, but did not result in a
significant change in protrusion type on 2D glass. When Tm3 was transfected into WSU-HN31, a metastatic
head and neck squamous cell carcinoma cell line, intracellular pressure was marginally greater than the negative
control. Tm3 transfected WSU-HN31 cells showed little cortactin-positive lamellipodia, slightly greater than
the negative control. In contrast, controls and transfectants with tropomyosin isoform 5b (Tm5b) exhibited
similar intracellular pressures and lamellipodial formation using HFF and WSU-HN31 cell lines. Such variation
suggests tropomyosin isoforms exhibit different functions between cell types. While a direct correlation between
intracellular pressure and the mode of cellular protrusion formation in response to tropomyosin expression
was not evident, associated mechanisms involving the important biophysical property of intracellular pressure
warrant further study.
Bates-Andrews Day Abstracts
Manipulating Intracellular Pressure in Invading Oral Cancer Cells
Also presented at the 2015 IADR General Session in Boston. Abstract #1659.
Tufts University School of Dental Medicine
23
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Dab2-E-cadherin Duo: A New Role in Squamous Cell Carcinoma Development
Elizabeth Bingham,*1 Samuel Kamlarz,2 Shawheen Saffari,1 Ronney Tay,1 Jorge Reyes,3 James Baleja,4 and
Addy Alt-Holland1
1Tufts
University School of Dental Medicine, Boston; 2University of Massachusetts, Amherst; 3Wentworth
Institute of Technology, Boston; 4Tufts University Sackler School of Graduate Biomedical Sciences, Boston
Objective: Disabled2 (Dab2) is an adaptor protein involved in cellular endocytosis and recycling machinery,
and its down-regulation has been associated with progression of epithelial cancers. However, Dab2 involvement
in the early stages of squamous cell carcinoma (SCC) has not been elucidated. We previously reported that
transient loss of Dab2 is associated with decreased E-cadherin-mediated cell-cell contact, which led to increased
SCC cell spread. Here, we investigated whether the effect of a permanent Dab2 depletion on these cells is
dependent on their malignant potential.
Methods: The immortalized HaCaT and ras-transformed HaCaT keratinocytes (II-4) were transfected with
lentiviral-mediated sh-Dab2 sequences, which down-regulated Dab2 at the mRNA level. The levels of Dab2,
E-cadherin and other proteins were investigated by Western blot and immunofluorescent analyses, and cell
morphology was analyzed by bright field microscopy.
Results: A 3-fold and 2-fold decrease of Dab2
expression was achieved in the II-4 SCC cells and
HaCaT cells, respectively. E-cadherin, EEA1, and
Caveolin-1 proteins were moderately decreased
in HaCaT cells. In contrast, these proteins were
markedly down-regulated in II-4 cells. Increased
cell spread was confirmed in both cell cultures, and
immunofluorescent staining of HaCaT cells and,
moreover, of II-4 cells, showed the propensity of Dab2
to remain at the perinculear area instead of being
diffused throughout the cells cytoplasm.
Conclusions: Dab2 depletion in HaCaT and
II-4 SCC cells is associated with downregulation and
altered cellular localization of E-cadherin and other
endocytic proteins. Importantly, the extent to which
the characteristics of these cells are changed is dependent on their malignant potential. Our study sheds light on
the reciprocal relationship between Dab2 and E-cadherin, as affecting the expression of one influences the level
of the other. These data demonstrate that E-cadherin and Dab2 work in concert during SCC development, and
further elucidates their role in the progression of epithelial cancer.
Also presented at the 2015 IADR General Session in Boston. Abstract #1118.
24
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Jonathan Bishop,* William Brown, Ronald Perry, Masly Harsono, and Gerard Kugel
Objective: Bonding techniques and bonding agents are the main source of retention of a restoration. This
study compared the shear bond strength of Optibond™XTR(OP) Kerr™, Scotchbond™Universal(SBU) 3M™, and
AdheSE™Universal(AU) Ivoclar™ bonded to dentin and enamel at 15 minutes and 24 hours.
Methods: One hundred and forty-four human extracted teeth were collected, sectioned, and mounted in
acrylic blocks followed by exposing and finishing the enamel or dentin surfaces with 240 and 600 grit silicon
carbide papers. Six groups for dentin and enamel were made
(N=12). Each group was bonded following manufacturer
recommendations, placed on the Ultradent bonding jig (2.38
mm), filled with Herculite® Ultra (Kerr) and polymerized
for 20s using a Demi™ Plus curing light. Samples were either
stored for 24-hours at 100% humidity and tested or tested 15
minutes after the bonding procedure using an Instron® universal
testing machine at 1 mm/min crosshead speed and expressed in
MPa’s. The nature of the failure was observed with a 10X stereo
microscope (Leica–GZ6). Statistical analysis was done using
ANOVA.
Bates-Andrews Day Abstracts
In Vitro Adhesive Bond Strength of Three Universal Enamel-Dentin Bonding Agents
Results: See Tables 1 and 2.
Table 1. Bond strength testing Results: Mean (SD) in MPa.
Optibond XTR
SB Universal
Adhese Universal
Enamel 15 min
15.3(4.4)
16.8(3.5)
18.4(2.4)
Dentin 15 min
21.8(4.8)
24.5(4.4)
27.7(6.4)
Enamel 24 hr
18.8(4.8)
18.5(4.3)
23.2(7.2)
Dentin 24 hr
36.5(10.9)
32.4(10.6)
35.9(10.5)
Table 2. ANOVA testing results
Enamel 15 min
Dentin 15 min
Enamel 24 hr
Dentin 24 hr
Degrees of freedom:
Model, Error
2, 27
2, 27
2, 27
2, 27
F-Value
P-Value
1.83
3.30
2.23
0.38
0.179
0.052
0.127
0.686
No statistically significant difference was observed between groups in either the enamel-bonded or the dentinbonded cohort using ANOVA testing [15-min Enamel: F(2, 27)=1.83, p=0.179; 15-min Dentin: F(2, 27)=3.30,
p=0.052; 24-hour Enamel: F(2, 27)=2.23, p=0.127; 24-hour Dentin: F(2, 27)=0.38, p=0.686].
Conclusions: Despite variation in mean bond strengths between AU, OP, and SBU, no statistical difference
was observed. Further clinical testing is needed.
Study funded in part by KERR Corp. Also presented at the 2015 IADR General Session in Boston. Abstract #2298.
Tufts University School of Dental Medicine
25
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Ion Releasing Materials, Demineralization, and Shear Strength of
Orthodontic Brackets
Charles Bond,* Jacob Donohue,* Pamela Maragliano, Daniella Phillis, Jennifer Bassett Midle,
Ronald Perry, Gerard Kugel
Objectives: This pilot study compared the shear bond strength and demineralization of two ion-releasing
materials to a conventional bracket adhesive.
Methods: Three groups (N=6) of bonded orthodontic brackets were analyzed for shear bond strength
(SBS) (MPa) and demineralization (DIAGNOdent™, KaVo (DAG) score). A total of 18 teeth, 6 per group, were
assigned to the following groups: composite resin (Transbond XT Light Cure Adhesive™, 3M Unitek) (XT),
glass ionomer (Ionoseal™, Voco) (IO), and a bioactive restorative (Activa Bioactive™, Pulpdent) (AB). Teeth
were initially screened to determine no demineralization had taken place. Brackets were applied to both the
buccal and lingual side of each tooth. Three lingual and three buccal faces in each group were etched using 35%
phosphoric acid (Ultra-Etch™, Ultradent)
prior to bracket placement. Brackets were
applied using the respective material (XT,
IO, or AB) and light cured for 30 seconds.
Samples were placed in a demineralizing
solution (0.05 M acetate buffer pH 5.0)
for 30 days and upon removal were tested
for demineralization using a DAG and
SBS (MPa) using an Instron 5566A™
(Canton, Massachusetts). Comparisons
of materials were completed to test the
mean demineralization and shear strength
between groups (SPSS Version 21).
Results: Lower mean demineralization
was noted with AB (61.83±23.37)
compared to both the XT and IO groups,
however it was not statistically significant (p=0.74 and p=0.90) (Table 1). For both the etched and non-etched
groups, AB showed similar SBS (23.51±12.4 and 31.88±20.96) compared to XT and IO (p=0.85 and p=0.99)
(Table 2). No significance was noted between groups for both etch and non-etched (Table 3).
Conclusions: Although demineralization was less with AB, there was no statistical significance between
groups (p>0.05). Similarly, there was no significance noted between SBS of the groups (p>0.05). The results
warrant further research in this area.
Also presented at the 2015 IADR General Session in Boston. Abstract #3478.
26
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
William Brown,* Jonathan Bishop, Angel Park, Lindsay Fox, Elisa Giordano, and Ronald Perry
Objectives: Compare the bond strength of various self-adhesive dental cements to human dentin and
enamel using a universal testing machine (UltraTester™, Ultradent).
Methods: Five self-adhesive cements were used: MaxCem Elite™ (Kerr)MCE, MaxCem Elite™ New (Kerr)
MCE2.0, RelyX™ Unicem (3MESPE)UNI, G Cem™ LinkAce (GC America)GC, SmartCem® (DENTSPLY)
SC. One hundred-twenty samples were randomly divided into five groups with two bonding groups (enamel
and dentin) per product and 12 samples per group. Specimens were prepared and mounted in acrylic blocks
followed by exposing and finishing the enamel or dentin surfaces with 240 and 600 grit silicon carbide papers.
Each group was bonded following manufacturer recommendations using the Ultradent bonding jig (2.38 mm
diameter) and polymerized using a Demi™ Plus curing light. Samples were stored for 24 hours at 100% humidity
and tested using a universal testing machine at 1mm/min crosshead speed and expressed in MPa’s.
Results: Cements were analyzed using a one-way ANOVA and showed a statistical difference among tested
products and substrates p<0.001. Table 1 shows the results of the Tukey HSD test indicating which products
were statistically different. The results indicate that for both enamel and dentin surfaces Maxcem Elite New was
statistically higher to the other self-adhesive cements (25.45±2.80 and 25.80±5.14 MPa respectively. Overall
SmartCem had the lowest bond strength to enamel and dentin (8.55±3.37 and 11.93±5.88 MPa respectively.
Bates-Andrews Day Abstracts
Bond Strengths of Cements to Enamel and Dentin In Vitro
Table 1: Bond Strength Comparison Among Self-adhesive Cements
Enamel
Dentin
Cement
MCE
MCENew
UNI
GC
SC
MCE
MCENew
UNI
GC
SC
Mean
15.05B
25.45A
10.96BC
12.83BC
8.55C
13.58B
25.80A
15.15B
14.39B
11.93B
SD
4.38
2.80
3.12
4.22
3.37
3.30
5.14
4.43
2.64
5.88
P-Value
<0.001
<0.001
Note: Groups with same letter are not statistically different. (Tukey HSD test)
Conclusions: MCENew showed superior adhesive bonding results across all tested surfaces. Further testing
is needed.
Also presented at the 2015 IADR General Session in Boston. Abstract #804.
Tufts University School of Dental Medicine
27
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Effect of Curing Distances on the Bulk-Fill Composites
Minh Bui,* Alissa Mariano, Sridhar Janyavula, Ronald Perry, Masly Harsono, and Gerard Kugel
Objective: To compare and evaluate the effect of curing distances on the polymerization of several bulk-fill
composites at clinically relevant distances using two different curing lights.
Methods: Sample groups (N=16) of composites from Group 1 [experimental flow (DENTSPLY Caulk)],
Group 2 [experimental posterior bulk fill (DENTSPLY Caulk)], Group 3 [experimental posterior universal
(DENTSPLY Caulk)], Group 4 [SonicFill™ (Kerr)], Group 5 [Surefil SDR® (DENTSPLY Caulk)], Group 6 [Tetric
EvoCeram Bulk Fill® (Ivoclar Vivadent)] were placed in custom molds and light cured at distances of 0, 3, and
5 mm with the help of the Marc resin calibrator using the ISO 4049 test method. The remaining hard composite
length was measured with a digital micrometer and the value was divided by two per ISO 4049 protocol. Each
sub-group (N=8) tested two different curing lights: Light 1 [Demi™ Ultra Plus (Kerr)] and Light 2 [SmartLite
Focus (DENTSPLY Caulk)]. Analysis was conducted by one-way ANOVA and Tukey test at 95% confidence
interval. Significance was determined with p<0.05.
Results: Among bulk fills with the light at 0 mm distance, groups 1, 2, and 5 had a statistically significant
greater mean of average curing depth than groups 4 and 6. Group 5 had the highest average mean curing depth
while group 4 showed the lowest mean of the bulk fills (Table 1). The depth of cure had the largest drop when
comparing the light source from 0 mm to 5 mm and the smallest decrease when comparing the light source
from 3 mm to 5 mm (Table 2).
Table 1. Average composite curing depth (with light distance of 0 mm)
Composite (N=16)
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Mean of average curing depth
Standard Deviation
4.0200A
4.2484A
2.6497C
3.2456B
4.3425A
3.4059B
0.3106
0.3033
0.4913
0.1410
0.3859
0.1597
Means that do not share a letter are significantly different.
Table 2. Differences in distance of light source on curing depth
Differences in distance of light source
0 mm vs. 3 mm
3 mm vs. 5 mm
0 mm vs. 5 mm
Mean of decreased curing depth
Standard Deviation
−0.1767
−0.0975
−0.2742
0.2621 (p=0.040)
0.0593 (p=0.129)
0.0823 (p=0.007)
Conclusion: Among bulk fills, groups 1, 2, and 5 had higher curability than groups 4 and 6. While group 3,
the control group, was statistically different from all other groups, with a lower mean. This was as expected since
it is not bulk-fill composite. The depth of cure based on distance showed predictable results; the further away
the light source was from the composite, the less the composite was polymerized.
Also presented at the 2015 IADR General Session in Boston. Abstract #2202.
28
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
William Chao,* Vishavjeet Girn, Masly Harsono, Angel Park, and Gerard Kugel
Objective: To evaluate and compare the deflection at break of four commercial tooth-colored
restorative materials.
Method: Four groups (N=10/group) of
restorative materials were tested. Flexural
testing samples were prepared using a mold
25 mm in length, 2 mm in height and 2
mm in width (according to ISO Standard
4049). For Filtek™ (3M™ ESPE™) (Group
1), ACTIVA™ BioACTIVE Restorative™
(Pulpdent®) (Group 2), and Ketac™ Nano
(3M™ ESPE™) (Group 3), samples were
cured with a halogen curing light from top
and bottom surfaces for 40 seconds. Fuji
IX™ GP (GC America®) (Group 4) was selfpolymerized according to manufacturer’s
directions. Samples were then stored in
distilled water for 24 hours to ensure
polymerization of the material. All tests were performed using a universal testing machine (UTM) with 1K load
cell (Instron® 5566A, Norwood, Massachusetts). Flexural testing was determined using a three-point bending
fixture attached on a UTM machine at a 0.5 mm/min crosshead. The distance between the two supports was
set at 20 mm. The radius of each support was 1 mm. Statistical analysis was completed using SAS 9.2. KruskalWallis and Dunn’s tests were performed to determine differences among the groups. Using the Bonferroni
correction, a p-value of 0.0083 was considered statistically significant.
Bates-Andrews Day Abstracts
Comparison of Deflection at Break of Four Dental Restorative Materials
Results:
Table 1. Deflection at Break (Flex Data) (in mm) of Restorative Materials
Group
1
2
3
4
N
10
10
10
7*
25th Percentile
0.40
0.90
0.10
0.10
Median
0.40
1.00
0.20
0.10
75th Percentile
0.40
1.10
0.20
0.10
*Three samples broke upon polishing
The Kruskal-Wallis test was statistically significant with p<0.001. Additional tests for multiple comparisons
using Dunn’s test were completed. Using the Bonferroni correction, groups 2 versus 3 and 2 versus 4 were
statistically significant. The other comparisons were not statistically significant.
Conclusion: Group 2 showed statistically significant greater deflection at break in comparison to two
other commercial tooth-colored restorative materials tested. This result is reflected in flexural strength and the
elastic modulus indicating better resistance to fracture and ability to absorb stress when compared to the other
materials tested.
Also presented at the 2015 IADR General Session in Boston. Abstract #2375.
Tufts University School of Dental Medicine
29
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Continued Characterization of the Novel Zebrafish Helicase Craniofacial Mutant
Jimmy Chen,* David Cheng, Viktoria Andreeva, and Pamela Yelick
Objective: Our goal was to further characterize the developmental defects of previously identified fast
track (ftt)tft9 zebrafish mutant and to determine the expression of the ftt helicase gene during embryonic
development.
Methods: Cryosectioning of 5 and 6 days post fertilization (dpf) wild type and mutant zebrafish embryos
along with H&E and immunohistochemistry with anti-ftt antibody was utilized to characterize the systemic ftt
defects and to highlight the expression pattern of the ftt helicase gene.
Results: H&E staining revealed that the ftt mutant presents with an incompletely absorbed yolk sac, an
anteriorly displaced intestine reduced in size and thickness of intestinal linings, a narrowed esophagus also
with a loss of lining, a reduced cerebellum and superior/inferior lobe, a narrowed pronephric duct and a
narrowed vertical myoseptum. The loss of intestinal linings and incompletely absorbed yolk sac may be
indicative of an underlying digestive problem.
In humans, the combination of these various
gut defects most resembles that of Crohn’s
disease. Mental retardation from the reduced
cerebellum and superior/inferior lobe along
with vertebral malformation from the narrowed
vertical myoseptum are also common anomalies
seen in cleft palate, which was phenotypically
observed previously in the craniofacial region.
The immunohistochemical analysis revealed an ftt
helicase protein expression pattern consistent with
the observed phenotype showing strong staining
signals in the esophagus, liver, intestine, pronephric
duct, cerebellum, superior/inferior lobes, and the
vertical myoseptum. Additional staining signals
are also observed in the eye and olfactory pit
region, confirming phenotypic expression in the
neurocranium observed previously.
Conclusion: Apart from the important role
the ftt helicase plays in craniofacial development
identified previously, our data also suggest an important role of the ftt helicase in the development of the GI
tract and the cerebral region. Future functional characterizations of the ftt helicase mutant will be used to
further our understanding of human craniofacial development and its association with GI defects and provide
new inroads for more effective therapies for the prevention and repair of such defects.
Also presented at the 2015 IADR General Session in Boston. Abstract #3030.
30
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Elena Ciciolla,* Rachel Cohen, Paul Stark, Gerard Kugel, and Ronald Perry
Objectives: To evaluate whether substituting bovine coronal dentin and enamel for human hard tissue
specimens is appropriate during shear bond strength (SBS) analysis of dental adhesives.
Methods: Sixty caries-free human third molars and sixty bovine central incisors were polished with pumice
and embedded in a cylindrical base. Half of the human and bovine teeth were ground to dentin with a watercooled grinder using 320-grit silicon carbide paper
at 150 RPM. The remaining teeth were ground to a
flat enamel surface. Four groups of thirty specimens
were made (N=30): bovine enamel, human enamel,
bovine dentin, and human dentin. Each group was
treated with an adhesive system (N=10): 3M ESPE
Adper Scotchbond® (Adhesive 1), Kerr Optibond
Solo Plus® (Adhesive 2), and DENTSPLY Caulk
Prime and Bond NT® (Adhesive 3), all following
recommended manufacturer’s instructions.
Diameter buttons of 2.8 mm, using DenMat®
Virtuoso universal composite, were bonded to each
specimen using an Ultradent Jig®, light cured for
15 seconds with DenMat LED flashlight magna
4.0®, and stored in distilled water for 24 hours at
37°C. The SBS of the specimens were tested using
a Universal Testing Machine (Instron5566A®,
Norwood, Massachusetts) with a 500N load cell and cross-head speed of 1 mm/min. The data was analyzed
using independent sample t-test analysis. A p-value <0.05 was considered statistically significant.
Bates-Andrews Day Abstracts
Dental Adhesive Shear Bond Strength: Comparing Human and Bovine Teeth
Results:
Table 1: All units for shear bond strength are in (MPa±SD)
Dental Adhesive System
Adhesive 1
Adhesive 2
Adhesive 3
Bovine Enamel
Human Enamel
Bovine Dentin
Human Dentin
11.33±8.37
23.41±7.59
25.63±5.03
24.99±8.61
16.03±14.54
31.83±10.27
4.83±4.69
6.30±5.63
13.88±4.81
11.53±12.99
11.60±8.81
14.90±8.89
A statistically significant difference was found between Adhesive 1 for both bovine and human enamel and
dentin. When binding to a dentin substrate, a statistically significant difference was found with Adhesive 2.
Overall, there is a statistically significant difference between bonding on bovine and human teeth (p<0.002)
when using dentin as the substrate.
Conclusion: These results suggest that human and bovine teeth are not equivalent when testing SBS on
a dentin substrate. This difference should be considered when evaluating the appropriateness of substituting
bovine for human specimens.
Also presented at the 2015 IADR General Session in Boston. Abstract #625.
Tufts University School of Dental Medicine
31
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Pilot SEM Analysis of Low pH Whitening Agents
Rachel Cohen,* Elena Ciciolla, Gerard Kugel, and Ronald Perry
Objective: The majority of in-office whitening systems are formulated as basic solutions containing 25%
hydrogen peroxide (H2O2). Lowering pH has been used as a method to increase the stability of H2O2, but at the
risk of etching the enamel surface. LumiSmile White In-office® (LS) (DenMat) is an acidic (pH=5.3) whitening
agent formulated to increase the stability and penetration of H2O2 while protecting the enamel surface from
acid-etching with the addition of calcium phosphate. The objective of this pilot study was to evaluate the effect
of various acidic whitening agents such as LS on surface enamel compared to water (H2O) using scanning
electron microscope (SEM) analysis.
Methods: Two bovine teeth were sectioned
along their long axes into four pieces. One section
of each tooth had one of four treatments applied
to its enamel surface: H2O, 37% phosphoric acid
(H3PO4), LS containing calcium phosphate (LS+),
and LS without calcium phosphate (LS-). Each
treatment was applied to the enamel surface for
45 minutes, followed by thorough rinsing and
a second 45-minute treatment. Specimens were
kept in distilled water for one month and analyzed
with SEM (JEOL6340F Field Emission) at various
magnifications.
Results: Interpretation of SEM photographs
revealed surface similarities between H3PO4 and LS- treatment (Figure 1A, 1B): application of these products
appeared to etch the enamel surface. The H2O and LS+ treatments appear not to disrupt the enamel surface
(Figure 1C, 1D).
Figure 1:
A) H3PO4 applied to enamel surface of tooth #1
B) LS- applied to enamel surface of tooth
C) H2O applied to enamel surface of tooth
D) LS+ applied to enamel surface of tooth
Conclusion: A pilot comparison of the effect of acidic whitening agents suggested that LS+ offers greater
protection of the enamel surface compared to other acidic agents that lack calcium phosphate. Additional
testing and analysis is necessary to validate and investigate the clinical relevance of this finding.
Also presented at the 2015 IADR General Session in Boston. Abstract #367.
32
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Jessie Reisig, Amanda Merikas, John Constantine,* Gerard Kugel, and Ronald Perry
Objectives: To test the validity of directly
comparing the hydrophilic properties of impression
materials in the unset state using newly developed
2-material-side-by-side interface setup and
examining how a drop of water placed on this
interface behaves.
Methods: Two polyether impression materials
and one experimental medium-bodied VPS
impression material (N=5) were tested against
themselves. Each test sample was made by: mixing
each material using Pentamix™-3 (3M ESPE) with
standard mixing times; creating a 2-mm-thick
interface of each sample material separately on
microscope slides, placing the slides containing
samples to be compared side-by-side; placing a
5µl drop of water on the interface by a DropShape Analysis System (DSA-30, Krüss) within 60s after the start
of mixing. Bitmap video files of the water drop encountering the interface were recorded and converted to
JPEG images at selected time frames. At a drop age of 2 s, the horizontal spreading radius of water in pixels
on each material from the center of the water dropper was recorded using JPEG files and measurement tools
using Microsoft Paint®, and a standardized ratio was calculated. A conversion between pixels and millimeters
is available through DSA-30. One-sample t-tests were conducted to determine the statistical significance using
Minitab® version-16. Because compared samples were of the same material, the expected results had a ratio=1.
Bates-Andrews Day Abstracts
A New Side-by-Side Initial Hydrophilicity of Impression Materials Technique
Results: All ratios of mean horizontal water spread fall within the greatest one standard of deviation found
(0.12), ranging 0.89–1.12. In all one-sample t-tests performed, p>0.05, ranging from p=0.37–1.00 (Table 1).
Table 1. Ratio of Horizontal Water Spread Results
Lot Number
Ratio of Mean
Water Spread (SD)
P-Value
554904
559759
1.02 (0.04)
1.00 (0.12)
0.370
1.000
554079
1.02 (0.08)
0.621
Polyether Materials
Impregum Penta Soft (3M ESPE)
Impregum Penta (3M ESPE)
VPS Material
Experimental Medium-bodied-VPS (3M ESPE)
Conclusion: The three impression materials tested failed to reject the expected horizontal water spread
ratio of 1 (one-sample t-test, p>0.05). The new technique used was proven to be effective and can be used to
compare hydrophilicity of different impression materials at different setting stages in the future. The clinical
relevance of hydrophilicity in the unset stage has yet to be tested.
Also presented at the 2015 IADR General Session in Boston. Abstract #2422.
Tufts University School of Dental Medicine
33
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Regulation of Chondrogenesis and Osteogenesis by miRNA-342-3p Transduction
in Mice
Grace Creech,* Xiaoying Wang, and Jake Chen
Objective: To analyze effects of miRNA-342-3p up-regulation on bone tissue regeneration and formation
during wound healing by real-time quantitative PCR and microCT.
Methods: Critical-sized defects (4 mm diameter) were created using dental bur and slow-speed handpiece
on the left and right side of the calvaria of six-week-old mice under anesthesia. Defects on the right-side
experimental group (N=11) were repaired with silk scaffold (pore size 500–600 microns, disk-shaped, 4 mm
diameter, and 2 mm thick) that had been incubated for 4 hours with a serum-free suspension (2 × 107 cells/
ml) of miRNA-342-3p transduced C57BL/6J mouse BMSCs. Defects on the left side of the calvaria control
group (N=11) were repaired with silk scaffold seeded with a suspension of BMSCs transduced with an empty
vector. Six weeks later, calvarial bone from both groups was dissected from euthanized mice and fixed in 10%
neutral-buffered formalin solution overnight. Samples were then kept in 70% ethanol. Calvarial bone tissue was
scanned with high-resolution micro-computed tomography (CT40; Scanco Medical, Basserdorf, Switzerland)
with settings of 1024 x 1024 pixel matrix and slice thickness of 20 μm. Images were segmented using a nominal
threshold value of 225. RNA was isolated and purified from samples using Invitrogen TRIzol® reagent, then
reverse transcribed with Invitrogen SuperScript® First-Strand Synthesis System according to manufacturer’s
instructions. qPCR was carried out using SYBR® Green I Master mix, DNA template, and sequence specific
primers for Sox9, ColX, ALP, Aggrecan, OCN, and GAPDH. ΔΔCt method was used for quantifying gene
expression relative to the housekeeping gene GAPDH.
Results: MicroCT was used to observe
and reconstruct the morphology of the newly
formed bone. A substantial amount of newly
formed bone was visible in the experimental
group, compared to a minimal amount of newly
formed bone in the control group. qPCR was
used to observe the effects of miRNA342-3p
overexpression on mRNA levels of osteogenic
and chondrogenic markers. mRNA levels of the
osteogenic markers ALP and OCN increased
significantly in the experimental group as
compared to the control group. mRNA levels
of chondrogenic markers Sox9, ColX, and
Aggrecan were reduced in the experimental
group as compared to the control group.
Conclusion: Results suggest miRNA-342-3p increases bone formation and regeneration, possibly mediating
the process by up-regulating osteogenic related molecules and down-regulating chondrogenic related molecules.
This project was supported by NIH grant DE21464 to JC.
34
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Kunal Dani,* Steven Eisen, and Gerard Kugel
Objectives: To evaluate the effect of three different delivery techniques of placing bulk-fill composite
restorations (pre-warming, sonic vibrations, and conventional method) on the shear bond strength (SBS) of
these restorations.
Methods: Thirty-six extracted caries-free human molars were used for the study. The occlusal surfaces
were flattened using diamond wheel (Isomet™, Buehler) and polished using Sic paper until 320 grit (Ecomet™,
Buehler) to expose the flat dentin surface. The tooth surfaces were etched (Ultra-Etch®, Ultradent, 37%
Phosphoric acid), for 15s, and bonded (Excite® F, Ivoclar Vivadent). With the aid of a jig, Tetric Evoceram® bulk
fill (Ivoclar Vivadent) was applied to the prepared surface of the tooth. The restorations were cured following
the manufacturer’s protocol. The samples were randomly divided into three groups (N=12). In the first group,
the bulk fill was placed using conventional placement of 4 mm. In the second method, it was placed using sonic
vibrations using Sonicfill™ handpiece, Kerr Corporation. In the third group it was placed after pre-warming the
composite to 54°C using Calset™ composite warmer. The samples obtained were kept in a water bath (37°C/24
hours). SBS was tested using Instron®
Machine (0.1 mm per second). Statistical
analysis was performed using the Kruskal
Wallis test (p=0.05) and Mann-Whitney
U test using Bonferroni correction
(p=0.0167).
Bates-Andrews Day Abstracts
Comparison of Two Different Delivery Techniques for the Placement of
Bulk-Fill Composites
Results: Based on the current bench
study performed, the test revealed higher
mean values of SBS to dentin using prewarming of composites (8.25±4.32 MPA)
as compared to the sonic vibration method
(5.61±4.13MPA) or the conventional
method (5.84±2.88MPA). Kruskal Wallis
and Mann-Whitney test results were not
statistically significant (p-values>0.05).
Conclusions: No statistically
significant difference was found between groups. However, pre-warming of bulk-fill composites did show higher
SBS and may serve as a better alternative of placing bulk-fill composite restorations than the conventional
method. Further studies comparing SBS, microleakage, and physical parameters are recommended.
Also presented at the 2015 IADR General Session in Boston. Abstract #2091.
Tufts University School of Dental Medicine
35
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Human Papillomavirus and Oropharyngeal Cancer: Dental Students’ Knowledge
and Attitudes
Ignacio De La Cruz,* Wanda Wright, Jennifer Bassett Midle, and John Morgan
Objectives: Dental students as future healthcare professionals have the potential to raise the public’s
awareness about human papillomavirus (HPV) and oropharyngeal cancer. The aim of this exploratory study was
to develop an instrument to assess American dental students’ knowledge of HPV and oropharyngeal cancer, and
their attitudes towards addressing HPV and
oropharyngeal cancer with their patients.
Methods: A 26-item questionnaire
based on published articles, CDC
publications, and consultations with a
CDC dental officer was developed to
assess dental students’ knowledge and
attitudes about HPV and oropharyngeal
cancer. Six individuals (two dentists, two
physicians, and two researchers) were asked
to review the content of each question to
assure accuracy (content validity). Each
participant rated importance (1=very
important, 2=important, 3=moderately
important, 4=of little importance, 5=not
important) of each question on a fivepoint Likert scale and whether it should be included (0=no, 1=unsure, 2=yes). Five students completed eight
standardized questions to assess the clarity of the questions and ability of the respondent to understand each
item (face validity). Tufts Health Sciences IRB granted exempt status.
Results: Face validity respondents indicated that the questions and response categories were relevant and
easy to understand. One content validity respondent recommended clarification of abbreviations and more
specific wording in the phrasing of four attitude questions in order to improve readability and accuracy.
Conclusions: A survey document was developed to assess dental students’ knowledge and attitudes about
HPV and oropharyngeal cancer. The instrument was revised and finalized based on face and content validation.
The final survey will be implemented and results will be available for the March IADR session.
Also presented at the 2015 IADR General Session in Boston. Abstract #0932.
36
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Risha De Leon,* Tofool Al Ghanem, and Steven Eisen
Purpose: There is a significant increase in non-U.S.–trained dentists every year in the United States. In most
states, foreign-trained dentists need to complete a two-year program granting a D.D.S./D.M.D., and they must
successfully pass the National Board Dental Examination administered by the American Dental Association
via the Joint Commission on National Dental Examinations prior to receiving the dental licensure. As of 2006,
there were a total of 24 schools offering this program, with varying number of students accepted into the
program. Student performance is gauged via
competency examinations. Competencies
are a basis of proper evaluation of student
progression (Albino et al., 2008, and
Chambers et al., 1998). Given the importance
of competency examinations, it is important
to determine whether the students’ preclinical exam correlates to their competency
examinations in their clinical experience. For
pre-doctoral programs, results have shown no
correlation between a typodont preparation
examination and clinical competency exam
involving the preparation of a full crown
(Curtis et al., 2007). This study aims to
determine whether this trend is apparent in
the international student program as well.
Bates-Andrews Day Abstracts
Comparison of Pre-clinical and Clinical Performance in Operative Dentistry and
Fixed Prosthodontics of the International Student Program
Methods: The international student program at Tufts University School of Dental Medicine (TUSDM)
begins in April. Students undergo a rigorous syllabus for four months concentrating on the different aspects
of dentistry to prepare them for the clinical curriculum. Two of the concentrations are operative dentistry and
fixed prosthodontics. During these pre-clinical courses, students undergo exercises on typodont teeth, written
examinations, and pre-clinical competencies to display their skill set for the said concentrations in dentistry.
Students receive a final grade out of 100, with 70 as passing and 90 as honors. In the clinical curriculum,
the students go through different competencies that average a final grade for operative dentistry and fixed
prosthodontics. In the study, the average of pre-clinical practical grades and clinical grades were gathered. The
data was then compared between the final grade of the pre-clinical and clinical experience to see any relation
between the two results. The data was obtained retrospectively from graduating class of 2010 to 2014, using
a convenience sample of 76 students. Grades were acquired from the Office of Registrar at Tufts University
School of Dental Medicine from April 1, 2009, to May 30, 2014, with no identifying marks. IRB #11369 approval
exempt was attained.
Results: Preliminary data was evaluated with the Class of 2010 with a total of 22 students. Data shows 18%
of the class had a decrease in their pre-clinical grade compared to their clinical grade with an average difference
of 3 points. Of the class, 82% had an increase in their clinical grade from their pre-clinical grade. The range of
difference is from 0.5–14.0 points increase with an average of 5.2. Of the total, 22% students who had a higher
clinical grade compared to their pre-clinical grade had a large difference that ranged from 10.5–14.0 points.
Tufts University School of Dental Medicine
37
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Evaluating NaOCl Penetration into Dentinal Tubules Using GentleWave™ System
Lindsay Fox,1* A. Sherman,2 P. Vandrangi,2 M. Kakpour,2 Ronald Perry,1 and Gerard Kugel1
1Tufts
University School of Dental Medicine, Boston; 2Sonendo®, Laguna Hills, California
Objective: To evaluate dentin disinfection
by measuring the penetration depth of sodium
hypochlorite (NaOCl) into dentinal tubules using
the GentleWave™ system and ultrasonic agitation.
Methods: Forty extracted human molars were
accessed and instrumented to 15/0.04 rotary
file, cleaned to remove pulp tissue, immersed in
crystal violet dye and incubated (37°C) overnight.
Samples were rinsed with water for 30 minutes
and randomly divided into four treatment
groups (N=10): (1) GentleWave™ system, (2)
PiezonMaster™700(EMS)ESI-tip passive, (3)
PiezonMaster™700(EMS)ESI-tip active ultrasonic
activation with maximum irrigation rate, and (4)
positive control (no NaOCl). Following treatments,
samples were rinsed with distilled water for one
minute. Crowns were removed and roots were split longitudinally. The depth of NaOCl penetration (DP)
into dentinal tubules was imaged and analyzed using Nikon® stereo-microscope and software. Statistical
comparisons were done with Welch’s t-test (p<0.05). Pearson correlation coefficients (r) were calculated for
degree of dependence between DP and distance from the apex.
Results:
NaOCl Penetration (µm)
Group 1
Apical
Middle
Distal Canal
Average
385.64
399.50
SD
±117.05
±118.54
Mesial Canal
Average
416.31
385.87
SD
±112.27
±133.67
Group 2
Apical
Middle
Group 3
Apical
Middle
Group 4
Apical
Middle
77.00
±73.80
137.34
±102.53
71.18
±131.87
235.97
±97.08
0
0
2.18
±4.94
47.31
±70.17
129.45
±72.73
114.39
±57.04
264.01
±115.31
0
0
17.32
±57.44
Conclusions: Group 1 when compared to group 2 and group 3 was significantly different (p<0.05) for
the apical region of both mesial and distal canals and middle region of distal canals. No significant difference
was observed between group 2 and group 3 (p>0.05). The DP in the middle region was statistically greater than
that in the apical region for group 2 and group 3 (r=0.91 and r=0.94, respectively), whereas group 1 showed no
difference in DP between location and type of canal (r=0.0002). Group 1 demonstrated higher DP at canal apices
than group 2, and no difference was observed in canal.
Study funded in part by Sonendo®. Also presented at the 2015 IADR General Session in Boston. Abstract #3874.
38
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
David Frantz,* Kanchan Ganda, Britta Magnuson, Jennifer Bassett Midle, and Melissa Ing
Objective: Dental educators are keen on incorporating new teaching methods to promote learning. This
pilot study compared knowledge gained by students using traditional lecture versus a computerized virtual
patient avatar. The secondary aim was to compare student attitudes towards traditional classroom lecture versus
a computerized avatar.
Method: Sixteen second-year pre-doctoral dental students were recruited and given a computerized pre-test
prior to a learning module. The pre-test questions pertained to the lecture/avatar material later presented to
establish baseline knowledge and allow post-test comparison. Students were randomized into two eight-subject
groups, with one group taught via PowerPoint lecture and the other via interactive avatar. A computerized posttest was given following each module with the same questions as the pre-test plus three Likert-scale questions
querying each subject’s attitudes towards the teaching method.
Results: Data were analyzed using a
Likert scale and Fisher Exact test. Students
were asked if their group’s learning module
was an effective teaching method, if the
module used aided material retention,
and if the module would assist their
patient care. Pre-test and post-test results
were also compared. A positive trend
towards significance (<0.20) was seen
for avatar effectiveness and information
retention, with p-value=0.1580 and 0.1189
respectively. Controlling for pre-test scores,
repeated measures analysis evaluated
increase in knowledge by learning module
type; a p-value of 0.1367 suggested a greater
increase in knowledge from pre- to posttest for the avatar, but significance was not reached at alpha of 0.05. A significant difference (<0.05) was found
for the avatar assisting in patient care versus traditional lecture, with p-value=0.0438.
Bates-Andrews Day Abstracts
Comparing Two Teaching Methods: Virtual Patient Avatar vs. Traditional Lecture
Conclusions: The data trends towards significance in positive student attitude regarding effectiveness of
the avatar module, in the avatar for retention of the material taught versus traditional lecture, and in the avatar
module resulting in a greater increase in knowledge from pre- to post-test versus standard lecture. A significant
difference was found regarding positive avatar impact on student patient care. Overall, the avatar teaching
method shows better post-test evaluations, but this pilot study is limited due to small sample size; a larger
sample in a future full-size study may show difference in the two p-values trending towards significance (<0.20).
Also presented at the 2015 ADEA Annual Session in Boston.
Tufts University School of Dental Medicine
39
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Effect of Elevated Temperatures on Fluoride Ion Release of Varnish
Katharina Fung,* Myles Clancy,* Steven Eisen, Masly Harsono, Gerard Kugel, John Morgan, Angel Park,
and Matthew Finkelman
Objective: The aim of this study was to evaluate fluoride ion release of varnish in artificial saliva when stored
in elevated temperatures for 72 hours.
Methods: Sealed fluoride varnishes (Enamel Pro®Varnish) were stored in water baths at temperatures of
two groups (N=12): 40°C, 52°C, and control 24°C. Artificial saliva was made in the lab from (mmoles/L):
MgCl2.6H2O(0.2), KH2PO4(4.0), KCl(30.0), NaN3(0.3) and CaCl2(0.7). After 72 hours, varnishes were removed
and painted onto 2 x 5 mm polyester sheet and immersed in a 4 ml solution of artificial saliva and TISAB II
buffering solution (1:1) in a polystyrene vial. Fluoride release was analyzed after 1 and 2 hours with a fluoride
ion-specific electrode (Thermo Scientific™, No 0809, Beverly, Massachusetts).
Results: Data results were normal based on Shapiro-Wilk’s test. A one-way ANOVA test was implemented to
check for mean differences. At 1 hour (N=12), 24°C mean was 32.98±7.45 ppm, at 40°C mean was 33.40±7.17
ppm, and at 52°C mean of 36.02±6.8 ppm.
One-way ANOVA of group yielded no
significant differences between each group
(p<0.05). At 2 hours, at 24°C the mean
was 39.52±10.76 ppm, at 40°C the mean
was 39±9.29 ppm, and at 52°C mean was
46.16±10.47 ppm. One-way ANOVA of
the group at 2 hours yielded no significant
differences between each group (p<0.05).
Conclusions: Although it was
predicted that higher temperatures would
cause a decrease in fluoride release of
varnish, results were not statistically
significant to confirm or reject the
hypothesis. Based on observations at the 1
and 2 hour marks, the highest temperature seemed to possess an elevated level of fluoride releasing activity on
average. However with inconclusive data, it would be beneficial in future studies to increase sample size as well
as control for the variability in the application of varnish to produce more significant results.
Also presented at the 2015 IADR General Session in Boston. Abstract #678.
40
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Yamila Garber,* Shankeertha Sundaralingam, Mabi Singh, Athena Papas, Angel Park, and Britta Magnuson
Objectives: The aim of this study was to determine if Tufts University School of Dental Medicine (TUSDM)
research participants in a clinical screening study were reflective of the population in Massachusetts.
Methods: Demographic data from 468 participants, age 18–65, in a clinical screening study for caries
conducted by the Oral Medicine Department at TUSDM from January 2010 to February 2012 was collected.
This was compared to publicly available U.S. Census data for Massachusetts, from a similar time period
(2009/2010) and same age group.
Results: The population of Massachusetts in 2010 was 6,547,629.
Of that, 51.14% was female. In the clinical study 47.72% were female.
The average income in 2010 for Massachusetts residents was $62,072.
The majority of the clinical trial participants (50.45%) had an annual
income of less than $30,000 at the time of the study. See Table 1 for BMI,
smoking, and disease status. See Table 2 for race data.
Table 1. BMI, Smoking, and Disease Status: MA Census Data 2009 vs.
Study Data
Female
Male
BMI>30
Tobacco smokers
Heart disease
Hypertension
Diabetes
MA Census Data 2009
51.14%
48.85%
19.80%
17.60%
1.67%
16.17%
4.77%
Bates-Andrews Day Abstracts
Demographic Comparison of TUSDM Research Participants vs. Massachusetts
Census Data
Clinical Study Data
47.72%
52.28%
25.63%
23.33%
1.74%
11.52%
5.87%
Table 2. Race: MA Census Data 2010 vs. Study Data
Race
White
Black or African American
American Indian/Alaskan Native
Asian
Hispanic
MA Census Data 2010
80.40%
6.60%
0.30%
5.30%
9.60%
Clinical Study Data
58.96%
25.47%
0.95%
6.84%
13.74%
Conclusions: The results suggest that the prevalence of BMI>30, tobacco smoking, heart disease,
hypertension, and diabetes was similar between the study group and the Massachusetts population. There was
a difference in average income. Additionally, there was a difference in racial diversity. This suggests that the
population screened for the clinical study is reflective of the overall Massachusetts population except in regard
to annual income and racial diversity.
Also presented at the 2015 IADR General Session in Boston. Abstract #4161.
Tufts University School of Dental Medicine
41
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Select Characteristics of Developmentally Disabled Adults with No Untreated Caries
Hannah Gilman,* Jane Steffensen, Angel Park, and John Morgan
Objective: Individuals with intellectual/developmental disabilities (I/DD) are reported to have a high
prevalence of dental caries. This study describes characteristics of dentate adults with I/DD who presented to the
Tufts Dental Facilities with no untreated dental caries, either with existing restorations or with no restorations.
Methods: This cross-sectional study analyzed clinical and demographic data from axiUm electronic records
of dentate adults with I/DD aged >20 years who received an oral examination from April 1, 2009, to March 31,
2010. Independent variables included disability level (mild, moderate, profound), residence type (communitysupported, independent and institutional) and selected comorbidities. Analysis was conducted on the subset of
study participants with no untreated caries. Data were analyzed using SPSS. Associations were tested using chisquare analysis.
Results: Of the 4,218 dentate adults in
the study, 2,859 had no untreated dental
caries, and of those, 82.1% (N=2,346) had
restorations (Rest) and 17.9% (N=513) had
no restorations (NoRest). The prevalence
of profound disability in the Rest group vs.
the NoRest group was 39.4% (N=1,518) vs.
63.4% (N=318) respectively, p<0.001; those
living in institutions was 12.4% (N=2328)
vs. 23.0% (N=511) for Rest vs. NoRest
respectively, p<0.001; and of the reported
comorbidities, the prevalence of epilepsy,
cerebral palsy and gastronomy tubes was
37.9% vs. 44.4%, 17.0% vs. 24.6% and 6.2%
vs. 14.8% for Rest vs. NoRest respectively,
p<0.001.
Conclusions: The data from this preliminary analysis showed that the dentate adults with I/DD in the
NoRest group were on average of a more profound disability level, more likely to reside in institutional living
situations, and had a higher prevalence of epilepsy, cerebral palsy, and gastronomy tubes. Future studies may
explore the prevalence of periodontal disease and investigate further reasons why more profound disability
level, institutional living, and specific comorbidities would be associated with a lower prevalence of dental caries
in this population group.
Also presented at the 2015 IADR General Session in Boston. Abstract #1444.
42
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Vishavjeet Girn,1* Khoa Tran,1 Courtney Robinson,1 Edsel Ing,2 Angel Park,1 Matthew Finkelman,1
William Chao,1 Jonathan Bishop,1 Gerard Kugel,1 and Melissa Ing1
1Tufts
University School of Dental Medicine, Boston; 2University of Toronto, Toronto
Objectives: Most dental schools offer both magnifying loupes and light emitting diode (LED) headlamps
to students as part of their instrument kit. However, blue wavelength 440–880 nm, such as that found in LEDs,
has been linked to macular degeneration. Tufts University School of Dental Medicine (TUSDM) students
and faculty were surveyed to determine whether they experienced any adverse effects such as blurry vision or
headaches that may be linked to LED headlamp use.
Methods: The sample included faculty
and first, second, third, and fourth year
pre-doctoral students at TUSDM. The
online survey tool Qualtrics was used to
administer a 21-question survey regarding
use of loupes with or without headlamps,
brands used, and frequency of use, and
to account for any experience of negative
effects.
Bates-Andrews Day Abstracts
Are We in the Dark: LED Headlamp Use at TUSDM
Results: In the study, 1,361 students
and faculty were contacted; a total of 440
completed the survey. Of these, 82.3%
reported using LED headlamp with
magnifying loupes. Respondents’ average
use of an LED headlamp was 3.36 hours per
day. Median use was 3 hours per day (IQR: 2.0, 4.0). Of those using an LED headlamp, 13.0% reported turning
the LED off during a procedure and 52.4% reported at least one experience of negative effects including blurry
vision, headaches, double vision, or other visual disturbance.
Conclusions: More than half of those surveyed who used LED headlamps experienced some sort of visual
disturbance. Blue light hazard from LED usage and subsequent retinal damage are not well understood. Safety
education could possibly minimize future visual problems by suggesting the changing of light intensity or
limiting time usage.
Also presented at the 2015 IADR General Session in Boston. Abstract #924.
Tufts University School of Dental Medicine
43
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
The Prevalence of Global Service Programs in United States Dental Schools
Aidee Nieto-Herman, Daniel Gonzalez,* Ingrid Romero, Zuzana Mendez, Michelle Webb, Nikhil Manocha,
Kimyen Nguyen, Jessica Restrepo, Gursimran Reen, Ada Alfonso, Keerthy Chilakamarry, and
Sadaf Foroutan
This study evaluated global service programs (GSPs) as an integral part of United States dental school curricula.
In 2003, the American Dental Education Association (ADEA) stated some schools are increasing extramural
opportunities to introduce students to patients of different needs, cultures, and dental delivery services.
According to the American Dental Association (ADA) in 2009, nearly half of the dental schools in the United
States offer international volunteer opportunities to their students. This descriptive study determined how many
dental schools in the United States incorporated global service learning in their dental curricula. Furthermore,
the study describes the unique exchange program experience between Tufts University School of Dental
Medicine (TUSDM) and the University Pedro Henriquez Urena (UNPHU) in the Dominican Republic.
Objective: The objective of this study was to determine the importance of incorporating global health
service into the dental curricula with the goal of preparing dental students to help reduce oral-health disparities
and prepare them to work effectively with culturally diverse patients.
Methods: An evaluation of the 65 dental
schools, 41 public and 24 private, was included.
Scientific papers and journal articles (N=191)
were screened closely using search engines
PubMed and Medline from the past ten years,
which were systematically filtered to 8 articles.
Results: It was found that 31.3% (less than
one third) of all American dental schools
incorporate global service learning trips into the
dental curriculum, 42.2% do not incorporate
these trips into the curriculum, and the
remaining 26.5% are unknown. The percentages
were almost the same between private and
public. For this reason, the p-value was not
statistically significant using chi-square test
analysis (p>0.05).
Recommendations: Global service programs should be offered to college pre-dental students and firstand second-year graduate students regardless of prior experience in global health. The study suggests that U.S.
dental schools should include exchange programs and foster sustainable site partnerships.
Conclusion: This study found that less than one third of all dental schools in the United States incorporate
global service programs in their curriculum. Many dental students aspire to incorporate global health into their
future careers, while others seek international opportunities to better prepare themselves for private practice in
United States.
44
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Federico Ausenda, Joshua Hall,* Shivam Patel, Brent Popovich, Daniel Chay, Daniel Coleman,
Natalie Jeong, and Paul Levi
Objectives: The first aim was to determine the efficacy of toothbrushes in removing artificial plaque over a
4-month period using a stationary bristle technique (a modification of the Bass technique) or a scrub technique.
The second aim was to determine the amount of wear on a toothbrush when brushing with a stationary bristle
technique or a scrub technique, over a 4-month period on a typodont.
Methods: At baseline and at each
2-week interval, each brush was
photographed from the top down in three
sections under 40X magnification. At
the same intervals, artificial plaque was
applied to the buccal/lingual surfaces of
the “Ramfjord” teeth. The typodonts were
photographed buccal/lingually and brushed
for two minutes, then photographed again.
The scrub (N=2) and stationary bristle
(N=2) techniques, with dentifrice and
water, were used. Each model was brushed
on all surfaces for 2 m per brushing session.
This was repeated to simulate brushing
twice a day for four months. Technique and
temporal indicators were removed from all photographs, and each was assigned a randomized identification
number. Two blind evaluators measured the length and width of each toothbrush section to analyze wear and
assessed plaque removal using the Sillness and Loe plaque score.
Bates-Andrews Day Abstracts
Toothbrush Wear and Plaque Removal Efficacy over Time
Results: The scrub technique removed significantly (p=0.0004) more supragingival plaque than the
stationary bristle technique. Toothbrush length and width measurements increase over time for both
techniques; scrub technique deforms width more than stationary bristle technique, but not length.
Conclusions: Although toothbrushes wear down over time using either the scrub or the stationary bristle
technique, neither had a definitive effect on removing artificial plaque as time progressed. These results on
artificial plaque provide merit for a clinical study looking at plaque removal, as it implies that toothbrushes may
not need to be replaced as frequently as recommended.
Also presented at the 2015 IADR General Session in Boston. Abstract #3070.
Tufts University School of Dental Medicine
45
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Fluoride Content in Green Tea
Melissa Ing, David Frantz, Britta Magnuson, Masly Harsono, Jennifer Bassett Midle, Matthew Finkelman,
Alexis Irby,* and Gerard Kugel
Objectives: Camelia sinensis, the tea plant, is a natural bioaccumulator of fluoride, which is uptaken and
incorporated into the plant when it is grown in fluoride containing soil. The fluoride is released upon brewing
the tea. This study measured the fluoride released from four Asian green teas.
Methods: Asian sencha variety loose-leaf green teas were obtained from Sri Lanka, South Korea, China,
and Japan. Each tea was brewed 20 times, each time using 2.5 grams of loose-leaf tea and 120 cm³ of deionized
water. Brewing time was two minutes, and brewed tea was analyzed using a fluoride probe. As control, the
above process was done using deionized water without any tea. All reusable articles used in the experiment were
cleaned using deionized water between experimental runs.
Results: The normality assumption was
checked and violated so nonparametric
measures were conducted in this analysis.
Medians and interquartile ranges of
fluoride concentrations were reported for
each tea type; Chinese 6.83 ppm (0.14),
Korean 5.36 ppm (0.10), Ceylon 3.58 ppm
(0.14), and Japanese 1.88 ppm (0.14). A
Kruskal-Wallis test found a significance
difference between groups of tea (H=95.06,
df=4, p-value<0.0001). Nonparametric
post-hoc tests found significant differences
between the Chinese tea, with both Ceylon
and Japanese tea, and significant differences
between Korean tea with Japanese tea. All
teas were significantly different from the
control group.
Conclusions: The Chinese tea had the highest amount of fluoride released while the Japanese had the
lowest. Chinese tea was not significantly different, though, from the second highest, Korean, but was different
than both Ceylon and Japanese tea. This study showed that teas from different countries varied in the amount of
fluoride they contained. When considering a person’s daily fluoride intake, tea consumption habits and origin of
tea should be evaluated.
Also presented at the 2015 IADR General Session in Boston. Abstract #2546.
46
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Mansi Jailwala,* Diana Esshaki, Gülsün Gul, Jennifer Bassett Midle, and Kanchan Ganda
Objectives: The objectives of this study were to survey and assess dental students’ knowledge and attitudes
toward domestic violence (DV) patients; to compare the DV curriculum experience of second-, third-, and
fourth-year dental students; to ascertain how the knowledge and opinions of students evolve as they gain
training; and to evaluate if the curriculum and clinical experience at Tufts University School of Dental Medicine
(TUSDM) enhance students’ knowledge and attitudes.
Methods: A pre-validated survey tool,
PREMIS (Physician Readiness to Manage
Intimate Partner Violence Survey), was
modified and used to survey second-,
third-, and fourth-year dental students. The
survey included questions in three sections:
background experience, intimate partner
violence (IPV) knowledge, and opinions.
An online survey tool, Qualtrics, was used
to survey students. Statistical analyses were
performed with SAS software (version 9.3).
Descriptive statistics were computed for each
of the three classes. Statistical significance
between classes was assessed via ANOVA
for the normally distributed continuous
measures, with Tukey’s HSD post-hoc tests
and Kruskal-Wallis test for not normally distributed continuous measures. Chi-square tests were conducted for
categorical measures. P-values<0.05 were considered statistically significant.
Bates-Andrews Day Abstracts
Evaluating Dental Students’ Readiness in Managing the Domestic Violence Patient
Results: The sample population for the survey was 58.4% second years, 24.8% third years and 14.2% fourth
years. Analysis showed no significant differences in preparedness, knowledge, and opinions between the
three classes. The median level of preparedness that the TUSDM students reported having working with DV
patients was 4 on a scale of 1–7. The median score for knowledge was 4–5 on a 1–7 scale with the exception of
knowledge on developing a safety plan for DV patients and the relationship between DV and pregnancy was 3.
In the opinion section where students were asked to show how much they agree or disagree with a DV-related
statement, the answers varied.
Conclusions: TUSDM’s curriculum is striving to train students to assist DV patients. Most students are at
the 50th percentile in knowledge and preparedness indicating that the curriculum has room for improvement in
certain areas but it is effectively raising awareness and comfort level of the students.
Tufts University School of Dental Medicine
47
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Oral-Health Related Quality of Life in Sjögren’s Syndrome: A Continuation
Samantha Keck,* Athena Papas, Angel Park, Matthew Finkelman, Britta Magnuson, and Mabi Singh
Objectives: This study investigated oral-health related
quality of life (OHRQoL) in patients with Sjögren’s
syndrome (SS).
Methods: A comprehensive web-based questionnaire
(Qualtrics) was created using the OHIP-14 Questionnaire, and
questions from the Harrison Interactive Survey on Sjögren’s
syndrome previously administered by the Sjögren’s Syndrome
Foundation (SSF). After IRB review, the SSF emailed the
questionnaire to their members. Members of SSF were asked
to forward the questionnaire to a peer of similar age and same
gender that had not been diagnosed with SS to serve as a
control group. All data were de-identified. For categorical data,
the percentages and frequencies were calculated. The mean
and median were analyzed for continuous data. Chi-squared
tests and ANOVA were run using SAS 9.2.
Results: Preliminary analysis of the data included 1,336 individuals with primary SS (95.94% female),
143 with secondary SS (98.31% female), and 162 for the peer control population (95.27% female). There was
no statistical difference between the ages of the three groups (mean=59.1, p=0.327). Participants were asked
five questions in regards to the dental work completed (Table 1). Of the five questions, the only statistically
significant difference between SS and the comparison population was noted in whether fillings or crowns
have been placed in the last 12 months (Table 1). Table 2 lists the continuous data regarding the amount of
dental visits as well as the amount spent out of pocket on dental work within the last 12 months for the three
populations. The mean amount spent by primary SS patients was $1,595.30 (±$3,234.04), $1,663.18 (±$2,814.33)
for secondary SS patients and $488.06 (±$936.49) for the comparison population.
Table 1
Primary Sjögren’s
Syndrome (Col Pct)
Have you had any dental
implants?
Have you had any root
canals?
Have you had any
extractions (not including
wisdom teeth)?
48
Secondary Sjögren’s
Syndrome (Col Pct)
Comparison
Population (Col Pct)
P-Value
20.53%
19.49%
17.81%
p=0.989
69.18%
63.56%
55.48%
p=0.074
50.65%
50.43%
46.94%
p=0.585
Have you had any fillings in
the past 12 months?
45.08%
51.69%
22.76%
p<0.001
Have you had any crowns
placed in the past 12
months?
37.64%
42.74%
18.37%
p<0.001
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
How many dental visits did you make
in the past 12 months?
How much did you spend out of
pocket on dental work in the past 12
months?
Primary Sjogren’s
Syndrome
Secondary Sjogren’s
Syndrome
Comparison
Population
3.29±2.83
3.15±2.37
1.98±1.00
$1,595.30
$1,663.18
$488.06
±$3,234.04
±$2,814.33
±$936.49
Conclusions: Both primary and secondary Sjögren’s syndrome reported more fillings and crowns as well as
increased amount spent out of pocket on dental work within the last 12 months compared to their peer controls
population.
Also presented at the 2015 IADR General Session in Boston. Abstract #1022.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Table 2
49
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparison of Microleakage Evaluation Methodology of Beveled
Composite Restorations
Julia Kim,* Tofool Alghanem, Gerard Kugel, and Masly Harsono
Objective: To observe the microleakage of Class-II
restorations using two different microleakage evaluation
methodologies.
Methods: A total of sixty Class-II preparations were
prepared on caries-free extracted human molars by a single
operator. All preparations were approximately 1.5 mm
in depth at the pulpal floor and 2.5 mm at the gingival
floor, with 0.5 mm bevel on enamel all around cavosurface
margins at 45°. Samples were randomly assigned into four
groups (N=15 each, two with phosphoric acid etching (E)
and two without (WE)). AdheSE® adhesive system was
applied according to the manufacturer’s instructions. Then
the samples were filled with Filtek Supreme Ultra (3M
ESPE) and cured for 20 seconds with an LED light (DEMI,
Kerr). Apices of teeth were blocked with wax and tooth
surfaces were covered with nail polish except for 2 mm around cavosurface margins. One group each from E
and WE was thermocycled for 2,500 cycles in water between 5°C and 50°C with a dwell time of 15 seconds and
then immersed in 2% methylene blue solution for 10 hours (H2O) The other two groups were thermocycled
in the same manner in buffered 2% methylene blue solution (Blue). Samples were embedded into acrylic and
sectioned in the mesio-distal direction (Isomet, Buehler). Microleakage scores towards pulpal floor (P) and axial
wall (A) were recorded under a light microscope (Olympus SZX16). Statistical analysis was conducted using an
ordinal logistic regression test. Statistical significance was predetermined at p<0.05.
Results: The table shows the number of samples in each scoring group. Groups that used phosphoric
acid etching had lower microleakage scores. Groups that were thermocycled methylene blue solution had
more microleakage scores of 4 towards axial wall, but the difference between the groups was not statistically
significant.
Microleakage score towards
Pulpal Floor (P) / Axial wall (A)
0=no microleakage
1=25% towards (P)/(A)
2=50% towards (P)/(A)
3=75% towards (P)/(A)
4=100% towards (P)/(A)
Group 1
E+H2O
9/6
4/6
1/1
1/1
0/1
Group 2
WE+H2O
6/2
3/4
2/2
0/1
4/6
Group 3
E+Blue
10/6
3/1
2/5
0/0
0/3
Group 4
WE+Blue
5/2
4/1
2/4
1/1
3/7
Conclusions: Using phosphoric acid etching significantly reduces microleakage scores (p=0.01). No
significant difference in microleakage scores was seen between samples that were thermocycled in methylene
blue solution instead of water (p>0.05).
Also presented at the 2015 IADR General Session in Boston. Abstract #647.
50
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Yun Ae Kim,* Diana Esshaki, Britta Magnuson, Jennifer Bassett Midle, and Kanchan Ganda
Objective: The purpose of this study was to evaluate the prevalence of hepatitis B in all patients getting
a medical consult at TUSDM. Both the hepatitis-B–positive patients and the hepatitis-B–negative patients
were further subdivided into to Asian-American versus non–Asian-American. The hypothesis was that the
prevalence of hepatitis B in Asian-American patients would be much higher in comparison to the non-Asian
patients getting a medical consult at TUSDM. The age and gender of the hepatitis B patients were also subject to
analysis.
Method: A retrospective analysis was conducted of medically complex patients who were treated at TUSDM
undergraduate clinic from June 2004 to May 2014. The study population was analyzed for patient demographics
and disease status analysis by reviewing Medical Consult and Comprehensive Health History forms on axiUm,
respectively.
Results: The prevalence rate of hepatitis
B in the Asian population was 4.2%. This
rate was comparatively much higher than
any other race. When comparing the
two racial groups Asians vs. non-Asians,
a chi-squre <0.0001 indicated the two
groups are significantly different in the
distribution of proportions among HepB
negative and HepB positive. An odds ratio
of 0.488 was found, indicating Asians
are 48% more likely to be HepB positive
than non-Asians. Age and gender were
addressed for all patients getting a medical
consult in axiUm. Age and gender were
also addressed for the hepatitis-B–infected
population separately. Although there were more females in the patient population getting a medical consult,
there were more males with hepatitis B than females.
Bates-Andrews Day Abstracts
Analyzing the Prevalence of Hepatitis B in Asian-American Patients and Non-Asian
Americans with a Medical Consult at Tufts University School of Dental Medicine
Conclusion: The original hypothesis of this research was confirmed. It was shown that of the patients
getting a medical consult at TUSDM, Asians showed the greatest prevalence rate of hepatitis B. This conclusion
confirms and parallels research that has been conducted on Asian Americans elsewhere in the United States.
Also presented at the 2015 ADEA Annual Session in Boston.
Tufts University School of Dental Medicine
51
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Rural Zambia Oral-Health Dental Services: Utilization Outcomes
Alice Ko,* Maryam Mahdavi, Angel Park, and John Morgan
Objective: The World Health Organization’s
recommendations for the prevention of
non-communicable diseases and improved
quality of life include prevention-focused oralhealth programs. The aim of this study was
to investigate various oral-health indicators
(pain, required extractions, and treatment
urgency (TU)) of patients who participated in a
preventive-focused oral-health program in rural
Zambia from 2007–2013. First-time members
(non-repeaters) in addition to patients returning
to the program (repeaters) were assessed for
oral-health outcomes.
Methods: Data was collected each year
from screening forms recorded by a calibrated
dental team. All records were de-identified,
entered in Access, and crude bivariate analyses completed using SAS 9.2. Patients were divided into 2 groups:
non-repeaters and repeaters. TU of each patient visit was recorded as 0=no obvious problem; 1=early dental
problem; 2=urgent care. Other data include pain (0=no; 1=yes) and extractions (0=no; 1=yes).
Results: From 2007–2013, a total of 3,132 individuals (2,633 non-repeaters and 499 repeaters) were seen.
Preliminary analysis indicates that, for non-repeaters vs. repeaters, 47.0% (1,238) vs. 63.5% (317) reported pain
and 41.1% (1,082) vs. 54.1% (270) required extractions, respectively. Treatment urgency was evaluated for the
first repeated year (2008) and last repeated year (2013) of the program. For non-repeaters vs. repeaters, TU=2
was 30.2% vs. 42.0% in 2008 and 29.7% vs. 31.0% in 2013. TU=0 was 18.2% vs. 25.0% in 2008 and 57.5% vs.
47.3% in 2013, respectively.
Conclusion: Preliminary results indicate that a greater percentage of repeaters reported pain and required
extractions than non-repeaters. This would be consistent with repeaters better identifying problems and
returning for treatment. However, the proportion of TU=2 decreased and TU=0 increased over the study period
for both patient pools. This would be consistent with an overall population seeking preventive care. Further
assessment of the program, including qualitative methodologies, would assist in project development and
strategic planning.
Also presented at the 2015 IADR General Session in Boston. Abstract #3871.
52
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Zachary Carnow, Yujin Lee,* Paul Kim, Christina Penn, Tannaz Shapurian, Robert Gyurko, Paul Levi Jr.
Objective: To study the relationship
between periodontal bone loss and age.
Methods: A retrospective review of
1,000 electronic patient records in the
pre-doctoral clinics of TUSDM was
performed to observe comprehensive oral
examinations and digital radiographs.
Patient records from January 1, 2012,
to July 8, 2014, were grouped in 10 age
cohorts ranging from 15 to 64 years. For
each age group, 100 records were randomly
selected for inclusion in the study. Data
were gathered regarding patient age and
periodontal bone loss. Presence of at least
one interproximal site with a distance of
more than 2.5 mm between the cementoenamel junction and the alveolar bone crest as measured on bitewing
radiographs was considered evidence of periodontal bone loss.
Bates-Andrews Day Abstracts
Prevalence of Periodontal Bone Loss as a Function of Age
Results: Simple logistic regression analysis shows there is a significant relationship between the increase of
age and prevalence of periodontal bone loss, p <0.0001 (Graph 1). The minimum prevalence value for bone loss
occurs in the age group between 15 and 19, whereas the maximum prevalence value for bone loss occurs in the
age group of 55 to 59 (Table 1). Also, we note that there are incremental differences between the age groups,
and the biggest incremental difference happens between ages 34 to 39 and also at 54 and 59 (Graph 2). Further
statistical analyses are needed to corroborate the trend with calculation.
Graph 1: Percentage of people
within each age group pooled
into two groups: no bone loss
(radiographic bone loss=0)
and presence of bone loss
(radiographic bone loss=1) vs. age
Tufts University School of Dental Medicine
53
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Table 1. The prevalence of periodontal bone loss within each age group
Age group
Prevalence (%)
15–19
1.96
20–24
4.76
25–29
11.88
30–34
23.64
35–39
36.89
40–44
42.16
45–49
44.86
50–54
48.04
55–59
64.36
60–64
64.04
Graph 2. Prevalence of periodontal bone loss changing with age
Conclusion: A significant relationship exists between the prevalence of periodontal bone loss and age. The
age groups show different incremental differences. Further statistical analysis is needed to determine specifically
at what age the increase is most pronounced. Also for the future we want to look at whether there are differences
with gender, tobacco use, BMI, and systemic diseases and compare all of these groups to look for significant
differences.
Also presented at the 2015 IADR General Session in Boston. Abstract #2448.
54
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Heather Leung,* Jennifer Bassett Midle, and Yun Saksena
Objective: Admission to dental school is highly competitive, with admittance rates in the single digits. Each
year, the admissions selection committee faces the difficult task of determining which students to admit to their
four-year professional program. Admissions information data, such as Dental Admissions Test (DAT) scores,
undergraduate grade point average (uGPA), and scientific grade point average (sGPA), have commonly been
used to predict academic success in dental school. However, this information can also be utilized to identify
students who may be at risk for low academic performance. This study aims to explore the potential of DAT
scores, cumulative undergraduate GPA (uGPA), and science GPA (sGPA), as being possible predictors of failure
at TUSDM.
Methods: Following approval from the Tufts University Institutional Review Board, the Tufts University
School of Dental Medicine (TUSDM) Office of Admissions and Student Affairs reviewed the academic records
of the pre-doctoral students of the 2013, 2014, 2015, 2016, and 2017 classes at TUSDM (N=885). Administrators
identified each student as having failed or not failed a first- or second-year course and matched him/her to his/
her undergraduate DAT scores (academic average (AA), total science
(TS), quantitative reasoning (QR), reading comprehension (RC), and
biological sciences (Bio)); cumulative undergraduate GPA (uGPA);
science GPA (sGPA); biology, chemistry, physics GPA (BCP GPA); and
non-science GPA (nsGPA). Univariate descriptive statistics (counts
and percentages, and means and standard deviations for continuous
measures like DAT scores, uGPA, and sGPA) were computed for the
group of students who failed and the group of students who did not
fail a first- or second-year course. All data had been de-identified.
Statistical significance between the groups was assessed via bivariate
analysis (t-tests) for the continuous measures. All p-values<0.05
were considered statistically significant. All statistical analyses were
performed using SPSS Version 21.
Bates-Andrews Day Abstracts
Quantitative Admissions Criteria as Predictor of Academic Failure at TUSDM
Results: Each pre-doctoral class comprised of about 20% of the
sample population (N=885), with around 10% (N=91) having failed
and 90% (N=794) having not failed a first or second year course. A
significant difference between the failure (F) and no failure (NF) groups was determined for the following DAT
scores: academic average (mean F=19.242, mean NF=19.743, p=0.004), quantitative reasoning (mean F=17.275,
mean NF=18.142, p=0.002), and total science (mean F=19.308, mean NF=19.713, p=0.036). The reading DAT
score demonstrated a relationship that was “trending towards significance” (mean F=20.341, mean NF=20.844,
p=0.078). No statistical difference was found in the uGPA variables and biology (p=0.254) DAT score for the
failure and no failure groups (p>0.05).
Conclusion: This study found that DAT scores, not undergraduate GPA, differed across the failure and
no failure groups, illustrating the fact that DAT scores are related to failure while uGPA variables are not. This
suggests that certain DAT scores are related to failure and may serve as a good indicator of academic failure at
the dental school level. However, future analysis will be needed to evaluate whether these relationships are true
for all students, when controlling for such factors as gender, race, and age.
Also presented at the 2015 ADEA Annual Session in Boston.
Tufts University School of Dental Medicine
55
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
The Effect of Collagen I and Fibronectin on the Inflammatory Potential of THP-1
Macrophages: Baseline Cytokine Measurements
James Leung,* Jason DeFuria, and Jonathan Garlick
Objective: Previous studies have suggested that the M1 and M2 macrophage subtypes are involved in
systemic scleroderma (SSC), a chronic connective tissue disorder that manifests in persistent fibrosis, due
to their ability to produce cytokines that induce fibrosis such as Interleukin 13 (IL-13) and inhibit collagen
turnover such as Tumor Necrosis Factor α (TNF-α) and Interleukin 1β (IL-1β). M1 macrophages can be
activated via the TLR-4 signaling pathway and secrete IL-1β and TNF-α, which upregulate factors that inhibit
collagen, and therefore contribute to pathological collagen accumulation in affected sites in disease. Chronic
TLR-4 signaling has been implicated in SSC and fibrosis. The goal of this experiment is to investigate and
establish baseline levels of the M1 macrophage IL-1β and TNF-α gene expression in response to collagen and
fibronectin.
Methods: Monocyte-like THP-1 cells were plated on untreated plastic, collagen 1 (Col1), fibronectin and
suspension plates, differentiated with 100 nM phorbol myristate acetate for 72 h, and stimulated for 24 h
with lipopolysaccharide (LPS) at 10, 100, and 1000 ng/mL concentrations. IL-1β and TNF-α transcripts were
analyzed by real time qPCR and data was analyzed with the Pfaffel method.
Results: In response to LPS, changes
in THP-1 macrophage IL-1β and TNF-α
expression were revealed to be sensitive to
substrate composition. Col1 sensitized IL1β in response to low dose LPS and both
Col1 and fibronectin attenuated TNF-α
expression while cells on plastic exhibited
a non-specific, increased inflammatory
response.
Conclusion: Using substrates found
in vivo is important to understand
biologically relevant, substrate specific
effects on macrophage function and
inflammatory gene expression. TLR-4 and
integrin signaling may be viable targets for
inhibition of inflammatory cytokines that can promote collagen accumulation. Future studies should evaluate
the expression of other pro-/anti-inflammatory targets such as IL-10, IL-13, TGF-β and IL-6, the response of
monocytes from SSC patients, and the response in 3D ECM environments.
Also presented at the 2015 IADR General Session in Boston. Abstract #3308.
56
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Maryam Mahdavi,* Angel Park, and John Morgan
Objective: Limited literature on outcomes of dental aid organizations (DAOs) exists. The World Health
Organization encourages DAOs to collect, analyze, and share data to advance dental public health efforts. This
study provided an assessment of a preventative focused oral-health program introduced in rural Zambia in
2007. Prior to annual visits of this program, no local dental services were available.
Methods: Data were collected from a screening instrument based on the Association of State and Territorial
Dental Directors. Oral-health personnel examined 3,392 individuals between 2007 and 2013. For each
participant, age, gender, presence of untreated caries (UntxCs), pain, required extractions, and treatment
urgency (TU, no obvious problem=0,
early dental care=1, urgent care=2) were
recorded. Data for 2013 were entered in
Access, merged with 2007–2012 data, and
analyzed using SAS 9.2.
Results: The study population (age
1–93 years) was 59.7% female with mean
(SD) age of 25.3 (17.4). From 2007–2012,
the number of participants each year
was 193–723 (mean=441) with the most
participants (N=736) in 2013. For 2007–
2012, the proportion of participants <12
years each year ranged from 19.5% (N=95)
in 2010 to 30.1% (N=217) in 2012; in 2013,
38.8% (N=289) were <12. From 2007–2012,
the percentages of participants in any
given year with the following conditions were: required extractions, 37.5–49.5%; pain, 38.7–63.8%; UntxCs,
56.2–79.9%; and TU=2 score, 32.7–50.5%. In 2013, the reported conditions were proportionally lower in each
category: required extractions, 27.5%; pain, 33.8%; UntxCs, 41.5%; TU=2 score, 30.2%.
Bates-Andrews Day Abstracts
Oral-Health Status/Outcomes Assessment of Oral-Health Program in Zambia
Conclusions: These results show an increase in the proportion of younger participants in 2013 as well as
improved oral-health indicators for those attending a long-standing oral-health outreach program. Further
research including qualitative methodologies would help assess the impact of this program on the community
and future directions for program growth.
Also presented at the 2015 IADR General Session in Boston. Abstract #740.
Tufts University School of Dental Medicine
57
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Assessment of Dental Students’ Knowledge, Attitude, and Perception of
HIV/HBV/HCV
Justin Maillet,* Wanda Wright, Jennifer Bassett Midle, Helene Bednarsh, and John Morgan
Objective: Improvements in medical management have resulted in decreased mortality from HIV, HBV, and
HCV and more persons living with these viral conditions. In order to provide optimum care for these patients,
practicing dentists must be both knowledgeable and confident in treating these diseases. Our objective is to
measure the knowledge, attitudes, and risk perception of students across all four years at TUSDM when treating
patients with these diseases in order to have an accurate idea of how prepared Tufts graduates are to treat this
growing population. We hypothesize that knowledge, attitudes, and perception will improve over the four years
at TUSDM and that those who are more knowledgeable will have more positive attitudes and perceptions.
Methods: A pre-tested self-administered questionnaire was developed and divided into four sections;
knowledge, attitudes, risk perception, and education at TUSDM. The 41-question survey was sent out
electronically and was accessible to all four classes at the University for four weeks. All answers were kept
anonymous and participants were not required to answer every question.
Results: Although the majority of
students were knowledgeable about the
methods of transmission of HIV, HBV,
and HCV, they were less knowledgeable
about treatment options, progression of the
diseases, and occupational exposures such
as a needle-stick. Of the students, 91.86%
believe it is their professional obligation to
treat patients with bloodborne diseases, yet
27.38% of those surveyed would prefer not
to treat an infected patient. Confidence in
treating these patients showed the greatest
amount of statistical variation, with 28.74%
of students unsure of their ability; however,
83.91% believed their confidence would
increase after finishing their education.
Conclusion: Students at TUSDM have an adequate baseline understanding of the transmission of
bloodborne pathogens that increases over their time at the school; however, it is necessary to provide more
education on treatment options and disease progression, especially with the number of infected patients on
the rise. Although some students feel they are capable of treating bloodborne infected patients, increased
opportunities to provide treatment within the TUSDM clinic would increase confidence and foster better
attitudes and perceptions.
58
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Alissa Mariano,* Minh Bui, Ronald Perry, Sridhar Janyavula, and Gerard Kugel
Objective: To evaluate the shear bond strength to dentin and enamel on commercially available bonding
agents in total-etch and self-etch modes.
Methods: Four bonding agents
Prime & Bond Elect® (PBE) DENTSPLY,
Scotchbond™ Universal (SBU) 3M,
Adhese® Universal VivaPen (AUVP)
Ivoclar Vivadent, and Clearfil™ Universal
(CU) Kuraray Dental were used on enamel
and dentin according to manufacturers’
specifications. A total of 32 specimens of
human enamel (N=8) and 32 specimens
of human dentin were prepared by ISO
29022. The teeth were sectioned using
an IsoMet™ low-speed saw embedded
(Buehler) in acrylic resin and trimmed to
expose the desired surface. The surfaces
were polished with 400-grit SiC paper and
finished with 600-grit SiC paper. The specimens were randomly divided into groups with the universal bonding
agent used in both total and self-etch modes on enamel and dentin respectively. Each specimen was bonded
using Ultratester™ shear bond strength system (Ultradent) and the corresponding adhesive technique with TPH
Spectra™ LV composite A3 (DENTSPLY). The specimens were stored 24 h at 37°C and 100% relative humidity.
Shear bond strength was then tested at 1 mm/min using the Ultratester notched cross-head. Analysis was
conducted using the Tukey method and run at 95% confidence. Significance was determined with p<0.05.
Bates-Andrews Day Abstracts
Shear Bond Evaluation of Bonding Agents on Enamel and Dentin
Results: PBE demonstrated the highest mean shear bond strength for both total etch on enamel and self-etch
on dentin (Table 1).
Table 1
PBE
SBU
AUVP
CU
Enamel Total-Etch (N=8)
Mean MPa
Std Dev
34.75
7.175
33.944
5.25
32.338
8.234
25.97
5.711
Dentin Self-Etch (N=8)
Mean MPa
Std Dev
31.013
6.648
18.536
5.111
28.108
7.015
20.384
6.666
Conclusions: PBE, SBU, and AUVP bond strengths were all comparable using a total-etch system on
enamel. PBE and AUVP had statistically higher bond strengths when compared to SBU and CU when used in
the self-etch mode on dentin. This may have clinical relevance in improving the bond strength of composite
restorations to enamel and dentin. Further study is required to determine optimal shear bond outputs for the
various competing bonding agents.
Also presented at the 2015 IADR General Session in Boston. Abstract #822.
Tufts University School of Dental Medicine
59
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Open Air Aging Effects on Enamel-Dentin Adhesive Systems In Vitro
Matthew Marquis,* Gerard Kugel, Ronald Perry, and Masly Harsono
Objectives: The aim of this study was to test over time the shear bond strengths (SBS) of three universal
adhesive systems on dentin after the systems were exposed to air in order to compare open-bottle composite
bonding systems to closed-system adhesives.
Methods: Ninety caries-free
extracted human teeth (all types) were
sectioned at their occlusal thirds and flat,
exposed dentin surfaces were polished
at increasingly fine increments (120grit, 240-grit, 320-grit) for 30 seconds.
Samples were divided into 3 groups
(N=10): Ivoclar’s AdheSE® Universal
Pen (IP, closed system), Optibond™
XTR (OP, two-bottle open system), and
P&Belect® (PB, one-bottle open system).
Seven time-points were chosen (0, 2,
4, 6, 8, 10, 12 weeks). The amounts of 2
drops/3 pen clicks were dispensed from
each system, which was followed by 15
minutes of air exposure/weekday. At
each time point, Filtek™ Supreme Ultra composite buttons were bonded to the dentin surfaces using self-etch
manufacturer specifications and samples were left to polymerize (24 hr, deionized water). Samples were then
tested via Instron® (Model 5566A) and the change in SBS was analyzed using a paired t-test. The comparison
of the 3 groups was done using one-way ANOVA (SAS v9.2). Tested dentin samples were re-polished with the
aforementioned polishing protocol for reuse.
Results:
Trends in SBS (mPa) (letter A denotes no statistical significance):
Avg SBS 0 wk
Avg SBS 12 wk
Avg ΔSBS
P-Value
IP
26.6A
26.8A
−0.506A
0.397A
OP
22.3A
24.7A
−0.370A
0.590A
PB
15.5B
8.39B
−1.580B
0.008B
Conclusions: The results of this investigation indicate that there is no significant decrease in SBS over the
twelve-week time period evaluated using IP and OP while there is a significant decrease in SBS for PB.
Sponsored in part by Ivoclar. Also presented at the 2015 IADR General Session in Boston. Abstract #815.
60
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Alexa Martin,* Diana Esshaki, and Harish Gulati
A dental student’s professional image depends on his/her appearance, style of communication, and behavior
both in and out of the dental setting. The evolving world of technology and social media presents unclear rules
and blurred lines about what is appropriate behavior and communication for students with regard to their
professional image. As these electronic domains increase in popularity, it is important to understand dental
students’ views on what is appropriate behavior in order to develop a curriculum that prepares them to interact
with their patients in a professional manner.
The aim of this study was to describe student views on what is acceptable dress attire, behavior, communication
methods with patients, and social media interactions with patients. A multiple-choice survey was created and
distributed via LISTSERV to all dental students at Tufts University School of Dental Medicine and analyzed to
compare answers among class years.
The majority (90%) of students agreed that the way they dress in clinic plays a significant role in how their
patients perceive them as professionals. The majority disagreed that it is okay to be friends with patients on
social media (73%), that it is acceptable to post photos of patient care on social media (79%), and that using
shorthand/emoji while texting patients is an acceptable way to communicate (65%). Less than half (44%)
disagreed that it is acceptable for two dental students to discuss a patient’s medical history in an empty
operatory during a clinic session. Class years were significantly different (p=0.017) in their responses to the
statement about the acceptability of shorthand/emoji in text messages. Students in the class of 2018 were most
likely to disagree with the statement (85%); students in the class of 2015 were least likely to disagree (50%).
Student responses to other statements did not vary significantly by class year (p>0.05).
Bates-Andrews Day Abstracts
Student Perspectives on Professionalism in Dentistry
Results suggest that students are aware that the way they dress influences how their patients perceive them as
professionals. There is a mixed awareness amongst students about acceptable behavior online and while texting.
It is essential that we clearly define and educate students about appropriate behavior in the future.
Tufts University School of Dental Medicine
61
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Student Self-Assessment vs. Faculty Evaluation of Operative Dentistry
Practical Examinations
Lauren Marzouca,* Bradley Belous,*
Jennifer Denike,* Gerard Kugel, Angel Park, and
Steven Eisen
Objective: Practicing dentists rely on self-assessment
in order to provide the highest level of oral healthcare.
Accordingly, a comprehensive goal of dental education
is to foster a self-critiquing, critically thinking mind in
novice dental professionals. While a literature review
revealed a great deal of research focusing on the benefits
of critical thinking and self-assessment in relation to
success and clinical discernment in nursing and medical
students, there is a distinct lack of data concerning dental
student self-evaluation, especially in the preclinical setting. Therefore, this study aimed to examine first-year
dental students’ self-assessment ability, while also comparing it to faculty grading. Additionally, correlations
between students’ self-assessment and faculty grading will indicate that Tufts University School of Dental
Medicine’s (TUSDM) calibration procedures are reliable and valid tools.
Methods: Throughout the 2013–14 school year, the D17 students completed six regularly-scheduled
operative dentistry practical examinations in simulation clinic. After completing each examination, students
self-assessed their work, and then left their self-assessment forms at their seats. Next, two randomized and
calibrated faculty members collaboratively scored each students’ practical. Both students and faculty used the
same 10-point grading scale, with the lowest passing score being a 7. Student self-assessment and faculty score
were coupled using seat number, and the data was not linked to identifiable information.
Results/Conclusion: One hundred ninety-two (N=192) D17 students were eligible to participate. The
lowest response rate occurred on practical #4 (76%) and the highest response rate occurred on practical #1
(95%). When a student self-assessed his or her work within 0.5 points higher or lower than the faculty grade,
the student was deemed to have graded accurately or “the same” as faculty. The “same” scoring ranged from 49%
to 59% of students throughout the 6 practical examinations. The remaining students self-assessed themselves
greater than 0.5 points away from the faculty score. The majority of students tended to overestimate their
work. This most often occurred on practical examinations where students were asked to complete Class I or II
preparations. Meanwhile, students underestimated or scored their work “the same” most frequently on practical
examinations which were assessing Class I or II amalgam or composite restorations. The highest over-estimation
(41% of students) occurred on practical #1, a Class I preparation. This was anticipated because at this early stage
of dental education, D17 students were inexperienced at self-assessment and operative dentistry. Additionally,
the mean faculty score (8.04, on average) was lower than the mean student score (8.27, on average), not only
overall, but also on each individual practical. It was determined that mean student scores were closer to mean
faculty scores on practical examinations that were assessing restorations rather than preparations. Overall, it was
determined that students improved both on self-assessing and on the practical examinations throughout the
eight-month operative dentistry course, but faculty do tend to score students lower than students anticipate.
Also presented at the 2015 ADEA Annual Session in Boston.
62
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Amanda Merikas,* Jessie Reisig, Ronald Perry, and Gerard Kugel
Objectives: Evaluate the effect of coating materials on surface hardness (SH) of several brands of glass
ionomer restoratives (GIC).
Methods: Total of N=300 samples were divided between 9 test groups
using 5 different GICs ((3M ESPE Ketac™ Molar Quick Aplicap™ (KMQ),
Ketac Molar-New Formulation (KM-NF), GC America Equia™ Fil
(EQF), Fuji IX™ (FIX), and VOCO IonoStar® Molar (IM)). There were
7 test groups with coating, with 2 uncoated as controls. In each group, 12
samples were prepared according to manufacturer instructions using 4 x
6 mm aluminum ring jigs, placed in 37°C water bath (5 min), had coating
applied, were placed in a distilled water bath (37°C/24 hrs), and either
had no grinding or were ground down to 4.0 mm or 3.9 mm with 320-grit
sandpaper. SH after coating removal (4.0 mm samples) and the effect on
underlying GIC (3.9 mm samples) was evaluated. SH was measured using
a universal Zwick/Roell machine loaded for 30 sec/357.9 N with ball
point of r=0.5 mm. Statistical analysis was used (one-way ANOVA/Tukey
method tests/p<0.05).
Bates-Andrews Day Abstracts
Effect of Coatings on Surface Hardness of Glass Ionomer Cements
Results:
Table 1: 24-Hour Surface Hardness of GIC with and without Coatings
Manufacturer
Product
Coating
3M ESPE
3M ESPE
3M ESPE
3M ESPE
3M ESPE
3M ESPE
GC
GC
VOCO
KMQ
KMQ
KMQ
KM-NF
KM-NF
KM-NF
EQF
FIX
IM
None
SBU
Ketac Glaze
None
SBU
Ketac Glaze
Equia Coat
G Coat Plus
Easy Glaze
µ±SD (MPa)
no grinding
N=12
531.6±77.5cde
536.9±49.3cd
355.8±108.7ghij
464.2±68.3def
380.7±81.9fghi
357.5±120.2ghij
391.5±58.8fghi
363.4±51.8fghij
258.5±30.1hij
µ±SD (MPa)
4.0 mm
N=12
x
711.2±116.5a
581.9±99.4bc
x
647.8±43.5ab
651.3±94.5ab
386.5±59.5fghi
431.3±59.4efg
288.0±21.8ij
µ±SD (MPa)
3.9 mm
N=12
598.7±81.5bc
668.9±86.2ab
565.4±38.8bcd
573.4±55.2bc
595.8±49.4bc
585.7±83.9bc
425.6±35.9efg
396.1±33.9fgh
297.4±24.3j
(Values with similar superscripts show statistically insignificant differences)
Conclusions: KMQ plus Scotchbond™ Universal (SBU) and grinding/coating removal has statistically
higher SH than all other groups except for KM-NF plus coating. Without a coating, the substructure of KMQ
has statistically higher SH than all other brands of GIC. KM-NF with coating removal has statically higher SH
than all other groups except KMQ, where it is statistically equivalent. Without coating, KM-NF is statistically
equivalent to (FIX and EQF) with coating. FIX, EQF, IM coated and with coating removal display statistically
insignificant differences in SH amongst themselves. SH of IM was statistically less than other GICs (p<0.05).
The use of a coating on a GIC may have the effect of increasing the SH of the underlying GIC despite the coating
itself having a relatively soft surface hardness. Further testing is needed.
Supported in part by 3M ESPE. Also presented at the 2015 IADR General Session in Boston. Abstract #898.
Tufts University School of Dental Medicine
63
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Checklist Intervention to Assess Dental Student Organization and Communication
Kathleen Molgaard* and David Leader
Objective: This study was conducted as a modified continuation of a 2012 pilot study performed by Dr.
David Leader and Dr. Jill Kollar (a dental student at the time). The study examined the use of checklists in the
pre-doctoral clinic at Tufts University School of Dental Medicine in order to assess their effectiveness on student
organization, efficiency, and confidence in performing procedures and writing case notes.
Methods: Third- and fourth-year
student participants were randomly split
into experimental and control groups. The
experimental group received a checklist
to use during the course of the study and
the control group did not. Working with
a statistician, we determined that the
experimental and control groups should
each contain at least 30 students using
a standard effect size calculation. The
impact of the checklist was measured using
a comparison of surveys distributed to
both groups before and after the period of
checklist use.
Results: We were unable to achieve
a sample size large enough to produce
statistically significant results. Although
more students expressed interest, when we ultimately ran the study 13 responded to survey one (7 control,
5 experimental) and 8 responded to survey two (5 control and 3 experimental). We also received several
comments from the students about their experience using the checklist.
Conclusion: Even though the study did not produce sufficient data, we learned from the setbacks and can
use this knowledge to guide further experiments. Recruiting participants in the summer, when many students
are away or have a lighter patient load, could have contributed to the lack of participation. Since this study was
based off of a previous study, we used the original checklist. In future iterations of the experiment, rewriting the
checklist with input from multiple PCs as well as students could be beneficial. The physical paper checklist could
have been a barrier to use, thus future studies could use a digital version (computer or smart device). We could
also narrow the focus to students entering the clinic who may be more eager to participate.
64
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Sahar Mostafavi,* Yun Saksena, Morton Rosenberg, and Jennifer Bassett Midle
Hands-on preclinical training for local anesthetic
injections is limited in most dental school
curricula, despite the fact that it is a stressful
procedure for both students and patients. A
largely accepted aspect of local anesthetic
injection education in dental schools is studentto-student injections. Administration of local
anesthesia injections can be a source of stress
for many students, and surveys have shown
that students feel they need more practice in
these techniques prior to administering them
to patients. Student-to-student injections alone
may not be sufficient in training students to
confidently and successfully administer local
anesthesia injections. In addition, student-tostudent injections may present ethical questions
and legal ramifications if complications occur, as they are often done without obtaining informed consent
from participating students. Therefore, an alternative approach to teaching local anesthetic injections, such as
a preclinical model, could be beneficial for students to gain confidence and clinical expertise. This pilot study
aimed to evaluate the use of an injection simulation-model as part of the education prior to administering
inferior alveolar nerve blocks (IANB) on patients. After approval by Tufts University IRB, sixty students from
TUSDM Class of 2016 who had not yet administered an IANB injection on a patient were recruited and split
into three groups: two intervention groups who used the simulation-model, and one control group who did not.
The model was donated by the DRSK group with anatomical landmarks mimicking those of the mouth and a
green signal confirming correct location of needle insertion and successful nerve block. All groups completed
pre-intervention, post-intervention, and post-clinic surveys with yes/no and opinion questions based on Likert
scale to assess confidence in administering an injection, opinions on the model, and clinical outcome on the
first patient injection as measured by number of needle insertions, time until numbness, number of anesthetic
cartridges used, and occurrence of adverse events. We postulate that students who used the model to prepare
felt more confident in administering their first IANB injection in the clinic and had increased successful clinical
outcomes than the control group. Preliminary data based on surveys received thus far indicate students found
the simulation-model beneficial.
Bates-Andrews Day Abstracts
Preparing for Inferior Alveolar Nerve Block Using an Injection Simulation-Model
Also presented at the 2015 ADEA Annual Session in Boston.
Tufts University School of Dental Medicine
65
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
How Much Time Do Students Spend Answering Difficult Exam Questions?
Zachary Neitzey,* Jennifer Bassett Midle, and Yun Saksena
It is often said that people spend more time on what they claim to be more difficult exam questions. We now
have the technology to investigate this claim. The goal of this research was to determine if there is a relationship
between the time exam-takers spend per question and the difficulty of the respective questions. The exam data
was recorded using ExamSoft, a program on which the first-year dental students from Tufts University class of
2017 took all their exams. This information was collected from a total of 894 questions that were on 18 exams.
The exams were from five different didactic courses that include basic pathology, biochemistry, dental anatomy,
operative dentistry, and medicine. We used
the difficulty and discrimination indices
to quantitatively determine question
difficulty. The mean difficulty index was
0.85 with a standard deviation of 0.16. The
mean discrimination index was 0.20 with
a standard deviation of 0.16. Simple linear
regressions were conducted to evaluate
the relationship between the difficulty and
discrimination indices and average time.
The relationship between the indices and
time was significant (p<0.01), even when
controlling for word count in the exam
questions. We looked at each of the five
classes separately and found similar results.
The results support the hypothesis that
students spent more time on questions that are considered more difficult. We also found that students spend
significantly more time on questions with a greater word count. Many people claim that they spend more time
on questions that they thought were more difficult. These results quantitatively show that this claim may not be
far from the truth.
Also presented at the 2015 ADEA Annual Session in Boston.
66
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Joann O’Brien,* Anna Maione, Avi Smith, Behzad Gerami-Naini, and Jonathan Garlick
Objectives: Many diabetic patients develop diabetic foot ulcers (DFU), which often fail to heal and do not
respond to treatment. During proper wound healing, transforming growth factor-beta (TGF-β) stimulates
dermal fibroblasts to produce an extracellular matrix (ECM). The objective of this work was to determine if and
how fibroblasts derived from DFUs respond to TGF-β to form an ECM.
Methods: Primary fibroblasts were isolated from skin biopsies obtained from diabetic foot ulcers (DFUFs)
and were compared to site matched diabetic patients (DFFs) and non-diabetic control patients (NFFs). To
examine how DFU-derived fibroblasts secrete and assemble an ECM, we utilized a 3D, tissue-engineered ECM
model. Differences between ECM tissues produced by DFUFs, DFFs and NFFs treated with and without TGF-β
were evaluated histologically in terms of:
morphology, total cell count, and percent
proliferating cells (Ki67 stain).
Results: The ECM morphology
was significantly changed with TGF-β
stimulation. Tissues that were untreated
were long and thin, compared to treated
tissues, which were thick and short. We
also observed that the total number of
cells in each tissue section increased
with TGF-β stimulation, suggesting that
TGF-β could be stimulating proliferation.
Similarly, Ki67 staining demonstrated that
TGF-β treatment increased the number of
proliferating fibroblasts.
Bates-Andrews Day Abstracts
Diabetic Foot Ulcer Fibroblasts Proliferate and Produce Extracellular Matrix in
Response to TGF-β
Conclusion: The overall goal of the lab is to reprogram these repair deficient DFU-derived fibroblasts
from a non-healing to a healing phenotype. This quantitative analysis helped the lab learn more about potential
defects in ECM production in diabetic foot ulcers in comparison to non-ulcer fibroblasts. The data show that
TGF-β altered ECM production and fibroblast proliferation. The experiment also demonstrated that DFUs are
able to respond to TGF-β, suggesting that TGF-β treatment/stimulation could aid in ECM production in nonhealing ulcers. In the future, the lab will further investigate differences in the composition of the ECM formed
by DFUFs, DFFs, and NFFs.
Tufts University School of Dental Medicine
67
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
A Literature Review of the Extraction Decision in Orthodontics
Rumpa Ganguly, Lokesh Suri, and Felisha Patel*
Objectives: To provide an organized resource for clinicians and patients to use to understand the treatment
option and outcomes for orthodontics in terms of extracting permanent teeth or not extracting. Also to
compare and determine trends of the effects on soft and hard tissues from these two different treatment plans.
Methods: Literature published from January 2000 to current was searched in the electronic databases
Cochrane Central Register of Controlled Trials and PubMed. Study inclusion criteria included: comparing
the extraction technique versus no extraction, average age of participants was 10 years old, and, if relevant,
crowding between 4–10 mm. The
articles were then grouped according to
their method and results. The common
variables observed in the studies were
cephalometric angles, lower lip thickness,
and incisor inclination. The cephalometric
measurements include SNA, SNB, ANB,
IMPA, interincisal angle, distance from lips
to the E plane, and nasolabial angle.
Results: In total, 23 articles have
been reviewed, and 10 appear to fit the
criteria. Although some studies showed
contradicting results, there can be some
associations drawn. A trend can be noted of
an increase in IMPA, an increase in lower
lip thickness, and a proclination of incisors/
lower lip after orthodontic treatment with no extractions. In extraction cases, almost the opposite effect occurs
as lips are more retruded and incisors are more retracted. These findings along with the other variables provide
an insight as to what facial profiles would be best suited for which treatment.
Conclusions: Patients with more proclined incisors and more protrusive lips may be better with an
extraction treatment plan to help compensate these traits. It has been noticed in some of these studies that
pretreatment variables can help predict an outcome. To decide the best treatment, each case should be assessed
individually as other factors such as crowding, age, and malocclusion can lead to vastly different results.
Also presented at the 2015 IADR General Session in Boston. Abstract #1523.
68
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Charles Pham,* Noshir Mehta, Chao Lu, Britta Magnuson, Shuchi Dhadwal, Matthew Finkelman,
and Ronald Kulich
Objective: The aim of this study is the development of a screening questionnaire for opioid risk for
general dentistry.
Materials and Methods: During phase one of our questionnaire design, seven thought leaders were
interviewed in the orofacial pain field to gain their insight on what they feel would be important for general
dentists to know before prescribing their patients opioids. The second phase was item development using
standardized steps from previous research in questionnaire design. Length, grammar, specificity, simplicity,
and social desirability of the questions were reviewed. Negatively worded questions, double-barreled questions,
and confusing adverbs were eliminated. The questionnaire was presented to individuals not involved in the
project. The questionnaire will be determined to have face validity if it appears sufficiently transparent and
coherent to individuals who complete it. Content validity requires the use of experts in the subject matter. We
will present the questionnaire to orofacial pain clinicians to evaluate whether the questionnaire items assess
the defined content adequately. The third phase will involve administration of the draft questionnaire to 20
subjects who currently use opioids or have used them within 12 months. Item analysis and test-retest reliability
will be addressed. The questionnaire will be administered to subjects onsite at the TUSDM Craniofacial Pain
Center presenting with current opioid use. The questionnaire will be administered at the beginning and end
of appointments. This will address the
reliability of the instrument.
Bates-Andrews Day Abstracts
Screening Instrument for Opioid Risk in General Dentistry:
Initial Questionnaire Construction
Results: During the interview with
the thought leaders, we were presented
with relevant content based on their
clinical expertise. Per the thought leaders,
important considerations included: alcohol
and drug use, arrests for DUI, running
out of opioids early, losing prescriptions,
mental health issues, concurrent sleeping
medications, and other factors. With
information from the thought leaders
and previously published research, a 19item questionnaire was completed and
submitted to IRB for approval.
Conclusion: These are the initial steps toward the development of a questionnaire with sufficient reliability
and predictive validity for use within a general dental practice. Upon completion of test-retest reliability, we will
move toward completion of final steps in questionnaire development including the predictive validity of the
questionnaire.
Tufts University School of Dental Medicine
69
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Silk Fiber Implant Coatings for the Localized Release of Antibiotics
Stephanie Phillis,* Sarah Schuback,* Driss Zoukhri, Gerard Kugel, David Kaplan, and Roberto Elia
Objectives: The purpose of the present study was to fabricate silk fiber implant coatings for the release
tetracycline and assess the release by measuring inhibition of S. mutans growth.
Methods: An aqueous solvent-processing method was used to generate the silk biomaterial from B. mori
for implant coatings. Tetracycline-loaded silk was then pipetted onto titanium implant studs, and an electric
current was run through the material to convert it to an adhesive gel coating. Identical tetracycline-loaded silk
was placed on filter paper discs and used as controls. To examine the rate of tetracycline release from the silk
coatings, the coated titanium studs were incubated with S. mutans on agar plates and removed after 30 minutes,
60 minutes, or 3 hours (study 1) or up to 3 days (study 2).
Results: Kinetics studies showed that titanium studs effectively released tetracycline as fast as 30 minutes.
There were similar zones of inhibition with the studs when compared to their positive paper controls (Table 1).
Once it was determined that tetracycline can be released from the studs, the duration of release was investigated.
Table 2 shows that on day 1 there is no difference between the studs loaded with 3 or 6 mg/ml tetracycline and
their paper counterparts. After two days, the difference
between the inhibitions by the stud vs. paper was
apparent (Table 2). By the third day there was very little
inhibition.
Table 1: Kinetics of tetracycline release
Time (Hours)
0.5
1.0
3.0
6 mg/ml Tetracycline
Stud
Paper
5.6±1.5
4.0±1.0
4.8±1.6
2.4±1.1*
4.0±1.0
2.4±1.9
Data are means±SD, N=5. *Denotes a statistically significant
difference compared to stud.
Table 2: Effect of dose and time on tetracycline release
Time (Days)
1
2
3
3 mg/ml Tetracycline
Stud
Paper
5.8±1.1
6.0±0.7
0.8±1.1
1.8±1.5
0
0
6 mg/ml Tetracycline
Stud
Paper
6.6±0.6
6.2±0.5
1.0±0.7
4.2±1.3*
0
1.8±0.8
Data are means±SD, N=5. *Denotes a statistically significant difference compared to stud.
Conclusions: Our data showed that tetracycline can be loaded in e-gels and released as fast as 30 minutes
and maintains release for up to 24 hours. An important implication of this work is that tetracycline-releasing
silk implant coatings have the potential to reduce dental implant-related periodontal infections during the first
24 hours after the implant procedure, which is the time period when these infections most commonly arise.
Also presented at the 2015 IADR General Session in Boston. Abstract #111.
70
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Christina Piacquadio,* Angel Park, and John Morgan
Objective: To explore speech language pathologist (SLP) knowledge of oral health for persons with
intellectual/developmental (I/D) and acquired disabilities and the extent to which they implement this
knowledge into practice.
Methods: Upon obtaining exempt status from Tufts University IRB, a 19-item questionnaire was modeled
from a questionnaire of occupational therapists’ knowledge of oral healthcare with regards to individuals
with I/D and acquired disabilities. The survey was self-administered using Qualtrics format. Prior to using
the questionnaire, a review panel (9
individuals, N=9) of dentists, dental
hygienists and speech language pathologists
completed the survey and answered six
feedback questions to ensure face and
content validity. Open-ended questions
were asked assessing the clarity and content
of questions and ability of respondents
to understand each question. Referral
recruitment was used by approaching
selected SLPs.
Bates-Andrews Day Abstracts
Speech Pathology and Oral Health of Individuals with Developmental/
Acquired Disabilities
Results: Most respondents (77%)
believed there was an important role played
by the SLP in providing recommendations
for oral healthcare, including referrals
to dentists, for individuals with I/D
disabilities; additionally, 62% agreed that they had the opportunity to recognize dental diseases/issues in
their patients. However, over half (62%) did not feel confident in their abilities to recognize dental diseases/
issues in their patients while in their capacity as a SLP, and 65% reportedly did not believe they had developed
skills sufficient to address modification recommendations for oral healthcare for individuals with cognitively/
physically/behaviorally disabled patients during their post-academic training.
Conclusions: It was found that the majority of SLP respondents believed there was a role for them in the
oral healthcare of individuals with I/D and acquired disabilities, but most of them felt that although they had
the opportunity to recognize dental diseases while working as a SLP they were not confident in their abilities to
do so.
Also presented at the 2015 IADR General Session in Boston. Abstract #4165.
Tufts University School of Dental Medicine
71
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Direct Pairwise Comparison of Initial Hydrophilicity of Unset Impression Materials
Jessie Reisig,* Amanda Merikas, Gerard Kugel, and Ronald Perry
Objectives: To directly compare the hydrophilic properties of polyether, vinyl polysiloxane (VPS), and
one newly-developed super-hydrophilic-VPS impression materials in the unset state. The comparison was
performed in a newly developed two-material-side-by-side interface setup, by examining how a drop of water
placed on this interface behaves.
Methods: Five VPS impression materials (N=5) were tested
against two polyether impression materials (Impregum™
Penta™ (3M ESPE) and Impregum™ Penta™ Soft (3M ESPE))
and one experimental medium-bodied VPS (3M ESPE). The
experimental medium-bodied VPS was additionally tested
against the two polyether impression materials. Each test
sample was made by: mixing each material using Pentamix™-3
(3M ESPE) with standard mixing times; creating a 2 mm thick
interface by placing materials side-by-side; placing a 5 µl drop
of water on the interface by a DropShape Analysis System
(DSA-30, Krüss) within 60 s of the start of mixing. At a drop
age of 2 s, the horizontal spreading radius of water in pixels
on each material was recorded and a standardized ratio was
calculated. A one-way ANOVA and Tukey test were conducted
to determine the statistical significance using Minitab®
version-16.
Results: The ratios comparing different materials varied in statistical similarity and difference (Table 1).
Table 1. Ratio of Mean Water Spread
Ratio, (SD), grouping-relation
Material Tested (columns): Material Tested (rows)
Impregum Penta
Soft (3M ESPE)
VPS Materials
Lot Number
554904
Aquasil™-Ultra-Monophase
140325
4.72(0.37)A
(DENTSPLY)
EXA’lence™-370-Medium1401161
4.08(1.00)A
Body (GC-America)
Flexitime®-Monophase390175
3.92(1.65)A
Dynamix (Heraeus-Kulzer)
Affinis®‑Monobody‑SystemF36422
4.72(0.37)A
360 (Coltene‑Whaledent)
715246
4.10(0.24)A
Honigum®-Mono (DMG)
Experimental-Medium554079
2.29(0.44)B
bodied-VPS (3M ESPE)
Impregum Penta
(3M ESPE)
559759
Experimental-Mediumbodied-VPS (3M ESPE)
554079
3.18(0.44)B
8.06(0.75)BC
3.46(0.42)AB
10.04(0.78)A
2.24(0.50)C
4.08(0.40)D
4.10(0.33)A
7.06(0.770)C
4.10(0.24)A
8.94(1.30)AB
2.13(0.14)C
Ratios in the same column with the same letters are not significantly different from each other.
72
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Also presented at the 2015 IADR General Session in Boston. Abstract #2421.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Conclusion: Polyether materials tested are more hydrophilic than VPS materials in side-by-side test
(ratio>1, p=0.000). The experimental medium-bodied VPS is more hydrophilic than other VPS materials tested
(ratio>1, p=0.000). When the experimental medium-bodied VPS is compared with the polyether materials
tested at the early stage (60 s after mixing, 2 s after initial water contact), polyether materials behaved equally
to each other (t-test, p=0.467) and showed greater hydrophilicity than the experimental medium-bodied VPS
(ratio<1, p=0.000). The clinical relevance has yet to be tested.
73
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Survey about Use of Checklist for Orthognathic Surgeries among Oral and
Maxillofacial Surgeons
Sepideh Sabooree,* Archana Viswanath, Paul Stark, Paula O’Brien, and Maria Papageorge
One of the major procedures done by oral and maxillofacial surgeons is orthognathic surgery. This surgery is
performed to restore esthetics and function in patients suffering from severe dentoalveolar discrepancies that
are not restorable by other non-surgical means. This is a multidisciplinary and very lengthy procedure that
requires precise treatment planning and cooperation of different specialists including an orthodontist and an
oral surgeon prior to the procedure.
The purpose of this study was to determine
the attitudes among practicing oral
surgeons in United States towards using a
surgical safety checklist for orthognathic
surgery. Another purpose of this study
is to determine the prevalence of using a
surgical safety checklist for orthognathic
surgery among oral surgeons in the United
States.
Recruitment for the survey consisted
of emailing 1,000 randomly selected
oral surgeons with a valid email address
published in the American Association
of Oral and Maxillofacial Surgeons
(AAOMS) directory. Qualtrics (a survey
administration tool) was used to facilitate the distribution and completion of surveys. The survey will be open
for 60 days (started on January 13, 2015). A reminder email will be sent out on day 30 and 45.
Of the participants, 39 have completed the survey (35 male, 4 females) within the first month. The majority of
these people are practice owners (29). Of all these participants, 17 (46%) of them perform 1–10 orthognathic
procedures per week. However, out of this group of people, only 13 of them (34%) use a checklist for this
procedure. Doctors that had stated that they do not use a checklist were asked if they would use the checklist if
provided with one, and 76% of them had answered “yes.”
Although this is an ongoing study, based on the current data, a majority of doctors have found use of checklist
useful or they have shown interest in using a checklist if provided with one.
Also presented at the 2015 IADR General Session in Boston. Abstract #1634.
74
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Shawheen Saffari,* Samuel Kamlarz, Elizabeth Bingham, Ronney Tay, Jorges Reyes, James Baleja,
and Addy Alt-Holland
Objective: In many epithelial cancers, such as esophageal carcinoma, the adaptor protein Disabled-2 (Dab2),
which is crucial for intact cellular endocytosis and recycling, is downregulated. However, Dab2’s role in the
development of skin squamous cell carcinoma (SCC) has not been investigated. To elucidate the potential
involvement of Dab2 in altering the tumor microenvironment to support SCC progression, we investigated the
consequences of Dab2 depletion on the characteristics and growth of human dermal fibroblasts.
Methods: Human dermal fibroblasts were transfected with a control sh-scrambled sequence or different
lentiviral-mediated shDab2 sequences in order to downregulate Dab2 at its mRNA level. The expression of
Dab2, Eps15, EEA1 and Caveolin-1 in these cells were analyzed by Western blot and immunofluorescent
analyses. Cell counts were performed daily to analyze cell proliferation rate.
Results: Using Western blot analysis, we
observed a 5-fold decrease in Dab2 level,
as well as downregulation of the associated
proteins Eps15, EEA1 and Caveolin-1 in
shDab2-fibroblasts when compared to
control fibroblasts. Immunofluorescence
analysis revealed faint cytoplasmic Dab2
staining in shDab2-fibroblasts that further
confirmed the depletion of this protein in
these cells, in comparison to strong Dab2
staining in control fibroblasts. Importantly,
Dab2 depletion significantly increased
fibroblast proliferation.
Bates-Andrews Day Abstracts
Dab2-Dependent Modulation of the Tumor Microenvironment Can Promote
Cancer Development
Conclusions: The tumor
microenvironment is composed of
neoplastic epithelial cells that coexist with a variety of stromal cell types and supportive stromal components.
Whereas other work from our lab showed that Dab2 depletion in SCC tumor cells can promote SCC
progression, the results of this study demonstrate that decreased Dab2 expression in dermal fibroblasts can
profoundly affect the behavior and growth of these quiescent cells. These results suggest not only that Dab2 loss
in neoplastic keratinocytes can support cancer development, but Dab2 loss in dermal fibroblasts can potentially
affect the tumor microenvironment and further support the growth of tumor cells to enhance SCC progression.
“Tufts Collaborates!” grant awarded to Drs. Alt-Holland and Baleja funded this study. Also presented at the 2015
IADR General Session in Boston. Abstract #1119.
Tufts University School of Dental Medicine
75
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Caries Risk Correlates among Adults with Intellectual and
Developmental Disabilities
Mary Sayegh,* Jane Steffensen, Angel Park, and John Morgan
Objectives: The literature shows that individuals with intellectual and developmental disabilities (IDDs)
have a higher risk for dental caries. This study aims to identify associated factors in IDD patients having the
highest risk for dental caries, as defined as having four or more restorations.
Methods: This cross-sectional study utilizes demographic and clinical information obtained from the
electronic health records of dentate adults ≥20 years of age who received treatment between April 1, 2009, and
March 31, 2010, at the Tufts Dental Facilities (TDF). The variable, ≥4 restorations, was calculated from the
number of restorations reported in the Axium dental record. The information collected included intellectual
disability level (ID), cooperation level (0=least able, 6=most able), type of residence, and untreated caries. The
information was analyzed using SPSS software and chi-square tests.
Results: This study included 4,218
dentate adults (422 with ≥4 restorations
compared to 3,796 who had <4
restorations). Of those with reported ID
levels, 22.9% (N=63) with ≥4 restorations
had profound ID compared to 39.5%
(N=960) with <4 restorations, p<0.001.
Of those with reported cooperation levels,
53.4% (N=218) with ≥4 restorations were
more highly cooperative compared to
32.0% (N=1191) with <4 restorations,
p<0.001. Nearly one third (32.9%, N=137)
of those with ≥4 restorations lived
independently compared to 17.8% (N=668)
of those with <4 restorations, p<0.001.
The majority (83.2%, N=351) of patients
with ≥4 restorations had untreated caries
compared to 26.6% (N=1,008) of those
with <4 restorations, p<0.001.
Conclusions: The data showed that adults with IDD with ≥4 restorations had less profound disability
level, lived more independently, were more cooperative, and had more untreated caries than those with <4
restorations.
Also presented at the 2015 IADR General Session in Boston. Abstract #1443.
76
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Anjalee Shah,* Diana Esshaki, Jennifer Bassett Midle, and Kanchan Ganda
Nationwide, training in the management of medical emergencies in the dental school setting is limited. Tufts
University School of Dental Medicine’s Division of Medicine addressed this gap in education by implementing
a novel training program to teach students
and faculty how to manage medical
emergencies in dental clinics. This program
focused on management of common
medical emergencies, standard protocols,
and how to use emergency equipment.
The Division of Medicine’s training
program consisted of two sessions. The
first session focused on medical emergency
management protocols at TUSDM. That
included which code teams to call, tasks
of responders, and clinically addressing
medical emergencies. The second
session showed what medical emergency
equipment is available, their contents, and
demonstrated how to use them step-bystep. At the completion, both faculty and students participated in an online survey about their prior training in
medical emergency management and comfort level with managing medical emergencies post-training.
Bates-Andrews Day Abstracts
Analyzing the Impact and Perceptions of Medical Emergency Training for Faculty
and Students at TUSDM
Of the 195 people who participated and completed the online survey, 23.6% were D15s, 37.9% D16s, 33.8%
faculty and 4.6% were unspecified. From this group, 17.4% of people reported that they had previously
encountered a medical emergency with a patient in the TUSDM clinic. The most prevalent emergencies
experienced were hypoglycemic reaction, vasovagal syncope and needle stick. Prior to this training session 8.7%
of the participants felt completely uncomfortable in managing medical emergencies, 48.2% felt uncomfortable,
and 36.4% felt comfortable, and 3.6% felt completely comfortable in managing medical emergencies. After
completing the training, 87.2% of participants noted they felt the training was helpful or very helpful, 72.9% of
the participants noted that they now feel comfortable or very comfortable in managing medical emergencies,
and 81.0% of the participants noted that they are likely or very likely to offer their help in a medical emergency.
This study showed that the majority of participants felt they benefited from participating in the medical
emergency training program. Suggestions for improvement ranged from requests to receive training in smaller
groups, to more hands-on interactive sessions. With this information, TUSDM can continue the evolution of the
medical emergency program and share pertinent information with the dental community.
Tufts University School of Dental Medicine
77
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Developing Software to Detect Incipient Caries in Radiographs
Tej Shah,* Cristina Sevilla, and Aruna Ramesh
Introduction: Bitewing radiographs are the current standard of care for detecting interproximal caries
in posterior teeth. However, finding caries that are small or incipient can be time consuming for the dentist.
Therefore, a software program was created in order to function as a supplement to visual radiographic diagnosis
as it can flag incipient caries in a bitewing radiograph, which will allow a dentist to critically assess these flagged
areas. This software, “gdrip” (GNU Dental Radiograph Image Program) is a generic digital radiograph viewer
that contains a feature to detect incipient caries. It does this by making a number of assumptions about the
layout of the bitewing radiograph and the orientation of the teeth. Afterwards, it looks for decalcified areas of
the tooth and “red flags” areas that could be incipient caries.
Aim and Hypothesis: The aim of the study was to test the accuracy of gdrip in detecting interproximal
incipient caries in a bitewing radiograph. The goal of the project was to improve gdrip enough to achieve 80%
true positive accuracy. This accuracy
rate was determined based on a balance
between having a useful tool and clinicians’
ability to ignore incorrect results.
Significance: If the software is able to
accurately detect incipient caries, it would
not only save dentists time, but it would
also help red-flag areas that may have been
missed by the dentist.
Materials and Methods: The
materials that will be used will be sample
radiographs and the program gdrip.
TUSDM axiUm records from new patients
seen during January 1, 2014, to May 31,
2014, were reviewed. A staff member of the
radiology department (who is a co-investigator on this study) who has access to the radiographs will access the
records and look for qualifying radiographs. There were 200 records that were reviewed in order to find the 100
qualifying radiographs.
Results: With the 100 radiographs, there were 1,600 total surfaces that could have a carious lesion. Out of
those 1,600 surfaces, gdrip correctly identified 1,441 surfaces to have or not have a carious lesion based on the
findings by the board certified radiologists. This gives gdrip an overall accuracy of 90.1%. Gdrip does have room
for improvement and new algorithms can be applied to increase gdrip’s accuracy even further.
78
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Paul Shamirian,* Moonyoung Lee, Georgios Kanavakis, and Angel Park
Objective: To utilize full head CBCT scans to investigate the relationship between third molar inclination
and vertical skeletal pattern.
Materials and Methods: In
the study, 45 full head CBCT scans were
obtained from Tufts University School
of Dental Medicine and reviewed.
An orthogonal lateral cephalometric
radiograph was generated and traced
using Dolphin Imaging software (Version
11.0.03.40 Premium, Dolphin Imaging,
Chatsworth, California, 2010). The
inclination of the mandibular third molar
was measured in the sagittal and coronal
planes using InvivoDental 3D (version 5.3,
Anatomage, San Jose, California). Pearson
correlations and a canonical correlation
analysis were used to determine if there
was a relationship between the third molar
inclination and the lateral cephalometric measurements.
Bates-Andrews Day Abstracts
Correlation between Mandibular Third Molar Inclination and Mandibular Divergence
Results: The canonical correlation between the lateral cephalometric measurements and the third molar
inclination was weak (0.334≤r≤0.429, p>0.05). There was a strong correlation between the third molar
inclination in the coronal and the sagittal view (r=0.80).
Conclusion: The present study showed that there was no relationship between the patient’s mandibular
third molar sagittal or coronal inclination and vertical skeletal pattern. A strong relationship was found between
the coronal inclination and the sagittal inclination of the mandibular third molar. The correlation could be a
useful guide to estimate third molar position when a CBCT scan is not available.
Tufts University School of Dental Medicine
79
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
80
Impact of the “Fourth-Floor Initiative” at TUSDM on Clinical Efficiency
Laura Shim,* Paul Stark, Jennifer Bassett Midle, and Yun Saksena
Tufts University School of Dental Medicine (TUSDM) has introduced a curriculum change entitled the “FourthFloor Initiative” to the fourth-floor undergraduate clinics. The purpose of this study was to determine whether
the curriculum changes were successful in improving clinical efficiency in the fourth-floor clinics as compared
to previous years as well as the third-floor clinics operating under the old curriculum model. This study focuses
on two specific changes within the Fourth-Floor Initiative: 1) The addition of scheduling coordinators and 2)
the cross-training of core faculty to be able to co-approve certain procedures to completion. The effect of the
scheduling coordinators was measured by
chair utilization (number of patient visits
and empty chairs). The outcomes of crosstraining core faculty were analyzed by
points generated by the students. The thirdfloor clinics and historical data were used
as a controls. T-tests for continuous factors
and chi-squared tests for categorical factors
were used for analysis. The comparison
will determine if the Fourth-Floor
Initiative increased its clinical efficiency in
terms of chair utilization and procedure
completions. Surveys were used to assess
students’ perceptions of efficiency in
their clinics as well. Current data suggests
that although chair utilization did not
considerably change, the number of points notably increased from that of the control—suggesting that although
there wasn’t a huge impact with the scheduling coordinators, there were significant results due to the crosstraining of faculty. Surveys revealed that students on both third and fourth floors saw improvements in clinical
efficiency as the semester progressed. Overall, the data suggests that the Fourth-Floor Initiative was successful in
increasing clinical efficiency within the clinic. However, the continuation of data collection throughout the year,
especially once the curriculum change takes effect on other floors, will give more conclusive results to this study.
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Shankeertha Sundaralingam,* Yamila Garber, Mabi Singh, Athena Papas, Angel Park, and
Britta Magnuson
Objectives: The aim of this study was
to determine if the population of clinical
trial participants seen at Tufts University
School of Dental Medicine (TUSDM) are
similar in demographics and oral-health
status to pre-doctoral dental clinic patients
at TUSDM.
Methods: Demographic information
(age, sex, and dental insurance status) and
oral-health status, [number of decayed,
missing, filled teeth (DT, MT, FT)] data was
collected from 468 participants of a clinical
trial screening for caries conducted by the
Oral Medicine Department at TUSDM
between January 2010 and February 2012.
This was compared to a random sample of 1,000 patients (roughly 2:1 to study group) seen in the TUSDM
pre-doctoral clinic for an initial comprehensive exam during the same time period. Subjects in both groups
were between the age of 18 and 65. Chi square and Mann-Whitney U tests were used to see if there were any
statistically significant differences between the clinic and trial populations (alpha=0.05).
Bates-Andrews Day Abstracts
A Comparison Study: TUSDM Clinical Trial Participants vs. Clinic Patients
Results: The mean (SD) age of trial participants was 40.5 years (12.3) compared to 41.6 (13.8) in the clinic
group (p=0.23). Trial participants were 47.6% female, clinic patients were 50.5% female (p=0.29). 32.4% of trial
participants and 43.2% of clinic patients reported having dental insurance at the time of their visit (p<0.01). See
Table 1 for DT, MT, FT data.
Table 1. DT, MT, FT Data Trial vs. Clinic
DT
MT
FT
Trial
Median
25th, 75th
3.0
1.0, 6.0
4.0
3.0, 6.0
9.0
4.0, 12.0
Clinic
Median
25th, 75th
1.0
0.0, 5.0
4.0
2.0, 7.0
8.0
3.0, 12.0
P-Value
<0.0001
0.14
0.02
Conclusion: There was no significant difference in age and sex between the two groups; however, the
clinic patients group had a significantly higher percentage of individuals with dental insurance. Clinical trial
participants had a significantly higher number of decayed teeth and filled teeth than the clinic patient group.
These results suggest that while demographics of both groups were similar, oral-health status and insurance
status were not.
Also presented at the 2015 IADR General Session in Boston. Abstract #4162.
Tufts University School of Dental Medicine
81
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Microleakage Evaluation of Elevated Temperatures in Dental Restoratives
Michelle Ta,* Tian Yuan, Angel Park, Steven Eisen, and Gerard Kugel
Objective: To compare marginal microleakage across three different restoratives—glass ionomer, bioactive
restorative, and dental composite—after heating materials prior to placement. The delivery and storage of
materials exposed to high temperatures prior to placement may compromise its restorative properties.
Methods: Ninety standard Class II slot preparations
were performed on non-carious human molars with
approximately 3 mm depth at gingival floor and 4 mm
width bucco-lingually. Samples were randomly assigned
into 9 groups (N=10). Three dental restoratives were tested:
Ketac™ Nano light-curing glass ionomer 3M ESPE (KN),
Activa™ bioactive restorative Pulpdent (AB), and Filtek™
Supreme Ultra composite 3M ESPE (FS). Materials were
placed in a closed container and heated separately for
120 hours in incubator at either 24°C, 40°C, and 52°C.
All materials were applied according to manufacturer’s
instructions. Completed restorations were thermocycled
for 3,500 cycles between 5°C and 55°C. Samples were
immersed in 2% methylene blue dye for 8 hours. Samples
were embedded in acrylic resin, sectioned mesio-distally,
and evaluated under stereomicroscope (Olympus, SZX16).
A dye-penetration-to-axial-wall (DP) score was used on gingival floor: 0=0% DP, 1=1–25% DP, 2=26–50%
DP, 3=50–75% DP, and 4=100% DP. Median and inter-quartile ranges (IQR) were computed, and KruskalWallis tests were completed for significant differences in microleakage mean scores for the products at different
temperatures and across temperatures for each product.
Results: Table 1 displays IQR, mean score, and p-value comparison within products. Table 2 displays mean
score and p-value comparison across the same temperature. Mean scores are calculated based on mean ranks
and total number of observations of only the selected groups.
Table 1: Comparisons within Products at Different Temperatures
Product
Temperature
25th Percentile
Median
75th Percentile
Mean Score
P-Value
KN
24°C
2
2.5
3
11.7
KN
40°C
3
3
4
15.2
0.299
KN
52°C
2.5
4
4
17.3
AB
24°C
1
1
2
11.5
AB
40°C
0
2
3
14.1
0.120
AB
52°C
2
3
3
19.1
FS
24°C
0
0.5
1
7.0
FS
40°C
2
2
2
17.7
<0.001
FS
52°C
2
2
3
20.6
Table 2: Mean Scores across Temperatures
24°C
40°C
52°C
82
KN
23.1
21.8
19.4
AB
13.2
11.3
14.1
FS
8.6
11.6
11.0
P-Value
<0.001
0.003
0.076
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Also presented at the 2015 IADR General Session in Boston. Abstract #3873.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Conclusion: The composite-based material (FS) showed statistically greater difference in microleakage with
temperature change. However, the glass ionomer-based material (KN) showed statistically greater microleakage
overall when compared to AB and FS. Storage of dental materials in prolonged elevated temperatures indicates
increased microleakage.
83
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Generation of Three-Dimensional Bioengineered Tissue Constructs of
Nasopharyngeal Carcinoma
Ronney Tay,* Shawheen Saffari, Mark Bernardo, Samuel Kamlarz, Pamela Smith, James Baleja, and
Addy Alt-Holland
Objectives: Although nasopharyngeal
carcinoma (NPC) is a highly metastatic
cancer, the regulatory mechanisms that
drive the aggressive behavior of this disease
are still elusive. We previously showed
that bona fide human NPC tumor spheres
isolated from lung mediastinal lymph
node metastasis can be propagated in cell
cultures and colonize lung tissues in mice.
Here, we generated three-dimensional
bioengineered tissues that supported the
growth and behavior of NPC tumor spheres
in vitro.
Methods: Eight months following
injection of human NPC tumor spheres
to mice, sphere structures that likely represent NPC metastases were observed in dissected mouse lung tissues.
Co-cultures of human stromal cells with tumor spheres that migrated out of these tissues were grown in
two-dimensional cell cultures and in three-dimensional bioengineered collagen scaffolds in vitro. Cultures
were characterized for their morphology and metabolic profiles by bright-field microscopy and 1H-NMR,
respectively.
Results: Tumor spheres grew in their size and number in dissected mouse lung tissues in the presence of
human stromal cells. Interestingly, tumor spheres that migrated out of these tissues continued their growth
in the culture plate and were successfully expanded in sequential monolayer cell cultures. When embedded
together with stromal cells in three-dimensional constructs, rapid sphere growth was observed. Moreover,
spheres and stromal cells migrated out of the engineered constructs and expanded in the culture plates.
Comparative metabolomics revealed similar patterns of metabolic activity in conditioned media from dissected
lung tissues and bioengineered constructs.
Conclusions: The three-dimensional engineered constructs provided a supportive microenvironment that
enabled NPC tumor spheres to maintain their inherent growth and migratory capabilities, similar to those of
tumor spheres that developed in genuine lung tissues. These in vivo-like bioengineered tissues will allow us to
begin deciphering the mechanisms that underlie the development and progression of NPC, which is central for
the development of new NPC therapies.
Also presented at the 2015 IADR General Session in Boston. Abstract #299.
84
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Kanupriya Tewari,* Masly Harsono, Matthew Finkelman, John Morgan, and Gerard Kugel
Objectives: To investigate how elevated storage temperatures affect the microtensile bond strength (MTBS)
of a total-etch adhesive to dentin. This study is part of a larger analysis that aims to establish standardized
recommendations for management of materials in settings where cooling systems may not be accessible (i.e.,
under extreme local climate conditions in resource-limited countries).
Methods: Forty-two sound extracted human molar teeth were obtained. ExciTE® F adhesive (Ivoclar,
Vivadent) was stored for 72 hours at three temperatures: 24°C (standard room temperature), 40°C and 52°C.
Flat dentin surfaces were cut with diamond wheel (Isomet, Buehler) and teeth were randomly divided into the
three groups (N=14). The bonding agent was applied on the prepared dentinal surface, thinned using an airwater syringe, and light-cured 10 seconds. Filtek™ Supreme nanohybrid composite (3M ESPE) was applied in
two layers of 2.0 mm each. Layers were cured for 20 seconds (per manufacturer’s instructions). Bonded teeth
were stored in 0.9% Thymol at 37°C for 24 hours and sectioned in 1 mm increments in two directions to create
beams with adhesive areas of 1 mm2. Beams
were subjected to microTBS testing using
a universal testing machine (Bisco Corp,
Illinois) and force applied to create fracture
was recorded. Statistical significance was
assessed using one-way ANOVA, with
post-hoc tests conducted via Tukey’s HSD.
P-values less than 0.05 were considered
statistically significant.
Bates-Andrews Day Abstracts
Effect of Elevated Temperature on Adhesive Microtensile Bond Strength
Results: All groups exhibited statistically
significant differences, p≤0.001.
Conclusions: As the temperature
at which the bonding agent was stored
increased, microtensile bond strength
significantly decreased. Further research is suggested to assess the impact of temperatures ≥40°C on restorative
materials that may be used under conditions where temperature controlled storage and usage may not be
available (shipping conditions/economically developing nations).
Also presented at the 2015 IADR General Session in Boston. Abstract #814.
Tufts University School of Dental Medicine
85
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Complications following Third Molar Extractions at TUSDM: A Case Control Study
Jordan Thomas,* Alireza Ashrafi, Sarah Pagni, Archana Viswanath
Background: Surgical extraction of third molars is one of the most common oral surgical procedures.
Complications related to third-molar removal range from 4.6% to 30.9%. The four most common postoperative
complications of third-molar extraction reported in
the literature are localized alveolar osteitis, infection,
bleeding, and paresthesia.
Objective: Identify risk factors associated with
complications following third-molar extractions and
evaluate treatment outcomes.
Methods: This retrospective chart review casecontrol study was conducted at the Department of
Oral and Maxillofacial Surgery, Tufts University
School of Dental Medicine. Following Tufts Medical
Center IRB approval, digital dental records from
patients with documented wisdom teeth removal
from the past 5 years were compiled. TUSDM IT
team performed a database search of patients with
a follow-up visit within three months of extractions
that resulted in over 1,500 patients. A total of 250
total patient charts were selected at random, and each patient chart was categorized based on the presence or
absence of complications. In order to obtain statistically significant data, it was determined that a 2:1 ratio of
controls to cases would be used. Patients were categorized as a “control” if there were no complications after
extractions and patients were categorized as a “case” if there was a complication. Of the 250 charts evaluated, 30
patients were categorized as a “case” and 60 random patients were then categorized as a “control.” Dental records
were de-identified and analyzed using Stata13. The following variables were identified: demographics (age,
sex, social habits), medical and dental history, site of extracted teeth, position of third molar, distal space and
depth of inclusion, degree of retention, presence of prior radiolucent lesions, presence of adjacent permanent
second molar, concomitant medications, presence of purulence or necrotic tissue at the time of surgery, surgical
technique used, post-operative medications, surgeon’s credential.
Results: A total of 250 patient charts were evaluated in order to categorize 60 controls and 30 cases. The
30 cases identified included 16 cases of alveolar osteitis, 4 cases of paresthesia of the chin or side of face, 4
cases of bony spicules, 3 cases of lingual paresthesia, 2 cases of surgical site infection and 1 case of lingual
and chin paresthesia. There is significant association (p<0.05) between post-surgical complications and sex
(women are associated with higher numbers of post-surgical complications than men), history of allergies,
location of extraction, prior radiotransparent lesions and antibacterial mouth rinse prescription (cases had
fewer mouth rinse prescriptions than controls). There is no significant relationship (p>0.05) between postsurgical complications and marijuana use, alcohol consumption, smoking, degree of impaction, concomitant
medications, post-operative medications, and surgeon’s credentials.
Conclusion: This is an ongoing study and further analysis is needed to further identify risk factors
associated with individual complications following third molar extractions and evaluate treatment outcomes.
86
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Hilde Tillman, Avanthi Tiruvadi,* and Jennifer Barton
Objectives: To provide an organized resource for clinicians to use to understand the importance of
diagnostic panoramic radiographs in detecting carotid artery calcifications for patients at risk for coronary
artery disease, given their medical and dental history.
Methods: Literature published from 2000 to present day was searched in the PubMed electronic database.
Study inclusion criteria included: coronary artery disease, age, sex, diagnosed diabetes mellitus, obesity,
hypertension, high cholesterol, and chronic renal disease and periodontal disease.
Results: In the study, 14 articles have
been reviewed and 14 appear to fit the
criteria. Although some studies refute the
practical diagnostic use of panoramic for
diagnosis of coronary artery disease, there
can be some associations drawn from the
literature. A trend can be noted in the
association between diabetes mellitus,
hypertension, age and sex, chronic renal
disease, and periodontitis and the visible
presence of carotid plaques in panoramic
radiographs.
Bates-Andrews Day Abstracts
A Literature Review of Carotid Plaque Detection in Panoramic Radiographs
Conclusions: Patients with the
aforementioned diagnosed diseases were
at higher risk of developing coronary
artery disease and in turn had a positive
correlation with detection of carotid artery plaques in panoramic radiographs. Given this correlation, further
medical tests are recommended and the radiograph is solely a preliminary screening tool for coronary artery
disease.
Tufts University School of Dental Medicine
87
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Evaluation of the Promotion of Critical Thinking and Integration of Evidence-Based
Dentistry in the Pre-doctoral Clinical Courses
Bianca Velayo,* Paul Stark, Tofool Alghanem, Jennifer Bassett Midle, Matthew Finkelman, and
Haomiao Wang
Introduction: According to the Dental Education Standards put forth by the Commission of Dental
Accreditation, the curriculum should employ methods that support the development of critical thinking and
problem solving skills. Additionally the educational program must incorporate the principles of evidence-based
dentistry (EBD) during the process of patient care. Recently, Tufts University School of Dental Medicine has
started some initiatives to teach the students about EBD, but the promotion
of critical thinking and the integration of EBD into the curriculum have
been left up to the individual course directors. The aim of this pilot study is
to evaluate teaching styles that stimulate critical thinking and the application
of EBD in the dental school’s preclinical dental curriculum.
Methods: Video captured lectures from Tufts University Science
Knowledgebase (TUSK) system were extracted and used for this project.
The sample size consisted of 216 unique concepts presented in 36 randomly
selected recorded lectures from 6 pre-doctoral clinical courses from the
2013–2014 academic year. These courses are second-year endodontics, fixed
prosthodontics, radiology, pediatric dentistry, and dentures, and thirdyear craniofacial function. A validated instrument specifically designed for
this study was used to assess each lecture. The lectures were scored for its
promotion of critical thinking (from 0 to 7), and each concept within each
lecture was scored for its use of evidence (from 0 to 3). For each lecture, the
average evidence score per concept was calculated and this was correlated
against the critical thinking score of the lecture.
Results: The results show that mean evidence/concept score is 0.451 (SD=0.592), mean number of concepts
per lecture is 4.67 (SD=2.07), the mean critical thinking score is 1.44 (SD=1.40), and the mean evidence score
per lecture is 2.19 (SD=2.87). There was no statistically significant relationship between critical thinking
score and average EBD score/concept as determined by a simple linear regression (r=0.013, p=0.938). The
results suggest that lecturers are making an effort to make lectures more interactive in order to stimulate
clinical reasoning, self-assessment, and curiosity. Additionally, students are being provided information to
independently find and critique the evidence. However, overall there is room for improvement in promoting
critical thinking and integrating EBD in pre-clinical courses. The data highlights specific areas that can be
targeted for future development.
Conclusion: Early and frequent exposure to EBD in the pre-doctoral curriculum can increase the number
of dentists who practice and feel comfortable applying EBD. This baseline research is the first step to being able
to incorporate EBD as part of the dental curriculum and eventually students’ future dental practices. Future
directions include refining the instrument to improve data collection of critical thinking and EBD scores,
looking at different modalities of collecting data other than video, and increasing the sample size. We plan to use
this data as a benchmark in outcomes assessment evaluating EBD and critical thinking in accordance to CODA
Standards.
Also presented at the 2015 ADEA Annual Session in Boston.
88
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Haomiao Wang,* Bianca Velayo, Tofool Alghanem, and Paul Stark
Introduction: Evidence-based dentistry (EBD) is a contemporary approach to patient-treatment that
uses the most recent and relevant scientific research to augment a dentist’s professional experience and expertise
to form a superior basis for treatment planning and decision-making. EBD and critical thinking (CT) go
hand-in-hand; a dentist must possess the critical thinking skills necessary to faithfully apply the appropriate
evidence to a given case. Sections 1.1–1.3 of the ADEA Foundation Knowledge and Skills for the New General
Dentist directly emphasizes the essentials of CT and its use in integrating research with clinical expertise and
a patient’s values for the evidence-based practice of dentistry. Accordingly, an increasing number of dental
schools, including the Tufts University School of Dental Medicine (TUSDM), are transitioning towards schoolwide implementation of clinical curricula that are supplemented by EBD and aid in the development of critical
thinking skills. Currently, however, at TUSDM, the level of
incorporation of EBD/CT in a course varies wildly from course to
course, with complete dependence on individual course directors.
In order to accomplish widespread curriculum change, it is first
necessary to devise a tool with appropriate criteria that assesses
the level at which each course currently promotes EBD and
critical thinking skills. The aim of this study is to formulate and
validate such an instrument.
Bates-Andrews Day Abstracts
Validation of Evidence-Based Dentistry and Critical Thinking Application
Assessment Tool
Methods: Development, face validity, construct validity, and
test-retest reliability was performed in order to generate the
instrument. Two investigators reviewed appropriate literature
to identify the most critical elements of EBD/CT. From this
information, they developed the instrument, which was then
evaluated for face validity by two additional co-investigators with
knowledge of the subject matter, then construct validity by two
experts in the subject matter.
Results: Class activities, participation encouragement, assessment of the students’ understanding of the
materials taught, and the presence of after-class activities to apply the learned materials were identified as the
most important components of teaching with critical thinking. For the EBD part, the use of EBD identifiers,
level of evidence used, information about the evidence used, and the limitation of the evidence were identified
as most important elements for teaching. These predetermined components were formulated into questions that
were assessed for face validity and construct validity. Corrections and changes were made as needed to finalize
the tool. The completed tool was finalized (Appendix) and scores were assigned to it as follows:
• Th
e extent to which critical thinking was promoted throughout the lecture (0–7, with 0 points meaning
zero promotion of critical thinking and 7 points meaning maximum promotion of critical thinking).
• Th
e extent to which the use of evidence was used to support concepts (0–12, with 0 points meaning zero
use of evidence to support concepts and 12 points meaning maximum use of evidence to support concepts.
For the test-retest reliability, Pearson correlation was calculated (work is in progress).
Also presented at the 2015 ADEA Annual Session in Boston.
Tufts University School of Dental Medicine
89
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Optimization of Snai1 siRNA Transfection in Murine Bone Marrow Derived
Mesenchymal Stem Cells
Kathryn Weber,* Hema Aluri, Helene Armaos, Suharika Soudam, and Driss Zoukhri
Objective: The transcription factor
Snai1 is the master regulator of epithelialmesenchymal transition (EMT) and
mesenchymal-epithelial transition (MET).
The purpose of this study was to determine
the optimal siRNA for silencing Snai1
expression in bone marrow derived
mesenchymal stem cells (BD-MSCs) in
order to induce MET.
Methods: BD-MSCs were cultured
in six well plates in IMD media until the
cells reached 50–60% confluency. Eight
different Snai1 siRNA were purchased
from OriGene, Dharmacon, and IDT. The
transfection reagent Neofectin was mixed
with each of the Snai1 siRNA samples (25 nM for Dharmacon and IDT and 30 nM for Origene) and incubated
for 15–20 minutes at room temperature. Next the siRNA and Neofectin mixture was added to the six well plates
and incubated for 48 hours at 37°C and 5% CO2. The transfected cells were lysed, RNA extracted and RT-PCR
for Snai1, and the housekeeping gene GAPDH expression performed. To ensure the efficiency of transfection,
cells were grown on 8-well chamber slides and transfected with a fluorescently labelled siRNA. After 48 hours,
the number of fluorescently labeled cells was counted.
Results: Transfection efficiency of BD-MSCs using Neofectin was over 80% when using a fluorescently
labeled siRNA. Image J analysis of the gel electrophoresis from RT-PCR was used to determine the percent
decrease in Snai1 expression when compared to control non-transfected cells. Four IDT siRNAs had on average
a percent decrease of 31.7%, 28.5%, 20.1%, and 16.2%, respectively, when compared to control. One OriGene
siRNA had an increase of 9.3% while two other ones had a 14.9% and 22.8% decrease in expression when
compared to control. The Dharmacon siRNA showed a 1.8% increase in expression.
Conclusion: The siRNA sequences and protocols used for transfection in this study did not efficiently
downregulate Snai1 in BD-MSCs. Since cell permeability using NeoFectin was found to be over 80%, it is most
likely that the siRNA sequences and/or the transient transfection time was not optimal. Future experiments will
test lentiviral Snai1 siRNA transfection to assess if this method of transfection is better suited for BD-MSCs.
90
Student and Faculty Research Abstracts 2014 –2015
Predoctoral Student Presentations
Ellen Patterson,1 Natalie Hagel,1 Kristeen Perry,2 Jennifer Bassett Midle,1 and Fadi White1*
1Tufts
University School of Dental Medicine, Boston; 2Massachusetts College of Pharmacy and Health Sciences
University, Boston
Objectives: The objectives of this study are: 1) to demonstrate that an interprofessional education (IPE)
intervention for hygiene and dental students will positively impact student attitudes toward teamwork and
interprofessional collaboration, and 2) to develop and test a new scale to measure student attitudes toward
dental teamwork.
Methods: Thirty volunteer third- and fourth-year dental students and 16 dental hygiene students
participated in five weekly interprofessional learning sessions. Dental and hygiene student were paired weekly
in clinic to provide direct patient care, followed by small group-learning sessions focused on teamwork and
communication skills. Participants and an unexposed control group completed two measures for pre- and posttest comparison—the validated Readiness for Interprofessional Learning Scale (RIPLS) and a newly developed
measure, the Attitudes Toward Dental Teamwork Scale (ATDTS). This 14-item measure was assessed for content
validity by a panel of seven experts and was evaluated for face validity with a test-retest reliability analysis.
Qualitative data from the participating students was also collected.
Bates-Andrews Day Abstracts
Impact of an Interprofessional Teamwork and Communication Mini-course for
Dental and Dental Hygiene Students
Results: All questions on the newly developed measure (ATDTS) were rated very important to important by
our expert panel, thus all questions were included. Reliability analysis, however, showed 5 of the 14 questions
had poor test-retest reliability scores. Participant vs. control group changes from pre-test to post-test RIPLS
scores showed a significant (p<0.05) change on only two of the measure subscales; the total score change
p-value was <0.10, indicating a trend toward significance. Comparison of pre- and post-test ATDTS scores
showed a significant change (p<0.05) for both groups; however, the control group showed greater change than
the participant group. Qualitative data collected from the student pre- and post-intervention indicate that the
intervention was an overall positive learning experience.
Conclusion: Although our data indicate that participant and control groups did not differ by demographics,
participants’ RIPLS scores were significantly higher prior to beginning the intervention (selection bias), likely
impacting our ability to measure the effect of this educational intervention. Although we did not measure a
statistically significant change in student attitudes, qualitative data indicated that the intervention was highly
valued by students. We recommend modification of the ATDTS measure for future use, and a more thorough
analysis of the recommended changes will be presented in the final poster.
Tufts University School of Dental Medicine
91
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
92
Postdoctoral Student Presentations
Effects of Operating Room Efficiency on the Dental Resident Experience
Faryn Bergera* and Jeffrey Graceffo*
Patients with intellectual and developmental disabilities are more likely to have poor oral hygiene, untreated
dental decay, and periodontal disease. As a result, comprehensive dental treatment in the operating room is
an important service for many of these special needs patients who are unable to receive oral rehabilitation in
the traditional dental setting. Many of these individuals receive care from residents training with the guidance
of experienced practitioners in the operating room. However, the desire for operating room efficiency and
minimization of anesthesia duration are factors that influence available time for dental care, resident training
experience, and possibly treatment
outcomes. The purpose of this study is
to examine potential variables in the
operating room setting that can influence
both patient outcomes and dental resident
experience. Future research methodology
will also be proposed in order to better
understand the effects of these factors,
determine ways of enhancing dental
resident training and improving treatment
for special needs individuals in the
operating room setting.
Student and Faculty Research Abstracts 2014 –2015
Postdoctoral Student Presentations
Sucheta Budania,* Matthew Finkelman, and Cheen Loo
Purpose: The purpose of the study
was to assess the knowledge of pregnant
women in oral health. An informational
seminar session on oral health was used
to determine how beneficial such training
would be in improving pregnant women’s
dental knowledge.
Methods: A pre/post-test design
was used to evaluate the effectiveness
of a seminar session given to pregnant
women treated at Tufts Medical Center.
Knowledge-based and belief-based
questions were used to determine the level
of knowledge of oral health.
Bates-Andrews Day Abstracts
Effectiveness of an Oral-Health Education Program for Pregnant Women at
Tufts Medical Center
Results: In the study, 66 subjects
participated in oral health awareness sessions and completed the questionnaire. The mean age of all participants
was 30.6 (SD=4.4). Of the participants, 40% reported receiving information about dental care from their
prenatal provider. Preliminary results show that for the knowledge-based questions, the percentage of correct
answers from the pre-test was 74.6% while the percentage of correct answers from the post-test was 96.9%. The
results suggest that pregnant women could benefit from oral-health education.
Conclusion: Pregnancy affords a unique opportunity to educate women on the importance of oral health.
Preliminary results showed that there may be potential benefit to an oral-health educational session for pregnant
women at Tufts Medical Center. Prenatal education should universally adopt an oral-health component.
Also presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Tufts University School of Dental Medicine
93
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Three-Dimensional Bone and Soft Tissue Reconstruction with Implant Placement In
Esthetic Areas following Severe Trauma: A Case Report
Irina Dragan,* Hidetada Moroi, and Charles Hawley
Implant placement in maxillary esthetic areas requires respecting certain critical parameters, including
the location of the final prosthesis. The three-dimensional reconstruction of maxillary anterior esthetics
after trauma is complicated by the vertical
and horizontal extent of damage, vestibular
depth, biotype, and the amount of remaining
keratinized tissue. This case report describes key
points to consider in performing successfully
horizontal and vertical guided bone regeneration
procedures using tenting screws and titanium
mesh non-resorbable membranes. Soft-tissue
reconstruction and conditioning is essential
in delivering acceptable esthetic outcomes.
The current report focuses on the sequential
planning, timeline, and surgical procedures
performed in order to achieve favorable
periodontal outcomes in esthetic areas following
severe trauma.
Healthcare Providers’ Role in Decreasing Opioid Abuse
Kyle Dunmire,* Ainslee Flavell,* and Kiirsten Finn*
The number one symptom that brings even the
most reluctant patient into a dental practice is
pain. Most general dentists would agree that
management of acute pain is an essential skill
for maintaining a successful practice. However,
the prescribing of opioids has caused an increase
in the accessibility of narcotic pain medications
and contributes to the growing trends of fatal
overdoses. All prescribers have a responsibility
to minimize drug misuse while still maintaining
legitimate access to opioids for patients in need.
Many states have begun implementing Internetbased prescription drug monitoring programs
and databases since non-medical use of pain
prescriptions are usually more common from
dental clinics. Unfortunately, evidence-based
medicine does not support opioids as first-line analgesics for dental pain.
Assessment of each patient along with thorough review of records and constant contact with patients’ other
healthcare providers may decrease the risk of diversion and non-medical use of opioids.
94
Student and Faculty Research Abstracts 2014 –2015
Postdoctoral Student Presentations
Osama Felemban,* Aruna Ramesh, Jennifer Bassett Midle, and Cheen Loo
Purpose: The purpose of this in vitro study is to evaluate the diagnostic efficacy of cone beam computed
tomography (CBCT) and extraoral bitewings in detection of interproximal caries and determining the depth of
carious lesions compared to intraoral bitewings.
Methods: Cadaver heads with 70 posterior teeth were radiographically imaged with i-CAT CBCT, ProMax
3D CBCT, ProMax (extraoral bitewings), and intraoral digital bitewings. The teeth were then extracted and
sectioned for histological evaluation under the microscope. Six pediatric dentistry residents evaluated each
proximal surface. Inter-observer agreement, sensitivity, and specificity were calculated. ROC curves were
analyzed using ANOVA test.
Results: Preliminary results from 40 teeth showed that 51.9% of the proximal surfaces were sound and 48.1%
were carious. Statistical analysis will be carried out after the completion of the data collection and resident
observation.
Conclusion: Statistical analysis will be carried out after the completion of the data collection and resident
observation.
Dental Management of Patients with Adrenal Insufficiency, Based on
Literature Review
Bates-Andrews Day Abstracts
The Efficacy of CBCT and Extraoral Bitewings in Detection of Interproximal Caries
Marina Karnaukh,* Neelam Shah,* and Khoa Tran*
Patients with adrenal insufficiency are treated with long-term steroid use. It has been common practice amongst
dentists to increase steroid coverage of such patients before and after routine dental procedures to prevent
adrenal crisis. To evaluate the need for supplemental steroids, relevant articles addressing adrenal insufficiency
and adrenal crises in dentistry were reviewed. The results of these articles showed the low incidence of adrenal
crisis following dental procedures, including major surgeries. Based on these reports, it can be concluded
that the dental management of hypoadrenal patients on long-term steroids should be modified. The rarity of
adrenal crisis in dentistry strongly suggests that routine dental procedures can safely be completed without any
additional steroid coverage.
Tufts University School of Dental Medicine
95
Bates-Andrews Day Abstracts
Postdoctoral Student Presentations
Dental Management and Complications of Patients with Turner Syndrome
Elaina Kazes* and Amrita Singh*
Turner syndrome is one of the most common
chromosomal abnormalities that affects
development in approximately 1 in 2,000
female births. It is characterized by anomalies
of the X chromosome and encompasses several
conditions in patients. It has been shown that
dental hygienists and dentists are likely to detect
the condition because it manifests clinically in
the oral cavity first. Being aware of common
dental manifestations and considerations with
patients who have the syndrome can aid in the
proper treatment and preparation of the patient
as well as avoiding potential issues that can
ensue.
Biomechanical Evaluation of Different Systems, Locking and Conventional, for Fixing
Sagittal Osteotomy in Major Advances with or without Anticlockwise Rotation
Gustavo Batista Grolli Klein,* Gabriel Cury Mendes, Paulo Domingos Ribeiro Jr., Maria Papageorge, and
Archana Viswanath
Purpose: The overall objective of this in vitro
study was to assess the biomechanical stability
of 6 different osteosynthesis methods after
sagittal split ramus osteotomy by simulating
the masticatory forces and using a 3-point
biomechanical test method.
Materials and Methods: Sixty
polyurethane hemi-mandibles with bone-like
consistency were randomly assigned to 2 groups,
each group containing 6 subdivisions (N=5),
and subjected to sagittal split ramus osteotomy.
After 10-mm advancement of the distal segment
(group 1) and 10-mm advancement of the distal
segment combined with 20° counterclockwise
rotation (group 2), the bone segments were fixed by different osteosynthesis methods using 2.0-mm miniplate/screw systems: subdivision A, one 4-hole conventional straight mini-plate; subdivision B, one 4-hole
locking straight mini-plate; subdivision C, two 4-hole conventional mini-plate; subdivision D, two 4-hole
locking mini-plate; subdivision E, one 6-hole conventional sagittal mini-plate; subdivision F, one 6-hole locking
sagittal mini-plate. All models were mounted on a base especially constructed for this purpose. Using a 3-point
biomechanical test model, the hemi-mandibles were loaded in compressive strength in an Instron machine
(Norwood, Massachusetts) until a 3-mm displacement occurred between segments vertically or horizontally.
96
Student and Faculty Research Abstracts 2014 –2015
Postdoctoral Student Presentations
Conclusion: The use of two mini-plates still remains as a form of fixation, on sagittal split osteotomy, with
the less displacement, even in large advancements with or without counterclockwise rotations.
The Influence of Community Service Learning Externship on Pre-doctoral Dental
Students’ Future Management of Pediatric Patients
Sage Yoo,* Wanda Wright, Cheen Loo, and Alfred Rich
Purpose: The object of this study was to determine if experiences outside of school clinic affects the attitudes
of pre-doctoral students toward managing the oral-health problems of pediatric population.
Method: A survey will be administered to pre-doctoral class of 2015 (N=179). Students will be surveyed after
they have completed their CSLE. The survey consisted of questions about expectation from CSLE, preference
of working with adult or pediatric patients prior and post CSLE, primary concern in treating pediatric patients,
and what additional training would help
more with treating pediatric patients.
Hypothesis testing will be conducted using
the one-sample t-test. Categorical data
will be tested using chi-square test for
association.
Bates-Andrews Day Abstracts
Results: In all cases, the fixations show better performance in advancement only, against advancement
combined with 20° counterclockwise rotation. The use of 2 straight mini-plates shows more resistant, followed
by sagittal mini-plates and one straight mini-plate in both groups. The main forces were respectively: 0.1059
KN, 0.0599 KN, 0.0443 KN in conventional system and 0.1271 KN, 0.0665 KN, 0.0535 KN in locking system, for
group 1. About group 2 the forces were respectively: 0.0930 KN, 0.0505 KN, 0.0330 KN in conventional system,
and 0.1103 KN, 0.0569 KN, 0.0411 KN in locking system.
Results: In the study, 70 responses
have been received from the students.
Data collection is still in progress.
Statistical analysis will be carried out upon
completion of the data collection.
Conclusion: Data collection is still in
progress. Statistical analysis will be carried
out upon completion of the data collection.
Research supported by DHHS-HRSA
#D84HP19955.
Tufts University School of Dental Medicine
97
Behavioral, Epidemiologic, and Health Services
Faculty Abstracts
Note: Names marked with an asterisk denote presenter of paper.
Behavioral, Epidemiologic, and Health Services Research
Risk and Prognostic Factors for Multidrug-Resistant Acinetobacter baumannii
Complex Bacteremia: A Retrospective Study in a Tertiary Hospital of West China
Quinquin Liu,1 Wenzhang Li,2 Xinmiao Du,1 Weijing Li,1 Taiqing Zhong,1 Yin Tang,3 Yulin Feng,1
Chuanmin Tao,1 and Yi Xie1
1West
China Hospital, Sichuan University, Chengdu, Sichuan, China; 2First Affiliated Hospital of Chengdu Medical
College, Chengdu, Sichuan, China; 3Tufts University School of Dental Medicine, Boston
Background: The increasing prevalence and mortality of multidrug-resistant (MDR) Acinetobacter
baumannii complex-associated infections, especially bacteremia, in healthcare settings poses a great threat to
public health. We proceeded to investigate the risk and prognostic factors for MDR A. baumannii complex
bacteremia in mainland China.
2014 –2015 Faculty Abstracts
Methods: This retrospective study was conducted at West China Hospital from January 2009 to December
2013. Using a computer-assisted microbiology laboratory database, patients with MDR A. baumannii complex
bacteremia were included as the case group, while those infected with non-MDR A. baumannii complex were
selected as the control group. The clinical data were collected and analyzed.
98
Results: There were 241 non-duplicated A. baumannii complex blood isolates identified in our research,
with the overall rate of multidrug resistance reaching 75.52% over the past five years. Using multivariate logistic
analysis, being in the intensive care unit (ICU) (adjusted odds ratio [aOR], 5.84; 95% confidence interval [CI],
1.67–20.44), increased Pittsburgh bacteremia score (aOR, 6.55; 95% CI, 1.27–33.70), and use of carbapenem
(aOR, 8.90; 95% CI, 1.71–46.30) were independent risk factors for MDR acquisition among patients with A.
baumannii complex bacteremia. Older age (aOR, 1.02; 95% CI, 1.00–1.04), being post-transplantation (aOR,
5.21; 95% CI, 1.13–24.04), having a higher Pittsburgh bacteremia score (aOR, 2.19; 95% CI, 1.08–4.47), and
having a lower level of albumin (aOR, 0.93; 95% CI, 0.88–0.99) were identified as independent risk factors for
30-day mortality in patients with MDR A. baumannii complex bacteremia.
Conclusion: In conclusion, our research revealed the risk factors associated with acquisition of and
mortality from MDR A. baumannii complex bacteremia, which may be used to prioritize infection control
practices and prognostic evaluations.
Published in PLoS One. 2015 Jun 17;10(6):e0130701. doi: 10.1371/journal.pone.0130701. eCollection 2015.
Student and Faculty Research Abstracts 2014 –2015
Behavioral, Epidemiologic, and Health Services
Engaging Hygienists in Meth-Mouth Education: Qualitative Pilot (Phase II)
Jennifer Towers,* Susan Gallagher, and Gina Heideman
Objectives: Design theory-based health communication campaign for dental hygienists to reduce
morbidity/mortality of adolescent methamphetamine use. Qualitative pilot test of Idaho adolescent dental
patients was designed to determine opinions/preferences about meth-mouth education/meth-use prevention
and protocol, delivery, images, and language for dental office meth-use prevention materials.
Methods: Snowball sample of six female subjects aged 14–15 participated in focus group. Inclusion criteria:
aged 10–19, English-speaking, annual dental hygiene appointment, written permission from parent/guardian.
Ninety-minute in-person focus group was recorded for content analysis. IRB-approved, Extended Parallel
Process Model-informed, Moderator’s Guide aided participant feedback on meth mouth/crank bugs pictures/
language for teaching aid used by hygienists.
Results: Of the group, 50% understood intent of meth-mouth advertisements; 100% felt graphics were
impactful; many but not all felt depictions were realistic. Mild meth-mouth cases elicited a less-dramatic
response than advanced cases. Fifty percent felt most extreme cases should be shown to dental patients without
qualification; other half felt there should be age considerations. Term “crank bugs” was not familiar to majority;
they questioned validity/occurrence of meth-high psychosis. Questions about pain and scientific/medical
causes emerged with demand for meth use facts and “myth busting.” Potential thematic use of zombies for
teaching aid was deemed interesting but comic book medium was overwhelmingly rejected. Subjects felt meth
use information should be widely distributed but mobile messaging not preferred due to lack of smart phone
availability/financial hardship. All felt printed posters/pamphlets would be most effective for dental offices and
liked billboards, preferring public awareness over a private experience.
Presented at the 2015 IADR General Session in Boston. Abstract #2885.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusions: Understanding health outcomes etiology was central to subjects’ acceptance of susceptibility
and severity of meth mouth/crank bugs. Access to information and preferred communication channels are
affected by perceived/actual socioeconomic status. The Extended Parallel Process Model could be effective with
this demographic. There are needs for further audience segmentation and tailored campaign executions.
99
Cancer Biology and Tissue Engineering
Cancer Biology and Tissue Engineering
Maintenance of Functional Embryoid Bodies in Cryopreservable, Microfluidic Chips:
A Platform for Personalized Medicine
Raymond Anchan,1 Sinan Guven,1 Jennifer Lindsey,1 Michael Nickerson,1 Sireesha Chinthala,1
Behzad Gerami-Naini,1,2 Utkan Demirci,1,3
1Brigham
and Women’s Hospital, Harvard Medical School, Boston; 2Tufts University School of Dental Medicine,
Boston; 3Massachusetts Institute of Technology, Cambridge, Massachusetts
Object: Employ microfluidic cassettes as a novel platform for long-term culture and cryopreservation of
functional, differentiated mouse embryoid bodies.
2014 –2015 Faculty Abstracts
Materials and Methods: Embryoid bodies (EBs), grown in suspension from mouse embryonic stem
cells (ESCs), were embedded in Matrigel-coated channels with a constant 1 µl/min flow of culture media for
21 days. EB viability, differentiation, and functionality were assayed as measures of the culture system’s efficacy.
Viability was assessed with live/dead stains and BrdU proliferation assays. Differentiation was analyzed with
immunocytochemistry (ICC) for markers of endoderm, ectoderm, and mesoderm, as well as ovarian tissue.
Hormone synthesis served as an indicator of EB differentiation and functionality. Conditioned media collected
over 24 hr interval period was assayed by ELISA for estradiol (E2), progesterone (P4), and testosterone (T)
synthesis. We also slow-froze sealed microfluidic cassettes in isopropanol, thawed these, and measured viability
and functionality of the EBs.
100
Results: EBs grown in microfluidic cassettes maintain long-term viability and proliferation after 21 days.
Differentiation of EBs in the microfluidic system was verified, as shown by ICC of cell markers from all three
germ layers and expression of ovarian cell markers (inhibin, Cyp19a1, and AMHR). Functional analyses show
increasing synthesis of E2 (15 pg/ml on day 1 to 31 pg/ml on day 20). Cryopreserved EB-laden microfluidic
chips recovered upon thawing and continued hormone synthesis.
Conclusion: Microfluidic culture of functional EBs is a promising system that can maintain EB viability,
differentiation, and functionality even after recovery from cryopreservation and afford an opportunity to
develop patient-specific cassettes of differentiated human ESCs that may be stored, used in drug testing, or
harvested for hormones.
Support: NIH 1 R01 EB015776-01A1 (SG, RMA, UD)
Presented at the 2014 Annual Meeting of the American Society for Reproductive Medicine in Honolulu, Hawaii,
October, 2014.
Student and Faculty Research Abstracts 2014 –2015
Craniofacial Biology
Craniofacial Biology
Functional Characterization of Retinoblastoma in Tooth Development
Weibo Zhang, Viktoria Andreeva, Betsy Vazquez, Jodie Pietruska, Philip Hinds, and Pamela Yelick
Objectives: Recently, it has become evident that retinoblastoma 1 (Rb1), a tumor suppressor gene, also plays
important roles in cell fate determination and differentiation of multiple tissues. In this study, we evaluated the
role of Rb1 in tooth development.
Methods: Transgenic 3.6Col1a1-Cre::Rb conditional knock-out (KO) mice were generated by crossing
Rbf19/f19 and 3.6-Col1a1Cre transgenic mice. Evaluation of tooth development in KO, HET and WT mice was
performed using histological and immunohistochemical (IHC) analyses of tooth differentiation marker gene
expression. Due to the fact that conditional Rb KO mice die at or just before birth, we performed kidney capsule
implantation of E14.5 mandibles obtained from KO, HET and WT 3.6Col1a1::Rb mice, grown for 9 days, 23
days, 1, and 2 months. Harvested jaw implants were evaluated using X-ray, SEM, micro-CT, sectioned in situ
hybridization (ISH), real-time PCR, histological and IHC analyses. TUNEL assay were used to evaluate cell
apoptosis and proliferation, respectively, in jaw implants. Chromatin immunoprecipitation (ChIP) assays were
used to determine the role of Rb1 to tooth development.
Results: X-ray, SEM, and micro-CT analyses revealed reduced and less organized dentin formation in
3.6Col1a1::Rb KO mouse teeth as compared to aged matched Het and WT animals. Histological analysis
confirmed reduced dentin formation, which was accompanied by increased levels of dental pulp cell apoptosis,
which was confirmed by TUNEL assay. Reduced odontoblast differentiation marker genes expression was shown
using IHC and real-time qRT-PCR. CHIP assays were used to demonstrate that Rb1 and Runx2 cooperative
binding to promoter sites within the Dspp and Dmp1 genes.
Presented at the 2015 IADR General Session in Boston. Abstract #0098.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusions: These studies demonstrate, for the first time, previously unknown roles for Rb1 in
odontoblast differentiation and survival.
101
Dental Materials
Dental Materials
Comparison of Microleakage between Bulk-Fill Flowable and Nanofilled ResinBased Composites
Eman AlSagob, David Bardwell, Samer Khayat, Paul Stark, and Ala Ali
Objectives: The objective of this study was to compare the marginal leakage (silver nitrate uptake) of
nanohybrid resin-based composite (RBC) and two bulk-fill flowable RBCs with specific clinical protocols.
Methods: Four experimental groups of RBC were investigated including conventional composite Filtek™
Supreme in 2 mm increment (FS2), Filtek™ Supreme in 4 mm increment (FS4), Filtek™ Supreme Flowable (BFF),
and SureFil® SDR® flow (SDR). Class II box preparations (4 x 4 x 3 mm) in extracted intact human molars were
prepared and restored using the experimental groups, all according to the manufacturers’ recommendations,
except FS4, which was applied in 4 mm increment instead of the 2 mm recommendation of the manufacturer.
Samples were aged by thermocycling (2000 cycles). Microleakage was calculated by measuring dye penetration
in sectioned teeth using a stereomicroscope. Results were analyzed using one-way analysis of variance
(ANOVA), with Bonferroni post hoc test, and Mann-Whitney/Wilcoxon test at α=0.05 significance level.
Results: BFF and FS2 exhibited the least dye penetration and microleakage measurement with no significant
difference between the two groups with mean (standard deviation) of 1.90 (4.59) and 1.99 (2.24) respectively,
followed by SDR with a mean of 3.91 (6.63). FS4 showed the highest microleakage with significant difference in
comparison to BFF and FS2 with a mean of 8.02 (4.01).
2014 –2015 Faculty Abstracts
Conclusions: The microleakage of the bulk-fill composites BFF and SDR are comparable to conventional
composite FS2; however, it’s more predictable to use FS2 due to its reliable results.
Presented at the 2015 IADR General Session in Boston. Abstract #0648.
Effect of Curing Light and Restoration Location on Energy Delivered
Sapan Bhatt,1 Coralie Ayer,2 Richard Price,2 and Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Dalhousie University School of Dentistry, Halifax, Nova Scotia
This study determined how long it would take skilled operators to deliver 16 J/cm2 to an anterior or a posterior
restoration using different light-curing units (LCUs). Three skilled operators used the following LCUs at
two locations in the MARC-patient simulator: Optilux 501 standard mode for 20 s; Sapphire Supreme for
5 s; Elipar™ S10 for 5 s and 20 s; Demi™ Plus standard mode for 5 s; SmartLite® Max boost mode for 5 s
and continuous mode for 20 s; Radii Plus for 30 s; Valo (main version) in standard mode for 20 s and Xtra
Power mode for 3 s; and Valo Cordless in standard mode for 20 s and Xtra Power mode for 3 s. The three
MARCtrained operators made 30 readings with each light over 7 days. The energy (J/cm2) delivered to the
anterior Class III and posterior Class I simulated restorations in MARC was recorded using a laboratory-grade
spectroradiometer, and the time each light would take to deliver 16 J/cm2 calculated. ANOVA and Fisher’s PLSD
tests compared differences in the time to deliver 16 J/cm2 of energy, α=0.05. Three-way ANOVA showed there
was no significant difference between the operators, but there was a difference between the lights and locations.
The Valo main and Valo Cordless in the Xtra Power mode delivered 16 J/cm2 in the shortest time at both
locations. The Radii Plus took the longest to deliver 16 J/cm2, taking twice as long in the posterior location.
Published in Compend Contin Educ Dent. 2015 Mar;36(3):208-10, 212, 214.
102
Student and Faculty Research Abstracts 2014 –2015
Dental Materials
Change in Bond Strength of Selected Bonding Agents over Time
Sapan Bhatt, Richard Price, Ronald Perry, and Gerard Kugel
Objectives: To investigate the change in shear bond strength of selected bonding agents over a 3-year period.
Methods: Two self-etching bonding systems, Clearfil SE™ (CF, Kuraray), Peak SE™ (PS, Ultradent), and two
phosphoric acid total-etch bonding systems, Peak LC (PT, Ultradent), Single Bond™ (SB, 3M ESPE), were used
according to manufacturer’s instructions to bond Filtek Z100™ (3M ESPE) to human dentin on extracted third
molars. Group 1 for each system (N=12) was stored (37°C, 24 hours) and group 2 (N=12) was stored (37°C,
3 years) before de-bonding using Ultradent notched blade. Lowest bond strength value in each group was
discarded. Results were compared with two-way ANOVA and Fisher’s PLSD test (α=0.05).
Results: Table 1. Mean shear bond strengths for selected bonding systems and difference in bond strength
between 2 groups. Superscript letters A,B,C indicate bonding systems with no significant difference. * = significant
difference between bond strength in group 2 versus group 1 (Fisher’s, p<0.05).
Mean Bond Strength (mPa)±SD
Difference in Mean Bond Strength (mPa)
Group 1
Group 2
CF
46.8±3.9A
36.9±13.7C
−9.9*
PS
44.5±5.9A
42.3±11.6C
−2.2
SB
37.3±4.6B
33.9±7.7C
−3.4
PT
36.0±10.6B
37.0±12.9C
1
Presented at the 2015 IADR General Session in Boston. Abstract #0816.
Effect of Phosphoric Acid on Vitrebond Plus Resin-Modified Glass Ionomer
Jonathan Bishop, William Chao, Melissa Ing, Steven Eisen, Aikaterini Papathanasiou, and Gerard Kugel
Objective: This study sought to determine whether phosphoric acid etching of Vitrebond Plus RMGI liner/
base material (3M ESPE; St. Paul, MN) affects the shear bond strength between itself and Filtek Supreme Ultra
nanocomposite (3M ESPE).
Methods: In the study, 3 mm x 6 mm cylindrical molds were filled with Vitrebond Plus RMGI liner and
light-cured for 20 seconds. Samples were then either treated with 35% phosphoric acid (Group 1; N=27); or
not treated with phosphoric acid (Group 2: N=26). All samples were then treated with ExciTE F total-etch
bonding agent (Ivoclar Vivadent; Amherst, New York) and light-cured for 10 seconds. Once the bonding agent
was cured, Filtek Supreme Ultra nanocomposite was placed over the Vitrebond Plus RMGI liner using 8 mm x
3 mm cylindrical molds and light-cured for 40 seconds using a light-emitting diode curing light (DEMI Plus,
Kerr; Orange, California). All samples were treated in accordance to manufacturers’ instructions. After sitting
at room temperature for 24 hours, the shear bond strength of each sample was determined using a universal
testing machine at a crosshead speed of 1.0 mm/min.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusions: Storage for three years had a significant negative effect on shear bond strength for CF (Table
1). While self-etching bonding systems yielded significantly stronger bonds after 24 hours of storage, there was
no significant difference between the systems after three years. These findings suggest further investigation into
the change in shear bond strength for self-etch and total etch-bonding systems over time.
103
Dental Materials
Results: No statistically significant difference was observed between the acid-etched and non-etched groups
(p=0.918).
Significance: Findings suggest that clinicians who currently implement selective-etching may no longer
need to use this technique when using Vitrebond Plus RMGI liner and Filtek Supreme Ultra together because
there is no detriment as a result of etching Vitrebond Plus RMGI liner. Clinically, this may decrease both
application time and indicates that phosphoric acid neither positively nor negatively alters bond strength
between the two materials.
Published in the Journal of Cosmetic Dentistry, Fall 2014, Volume 30, Number 3.
Composite Replacement of Amalgam Restorations: An In Vitro Examination
Hetaf Redwan, David Bardwell, Hans-Peter Weber, Ala Ali, Samer Khayat, and Matthew Finkelman
Objectives: Evaluate microleakage of composite restoration when bonded to tooth structure previously
restored with amalgam material compared to that of freshly cut dentin.
2014 –2015 Faculty Abstracts
Methods: Thirty extracted intact human molars were mounted in autopolymerizing acrylic resin. Class II
box preparations were prepared on the occluso-proximal surfaces of each tooth (4 mm bucco-lingual width and
2 mm mesio-distal depth) with the gingival margin 1 mm above the CEJ. Each cavity was restored using high
copper amalgam restoration (Disperalloy®, Dentsply), thermocycled for 10000 cycles. Amalgam restorations
were removed and replaced with Filtek™ Supreme Ultra Universal (3M ESPE) excluding five of them, which
were used for the SEM and EDX composite resin then thermocycled for 5,000 cycles. Twenty samples were
randomly selected for dye penetration testing utilizing silver nitrate staining to detect microleakage. Specimens
were analyzed with a stereomicroscope at a magnification of 20x. All measurements were done in μm; two
readings were taken for each cavity at occlusal and proximal margins.
104
Results: Corrosion properties were not detected in either group. No statistically significant difference
between the microleakage of the two groups was found using a 0 to 3 scale at the occlusal margins (McNemar’s
test, p=0.727) or proximal margins (Wilcoxon signed-rank test, p=0.174). No significant difference was found
between the two groups using the percentage measurements and Wilcoxon signed-rank test at either the
occlusal (p=0.675) or proximal (p=0.513) margins. However, marginal microleakage was statistically significant
between the proximal and occlusal margins (p<0.001).
Conclusions: Within the limitations of this in vitro study, no significant difference was found between the
microleakage of non-discolored dentin in teeth that were previously restored with amalgam compared with
freshly cut dentin. However, marginal microleakage in the proximal surface was higher than that in the occlusal
surface.
Presented at the 2015 IADR General Session in Boston. Abstract #0848.
Student and Faculty Research Abstracts 2014 –2015
Diagnostic Sciences
Diagnostic Sciences
Predictable Technique to Register Retruded Contact Position Using a Disposable Jaw
Relation Recording Device
T. Daher,1 William Lobel,2 J. Massad,3 S. Ahuja,3 and Z. Danilov4
1Loma
Linda University, School of Dentistry, Loma Linda, California; 2Tufts University School of Dental Medicine,
Boston; 3University of Tennessee Health Science Center, Memphis, Tennessee; 4Danilov Dental Laboratory,
Carmichael, California
The dental literature presents various definitions and techniques to describe and register centric relation (CR)
or centric occlusion (CO). Briefly reviewing the literature in relation to CR, this article proposes the use of
the term retruded contact position (RCP), clinically defined as retruded, unstrained, repeatable position and
where the mandibular movements start when a Gothic arch tracing is used. With this clinical definition, a
technique can be easily selected that meets all the requirements of such a position. The article discusses the
use of a jaw recorder that is an intraorally graphic recording device that results in a tracing of mandibular
movements in one plane, with the apex of the tracing indicating the retruded, unstrained, and repeatable
relationship. The intersection of the arcs produced by the right and left working movement form the apex of the
Gothic arch tracing. Several clinical situations using the jaw recorder are described. Clinicians can now quickly
and accurately record RCP, balance complete, partial, or implant dentures, and orthopedically reposition the
mandible. The technique achieves highly reliable and reproducible results.
Published in Compend Contin Educ Dent. 2015 May;36(5):323-329;quiz330.
CBCT Valuable for Diagnosis of Tooth Fracture
Data Sources: PubMed, Embase, Web of Science, ProQuest Dissertations & Theses, CNKI and SIGLE
databases.
Study Selection: Two reviewers independently selected studies. Studies examining the diagnostic
accuracy of CBCT for tooth fractures in vivo were considered. Only studies with a minimum of ten participants
using a reference test of surgical exploration or extractions to establish the diagnosis of tooth fractures were
included.
Data Extraction and Synthesis: Data abstraction was carried out independently by two reviewers
and study quality assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.
The main study outcomes were sensitivity, specificity, positive likelihood ratio (LR), negative LR and summary
receiver operating characteristic (SROC).
Results: Twelve studies were included in a meta-analysis. The pooled sensitivity was 0.92 (95% CI=0.89–0.94)
and pooled specificity 0.85 (95% CI=0.75–0.92). The pooled positive and negative likelihood ratios were 5.68
(95% CI=3.42–9.45) and 0.13 (95% CI=0.09–0.18) respectively. The summary receiver operating characteristic
was 0.94 (95% CI=0.90–0.98). The pooled prevalence of tooth fractures in patients with clinically suspected
but periapical-radiography-undetected tooth fractures was 91% (95% CI=83%–97%). Positive and negative
predictive values were 0.98 and 0.43 (subgroup analysis: 0.98 and 0.28 for endodontically treated teeth; 0.99 and
0.77 for non endodontically treated teeth).
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
David Leader
105
Diagnostic Sciences
Conclusions: We suggest that CBCT has a high diagnostic accuracy for tooth fractures and could be used
in clinical settings. We can be very confident with positive test results but should be very cautious with negative
test results. For patients with negative results, close follow-ups are recommended. The diagnostic accuracy
of CBCT is similar among different types of tooth fractures, which should be interpreted with caution due to
unavailability of data for subgroup analysis on horizontal and oblique tooth fractures.
2014 –2015 Faculty Abstracts
Published in Evid Based Dent. 2015 Mar;16(1):23-4. doi: 10.1038/sj.ebd.6401082.
106
Student and Faculty Research Abstracts 2014 –2015
Education Research
Education Research
Saudi and U.S. Dental Student Attitudes toward Treating Individuals with
Developmental Disabilities
Zuhair Alkahtani, Paul Stark, Cheen Loo, Wanda Wright, and John Morgan
This study was conducted to compare the attitudes of senior dental students at the Faculty of Dentistry at
King Abdulaziz University (KAU) in Jeddah, Saudi Arabia, and at Tufts University School of Dental Medicine
(TUSDM) in Boston about providing dental care to individuals with developmental disabilities (DD). Two
subsequent classes of senior dental students at both universities were surveyed using a pretested, validated,
online questionnaire. The students’ demographic and educational data were collected, along with information
about their experience, training, and attitudes toward this population. Two hundred and fourteen students
responded to the online survey, for a response rate of 35 percent (51 percent for KAU students and 21 percent
for TUSDM students). Students at TUSDM had more training, more experience, and more positive attitudes
toward individuals with DD compared to KAU students (p<0.05). Students who reported having previous
experience with individuals with DD had more positive attitudes than students who reported no experience
with these individuals (p<0.05). Students who reported being prepared to treat individuals with DD had more
positive attitudes than students who reported not being prepared (p<0.05). These findings suggest an association
between predoctoral education in the treatment of individuals with special needs and having positive attitudes
toward providing oral health care to individuals with DD.
Published in J Dent Educ 2014 Aug; 78(8):1145-53.
A Virtual Patient Avatar: Enhancing Dental Education and Patient Care
Conclusion: The created virtual patient avatar allows for an interactive experience that dental students can
use to learn comprehensive treatment planning. Scenarios cover medically and dentally complex patients, dental
material demonstrations, and responsive questions and answers with different outcomes possible depending
2014 –2015 Faculty Abstracts
Tufts University School of Dental Medicine
107
David Frantz, Kanchan Ganda, Britta Magnuson, and Melissa Ing
Purpose: Integrating comprehensive care in dental school curriculum is critical from the very beginning.
Development of virtual patient avatar technology for dental education is important as it allows for the earliest
introduction to comprehensive care. This can have a positive impact on dental student learning and patient
care. Avatars can promote student critical thinking by allowing for case-based scenarios and simulation of
comprehensive care. Additionally, avatars can enhance dental care by allowing students to simulate interactions
and treatment with patients prior to clinical experience. Simulations allow for students to practice and learn
from their treatment planning options, so mistakes, when made, are still virtual. The purpose of this abstract
was to develop a virtual patient avatar to be used in the dental school setting.
Methods: The virtual patient is written in the C# programming language and runs on the state-of-the-art
cross-platform Unity three-dimensional engine. The avatar can be quickly reconfigured to provide virtual
patients of any desired age, gender, or nationality. The avatar enables a realistic 3D patient for medical and social
interaction along with a fully detailed, life-like 3D dentition. In its current version, simple C#, JavaScript, or Boo
programming language scripts can be used to quickly reconfigure the system for different scenarios, but a userfriendly graphical configuration system is under development.
Education Research
on students’ answers. This interactive computerized visualization enhances critical thinking skills and allows
students to explore treatment plan options for patients with diverse issues.
Presented at the 2015 ADEA Annual Session and Exhibition Tech Expo in Boston.
Administrative Trends in U.S. Dental Schools
Martin Fu,1 Angel Rodriguez,2 Rebecca Chen,1 Earl Fu,3 Shu-Yi Liao,4 and Nadeem Karimbux5
1Harvard
School of Dental Medicine, Boston; 2Boston University School of Dental Medicine, Boston; 3School of
Dentistry, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC; 4University of
California, Riverside, California; 5Tufts University School of Dental Medicine, Boston
2014 –2015 Faculty Abstracts
The aims of this study were to analyze the administrative trends in U.S. dental schools at the beginning and
end of a thirteen-year period and to identify the predictive factors for those changes. Administrative trends
were measured by the difference in the number of major administrative positions for 1997 and 2010 reported
in American Dental Education Association (ADEA) and American Dental Association (ADA) publications.
Secondary measures (program length, student enrollment, and tuition) were also gathered. The mean numbers
of administrative positions per school significantly increased over the study period, while the mean number
of clinical science departments per school significantly decreased. The change in the number of directors was
positively correlated with the change in student enrollment, but inversely correlated with the change in number
of vice/associate/assistant deans. The change in the number of clinical science departments was positively
correlated with changes in student enrollment and out-of-state tuition, but inversely correlated with the change
in in-state tuition. The number of all departments per U.S. dental school significantly decreased in this period.
The schools that had consolidation of clinical science departments were less likely to have increases in student
enrollment and out-of-state tuition, but more likely to have increases in in-state tuition.
108
Published in J Dent Educ. 2014 Nov;78(11):1508-12.
Evaluation of Student Research Environment and Intramural Research Database
at Tufts
Kelly Leong, Minh Bui, Angel Park, and Yumi Ogata
Objectives: This study explored student and faculty opinions and about the student research environment
at Tufts University School of Dental Medicine (TUSDM). Secondarily, a novel intramural web-based research
mentor database was evaluated for usability.
Introduction: According to the Journal of Dental Education, research experience has become an
important component for the vitality and future of dental education. Student research facilitates criticalthinking abilities and scientific advances and fosters a supportive community. In implementing a new resource
for young students who are interested in research, thorough evaluation must be made to assess for practicality.
Introducing students to research early on in their careers will help strengthen the research community
at TUSDM and hopefully lead to increased interest and retention. This project represents one of the first
evaluations of TUSDM’s research environment from both student and faculty perspectives.
Methods: A mixed-methods project with dental student focus groups and faculty key informant interviews
was conducted. Inclusion criteria were 2014 Bates Andrews Research Day poster presentation or mentorship.
All subjects evaluated research database site (TUSK hosted information).
Student and Faculty Research Abstracts 2014 –2015
Education Research
Results: Time was the biggest barrier for both students and faculty. From a student perspective, timemanagement was instrumental in successful research project completion. From a faculty perspective, there was
too little time to mentor students and have them engage in a full project during time allotted. Most students
had found their research mentors through word-of-mouth, and it was overwhelmingly the preferred method of
finding a mentor. Faculty reported that their student recruits came either through the Dean’s Honors program,
word-of-mouth from previous students, or were students who were interested in specializing. They cited the
annual student mixer as an important way to meet students. Of the students, 100% responded that they would
use the website, and 100% of faculty thought it would be helpful for students. Those with more experience
viewed the resource more positively. Students navigated the resource intuitively and commented that “the way
it was set up was very clear” and it was “easy to use.” Faculty felt that defining different types of research on the
homepage (e.g., basic science vs. clinical) would be helpful for younger students. Both groups hoped for more
information such as lab websites, pictures, and space availability in labs. Senior subjects realized difficulty in
maintenance.
Conclusions: This study highlights current attitudes about TUSDM student research. Both faculty and
students expressed time and time management as a limiting factor for their pursuits. While faculty felt most
of their students were pursuing research due to their interests in specializing, a small sample of students
demonstrated that this may not necessarily be true. Both groups commented the TUSDM Research Database
would be a useful first resource for young dental students interested in pursuing research opportunities, though
improvements can be implemented.
Presented at the 2015 ADEA Annual Session & Exhibition, Boston, #164.
Background, Training Experiences, and Career Plans of U.S. Periodontal Residents:
Report of a Web-Based Survey
1Brigham
and Women’s Hospital, Boston; 2King Abdulaziz University, Jeddah, Saudi Arabia; 3Private practice,
Denver, Colorado; 4Boston University, Boston; 5Tufts University School of Dental Medicine, Boston
The purpose of this cross-sectional study was to survey the backgrounds and perspectives of U.S. periodontal
residents in 2012. A 64-item web-based survey was distributed to all periodontal residents in the United States
(544 residents enrolled in 54 graduate programs) via email in March 2012. Data on the residents’ demographics,
experiences during graduate periodontal training, and goals were collected and analyzed, and percentages
were calculated. The survey had a 19.1% response rate. Most of the respondents (74%) had graduated from
international dental schools, and 81.7% were in combined programs (clinical training combined with a master’s
degree, Ph.D., or other doctoral degree). Almost one-fourth of the responding residents (24%) reported a
total debt of more than $300,000 after graduation. More than 60% of the respondents planned to practice in a
private setting as an associate, partner, or solo practice owner. The responding residents reported having chosen
their graduate programs based mainly on the programs’ clinical education and reputation (72% and 48%,
respectively). Future studies will determine educational trends and outcomes for periodontal residents in the
longer term.
Published in J Dent Educ. 2015 Jan;79(1):64-71.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Hani Mawardi,1,2 Ardavan Fateh,3 Lena Elbadawi,4 and Nadeem Karimbux5
109
Education Research
Comfort Levels among Predoctoral Dental and Dental Hygiene Students in Treating
Patients at High-Risk for HIV/AIDS
Zuhair Natto, Majdi Aladmawy, and Thomas Rogers
Purpose: The purpose of this article is to discuss the impact of the training program for predoctoral dental
and hygiene students at Loma Linda University School of Dentistry (LLUSD, Loma Linda, California) with
regard to issues related to treating patients with a high risk of having HIV/AIDS.
Methods: LLUSD offers a training program for fourth-year dental hygiene and predoctoral dental students
that addresses the oral healthcare needs of persons with HIV disease. The training occurs in small groups 2 days
per week at a community clinic serving HIV-positive individuals. Three academic quarters are required to train
all fourth-year students each year. Evaluation of program effectiveness is conducted by means of pre- and postsession surveys. Dental hygiene and dental students completed the pre-survey during the spring quarter of their
third year in public health dentistry courses. The same students completed the post-session survey at the end of
their weekly training sessions during the fourth year.
Results: The overall change in all areas related to the students’ comfort level in treating patients in the 3
defined categories is in a positive direction (p-value<0.0001). The change was much higher among dental
hygiene students compared with predoctoral dental students.
Conclusion: A comparison of pre- and post-session surveys reveals a significant improvement in students’
perception of and comfort level with treating patients who are homosexual/bisexual or intravenous drug users
or who have a history of blood transfusion in both student groups upon completion of the HIV and the dentist
training program at LLUSD.
2014 –2015 Faculty Abstracts
Published in Journal of Dental Hygiene 2015 June;89(3):162-9.
110
The Influence of Examiner Type on Dental Students’ OSCE Scores
Sang Park,1 Arthur Kim,1 Joshua Kristiansen,1 and Nadeem Karimbux2
1Harvard
School of Dental Medicine, Boston; 2Tufts University School of Dental Medicine, Boston
The purpose of this study was to evaluate the difference in grading of objective structured clinical examinations
(OSCEs) at Harvard School of Dental Medicine (HSDM) by full-time faculty examiners, part-time faculty
examiners, and postgraduate resident examiners. The OSCE is an evaluation of clinical competence and is used
as a multidisciplinary examination at HSDM. Two examiners are selected for each of ten disciplines. Evaluators
meet to review the case before the OSCE is given, and faculty examiners are given the opportunity to write exam
questions based on the students’ expected level of knowledge and ability. All examiners also meet on the day
of the OSCE to review the case and discuss relevant issues. Students are randomly assigned to examiners and
meet with one examiner at a time in each discipline during the examination. Analysis of OSCE scores on four
exams given to HSDM students between 2012 and 2013 suggests that part-time faculty members tended to score
students significantly higher than full-time faculty members or postgraduate residents. This may be a result of
reduced contact time between students and the part-time faculty although it may also point to a need for more
efforts in calibration of the part-time faculty members who take part in the OSCE.
Published in J Dent Educ. 2015 Jan;79(1):89-94.
Student and Faculty Research Abstracts 2014 –2015
Education Research
A Pilot Dental Teamwork Course Focused on Interprofessional Competencies
Ellen Patterson, Natalie Hagel, Kristeen Perry, Jennifer Bassett Midle, and Fadi White
Problem: Interprofessional teamwork skills are essential for all future healthcare professionals. In clinical
dental practice, communication and collaboration between dental team members are imperative for safe and
effective patient care. The future integration of newly emerging dental team roles, such as advanced practice
dental hygienists and dental therapists, will require that all future oral health practitioners have adequate
training in interprofessional competencies.
Objective: The purpose of this study was to introduce intra-professional clinical collaboration and small
group learning sessions to dental and dental hygiene students to evaluate teamwork and communication skills
based on interprofessional competencies. The goal was to pilot a replicable curriculum to encourage students
of both disciplines to learn clinical skills with and from one another, recognize one another’s clinical roles and
responsibilities, and practice transferrable skills for effective teamwork and communication.
Method: Quantitative and qualitative data was collected utilizing validated pre-test/post-test questionnaires;
Readiness for Interprofessional Learning Scale (RIPLS) and Dental Roles and Responsibilities, along with selfassessment evaluation. Third and fourth year dental student participants (N=16) were volunteers; dental hygiene
participants (N=7) in their final year were assigned. The control groups (47, N=32 dental, N=15 dental hygiene)
were students who did not take the course.
Conclusions: This study revealed evidence that this pilot course holds promise as an innovative model
for teaching dental and dental hygiene students the foundational concepts and skills for collaborative
interprofessional practice, both within and beyond the dental team. Additionally, the finding from this study
suggests dental and dental hygiene students have divergent opinions about one another’s responsibilities. Future
studies should explore understanding students’ role perceptions as well as research on effective interprofessional
teaching methods to assist in developing effective teaching materials and approaches to foster safe and effective
teamwork.
Presented at the 2015 ADEA Annual Session & Exhibition in Boston.
An Interdisciplinary, Team-Based Design for an Oral and Maxillofacial Radiology
Course for Postdoctoral Dental Students
Aruna Ramesh, Rumpa Ganguly, and Donna Qualters
This article describes the transition of an oral and maxillofacial radiology course from a traditional lecture
format to an interactive case-based, team-based, interdisciplinary, and intraprofessional learning model in
advanced dental education. Forty-four postdoctoral dental students were enrolled in the course over a twelve-
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Results: Quantitative data: Participant and control groups were similar; non-significance was found for the
following factors using Pearson chi-square test at alpha=0.05 and independent t-test at alpha=0.05: gender,
age, education level, prior professional training, future professional plans, and prior exposure to IPE. Study
participants’ total RIPLS scores at pre-test were higher than controls’ (approaching significance at p<0.1).
Statistically significant (p<0.05) results for pre-test to post-test changes were found for the total RIPLS and the
team collaboration subscale only. Qualitative data: Students self-assessed addressing the value and impact of
each session. Overall, both disciplines (84%) valued the interactive, small-group format, clinical collaboration,
and teamwork skills training as additions to professional education.
111
Education Research
week period in the fall semester 2012. The class consisted of U.S.- and non-U.S.-trained dentists enrolled in
advanced education programs in various dental disciplines. The course faculty preassigned interdisciplinary
teams with four or five students in each. The class met once a week for an hour. Ten of the twelve sessions
consisted of a team presentation, individual quiz, team quiz, and case discussion. Each member of a team
completed peer evaluation of other team members during weeks six and twelve of the course. The final course
grade was a composite of individual and team quiz grades, team presentation, and peer evaluation grades. The
overall class average was 90.43. Ninety-five percent of the class (42/44) had total team grades equal to or greater
than total individual quiz grades. The objective of creating a new case-based, team-based, interdisciplinary,
intraprofessional learning model in advanced dental education was achieved, and the initial student perception
of the new format was positive.
2014 –2015 Faculty Abstracts
Published in J Dent Educ. 2014 Sep;78(9):1339-45.
112
Student and Faculty Research Abstracts 2014 –2015
Endodontics Research
Endodontics Research
Root Fracture Resistance Evaluation Using Different Posts and Ferrule Heights
Ekaterini Antonellou,* Masly Harsono, Gerard Kugel, Matthew Finkelman, and Khadiga Elfallah
Objectives: To evaluate the difference between fracture resistances of endodontically treated teeth restored
with glass, quartz, and metal posts with different ferrule heights.
Methods: Sixty extracted single rooted teeth (N=10/group) with root length of at least 14 mm were tested.
Samples were disinfected, cleaned, and sectioned at 2 mm above CEJ. Endodontic treatment was performed.
Three main groups received either metal (A), glass (B) or quartz posts (C). Within those groups, two subgroups
had 1-mm or 2-mm ferrule height. Paracore composite build-up was used with paraforms. Preparation with
deep chamfer finish line of 0.7 mm was performed. A rubber stop was used in the bur to differentiate the ferrule
height for 1 mm and 2 mm. All ceramic crowns of Empress were fabricated using E4D CAD/CAM system.
Compression test was done with direction of 135° to the long axis of the teeth. Kruskal-Wallis test was used to
compare the post types. Post hoc test analyses were conducted via the Mann-Whitney U test when the KruskalWallis test was statistically significant. The Mann-Whitney U test was used to compare the two ferrule heights.
Results: Difference in root fracture resistance was statistically significant only among the post types
(p-value=0.021) with 2 mm ferrule. The metal posts had the highest fracture resistance compared to the quartz
and fiber posts and the difference was statistically significant (p-value<0.05). The difference in ferrule heights
groups was statistically significant with (p-value=0.019) only within quartz fiber post groups where the 1 mm
ferrule group had higher fracture resistance than the 2 mm.
Presented at the 2015 IADR General Session in Boston. Abstract #3853.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusions: Within the 2-mm ferrule height group, endodontically treated teeth restored with metal posts
had the highest fracture resistance followed by those restored with glass and quartz posts. Within quartz posts
groups, teeth with 1-mm ferrule height had a higher fracture resistance compared to those of 2 mm.
113
Geriatric Oral Research
Geriatric Oral Research
Geriatric Patients’ Oral Quality of Life and Oral Health Status
Jennie Leikin, Matthew Finkelman, and Britta Magnuson
Objectives: Examine geriatric patients’ oral quality of life (QoL) at Tufts University School of Dental
Medicine (TUSDM) (as measured by the General Oral Health Assessment Index (GOHAI)) and oral health
status (as measured by periodontal status, number of missing teeth, presence of decay, and presence of
restorations).
Methods: Thirty-five senior citizens (aged ≥65) at TUSDM were consented for participation. GOHAI
questionnaire and demographic information was collected. Periodontal status and dental health records were
reviewed for dental status. Descriptive statistics were reported. Kruskal-Wallis tests and Spearman correlations
were calculated. P-values less than 0.05 were considered significant. STATA13 was used for statistical analyses.
2014 –2015 Faculty Abstracts
Results: The 35 subjects included 19 females and 16 males; 33 white/Caucasian subjects, 1 black/
African American subject, and 1 Asian subject. Scoring of GOHAI was on a scale of 0–60 (lower numbers
corresponding to a better oral QoL). The GOHAI median score=18 (range 9–34). Five subjects had clinical
periodontal health with a median GOHAI score=18 and IQR=2.00. Thirteen subjects had gingivitis with a
median GOHAI score=16 and IQR=9.00. Seventeen subjects had periodontitis with a median GOHAI score=19
and IQR=8.00. Periodontal status compared to GOHAI had p-value=0.163. GOHAI compared to number of
previously filled teeth had p-value=0.006. GOHAI compared to previously filled teeth was negatively correlated
with subjects with fewer previously restored teeth having lower GOHAI scores. GOHAI compared to number of
decayed teeth had p-value=0.302. GOHAI compared to number of missing teeth had p-value=0.546.
114
Conclusions: This study showed subjects who had fewer previously filled teeth reported statistically
significantly lower GOHAI scores in senior citizen patients presenting at TUSDM. There was insufficient
evidence that periodontal status was associated with the GOHAI score. No statistical significant evidence was
found to support an association between GOHAI and either number of decayed teeth or number of missing
teeth.
Presented at the 2015 IADR General Session in Boston. Abstract #1781.
Factors Contributing to Tooth Loss among the Elderly: A Cross Sectional Study
Zuhair Natto, Majdi Aladmawy, Mohammed Alasqah, and Athena Papas
Background: The present study evaluates the influence of several demographic, health, personal, and
clinical factors on the number of missing teeth in old-age samples.
Methods: The number of patients included was 259; they received a full mouth examination and answered
a questionnaire provided by one examiner. All the variables related to teeth loss based on the literature were
included. These variables focused on age, gender, race, marital status, clinical attachment level, pocket depth,
year of smoking, number of cigarettes smoked per day, number of medications, root decay, coronal decay, health
status, and year of education. Statistical analysis involved stepwise multivariate linear regression.
Results: Teeth loss was statistically associated with clinical attachment level (CAL) (p-value=0.0001),
pocket depth (PD) (0.0007) and education level (0.0048). When smoking was included in the model, age was
Student and Faculty Research Abstracts 2014 –2015
Geriatric Oral Research
significantly associated with teeth loss (0.0037). At least one of these four factors was also related to teeth loss
in several specific groups such as diabetes mellitus, male, and White. The multiple linear regressions for all the
proposed variables showed that they contributed to teeth loss by about 23%.
Conclusions: It can be concluded that less education or increased clinical attachment level loss may
increase number of missing teeth. Additionally, age may cause teeth loss in the presence of smoking.
Published in Singapore Dental Journal 35:17-22, Dec 2014.
Oral Implications of Polypharmacy in the Elderly
Mabi Singh and Athena Papas
One of the major side effects of medications prescribed to elderly patients is the qualitative and quantitative
alteration of saliva (salivary hypofunction). Saliva plays a pivotal role in the homeostasis of the oral cavity
because of its protective and functional properties, including facilitating speech, swallowing, enhancing taste,
buffering and neutralizing intrinsic and extrinsic acid, remineralizing teeth, maintaining the oral mucosal
health, preventing overgrowth of noxious microorganisms, and xerostomia. With salivary hypofunction, a
plethora of complications arise, resulting in decreased quality of life. The anticholinergic effects of medications
can be overcome, and the oral cavity can be restored to normalcy.
Published in Dent Clin North Am. 2014 Oct;58(4):783-96. doi: 10.1016/j.cden.2014.07.004. Epub 2014 Aug 5.
2014 –2015 Faculty Abstracts
Tufts University School of Dental Medicine
115
Implantology Research
Implantology Research
Histomorphometric Results in Ridge Preservation Procedures Comparing Various
Graft Materials in Extraction Sockets with Nongrafted Sockets in Humans:
A Systematic Review
Lucia Barallat,1 Vanessa Ruíz-Magaz,1 Paul Levi Jr.,2 Santiago Mareque-Bueno,1 Pablo Galindo-Moreno,3
and José Nart1
1International
University of Catalonia, Barcelona, Spain; 2Tufts University School of Dental Medicine, Boston;
3University of Granada, Granada, Spain
Introduction: The aim of this systematic review was to evaluate, from a histological point of view, the
amount of newly formed bone in ridge preservation procedures using various graft materials in comparison
with natural healing (NH) and to determine which is the ideal type of graft to be used.
Materials and Methods: A search strategy was developed to find articles in a human model published
between 1990 and January 2013 in English language using MEDLINE database.
2014 –2015 Faculty Abstracts
Results: Thirty-four articles were included in this systematic review. When comparing the percentage
of newly formed bone using various grafting materials with NH, calcium sulfate, magnesium enriched
hydroxyapatite, and porcine-derived bone grafts offered the best outcomes. However, due to the heterogeneity
of the included studies, the search was extended to determine which type of graft resulted in the greatest bone
formation.
116
Conclusion: When comparing ridge preservation with NH, only three studies encountered a greater
amount of newly formed bone in the ridge preservation group, whereas the rest did not find statistically
significant differences or even observed a greater percentage of newly formed bone in the control group.
Therefore, more studies are needed to determine whether the use of graft materials enhances new bone
formation in contrast to NH alone and to determine the most effective bone grafting material.
Published in Implant Dent. 2014 Oct;23(5):539-54.
Assessment of Atmospheric Pressure Plasma Treatment for Implant
Osseointegration
Natalie Danna,1 Bryan Beutel,1 Nick Tovar,1 Lukasz Witek,2 Charles Marin,3 Estevam Bonfante,3
Rodrigo Granato,3 Marcelo Suzuki,4 and Paulo Coelho1
1New
York University, New York, New York; 2Oklahoma State University, Stillwater, Oklahoma; 3University of São
Paulo Bauru College of Dentistry, Bauru, SP, Brazil; 4Tufts University School of Dental Medicine, Boston
This study assessed the osseointegrative effects of atmospheric pressure plasma (APP) surface treatment for
implants in a canine model. Control surfaces were untreated textured titanium (Ti) and calcium phosphate
(CaP). Experimental surfaces were their 80-second air-based APP-treated counterparts. Physicochemical
characterization was performed to assess topography, surface energy, and chemical composition. One implant
from each control and experimental group (four in total) was placed in one radius of each of the seven male
beagles for three weeks, and one implant from each group was placed in the contralateral radius for six weeks.
After sacrifice, bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) were assessed. X-ray
photoelectron spectroscopy showed decreased surface levels of carbon and increased Ti and oxygen, and
Student and Faculty Research Abstracts 2014 –2015
Implantology Research
calcium and oxygen, posttreatment for Ti and CaP surfaces, respectively. There was a significant (p<0.001)
increase in BIC for APP-treated textured Ti surfaces at six weeks but not at three weeks or for CaP surfaces.
There were no significant (p=0.57) differences for BAFO between treated and untreated surfaces for either
material at either time point. This suggests that air-based APP surface treatment may improve osseointegration
of textured Ti surfaces but not CaP surfaces. Studies optimizing APP parameters and applications are warranted.
Published in Biomed Res Int 2015;2015:761718. doi: 10.1155/2015/761718. Epub 2015 May 19.
Full Mouth Implant Rehabilitation with Staged Approach: Six-Year Clinical Follow-Up
Panos Papaspyridakos
Objective: The transition of patients from failing dentition to complete arch implant rehabilitation often
requires that the patient is rendered edentulous and has to wear a removable complete denture for varying
periods of time. In order to avoid removable provisionalization, the staged treatment approach allows for fixed
interim prosthesis throughout the rehabilitation process, patient comfort, and prosthodontic control.
Clinical Considerations: The purpose of this clinical report is to describe a combination of staged
approach with guided flapless surgery for minimally invasive treatment. The patient had fixed interim
prostheses during the entire rehabilitation process. The various implant prosthodontic stages are illustrated
for the complete arch prosthetic rehabilitation and the 6-year follow-up outcome is reported. A patient with
debilitated dentition was treated with this combined protocol and was followed for 6 years after definitive
prosthesis insertion.
Materials and Methods: A stone cast of an edentulous mandible with five implants was fabricated to
2014 –2015 Faculty Abstracts
Conclusion: Implant and prosthesis success rates were 100% with minor biologic and no technical
complications encountered up to 6-year recall. Guided surgery has the advantage of prosthetically driven
implant placement and minimal postoperative sequelae, whereas the staged approach allows for fixed
provisionalization throughout the entire treatment period.
Tufts University School of Dental Medicine
117
Clinical Significance: As the computer-guided surgery protocols continue to evolve and improve,
further clinical studies are necessary to assess accuracy and make this exciting technology even safer for the
average clinician. The clinical significance of this case report lies in the treatment sequence combined with
cutting edge technology for maximum patient comfort and prosthodontic control. Guided flapless surgery with
prosthodontically driven implant placement led to predictable rehabilitation with no major complications after
6 years. A staged approach with fixed interim prostheses was used throughout the entire rehabilitation period,
optimizing patient satisfaction and comfort. Natural canine guidance was the occlusal scheme of choice.
Published in J Esthet Restor Dent. 2015 Jul;27(4):213-23. doi: 10.1111/jerd.12158. Epub 2015 May 18.
Digital vs. Conventional Implant Impressions for Edentulous Patients:
Accuracy Outcomes
Panos Papaspyridakos, German Gallucci, Chun-Jung Chen, Stijn Hanssen, Ignace Naert, and
Bart Vandenberghe
Purpose: To compare the accuracy of digital and conventional impression techniques for completely
edentulous patients and to determine the effect of different variables on the accuracy outcomes.
Implantology Research
serve as master cast (control) for both implant- and abutment-level impressions. Digital impressions (N=10)
were taken with an intraoral optical scanner (TRIOS, 3shape, Denmark) after connecting polymer scan
bodies. For the conventional polyether impressions of the master cast, a splinted and a non-splinted technique
were used for implant-level and abutment-level impressions (4 cast groups, N=10 each). Master casts and
conventional impression casts were digitized with an extraoral high-resolution scanner (IScan D103i, Imetric,
Courgenay, Switzerland) to obtain digital volumes. Standard tessellation language (STL) datasets from the five
groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to
assess the 3D (global) deviations. To compare the master cast with digital and conventional impressions at the
implant level, analysis of variance (ANOVA) and Scheffe’s post hoc test was used, while Wilcoxon’s rank-sum
test was used for testing the difference between abutment-level conventional impressions.
Results: Significant 3D deviations (p<0.001) were found between group II (non-splinted, implant level) and
control. No significant differences were found between groups I (splinted, implant level), III (digital, implant
level), IV (splinted, abutment level), and V (non-splinted, abutment level) compared with the control. Implant
angulation up to 15° did not affect the 3D accuracy of implant impressions (p>0.001).
Conclusion: Digital implant impressions are as accurate as conventional implant impressions. The splinted,
implant-level impression technique is more accurate than the non-splinted one for completely edentulous
patients, whereas there was no difference in the accuracy at the abutment level. The implant angulation up to 15°
did not affect the accuracy of implant impressions.
Published in Clin Oral Implants Res. 2015 Feb 13. doi: 10.1111/clr.12567. [Epub ahead of print]
2014 –2015 Faculty Abstracts
A Retrospective Radiographic Study on the Effect of Natural Tooth/Implant Proximity
and an Introduction to the Concept of a Bone-Loading Platform Switch
118
Ranier Urdaneta, Rudolf Seemann, Irina Dragan, William Lubelski, Joseph Leary, and
Sung-Kiang Chuang
Purpose: To evaluate the effect of tooth/implant proximity using an implant system with a double platform
shift that was designed to load bone coronal to the implant abutment interface.
Material and Methods: A retrospective cohort study was conducted between January 2008 and
December 2009. The sample was composed of patients who had received at least one 5-mm wide HA coated
single-tooth Bicon implant that had been placed adjacent to at least one natural tooth. Descriptive statistics and
univariate and multivariate linear mixed-effects regression models adjusted for multiple implants in the same
patient were utilized. Primary predictor variable was the horizontal distance between implant and adjacent
tooth and the primary outcome variable was the change in peri-implant bone levels overtime.
Results: In the study, 206 subjects who received 235 plateau root form implants were followed for an average
of 42 months. Tooth/implant distance ranged between 0 to 14.6 mm. Out of 235 implants, 43 implants were
placed <1 mm to an adjacent natural tooth on mesial and/or distal sides. The proximity of a plateau root
form implant was not associated with complications on the adjacent tooth such as bone loss, root resorption,
endodontic treatment, pain, or extraction. The proximity of an adjacent tooth was not a risk factor for the failure
of a plateau root form implant. After adjusting for other covariates in a multivariate model, the proximity of a
natural tooth did not have a statistically significant effect in peri-implant bone levels (p=0.13). The extraction of
an adjacent tooth was associated with a significant increase in peri-implant bone loss (p=0.008).
Student and Faculty Research Abstracts 2014 –2015
Implantology Research
Conclusions: The placement of a plateau root form implant with a sloping shoulder in close proximity to
an adjacent tooth did not cause damage to that tooth or lead to bone loss or the failure of the implant.
Published in Int J Oral Maxillofac Implants. 2014 Nov–Dec;29(6):1412-24.
2014 –2015 Faculty Abstracts
Tufts University School of Dental Medicine
119
Mineralized Tissue
Mineralized Tissue
Epigenetically Modified BMSCs in Regenerating Dental and Craniofacial
Bone Tissues
Kyle Smith,* Jake Chen, Qisheng Tu, and Qianqian Han
Objectives: The purpose of this project is to understand PHD Finger Protein 8 (PHF8) regulating bone
growth in order to develop applications for use in regenerating bone tissue. In our project, we investigated PHF8
in order to understand how bone marrow stromal cells (BMSCs) are regulated for bone growth. In this study,
we hypothesized that PHF8 promotes osteoblastogenesis by epigenetically regulating the expression of SATB2.
Ultimately, it is our goal to develop epigenetically modified BMSCs, as they will be useful for in vivo applications
in bone regeneration.
2014 –2015 Faculty Abstracts
Methods: Our experimental design involved determining if the epigenetic enzyme PHF8 changed during
osteogenic differentiation. BMSCs were obtained from mice (4-week-old) and treated with an osteogenic
medium for 1, 3, 7, 10, 14 and 21 days. MC3T3-E1 cells (a preosteoblast) were also induced to differentiate
with an osteogenic medium. In order to determine if PHF8 could directly affect osteogenic differentiation,
we overexpressed and knockdowned PHF8 expression in MC3T3-E1 cells and BMSCs. Once the BMSCs and
MC3T3-E1 cells were treated, the expression of PHF8 and other bone markers were detected using real-time
PCR and Western blotting.
120
Results: Our results found that the expression of PHF8 and SATB2 increased in parallel during osteogenic
differentiation. Overexpression and knockdowned PHF8 were found to coincide with the expression of a variety
of osteogenic markers. Our findings indicated PHF8 overexpression could upregulate all bone marker genes
and knockdowned PHF8 using shRNA downregulated the expression of SATB2, OSX, Runx2, BSP and OC in
MC3T3-E1 cells and BMSCs.
Conclusions: Collectively, our results suggest that PHF8 enhances osteogenic differentiation by modulating
histone methylation states of SATB2 and converting its chromatin into an active transcriptional conformation.
We expect that epigenetic regulation of BMSCs during osteogenic differentiation will promote SATB2dependent activation and facilitate bone regeneration in tissue engineering.
Presented at the 2015 IADR General Session in Boston. Abstract #3866.
Adiponectin Regulates Bone Marrow Mesenchymal Stem Cell Niche through
A Unique Signal Transduction Pathway: An Approach for Treating Bone Disease
in Diabetes
Liming Yu, Qisheng Tu, Qianqian Han, Lan Zhang, Lei Sui, Leilei Zheng, Shu Meng, Yin Tang, Dongying Xuan,
Jin Zhang, Dana Murray, Q. Shen, Jessica Cheng, Sung-Hoon Kim, Lily Dong, Paloma Valverde, X. Cao, and
Jake Chen
Adiponectin (APN) is an adipocyte-secreted adipokine that exerts well-characterized antidiabetic properties.
Patients with type 2 diabetes (T2D) are characterized by reduced APN levels in circulation and impaired stem
cell and progenitor cell mobilization from the bone marrow for tissue repair and remodeling. In this study, we
found that APN regulates the mobilization and recruitment of bone marrow-derived mesenchymal stem cells
(BMSCs) to participate in tissue repair and regeneration. APN facilitated BMSCs migrating from the bone
marrow into the circulation to regenerate bone by regulating stromal cell-derived factor (SDF)-1 in a mouse
Student and Faculty Research Abstracts 2014 –2015
Mineralized Tissue
bone defect model. More importantly, we found that systemic APN infusion ameliorated diabetic mobilopathy
of BMSCs, lowered glucose concentration, and promoted bone regeneration in diet-induced obesity mice.
In vitro studies allowed us to identify Smad1/5/8 as a novel signaling mediator of APN receptor AdipoR1 in
BMSCs and osteoblasts. APN stimulation of MC3T3-E1 osteoblastic cells led to Smad1/5/8 phosphorylation
and nuclear localization and increased SDF-1 mRNA expression. Although APN-mediated phosphorylation of
Smad1/5/8 occurred independently from adaptor protein, phosphotyrosine interaction, pleckstrin homology
domain, and leucine zipper containing 1, it correlated with the disassembly of protein kinase casein kinase 2
and AdipoR1 in immunoprecipitation experiments. Taken together, this study identified APN as a regulator of
BMSCs migration in response to bone injury. Therefore, our findings suggest APN signaling could be a potential
therapeutic target to improve bone regeneration and homeostasis, especially in obese and T2D patients.
Published in Stem Cells. 2015 Jan;33(1):240-52. doi: 10.1002/stem.1844.
2014 –2015 Faculty Abstracts
Tufts University School of Dental Medicine
121
Neuroscience /TMJ/Pain
Neuroscience / TMJ/Pain
A New Electronic Diary Tool for Mapping and Tracking Spatial and Temporal Head
Pain Patterns in Migraine
Gabi Barmettler,1 Jennifer Brawn,2 Nasim Maleki,1 Steven Scrivani,3 Rami Burstein,4 Lino Becerra,1,6 and
David Borsook1,6
1Boston
Children’s Hospital, Harvard Medical School, Waltham, Massachusetts; 2University of Oxford, Oxford,
UK; 3Tufts University School of Dental Medicine, Boston; 4Tufts University School of Medicine, Boston; 5Beth
Israel Deaconess Medical Center, Boston; 6McLean Hospital, Harvard Medical School, Belmont, Massachusetts
Aim: We present an electronic tool for collecting data on the patterns of migraine headache onset and
progression.
Methods: A digitized map consisting of 44 color-coded segments was defined based on previous reports of
migraine pain and the distribution of nerves in the face, head, and neck. The map was overlaid on a schematic
map of the face, head, and neck nerves. Thirty-six patients (N=36, 28 female/8 male), who met ICDH-II criteria
for episodic migraine and had headaches for at least three years identified all regions where pain typically
started and how pain spread and subsequently progressed.
2014 –2015 Faculty Abstracts
Results: Consistent with previous findings, throbbing was the most prevalent quality of migraine pain,
always present in 70% of patients surveyed. For the 70% of the patients with throbbing pain, the temple was
the onset site of throbbing pain, with no significant difference in the laterality of onset site (58.3% on the right
vs. 55.6% on the left hemisphere). The tool was able to capture patterns of pain distribution for throbbing and
pressure headache pain and also may be used to assess the change in the pattern of the pain distribution as the
disease progresses.
122
Discussion: The pain map survey may be a useful tool for recording and tracking the temporal pattern of
migraine onset both for clinical and research purposes. The tool could be used to create maps of pain locations
on a large population scale and thus will be a very useful tool in correlating the temporal nature of headache
symptoms with potential mechanisms of disease evolution.
Published in Cephalalgia. 2015 Apr;35(5):417-25.
Safety and Efficacy of LY2951742, a Monoclonal Antibody to Calcitonin Gene-Related
Peptide, for the Prevention of Migraine: A Phase 2, Randomized, Double-Blind,
Placebo-Controlled Study
David Dodick,1 Peter Goadsby,2 Egilius Spierings,3 Joel Scherer,4 Steven Sweeney,5 and David Grayzel6
1Mayo
Clinic, Phoenix, Arizona; 2Kings College London, London, UK; 3Tufts University School of Dental Medicine;
4Eli Lilly and Company, Indianapolis, Indiana; 5Arteaus Therapeutics, Cambridge, Massachusetts
Background: Migraine remains poorly treated, with few effective preventive drugs available. We assessed
the safety and efficacy of LY2951742, a fully humanized monoclonal antibody to calcitonin gene-related peptide,
for migraine prevention.
Methods: We did a randomized, double-blind, placebo-controlled, phase 2 proof-of-concept study at 35
centers in the United States. Patients aged 18–65 years with 4 to 14 migraine headache days per month were
Student and Faculty Research Abstracts 2014 –2015
Neuroscience /TMJ/Pain
randomly assigned (1:1) to LY2951742 or placebo by a computerized randomization scheme. LY2951742 (150
mg) or placebo were given as a subcutaneous injection once every 2 weeks for 12 weeks. The primary endpoint
was the mean change in number of migraine headache days per 28-day period assessed at 9–12 weeks. Safety
was assessed over 24 weeks, including the 12-week treatment period and the subsequent 12 weeks after study
drug administration. Patients and treating investigators were masked to treatment allocation. Analyses were
by intention to treat. A mixed-effects model of repeated measures was used, including patient baseline value,
treatment, visit, and treatment-by-visit interaction as fixed effects, and patients as random effects. Safety
measures were analyzed according to the treatment received. This study has been completed and is registered
with ClinicalTrials.gov, NCT01625988.
Findings: Between July 31, 2012, and September 18, 2013, 218 patients were randomly assigned to
LY2951742 (N=108, but one patient withdrew before treatment) or placebo (N=110). The mean change
from baseline to week 12 in the number of migraine headache days was −4.2 (SD 3.1; 62.5% decrease) in the
LY2951742 group compared with −3.0 (SD 3.0; 42.3% decrease) in the placebo group (least-squares mean
difference −1.2, 90% CI −1.9 to −0.6; p=0.0030). Adverse events that occurred more frequently with LY2951742
than with placebo included injection site pain, erythema, or both (21 [20%] of 107 vs. 7 [6%] of 110), upper
respiratory tract infections (18 [17%] vs. 10 [9%]), and abdominal pain (6 [6%] vs. 3 [3%]). There were two
serious adverse events reported in the treatment arm and four in the placebo arm, none of which were deemed
to be related to the study drug.
Interpretation: These results provide preliminary evidence that LY2951742 might be beneficial in
migraine prevention and provide support for the role of calcitonin gene-related peptide in the pathogenesis of
migraine. Further controlled studies are needed to assess the safety and efficacy of monoclonal calcitonin generelated peptide antibodies for the preventive treatment of migraine.
Funding: Arteaus Therapeutics. Published in Lancet Neurol. 2014 Sep;13(9):885-92.
Egilius Spierings, Stephen Donoghue, Alec Mian, and Christian Wöber
Migraine is, to a great extent, a genetically determined disorder. Once it has manifested itself, it generally
continues for years if not for decades. While the migraine is active, headaches can seemingly occur
spontaneously but are often reportedly precipitated by events or factors, known as migraine triggers, the
interplay of which is the topic of this paper. Among migraine triggers, the menstrual cycle is an important one
that probably accounts for much of the excess of migraine in women compared with men. Much has also been
written about stress as a trigger of migraine, with headache occurring after rather than during stress, when
relaxation occurs. Stress is also 1 of the 4 most often acknowledged headache triggers in general, the others
being fatigue, not eating on time, and lack of sleep. Singularly, the triggers are generally necessary but not
sufficient, i.e., not powerful enough to bring on headache by themselves and, hence, compounding of those
triggers is usually required. There is evidence to suggest that the premenstrual phase has a magnifying effect on
the stress-headache interaction. The same is true for low-sleep duration with the (predictive) model fitting best
when stress and low-sleep duration are considered additive. Menstruation has been identified as possibly the
only absolute trigger of headache that is both necessary and sufficient. The scientific study of migraine triggers
requires knowledge not just of how often in an individual a trigger is followed by migraine headache but also
of how often it is not. Having identified trigger-headache associations, it needs to be determined which triggers
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Sufficiency and Necessity in Migraine: How Do We Figure Out If Triggers Are
Absolute or Partial and, If Partial, Additive or Potentiating?
123
Neuroscience /TMJ/Pain
are causative in the individual, either singly or in combination with others. This requires running an experiment
with the individual that involves behavioral intervention to change exposure to a given trigger and determine
whether that improves migraine. The ubiquitous adoption of the smart phone as a personal-data entry device,
along with the possibility of bringing the results of sophisticated statistical analysis into the hands of patients
and physicians, may well provide us with an important set of tools that will finally allow the unravelling of the
age-old migraine-trigger puzzle.
2014 –2015 Faculty Abstracts
Published in Curr Pain Headache Rep. 2014 Oct;18(10):455
124
Student and Faculty Research Abstracts 2014 –2015
Nutrition
Nutrition
Effect of Dried California Mission Figs on Mineral Status and Food Replacement
Heba Alshaeri, Zuhair Natto, Serena Tonstad, Ella Haddad, and Karen Jaceldo-Siegl
Objective: Figs are a rich source of several different minerals and fibers. We studied the effect of the
consumption of dried California Mission figs on mineral and nutrient levels, as well as the effect of the addition
of figs to a self-selected habitual diet on dietary patterns.
Design: A crossover randomized controlled trial study design in which participants with a mean of age
of approximately 56 years were randomly assigned to eat either their usual diet for 5 weeks or to add dried
California Mission figs (120 g/d) to their usual diet for 5 weeks, after which they crossed over to the other group
for an additional 5 weeks. Six 24 h dietary recalls and four blood samples were obtained from each participant.
Setting: Loma Linda University School of Public Health, Loma Linda, California.
Subjects: A follow-up study using data collected from eighty-eight American males and females from
September to December 2008.
Results: Diets reported in the 24 h dietary recall during the fig-supplemented diet period were significantly
higher in Ca and K in the dietary and total phase (p-value<0.05). Nevertheless, data on mineral levels in the
body gathered by means of biochemical analyses from blood samples were nearly the same for both the figsadded and the participants’ standard diet. The estimated displacement suggests that eating figs resulted in the
elimination of 4% of desserts, 5% of vegetables, 10% of dairy products, 23% of grain products and 168% of
beverages from other sources that participants would otherwise consume.
Published in Public Health Nutrition 18(6):1135-40, Apr 2015.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusions: Based on 24 h dietary recalls, the daily consumption of figs may increase the intake of several
different minerals. However, mineral levels in blood samples were not altered significantly.
125
Oral Health Research
Oral Health Research
Seal Away Caries Risk
Natalie Hagel and Dorothy Vannah
Since the first meta-analysis of clinical trials was conducted on the efficacy of sealants in 1993, a significant
body of evidence has demonstrated their ability to prevent pit and fissure caries in children, making them one
of the most successful preventive measures in dentistry. In the 1950s, Buonocore introduced the acid-etch
procedure, which laid the groundwork for the development of sealants as the best preventive agent against
pit and fissure caries. Placing a dental sealant on the chewing surfaces of a tooth with deep pits and fissures
protects it against food and bacterial plaque. The sealant works by creating a physical barrier separating the
tooth surface from the acids produced by plaque, which cause tooth decay. The acid-etch technique also is part
of the move toward a minimally invasive approach to restorative dentistry, which is based on preserving healthy
tooth structure through prevention, remineralization, and minimal intervention. Placement of dental sealants is
recommended depending on patients’ level of caries risk. The American Dental Association (ADA) Council on
Scientific Affairs recommends the placement of dental sealants on the primary and permanent teeth of children,
adolescents, and adults who are at increased risk of caries. The best predictors of caries risk are prior caries
experience, history of fluoride use, fissure anatomy, plaque load, and dietary habits. Sealants are most commonly
placed on the molars, which contain many pits and fissures. They also can aid in caries prevention when applied
to premolars. Research shows that a sealant must seal over the tooth’s occlusal surface—completely keeping
out fermentable food substrates—in order for it to be effective. Sealants can last up to 10 years, but oral health
professionals need to periodically check their status and replace them when necessary.
2014 –2015 Faculty Abstracts
Published in Dimensions in Dental Hygiene, June 2015.
126
Extended Efficacy of 1.5% Oxalate Strips on Dentinal Hypersensitivity
Britta Magnuson, Mabi Singh, Athena Papas, Elizabeth Tzavaras, Joseph Cimmino, Robert Gerlach, and
Melanie Miner
Objectives: Clinical research was conducted to assess the long-term effectiveness of 1.5% oxalate strips on
dentinal hypersensitivity.
Methods: A clinical study assessed durability of oxalate treatment of dentinal hypersensitivity with ad lib
oral hygiene. The target population was clinical trials subjects who received 1.5% oxalate gel strips (Crest® SensiStop™ Strips, The Procter & Gamble Co.). Test products were dispensed in blinded packaging for professional
administration 3x over a week plus regular hygiene for 1 month. Institutional review was obtained to recruit
subjects for a single additional post-study evaluation with up to 4 months of uncontrolled oral hygiene.
Sensitivity was evaluated clinically using cool air (1 sec) and cool water (single drop) stimuli applied directly
to test sites, graded by a clinical examiner using a standard 4-point scale (Schiff), and by each subject using a
pain-ranking scale (VAS) on a tablet-based application. Long-term safety was assessed by clinical examination.
Responses during uncontrolled monitoring were compared to baseline and post-treatment month 1 to assess
overall durability.
Results: A total of 41 subjects received 1.5% oxalate strips and provided informed consent for post-study
monitoring. Mean (SD) age was 47.2 (13.5), the population was diverse with respect to gender and ethnicity,
and the post-treatment evaluations ranged from 68 to 149 days after initial treatment. At the post-treatment
Student and Faculty Research Abstracts 2014 –2015
Oral Health Research
visit, oxalate strip users exhibited 81% and 91% reductions in air and water sensitivity, respectively, differing
significantly (p<0.004) from baseline. There was no evidence of a significant (p>0.18) sensitivity relapse with
extended ad lib oral hygiene. Generally similar outcomes were observed with subject-assessed pain, with VAS
continuing to differ significantly (p<0.002) for air and water after months of uncontrolled hygiene.
Conclusions: Clinical research demonstrated sensitivity benefits with 1.5% oxalate gel strips that were
durable for months after initial use and evident across different methods and stimuli.
Presented at the 2015 IADR General Session in Boston. Abstract #0995.
The Prevalence and Severity of Dental Caries in Chad: A Pilot Study
Zuhair Natto, Floyd Petersen, and Q. Niccola
Objective: This study was undertaken to determine the prevalence and severity of dental caries among a
cross section of a sample from different locations in Chad as part of a general assessment of their oral health
status.
Methods: A cross-sectional descriptive survey of a nationwide sample included volunteers, 10 years or
older, for a total of 1,011 participants. The survey consisted of a brief interview followed by a 1–2 minute oral
examination of each subject.
Results: The mean age of the participants was 29.61±12.59 years and the total mean value for decayed/
missing/filled teeth (DMFT)=1.96±1.78. Females had a higher mean DMFT (2.72±1.88); decayed (2.82±1.07);
missing teeth (1.81±1.14) than males (1.61±1.60): decayed (2.11±1.09); missing (1.45±0.89, respectively; all
p<0.001). The older group (>30 years) had higher DMFT (2.79±1.93) than the younger group (<30 years;
p<0.001). Urban area showed lower DMFT (1.81±1.68) than rural areas (2.31±1.95).
Published in Niger Postgrad Med J 21(3):241-4, Sep 2014.
The Oral Health Status and the Treatment Needs in Chad: A Pilot Study
Zuhair Natto, Floyd Petersen, and Q. Niccola
Aims and Objectives: This study was designed to evaluate dental conditions, factors contributing to
these conditions, and treatment needs among a population from different places in Chad, as part of a general
assessment of their oral health.
Patients and Methods: A cross-sectional nationwide survey was conducted with 1,011 participants. The
survey consisted of a brief health interview (conducted by dental students and public health specialists) followed
by a 1–2 minutes oral examination (conducted by dental students and dentists).
Results: Of the subjects, 64.0% had experienced dental pain, 66.7% had decayed teeth, and 56.6% had gum
diseases. Dental pain was found to be distributed according to age, gender, and locations (p<0.001). Only 25% of
the participants had ever visited a dentist. Males were shown to engage in more tobacco use than females (19.2%
vs. 0.3%), while females were more likely to have visited a dentist than males (30.8% vs. 22.8%). Brushing of
teeth occurred more often in urban than in rural locations (p<0.001), while date, sugar cane, and cola nut intake
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusion: In this study, the prevalence of dental caries is very low, which is similar to the most of the
African Saharan and sub-Saharan countries. However, there is need to establish caries control programs to
prevent tooth decay in the future and help people maintain lifelong dental health.
127
Oral Health Research
were statistically significant in the older generation compared to the younger subjects (p<0.001).
Conclusion: There was a significant need for dental treatment and care in the sample population. In
addition, the availability of sugar, combined with poor knowledge and lack of utilization of preventive and
restorative oral healthcare services, have contributed to several dental conditions.
Published in Niger Postgrad Med J. 21(3):245-9, Sep 2014.
Safety and Effectiveness of Two-Step Paste/Gel Sequence with
Medication Hyposalivation
Athena Papas,* Mabi Singh, Britta Magnuson, Elizabeth Tzavaras, Joseph Cimmino, Mary Kay Anastasia,
and Robert Gerlach
2014 –2015 Faculty Abstracts
Objectives: A randomized controlled trial was conducted to evaluate safety and effectiveness of a two-step
paste/gel oral hygiene sequence with reduced salivary flow.
128
Methods: Institutional review was obtained for the protocol, consent and advertising. The study targeted
adults with medication-associated hyposalivation to assess safety in this population. Eligible subjects
(medication history and ≤0.2 mL unstimulated saliva) were randomly assigned to one of two oral hygiene
groups: 1) two-step 0.454% SnF2 then 3% H2O2 paste and gel sequence (Crest® Pro-Health HD™) or 2) regular
0.76% NaMFP paste control (Colgate® Cavity Protection). Test products were dispensed with a regular manual
brush in blinded over-labeled kits for twice daily use with marketed instructions for use. Subjects were evaluated
at baseline and after 2 & 6 weeks of test product use. Safety was assessed as adverse events from clinical
examination and interview. Digital plaque image analysis of the anterior facial teeth measured fluoresceindisclosed daytime plaque levels, and unstimulated saliva was collected over a 5 minute period in pre-weighed
vials.
Results: Of the subjects, 49 ranging from 31 to 80 years of age (53% female) were enrolled, and 45 completed
week 6. Relative to baseline, only two-step paste and gel sequence differed significantly (p<0.005) from baseline
on daytime plaque coverage, and salivary flow increased significantly (p=0.033) in that group. Between-group
comparisons for daytime plaque favored the two-step sequence with 41–46% improvements in plaque control.
At week 6, adjusted daytime plaque means (SE) were 5.9 (0.7) and 10.0 (1.1) for the two-step and control
groups, respectively (p<0.004). Adverse events were mild in severity, groups differed significantly (p=0.02) on
occurrence, and events did not contribute to dropout.
Conclusion: In a randomized controlled trial, use of stannous fluoride plus hydrogen peroxide paste and
gel improved daily plaque control among individuals with medication-associated hyposalivation.
Presented at the 2015 IADR General Session in Boston. Abstract #3205.
Randomized Controlled Trial Evaluating Use of Oxalates for Dentinal Hypersensitivity
Mabi Singh, Athena Papas, Britta Magnuson, Elizabeth Tzavaras, Joseph Cimmino, Melanie Miner, and
Robert Gerlach
Objectives: A randomized positively-controlled trial was conducted to evaluate the durable effects of 1.5%
oxalate strips on dentinal hypersensitivity.
Methods: Informed consent and baseline measurements were obtained from adults with recession and air-
Student and Faculty Research Abstracts 2014 –2015
Oral Health Research
related dentinal hypersensitivity. Balancing for baseline air sensitivity and age, eligible subjects were randomly
assigned to one of two oxalate groups: commercial (the experimental group) or professional (the positive
control group). The experimental group received 1.5% oxalate gel strips (Crest® Sensi-Stop™ Strips, The Procter
& Gamble Co.), while the control group received a professional oxalate acid potassium salt solution (Super
Seal® Dental Desensitizing Liner, Phoenix Dental). Both oxalate products were professionally administered
at sensitive test sites following manufacturer’s instructions. Subjects received a blinded anticavity paste and
manual brush, 2 additional reapplication visits were scheduled over a 1-week period, and subjects returned
1-month later for evaluation. Sensitivity was evaluated before/after treatment with air (1-sec cool air) and water
(single drop of refrigerated water) stimuli. Sensitivity was measured after each stimulus by a clinical examiner
using a standard 4-point scale (Schiff), and by each subject using a pain-ranking scale (VAS) on a tablet-based
application, while safety was assessed by examination. Clinical evaluations were blind to assignment.
Results: The population (N=80) was diverse with respect to gender, ethnicity, and age (22–82 years).
Repeated treatment with both the commercial and professional oxalate treatments resulted in significant
(p<0.05) reductions in sensitivity for all stimuli and methods. At the 1-month post-treatment recall, the adjusted
mean (SE) Schiff air and water responses were 0.19 (0.05) and 0.07 (0.23) for the experimental group, compared
to 0.22 (0.06) and 0.06 (0.20) for the positive control. Groups did not differ significantly (p>0.61) on examiner
or self-graded air or water sensitivity.
Conclusions: In clinical research, a commercial oxalate strip and professional oxalate treatment
demonstrated similar reductions in dentinal hypersensitivity.
Presented at the 2015 IADR General Session in Boston. Abstract #0996.
Declining Treatment Clinical Trial to Assess Dentinal Hypersensitivity Relief
Objectives: This pilot clinical study used a novel design with declining treatment to assess dentinal
hypersensitivity relief with a professionally-administered desensitizing agent.
Methods: After institutional review, informed consent was obtained from adult volunteers with evidence of
dentinal hypersensitivity at recession test sites. Two stimuli were used to provoke sensitivity: 1-sec application
of cool air (~21°C, 40–60 psi) followed by a single drop of refrigerated (~2°C) water. Sensitivity was measured
after each stimulus by a trained clinical examiner using a standard 4-point scale (Schiff), while subjects used
a Visual Analog Scale. Sites with an air response (Schiff>1) received a marketed oxalate acid potassium salt
solution (Super Seal® Dental Desensitizing Liner, Phoenix Dental), while sites with an air response of 0 received
room temperature water as a negative control. Applications were identically blinded to subjects via professional
application of 1 or 2 drops of liquid at test sites with a cotton pellet for 30 sec and then gently air dried. Subjects
received a blinded anticavity paste and manual brush, 3 reapplication visits were scheduled over a 2-week
period, and subjects returned 1 month later for evaluation.
Results: Of the subjects, 17 (mean age=49.5 years, 65% male) were enrolled and completed the study. At
baseline, sensitivity means (SD) were 1.73 (0.65) for air, 1.90 (0.70) for water, and 52.2 (23.9) for VAS. Repeated
measures modeling demonstrated significant (p<0.002) reductions in sensitivity at first retreatment (visit 2). By
visit 4, sensitivity means (SD) were 0.31 (0.48) for air with 59% of subjects exhibiting no air sensitivity. Response
for water and air were generally similar, relief generally persisted at the 1-month recall, and treatment was welltolerated.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Mabi Singh, Athena Papas, Elizabeth Tzavaras, Matthew Barker, and Robert Gerlach
129
Oral Health Research
Conclusions: A novel declining treatment design demonstrated significant initial reductions in
hypersensitivity with a professionally applied oxalate solution with effects maintained for 1 month.
Presented at the 2015 IADR General Session in Boston. Abstract #0994.
Oral Medicine Referrals at a Hospital-Based Practice in the United States
Alessandro Villa,1 Shannon Stock,2 Ali Aboalela,1 Mark Lerman,3 Sook-Bin Woo,1 Stephen Sonis,1 and
Nathaniel Treister1
1Harvard
School of Dental Medicine, Boston; 2College of the Holy Cross, Worcester, Massachusetts; 3Tufts
University School of Dental Medicine, Boston
Objective: The objective of this study was to characterize the outpatient oral medicine (OM) clinic at
Brigham and Women’s Hospital (BWH), with particular emphasis on patient demographic characteristics and
referral patterns.
2014 –2015 Faculty Abstracts
Materials and Methods: A retrospective case record review of all initial consultations with OM experts
at BWH from 2008 to 2010 was conducted. Data included demographic information, type of medical insurance,
reason for referral, referring doctor’s specialty, and distance between the patient’s home and the referring doctor
as well as BWH, number of prior doctors seen for the presenting problem (per patient report), tests ordered at
the consultation visit, and clinical diagnoses.
130
Results: There were 1,043 new outpatient consultation visits. Patients lived a median distance of 9.5 miles
from the referring doctor and 18.9 miles from BWH and saw a median of one doctor (range 0 to 9) before
consultation. Two thirds of patients were referred by physicians. The most common diagnoses included
immune-mediated mucosal conditions (27.2%), orofacial pain disorders (25.1%), benign tumors or neoplasms
(10.3%), and dysplasia and cancerous conditions (7.6%). Biopsy was the most frequent test performed at
consultation.
Conclusions: Patients with oral conditions often see more than one doctor before being referred to an
OM expert and typically travel twice the distance to the expert compared with that between their home and the
referring doctor. Equal efforts should be made to increase awareness of the importance of the specialty of OM
among dentists, physicians, and the public.
Published in Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Apr;119(4):423-9. doi: 10.1016/
j.oooo.2015.01.003. Epub 2015 Jan 20.
Student and Faculty Research Abstracts 2014 –2015
Oral Surgery Research
Oral Surgery Research
Surgical Safety Checklist Use among Oral Surgeons in AAOMS Database
Andras Balint, Archana Viswanath, Maria Papageorge, Daniel Oreadi, Morton Rosenberg, and
William Gilmore
Objectives: Improving surgical safety has become a high priority in order to ensure patient safety. In 2008,
the WHO World Alliance for Patient Safety developed a Surgical Safety Checklist and published data on its
efficacy. The overall objective of this study is to determine the attitudes and prevalence of usage of ambulatory
oral and maxillofacial Surgery Safety checklist among oral surgeons.
Methods: Recruitment for the survey consisted of emailing 1,000 oral surgeons with a valid email address
published in the American Association of Oral and Maxillofacial Surgeons (AAOMS) directory. There was no
bias in subject selection since the email addresses were randomly selected by a person not involved in the study.
Qualtrics (survey tool of Tufts University) was used to facilitate the distribution and completion of surveys.
Results: A total of 110 oral surgeons responded to the survey. Of these, 94% were male; 82% were in private
practice, and only 37% reported using a checklist in their practice. Of the participants, 60% (N=66) reported
that they were not using a surgical safety checklist for ambulatory surgery; 93% reported that if provided they
would consider implementing a surgical safety checklist in their practice. Of oral surgeons, 26% reported that
they were not using a safety checklist in their practice although they reported that they were performing more
than 30 procedures a week.
Conclusions: Although not statistically significant, the majority of the oral surgeons who had completed
OMFS training more than 20 years ago reported not using a checklist in their practice.
Essentials of Airway Management, Oxygenation, and Ventilation:
Basic Equipment and Devices
Daniel Becker, Morton Rosenberg, and James Phero
Offices and outpatient dental facilities must be properly equipped with devices for airway management,
oxygenation, and ventilation. Optimizing patient safety using crisis resource management involves the entire
dental office team being familiar with airway rescue equipment. Basic equipment for oxygenation, ventilation,
and airway management is mandated in the majority of U.S. dental offices, per state regulations. The immediate
availability of this equipment is especially important during the administration of sedation and anesthesia,
as well as the treatment of medical urgencies/emergencies. This article reviews basic equipment and devices
essential in any dental practice, whether providing local anesthesia alone or in combination with procedural
sedation.
Published in J Mass Dent Soc. 2015 Spring; 64(1):22-5.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Presented at the 2015 IADR General Session in Boston. Abstract #1634.
131
Oral Surgery Research
Post Discharge Nausea and Vomiting following Third-Molar Extractions under
Ambulatory Anesthesia
Ray English III, Alireza Ashrafi, Sepideh Sabooree, Mina Boulos, and Archana Viswanath
2014 –2015 Faculty Abstracts
Background and Purpose: One of the most common ambulatory oral surgical procedures done today
is removal of third molar teeth. However, as with any other surgeries, there are complications associated with
oral surgeries. Post discharge nausea and vomiting (PDNV) is one of the complications commonly seen in
ambulatory surgeries. PDNV has a negative impact on patient recovery, and it would be beneficial to identify
the risk factors associated with this condition to improve quality of patient care. While the overall incidence
of PDNV after general anesthesia is well established to be about 25%, data on the incidence of PDNV after
ambulatory surgery patients are limited and conflicting. According to the study done by Apfel, et al., a PDNV
prediction model will help clinicians to better identify patients who might benefit from long-acting antiemetics
such as transdermal scopolamine, aprepitant, and/or palonosetron. Therefore, finding the incidence of PDNV
after third-molar extraction and developing a risk-factor model for this complication would not only allow the
oral surgeons to understand how to plan individualized treatment for patients, but it would also allow patients
to experience a more pleasant and quick recovery. The overall objective of this study is to report the incidence of
PDNV in patients undergoing third-molar extractions under ambulatory anesthesia and identify independent
risk factors.
132
Methods: This study was conducted in the Department of Oral Surgery at Tufts University School of Dental
Medicine. Following IRB approval and written informed consent, a total of 72 subjects were recruited for this
prospective study. All subjects between 15 and 60 years who underwent third-molar extractions under general
anesthesia were invited to participate in this study. Subjects were provided a questionnaire to be completed for a
week following surgery on a daily basis, in regards to development of PDNV and medication use. The following
risk factors were included in the analysis: demographics (age, gender, and race), history of motion sickness,
smoking status, time for the procedure, surgical extraction score, dose of anesthetic medications (Midazolam,
Fentanyl, Propofol, Decadron, Ketamine), and post-operative opioid and antibiotic usage. Fisher’s exact test was
performed to identify potential predictors for PDNV, and a p<0.05 was considered significant.
Results: A total of 41 out of 72 subjects completed and returned the questionnaire (demographics: age
23.29±5.3 years, 54.8% female, 45.2% male). Overall incidence of nausea was 51% and vomiting/retching was
12% during the first 48 hours post discharge. None of the predictors listed above were found to be significant
risk factors for PDNV (p<0.05) in this population.
Conclusions: The incidence and severity of PDNV after extraction of third molars under ambulatory
anesthesia may be substantially underestimated. Results of this study showed that a total of 51% of patients
developed nausea during the first 48 hours post discharge. However due to limited sample size this study failed
to identify independent risk factors for development of PDNV.
Accepted for presentation at the Third Annual ACOMS Resident meeting (November 8–9, 2014) at the Jefferson
Medical College in Philadelphia.
Student and Faculty Research Abstracts 2014 –2015
Oral Surgery Research
Efficacy of HemCon Dental Dressing in Reducing Postsurgical Complications
following Mandibular Third-Molar Extractions
Ross Fahey, Daniel Oreadi, Ghassan Darwish, and Archana Viswanath
Background and Purpose: The surgical removal of impacted mandibular third molars results in
tissue trauma, inflammation, and bleeding and is most often accompanied by moderate to severe pain. The
HemCon® Bandage is an FDA-cleared chitosan-based flat bandage that controls severe arterial bleeding from
traumatic injuries. HemCon dental dressing material (HemCon Medical Technologies, Inc., Portland, Oregon)
has an effect to improve the hemostasis and stabilize the clot in anti-coagulated patient. The dressings becomes
adherent when in contact with the oral wound environment and provides a protective layer. It provides a
physical barrier to protect the wound surface while reducing pain. In addition it has antibacterial property
that may aid in reducing the incidence of alveolar osteitis following third-molar extraction. The objective of
this study was to evaluate the efficacy of the HemCon Dental Dressing in reducing pain and swelling following
third-molar extractions. The hypothesis is that early control of bleeding will help to prevent or reduce the sequel
of post-surgical third-molar extraction complications.
Results: A total of 18 patients participated in the study (demographics: age 21±3.6 years, 52% female, 48%
male). Although the pain scores and swelling were lower for the HemCon treated sites, these scores were not
statistically significantly different than control-treated sites (p<0.05). There was no difference between surgical
healing between the HemCon-treated site and control site. There was no negative healing sequela associated
with early hemostasis of oral surgical wounds.
Conclusion: Previous studies have shown that HemCon is effective in controlling bleeding following teeth
extractions in subjects who are on oral anticoagulant therapy. Results from this study showed that there is no
significant difference between HemCon-treated side vs. controls in reducing post-operative pain and swelling.
We concluded that although HemCon dental dressing is safe to use in the oral cavity, it offers no additional
clinical benefit for normal healthy patients undergoing third-molar extractions.
Accepted for presentation at the Third Annual ACOMS Resident meeting (November 8–9, 2014) at the Jefferson
Medical College in Philadelphia.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Methods: Following IRB approval and written informed consent, subjects were enrolled in this prospective,
randomized, single-blinded, controlled, split mouth design clinical trial. This study was conducted at the
Department of Oral Surgery at Tufts University School of Dental Medicine. All subjects between 18 and 30
years for whom a decision had been made to extract symmetric bilateral bone-impacted mandibular third
molars (Pell and Gregory classification; class 1 B and class 2 A and B) were invited to participate in the study.
The primary end point of this study was post-operative pain and the secondary endpoints were post-operative
healing and swelling. The scores were analyzed by nonparametric t-tests (Wilcoxon signed rank test) to
determine whether statistically significant differences exist between the experimental and control specimens in
regards to both swelling and pain. The Mann-Whitney U test was used to assess differences that exist between
experimental groups in regards to wound healing.
133
Oral Surgery Research
Crestal Bone Resorption in Augmented Bone Using Mineralized Freeze-Dried Bone
Allograft or Pristine Bone during Submerged Implant Healing: A Prospective Study
in Humans
Hsiang-Yun Huang, Yumi Ogata, James Hanley, Matthew Finkelman, and Yong Hur
Background: There is limited evidence on the crestal bone level changes around implants placed in bone
augmented by guided bone regeneration (GBR) during submerged healing. The purpose of this study was to
prospectively compare radiographic crestal bone changes around implants placed in augmented bone with
changes around implants placed in pristine bone.
Materials and Methods: Patients receiving dental implants in the augmented or pristine mandibular
posterior edentulous ridge were included in the study. The digital standardized radiographs from the implant
placement procedure were compared to the radiographs from the second-stage procedure to evaluate the periimplant marginal bone level changes. The soft tissue thickness (ST), width of keratinized mucosa (wKM), and
early cover screw exposure (eIE) were measured at the time of the second-stage procedure.
Results: A total of 29 implants in 26 patients, 11 in augmented bone (test group) and 18 in pristine bone
(control group), were analyzed. The mean peri-implant bone loss (ΔBL) was 0.74±0.74 mm (mean±SD) in the
test group and 0.25±0.55 mm (mean±SD) in the control group. The differences between the test and control
groups in the mesial, distal, and mean peri-implant crestal bone level changes were statistically significant
(p=0.009, p=0.004, and p=0.001, respectively). The confounding factors (ST, wKM, and eIE) were adjusted.
2014 –2015 Faculty Abstracts
Conclusions: More peri-implant crestal bone loss during the submerged healing period was observed in
augmented bone than in pristine bone. Augmented bone may not exhibit the same characteristics as pristine
bone during the implant submerged healing period.
134
Published in Clin Oral Implants Res. 2014 Nov 10.
A Prospective Randomized Controlled Trial of Two Different Sedation Sequences for
Third-Molar Removal in Adults
Ruba Khader, Daniel Oreadi, Matthew Finkelman, Marcin Jarmoc, Sanjeet Chaudhary, Roman Schumann,
and Morton Rosenberg
Purpose: In oral and maxillofacial outpatient surgery, sedation techniques are an important component in
patient management for a wide variety of surgical procedures. Fentanyl and midazolam are commonly used
sedatives with different mechanisms of action and specific analgesic or amnestic properties. This study examined
whether the order of their administration would affect a patient’s pain perception or procedural vital signs.
Materials and Methods: After institutional review board approval and written informed consent,
a prospective, randomized, parallel-group clinical trial was conducted in patients who planned to undergo
removal of at least two third molars under intravenous moderate sedation. Patients were randomly assigned to
one of two groups. The fentanyl-first group received fentanyl and then midazolam; the midazolam-first group
received midazolam and then fentanyl. Recollection of the intraoperative pain score was assessed 24 hours after
surgery using the Wong-Baker FACES pain scale. The Mann-Whitney U test was used to assess for the presence
of a statistically significant difference between the two groups. Statistically significant differences in procedural
vital sign fluctuations were examined using the t-test. Patients’ satisfaction with the procedure was assessed and
intergroup comparisons were made.
Student and Faculty Research Abstracts 2014 –2015
Oral Surgery Research
Results: Sixty-six patients were enrolled, one of whom did not complete the study. Recollected procedural
pain scores at 24 hours after surgery were not statistically different between groups. Median scores on the
Wong-Baker FACES pain scale for the two groups were 2.0 (interquartile range, 3.1) for the fentanyl-first group
and 1.5 (interquartile range, 2.5) for the midazolam-first group (p=0.333). There was no statistical difference
in the change in vital signs from baseline to two surgical end points in the two groups. In addition, patient
satisfaction with the procedure did not statistically differ between the two groups.
Conclusions: In this study, selective sequencing of midazolam or fentanyl during an intravenous moderatesedation procedure did not result in a measurable difference of recollected procedural pain scores at 24 hours
after third-molar extraction. The choice of the sedation agents and the order of their administration should be
tailored to the patient’s needs, type of surgical procedure, and surgeon preference.
Published in J Oral Maxillofac Surg. 2015 Feb;73(2):224-31.
Biomechanical Evaluation of Different Systems, Locking and Conventional, for Fixing
Sagittal Osteotomy in Major Advances with or without Counterclockwise Rotation
Gustavo Batista Grolli Klein, Corey Decoteau, Harshiv Vyas, Paulo Domingos Ribeiro Jr., Maria Papageorge,
and Archana Viswanath
Purpose: The overall objective of this in vitro study was to assess the biomechanical stability of six different
osteosynthesis methods after sagittal split ramus osteotomy by simulating the masticatory forces and using a
3-point biomechanical test method.
Accepted for presentation at the ACOMS 36th Annual Scientific Conference and Exhibition, April 18-20, 2015 at
the Ritz-Carlton Fort Lauderdale, Florida.
2014 –2015 Faculty Abstracts
Method: Sixty polyurethane hemi-mandibles with bone-like consistency were randomly assigned to two
groups, each group containing six subdivisions (N=5), and subjected to sagittal split ramus osteotomy. After
10-mm advancement of the distal segment (group 1) and 10-mm advancement of the distal segment combined
with 20° counterclockwise rotation (group 2), the bone segments were fixed by different osteosynthesis methods
using 2.0-mm mini-plate/screw systems: subdivision A, one 4-hole conventional straight mini-plate; subdivision
B, one 4-hole locking straight mini-plate; subdivision C, two 4-hole conventional mini-plate; subdivision D, two
4-hole locking mini-plate; subdivision E, one 6-hole conventional sagittal mini-plate; subdivision F, one 6-hole
locking sagittal mini-plate. All models were mounted on a base especially constructed for this purpose. Using
a 3-point biomechanical test model, the hemi-mandibles were loaded in compressive strength in an Instron
machine (Norwood, Massachusetts) until a 3-mm displacement occurred between segments vertically or
horizontally.
Tufts University School of Dental Medicine
135
Results: In all cases, the fixations show better performance in advancement only, against advancement
combined with 20° counterclockwise rotation. The use of two straight mini-plates shows more resistant,
followed by sagittal mini-plates and one straight mini-plate in both groups. The main forces were respectively:
0.1059 KN, 0.0599 KN, 0.0443 KN in conventional system and 0.1271 KN, 0.0665 KN, 0.0535 KN in locking
system, for group 1. About group 2 the forces were respectively: 0.0930 KN, 0.0505 KN, 0.0330 KN in
conventional system, and 0.1103 KN, 0.0569 KN, 0.0411 KN in locking system.
Conclusions: The use of two mini-plates still remains as a form of fixation, on sagittal split osteotomy, with
the less displacement, even in even in large advancements with or without counterclockwise rotations.
Oral Surgery Research
Airway Assessment for Office Sedation/Anesthesia
Morton Rosenberg and James Phero
Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the
preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive
outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice
and focuses on predicting the success of advanced airway rescue techniques.
2014 –2015 Faculty Abstracts
Published in Anesth Prog. 2015 Summer;62(2):74-80; quiz 80-1.
136
Student and Faculty Research Abstracts 2014 –2015
Orthodontics
Orthodontics
An Active, Skeletally Anchored Transpalatal Appliance for Derotation, Distalization,
and Vertical Control of Maxillary First Molars
Jan Hourfar,1 Björn Ludwig,2 and Georgios Kanavakis3
1University
of Heidelberg, Germany; 2University of Homberg/Saar, Germany; 3Tufts University School of Dental
Medicine, Boston
Objective: The objective of this investigation was to evaluate treatment outcomes of the skeletally anchored
Frog appliance.
Design: A single-center, retrospective study was performed.
Setting: Private orthodontic practice.
Participants: Patients who had undergone comprehensive orthodontic treatment with the skeletally
anchored Frog appliance.
Methods: In the study, 43 participants (20 males and 23 females) who had received treatment with the
skeletally anchored Frog appliance were included. In order to explore dentoalveolar and skeletal treatment
outcomes, pre- (T1) and post- (T2) treatment measurements were performed on patients’ plaster models and
cephalometric images. Comparisons between T1 and T2 were made by means of a student’s t-test. All statistical
analyses were conducted at the 0.05 level of statistical significance.
Methods: Orthodontic records of 100 subjects were reviewed. Crown to root angulations of all lateral
incisors were measured manually on the final panoramic radiographs. Also, three experienced orthodontists
were asked to visually inspect the morphology of the lateral incisors on the panoramic radiographs. A mixed
model was used to test the difference in crown to root angulation of the lateral incisor between the experimental
and the control group. The association between the examiners’ observations and the presence of a canine
2014 –2015 Faculty Abstracts
Results: Study model analysis revealed a statistically significant derotation of maxillary molars
(μΔ(T2–T1)= 9.5°, p<0.001) as well as an increase in transverse arch dimensions at the end of treatment
(μΔ(T2–T1)= 2.2 mm, p<0.001). Cephalometric changes included bodily distalization of maxillary molars
(μΔ(T2–T1)= −1.9 mm, p<0.001), as well as noticeable angular displacement (μΔ(T2–T1)= 4.1°, p = 0.004). No
significant anchorage loss was observed, as displayed by the limited change in maxillary incisor position
(μΔ(T1–T2)= 0.2 mm, p= 0.45). In addition, excellent vertical control of the maxillary molars was achieved,
with no change in the mandibular plane (ML/NSL) angle (μΔ(T2–T1)= 0.3°, p = 0.38).
Tufts University School of Dental Medicine
137
Conclusions: The skeletal Frog is effective in derotating and distalizing maxillary molars without
anchorage loss and with excellent vertical control.
Published in J Orthod. 2014 Sep;41 Suppl 1:S24-32.
Morphology of Lateral Incisor Adjacent to Palatally Impacted Canines
Georgios Kanavakis,* Moonyoung Lee, and Sreedevi Srinivasan
Objectives: To explore differences in crown to root angulation between lateral incisors adjacent to palatally
impacted canines (PIC) and lateral incisors adjacent to normally erupted canines (NC).
Orthodontics
impaction was assessed by means of a chi-square test. All analyses were performed at the 0.05 level of statistical
significance.
Results: A significant (p=0.009) difference of 2.3 degrees in crown to root angulation was found between
groups. Also, 66.7% of the lateral incisors that were identified as “abnormal” by the panel of orthodontists were
adjacent to a PIC; 65.2% of lateral incisors that were identified as “normal” were located adjacent to NECs.
Conclusions: The root of lateral incisors adjacent to PICs is angulated more mesially compared to lateral
incisors adjacent to NECs. In addition, clinicians are somewhat able to predict if a canine is palatally impacted
by visually observing the crown to root angulation of the adjacent lateral incisor. Evaluating the crown to
root angulation of a lateral incisor on a panoramic image might facilitate early diagnosis of palatally impacted
canines.
Presented at the 2015 IADR General Session in Boston. Abstract #3826.
Clinical Outcomes of Cases with Missing Lateral Incisors Treated with the
“T”-Mesialslider
Georgios Kanavakis,1 Björn Ludwig,2 Marco Rosa,3 Bjorn Zachrisson,4 and Jan Hourfar5
University School of Dental Medicine, Boston; 2University of Homburg/Saar, Germany; 3Insubria University,
Varese, Italy; 4University of Oslo, Oslo, Norway; 5University of Heidelberg, Germany
2014 –2015 Faculty Abstracts
1Tufts
138
The objective of this article is to review the fabrication and activation procedures of the “T”-Mesialslider and to
present the clinical outcomes in cases where canine substitution is the treatment of choice for missing maxillary
lateral incisors. The “T”-Mesialslider allows for effective mesial translation of the canines and the posterior
dentition, without significant loss of anterior anchorage and with good vertical control. Possible adverse effects
of the appliance and clinical recommendations for their management are also discussed. In canine substitution
cases with high anchorage demands, the “T”-Mesialslider provides an effective treatment option.
Published in J Orthod. 2014 Sep;41 Suppl 1:S33-8
Comparison of Shear Bond Strength, Excess Adhesive Flash, and Bonding Time of
Two Flash-Free Bonding Techniques
Moonyoung Lee and Georgios Kanavakis
Objectives: Excess adhesive flash (EAF) around brackets can contribute to the development of white spot
lesions and lengthen the bonding process. To minimize EAF, flash-free bonding systems have been developed.
In this study, the efficiency of two systems—APC™ Flash-Free Adhesive Coated System and the Manual FlashFree Bonding System—were compared in terms of (1) the time to bond a bracket, (2) the amount of EAF
around the bracket after bonding (mm2), (3) the shear bond strength, and (4) the adhesive residue index (ARI).
Methods: Extracted human maxillary premolar teeth were used for this in vitro study. The teeth were cleaned
with pumice, etched with Transbond Plus Self-Etching Primer (3M Unitek), and divided into three groups (12
teeth per group): group 1—brackets bonded using pre-pasted APC™ Flash-Free Adhesive Coated System and
no flash was removed; group 2—brackets bonded using Transbonx XT Light Cure Adhesive Paste in which the
adhesive was manually placed on the bracket base and no flash was removed; and group 3—control group—3M
APC PLUS pre-pasted brackets bonded and the extruded flash was removed. Bonding time was measured using
a stopwatch (seconds). The EAF was measured using an 8X digital microscope. Bond strength was measured
Student and Faculty Research Abstracts 2014 –2015
Orthodontics
using an Instron that applied a gingivo-occlusal load at a crosshead speed of 1 mm/min. The ARI was evaluated
according to the methods of Bishara and Trulove on a scale from 1 to 5. Repeated measures ANOVA and posthoc Tukey tests were used for statistical analysis.
Results: It took significantly (p<0.001) less time to bond in the APC Flash-Free group (mean, 30.7±3.3 s)
compared to the control group (mean, 41.8±4.0 s) and the manual flash-free group (mean, 39.2±2.8 s). The APC
Flash-Free bracket had significantly (p<0.001) greater shear bond strength (mean, 13.7±2.2 MPa) compared
to the control group (mean, 10.8±2.0 MPa) and the manual flash-free group (mean, 10.4±1.4 MPa). The ARI
was significantly (p<0.001) greater with the APC Flash-Free bracket compared to that of the other two groups.
Because the magnification of the 8X digital microscope was found to be inadequate, the EAF was not measured.
Conclusions: Compared to other methods of bonding, the APC™ Flash-Free Adhesive Coated System can
potentially reduce bonding time while increasing shear bond strength.
Presented at the 2015 IADR General Session in Boston. Abstract #0807.
Newly Defined Landmarks for a Three-Dimensionally Based Cephalometric Analysis:
A Retrospective Cone-Beam Computed Tomography Scan Review
Moonyoung Lee, Georgios Kanavakis, and R. Matthew Miner
Objectives: To identify two novel three-dimensional (3D) cephalometric landmarks and create a novel
three-dimensionally based anteroposterior skeletal measurement that can be compared with traditional twodimensional (2D) cephalometric measurements in patients with Class I and Class II skeletal patterns.
Results: The M measurement, ANB, and APDI could statistically differentiate between patients with Class I
and Class II skeletal patterns (p<0.001). The M measurement exhibited a correlation coefficient (r) of −0.79 and
0.88 with APDI and ANB, respectively.
Conclusions: The overall centroid landmarks and the M measurement combine 2D and 3D methods of
imaging; the measurement itself can distinguish between patients with Class I and Class II skeletal patterns
and can serve as a potential substitute for ANB and APDI. The new three-dimensionally based landmarks and
measurements are reliable, and there is great potential for future use of 3D analyses for diagnosis and research.
Published in Angle Orthod. 2015 Jan;85(1):3-10.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Materials and Methods: Full head cone-beam computed tomography (CBCT) scans of 100 patients
with all first molars in occlusion were obtained from a private practice. InvivoDental 3D (version 5.1.6,
Anatomage, San Jose, California) was used to analyze the CBCT scans in the sagittal and axial planes to create
new landmarks and a linear 3D analysis (M measurement) based on maxillary and mandibular centroids.
Independent samples t-test was used to compare the mean M measurement to traditional 2D cephalometric
measurements, ANB and APDI. Interexaminer and intraexaminer reliability were evaluated using 2D and 3D
scatterplots.
139
Orthodontics
Interlot Variations of Transition Temperature Range and Force Delivery in CopperNickel-Titanium Orthodontic Wires
Renée Pompei-Reynolds and Georgios Kanavakis
Introduction: The manufacturing process for copper-nickel-titanium archwires is technique sensitive.
The primary aim of this investigation was to examine the interlot consistency of the mechanical properties of
copper-nickel-titanium wires from two manufacturers.
Methods: Wires of two sizes (0.016 and 0.016 × 0.022 in) and three advertised austenite finish temperatures
(27°C, 35°C, and 40°C) from two manufacturers were tested for transition temperature ranges and force delivery
using differential scanning calorimetry and the 3-point bend test, respectively. Variations of these properties
were analyzed for statistical significance by calculating the F statistic for equality of variances for transition
temperature and force delivery in each group of wires. All statistical analyses were performed at the 0.05 level of
significance.
Results: Statistically significant interlot variations in austenite finish were found for the 0.016 in/27°C
(p=0.041) and 0.016 × 0.022 in/35°C (p=0.048) wire categories, and in austenite start for the 0.016 × 0.022
in/35°C wire category (p=0.01). In addition, significant variations in force delivery were found between the two
manufacturers for the 0.016 in/27°C (p=0.002), 0.016 in/35.0°C (p=0.049), and 0.016 × 0.022 in/35°C (p=0.031)
wires.
2014 –2015 Faculty Abstracts
Conclusions: Orthodontic wires of the same material, dimension, and manufacturer but from different
production lots do not always have similar mechanical properties. Clinicians should be aware that coppernickel-titanium wires might not always deliver the expected force, even when they come from the same
manufacturer, because of interlot variations in the performance of the material.
140
Published in Am J Orthod Dentofacial Orthop. 2014 Aug;146(2):215-26.
Surgeon Agreement/Bias When Evaluating Lip Surgery Outcomes in CL/P Patients
Carroll Trotman, Jing Yu, Ceib Phillips, and Gary Kotch
Objectives: A systematic evaluation approach to quantify circumoral (lip) disability in patients with cleft
lip/palate (CL/P) combining (1) a subjective evaluation of still photographs of patients (STILLS) and (2) a
dynamic 3D objective/statistical modeling of facial movements (OD3DM) was developed. Previous studies
demonstrated that when surgeons used this method, they changed their treatment plans for lip revision surgery.
As a follow up, we sought to determine the agreement and bias among surgeons for each component of this
approach—STILLS versus OD3DM.
Methods: The sample consisted of 21 children with repaired CL/P who had lip revision surgery and five
surgeons experienced in cleft care. For each patient, each surgeon viewed the pre-surgery and post-surgery
STILL photographs side-by-side, and then repeated the process with the OD3DM animations. Surgeons were
asked whether the patient had a change in facial appearance after viewing the STILLS, and then after viewing
the OD3DM. “A change” was coded as “E” and “no change” as “N.” Inter-method and inter-observer agreement
was measured using Kappa coefficients, ICC, and generalized correlation coefficients. Inter-method and interrater bias was examined using Mantel-Haenszel methods and McNemars tests.
Results: There was highly significant inter-observer bias among the surgeons (p<0.004) for both methods.
The inter-method bias was small but significant for one surgeon who assigned more “E”s with the OD3DM
Student and Faculty Research Abstracts 2014 –2015
Orthodontics
versus more “N”s with the STILLS. The agreement between the two methods was moderate (Kappa=0.480,
[95% CI, 0.194–0.766]). The inter-observer agreement was poor although slightly better with the STILLS
(Kappa=0.224, [95% CI, 0.105–0.455]) than the OD3DMD (Kappa=0.072, [95% CI, 0.162–0.259]).
Conclusions: (1) With both the STILLS and OD3DMD, surgeons exhibited bias in their judgments that
had a negative impact on their agreement patterns. (2) The lack of high agreement between the two methods
would be expected since they measure different attributes: facial form versus movement.
Presented at the 2015 IADR General Session in Boston. Abstract #1243.
2014 –2015 Faculty Abstracts
Tufts University School of Dental Medicine
141
Pediatric Dentistry Research
Pediatric Dentistry Research
Efficiency and Patient Satisfaction with the Isolite System vs. Rubber Dam for
Sealant Placement in Pediatric Patients
Muhanad Alhareky, Danya Mermelstein, Matthew Finkelman, Jehan Alhumaid, and Cheen Loo
Purpose: The purpose of this clinical study was to compare the chair time and degree of patient satisfaction
after use of the Isolite system (IS) versus rubber dam (RD) during the application of pit and fissure sealants.
Methods: The patients included in this study ranged from 7 to 16 years old. In each subject, pit and fissure
sealants were applied to one permanent molar in each quadrant. IS dental isolation was used on one side; RD
isolation was used on the other side. Chair time was assessed using a stopwatch, and patient acceptance was
evaluated using a questionnaire.
Results: Forty-two subjects (23 females and 19 males) were enrolled in the study. The average chair time was
19.36 minutes for the application of pit and fissure sealants on the RD side; average chair time was 10 minutes
for the IS side (p<0.001). Sixty-nine percent of the subjects were more comfortable using IS, while 31 percent
found RD to be more comfortable (p=0.02).
Conclusion: Isolite is a viable alternative to the conventional rubber dam. The use of Isolite is associated
with reduced chair time and greater patient satisfaction.
Published in Pediatr Dent 2014 Sep–Oct;36(5):400-4.
2014 –2015 Faculty Abstracts
Post-traumatic Apexogenesis of an Immature Maxillary Central Incisor:
A Case Report
Sonia Arevalo, Cheen Loo, and Mohammad Hassan
The treatment of pulpal injury in an immature apex often presents a challenge for the clinicians. Apexification
and apexogenesis are the indispensable treatment choices for teeth with open apices. This case report presents
the treatment for an 8-year-old Hispanic male that presented to clinic for treatment of a right central maxillary
incisor previously traumatized. This case was managed with apexogenesis as a primary mode before considering
apexification. The endodontic therapy consisted of periodical changes of calcium hydroxide dressing and a
definitive root canal filling with mineral trioxide aggregate (MTA). Shortly after endodontic treatment had been
completed, the tooth suffered repeated trauma. During the emergency dental visit, the tooth was avulsed and
immediately replanted. Tooth was splinted for 4 weeks. Post-operative follow up has been done up to 4 months
with mild to no root resorption.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015
Anterior Crossbite Correction in Mixed Dentition: A Case Report
Ammar Asali and Marjan Askari
Anterior crossbite is one the most common malocclusion forms seen in mixed dentition. Multiple different
modalities have been described in the literature. This report describes anterior crossbite in a 9-year-old female
and its correction using a fixed functional appliance along with protraction facemask therapy.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015
142
Student and Faculty Research Abstracts 2014 –2015
Pediatric Dentistry Research
Full Mouth Rehabilitation for a Von Willebrand Disease Patient under General
Anesthesia: A Case Report
Ammar Asali and Cheen Loo
This report describes Von Willebrand (VWD) disease and its dental management for a 3-year-old with severe
early childhood caries (S-ECC). VWD can cause bleeding complications if not managed. Treatment depends on
type and severity of defect. Successful delivery of quality care requires proper knowledge and communication
between the physician and treating dentist. Presented is a case of type 2 VWD managed in the operating room
following hematologist’s recommendations utilizing multiple medications.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Effect of DentalVibe in Pain Perception during the Administration of Local Anesthetic
in Pediatric Dental Patients
Jason Ching, C. Brambila, Cheen Loo, Alfred Rich, and Angel Park
Purpose: The purpose of this study is to measure and compare pain reactions in subjects, 4–10 years old,
during administration of dental local anesthesia with and without the use of the DentalVibe Injection Comfort
System. Hypothesis: Pain reaction of anesthesia with and without DentalVibe will be measured using The
Wong Baker Pain Scale. The primary hypothesis is that the pain score from the procedure that had anesthesia
administration with DentalVibe will be lower than the pain score from the procedure that only used anesthesia
in children aged 4–10. Secondary is that anxiety will have positive correlation with pain scale rating.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Osama Felemban, Jennifer Bassett Midle, Cheen Loo, and Aruna Ramesh
Purpose: The purpose of this in vitro study is to evaluate the diagnostic efficacy of cone beam computed
tomography (CBCT) and extraoral bitewings in detection of interproximal caries and determining the depth of
carious lesions compared to intraoral bitewings.
Methods: Cadaver heads with 70 posterior teeth were radiographically imaged with i-CAT CBCT, ProMax
3D CBCT, ProMax (extraoral bitewings), and intraoral digital bitewings. The teeth were then extracted and
sectioned for histological evaluation under the microscope. Six pediatric dentistry residents evaluated each
proximal surface. Inter-observer agreement, sensitivity, and specificity were calculated. ROC curves were
analyzed using ANOVA test.
Results: Preliminary results from 40 teeth showed that 51.9% of the proximal surfaces were sound and 48.1%
were carious. Statistical analysis will be carried out after the completion of the data collection and resident
observation.
Conclusion: Statistical analysis will be carried out after the completion of the data collection and resident
observation.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
The Efficacy of CBCT and Extraoral Bitewings in Detection of Interproximal Caries
143
Pediatric Dentistry Research
Interceptive Orthodontic Treatment with Habit Breaking Appliance: A Case Report
David Juhn, Cheen Loo, and Marjan Askari
Management and treatment of crossbites and oral habits are important in a developing dentition. Management
includes recognizing and diagnosing each individual patient independently and providing necessary treatment.
AAPD guidelines defines crossbites as any abnormal buccal-lingual relation between opposing incisors,
molars, or premolars in the centric relations. Crossbites can be further categorized as dental, skeletal, or a
combination of both. Oral habits such as nonnutritive sucking, bruxing, tongue thrust swallow, and abnormal
tongue position may change teeth and dentoalveolar structures. These changes may include increased overjet,
reduced overbite, posterior crossbite, or long facial height. A case report of thumb sucking habit associated with
posterior crossbite is presented and treated using a quad-helix with palatal crib appliance.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Effectiveness of an Oral Health Education Program for Obstetrician/Gynecologist
Residents at Tufts Medical Center
Lily Parsi, Matthew Finkelman, Devina Shah, E. Kim, Alfred Rich, and Cheen Loo
2014 –2015 Faculty Abstracts
Purpose: The purpose of the study was to assess obstetrician/gynecologist (OB/GYN) residents’ knowledge
and training in oral health and the effectiveness of an educational program for OB/GYN residents at Tufts
Medical Center. An informational seminar session on oral health was used to determine how beneficial such
training would be in improving OB/GYN residents’ dental knowledge.
144
Methods: A pre-post test design with a three-month follow-up was used to evaluate the effectiveness of
a seminar session given to OB/GYN residents at Tufts Medical Center. Knowledge-based and belief-based
questions were used to determine the level of knowledge of oral health.
Results: Preliminary results of 26 subjects: Subjects participated in oral health awareness sessions and
completed the questionnaire. The mean age of participants was 29 years old. Results via the General Estimating
Equation Model show that for the knowledge-based questions the subject has 4.33 times the likelihood of
getting an additional question correct when comparing the pre- and post-test results (p<0.001). The subject
is 3.18 times more likely of getting one additional question correct between the scores on the pre-test and the
3-month follow-up (p<0.001). In regards to the belief-based questions, results displayed trends towards a more
favorable attitude overall towards conducting an oral exam during routine obstetric visits and becoming more
up-to-date on oral health issues after the seminar.
Conclusions: Pregnancy affords a unique opportunity to educate women on the importance of oral
health. The preliminary results showed that there is a benefit to an oral health educational session for OB/
GYN residents at Tufts Medical Center. Thereby, a similar training module can be brought to other OB/GYN
residencies and OB/GYNs in an effort to enhance the symbiotic relationship between the medical and dental
professions.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Student and Faculty Research Abstracts 2014 –2015
Pediatric Dentistry Research
Effectiveness of Oral Health Education for Pediatric Nurse Practitioner Students at
Northeastern University
John Stark, Matthew Finkelman, Alfred Rich, M. Dolce, L. Malone, and Cheen Loo
Purpose: The purpose of this study was to compare the effectiveness of an educational program for pediatric
nurse-practitioner students at Northeastern University in oral hygiene, nutritional counseling, disease
prevention, and knowledge in dental emergencies.
Methods: All subjects completed a questionnaire containing pre- and post-seminar questions to analyze
effectiveness of the oral health education program. Results were compared with a 3-month follow-up survey that
was completed by the same subjects and returned via email.
Results: Of the subjects, 24 participated in three oral health awareness sessions and completed the
questionnaire. Preliminary results suggest that for knowledge-based questions, there was an increase in scores
between the pre- and post-tests. Statistical analysis will be carried out after the completion of the 3-month
follow-up survey and subsequent data collection.
Conclusion: Interprofessional education programs provide a unique opportunity to reinforce the
importance of oral health and broaden the reach of oral healthcare. The study showed that there is a significant
benefit to an oral health educational session for PNPs at Northeastern University. Thereby, a similar training
module can be provided to other health professionals for similar benefits.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Dental Externship and Influential Factors on Future Pediatric Care
Sage Yoo, Cheen Loo, Matthew Finkelman, Alfred Rich, and Wanda Wright
Method: A survey will administer to a pre-doctoral class of 2015 (N=179). Students will be surveyed after
they have completed their CSLE. The survey consists of questions about expectation from CSLE, preference of
working with adult or pediatric patients prior and post CSLE, primary concern in treating pediatric patients,
and what additional training would help more with treating pediatric patients. Hypothesis testing will be
conducted using the one-sample t-test. Categorical data will be tested using chi-square test for association.
Result: Data collections are still in progress. Statistical analysis will be carried out upon completion of the
data collection.
Conclusion: Data collections are still in progress. Statistical analysis will be carried out upon completion of
the data collection.
Presented at the American Academy of Pediatric Dentistry’s 68th Annual Session, Seattle, May 21–24, 2015.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Purpose: The object of this study was to determine if experiences outside of a school clinic affects the
attitudes of pre-doctoral students toward managing the oral health problems of pediatric population.
145
Periodontal Research
Periodontal Research
Impact of Patient Compliance on Tooth Loss during Supportive Periodontal Therapy:
A Systematic Review and Meta-analysis
C.T. Lee,1 H.Y. Huang,2 Teresa Sun,3 and Nadeem Karimbux3
School of Dental Medicine, Boston; 2School of Dentistry, National Defense Medical Center, Taipei,
Taiwan; 3Tufts University School of Dental Medicine, Boston
2014 –2015 Faculty Abstracts
1Harvard
146
Periodontal treatment consists of active periodontal therapy (APT) and supportive periodontal therapy (SPT).
Regular SPT is recommended to prevent and control the occurrence of periodontal disease following APT. A
patient’s compliance with SPT is considered one of the most important factors affecting long-term periodontal
status. Tooth loss is generally considered the final outcome of periodontitis. This review aimed to analyze the
relationship between patient compliance with regular SPT and tooth loss. The PRISMA (Preferred Reporting
Items for Systematic Reviews and Meta-Analyses) guideline for systematic reviews was used. A search of articles
was conducted using MEDLINE (PubMed) and other databases. Quality assessments of selected studies were
performed. To assess the effect of compliance on tooth loss during SPT, pooled risk ratio of tooth loss (RRTL)
was used as the primary outcome. Pooled risk difference of tooth loss (RDTL) and weighted mean difference
of tooth loss rate (WDTLR) were used as secondary outcomes. Subgroup analysis and meta-regression were
conducted to evaluate the effects of different variables. In total, 710 articles were screened. Eight studies, which
had a regular-compliance (RC) group and an erratic-compliance (EC) group with at least a 5-y follow-up
period, qualified for the meta-analysis. The risk of tooth loss in the RC group was significantly lower than that in
the EC group (pooled RRTL: 0.56 [confidence interval (CI): 0.38, 0.82]; pooled RDTL: −0.05 [CI: −0.08, −0.01]).
The definition of compliance was a variable significantly related to risk ratio of tooth loss. Patients in the RC
group had significantly lower tooth loss rate during SPT than did patients in the EC group (WDTLR: −0.12
[CI: −0.19, −0.05]). Teeth have less risk of being lost if patients are more compliant with supportive periodontal
therapy. However, unidentified variables causing data heterogeneity and affecting the risk of tooth loss may have
been present. More well-controlled prospective studies are needed in the future.
Published in J Dent Res. 2015 Jun;94(6):777-786. Epub 2015 Mar 27.
Is There a Relationship between Periodontal Disease and Causes of Death?
A Cross Sectional Study
Zuhair Natto, Majdi Aladmawy, Mohammed Alasqah, and Athena Papas
The aim of this study was to evaluate whether there is any correlation between periodontal disease and mortality
contributing factors, such as cardiovascular disease and diabetes mellitus in the elderly population. A dental
evaluation was performed by a single examiner at Tufts University dental clinics for 284 patients. Periodontal
assessments were performed by probing with a manual UNC-15 periodontal probe to measure pocket depth
and clinical attachment level (CAL) at six sites. Causes of death was abstracted from death certificate. Statistical
analysis involved ANOVA, chi-square and multivariate logistic regression analysis. The demographics of the
population sample indicated that most were females (except for diabetes mellitus), white, married, completed
13 years of education, and were 83 years old on average. CAL (continuous or dichotomous) and marital status
attained statistical significance (p<0.05) in contingency table analysis (chi-square for independence). Individuals
with increased CAL were 2.16 times more likely (OR=2.16, 95% CI=1.47–3.17) to die due to CVD and this effect
Student and Faculty Research Abstracts 2014 –2015
Periodontal Research
persisted even after control for age, marital status, gender, race, years of education (OR=2.03, 95% CI=1.35–
3.03). CAL (continuous or dichotomous) was much higher among those who died due to diabetes mellitus or
out of state of Massachusetts. However, these results were not statistically significant. The same pattern was
observed with pocket depth (continuous or dichotomous), but these results were not statistically significant
either. CAL seems to be more sensitive to chronic diseases than pocket depth. Among those conditions,
cardiovascular disease has the strongest effect.
Published in Braz Dent J 2015 Jan–Feb;26(1):33-8.
Comparison of Different Lasers for the Treatment of Peri-implantitis:
A Systematic Review
Zuhair Natto,* Majdi Aladmawy, Paul Levi, and Hom-Lay Wang
Objectives: To evaluate the efficacy of various types of lasers (Nd:YAG, CO2, Diode, Er,Cr:YSGG, and
Er:YAG) in the treatment of peri-implantitis and their use in surgical and nonsurgical procedures.
Methods: Human studies for the treatment of peri-implantitis with laser therapy published between January
2002 and January 2014 were collected utilizing the electronic database of PubMed, Ovid MEDLINE, Cochrane,
and Google Scholar. Two reviewers conducted the study selection, data collection, and validity assessment.
Methods: Implant placement data from 49 patients with 116 implants (mean age 59.7 years [29–88
years], 2.4 average number of implants [1–8 implants], 51±25 months median follow-up time after prosthetic
placement) was retrieved from electronic records and a detailed history for possible risk indicators was obtained
at a follow-up examination. Clinical parameters were recorded by two calibrated examiners and radiographic
evaluation was performed by one examiner, blinded to any clinical measurements. Data was analyzed with
SAS 9.2.
2014 –2015 Faculty Abstracts
Results: Of the studies, 812 were selected initially by a title search; 13 studies were then chosen for this
review. No human studies evaluated the effect of Nd:YAG laser (neodymium-doped yttrium aluminum garnet;
Nd:Y3Al5O12) on peri-implantitis. The CO2 (carbon dioxide) laser is reported to be safe and to possess an ability
to enhance bone regeneration. The diode laser (980 nm) seems to be effective in its bactericidal effect without
changing the implant surface pattern. The Er,Cr:YSGG (erbium, chromium-doped yttrium, scandium, gallium,
and garnet) laser was able to obtain bone regeneration around a failing implant shown in one case report, while
the Er:YAG laser exhibits a high bactericidal effect against periodontopathic bacteria at a low energy level.
Tufts University School of Dental Medicine
147
Conclusions: Although lasers showed promising results in reducing clinical signs of peri-implantitis,
due to the limited of small sample sizes and short follow-up periods, no firm conclusion can be drawn at this
moment. Hence, there is a need for more well-designed, longitudinal, randomized controlled clinical trials.
Presented at the 2015 IADR General Session in Boston. Abstract #4030.
Prevalence of Peri-implant Diseases: A Cross-Sectional Study
Evangelos Papathanasiou, Natalie Jeong, Angel Park, James Hanley, and Andreas Parashis
Aim: This cross-sectional study was designed to evaluate the health status data of implants in patients treated
at Tufts University School of Dental Medicine between 2004 and 2010 with implant-supported prostheses of at
least 2 years in service.
Periodontal Research
Results: Peri-implant mucositis (M) occurred in 12.1% of the implants and 16.3% of the subjects. Periimplantitis (PI) was found in 11.2% of the implants and 20.4% of the subjects and occurred more frequently in
males and older subjects. Of the implants, 84.6% with PI were in the maxilla and 15.4% in the mandible; 14%
and 21.4% of the implants were classified as M and PI respectively when bone augmentation was performed
during placement (36.2% of the implants). Of those implants with screw-retained prostheses (56%), 12.3% and
6.2% were classified as M and PI respectively, while the respective percentages for cement-retained prostheses
(44%) were 11.8% and 17.6%.
Conclusion: The preliminary data of this study in patients in the United States support similar prevalence
of peri-implantitis, but lower prevalence of peri-implant mucositis at both implant- and patient-level compared
to those reported from patients worldwide.
Presented at the 2015 Europerio 8 Meeting in London, UK.
Suppressor of Cytokine Signaling-3 Regulates Macrophage Response to
Porphyromonas gingivalis
Evangelos Papathanasiou,* Alpdogan Kantarci, Antonios Konstantinidis, Danielle Stephens, Hongwei Gao,
and Thomas Van Dyke
2014 –2015 Faculty Abstracts
Objective: Porphyromonas gingivalis plays a key role in the pathogenesis of periodontitis by triggering
the host response. Suppressor of cytokine signaling (SOCS) proteins are negative regulators of inflammatory
cells that inhibit cytokine signaling pathways. Our goal was to evaluate the role of SOCS-3 regulation in the
inflammatory phenotype of macrophages challenged with lipopolysaccharide (LPS) from P. gingivalis.
148
Methods: Peritoneal macrophages were elicited with 4% thioglycolate broth and isolated from 8-week
old myeloid SOCS-3-knockout (KO) and wild-type (WT) C57Bl6-B.129 mice by differential centrifugation.
Macrophages were cultured at a concentration of 1.5x106 cells/ml in 6-well plates. After 2 hours, non-adherent
cells were discarded and the remaining adherent cells were treated with either culture medium alone (control)
or with 100 ng/ml P. gingivalis A7436 LPS (N=6 per group). Supernatants were collected after 18 hours and
cytokine levels were assessed using Luminex multiplex bead immunoassay.
Results: P. gingivalis LPS stimulation resulted in a significant increase in the secretion of IL-1β, IL-6 and
IL-10 in macrophages from myeloid SOCS-3-KO mice compared to macrophages from WT mice (59.5±7.4
vs. 48.6±2.5 pg/ml, 1,303±226 vs. 971±71pg/ml, 104.5±12.3 pg/ml vs. 73.7±2.9 pg/ml; respectively p< 0.05).
Macrophages from myeloid SOCS-3-KO animals produced similar levels of IL-17A, MCP-1 and GRO/KC to
WT after stimulation with P. gingivalis LPS (50.2±12.8 vs. 33.0±4.4 pg/ml, 331.4±30.1 vs 322.5±17.9 pg/ml,
106.8±19.8 vs. 93.8±5.2 pg/ml; respectively p>0.05).
Conclusions: We have previously reported that myeloid SOCS-3-KO mice exhibit increased susceptibility
to periodontal bone loss in a P. gingivalis-induced periodontitis model. The results of this study support
the conclusion that deletion of the repressor molecule SOCS-3 causes an elevated macrophage-mediated
inflammatory response to P. gingivalis that increases the inflammatory response to periodontal pathogens and
susceptibility to periodontitis.
Presented at the 2015 IADR General Session in Boston. Abstract #3216.
Student and Faculty Research Abstracts 2014 –2015
Periodontal Research
Periodontal Treatment for Preventing Adverse Pregnancy Outcomes: A Meta- and
Trial Sequential Analysis
Falk Schwendicke,1 Nadeem Karimbux,2 Veerasathpurush Allareddy,3 and Christian Gluud4
1Charité—Universitätsmedizin
Berlin, Berlin, Germany; 2Tufts University School of Dental Medicine, Boston;
3College of Dentistry—The University of Iowa, Iowa City, Iowa; 4Centre for Clinical Intervention Research,
Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Objectives: Periodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal
treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis
and trial sequential analysis.
Methods: An existing systematic review was updated and meta-analyses performed. Risk of bias,
heterogeneity, and publication bias were evaluated, and meta-regression performed. Subgroup analysis was
used to compare different studies with low and high risk of bias and different populations, i.e., risk groups. Trial
sequential analysis was used to assess risk of random errors.
Conclusions: Providing periodontal treatment to pregnant women could potentially reduce the risks of
perinatal outcomes, especially in mothers with high risks. Conclusive evidence could not be reached due to
risks of bias, risks of random errors, and unclear effects of confounding. Further randomized clinical trials are
required.
Published in PLoS One. 2015 Jun 2;10(6).
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Results: Thirteen randomized clinical trials evaluating 6,283 pregnant women were meta-analyzed. Four
and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant
effect on preterm birth (odds ratio [95% confidence interval] 0.79 [0.57–1.10]) or low birth weight (0.69
[0.43–1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For
populations with moderate occurrence (<20%) of preterm birth or low birth weight, periodontal treatment was
not efficacious for any of the outcomes, and trial sequential analyses indicated that further trials might be futile.
For populations with high occurrence (≥20%) of preterm birth and low birth weight, periodontal treatment
seemed to reduce the risk of preterm birth (0.42 [0.24–0.73]) and low birth weight (0.32 [0.15–0.67]), but trial
sequential analyses showed that firm evidence was not reached. Periodontal treatment did not significantly
affect perinatal mortality, and firm evidence was not reached. Risk of bias but not publication bias or patients’
age modified the effect estimates.
149
Prosthodontics Research
Prosthodontics Research
Marginal and Internal Fit of Five- and Three-Axis CAD/CAM Inlays
Norah Alajaji,* David Bardwell, Hiroshi Hirayama, Samer Khayat, Matthew Finkelman, and Ala Ali
Objectives: To evaluate the marginal and internal adaptation of CAD/CAM lithium-disilicate inlay
restorations fabricated by two milling systems (five and three-axis), and a heat-press technique.
2014 –2015 Faculty Abstracts
Methods: Fifteen poly-methyl methacrylate models (premolar tooth #12, Kilgore International Inc.,
Coldwater, Michigan) with MOD cavity preparation were fabricated. Lithium-disilicate inlay restorations were
obtained by three different fabrication techniques and fitted to their single respective die (N=45, N=15/gp)
as follows: group 1, E4D three axis milling system; group 2, Tizian™ Cut 5 five axis milling system; group 3,
conventional heat-press technique. Gaps were evaluated by X-ray microtomography (mCT) (Nikon Metrology,
Inc., Americas). Marginal gap (MG), occlusal-marginal gap (OMG), proximal-marginal gap (PMG), gingivalmarginal gap (GMG), absolute marginal discrepancy (AMD), axial-internal gap (AIG) and occlusal-internal
gap (OIG) were evaluated at 120 different points per inlay. Data analyzed using repeated measures ANOVA.
Pairwise comparisons were conducted for post-hoc tests and the Bonferroni correction was used to adjust for
multiple comparisons (α=0.007).
150
Results: The heat-press group demonstrated significantly smaller mean-values amongst all outcomes
compared to CAD/CAM groups except for GMG, where there was no statistically-significant difference between
groups in the ANOVA (p=0.042). Within the CAD/CAM groups, the five-axis group showed significantly lower
OMG mean-value (51.08±12.46 μm) compared to the three-axis group (79.93±19.41 μm; p<0.001), and lower
AIG mean-value (104.98±14.05 μm) compared to the three-axis group (143.56±12.44 μm; p<0.001). There was
no significant difference between the five-axis and the three-axis groups’ AMD, MG, PMG and OIG locations
(p>0.007).
Conclusions: Within the limitations of this in vitro study, different fabrication techniques affected the
marginal and internal adaptation of ceramic inlay restorations. The heat-press group showed the best marginal
and internal adaptation results; however, in every group, all samples were within the clinically acceptable MG
limit (100 μm). Among CAD/CAM groups, the five-axis had better AIG and OMG values compared to the
three-axis values.
Presented at the 2015 IADR General Session in Boston. Abstract #2344.
Comparison of Candida Albicans Adhesion to Various Denture Base Materials
Alaa Makke,* Carol Kumamato, Amit Sachdeo, Matthew Finkelman, and Ali Muftu
Objectives: Denture stomatitis is a common fungal infection, affecting up to 76% of removable denture
patients and is often associated with Candida Albicans (CA) biofilms. A wide range of materials with various
processing techniques are used for denture bases. This research examines the adhesion of CA to the surface of
various denture base materials and its relation to surface roughness.
Methods: Rectangular samples of (15 x 5 x 2 mm)(N=15) were fabricated for seven different denture base
materials: group 1, Avadent® CAD/CAM (A); group 2, Eclipse® DENTSPLY, (E); group 3, SR Ivocap® High
Impact, Ivoclar Vivadent (SRI-HI); group 4, Clear Ivocap®, Ivoclar Vivadent (CI); group 5, Lucitone® FRS
flexible, DENTSPLY (L-FRS); group 6, Nature-CRYL® Pour, GC America (NCP-GC); group 7, DC acrylic
Student and Faculty Research Abstracts 2014 –2015
Prosthodontics Research
Luciton® S.P., DENTSPLY (DC-SP). After polishing, surface roughness (Ra) values were measured using a
Mitutoyo® profilometer. All samples were incubated with CA suspension (SC5314) for 1 hour at 37°C. Serial
dilutions of the original suspension (106 cells/ml) were then plated, along with dilutions of the suspension that
was removed from the material, on several YPglucose agar plates and aerobically incubated at 37°C for 48 h.
Adherence was calculated by measuring the colony forming units (CFUs) bound to the pieces and the total
CFU and determining % binding. Statistical analyses were performed using Kruskal-Wallis tests and Spearman
Correlation analysis.
Results: Median of CA adhesion values ranged from (0.0) Avadent® to (8.0) Eclipse® (p<0.02). Overall, CI
(4.3) and SRI-HI (1.4) showed more adhesion than L-FRS (0.3), DC-SP (0.1), NCP-GC (0.2) and Avadent (0)
groups. Ra values also varied: L-FRS (0.7) and NCP-GC (0.12) showed rougher surfaces than CI (0.03), SRIHI
(0.03), Eclipse (0.05) and Avadent (0.03) groups (p<0.02). Significant correlations were observed between CA
and Ra as well.
Conclusions: Denture base materials differ in surface roughness values and CA adhesion; smoother
surfaces had less CA adhesion.
Presented at the 2015 IADR General Session in Boston. Abstract #2154.
Marginal and Internal Adaptation of Ceramic Crown Restorations Fabricated with
CAD/CAM Technology and the Heat-Press Technique
Hisham Mously, Matthew Finkelman, Roya Zandparsa, and Hiroshi Hirayama
Purpose: The purpose of the study was to evaluate the marginal and internal adaptation of E4D crowns
fabricated with different spacer thicknesses and to compare these crowns with those fabricated with the heatpress technique.
Material and Methods: The E4D system was used to fabricate 30 crowns for the first three groups,
with different spacer thickness settings: 30 μm, 60 μm, and 100 μm. In the fourth group, 10 lithium disilicate
crowns were fabricated with the heat-press technique. The occlusal gap, axial gap, vertical marginal gap, and
absolute marginal discrepancy were evaluated by X-ray microtomography. Statistical significance was assessed
with the Kruskal-Wallis test (α=0.05). For post hoc analyses, the Mann-Whitney U test was used alongside the
Bonferroni correction for multiple comparisons (α=0.008).
Results: Within the CAD/CAM groups, the 30-μm spacer thickness resulted in the lowest median axial gap
(90.04 μm), whereas the 60-μm spacer thickness resulted in the lowest median occlusal gap (152.39 μm). The
median marginal gap values of the CAD/CAM-60 group (49.35 μm) and CAD/CAM-100 group (46.65 μm)
were lower than those of the CAD/CAM-30 group (55.18 μm). No significant differences among the CAD/CAM
groups were observed for absolute marginal discrepancy. The heat-press group had significantly different values
than those of the CAD/CAM groups.
Conclusion: The spacer thickness and fabrication technique affected the adaptation of ceramic crowns.
The heat-press group yielded the best marginal and internal crown adaptation results. The 30- or 60-μm spacer
settings are recommended for the E4D CAD/CAM system.
2014 –2015 Faculty Abstracts
Statement of Problem: The accuracy of chairside computer-aided design and computer-aided
manufacturing (CAD/CAM) restorations is questionable, and the effect of the die spacer settings is not well
stated in the literature.
Published in J Prosthet Dent. 2014 Aug;112(2):249-56.
Tufts University School of Dental Medicine
151
Prosthodontics Research
Comparison of the Accuracy of Digital Impressions and Master Models
Rami Muadab,* Ali Muftu, Gerard Kugel, Matthew Finkelman, and Ala Ali
Objectives: To compare the accuracy of the digital impressions obtained from Cadent™ iTero and Lava™
C.O.S. and the accuracy of master models obtained from Cadent™ iTero, Lava™ C.O.S., and stone master models
from using conventional impressions technique.
Methods: A reference model was scanned to generate a CAD reference model (CRM). Ten digital
impressions were taken using iTero, and another ten digital impressions using Lava™ C.O.S. The scans were sent
for fabrication of master models. The digital impressions were compared to the CRM using Qualify software.
Ten conventional impressions of the reference model were taken then poured with die stone (Resin Rock).
All the master models were scanned and then compared to the CRM using the same software. The root mean
square (RMS) values were analyzed. Independent-samples t-tests with Bonferroni correction were used in the
first part of the study, and one-way ANOVA tests with Bonferroni correction were used in the second part of the
study (α≤0.017).
2014 –2015 Faculty Abstracts
Results: The results of the first part of the study revealed that the digital impressions obtained from the
Lava™ C.O.S. were more accurate compared to iTero (p-value <0.001). The results of the second part of the
study demonstrated significant differences between groups (p-value<0.001). Master models obtained from using
conventional impression technique were the most accurate, followed by master models obtained from Lava™
C.O.S. and lastly the master models obtained from iTero. There was no statistically significance between Lava™
C.O.S. and iTero in the full coverage design).
152
Conclusions: Within the limitations of this study we concluded that digital impressions obtained from
using Lava™ C.O.S. are more accurate compared to digital impressions obtained from using Cadent™ iTero.
Master models obtained from using conventional impression technique are more accurate than master models
obtained from Lava™ C.O.S. and the Cadent™ iTero.
Presented at the 2015 IADR General Session in Boston. Abstract #0572.
Transition from Failing Dentition to Complete-Arch Implant Rehabilitation with a
Staged Approach: A Three-Year Clinical Report
Panos Papaspyridakos and Vasilios Chronopoulos
The transition of patients from failing dentition to complete-arch implant rehabilitation often means that
the patient is rendered edentulous and has to wear a removable complete denture for a time. Many patients
find this objectionable. A staged treatment approach provides a fixed interim prosthesis for use throughout
the rehabilitation process, allowing patient comfort and prosthodontic control. This clinical report describes
a staged approach protocol with a new type of interim prosthesis. The prosthesis is supported by hopeless
teeth and the soft tissues of the maxillary tuberosities and mandibular retromolar pads for the complete-arch
implant rehabilitation of a patient with failing dentition. This protocol allows for a fixed interim prosthesis with
combined tooth and mucosa or implant support during the entire rehabilitation process, thus avoiding the use
of complete dentures. The implants and prostheses were functioning successfully after three years of clinical
service.
Published in J Prosthet Dent. 2014 Sep;112(3):423-8.
Student and Faculty Research Abstracts 2014 –2015
Prosthodontics Research
Life-Changing Diastema Closure: Direct Composite Restorations with
Minimal Intervention
Aikaterini Papathanasiou and Charilaos Asikis
In today’s esthetics-conscious society, an unesthetic smile can cause many social, emotional, and psychological
issues for an individual. Many patients do seek restorative treatment to improve their smile, choosing to
maintain a cautious and conservative approach. This article describes the treatment of a patient with large
diastema between his discolored maxillary anterior teeth. The treatment consisted of a combination of inoffice and take-home tooth whitening, followed by direct composite resin restorations. This case demonstrated
exceptional results with the most minimally invasive treatment approach.
Published in Journal of Cosmetic Dentistry, Spring 2015, Vol. 31;1:46-57.
Comparison of Marginal Adaptation Accuracy Using Different Impression Systems
Marwa Shembesh, Roya Zandparsa, Ala Ali, and Hans-Peter Weber
Objectives: The purpose of this in vitro study was to compare the marginal adaptation of 3-unit zirconia
fixed dental prosthesis (FDPs) obtained from two different intraoral digital scanners (3M™ True Definition,
and Cadent™ iTero), scanning of a silicone impression and the resulting master cast with an extraoral scanner
(3Shape™ lab scanner).
Results: The mean (SD) marginal gaps from highest to lowest were as follows: group 1, 81.4 μm (6.8); group
3, 62.4 μm (5.0); group 2, 50.2 μm (6.1); and group 4, 26.6 μm (4.7). One-way ANOVA revealed significant
differences (p<0.001) among the groups. The Tukey HSD tests demonstrated statistically significant differences
between all groups (p<0.001).
Conclusions: Within the confines of this study, it can be concluded that the marginal gap of all impression
techniques was within the acceptable clinical limit. Group 4 showed the lowest average gap among all groups
followed by group 2, group 3, and group1; these differences were statistically significant.
Presented at the 2015 IADR General Session in Boston. Abstract #3847.
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Methods: One reference model was fabricated from intact human mandibular left first premolar and first
molar teeth (teeth #19 and #21), which were prepared for a three-unit all ceramic FDP. Impressions were
obtained by using four impression systems (N=10); group 1 (Impression scan), group 2 (Stone cast scan), group
3 (Cadent iTero), and group 4 (Lava True Definition). Marginal adaptation of the zirconia FDPs was evaluated
with the Deltronic Optical Comparator at four points on each abutment. The mean, standard deviation (SD)
was reported for each group. One-way ANOVA was used to assess the statistical significance of the results with
post-hoc tests conducted via the Tukey HSD. P-values less than 0.05 were considered statistically significant. All
analyses were done with SPSS 22.0.
153
Prosthodontics Research
An In Vitro Comparison of Fracture Load of Zirconia Custom Abutments with Internal
Connection and Different Angulations and Thicknesses: Part II
Roya Zandparsa and Abdalah Albosefi
Purpose: The purpose of part II of this in vitro study was to compare the fracture load of two-piece zirconia
custom abutments with different thicknesses and angulations.
Materials and Methods: Forty zirconia custom abutments were divided into four groups as follows:
group A1, 0.7 mm thickness and 0° angulations; group A2, 0.7 mm thickness and 15° angulations; group
B1, 1 mm thickness and 0° angulations; group B2, 1 mm thickness and 15° angulations. As in part I, in all
groups, implant replicas were mounted in self-cure acrylic jigs to support the abutments. The zirconia custom
abutments were engaged in the implant replicas using a manual torque wrench. All jigs were secured and
mounted in a metallic vice and subjected to shear stress till failure using a universal testing machine with a 0.5
mm/min crosshead speed with the force transferred to the lingual surface of the zirconia custom abutments 2
mm below the incisal edge. The test specimens used in this study did not include a crown. The universal testing
machine was controlled via a computer software system, which also completed the stress-strain diagram and
recorded the breaking fracture load. The fracture loads were recorded for comparison among the groups and
subjected to statistical analysis (two-way ANOVA and Kolmogorov-Smirnov).
2014 –2015 Faculty Abstracts
Results: The mean fracture load of zirconia custom abutments across the groups (A1 to B2) ranged from
432±97 N to 746±275 N. The angulated zirconia custom abutment exhibited the highest fracture load, which
was statistically significant (p=0.045). The thickness of the zirconia custom abutment also had a positive
influence on the strength of the specimens (p=0.005).
154
Conclusions: In this study, the 15° angulated zirconia custom abutments showed the highest fracture load
of those investigated. The 1 mm thick zirconia custom abutments also exhibited significantly higher fracture
load compared to 0.7 mm abutments.
Clinical Implications: The results of this in vitro study will help dental practitioners with their
decision-making process in selecting the type of custom abutment to be used clinically.
Published in J Prosthodont. 2015 Apr 9. doi: 10.1111/jopr.12292. [Epub ahead of print]
Student and Faculty Research Abstracts 2014 –2015
Statistics Research
Statistics Research
Cognitive Diagnostic Models and Computerized Adaptive Testing:
Two New Item-Selection Methods That Incorporate Response Times
Matthew Finkelman, Wonsuk Kim, Alexander Weissman, and Robert Cook
A recent paper proposed an item-selection approach for computerized adaptive testing (CAT) in which the
psychometric information per time unit is maximized. The current research extended this methodology to
adaptive tests combined with use of a cognitive diagnostic model (CDM). Two new item-selection methods are
introduced for the combination of CDMs and CAT: posterior-weighted Kullback-Leibler information per-timeunit, and mutual information per-time-unit. These methods were compared with standard procedures in which
the amount of time required to complete an item is not considered. Simulation conditions with and without
attribute-balancing constraints indicated that, on average, the new methods required more items but took less
time than the standard procedures, while achieving comparable classification accuracy.
Published in Journal of Computerized Adaptive Testing, 2, 59-76.
Stochastic Curtailment in Adaptive Mastery Testing: Improving the Efficiency of
Confidence Interval-Based Stopping Rules
Haskell Sie,1 Matthew Finkelman,2 Jay Bartroff,3 and Nathan Thompson4
1American
Institutes for Research, Washington, D.C.; 2Tufts University School of Dental Medicine, Boston;
3University of Southern California, Los Angeles; 4Assessment Systems, Woodbury, Minnesota
A well-known approach in computerized mastery testing is to combine the Sequential Probability Ratio Test
(SPRT) stopping rule with item selection to maximize Fisher information at the mastery threshold. This
article proposes a new approach in which a time limit is defined for the test and examinees’ response times
are considered in both item selection and test termination. Item selection is performed by maximizing Fisher
information per time unit, rather than Fisher information itself. The test is terminated once the SPRT makes
2014 –2015 Faculty Abstracts
A well-known stopping rule in adaptive mastery testing is to terminate the assessment once the examinee’s
ability confidence interval lies entirely above or below the cut-off score. This article proposes new procedures
that seek to improve such a variable-length stopping rule by coupling it with curtailment and stochastic
curtailment. Under the new procedures, test termination can occur earlier if the probability is high enough that
the current classification decision remains the same should the test continue. Computation of this probability
utilizes normality of an asymptotically equivalent version of the maximum likelihood ability estimate. In two
simulation sets, the new procedures showed a substantial reduction in average test length while maintaining
similar classification accuracy to the original method.
Tufts University School of Dental Medicine
155
Published in Applied Psychological Measurement, 39, 278-292.
Utilizing Response Times in Computerized Classification Testing
Haskell Sie,1 Matthew Finkelman,2 Barth Riley,3 and Niels Smits4
1American
3University
Institutes for Research, Washington, D.C.; 2Tufts University School of Dental Medicine, Boston;
of Illinois, Chicago; 4Vrije Universiteit Amsterdam, The Netherlands
Statistics Research
a classification decision, the time limit is exceeded, or there is no remaining item that has a high enough
probability of being answered before the time limit. In a simulation study, the new procedure showed a
substantial reduction in average testing time while slightly improving classification accuracy compared with the
original method. In addition, the new procedure reduced the percentage of examinees who exceeded the time
limit.
2014 –2015 Faculty Abstracts
Published in Applied Psychological Measurement, 39, 389-405.
156
Student and Faculty Research Abstracts 2014 –2015
Tissue Engineering
Tissue Engineering
Dental Epithelial-Mesenchymal 3D Cell Sheets for Tooth Regeneration
Nelson Monteiro, Elizabeth Smith, and Pamela Yelick
Objectives: Dental epithelial-mesenchymal (DE-DM) cell interactions provide critical functions in tooth
development. Therefore, methods to promote proper DE-DM cell interactions for tooth regeneration have to
be established. The objective of this work was to optimize and investigate the DE-DM interactions using 3D cell
sheet technology. Parameters tested include: optimized cell seeding density; duration of in vitro culture; and
methods to co-culture human DM (hDM) and porcine DE (pDE) cell sheets.
Methods: pDE and hDM cells were each seeded on temperature-responsive tissue culture plates (UpCell,
CellSeed, Tokyo, Japan) at various cell densities (0.02, 0.114, and 0.228 cell 106/cm2) for 7, 14, and 21 days
to obtain the cell sheets. pDE/hDM co-culture was established by first seeding hDM cells at density of 0.114
cell 106/cm2 and culturing for 4 days, followed by the addition of pDE cells at the same cell density, and
continued culture for an additional 10 days. Layered cell sheet constructs were made by stacking the cell sheets.
Histological evaluations of cell sheet constructs were performed with hematoxylin-eosin (H&E) staining and
immunohistochemistry (IHC).
Results: hDM cell sheets were obtained after 21, 14, and 11 days at cell density of 0.02, 0.114, and 0.228 cell
106/cm2, respectively. pDE cell sheets were obtained only using the higher cell seeding density after 14 days in
culture. Thus, the optimal cell densities for the formation of the cell sheets was 0.114 cell 106/cm2 for hDM cells
and 0.228 cell 106/cm2 for pDE cells. H&E and IHC showed organized structures of each cell type alone, cocultured and multi-layered cell sheets.
Presented at the 2015 IADR General Session in Boston. Abstract #1403.
Silk Fibroin, a Functional Substrate for iPS-derived RPE Cells
Sheldon Rowan, Benjamin Chan, Waseem Khan Raja, Chiara Ghezzi, Avi Smith, Allen Taylor, David Kaplan,
Jonathan Garlick, and Behzad Gerami-Naini
Objectives: Age-related macular degeneration (AMD) is the major cause of human blindness in the United
States, whose incidence continues to increase in a burgeoning aging population. AMD occurs when retinalpigmented epithelial cells (RPE) and its juxtaposed membrane, Bruch’s membrane (BrM) on which they reside,
are compromised. Induced pluripotent stem cells (iPSCs) cells hold promise for personalized cell replacement
therapy, as well as providing an opportunity to study the fundamental disease mechanisms of AMD. We propose
to form a functional 3D human retinal tissue in vitro by placing RPE (derived from iPSCs) or ARPE19 human
RPE cells on the silk fibroin.
Methods: We employed silk membrane as a bio-mimetic BrM with different porosities coated with a variety
of extracellular matrix (ECM) proteins including 1) collagen IV, 2) laminin, 3) Matrigel and 4) non-coated
silk membranes to evaluate the potential of iPS derived-RPE cells and human ARPE-19 cells to attach and
proliferate on silk fibroin. We ascertained the state of differentiation and polarity using a series of well-defined
antibody markers. Apical and basal polarity was assed via expression of Ezrin and Bestrophin respectively. ZO1
Tufts University School of Dental Medicine
2014 –2015 Faculty Abstracts
Conclusions: This 3D dental cell sheet model can be used to study DE-DM cell interactions and for
potential use in tooth regeneration strategies.
157
Tissue Engineering
staining was employed to assess tight junction and hexagonal cellular architecture. Differentiation was assessed
via degree of pigmentation and RPE65 expression.
Results: ARPE-19 cells were viable and proliferated well on silk fibroin, yet differentiated poorly. IPSCderived RPE differentiated effectively in 2D-culture. However, markers of differentiation and polarity were
improved by culturing the cells on silk fibroin plus ECM.
Conclusions: Our results suggest that silk fibroin is a suitable BrM biomimetic substrate for RPE cells and
can be implemented for therapeutic transplantation in humans.
Presented at the 2015 IADR General Session in Boston. Abstract #1380.
Biomimetic Mineralized Tooth Constructs for Whole Tooth Bioengineering
2014 –2015 Faculty Abstracts
Elizabeth Smith, Ali Khademhosseini, and Pamela Yelick
158
Objectives: Globally, over 158 million people are suffering from tooth loss. Dental implants are currently
the most common therapy intended to replace the function of lost teeth. However, complications may occur
due to patient response to synthetic dental materials. The ability to engineer biomimetic replacement teeth
would be a highly desirable alternative therapy. Here we describe a biomimetic three-dimensional (3D) tooth
model as a platform for the development of novel regenerative approaches for tooth replacement in humans.
We have previously identified gelatin methacrylate (GelMA) hydrogel scaffold formulas that exhibit similar
elastic moduli as natural dental tissues, and elicit optimized porcine dental epithelial (pDE) and porcine dental
mesenchymal (pDM) cell morphology, metabolic activity and promote organized endothelial (HUVEC)
structures in vitro. When implanted and grown subcutaneously, pDE/pDM/HUVEC constructs expressed
dental cell differentiation markers and exhibited tooth and bone specific mineralization and vascularization.
Our objective here is to further optimize our biomimetic 3D tooth model by defining cell-seeding densities for
optimized pDE and pDM proliferation and differentiation.
Methods: We will examine three cell-seeding densities (30,000 cells/µl, 60,000 cells/µl and 90,000 cells/µl).
Replicate in vitro constructs will be prepared and grown for 1 and 14 days. Replicate samples will then be
grown in vivo for 2 and 4 weeks. Histological, immunohistochemical, and radiographic analyses will be used to
compare cellular organization, morphology, differentiation and biomineralization of both in vitro and in vivo
constructs.
Results: We expect that the higher cell seeding density will improve dental cell interactions and dentin and
enamel formation in biomimetic tooth constructs.
Conclusions: The results from this study will further establish dental cell encapsulated 3D GelMA hydrogel
constructs as biomimetic 3D models for functional tooth replacement in humans.
Presented at the 2015 IADR General Session in Boston. Abstract #1369.
Student and Faculty Research Abstracts 2014 –2015
Index of Authors
A
Aladmawy, Majdi, 110, 114,
146, 147
Alajaji, Norah, 150
Alasqah, Mohammed, 114, 146
Albosefi, Abdalah, 154
Alfonso, Ada, 44
Alghanem, Tofool, 50, 88, 89
Al Ghanem, Tofool, 37
Alhareky, Muhanad, 142
Alhumaid, Jehan, 142
Ali, Ala, 102, 104, 150, 152, 153
Alkahtani, Zuhair, 107
AlSagob, Eman, 102
Alshaeri, Heba, 125
Alt-Holland, Addy, 24, 75, 84
Aluri, Hema, 90
Anastasia, Mary Kay, 128
Andreeva, Viktoria, 30, 101
Antonellou, Ekaterini, 113
Arevalo, Sonia, 142
Armaos, Helene, 90
Asali, Ammar, 142, 143
Ashrafi, Alireza, 86, 132
Asikis, Charilaos, 153
Askari, Marjan, 142, 144
Ausenda, Federico, 45
B
Bak, Anna, 22
Baleja, James, 24, 75, 84
Balint, Andras, 131
Bardwell, David, 102, 104, 150
Barker, Matthew, 129
Barton, Jennifer, 87
Becker, Daniel, 131
Bednarsh, Helene, 58
Belous, Bradley, 62
Bergera, Faryn, 92
D
Berglund, Jason, 23
Bernardo, Mark, 84
Bhatt, Sapan, 102, 103
Bingham, Elizabeth, 24, 75
Bishop, Jonathan, 25, 27, 43
Bond, Charles, 26
Boulos, Mina, 132
Brown, William, 25, 27
Budania, Sucheta, 93
Bui, Minh, 28, 59, 108
Burstein, Rami, 122
C
Carnow, Zachary, 53
Chan, Benjamin, 157
Chao, William, 29, 43
Chaudhary, Sanjeet, 134
Chay, Daniel, 45
Chen, Chun-Jung, 117
Cheng, David, 30
Cheng, Jessica, 120
Chen, Jake, 34, 120
Chen, Jake Jinkun, 120
Chen, Jimmy, 30
Chilakamarry, Keerthy, 44
Ching, Jason, 143
Chronopoulos, Vasilios, 152
Chuang, Sung-Kiang, 118
Ciciolla, Elena, 31, 32
Cimmino, Joseph, 126, 128
Clancy, Myles, 40
Cohen, Rachel, 31, 32
Coleman, Daniel, 45
Constantine, John, 33
Cook, Robert, 155
Creech, Grace, 34
Tufts University School of Dental Medicine
Dani, Kunal, 35
Darwish, Ghassan, 133
Decoteau, Corey, 135
DeFuria, Jason, 56
De La Cruz, Ignacio, 36
De Leon, Risha, 37
Denike, Jennifer, 62
Dhadwal, Shuchi, 69
Dong, Lily, 120
Donoghue, Stephen, 123
Donohue, Jacob, 26
Dragan, Irina, 94, 118
Dunmire, Kyle, 94
E
Eisen, Steven, 22, 35, 37, 40,
62, 82
Elfallah, Khadiga, 113
Elia, Roberto, 70
English III, Ray, 132
Esshaki, Diana, 47, 51, 61, 77
F
Fahey, Ross, 133
Felemban, Osama, 95
Finkelman, Matthew, 40, 43, 46,
48, 69, 85, 88, 93, 104, 113,
114, 134, 142, 144, 145, 150,
151, 152, 155
Finn, Kiirsten, 94
Flavell, Ainslee, 94
Foroutan, Sadaf, 44
Fox, Lindsay, 27, 38
Frantz, David, 39, 46, 107
Fung, Katharina, 40
G
Gallagher, Susan, 99
Gallucci, German, 117
159
Ganda, Kanchan, 39, 51, 77, 107
Ganguly, Rumpa, 68, 111
Gao, Hongwei, 148
Garber, Yamila, 41, 81
Garlick, Jonathan, 56, 67, 157
Gerami-Naini, Behzad, 67,
100, 157
Gerard Kugel, 28, 50
Gerlach, Robert, 126, 128, 129
Ghezzi, Chiara, 157
Gilman, Hannah, 42
Gilmore, William, 131
Giordano, Elisa, 27
Girn, Vishavjeet, 29, 43
Gonzalez, Daniel, 44
Graceffo, Jeffrey, 92
Gulati, Harish, 61
Gul, Gülsün, 47
Gyurko, Robert, 53
H
Haddad, Ella, 125
Hagel, Natalie, 91, 111, 126
Hall, Joshua, 45
Hanley, James, 134, 147
Han, Qianqian, 120
Hanssen, Stijn, 117
Harsono, Masly, 25, 28, 29, 40,
46, 50, 60, 85, 113
Hassan, Mohammad, 142
Hawley, Charles, 94
Hinds, Philip, 101
Hirayama, Hiroshi, 150, 151
Huang, Hsiang-Yun, 134
Hur, Yong, 134
I
Ing, Melissa, 39, 43, 46, 107
Irby, Alexis, 46
160
J
L
Jaceldo-Siegl, Karen, 125
Jailwala, Mansi, 47
Janyavula, Sridhar, 28, 59
Jarmoc, Marcin, 134
Jeong, Natalie, 45, 147
Juhn, David, 144
Leader, David, 64, 105
Leary, Joseph, 118
Lee, Moonyoung, 79, 137,
138, 139
Lee, Yujin, 53
Leikin, Jennie, 114
Leong, Kelly, 108
Lerman, Mark, 130
Leung, Heather, 55
Leung, James, 56
Levi Jr., Paul, 53, 116
Levi, Paul, 45, 147
Lobel, William, 105
Loo, Cheen, 93, 95, 97, 107,
142, 143, 144, 145
Lubelski, William, 118
Lu, Chao, 69
K
Kamlarz, Samuel, 75, 84
Kanavakis, Georgios, 79, 137,
138, 139, 140
Kanchan Ganda, 47
Kantarci, Alpdogan, 148
Kaplan, David, 70, 157
Karimbux, Nadeem, 108, 109,
110, 146, 149
Karnaukh, Marina, 95
Kazes, Elaina, 96
Keck, Samantha, 48
Khademhosseini, Ali, 158
Khader, Ruba, 134
Khayat, Samer, 102, 104, 150
Kim, Julia, 50
Kim, Paul, 53
Kim, Sung-Hoon, 120
Kim, Wonsuk, 155
Kim, Yun Ae, 51
Klein, Gustavo Batista Grolli, 96,
135
Ko, Alice, 52
Konstantinidis, Antonios, 148
Kotch, Gary, 140
Kugel, Gerard, 25, 26, 29, 31,
32, 33, 35, 38, 40, 43, 46, 59,
60, 62, 63, 70, 72, 82, 85, 103,
113, 152
Kulich, Ronald, 69
Kumamato, Carol, 150
M
Magnuson, Britta, 39, 41, 46, 48,
51, 69, 81, 107, 114, 126, 128
Mahdavi, Maryam, 52, 57
Maillet, Justin, 58
Maione, Anna, 67
Makke, Alaa, 150
Manocha, Nikhil, 44
Maragliano, Pamela, 26
Mariano, Alissa, 28, 59
Marquis, Matthew, 60
Martin, Alexa, 61
Marzouca, Lauren, 62
Mehta, Noshir, 69
Mendes, Gabriel Cury, 96
Mendez, Zuzana, 44
Meng, Shu, 120
Merikas, Amanda, 33, 63, 72
Mermelstein, Danya, 142
Mian, Alec, 123
Student and Faculty Research Abstracts 2014 –2015
Midle, Jennifer Bassett, 22, 26,
36, 39, 46, 47, 51, 55, 58, 65,
66, 77, 80, 88, 91, 95, 111, 143
Miner, Melanie, 126, 128
Miner, R. Matthew, 139
Molgaard, Kathleen, 64
Monteiro, Nelson, 157
Morgan, John, 36, 40, 42, 52, 57,
58, 71, 76, 85, 107
Moroi, Hidetada, 94
Mostafavi, Sahar, 65
Mously, Hisham, 151
Muadab, Rami, 152
Muftu, Ali, 150, 152
Murray, Dana, 120
N
Naert, Ignace, 117
Natto, Zuhair, 110, 114, 125,
127, 146, 147
Neitzey, Zachary, 66
Nguyen, Kimyen, 44
Nieto-Herman, Aidee, 44
O
O’Brien, Joann, 67
O’Brien, Paula, 74
Ogata, Yumi, 108, 134
Oreadi, Daniel, 131, 133, 134
P
Pagni, Sarah, 86
Papageorge, Maria, 74, 96, 131,
135
Papas, Athena, 41, 48, 81, 114,
115, 126, 128, 129, 146
Papaspyridakos, Panos, 117, 152
Papathanasiou, Aikaterini, 153
Papathanasiou, Evangelos,
147, 148
Parashis, Andreas, 147
Park, Angel, 27, 29, 40, 41, 42,
43, 48, 52, 57, 62, 71, 76, 79,
81, 82, 108, 143, 147
Parsi, Lily, 144
Patel, Felisha, 68
Patel, Shivam, 45
Patterson, Ellen, 91, 111
Penn, Christina, 53
Perry, Kristeen, 111
Perry, Ronald, 25, 26, 27, 28,
31, 32, 33, 38, 59, 60, 63, 72,
102, 103
Petersen, Floyd, 127
Pham, Charles, 69
Phero, James, 131, 136
Phillips, Ceib, 140
Phillis, Daniella, 26
Phillis, Stephanie, 70
Piacquadio, Christina, 71
Pietruska, Jodie, 101
Pompei-Reynolds, Renée, 140
Popovich, Brent, 45
Price, Richard, 103
Q
Qualters, Donna, 111
R
Raja, Waseem Khan, 157
Ramesh, Aruna, 78, 95, 111, 143
Redwan, Hetaf, 104
Reen, Gursimran, 44
Reisig, Jessie, 33, 63, 72
Restrepo, Jessica, 44
Reyes, Jorges, 75
Ribeiro Jr., Paulo Domingos,
96, 135
Rich, Alfred, 97, 143, 144, 145
Tufts University School of Dental Medicine
Robinson, Courtney, 43
Rogers, Thomas, 110
Romero, Ingrid, 44
Rosenberg, Morton, 65, 131,
134, 136
Rowan, Sheldon, 157
S
Sabooree, Sepideh, 74, 132
Sachdeo, Amit, 150
Saffari, Shawheen, 24, 75, 84
Saksena, Yun, 55, 65, 66, 80
Sayegh, Mary, 76
Schuback, Sarah, 70
Schumann, Roman, 134
Scrivani, Steven, 122
Seemann, Rudolf, 118
Sevilla, Cristina, 78
Shah, Anjalee, 77
Shah, Devina, 144
Shah, Neelam, 95
Shah, Tej, 78
Shamirian, Paul, 79
Shapurian, Tannaz, 53
Shembesh, Marwa, 153
Shim, Laura, 80
Singh, Amrita, 96
Singh, Mabi, 41, 48, 81, 115,
126, 128, 129
Smith, Avi, 67, 157
Smith, Elizabeth, 157, 158
Smith, Kyle, 120
Smith, Pamela, 84
Soudam, Suharika, 90
Spierings, Egilius, 122, 123
Srinivasan, Sreedevi, 137
Stark, John, 145
161
Stark, Paul, 31, 74, 80, 88, 89,
102, 107
Steffensen, Jane, 42, 76
Stephens, Danielle, 148
Sui, Lei, 120
Sundaralingam, Shankeertha,
41, 81
Sun, Teresa, 146
Suri, Lokesh, 68
Suzuki, Marcelo, 116
T
Ta, Michelle, 82
Tang, Yin, 98, 120
Taylor, Allen, 157
Tay, Ronney, 24, 75, 84
Tewari, Kanupriya, 85
Thomas, Jordan, 86
Tillman, Hilde, 87
Tiruvadi, Avanthi, 87
Tonstad, Serena, 125
Towers, Jennifer, 99
Tran, Khoa, 43, 95
Trotman, Carroll, 140
Tu, Qisheng, 120
Tzavaras, Elizabeth, 126,
128, 129
U
Urdaneta, Ranier, 118
V
Valverde, Paloma, 120
Vandenberghe, Bart, 117
Van Dyke, Thomas, 148
Vannah, Dorothy, 126
Vazquez, Betsy, 101
Velayo, Bianca, 88, 89
162
Viswanath, Archana, 74, 86, 96,
131, 132, 133, 135
Vyas, Harshiv, 135
W
Wang, Haomiao, 88, 89
Wang, Hom-Lay, 147
Wang, Xiaoying, 34
Webb, Michelle, 44
Weber, Hans-Peter, 104, 153
Weber, Kathryn, 90
Weissman, Alexander, 155
White, Fadi, 91, 111
Wöber, Christian, 123
Wright, Wanda, 36, 58, 97,
107, 145
X
Xuan, Dongying, 120
Y
Yelick, Pamela, 30, 157, 158
Yoo, Sage, 97, 145
Yuan, Tian, 82
Yu, Jing, 140
Yu, Liming, 120
Z
Zandparsa, Roya, 151, 153, 154
Zhang, Jin, 120
Zhang, Lan, 120
Zhang, Weibo, 101
Zheng, L., 120
Zoukhri, Driss, 70, 90
Student and Faculty Research Abstracts 2014 –2015
NOTES
Dental Research Administration
Tufts University School of Dental Medicine
One Kneeland Street, DHS 1513
Boston, MA 02111
617-636 - 4045
Celebrating Excellence and
Achievement in Research
2012 –2013 Research Abstracts
Table of Contents
History of Bates-Andrews Day | Message from Dean Thomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Message from Dr. Kugel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Acknowledgements: Corporate Partners | Special Thanks to Faculty and Students. . . . . . . . . . 6
Bates-Andrews Day Proceedings | Keynote Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Bates-Andrews Day 2013 Awards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Predoctoral Student Presentations by Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Postdoctoral Student Presentations by Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Faculty Abstracts by Subject Area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5
Student Presentations And Abstracts
Predoctoral Student Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Postdoctoral Student Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Faculty Abstracts
Anesthesiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Behavioral, Epidemiologic, and Health Services Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Cancer Biology and Tissue Engineering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Cariology Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Craniofacial Biology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Dental Materials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Diagnostic Sciences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Education Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Endodontics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Geriatric Oral Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Implantology Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Methodology and Clinical Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Microbiology/Immunology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Mineralized Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Neuroscience / TMJ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Oral Health Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Oral Surgery Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Orthodontics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Pediatric Dentistry Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Periodontal Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Pharmacology, Therapeutics, and Toxicology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Prosthodontics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Pulp Biology and Regeneration Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Salivary and Lacrimal Gland Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Statistics Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Index of Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Tufts University School of Dental Medicine
3
History of Bates-Andrews Day
Since the 1930s, this day is held annually to honor George A. Bates, an alumnus of Tufts University
School of Dental Medicine, who taught Tufts medical and dental students. He was regarded by his
students as an inspiring instructor in histology. Bates Day at TUSDM helps to promote student
research and thereby enhance the opportunities for professional growth of our students, alumni,
and faculty.
The Robert R. Andrews Society is a student-run organization formed in 1921 in honor of Dr.
Andrews, an outstanding researcher and distinguished dental surgeon. The Andrews Society seeks to
promote dental research and to honor those who excel in it.
Message From the Dean
Welcome to Bates-Andrews Day 2013, a showcase of our predoctoral and postgraduate students’
research activities. This year’s event promises to be the largest yet, with over 70 student poster
presentations.
We are very pleased to have as our keynote speaker Kathleen O’Loughlin, D81, executive director
and COO of the American Dental Association and a member of our Board of Advisors.
Bates-Andrews Day gives our students the opportunity to share with the rest of the Tufts
community their accomplishments in fields of special interest. I applaud them for their initiative
and achievements.
Strengthening and increasing research activity and creating an environment that supports research
are integral parts of the School’s strategic plan.
I appreciate the dedication of the faculty advisors for their mentorship. Special thanks go to the
judges and the participation of the commercial exhibitors who help make this event possible.
Finally, Eileen Doherty’s leadership as director of predoctoral student research is highly valued, as it
enhances our students’ research experiences.
Huw F. Thomas, B.D.S., M.S., Ph.D.
Dean and Professor of Pediatric Dentistry
4
Student and Faculty Research Abstracts 2012 –2013
Message from Dr. Kugel
The research mission of Tufts University School of Dental Medicine promotes integration of
innovative studies in basic science, clinical practice, and public health. This book is evidence of
the progress we have made and will continue to make at the Dental School.
TUSDM welcomes the valuable partnerships and contributions of corporations, foundations,
NIH, and NIDCR to our mission. Working together, we have the means to perform ethical,
meaningful research in oral and general health care that can be applied for the benefit of the
scientific community and the public at large.
Researchers at TUSDM conduct studies in many areas, including bench and clinical studies
in dental materials, devices, and pharmaceuticals. We are presently pursuing groundbreaking
techniques in tissue engineering, bone remodeling, and Sjögren’s Syndrome. Tufts also
provides a wealth of opportunities for interdisciplinary research with our schools of nutrition,
biomedical sciences, veterinary medicine, and engineering.
The combination of disciplines and talent at Tufts University provides the ideal environment
for collaborative research and materials testing. Our record of contributions to the sciences and
our potential to influence the future of dental medicine are extensive.
As we work to continually promote oral health and improve the quality of life for the general
population, we remain aware that strategic partnerships are vital to our efforts. We recognize
the power of shared knowledge and are always looking to share resources and ideas. The pages
ahead reveal just a sample of our achievements thus far.
Gerard Kugel, D.M.D., M.S., Ph.D.
Professor and Associate Dean for Research
Tufts University School of Dental Medicine
5
Acknowledgements
Corporate Partners
The following commercial exhibitors and contributors helped to make this year’s
Bates-Andrews Day successful:
Dr. Chad Anderson, D04
Drs. Kane, Tesini, Soporowski
& Associates, LLP
Benco Dental Company
Living Legacy Financial Group
Brasseler USA
Massachusetts Dental Society
DENTSPLY
Dr. Kistama Naidu, D02
Designs for Vision
NCDR, LLC for Kool Smiles
Door to Door Dental
OraPharma
Eastern Dentists Insurance
Company
Patterson Dental
Gentle Communications, LLC
Septodont Inc.
GlaxoSmithKline
Shofu Dental Corp.
Henry Schein, Inc.
Surgitel Systems
Hu-Friedy
Ultradent Inc.
3M ESPE
The Procter & Gamble Company
Johnson & Johnson
Special thanks to the following Tufts faculty and students
Research Committee
Dr. Tofool Alghanem
Dr. Addy Alt-Holland
Dr. Jake Chen
Dr. Wai Cheung
Prof. Eileen Doherty
Dr. Jonathan Garlick
Dr. Michael Kahn
Dr. Gerard Kugel
Dr. John Morgan
Dr. Athena Papas
Dr. Alfred Rich
Dr. Naomi Rosenberg
Dr. Sreedevi Srinivasan
Dr. Paul Stark
Dr. Archana Viswanath
Dr. H.P. Weber
Dr. Pamela Yelick
Bates Student Research Group and Andrews Society Officers
Jeremy Plourde, President
Julianna Bair, Vice President
Shruti Pore, Secretary
Courtney Michelson, Treasurer
6
Student and Faculty Research Abstracts 2012 –2013
Bates-Andrews Day 2013
Wednesday, March 6, 2013
Schedule of events
11:00 am – 3:00 pm
Predoctoral and postdoctoral student posters on display
Commercial Exhibitors
3:30 pm – 4:30 pmKeynote Speech
4:30 pm
Awards Presentation and Reception
Keynote Address
Preservation of the Profession
Kathleen O’Loughlin, D.M.D., M.P.H.
Executive Director and Chief Operating Officer
American Dental Association
Dr. Kathleen O’Loughlin is executive director and chief operating officer
of the American Dental Association. Prior to joining the ADA, Kathy
served as the chief dental officer for United Health Group and president
and CEO of Delta Dental of Massachusetts.
Kathy practiced dentistry for over 20 years in Medford and Winchester,
Massachusetts, while serving as an assistant clinical professor at Tufts
University School of Dental Medicine in the Department of General
Dentistry as a course director. She received her bachelor’s degree cum
laude from Boston University in 1974 and her doctorate from Tufts
University summa cum laude in 1981. In 1998, Dr. O’Loughlin received a
master’s degree in public health and health care management from Harvard University. She currently
serves as a trustee of Tufts University and is a member of the executive committee and Board of
Advisors for Tufts Dental School.
Kathy is a member of several dental organizations and has received numerous awards.
Tufts University School of Dental Medicine
7
Bates-Andrews research Day 2013
8
Student and Faculty Research Abstracts 2012 –2013
Bates-ANdrews Day 2013 Awards
Best Postgraduate Poster Presentation
Dr. Eileen Saunders —“Pediatricians’ Knowledge of Oral Health Promotion in New England: A Survey”
Best Scientific Research Presentation by a Senior (Andrews Society Award)
Julianna Bair —“Shear Bond Strength of Resin Cements to Dentin and Enamel”
First Place ADA/DENTSPLY Student Clinician Award for Best Overall Predoctoral
Table Clinic
Amanda Merikas —“Contact Angle and Shear Bond Strength Tests of Silane Primers”
Second Place Award for Predoctoral Table Clinic
Kyler McEwen —“Dentin Shear Bond Strength of RMGI Cements”
Third Place Award for Predoctoral Table Clinic
Saad Butt —“Functional Characterization of alk8 in Zebrafish Mineralized Tissue Development”
Research Committee Award for Basic Science Research
Shruti Pore —“E-Cadherin Suppression Alters Dab2-Mediated Endocytosis in Squamous Cell Carcinoma Cells”
Massachusetts Dental Society and ASDA Public Health Award
Erica Stutius —“Developmentally Disabled Adults Treated under General Anesthesia: Periodontitis
and Correlates”
Omicron Kappa Upsilon (OKU) Hilde Tillman Award
Jaskaren Randhawa —“Analyzing the Trends and Associated Management Outcomes of Oral Lesions
and Medication Regimens among the HIV-Positive Patient Population at Tufts University School of
Dental Medicine”
Procter & Gamble Traveling Fellowship Award
Chase Larsen —“Fracture Toughness of Provisional Dental Materials”
Dr. Chad Anderson Family Award for Innovative Methodology and
Research Design
Lindsay Fox —“Marginal/Internal Fit of e.Max Impulse versus e.Max CAD All-Ceramic Crowns”
Multicultural Award for the Advancement of Dental Research
Errol Ramos —“Effect of Loupes on Ocular Blue Light Hazard: Indirect Viewing”
Oral Health Disparities Award
Natalie McClain —“Oral Health and Body Mass Index of Intellectually/Developmentally Disabled Adults”
Bates Student Research Group “Peer-Reviewed” Award
Nicolas Freda —“Comparison of Polymerization Stress using RMGI Bond and Resin Adhesive”
ADEA Student Group Educational Research Award
Dave Cho —“The Relationship between Performance on Perceptual Ability Test Section of DAT and Clinical
Success in Dental School”
Tufts University School of Dental Medicine
9
Predoctoral Student Presentations by Author
PREdoctoral STUDENT PresentationS
Ivy P. Ahluwalia, D14 (p. 24)
Extracellular Matrix Components and Mesenchymal-Epithelial Transition in Lacrimal Gland Cells
Kian Azarnoush, D15 (p. 25)
Epigenetic Therapy for Experimental Periodontitis in a Mouse Model
Julianna Bair, D13 (p. 26)
Shear Bond Strength of Resin Cements to Dentin and Enamel
Grant Beyer, D15 (p. 27)
Assessing Surface Roughness on Composite Restorations Using Different Abrasive Methods
Sapan Bhatt, D14 (p. 28)
Shore Hardness and Temperature of VPS Materials during Setting
Elizabeth Bingham, D15 (p. 29)
Effects of Dab2 on Endocytic Proteins in Squamous Cell Carcinoma
Stephanie Brue, D14 (p. 30)
Microabrasion Techniques for Removal of In Vitro Enamel Demineralization
Saad Butt, D15 (p. 31)
Functional Characterization of alk8 in Zebrafish Mineralized Tissue Development
Diego Camacho, D13, James Koehler, D13, and Kimberly Kocak, D14 (p. 32)
Retrospective Evaluation of Parameters Associated with Dental Implant Failure at
Tufts University School of Dental Medicine
Matthew Cannavo, D14 (p. 34)
Microleakage of Dental Composites
YooJung Chang, D15 (p. 35)
Microtensile and Shear Bond Strength on Dentin
Dave Cho, D14 (p. 36)
The Relationship between Performance on Perceptual Ability Test Section of DAT
and Clinical Success in Dental School
Lindsay Fox, D15 (p. 37)
Marginal/Internal Fit of e.Max Impulse™ Versus e.Max™ CAD All-Ceramic Crowns
Nicolas Freda, D13 (p. 38)
Comparison of Polymerization Stress Using RMGI Bond and Resin Adhesive
Ryan George, D15 (p. 39)
Compressive Strength of Bulk Fill Composite Materials
Sung Hong, D14 (p. 40)
Usage of Different Pharmacologic Categories of Medications in Intellectually/Developmentally Disabled Adults
Treated under General Anesthesia
Jenna Hubacz, D15 (p. 41)
Student Opinions on Pre-Clinical Instruction at TUSDM: A Survey
10
Student and Faculty Research Abstracts 2012 –2013
Predoctoral Student Presentations by Author
Rajvir Jutla, D14 (p. 42)
Site-Specific Patterns of Gene Expression in Diabetic-Foot Fibroblasts
Dohyun Kim, D14 (p. 43)
Medication and Prevalence of Caries in Intellectually/Developmentally Disabled Adults
Alice Ko, D15 (p. 44)
Phenotypic Characterization of Tft156N and Tft152N Zebrafish Mutants
Michael Kreitzer, D14 (p. 45)
Microleakage Evaluation of Bulk-Fill Layering Techniques in Class II Restorations
Hemanth Kunduru, D14 (p. 46)
Depth of Cure of Different Shades of Bulk Fill Composite
Gregory Lane, D13 (p. 47)
Social Impact of Oral Health on Psychiatric Inpatients
Jamie LaPierre, D14 (p. 48)
Mortality Data Thirty Years after Nutrition and Oral Health Study
Chase Larsen, D14 (p. 49)
Fracture Toughness of Provisional Dental Materials
John Lee, D14 (p. 50)
Retrospective Study of Oral Health Program in Zambian Children’s Home
Joon Hee Lee, D14 (p. 51)
Effect of Chlorhexidine on Dentin Bonding Strength
Judyth Lee, D14 (p. 52)
Effect of Loupes on Ocular Blue Light Hazard: Direct Viewing
Jennie Leikin, D15 (p. 53)
Geriatric Patients Dental Care and Eldercare Method: A Survey
Daniel Lim, D15 (p. 54)
Evaluation of Full Mouth Extraction and Selected Risk Factors in Intellectually/Developmentally Disabled
Patients Treated Under General Anesthesia
Wei Liu, D14 (p. 55)
Microleakage Evaluation of Adhesives Thickness Based on Clinical Radiologic Appearance
Andrew Luccio, D13 (p. 56)
Prevalence, Diagnosis, and Treatment of Peri-Implant Mucositis and Peri-Implantitis: A Survey of
U.S. Periodontists
Claire McCarthy, D15 (p. 57)
Wdr43, a Ribosome Biogenesis Factor, Regulates Zebrafish Neural Crest Development
Natalie McClain, D15 (p. 58)
Oral Health and Body Mass Index of Intellectually/Developmentally Disabled Adults
Tufts University School of Dental Medicine
11
Predoctoral Student Presentations by Author
Kyler McEwen, D14 (p. 59)
Dentin Shear Bond Strength of RMGI Cements
Amanda Merikas, D15 (p. 61)
Contact Angle and Shear Bond Strength Tests of Silane Primers
Courtney Michelson, D14 (p. 62)
Optimal Silk Coating Parameters for Dental Implants
Michael Neglia, D13 (p. 63)
Comparing Composite Wear Rates in Simulated Oral Media
Joann O’Brien, D15 (p. 64)
Growth Factor Secretion and In Vitro Repair Potential of Diabetic Foot Ulcer Fibroblasts
Austin Perera, D15 (p. 65)
Adherence of Silk Coatings to Titanium Treatments
Jeremy Plourde, D13 (p. 66)
Using 3D Imaging Software to Measure Marginal/Internal Fit of All-Ceramic Crowns
Shruti Pore, D14 (p. 67)
E-Cadherin Suppression Alters Dab2-Mediated Endocytosis in Squamous Cell Carcinoma Cells
Kasun Rajapaksha, D14 (p. 68)
Remineralization Efficacy of Different Concentrations of Xylitol Gum
Errol Ramos, D13 (p. 69)
Effect of Loupes on Ocular Blue Light Hazard: Indirect Viewing
Jaskaren Randhawa, D14 (p. 70)
Analyzing the Trends and Associated Management Outcomes of Oral Lesions and Medication Regimens among
the HIV-Positive Patient Population at Tufts University School of Dental Medicine
Laura Rein, D13 (p. 72)
Community Engagement in Global Oral Health Outreach Project Development
Sepideh Sabooree, D15 (p. 73)
Shear Bond Strength of Self-Adhesive Resin Cement Above/Below CEJ
Tej Shah, D15 (p. 74)
Automated Teeth Segmentation in Bitewing Radiographs Using Various Algorithms
Leslie Slowikowski, D14 (p. 75)
Oral Health and Diet Scores in Preschool Asian Children
Jesse Small, D15 (p. 76)
In Vitro Studies of a New Zirconium Alloyed Titanium for Implant Dentistry
Erica Stutius, D13 (p. 77)
Developmentally Disabled Adults Treated under General Anesthesia: Periodontitis and Correlates
12
Student and Faculty Research Abstracts 2012 –2013
Predoctoral & Postdoctoral Student Presentations by Author
Dane Swenson, D15 (p. 78)
Microtensile Bond Strength to Ground Enamel by Sealant Materials
Tracy Tat, D15 (p. 79)
Evaluating the Utility of Salivary Biomarkers as a Clinical Tool in Diagnosing Patients with
Temporomandibular-Disorder-Related Pain
Ramesh Thondapu, D14 (p. 80)
Effect of Accent on Marginal/Internal Fit of CAD/CAM All-Ceramic Crowns
Michelle Tsao, D14 (p. 81)
Microleakage of All-Ceramic Crowns across Three Classes of Luting Cements
Bianca Velayo, D15 (p. 82)
Using Pre-Clinical Dental Performance as an Indicator of Clinical Performance
Michelle Webb, D14 (p. 83)
The Reporting and Recognition by Healthcare Providers of Child Abuse and Neglect in the Latino Population:
Evidence-Based Study
Esther Yun, D14 (p. 84)
Comparison between One versus Two Occlusal Appliances in TMD Population
POSTDoctoral STUDENT PRESENTATIONS
Mohammed Alasqah (Periodontology) (p. 85)
The Influences of Implant Geometry and Surface Composition on Bone Response
Jehan AlHumaid (Pediatric Dentistry) (p. 86)
Comparison of the D-Termined Program and Standard Behavior Guidance Approaches for Children with
Autism Spectrum Disorder in Dentistry
Ghada Ali (MS) (p. 87)
Prevalence of Depression Symptoms among Patients with Obstructive Sleep Apnea: A Retrospective Analysis
Farrah Beg and Diran Balekian (General Practice Residency) (p. 88)
Incidence of Endocarditis in Down’s Syndrome Patients
Sanjeet Chaudhary (Oral and Maxillofacial Surgery) (p. 89)
A Prospective, Randomized, Controlled Clinical Trial of Two Different Sedation Sequences for Removal of
Third Molars in Adults
Irina Dragan (Periodontology) (p. 90)
Comparison of the Prevalence of Missing Teeth among Different U.S. Dental Schools
Rabie El Huni (Implant Fellowship) (p. 91)
The Effect of Different Dental Ceramic Systems on the Wear of Human Enamel: In Vitro Study
Harneet Grewal (Pediatric Dentistry) (p. 93)
Force Decay of Orthodontic Elastomeric Chains: A Product Comparison Study
Tufts University School of Dental Medicine
13
Postdoctoral Student Presentations by Author
Jamie Holden and Marion Hernon (General Practice Residency) (p. 94)
Dental Abscesses in the Non-Communicative Patient
Robert Reti (Oral and Maxillofacial Surgery) (p. 95)
Case of Spontaneous Gingival Bleeding
Eileen Saunders (Pediatric Dentistry) (p. 96)
Pediatricians’ Knowledge of Oral Health Promotion in New England: A Survey
Hitesh Tolani (General Practice Residency) (p. 97)
Dental Outreach in South End Churches
Aundrea Vereen (Prosthodontics and Operative Dentistry) (p. 97)
Assessment of Occlusal Stability with the Assistance of Wireless Electromyographic Tools
14
Student and Faculty Research Abstracts 2012 –2013
Faculty Abstracts by Subject Area
Faculty AbstractS
Note: Names marked with an asterisk denote presenter of paper.
Anesthesiology
Salivary Cortisol, Salivary Alpha Amylase, and the Dental Anxiety Scale (p. 98)
Hana Sadi, Matthew Finkelman, and Morton Rosenberg
Inferior Alveolar Nerve Block and Third-Molar Agenesis: A Retrospective Clinical Study (p. 98)
Jerry Swee, Anthony R. Silvestri Jr., Matthew D. Finkelman, Alfred P. Rich, Stanley A. Alexander, and
Cheen Y. Loo
BEHAVIORAL, EPIDEMIOLOGIC, AND HEALTH SERVICES RESEARCH
The Effect of Premarital Sex on Sexually Transmitted Infections (STIs) and High Risk Behaviors in Women
(p. 99)
Musie S. Ghebremichael and Matthew D. Finkelman
Nutritional Status of Highland and Lowland Children in Ecuador (p. 99)
Sozina Katuli, Zuhair S. Natto, Lawrence Beeson, and Zayda R. Cordero-Macintyre
Neural Correlates of Conventional and Care-Based Moral Decision-Making (p. 100)
Kelly K. Leong,* S.F. White, and R.J.R. Blaire
Knowledge of Oral Health in Caregivers of Developmentally Disabled Adults (p. 100)
Paula Minihan, John Morgan,* Angel Park, Konstantina Yantsides, Matthew Finkelman, Paul Stark, and
Aviva Must
The Oral Health Status of 4,732 Adults with Intellectual and Developmental Disabilities (p. 101)
John Morgan, Paula Minihan, Paul Stark, Matthew Finkelman, Konstantina Yantsides, Angel Park,
Carrie Nobles, Wen Tao, and Aviva Must
Position of the Academy of Nutrition and Dietetics: the Impact of Fluoride on Health (p. 102)
Carole A. Palmer and Joyce Ann Gilbert
Self-Reported Oral Cancer Screening by Smoking Status in Maryland: Trends over Time (p. 102)
Archana Viswanath, Timothy J. Kerns, John D. Sorkin, Diane M. Dwyer, Carmela Groves, and
Eileen K. Steinberger
Patients’ Expectations about Effects of Chemotherapy for Advanced Cancer (p. 103)
Jane C. Weeks, Paul J. Catalano, Angel Cronin, Matthew Finkelman, Jennifer W. Mack, Nancy L. Keating, and
Deborah Schrag
CANCER BIOLOGY AND TISSUE ENGINEERING
Three Dimensional Tissues as Powerful Tools for Cancer Research (p. 104)
Addy Alt-Holland, Michael Dame, and Brad Upham
Multidisciplinary Approaches for Answering Biological Questions (p. 104)
Addy Alt-Holland, Michael Fay, and Kolla Kristjansdottir
Advanced Microscopy Analysis of Cells and Tissues (p. 104)
Addy Alt-Holland and M. Walter
Design and Characterization of an EHD1 Inhibitor (p. 105)
Jim Baleja, Tiffany Corlin, Alyssa Kamens, Addy Alt-Holland, and Joshua Kritzer
Tufts University School of Dental Medicine
15
Faculty Abstracts by Subject Area
In Vitro 3D Full-Thickness Skin-Equivalent Tissue Model Using Silk and Collagen Biomaterials (p. 105)
Evangelia Bellas, Miri Seiberg, Jonathan Garlick, and David Kaplan
Alterations in Endocytic Proteins and Cell Morphology are Associated with Loss of Dab2 in Squamous
Cell Carcinoma (p. 106)
Elizabeth Bingham, Shruti Pore, Anna Maione, Jonathan Garlick, Jim Baleja, and Addy Alt-Holland
Dental Pulp Stem Cell-Epithelial Interactions in 2D and 3D Co-culture (p. 106)
Benjamin M.F. Chan, Anna Maione, Julia Caine, Elana Knight, Avi Smith, Yulia Shamis, Behzad Gerami-Naini,
G.T. Huang, and Jonathan A. Garlick
A Pilot Study of the Photoprotective Effect of Almond Phytochemicals in a 3D Human Skin Equivalent
(p. 107)
Julie A. Evans-Johnson, Jonathan A. Garlick, Elizabeth J. Johnson, Xiang-Dong Wang, and C.-Y. Oliver Chen
Review: Trophoblast Differentiation from Human Embryonic Stem Cells (p. 107)
T.G. Golos, M. Giakoumopoulos, and Behzad Gerami-Naini
Cellular Reprogramming to Reset Epigenetic Signatures (p. 108)
Kyle J. Hewitt and Jonathan A. Garlick
Strategies for Oral Mucosal Repair by Engineering 3D Tissues with Pluripotent Stem Cells (p. 108)
Kyle J. Hewitt, Yulia Shamis, Behzad Gerami-Naini, and Jonathan A. Garlick
Reprogramming Diabetic Foot Ulcer-Derived Fibroblasts to Improve Chronic Wound Repair (p. 109)
Anna G. Maione, Behzad Gerami-Naini, L. Park, Avi Smith, Vanessa Yanez, F. Tecilazich, E. Leal, Andreia
Gianotti-Sommer, Gustavo Mostoslavsky, Aristidis Veves, C. Kearney, D.J. Mooney, and Jonathan A. Garlick
Dab2 Role in Promoting the Pathogenesis of Human Skin Squamous Cell Carcinoma (p. 110)
Shruti Pore, Elizabeth Bingham, Anna G. Maione, Jonathan Garlick, Jim Baleja, and Addy Alt-Holland
E-Cadherin Loss Modifies Endocytic Processes in Human Squamous Cell Carcinoma Cells (p. 110)
Shruti Pore, Elizabeth Bingham, Tanja Petnicki-Ocwieja, Jonathan Garlick, Jim Baleja, and Addy Alt-Holland
RalA: A Double Edged Sword in Skin Squamous Cell Carcinoma (p. 111)
Adam G. Sowalsky, Addy Alt-Holland, Jonathan Garlick, and Larry A. Fieg
Characterization of the Wound Healing Profile of Diabetic Foot Ulcer (p. 112)
Vanessa Yanez, Julia Caine, Elana Knight, Anna Maione, David Mooney, Avi Smith, Jonathan Garlick, and
Aristidis Veves
In vitro Wound Healing Potential of Diabetic Foot Ulcer Fibroblasts (p. 112)
Vanessa Yanez, Anna Maione, Elana Knight, and Jonathan Garlick
CARIOLOGY RESEARCH
Fluoride Release from Uncoated and Coated Glass Ionomer Materials (p. 113)
Chanook D. Ahn,* Julianna Bair, Eunice Lee, Matthew Finkelman, Masly Harsono, Ronald Perry, and
Gerard Kugel
The Effect of Protective Factors on Shifting Caries Risk Classification (p. 114)
Tofool Al Ghanem* and Paul C. Stark
Predictors of Coronal Caries Progression in Adults: Results from the Prevention of Adult Caries Study
(p. 115)
Mabi Singh, Athena Papas, William Vollmer, James Bader, Reesa Laws, Gerardo Maupome, John Snyder, and
Peter Blanchard
16
Student and Faculty Research Abstracts 2012 –2013
Faculty Abstracts by Subject Area
CRANIOFACIAL BIOLOGY
Hemicrania Continua Should Not Be Classified as a Trigeminal Autonomic Cephalalgia (p. 116)
Egilius L. H. Spierings
Comparison between One versus Two Occlusal Appliances in TMD Population (p. 116)
Esther Yun, Brijesh Chandwani, Matthew Finkelman, and Noshir Mehta
Lineage-Specific Transcriptional Regulation of DICER by RUNX2 in Osteogenesis Process (p. 117)
Leilei Zheng, S. Meng, L. Yu, L. Zhang, Qisheng Tu, and Jinkun Chen
DENTAL MATERIALS
The Effect of Variations in Translucency and Background on Color Differences in CAD/CAM Lithium
Disilicate Glass Ceramics (p. 118)
Abdulaziz Al Ben Ali, Kiho Kang, Matthew D. Finkelman, Roya Zandparsa, and Hiroshi Hirayama
The Influence of Different Convergence Angles and Resin Cements on the Retention of Zirconia Copings
(p. 119)
Ala O. Ali, J. Robert Kelly, and Roya Zandparsa
SBS of Lithium Disilicate and Zirconia Ceramic Luted to Dentin (p. 119)
Christian Benitez,* Alyssa Fernandez, Matthew Finkelman, R. Ritter, Masly Harsono, and Gerard Kugel
Shear Bond Strengths of Adhesives on Both Enamel and Dentin (p. 120)
Alyssa Fernandez,* Christian Benitez, Matthew Finkelman, R. Ritter, Masly Harsono, and Gerard Kugel
Marginal Staining of Composite Bonded with Resin and RMGI Adhesives (p. 121)
Nicolas Freda, Michael Neglia, Catherine DeFuria,* Matthew Finkelman, Gerard Kugel, and Ronald Perry
Effectiveness of Cleaning Product on SBS (Lithium Disilicate/Zirconia) to Dentin (p. 122)
Stephanie John, Vishavjeet Girn,* Masly Harsono, Gerard Kugel, and Ronald Perry
Flexural Loading Strength of Provisional Restorative Material (p. 122)
Stephanie John,* Masly Harsono, and Ronald Perry
One Year Clinical Evaluation of an Experimental Self-Adhering Composite (p. 123)
Britta Magnuson, Masly Harsono,* Matthew Finkelman, Shradha Sharma, Susana Ferreira, Susan Macdonald,
Gerard Kugel, and Ronald D. Perry
Electrogel Silk Coating Interfaces on Dental Implants In Vitro (p. 124)
Courtney D. Michelson,* Austin Perera, Roberto Elia, Masly Harsono, Gary G. Leisk, Hans P. Weber, David
Kaplan, Matthew Finkelman, and Gerard Kugel
Consistency and Extrusion Force of Different Retraction Paste Materials (p. 125)
David Nill,* Ashley Brown, Masly Harsono, and Ronald Perry
Effectiveness of Shields in Reducing the Ocular Blue Light Hazard (p. 125)
Errol Ramos, Judyth Lee, Ashley Brown,* Richard Price, Ronald Perry, and Gerard Kugel
Comparison of Dimensional Accuracy of Digital Dental Models (p. 126)
Haitham Subeihi,* Hiroshi Hirayama, Matthew Finkelman, Roger G. Galburt, and Hans P. Weber
Evaluation of Surface Roughness as a Function of Multiple Blasting Processing Variables (p. 127)
Guilherme B. Valverde, Ryo Jimbo, Hellen Teixeira, Estevam A. Bonfante, Malvin N. Janal, and Paulo G. Coelho
Tufts University School of Dental Medicine
17
Faculty Abstracts by Subject Area
An In Vitro Comparison of Shear Bond Strength of Zirconia to Enamel Using Different Surface Treatments
(p. 128)
Roya Zandparsa, Nayrouz A. Talua, Matthew D. Finkelman, and Scott Schaus
DIAGNOSTIC SCIENCES
Assessing Use of a Standardized Dental Diagnostic Terminology in an Electronic Health Record (p. 129)
Oluwabunmi Tokede, Joel White, Paul Stark, Ram Vaderhobli, Muhammad F. Walji, Rachel Ramoni,
Meta Schoonheim-Klein, Nicole Kimmes, Anamaria Tavares, and Elsbeth Kalenderian
The Computerized Adaptive Diagnostic Test for Major Depressive Disorder (CAD-MDD):
A Screening Tool for Depression (p. 129)
Robert D. Gibbons, Giles Hooker, Matthew D. Finkelman, David J. Weiss, Paul A. Pilkonis, Ellen Frank,
Tara Moore, and David J. Kupfer
Education Research
Comparison of the Most Commonly Performed Procedures at Four Dental Schools (p. 131)
Pinelopi Pani, Eduardo Marcuschamer, Irina F. Dragan, Paul Levi, and Paul C. Stark
An Analysis of Patient Grievances in a Dental School Clinical Environment (p. 131)
Amit Sachdeo, Svetlana Konfino, Ross U. Icyda, Matthew D. Finkelman, Harish Gulati, Peter Arsenault, and
James Hanley
Case Based Patient Simulation Projects: Are They Helpful? (p. 132)
Yun Saksena
Treatment Planning in Dentistry Using an Electronic Health Record: Implications for Undergraduate
Education (p. 132)
Oluwabunmi Tokede, Muhammad Walji, Rachel Ramoni, Joel M. White, Meta Schoonheim-Klein,
Nicole S. Kimmes, R. Vaderhobli, Paul C. Stark, V.L. Patel, and Elsbeth Kalenderian
An Innovative HIV Training Program for Dental Hygiene Students (p. 133)
Periza Zaninovic, Zuhair S. Natto, Rodney L. Turner, Gerardo A. Toledo, Graciela G. Duran, James R. Trott,
and Thomas C. Rogers
Endodontics RESEARCH
Outcomes of Hospitalizations Attributed to Periapical Abscess from 2000 to 2008:
A Longitudinal Trend Analysis (p. 134)
Andrea Shah, Kelly K. Leong, Min Kyeong Lee, and Veerasathpurush Allareddy
geriatric oral RESEARCH
Mortality Data Thirty Years after Nutrition and Oral Health Study (p. 135)
Athena S. Papas, Pamela Corrado, and Jamie LaPierre*
IMPLANTOLOGY RESEARCH
The Influence of Implant Geometry and Surface Composition on Bone Response (p. 136)
Abdullah AlFarraj Aldosari, Sukumaran Anil, Mohammed Alasqah, Khalid A. Al Wazzan, Samer A. Al Jetaily,
and John Jansen
Comparision of Crestal Bone Level Changes Surrounding Five, Six and Eight MM Long PlatformSwitching Implants (p. 136)
Irina F. Dragan, S.K. Chuang, M. McKenna, and R.A. Urdaneta
18
Student and Faculty Research Abstracts 2012 –2013
Faculty Abstracts by Subject Area
The Correlation between the Nonsteroidal Anti-Inflammatory Drugs and the Changes in Crestal Bone Levels
Surrounding Dental Implants (p. 137)
Irina F. Dragan and R.A. Urdaneta
Optimal Silk Coating Parameters for Dental Implants (p. 138)
Roberto Elia,* Courtney Michelson, Austin Perera, Masly Harsono, Gary Leisk, David Kaplan,
Matthew Finkelman, and Gerard Kugel
NSAIDs and Crestal Bone Levels Surrounding Dental Implants: A Meta-Analysis (p. 139)
Irina Dragan,* R.A. Urdaneta, and Paul Stark
Bone Morphometric Evaluation around Immediately Placed Implants Covered with Porcine-Derived
Pericardium Membrane: An Experimental Study in Dogs (p. 139)
Ryo Jimbo, Charles Marin, Lukasz Witek, Marcelo Suzuki, Nick Tovar, Ioana Chesnoiu-Matei,
Irina Florentina Dragan, and Paulo G. Coelho
Electrogel Silk Coating Interfaces on Dental Implants In Vitro (p. 140)
Courtney Michelson, Austin Perera, Roberto Elia, Masly Harsono, Gary Leisk, Hans P. Weber, David Kaplan,
Matthew Finkelman, and Gerard Kugel
A Clinical Evaluation of Alveolar Bone Resorption after GBR (p. 141)
Yumi Ogata,* Matthew Finkelman, and Yong Hur
Porcine Pericardium Membrane around Immediately Placed Implants: An Experimental Study in Dogs
(p. 142)
H.S. Texeira, N. Tovar, C. Marin, R. Granato, L. Witek, I. Chesnoiu-Matei, Irina F. Dragan, Marcelo Suzuki,
R. Jimbo, and P.G. Coelho
Methodology and clinical trials
Prompt-Based Data Entry and Programming-Scripts to Reduce Data Entry Error (p. 143)
Joseph Kubiak III*
Detection and Characterization of Usability Problems in Structured Data Entry Interfaces in Dentistry
(p. 143)
Muhammad F. Walji, Elsbeth Kalenderian, Duong Tran, Krishna K. Kookal, Vickie Nguyen,
Oluwabunmi Tokede, Joel M. White, Ram Vaderhobli, Rachel Ramoni, and Paul C. Stark
microbiology/immunology
Comprehensive Analysis of Aerobic and Anaerobic Bacteria on Dental Bib Clips at the Hygiene Clinic
(p. 145)
Addy Alt-Holland, Christina M. Murphy, Anne Powers, Claire L. Kublin, Youjin Natalie Jeong, Michelle
DiMattia, Linh Pham, Angel Park, Matthew Finkelman, Maureen Lombard, James B. Hanley, Bruce J. Paster,
and Gerard Kugel
Patient Napkin Holders—Is There Potential Risk for Cross-Contamination? (p. 145)
Addy Alt-Holland,* Christina M. Murphy, Sreedevi Srinivasan, Rebekah Lucier, Claire L. Kublin, Jennifer M.
Fong, Joshua Goldfein, David L. Baker, Angel Park, Matthew Finkelman, Toshihisa Kawai, Bruce J. Paster, and
Gerard Kugel
Do Bib Clips Pose a Cross-Contamination Risk at the Dental Clinic? (p. 146)
Addy Alt-Holland, Sreedevi Srinivasan, Rebekah Lucier-Pryles, Claire L. Kublin, Jennifer M. Fong,
Joshua Goldfein, David L. Baker, Angel Park, Matthew Finkelman, Toshihisa Kawai, Bruce J. Paster,
and Gerard Kugel
Tufts University School of Dental Medicine
19
Faculty Abstracts by Subject Area
MINERALIZED TISSUE
Regulation of Energy Metabolism by Bone Sialoprotein, a Novel Endocrine Mechanism (p. 147)
Jake Chen, Yuwei Wu, Shu Meng, and Qisheng Tu
Modulating Osteogenic Differentiation of Induced Pluripotent Stem (iPS) Cells through Direct Inhibition of
SOX9 by MicroRNA-335-5p and MicroRNA-342-3p (p. 147)
Mengqi Huang, Yuhua Hu, Qisheng Tu, and Jake Chen
Inflammatory Cytokine Expression and RANKL-Induced Osteoclastogenesis Are Down Regulated by BRD4
Inhibitor, JQ1 (p. 148)
Shu Meng and Jake Chen
Suppressive Effects of BRD4 Inhibitor on Inflammatory Cytokine Expression and RANKL-Induced
Osteoclastogenesis (p. 149)
Shu Meng, Lan Zhang, Qisheng Tu, and Jake Chen
Epigenetic Therapy for Experimental Periodontitis in a Mouse Model (p. 149)
Shu Meng,* L. Zhang, Leilei Zheng, Kian Azarnoush, Qisheng Tu, and Jinkun Chen
Epigenetic Regulation of Osteogenic Transcription Factor SATB2 by PHF8, a Jumonji Family
Histone Demethylase (p. 150)
Qisheng Tu, Yuwei Wu, Shu Meng, Liming Yu, and Jake Chen
Central Roles of Adiponectin on Bone Formation through a Hypothalamic Relay (p. 151)
Yuwei Wu, Qisheng Tu, Jin Tang, Dana Murray, Jessica Cheng, Maribel Rios, Zhihui Tang, and Jake Chen
Adiponectin Promotes Bone Formation through a Novel Signal Mechanism (p. 152)
Liming Yu,* Qisheng Tu, and Jinkun Chen
Dual Effects of Adiponectin During Osteoblast Differentiation Through pSmad1/5/8 Signaling Pathway
(p. 152)
Liming Yu, Qisheng Tu, and Jake Chen
Adiponectin Recruits Osteoblastic Niche Cells through a Novel Mechanism (p. 153)
Liming Yu, Qisheng Tu, Qianqian Han, Lan Zhang, Leilei Zheng, Shu Meng, Jin Tang, Dana Murray,
Jessica Cheng, and Jake Chen
Isopsoralen Inhibits RANKL-Induced Osteoclastic Differentiation of RAW264.7 Cells by Suppressing
c-fos-NFATc1 (p. 154)
Jin Zhang, Shu Meng, Yuwei Wu, Liming Yu, Lan Zhang, Mengqi Huang, Qisheng Tu, and Jake Chen
Exercise Strengthens Bone through Myokine Irisin (p. 154)
Jin Zhang, Yuwei Wu, Liming Yu, Shu Meng, Lan Zhang, Mengqi Huang, Qisheng Tu, and Jake Chen
Effect of Adiponectin on the Expression of its Specific Receptor 1/2 in Osteoblasts and Osteoclasts under
Inflammatory Conditions (p. 155)
Lan Zhang, Qisheng Tu, Shu Meng, and Jake Chen
Animal Models for Jaw and Tooth Regeneration (p. 155)
Weibo Zhang, Pamela Yelick,* Viktoria Andreeva, Betsy Vazquez, Peter Kovach, and Erin Smith
20
Student and Faculty Research Abstracts 2012 –2013
Faculty Abstracts by Subject Area
NEUROSCIENCE/TMJ
Fat-Derived Adiponectin Enhances Bone Formation through the Central Nervous System (p. 157)
Yuwei Wu, Qisheng Tu, Jin Tang, Dana Murray, Jin Zhang, Jessica Cheng, Maribel Rios, Elise Morgan, Tao Xu,
Zhihui Tang, and Jake Chen
ORAL HEALTH RESEARCH
Water Flosser vs. Floss: Comparing Reduction in Bleeding Around Implants (p. 158)
Britta Magnuson,* Masly Harsono, Jacob Silberstein, Paul Stark, and Ronald Perry
Combination Hygiene Effects on Daytime Plaque with Ongoing Dental Treatment (p. 159)
Sujey Rodriguez-Lozano,* Hiroshi Hirayama, Gerard Kugel, M.L. Barker, Robert W. Gerlach, and Hans P. Weber
ORAL SURGERY RESEARCH
Morbidity and Mortality Associated with Tracheotomy Procedure in a University Medical Center (p. 160)
Daniel Oreadi and E. R. Carlson
Periimplant Tissue Response Following Connective Tissue Augmentation and Bone Grafting Procedure in
Conjunction with Immediate Single Implant Placement in the Aesthetic Zone: A Multicenter Study (p. 160)
A. Mastrorosa Agnini, M. Salama, A. Agnini, H. Salama, Irina F. Dragan, and D. Garber
A Prospective, Randomized, Controlled Trial of Two Different Sedation Sequences for Third Molar Removal
in Adults (p. 161)
Daniel Oreadi,* Ruba Khader, Matthew Finkelman, Marcin Jarmoc, Sanjeet Chaudhury, Roman Schumann, and
Morton Rosenberg
Alveolar Bone Dimensional Changes Following Tooth Extraction in Sites Treated With or Without PTFE
Membranes: A Histological Study in Dogs (p. 162)
H.S. Texeira, N. Tovar, C. Marin, I. Chesnoiu-Matei, Irina F. Dragan, and P.G. Coelho
ORTHODONTICS
The Role of Occlusal Curvatures and Maxillary Arch Dimensions in Patients with Signs and Symptoms of
Temporomandibular Disorders (p. 163)
Georgios Kanavakis and Noshir Mehta
PEDIATRIC DENTISTRY RESEARCH
Effectiveness of the D-Termined Program for Managing Children with Autism (p. 164)
Jehan AlHumaid, David Tesini, Matthew Finkelman, and Cheen Loo
Investigation of Failed Appointments Following Dental Emergencies in a Metropolitan Pediatric Population
(p. 164)
Sarah AlMugairin, P. Rattan, N. Gupte, and Cheen Y. Loo
Effect of Varnish, Sealant and Infiltrant on Proximal Caries Progression (p. 165)
Suha AlTounsi, Masly Harsono, Ronald Perry, Alfred Rich, Matthew Finkelman, and Cheen Y. Loo
Maxillary First Molar Distalization Using Two Techniques (p. 165)
Russel T. Choy, Harneet Grewal, Cheen Y. Loo, and Stanley Alexander
Force Decay of Orthodontic Elastomeric Chains—A Product Comparison Study (p. 166)
Harneet Grewal, Kasun Rajapaksha, Masly Harsono, Angel Park, Matthew Finkelman, and Stanley A. Alexander
Tufts University School of Dental Medicine
21
Faculty Abstracts by Subject Area
Effectiveness of an Oral Health Education Program for Pregnant Women (p. 166)
Ester Kim, Devina Shah, and Cheen Loo
Treatment of Mucocele Using Diode Laser: Two Case Reports (p. 167)
Ayman Sulimany, Cheen Loo, Azin Tarifard, and M. Kaplan
Prosthodontic and Orthodontic Management of Ectodermal Dysplasia: A Case Report (p. 167)
Azin Tarifard, Stanley Alexander, and Marcelo Suzuki
Cephalometric Evaluation of Shunt-Treated Pediatric Hydrocephalus: A Case Report (p. 167)
Robert Y.L. Zee, Cheen Y. Loo, and Stanley A. Alexander
PERIODONTAL RESEARCH
Increased Levels of Serum and Gingival Crevicular Fluid Monocyte Chemoattractant Protein-1 in Smokers
With Periodontitis (p. 168)
Sukumaran Anil, R.S. Preethanath, Mohammed Alasqah, Sameer A. Mokeem, and Pradeep S. Anand
A Selection of Suture Materials (p. 168)
Yong Hur,* Alice Ko, and Yumi Ogata
Soft-Tissue Alterations following Exposure to Tooth-Whitening Agents (p. 169)
Rebekah N. Lucier, Olivier Etienne, Jonathan A. Garlick, Gerard Kugel, and Christophe Egles
Comparison of Double-Flap Incision to Periosteal Releasing Incision for Flap Advancement:
A Prospective Clinical Trial (p. 169)
Yumi Ogata, Terrence J. Griffin, Alice C. Ko, and Yong Hur
Between-Visit Disclosed Natural Plaque Reproducibility Using Image Analysis (p. 170)
Athena S. Papas, Kristina Hatzipetrou, Elizabeth Tzavaras,* M.L. Barker, and Robert W. Gerlach
Plaque Prevention with SnF2 Paste, Flexible Brush, CPC Rinse Combination (p. 171)
Athena S. Papas, Kristina Hatzipetrou, Elizabeth Tzavaras,* M.L. Barker, and Robert W. Gerlach
Gingival Crevicular Fluid Levels of Interferon-γ, But Not Interleukin-4 or -33 or Thymic Stromal
Lymphopoietin, Are Increased in Inflamed Sites in Patients with Periodontal Disease (p. 171)
Evangelos Papathanasiou, F. Teles, Terrence Griffin, Emilio Arguello, Matthew Finkelman, James Hanley, and
Theoharis C. Theoharides
Enamel Matrix Derivative in Intrabony Defects: Prognostic Parameters of Clinical and Radiographic
Treatment Outcomes (p. 172)
Andreas O. Paraschis, Argy Polychronopoulou, Konstantinos Tsiklakis, and Dimitris N. Tatakis
PHARMACOLOGY, THERAPEUTICS, AND TOXICOLOGY
Image Analysis of Hygiene Regimen Effects on Recession-Site Plaque (p. 173)
Robert W. Gerlach, M.L Barker, Mabi L. Singh,* and Athena S. Papas
One-Year Survival of Deep Carious Restorations (p. 173)
Mabi L. Singh, Athena S. Papas,* V.P. Thompson, and D. Vena
PROSTHODONTICS RESEARCH
A Four-Year Follow-up of All Ceramic Crowns: Prospective Case Series (p. 175)
Ala Ali* and Roya Zandparsa
22
Student and Faculty Research Abstracts 2012 –2013
Faculty Abstracts by Subject Area
The Effect of Translucency of Y-TZP Based All-Ceramic Crowns Fabricated with Different
Substructure Designs (p. 176)
Naota Kumagai, Hiroshi Hirayama, Matthew Finkelman, and Shigemi Ishikawa-Nagai
Delayed Linear Dimensional Changes of Five High Strength Gypsum Products Used for the Fabrication of
Definitive Casts (p. 176)
Konstantinos X. Michalakis, N. Volkan Asar, Vasiliki Kapsampeli, Panagiota Magkavali-Trikka,
Argiris L. Pissiotis, and Hiroshi Hirayama
Biomechanical Considerations on Tooth-Implant Supported Fixed Partial Dentures (p. 177)
Konstantinos X. Michalakis, Pasquale Calvani, and Hiroshi Hirayama
A 3D Image-Superimposition CAD/CAM Technique to Record the Position and Angulation of the Implant
Abutment Screw Access Channel (p. 177)
Jong-Il Park and Tae-Ho Yoon
The Fabrication of a CAD/CAM Ceramic Crown to Fit an Existing Partial Removable Dental Prosthesis:
A Clinical Report (p. 178)
Tae-Ho Yoon and Won-Gun Chang
PULP BIOLOGY AND REGENERATION RESEARCH
Dental Pulp Stem Cell-Epithelial Interactions in 2D and 3D Co-culture (p. 179)
Benjamin Chan,* Anna Maione, J. Caine, E. Knight, Avi Smith, Y. Shamis, Behzad Gerami-Naini, G. Huang, and
Jonathan Garlick
SALIVARY AND LACRIMAL GLAND RESEARCH
Oral Candidiasis in Patients with Saliva Hypofunction (p. 180)
Mabi L. Singh, Pamela Corrado,* Kristina Hatzipetrou, Michelle Colindres, Elizabeth Tzavaras,
Joseph Cimmino, and Athena S. Papas
STATISTICS RESEARCH
Validation of the Survey Instrument Evaluating the Level of Discomfort, Pain, Bleeding and Swelling During
and After Dental Procedures (p. 181)
Irina F. Dragan, Britta Magnuson, and Paul C. Stark
Item Ordering in Stochastically Curtailed Health Questionnaires with an Observable Outcome (p. 182)
Matthew Finkelman, Wonsuk Kim, Yulei He, and Albert Lai
Curtailment and Stochastic Curtailment to Shorten the CES-D (p. 182)
Matthew Finkelman, Niels Smits, Wonsuk Kim, and Barth Riley
A Comparison of Computerized Classification Testing and Computerized Adaptive Testing in
Clinical Psychology (p. 182)
Niels Smits and Matthew D. Finkelman
Comparing the COHRI Dental Data Repository to NHANES Data (p. 183)
Paul Stark,* Angel Park, Duong Tran, Joel White, Elspeth Kalenderian, and Muhammad Walji
Tufts University School of Dental Medicine
23
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Student Presentations and Abstracts
Note: Names marked with an asterisk denote presenter of paper.
PREDOCTORAL STUDENT PRESENTATIONS
Extracellular Matrix Components and Mesenchymal-Epithelial Transition in
Lacrimal Gland Cells
Ivy P. Ahluwalia,* Elizabeth Kaminsky, Victor P. Galli, Nour Kahlil, Samantha You, Claire L.
Kublin, David L. Kaplan, Addy Alt-Holland, and Driss Zoukhri
Objectives: To optimize in vitro culture conditions to induce mesenchymal-epithelial transition (MET) in
lacrimal gland mesenchymal stem cells (MSCs).
Methods: Cryopreserved MSCs isolated from injured lacrimal gland explants were cultured under routine
conditions. Cells were seeded on either silk scaffold or tissue culture plates coated with one of the following
extracellular matrix (ECM) proteins: collagen type I, laminin, or fibronectin. Cells seeded without ECM gel
served as controls. Cells were harvested and either snap-frozen in optimal cutting temperature compound
(Tissue-tek) for immunohistochemistry (IHC) or fixed in TRIzol reagent (Invitrogen) for reverse transcription
polymerase chain reaction (RT-PCR).
Histological samples were sectioned at
15 μm on a cryostat. Mesenchymal cell
marker primers used for RT-PCR included:
N-cadherin, Vimentin, and Snai1. Epithelial
cell marker primers used included: E-cadherin,
Cytokeratin 8, and aquaporin 5. Expression of
the housekeeping gene G3PDH was used as an
internal control for RT-PCR.
Results: Histological sections demonstrate
that the cells attached to the silk scaffolds.
The cells frequently form a multilayer on
the scaffold. Cells seeded on collagen 1 and
fibronectin-coated plates showed increased
expression of epithelial markers. After 14 days
of culture, cells grown on laminin-coated
dishes showed a modest increase in epithelial gene expression over control. N-cadherin expression displayed
a slight decrease suggesting cells grown on laminin may be entering MET but expression of an additional
mesenchymal marker, Snai1, was increased in these same cells.
Conclusion: Cells grown on laminin showed a time-dependent increase in the expression of epithelial
markers, as well as a potential loss of mesenchymal markers. Longer in vitro incubations and incorporation of
growth factors may help identify optimal conditions under which these MSCs would transition to epithelial
cells.
Funded by NIH R01 EY012383. Also presented at the 2013 IADR/AADR/CADR General Session in Seattle,
Washington. Abstract #3946.
24
Student and Faculty Research Abstracts 2012 –2013
Epigenetic Therapy for Experimental Periodontitis in a Mouse Model
Kian Azarnoush,* Shu Meng, Lan Zhang, Leilei Zheng, Qisheng Tu, and Jake Chen
Objectives: BRD4 (Bromodomain-containing protein 4), a member of the BET family of proteins, plays
a key role in epigenetic regulation of genes controlling cell cycle progression, cancer development, and
inflammation. A newly discovered, cell permeable molecule named JQ1 specifically binds to and displaces BRD4
from chromatin therefore downregulating its function. This present study aims to investigate the epigenetic
regulatory effects of the BRD4 inhibitor JQ1, on the induced inflammatory response and bone destruction in
experimental periodontitis.
Methods: Twelve-week-old male C57BL/6J mice were randomly assigned into control group (n=12),
periodontitis group (n=11), and therapy group (n=8). Mice in periodontitis and therapy groups received
periodontal ligature around the maxillary second molars and daily oral inoculation of P. gingivalis. Mice in the
therapy group were subjected to JQ1 intraperitoneal injection daily (50 mg/kg), while mice in periodontitis
group were injected with vehicle (5% DMSO). After 10 days, gingival tissues were collected and inflammatory
cytokines were analyzed by
real-time PCR. The alveolar
bone loss was measured at
6 sites around the maxillary
second molars.
Results: The levels of
inflammatory cytokines,
including pro-inflammatory
IL-1beta, IL-6, IL-17, TNFalpha, and anti-inflammatory
IL-10 and TGF-beta, were
significantly increased in
diseased gingival tissues. JQ1
administration significantly
suppressed pro-inflammatory
cytokine production. The
increase of RANKL and
MMP-9 levels in gingival
tissues with periodontitis were inhibited by JQ1 therapy. The alveolar bone loss of control, periodontitis, and
therapy group was 0.12±0.04 mm, 0.31±0.06 mm, 0.22±0.02 mm, respectively. JQ1 treatment significantly
suppressed periodontal bone destruction caused by inflammatory response.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: This present study is the first to demonstrate that BRD4 inhibition by JQ1 significantly
suppresses inflammatory cytokine expression and alveolar bone destruction in experimental periodontitis.
These results suggest the potential of BRD4 regulation as a novel therapeutic approach in treating clinical
periodontitis in the future.
This project was supported by NIH grants DE16710 and DE21464 to JC.
Tufts University School of Dental Medicine
25
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Shear Bond Strength of Resin Cements to Dentin and Enamel
Julianna Bair,* Sapan Bhatt, Ronald D. Perry, and Gerard Kugel
Objectives: The purpose of this in vitro study was to compare different adhesive resin cements regarding the
degree of bond strength to dentin and enamel.
Methods: All materials were tested according to manufacturers’ instructions: Multilink Automix (MLA,
Ivoclar Vivadent), Panavia F 2.0 (PANF, Kuraray), Calibra Handmix (CAL, DENTSPLY), RelyX Ultimate
Automix (RUA, 3M ESPE) and RelyX Ultimate Clicker (RUC, 3M ESPE). RUA and RUC are available in self
etch (SE) and total etch modes (TE).
One hundred forty stainless steel cylinders
with 4 mm diameter were sandblasted,
silicated (Rocatec™-Plus) from 10 mm
distance for 15 seconds, and coated with
silane (3M ESPE™ Sil). One hundred
forty bovine teeth were embedded in
epoxy resin (SpeciFix) and the dentin
and enamel surfaces were cut (diamond)
and polished (320 grit sandpaper, wet).
The metal cylinders were then cemented
to each prepared surface (n=10) under
pressure (20 g/mm²) and according to
manufacturers’ instructions. Cements
were light cured (3M ESPE Elipar™ S10)
according to instructions, and specimens were stored 24 h at 36°C and 100% relative humidity. Shear bond
strength (SBS) was tested with a universal testing machine (ZwickZ010, crosshead speed: 0.75 mm/min) and
results were analyzed. Statistical analysis was performed by Minitab (Fisher LSD Multiple Range Test, 95%
confidence level, p<0.05). Values with the same characters are statistically not different.
Results: SBS [MPa±Std Dev]
Cement Materials
MLA
PANF
CAL
RUA-SE
RUA-TE
RUC-SE
RUC-TE
Dentin
24.8±9.8B
22.7±5.0B,C
17.3±9.7C
28.8±7.6B
40.8±4.1A
25.2±7.1B
38.1±5.4A
Enamel
42.5±6.4c
41.5±7.1c
48.5±6.0b
45.1±5.4b,c
61.1±4.6a
43.6±4.3b,c
65.0±5.8a
Conclusion: The adhesive resin cements RUA and RUC in total etch modes showed highest bond strength
for both dentin and enamel. CAL showed relatively low bond strength to dentin. Higher bond strength may
indicate better clinical performance.
Sponsored in part by 3M ESPE. Also presented at the 2013 IADR/AADR/CADR General Session in Seattle,
Washington. Abstract #3042.
26
Student and Faculty Research Abstracts 2012 –2013
Assessing Surface Roughness on Composite Restorations Using Different
Abrasive Products
Grant Beyer,*1 Matthew Finkelman,1 Masly Harsono,1 James Vlahakis,2 Gerard Kugel,1 and
Ronald Perry1
1Tufts
University School of Dental Medicine, Boston; 2Tufts University School of Engineering,
Medford, Massachusetts
Objectives: To evaluate the effect of different abrasive discs products on surface roughness of composite
restorations.
Methods: Four groups of ten samples of composite discs were prepared in this study. The samples were
made using a Teflon mold 7.5 mm diameter by 2 mm thick. The mold was placed on top of Mylar strip resting
on a glass slide. After the mold had been filled with composite (Filtek supreme Ultra, 3M ESPE) and packed
with a spatula, another Mylar strip was placed on top of the composite, and a second glass slide was pressed on
top. Samples were cured using a LED light (DEMI, Kerr) for 40 seconds. After being polymerized for 24 hours,
all composite discs were polished down with Sof-Lex Medium grit (3M ESPE) to remove the surface glaze
created from the Mylar strip and to have a
uniformly rough surface (Ra=0.3±0.05).
Samples were then randomly divided
into four groups and polished down
with finishing and polishing discs for 60
second intervals. A slow-speed contraangle handpiece with 18,000 rpm was
used to polish all the samples. The surface
roughness measurements were then taken
with a contact profilometer (Veeco Dektak
6m). A one-way ANOVA was used to test
the mean roughness between groups.
Statistical significance was predetermined
at level p<0.05.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Group
1
2
3
4
Materials
Sof-Lex Fine and Superfine (3M, ESPE)
Vortex 2 (3M, ESPE)
Vortex 1 (3M, ESPE)
Vortex 3 (3M, ESPE)
Mean Ra±SD
0.08347±0.021413
0.055845±0.028003
0.057873±0.012608
0.080196±0.048293
The p-value for one-way ANOVA was 0.099.
Conclusion: There were no significant differences within all groups in terms of mean Ra value.
Supported in part by 3M ESPE. Also presented at the 2013 IADR/AADR/CADR General Session in Seattle,
Washington. Abstract #681.
Tufts University School of Dental Medicine
27
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Shore Hardness and Temperature of VPS Materials during Setting
Sapan Bhatt,* Julianna Bair, Ronald Perry, and Gerard Kugel
Objectives: To investigate the setting of vinylpolysiloxane (VPS) materials through shore hardness A and the
temperature change during setting.
Methods: Four VPS materials (3M ESPE Experimental, Kerr Take 1, DENTSPLY Aquasil, Heraeus Flexitime)
were prepared in metal rings with a diameter of 4.25 cm and height of 0.5 cm. Shore hardness A was measured
with a device according to ASTM D2240. Values were recorded every 15 seconds for 10 minutes, with the value
at 10 minutes representing complete setting. Each VPS material showed a linear behavior between 0 and 80%
final hardness. This range was used to determine the slope at which setting occurred. Mean slope value for each
material (n=6) was calculated. The core temperature for each sample was observed every 15 seconds for 10
minutes (Testo110). The maximum temperature from each sample was recorded (n=6) and the mean for each
material was calculated.
Results: One-way ANOVA tests were conducted on the rates of setting for each product and maximum
temperatures (p<0.05, CI= 95%).
VPS materials
3M ESPE Experimental
Take 1
Aquasil
Flexitime
1Materials
Avg. Slope of Shore A Hardness
50.3A
36.8B
17.3C
19.4C
Avg. Max Temp (°C)
33.1A
27.7B
28.3B
25.4C
with the same letter are not significantly different from each other.
Conclusion: While no strict relationship exists between setting rate and maximum temperature, 3M ESPE
Experimental showed the fastest setting rate and achieved the highest temperature while Heraeus Flexitime
showed the slowest setting rate and lowest maximum temperature. The data suggests that temperature is only
one of several factors that affect setting rate.
Supported in part by 3M ESPE.
Also presented at the 2013 IADR/
AADR/CADR General Session
in Seattle, Washington. Abstract
#3143.
28
Student and Faculty Research Abstracts 2012 –2013
Effects of Dab2 on Endocytic Proteins in Squamous Cell Carcinoma
Elizabeth Bingham,* Shruti Pore, Anna G. Maione, Jonathan Garlick, James Baleja, and
Addy Alt-Holland
Objective: Loss of the tumor suppressor E-cadherin is a hallmark of the advanced stages of squamous cell
carcinoma (SCC). Nevertheless, how loss of cell-cell contacts promotes cell invasion in the onset of SCC is only
partially understood. Disabled-2 (Dab2) is a highly expressed adaptor protein that is involved in endocytosis of
surface proteins, such as beta1 integrins. We recently found that E-cadherin loss is associated with Dab2 downregulation and beta1 integrins up-regulation in SCC cells. Here we studied the correlation between E-cadherin
and the expression of key endocytic proteins in SCC cells and determined the consequence of Dab2 silencing on
tumor cell behavior.
Methods: Dab2, Eps15,
Intersectin, EEA1, and
Rab5 protein levels were
determined in lysates of
E-cadherin competent (II-4)
and E-cadherin suppressed
(II-4-Ecad-) skin SCC cells by
Western blot (WB) analysis.
Cultures were transfected with
si-Dab2-RNA and imaged to
analyze morphological changes.
Dab2 depletion was confirmed
by WB analysis.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: II-4-Ecad- cells
demonstrated reduced
expression of Dab2, Intersectin,
EEA1, and Rab5 proteins
in comparison to E-cadherin competent II-4 cells. Transfection of both cell types with si-Dab2 resulted in
effective reduction of Dab2, Eps15 and Rab5 in II-4-Ecad- cells, while it caused an opposing increase of Eps15
in II-4 cells. Moreover, Dab2 depletion had a dramatic effect on E-cadherin competent II-4 cells; it reverted the
phenotype of well-organized colonies and led to cell separation from each other—a characteristic of E-cadherin
suppressed II-4-Ecad- cell morphology.
Conclusions: Our study revealed that Dab2 plays a key role in the behavior of skin SCC cells, and that its
expression correlates with E-cadherin levels. These findings imply that Dab2 may be a potential biomarker for
other epithelial SCC, such as oral cancer, and may represent a novel target for SCC therapy.
“Tufts Collaborates!” grant awarded to Drs. Alt-Holland and Baleja funded this study. Also presented at the 2013
IADR/AADR/CADR General Session in Seattle, Washington. Abstract #453.
Tufts University School of Dental Medicine
29
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Microabrasion Techniques for Removal on In Vitro
Enamel Demineralization
Stephanie Brue,* Matthew Finkelman, Masly Harsono, and Gerard Kugel
Objective: This study serves to observe technique variations on depths of enamel removal in normal and
early demineralization of enamel (white spots).
Methods: Intact non-carious anterior and premolar human teeth were obtained for this study. Teeth were
sectioned into approximately 4 mm x 4 mm squares and embedded in resin. Samples were polished using
600-grit SiC paper to obtain a flattened enamel surface (Ecomet, Buehler). Samples were randomly assigned
to two groups (n=24): normal (NE) and demineralized enamel (DE). The DE group was immersed in a
demineralizing solution (2.2 mM CaCl2, 2.2 mM KH2PO4, 0.05M acetic acid, pH 4.4) for 96 hours at 37°C to
create the artificial demineralized lesion. Each group was randomly divided into three subgroups (n=8) and
treated with microabrasion material (Opalustre, Ultradent) with variation of techniques: using rubber cup
with heavy pressure (HP), light pressure (LP) and cotton swab with heavy pressure (CS). Pressure was recorded
using a digital scale. All samples were abraded for 60 seconds. The abraded samples were covered with resin
and sectioned longitudinally (Isomet, Buehler). The removal depths were measured under stereo microscope
(Olympus SZX16) with analysis software (Omninet9.0, Buehler). In addition, the microscopic surface geometry
of each group was captured using elastomeric sensor (GelSight). Statistical analysis was done using one-way
ANOVA. Statistical difference was predetermined at p<0.05.
Results:
Normal Enamel
Average
(μm±SD)
Max
Min
Demineralized Enamel
Heavy Pressure
Light
Pressure
Cotton
Swab
Heavy Pressure
Light Pressure
Cotton Swab
65.34±15.87
71.29±5.27
67.98±8.80
244.67±65.95
222.38±47.97
143.82±30.59
81.98
40.72
76.3
61.04
76.98
50.77
318.79
151.78
282.29
157.48
189.24
98.71
Conclusion: There was no statistically
significant difference in using various
techniques on normal enamel. However,
HP and LP groups yielded statistically
significant differences in removal depth
of demineralized enamel when compared
with CS group. When referencing these
techniques on the amount of enamel
removal, a more efficient microabrasion
procedure can be clinically accomplished.
Also presented at the 2013 IADR/AADR/
CADR General Session in Seattle,
Washington. Abstract #3255.
30
Student and Faculty Research Abstracts 2012 –2013
Functional Characterization of alk8 in Zebrafish Mineralized
Tissue Development
Saad Butt,* Peter Kovach, and Pamela Yelick
Objective: Alk8 is an important bone morphogenetic protein (BMP) receptor that is analogous to alk2
in mammals. It has been shown to play a significant role in early dorsal-ventral patterning of zebrafish
embryos and to be active in calcified tissues (tooth and bone) later in development. We wished to determine
more specifically its function in calcified tissue development, after the completion of early embryological
development.
Methods: To perform functional characterizations of alk8 in bone and tooth development, we created heatshock inducible, mCherry tagged constitutively active (CA), dominant negative (DN), and wild type (WT)
alk8 transgenic zebrafish lines. Three transgenic zebrafish groups were heat-shocked for 2 hours a day, 3 days
a week. Two groups, named LTE-5(1) and LTE-6(1), were heat-shocked for 1 month before being immediately
euthanized. The other, LTE-3(3), was heat-shocked for 3 months, and allowed to grow for another month
before euthanization. Mineralized tissues
were evaluated using Alizarin Red/
Alcian Blue staining, histological and
immunohistochemical analyses.
Results: A total of 11 CA-alk8mCherry(+), 7 CA-alk8-mCherry(-), 6
DN-alk8-mCherry(+) and 6 DN-alk8mCherry(-) fish were analyzed. We found
that CA-alk8-mCherry(+) zebrafish
exhibited distinct increased mineralized
tissue formation as compared to CA-alk8mCherry(-), and DN-alk8-mCherry(+)
and (-) groups. In particular, we observed
increased calcification of the caudal
vertebrae, caudal fin vertebrae, and fusion
of the caudal vertebra and hypurals.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: Our preliminary studies indicate that alk8 plays an important role in mineralized tissue
formation, and more specifically that its activation leads to increased bone formation, while inhibition of alk8
signaling resulted in reduced mineralized tissue formation. Ongoing molecular characterizations are being
conducted to determine the key signaling partners participating in this process.
We wish to thank all of the Yelick Lab members for their expert technical assistance and critical scientific input. This
research was supported by NIH/NIDCR R01 DE018043 (PCY). Also presented at the 2013 IADR/AADR/CADR
General Session in Seattle, Washington. Abstract #2593.
Tufts University School of Dental Medicine
31
Bates-Andrews Day Abstracts
32
Predoctoral Student Presentations
Retrospective Evaluation of Parameters Associated with Dental Implant
Failure at Tufts University School Dental Medicine
Paul Levi, Diego Camacho,* James Koehler,* Kimberly Kocak,* and Eduardo Marcuschamer
Objective: The aim of the study is to retrospectively analyze a cohort of patients who had implants placed at
Tufts University School of Dental Medicine (TUSDM) during the academic years 2004–2010 and who sustained
implant failure. This study investigated failure rates as well as possible causes of implant failure. The preimplant findings were reviewed: radiographs, medical history and habits, past and present dental information
(e.g., the history of why the natural tooth was lost), bone graft materials (bone type), previous bone
distribution, bone quality, the size, design and manufacturer of the implant(s), and other parameters that were
discovered in doing the research. Ultimately, through investigation and discovery of implant failure predictors,
present therapies can be improved for future procedures.
Method:
Experimental Design
• Utilizing the electronic dental management software Axium, patient records demonstrating
dental implant placement from 2004 to 2010 were accessed.
• Records involving failed implants were examined.
• Implant failure is defined as implants that had to be removed or implants that exfoliated.
Inclusion Criteria
• ADA Code D6010 (i.e., Surgical placement of implant body: endosteal implant—includes
second stage surgery and placement of healing cap)
• Evidence of Failure
• Diagnostic Radiographs
• Keywords in Case Notes (including but not limited to)
• “Implant failure”
• “Implant removed and/or re-do”
• “No osseointegration”
• “Mobility of implant”
• “Explantation”
• “Patient’s chief complaint”
• Procedure Codes
• D6100 Implant removal
• D7952A Implant salvage
• D6199 Unspecified implant procedure
• D4999 Unspecified periodontal procedure
Exclusion Criteria
• Patients where the information regarding the implant placement and the follow-up is
incomplete enough to not allow a thorough analysis were excluded.
Student and Faculty Research Abstracts 2012 –2013
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #1263.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Tufts University School of Dental Medicine
33
Results:
Year Placed
Implants Evaluated
Implant Failures Per Year
Yearly Implant Failure Rates
2004
242
15
6.2%
2005
911
55
6.0%
2006
910
50
5.5%
2007
1,435
55
3.8%
2008
1,312
35
2.6%
2009
1,136
44
3.8%
2010
1,278
31
2.4%
Total Implant Failure Rate 2004–2010
Total Successful Implants: 95.7%
Total Failed Implants: 4.3%
Conclusion: We found an overall failure rate of 4.3% at Tufts University School of Dental Medicine. We
calculated a failure rate range from 2.4% in 2010 to 6.2% in 2004.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Microleakage of Dental Composites
Matthew Cannavo,* Masly Harsono, and Gerard Kugel
Objective: To compare microleakage between SonicFillTM composite system and conventional
composite technique.
Methods: Forty standard Class II preparations were prepared on sound extracted human third molar teeth
by the same operator. Preparations were approximately 2.0 mm in depth at the occlusal floor and 4.0 mm in
depth at the gingival floor. Samples were randomly assigned into two groups (n=20). Two composite systems
were tested: Filtek Supreme Ultra (3M, ESPE) and SonicFillTM (Kerr). OptiBond Fl (Kerr) was used as a bonding
agent in both groups. All materials were used according to manufacturer’s instructions. Samples were cured
for 40 seconds with LED lights (DEMI, Kerr) and thermocycled for 2,500 cycles between 5°C and 50°C with a
dwell time of 30 seconds. Samples were immersed in a 50% ammoniacal silver nitrate solution for three hours
and exposed to a photodeveloping solution for six hours. Samples were embedded into acrylic and sectioned
in the mesio-distal direction (Isomet, Buehler). Microleakage was evaluated with analyzer software (Omnimet
9.0, Buehler). A penetration score was used on the proximal (P) and gingival (G) walls; 0=no microleakage,
1=minor microleakage, 2=half-way to the axial/pulpal wall, 3=more than half-way to axial/pulpal wall, 4=at or
beyond the axial/pulpal wall. Statistical analysis was conducted using non parametric Mann-Whitney U Test.
Statistical difference was predetermined at p<0.05.
Results:
Microleakage
0 (G/P)
1 (G/P)
2 (G/P)
3 (G/P)
4 (G/P)
Group 1 (Kerr) n=20
5/1
2/5
6/3
4/7
3/4
Group 2 (3M) n=20
1/2
3/3
7/5
4/4
5/6
Conclusions: No statistically significant difference found between groups in terms of microleakage,
p=0.967.
Also presented at the 2013 IADR/
AADR/CADR General Session
in Seattle, Washington. Abstract
#3557.
34
Student and Faculty Research Abstracts 2012 –2013
Microtensile and Shear Bond Strength on Dentin
YooJung Chang,* Joon Hee Lee, Eunice D. Lee, Matthew Finkelman, Masly Harsono,
Gerard Kugel
Objectives: The purpose of this study
was to compare two bond strengthtesting methods (shear and microtensile)
for examining dentinal bond strength of
two adhesive systems.
Methods: Seventy-eight extracted
caries-free human teeth were obtained
for this study. Flat dentin surfaces
were cut with diamond wheel (Isomet,
Buehler) and polished using SiC paper
up to 320 grit (Ecomet. Buehler).
Samples were randomly divided into 12
groups. Two testing methods were used:
shear bond strength (SBS) and microtensile bond strength (MTBS). Two
adhesive systems were tested: total etch (Ultra-Etch, Ultradent Inc.) and self-etch (Peak SE Primer, Ultradent
Inc.). Adhesives were applied according to manufacturers’ instruction. Those four groups were further split
into: no chlorhexidine (control), chlorhexidine applied before etching (CHX before), and chlorhexidine applied
after etching (CHX after). Filtek Supreme Plus (3M ESPE) composite was placed in a bonding jig (Ultradent
Inc.) for SBS testing, and placed incrementally for MTBS testing. Composite was cured for 40s with LED curing
light (DEMI, Kerr). MTBS samples were sectioned in 1 mm increments in two directions to create beams with
approximately 1 mm2 (Isomet 1000, Buehler). All samples were aged in artificial saliva for 1 month at 37°C. SBS
and MTBS testing were carried out using universal testing machine (Instron 5566A, Norwood, Massachusetts)
and microtensile tester (Bisco, Illinois), respectively. The fracture mode of each specimen was observed using a
stereo microscope (Olympus, Japan). Only adhesive mode was included in the data. Statistical analysis was done
by independent-sample t-test with Bonferroni correction.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Bonding Tests
MTBS
SBS
Adhesives (n=10) Control (MPa+SD) CHX before (MPa+SD) CHX after (MPa+SD)
TE
SE
TE
SE
29.2±8.6a
32.6±6.3a
12.6±6.5b
15.7±8.1b
22.8±8.2a
34.8±9.5a
22.1±7.8a
24.6±13.5a
29.6±5.6a
30.5±8.9a
28.0±15.7a
29.9±13.2a
Results with varying superscripts are statistically different (p<0.05).
Conclusion: Groups without CHX application showed a statistically higher bond strength using MTBS
compared to SBS. With additional application of CHX, there was no statistical difference between MTBS and
SBS.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #3538.
Tufts University School of Dental Medicine
35
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
The Relationship between Performance on Perceptual Ability Test Section
of DAT and Clinical Success in Dental School
Dave Cho,* Paul Stark, and Yun Saksena
Objectives: The purpose of this study was to determine if there is a relationship between perceptual ability
test (PAT) scores of admitted students and their subsequent clinical success in the third and fourth years of
dental school.
Methods: Student records for one graduated class (class of 2012) from Tufts University School of Dental
Medicine were examined in this study. PAT scores, clinic points, clinical competency exams and requirements
completed of those students were collected from the Office of Student Services and de-identified. The data was
then analyzed using SPSS software. PAT scores from the 2012 class served as the independent variable, while the
clinic points, clinical competency exams and requirements completed of the same student population served as
the dependent variable.
Results: A weak correlation was observed between students’ PAT scores and their average grade for
competency exams in the third and fourth years of dental school. Also, a weak correlation was observed between
students’ PAT scores and their average grade for operative competency exams. No other correlations were
observed between PAT scores of admitted students and the dependent variables in this study.
Clinic Pts Rqmts Passed CE CE Avg Operative Fpros Dx/Tx OMFS Perio Pedo OMFR
Pearson
Correlation
Sig.
(2-tailed)
N
0.043
−0.082
0.010
0.165*
0.282**
0.020 −0.077 0.069 0.018 0.152 0.036
0.581
0.296
0.901
0.035
0.000
0.802
0.326
164
164
164
164
164
164
164
0.383 0.823 0.051 0.653
164
164
164
161
Conclusion: PAT scores of admitted students and their clinical performances in the third and fourth year
did not show a strong correlation. Further research may involve a larger sample size and more variables. With
more data, it may be possible to discover a pre-dental criteria that shows a stronger correlation with clinical
success.
36
Student and Faculty Research Abstracts 2012 –2013
Marginal/Internal Fit of e.Max Impulse™ Versus e.Max™ CAD
All-Ceramic Crowns
Lindsay Fox,* Matthew Finkelman, Masly Harsono, and Gerard Kugel
Objective: To evaluate in vitro marginal and internal fit of all-ceramic crowns milled with conventional
e.max and impulse™ e.max lithium disilicate ceramic blocks made for CAD/CAM systems.
Methods: Typodont tooth #14 was prepared per standard specification to receive an all-ceramic crown
restoration. The preparation had well-defined, 1 mm circumferential shoulder gingival margin, 2 mm occlusal
reduction, rounded internal angles, and less than 20° total occlusal convergence. Forty-one #14 prep teeth were
duplicated using VPS impressions
material and poured in dental stone
type V. Each duplicated prep tooth
was randomly divided between Group
1 (n=21) and Group 2 (n=20) and
placed in a full-dentate typodont.
The prep teeth were scanned and
designed with the E4D system with
the same operator per manufacturer’s
instructions. Group1 was milled in
conventional e.max™ CAD blocks
and Group 2 was milled in Impluse™
CAD blocks. The milled CAD Crowns
were crystalized and cemented onto
the die using Multilink® Automix
(Ivoclar Vivadent) under constant
pressure of 100N and light cured on both sides for 20 seconds each. Samples were embedded in acrylic resin and
sectioned buccolingually. Sections were evaluated under stereo microscope and measured on the occlusal aspect
and three locations per buccal and lingual side of section: marginal-edge, mid-axial wall, and cusp-tip. The two
groups were compared using t-tests with Bonferroni correction. Statistical differences were predetermined at
(p<0.007).
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: No significant difference was found at the buccal and lingual margins in all groups.
µm±SD
Lingual
Group 1
n=21
Group 2
N=20
116.66±
54.55
116.14±
93.30
Mid lingual Lingual cusp
150.64±
78.65
119.38±
69.60
170.93±
59.33
188.65±
81.54
Occlusal
144.41±
37.22
171.46±
44.01
Buccal Cusp Mid Lingual
136.59±
39.46
159.45±
58.55
166.60±
103.32
196.58±
81.33
Buccal
113.86±
49.16
112.36±
42.39
Conclusion: Based on the statistical results there was no statistical difference in marginal and internal fit
between conventional e.max™ CAD blocks and e.max Impulse™ CAD blocks.
Supported in part byD4D Technologies and Ivoclar Vivadent. Also presented at the 2013 IADR/AADR/CADR
General Session in Seattle, Washington. Abstract #1949.
Tufts University School of Dental Medicine
37
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Comparison of Polymerization Stress Using RMGI Bond and
Resin Adhesive
Nicolas Freda,* Michael Neglia, Matthew Finkelman, Gerard Kugel, and Ronald Perry
Objectives: To compare
maximum polymerization
stress (MPa) and six-hour
polymerization stress (MPa) of a
bulk-filled composite bonded with
a resin adhesive, a RMGIC bond,
and co-cured with a RMGIC bond.
Methods: Clear acrylic rods
20 mm long and 5 mm diameter
(n=3) were sectioned, and one end
of each section was polished using
1500 silicon carbide paper. Rods
were then loaded on a universal
testing machine (Instron 5942) and
a metal gauge (1 mm Mitutoyo)
was used to establish a distance of
1 mm between prepared rods. In
groups 1 and 2 the adhesive systems Optibond XTR (Kerr) and Riva Bond LC (SDI) were applied to both ends
of the acrylic rods and light cured according to the manufacturer’s instructions. Composite was then placed
and excess material was trimmed and light cured using a LED curing light (Radii Plus, SDI) for 40 seconds
from one side. In group 3, a further layer of RMGIC bond was applied to each rod followed by immediate
composite placement. An extensometer (Instron) accurate to 10 nanometers was connected to the acrylic rods.
At 90 seconds a plastic cup was moved into position on the lower rod and filled with distilled water. Additional
water was added as needed. Maximum, average, and final polymerization stress (MPa) were recorded over 6
hours. The data was analyzed using one-way ANOVA analysis. A p-value of <0.05 was considered statistically
significant.
Results:
Group
Adhesive
Maximum Stress (MPa)
Average Stress (MPa)
Final Stress (MPa)
1
Optibond XTR
−4.7262±0.235
−4.0316±0.481
−4.2000±0.619
2
Riva Bond LC
−1.4297±0.358
0.1622±0.715
0.2048±0.979
3
Riva Bond LC (co-cure)
−2.4841±0.235
−1.2982±0.420
−1.2292±1.162
Conclusion: All results between maximum and average stress were statistically significant with group 2
yielding the lower stress. Groups 2 and 3 yielded a statistically lower final stress compared to group 1.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #1122.
38
Student and Faculty Research Abstracts 2012 –2013
Compressive Strength of Bulk Fill Composite Materials
Ryan George,* Masly Harsono, Ronald Perry, and Gerard Kugel
Objective: To compare the compressive strength, compressive deformation, and modulus of elasticity of
three different bulk fill composite materials.
Method: Three groups of twenty samples each of bulk fill composite materials were tested in this study.
The samples were made using Teflon mold 4 mm diameter by 8 mm thick. The mold was placed on top of a
polyester (Mylar) strip resting on a glass slab. After the mold had been filled with composite and packed with
a spatula, another Mylar strip was laid on top of the composite and a microscope slide was pressed on top.
Composites were cured with LED light (DEMI, Kerr) every 3–4 mm increment. Samples were removed from
the mold and excess was removed from the samples. After 24 hours of polymerization, compressive strength
was carried out using a universal testing machine (Instron 5566A, Norwood, Massachusetts) at a cross head
speed of 4 mm/min with 10K load cell. The compressive strength was measured according to DIN 53454 (ISO
9917 2001). Compressive deformation and modulus of elasticity were also measured. Statistical analysis was
conducted with one-way ANOVA. Statistical significance was predetermined at level p<0.05.
Results:
Group
X-tra base (VOCO)
VENUS Bulk Fill (Heraous)
SDR Surefill (DENTSPLY)
Compressive Strength
(MPa)
149.79±26.15a
Compressive Strain
(mm/mm)
0.09±0.01A
Modulus of Elasticity
(MPa)
1656.74±234.15P
148.45±28.27a
0.22±0.02B
670.78±89.56Q
74.31±26.9b
0.22±0.17B
447.86±207.06R
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results with varying superscripts are statistically different (p<0.05)
Conclusion: X-tra base group exhibited statistically higher modulus of elasticity and compressive strength
than all other groups.
Research sponsored in part by VOCO. Also presented at the 2013 IADR/AADR/CADR General Session in Seattle,
Washington. Abstract #2440.
Tufts University School of Dental Medicine
39
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Usage of Different Pharmacologic Categories of Medications in
Intellectually/Developmentally Disabled Adults Treated under
General Anesthesia
Sung Hong,* Angel Park, and John Morgan
Objectives: This study investigated medication usage by intellectually/developmentally disabled
(IDD) adults receiving dental treatment utilizing general anesthesia (GA). Associations between different
pharmacologic categories of medications and untreated caries and periodontitis were explored.
Methods: This cross-sectional study utilized data from clinical information recorded at the time of treatment
at the Tufts Dental Facilities (TDF) in the axiUm electronic health record (EHR). The study group consisted of
241 developmentally disabled adults ≥20 years of age who received dental treatment under general anesthesia
between April 1, 2009, and March 31, 2010. Medication usage for each patient was collected from axiUm and
recorded in an electronic spreadsheet program (MS Excel). The compiled database was converted to SAS data
sets for analysis (Version 9.2).
Results: The mean (SD) age
of this population was 45.27
(±11.22) years. There were 176
males (76.70%) and 124 females
(78.23%). Among different
pharmacologic categories of
medications, anticonvulsants
were the most common, with
51.83% of the patients taking
at least one, followed by
antipsychotics (45.53%), then
antidepressants (39.53%), and
anxiolytic medications (37.87%).
The untreated caries was most
prevalent in patients taking
antimuscarinics (90.91%), followed
by those taking antipsychotics
(90.00%), then by those taking
anti-Parkinson’s medications (86.36%). The periodontitis was most prevalent in patients taking antimuscarnics
(100.00%), followed by those taking anti-Parkinson’s (90.91%), then by those taking antiasthmatic medications
(87.76%).
Conclusion: The prevalence of untreated caries among the study population was 81.67% and that of
periodontitis was 77.33%. IDD patients taking antimuscarinic medications had the highest prevalence of
untreated caries and periodontitis. Also, patients on anti-Parkinson’s medications had the second highest
prevalence of periodontitis and third highest prevalence of untreated caries. It is important to note that some of
these patients were concurrently taking medications in different pharmacologic categories of drugs. Therefore,
they may have had either additive or decremental effects on their oral health. Follow-up studies are indicated
to examine the impact of individual medication usage on the oral health of adults with IDD requiring GA for
dental treatment.
40
Student and Faculty Research Abstracts 2012 –2013
Student Opinions on Pre-Clinical Instruction at TUSDM: A Survey
Jenna Hubacz,* Joanne Falzone, Britta Magnuson, and Steven Eisen
Objectives: Third and fourth year students at Tufts University School of Dental Medicine (TUSDM) were
surveyed regarding the adequacy of pre-clinical training. The goal was to determine student perceptions of
the strengths and weaknesses of the pre-clinical course material in operative dentistry and fixed/removable
prosthodontics.
Methods: For the study, 347 students of the 2012 and 2013 classes were surveyed using an online survey tool.
The survey contained 12 questions (6 multiple choice, 6 open-ended). It included questions regarding learning
style, which techniques and materials were suitably covered, which subjects were not, and which topics students
found superfluous.
Results: Of the total,
43 students responded,
all from the 2013 class.
Of these, 47% of students
stated that their preclinical training adequately
prepared them for the
clinic, 28% were neutral,
14% were unsatisfied,
and 12% selected “other.”
Also, 86% of students
stated that visual learning
worked well in their preclinical education, and
93% of students indicated
hands-on activities were
beneficial. Regarding the
knowledge and use of dental materials, 12% were very confident, 37% were somewhat confident, and 51% of
students did not feel confident. 84% indicated inlays/onlays required more clinical instruction. Open-ended
questions regarding materials/techniques that needed more instruction showed trending responses for caries
identification, composite use, temporary-filling material use, and removable prosthodontics techniques.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusions: Student responses indicated few topics should be taken out of the curriculum due to
redundancy, but students would like to see several topics added. Students felt the level of pre-clinical instruction
was insufficient in the use of dental materials. Caries identification, removable prosthodontics, and composite
use were also topics students expressed were insufficient. Students indicated visual learning was most helpful.
The results of this survey provided important information as to how pre-clinical courses can be better tailored
in the future to meet the needs of students.
Tufts University School of Dental Medicine
41
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Site-Specific Patterns of Gene Expression in Diabetic-Foot Fibroblasts
Rajvir S. Jutla,*1 Kyle Hewitt,1 Anna Maione,1 Julia Caine,1 Elana Knight,1 Avi Smith,1
Behzad Gerami-Naini,1 Aris Veves,2 and Jonathan A. Garlick1
1Department
Boston;
of Oral and Maxillofacial Pathology, Tufts University School of Dental Medicine,
of Surgery, Beth Israel Deaconess Medical Center, Boston
2Department
Objectives: Diabetic foot ulceration impairs quality of life and leads to prolonged hospitalizations,
demonstrating the need to develop novel sources of repair-competent, autologous cells. Our lab is developing
a novel therapeutic approach, based on induced pluripotent stem cell (iPSC) technologies, whose goal is to
reverse chronic wound fibroblasts from a non-healing to a healing phenotype. As a first step towards this goal,
we characterized the gene expression profile of fibroblasts cultured from ulcers and normal skin from diabetic
patients.
Methods: Fibroblasts were
harvested from non-healing ulcers or
normal skin from the feet of diabetic
patients (DFU 1, 3, 6) as well as from
normal plantar skin and palatal
mucosa from non-diabetic patients.
Microarray analysis was performed
on diabetic fibroblasts and control
oral fibroblasts, to identify genes from
diabetic patients that were altered.
Microarrays were then used to select
RNA targets to compare plantar skin
vs. oral fibroblasts from non-diabetic
patients by RT-PCR to establish how
site-specific expression patterns could
compare to those seen in diabetic
ulcer fibroblasts.
Results: Genes selected from the microarray relevant to wound repair included upregulated LOXL4,
SFRP1, and IGF2 and downregulated CDH6. These microarray results were confirmed when DFU 1, 3, 6 were
compared to oral fibroblast controls by RT-PCR analysis. However, DFU cells showed different patterns of gene
expression when compared to plantar skin control fibroblasts, suggesting the existence of site-specific patterns
of gene expression.
Conclusions: Site-matched, plantar fibroblasts displayed different patterns of gene expression compared
to non-site-matched, oral fibroblasts. Therefore, comparisons between DFU fibroblasts and those from
different sites, such as the oral cavity, are of limited use to predict patterns of expression. These studies lay the
groundwork for ongoing studies with the goal to improve the repair potency of DFU fibroblasts following their
reprogramming to iPSC and subsequent differentiation to repair-competent fibroblasts.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #3446.
42
Student and Faculty Research Abstracts 2012 –2013
Medication and Prevalence of Caries in Intellectually/Developmentally
Disabled Adults
Dohyun Kim,* Angel Park, and John Morgan
Objective: Oral health studies in adults with intellectual/developmental disabilities (IDD) strongly support a
high prevalence of caries. This study investigated the use of medications and the prevalence of untreated caries
in IDD adults.
Method: Clinical and demographic data were collected from a convenience sample of axiUm electronic
dental records of IDD adults (≥20 years of age) who received a dental exam between April 1, 2009, and March
31, 2010. Untreated caries and the number, type, and xerostomic potential of medications were recorded for
each subject. The compiled database (MS Access) was converted to MS Excel and analyzed using SAS, version
9.2. Associations were tested using chi-square analysis.
Result: Of the subjects, 899 (56.5% male) met the inclusion criteria. Of those, 719 (80%) were prescribed
xerostomic medications and 180 were not. Mean (SD) age was 50.7 years (14.2); range 21 to 96 years. The mean
(SD) and the median number of medications taken per subject were 9.5 (5.8) and 9, respectively. Xerostomic
medications were prescribed for 67.8% of 90 edentulous and 81.3% of 809 dentate subjects, p=0.0023.
Untreated caries prevalence in dentate subjects prescribed xerostomic medications was 34.0%; and 40.4% in
those not prescribed xerostomic medications, p=0.1404.
Conclusion: Medications were prescribed for the vast majority of the study population with a median
number of 9 medications per subject. Significantly more dentate subjects were prescribed xerostomic
medications than edentulous subjects. Prevalence of untreated caries in subjects taking xerostomic medications
was not significantly greater than in those not prescribed xerostomic medications. Medication usage is
considered a contributory factor of oral disease prevalence in IDD adults, but not well understood. Further
studies investigating the type, dosage, frequency, and xerostomic effect of medications in relation to untreated
caries may contribute to identifying the impact of medications on high caries risk adults with IDD.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
This study was supported
in part by grant
1RC1DE020396 from
the National Institute of
Dental and Craniofacial
Research, National
Institutes of Health,
Bethesda, Maryland. Also
presented at the 2013
IADR/AADR/CADR
General Session in Seattle,
Washington. Abstract #753.
Tufts University School of Dental Medicine
43
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Phenotypic Characterization of Tft156N and Tft152N Zebrafish Mutants
Alice Ko,*1 Andrew Trent Taylor,2 Caitlin Stewart-Swift,1 and Pamela C. Yelick1
1Tufts
University School of Dental Medicine; 2University of Massachusetts, Amherst
Objectives: The objective of this study is to define and characterize developmental defects in the Tft152N and
Tft156N zebrafish mineralized tissue mutants, identified in a forward genetic chemical mutagenesis screen.
Methods: Identified heterozygous adult
Tft152N and Tft156N mutants were incrossed,
and the resulting embryos were raised for 1,
2, 3, 4, and 5 weeks of age. We then utilized
Alizarin Red and Alcian Blue double staining
and in vivo Calcein stain to characterize
mineralized tissue defects in developmentally
staged mutant and wild type siblings.
Results: We determined that the earliest
time point in which the mineralized tissue
defects were observed in Tft156N mutants
was at 4 weeks post fertilization (wpf). The
observed Tft156N mutant phenotype appeared
to recover at ~7 wpf. We are currently
performing a similar developmental
mineralized tissue screen for the Tft152N
mutant.
Conclusion: The Tft156N mutant zebrafish exhibits a delay in mineralized tissue formation at 4 wpf, which
appears to recover at ~7 wpf. Ongoing studies are being conducted to confirm these results. Next generation
sequencing efforts are being conducted to define the molecular nature of the Tft152N and Tft156N mutant loci.
Ongoing molecular characterizations are being used to determine the effect of each mutation on osteoblast
differentiation. We anticipate that these studies will inform and improve our understanding of mineralized
tissue defects in humans.
This research was supported by NIH/NIDCR R01DE018043 [PCY]. Also presented at the 2013 IADR/AADR/CADR
General Session in Seattle, Washington. Abstract #1327.
44
Student and Faculty Research Abstracts 2012 –2013
Microleakage Evaluation of Bulk-Fill Layering Techniques in Class II
Restorations
Michael K. Kreitzer,* Masly Harsono, Matthew Finkelman, and Gerard Kugel
Objectives: The purpose of this study is to evaluate bulk-fill (BF) composites in Class II restorations.
Methods: Fifty standard Class II preparations were performed on non-carious human third molar teeth by
the same operator. The preparations were approximately 3.0 mm deep at the pulpal floor and 5.0 mm deep at
the gingival floor. All specimens were etched and then bonded using the same bonding agent (Scotchbond, 3M).
Samples were randomly assigned and restored using approximately a 4.0-mm BF composite increment followed
by a Filtek Supreme conventional nanocomposite veneer layer of 2.0 mm for improved esthetics and wear per
the manufacturer’s instructions. Completed restorations were thermo-cycled for 5,000 cycles, immersed in 50%
(W/V) ammoniacal silver nitrate solution for three hours and then photo-developing solution for sixteen hours.
Samples were embedded in acrylic and sectioned longitudinally across the gingival floor. Microleakage scores
for the gingival floor and proximal wall were measured under a light-microscope (Olympus SZX16).
Group (n=10)
1: Control
2: BF
3: BF
4: BF
5: BF
Composites
Filtek Supreme (3M ESPE)
Venus Bulk Fill, Flowable (Heraeus)
Filtek Supreme Plus Flow Restorative (3M ESPE)
Surefil SDR Flowable (DENTSPLY)
Tetric EvoCeram Bulk Fill (Ivoclar Vivadent)
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: Using the Kruskal-Wallis one-way ANOVA test, significant
difference was found among the groups for both gingival and proximal
microleakage (p-values = <0.001 and 0.005, respectively). The MannWhitney U-test with the Bonferroni correction was used to determine
the differences among the groups. For gingival microleakage group 1
was significantly different from group 2 (p<0.001), group 3 (p<0.001),
and group 5 (p<0.001). Group 3 was also found to be significantly
different from group 4 (p=0.001) and group 4 compared to group
5 (p=0.003). For proximal microleakage, group 1 was found to be
significantly different from group 3 (p=0.002) and group 5 (p<0.001).
Dye Penetration (DP) Score
Group 1 Group 2 Group 3 Group 4 Group 5
0 = No dye penetration (DP)
0/0
4/5
7/7
1/3
6/6
1 = DP to 25% of gingival floor (GF)/Proximal Wall (PW)
0/2
4/1
3/1
1/4
3/3
2 = DP to 50% of GF / PW
0/2
1/1
0/0
2/2
0/1
3 = DP to 75% of GF / PW
2/2
0/0
0/2
2/0
1/0
4 = DP to axial wall / pulpal floor
8/4
1/3
0/0
4/1
0/0
Conclusions: Based on the statistical results, there was a significant difference between using BF composites
in three of the four groups as compared to using solely a non-flowable nanocomposite. It was also evident that
using a BF layering technique provides better marginal adaptation on the gingival floor and proximal wall of the
restorations.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #3554.
Tufts University School of Dental Medicine
45
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Depth of Cure of Different Shades of Bulk Fill Composites
Hemanth Kunduru,* Matthew Finkelman, Eileen Doherty, Masly Harsono, and Gerard Kugel
Objectives: To evaluate the depth of cure of bulk-fill composite materials using the scraping method.
Methods: Four bulk-fill composite materials (Filtek, Surefil SDR, Tetric Evo Ceram, and Venus) were tested
in two different shades (except Venus). A total of seventy bulk composite rods were made using a stainless steel
mold 5 mm diameter by 8 mm depth. After filling the mold with bulk fill composite, a Mylar strip was placed on
top of the composite and compressed with a microscope slide. Samples were cured using an LED Light (DEMI,
Kerr) per manufacturer suggestion. After each test sample was cured, any uncured composite material was
scraped off the bottom of the rod (ISO 4049). The remaining cured composite material was measured with a
digital caliper to determine the depth of cure. Statistical analyses were accomplished using independent-sample
t-tests with Bonferroni corrections. Significance for statistical tests was predetermined at p<0.002.
Results: The depth of cure values in mm are summarized below.
Bulk Fill Material (n=10)
Filtek Bulk Fill (3M ESPE)*
Filtek Bulk Fill (3M ESPE)*
Surefil SDR (DENTSPLY)*
Surefil SDR (DENTSPLY)*
Tetric Evo Ceram (Ivoclar)
Tetric Evo Ceram (Ivoclar)
Venus Bulk Fill (Heraus)*
Shade
U
A2
U
A2
IVW
IVB
U
Curing Time (sec)
10
20
30
30
20
20
20
Depth of Cure (mm+SD)
6.37±0.10b, c
6.52±0.05a
6.36±0.07b, f
6.32±0.04b
6.28±0.16b, e
6.07±0.23b, d
6.48±0.06a, c, e
Results with varying superscripts are statistically different (p<0.002).
* is a flowable bulk-fill composite.
Conclusion: Both shades of Tetric Evo Ceram showed the lowest depths of cure among this group. The
highest value was for Filtek Bulk Fill (A2). However, all seven composites cured well beyond the manufacturers’
recommended curing depths of 4 mm or 5 mm.
Also presented at the 2013
IADR/AADR/CADR General
Session in Seattle, Washington.
Abstract #2437.
46
Student and Faculty Research Abstracts 2012 –2013
Social Impact of Oral Health on Psychiatric Inpatients
Sharan L. Schwartzberg, Gregory D. Lane,* Simon Levin, and Emery Sweeney
Psychiatric patients have significantly worse oral health than the general population, and this can have an effect
on their quality of life (Locker, Clarke, and Payne, 2000). Factors such as side-effect of medications, inadequate
access to oral health care, and dental phobias have been identified as mediating factors (Cormac and Jenkins,
1999; Mirza, Day, Phelan, and Wulff-Cochrane, 2001). The absence of oral health intervention increases
likelihood that serious diseases are undetected. Given the short length of stay in acute psychiatric inpatient
hospitalization, it is imperative that patients increase awareness of their oral health needs and resources are
available. An oral health education group led by dental students in occupational therapy is one such attempt.
A pilot study of 75 adult inpatients’ perceptions of their oral health was used as one step to inform the content
and processes of the group. Physical
pain, psychological discomfort, and
psychological disability, measured by the
Oral Health Impact Profile (OHIP-14)
(Slade, 1997), had the highest impact on
the total sample and the high impact group.
These findings are similar to previous
studies (Nuttall, Steele, Pine, White, and
Pitts, 2001; Slade, Nuttall, Sanders, Steele,
Allen, and Lahti, 2005). We recommend
shaping oral health education to directly
address these three dimensions and further
studying a shortened version of the OHIP14.
Tufts University School of Dental Medicine
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
47
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Mortality Data Thirty Years after Nutrition and Oral Health Study
Athena S. Papas, Pamela Corrado, and Jamie L. LaPierre*
Objective: Death records for a Metropolitan Boston population who had participated in a nutrition and oral
health study (started in 1981) were searched to determine cause of death and to compare their pertinent study
data to those still alive.
Methods: The subjects in the study had their periodontal attachment level determined at four sites per tooth
with a UNC-15 periodontal probe. Number of teeth and amputated crowns due to circumferential root caries
were recorded. Gender, race, and education were also recorded at baseline.
Results: The study population (n=391) had a mean age at baseline of 66 (40–80) 57% female, a mean number
of teeth of 22±6, 89.7% were Caucasian, 8.4% African American, and 1.9% other. Twenty-six participants
were smokers, and the mean number of years of education was 13.4±2.5. Those with more teeth consumed
a healthier diet. At 30 years post study baseline, 46% (156) were deceased (22% cardiovascular disease, 17%
other, 7% died out of state) and 54% (210) were still alive. ANOVA found race, gender, education, marital
status, number of teeth, and number of amputated roots to be significantly associated with mortality. A binary
logistic regression model for mortality including all these variables found race (p<0.024), amputated crowns
(p<0.006) and number of teeth (p<0.0001) to be significant. Those who had more than 23 teeth compared to
those who had less than
23 were significantly
more educated (p<0.007)
and had less mortality
(p<0.010). African
Americans had fewer teeth
and were less educated.
Those who died of
cardiovascular disease had
more significant and more
severe periodontal disease
than those who died of
other causes.
Conclusion: Loss
of teeth and having
amputated crowns affected
diet at baseline and later
affected mortality.
Funded in part by the Educational Foundation of America and the USDA. Also presented at the 2013 IADR/AADR/
CADR General Session in Seattle, Washington. Abstract #712.
48
Student and Faculty Research Abstracts 2012 –2013
Fracture Toughness of Provisional Dental Materials
Chase Larsen,* Masly Harsono, Matthew Finkelman, and Ronald Perry
Objective: To determine and compare the fracture toughness of four provisional dental materials.
Methods: Four groups of ten
samples each of provisional materials
were tested in this study. The samples
were made using a stainless steel mold
2 mm in height, 4.95 mm in width,
and 25 mm in length. After 24 hours
of polymerization, a notch (2.6±0.05
mm) was inserted into the middle of
each sample using a separating disc
(thickness 320 µm) attached to an
immobilized low speed hand piece.
Samples were observed under the
microscope for any defects. The threepoint bending test was performed
using a universal testing machine
(Instron, 5566A) at a cross-head
speed of 1 mm/min (load cell 500 N).
The notch was positioned centrally beneath the contact, and the distance between the two support rims was 20
mm. The radius of each support rim was 1 mm. The fracture toughness (K1C) was calculated according to ISO
13586. The Kolmogorov-Smirnov test was used to determine normal distribution, and the homogeneity of the
samples was checked using the Levene test. A one-way ANOVA was used to test the mean fracture toughness
between groups. Statistical significance was predetermined at level p<0.05.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Group (n=10)
1
2
3
4
Material
Protemp Plus (3M)
Luxatemp Solar (DMG)
Integrity (Dentsply Caulk)
Experimental (Heraus Kultzer)
Mean Fracture Toughness (MPa ∙ m0.5)
1.33±0.13a
0.98±0.04b,c
1.02±0.07b
1.38±0.19a
Conclusion: Group 2 exhibited a statistically lower resistance to crack propagation than all other groups,
whereas group 1 and group 4 exhibited a statistically higher resistance than group 3. No statistical difference is
evident between groups 1 and 4.
Research sponsored by Heraus Kultzer. Also presented at the 2013 IADR/AADR/CADR General Session in Seattle,
Washington. Abstract #653.
Tufts University School of Dental Medicine
49
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Retrospective Study of Oral Health Program in Zambian Children’s Home
John Lee,* Angel Park, Kerry Maguire, and John Morgan
Objective: Identifying the best program designs for preventive and treatment outreach in under-resourced
environments is challenging. Oral health education, screening exams, fluoride varnish, sealants, and atraumatic
restorative techniques were provided at a Zambian children’s home. This study aims to assess the oral health
impact of this international collaborative dental outreach project over a 7-year period.
Methods: Data was collected from yearly visits to the orphanage from 2004 to 2010. Screening exams by
dentists utilized the Association of State and Territorial Dental Directors basic screening survey tool (ASTDD
BSS) to document oral health needs of the study population. Of 515 visits, a total of 259 different patients
were documented. The mean age (SD) of each patient’s first visit was 7.8 (3.8) years (mixed dentition range),
with 53.3% males. Among the data collected from each visit was treatment urgency score (TU): 0=No obvious
problem; 1=early dental problem; and 2=urgent care [infection, toothache]. Dental records were de-identified,
exported to excel and crude bivariate analyses were completed in SAS.
Results: On average, 73.6 visits
(SD=31.5) were recorded each year
from 2004 to 2010. An average
of 27.8 new patients (SD=10.9)
were seen each year except for the
program’s first year in 2004. TU
scores of 0 increased from 2004
to 2005 from 44.3% to 73.9%
(chi-square, p=0.0349). TU score
analyses from 2005 to 2010 were
not statistically significant (Kruskal
Wallis, p=0.3876).
Conclusion: Crude results
suggest that the proportion of TU
visits with scores of zero increased
significantly after the first year of the program. These scores did not return to first year levels for the remainder
of study. This is consistent with a positive oral health effect by reducing disease urgency in the study population.
Exploration of outcomes is consistent with the World Health Organization’s recommendations for small-scale
oral health demonstration projects.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #421.
50
Student and Faculty Research Abstracts 2012 –2013
Effect of Chlorhexidine on Dentin Bonding Strength
Joon Hee Lee,* YooJung Chang, Matthew Finkelman, Masly Harsono, and Gerard Kugel
Objectives: The purpose of this
study was to evaluate the effect
of using chlorhexidine on dentin
bond strength with two types of
adhesive systems: total-etch and
self-etch.
Methods: Twenty extracted
caries-free human teeth were
sectioned horizontally with a
diamond blade precision saw
(Isomet, Buehler) and polished
using SiC paper up to 320 grit
(Ecomet. Buehler). Two adhesive
systems were tested: total-etch (TE)
(Ultra-Etch, Ultradent Inc.) and
self-etch (SE) (Peak SE Primer, Ultradent Inc.). Adhesives were applied according to manufacturers’ instruction.
For chlorhexidine (CHX) application, 0.2% CHX was applied for 1 minute on the dentin before or after the
etching procedures for both TE and SE. Filtek Supreme Plus (3M ESPE) composite was placed incrementally
of approximately 1.5–2 mm thickness each increment and cured for 40 seconds with LED curing light (DEMI,
Kerr). Samples were sectioned vertically in 1 mm increments with the precision saw in 0.300 mm/s velocity.
Samples were further sectioned by turning them 90° to create beams with an adhesive area approximately 1
mm2 (Isomet, Buehler). All specimens were aged in artificial saliva for 1 month at 37°C. Micro tensile bond
testing was carried out using Microtensile machine (Bisco, Illinois) with crosshead speed of 1 mm/min. The
fracture modes of each specimen were observed using a stereo microscope (Olympus, Japan). Only adhesive
mode was included in the data. Statistical analysis was done by two-way ANOVA, with post-hoc analysis
conducted via Tukey’s HSD. Statistical significance was predetermined at level p<0.05.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Adhesive systems
Group 1 TE
Group 2 SE
Control (MPa+SD)
12.6±6.5a
15.7±8.1a
CHX before (MPa+SD)
22.1±7.8b
24.6±13.5b
CHX after (MPa+SD)
28.0±15.7b
29.9±13.2b
Results with varying superscripts are statistically different (p<0.05)
Conclusion: There was no significant difference in bond strengths between TE and SE in the control group.
Application of chlorhexidine, either before or after etching, significantly strengthened the bond strength of both
total-etch and self-etch systems.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #1861.
Tufts University School of Dental Medicine
51
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Effect of Loupes on Ocular Blue Light Hazard: Direct Viewing
Judyth G. Lee,*1 Errol N. Ramos,1 R.B. Price,2 Ronald D. Perry,1 Daniel Labrie,3
and B. Sullivan2
1School
of Dental Medicine, Tufts University, Boston; 2Dept. of Clinical Dental Sciences, Dalhousie
University, Halifax, Nova Scotia, Canada, 3Physics and Atmospheric Science, Dalhousie University,
Halifax, Nova Scotia, Canada
Objectives: This study measured the effect magnification loupes have on the irradiance received by the eye
from a dental curing light (LCU).
Methods: Loupes with 3.5x magnification (Design for Vision [DFV], Carl Zeiss [CZ], Quality Aspirator
[QA]), and 2.5x magnification (DFV & QA) were tested over two days. The loupes were placed directly over
the entrance to an integrating sphere connected to a spectrometer (USB 4000, Ocean Optics). A Sapphire Plus
(Den-Mat) plasma arc LCU was fixed at a distance of 40 cm pointing directly at the entrance to this integrating
sphere. The spectral radiant power from this LCU was recorded 5 times, both without and with each of the
loupes focused at the entrance to the sphere. Using 0.02 radians as the angular subtense of the experiment, the
maximum permissible cumulative blue light hazard in an 8-hour day was calculated using guidelines set by the
American Conference of Industrial Hygienists (ACGIH). Weighted blue light irradiance values were compared
between the brands of loupes using Fisher’s PLSD, α=0.05.
Results: The loupes increased the blue light weighted irradiance values received by the pupil by up to 8 times
compared to without the loupes (p<0.05). However, since the resulting images on the retina were now 2.5x to
3.5x larger, according to the ACGIH guidelines, the maximum permissible cumulative ocular exposure to the
blue light in an 8-hour day was increased to only 10 to 15 s compared to that without the loupes (6 to 7 s).
Day 1
No Loupes DFV 2.5x
Weighted Irradiance
(mW/cm2)
Max. Daily Exposure
Time (seconds)
CZ 3.5x
No Loupes
Day 2
QA 2.5x DFV 3.5x
QA 3.5x
4.98
18.88
25.82
4.29
14.11
30.46
34.27
6.3
10.4
14.9
7.3
13.9
12.6
11.2
Conclusions: Under the extreme conditions simulating a high-power PAC light shone directly at the
eye from a distance of 40 cm, without magnification the maximum permissible cumulative daily exposure
was between 6 to 7 seconds. Through
magnification loupes, the maximum
cumulative daily exposure time was
between 10 to 15 seconds. Further studies
should be conducted on the effects of
magnification loupes.
Also presented at the 2013 IADR/AADR/
CADR General Session in Seattle,
Washington. Abstract #674.
52
Student and Faculty Research Abstracts 2012 –2013
Geriatric Patients Dental Care and Eldercare Method: A Survey
Jennie Leikin,* Britta Magnuson, and Matthew Finkelman
Objective: To assess and compare self-reported personal dental habits and oral comfort of a geriatric
population (age≥65) in three types of residences: assisted/independent living, at home with home-care, and
long-term rehabilitation facilities.
Methods: A 23-question survey was formatted including demographics, self-reported history of dental
care, personal dental habits, and oral comfort. Questions were based on those used in Tufts University School
of Dental Medicine (TUSDM) for incoming research subjects and General Oral Health Assessment Index
(GOHAI). The survey was validated
for clarity and conciseness by five
volunteers. Three facilities were selected
and fifty-two elders were surveyed.
Fisher’s exact and Kruskal-Wallis tests
were used to analyze the data.
Results: The living situation was
assessed with 16 subjects in assisted/
independent living, 31 at home
with home-care, and 5 in long-term
rehabilitation. The association between
living situation and denture wearing/
edentulism was not statistically
significant (p=0.188), with 80.8%
reporting having either full or partial
dentures and/or being edentulous. The association between living situation and daily oral maintenance was not
statistically significant (p=0.848), with 86.5% reporting brushing teeth/cleaning dentures at least once a day.
The association between living situation and regular dental visits was not statistically significant (p=0.150),
with 44.2% reporting visiting the dentist at least once a year. The association between living situation and
experiencing sensitivity in the past 3 months was not statistically significant (p=0.401), with 65.4% reporting
no sensitivity. The association between living situation and using medication to alleviate oral pain was not
statistically significant (p=0.398), with 78.8% reporting no use of medication. The association between living
situation and limiting food due to oral problems was not statistically significant (p=0.804), with 36.5%
reporting no limiting of food.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Conclusion: In this geriatric population when comparing denture wearing, overall dental habits, and oral
discomfort according to living situation, no statistically significant differences were found.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #1170.
Tufts University School of Dental Medicine
53
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Evaluation of Full Mouth Extraction and Selected Risk Factors in
Intellectually/Developmentally Disabled Patients Treated Under
General Anesthesia
Daniel Lim,* Angel Park, and John Morgan
Objectives: This study investigated the prevalence of full-mouth extraction and variables of age, gender,
cooperation level, and periodontal disease in intellectually/developmentally disabled (IDD) adults requiring
general anesthesia for dental treatment.
Method: A retrospective record review was completed utilizing clinical information entered by dentists at
the time of treatment at a state-supported system of dental clinics. Information was collected from axiUm
electronic health records for IDD adults aged 20 years and older and receiving dental treatment under general
anesthesia between 4/1/2009 and 3/31/2012. Data regarding full-mouth extraction, gender, age, cooperation
level, and periodontal disease were compiled into a database and converted to SAS version 9.2 for analysis (SAS
Institute, Cary, North Carolina). Chi-square tests were used to test bivariate associations of proportions. Nonparametric tests were used to test severity of periodontitis.
Results: The records of 747 IDD
patients met the inclusion criteria.
Their mean (SD) age (20–78 years) was
43.8 (12.6) years; 60.9% were male. All
subjects were dentate at beginning of
treatment. For 685 (91.7%) patients not
receiving full-mouth extraction (NFM),
mean (SD) age (20–73 years) was 42.8
(12.3) years; 61.6% were male. For 62
(8.3%) patients receiving full-mouth
extraction (FM), mean (SD) age (28–78
years) was 55.1 (9.7) years; 53.2%
were male. There was no statistically
significant difference in cooperation
levels between NFM and FM groups
(p=0.538). There was a statistically significant difference in prevalence of periodontitis between NFM and FM
groups (p=0.048). The severity of periodontitis differed statistically significantly between NFM and FM groups
(Mann Whitney U, p<0.001). The severity of periodontitis varied statistically significantly by cooperation levels
in FM group (Kruskal-Wallis, p=0.027) but not in NFM group (Kruskal-Wallis, p=0.664)
Conclusion: In the study population, cooperation levels were not statistically significant between non-fullmouth extraction and full-mouth extraction groups. Statistically significant differences regarding prevalence
of periodontitis were noted between NFM and FM groups. Additional studies are recommended to further
investigate risk factors for full-mouth extraction in the study group.
This study was supported in part by grant 1RC1DE020396 from the National Institute of Dental and Craniofacial
Research, National Institutes of Health, Bethesda, Maryland.
54
Student and Faculty Research Abstracts 2012 –2013
Microleakage Evaluation of Adhesive Thickness Based on Clinical
Radiologic Appearance
Wei Liu,* Angelica Levin, Matthew Finkelman, Masly Harsono, and Gerard Kugel
Objective: To observe the microleakage of different adhesives thickness showed on appearance in dental
radiographs.
Methods: Sixty-four extracted caries free human teeth were obtained for this study. Standard class II
preparations were performed on the tooth with approximately 2.5 mm deep at the occlusal and 4 mm deep
at the gingival floor. Samples were randomly divided into eight groups (n=8). Two commercially available
dentin adhesive agents were used with variation in number of coatings (amount) and drying methods.
Adhesives: Peak LC (PLC, Ultradent) and Scotchbond (SCT, 3M ESPE). Adhesives were applied according to
manufacturers’ instruction with exception of using the various amount of coatings—one coat (OC) or three
coats (TC)—and drying methods—no stream air-dried (ND) or air-dried with a gentle stream of air (GD).
Composite (Filtek Supreme, 3M ESPE) was used to restore the lesion. After the restorations were completed,
radiographs were taken and samples were thermocycled for 5,000 cycles between 5°C and 55°C with a dwell of
30 seconds. Samples were submerged in 50% (w/v) ammoniacal silver nitrate solution for three hours, followed
by photo developing solution for sixteen hours. Samples were embedded in acrylic and sectioned longitudinally.
Microleakage scores were assessed under stereo microscope. A penetration score was used on the proximal (P)
and gingival (G) walls; 0=no microleakage, 1=minor microleakage, 2=halfway to the axial/pulpal wall, 3=more
than halfway to axial/pulpal wall, 4=at or beyond the axial/pulpal wall.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results: The pulpal thickness of products were compared using mixed model. P-values of microleakage for
proximal and gingival walls were calculated using generalized estimating equations (GEE).
Microleakage
Score
PLC,
OC, ND
Radiographic appearance
221.25
(µm±SD)
±79.13
Cross-sectioned
266.13
adhesive thickness (µm±SD) ±148.97
0 (Ging/Prox)
0/0
1 (Ging/Prox)
3/5
2 (Ging/Prox)
2/4
3 (Ging/Prox)
4/0
4 (Ging/Prox)
2/1
PLC,
TC, ND
811.25
±20.31
944.48
±229.67
0/0
3/4
0/0
0/0
5/4
PLC,
OC, GD
170
±33.17
145.19
±74.47
5/6
2/3
0/1
2/0
0/0
PLC,
TC, GD
222.5
±51.17
141.27
±79.17
2/4
3/3
2/0
1/1
0/0
SCT,
OC, ND
280.0
±95
219.84
±96.88
0/3
1/3
2/0
0/0
4/1
STC,
TC, ND
1310.25
±383.21
1057.40
±295.78
0/0
0/2
0/1
1/1
8/5
SCT,
OC, GD
215.25
±29.55
195.76
±144.73
1/1
3/5
0/1
3/1
1/0
STC,
TC, GD
356.25
±251.39
207.14
±152.37
0/1
0/1
6/5
4/2
0/0
Conclusion: Teeth samples with no air-dried
showed more microleakage compare with gentle airdried group in both proximal and gingival walls. Less
amount of coating applied indicated less microleakage
in the proximal wall.
Also presented at the 2013 IADR/AADR/CADR General
Session in Seattle, Washington. Abstract #3030.
Tufts University School of Dental Medicine
55
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Prevalence, Diagnosis, and Treatment of Peri-Implant Mucositis and
Peri-Implantitis: A Survey of U.S. Periodontists
Andrew Luccio,* Evangelos Papathanasiou, Andreas Paraschis, and James Hanley
Objectives: Despite the reported successful treatment outcomes of replacing missing teeth with dental
implants, clinicians are increasingly challenged with the management of pathology of peri-implant tissues,
namely peri-implant mucositis and peri-implantitis. Although several studies have investigated their prevalence
and proposed different treatment modalities, there is insufficient information and evidence in relation to the
exact prevalence of peri-implant diseases and to the standard therapeutic protocol for their management. The
purpose of this study was to survey practicing U.S. periodontists in order to evaluate their attitudes towards
prevalence, diagnosis and therapeutic management of peri-implant mucositis and peri-implantitis.
Methods: A twenty-three question survey has been developed based on a previous survey. Periodontists that
currently practice in the United States (3,500 subjects) were contacted by sending the survey and a reminder
using the email manager and a link via SurveyMonkey. The listed email addresses in the member directory of
the American Academy of Periodontology (AAP)—accessible to all AAP members—were used. Upon collection
and data analysis, descriptive and frequency analysis for all investigated fields was conducted.
Results: Of the total, 250 U.S. periodontists (78.6% males, 62.6% with >10 years in practice, 75.4% in private
practice) completed the survey. Of the participants, 95.4% were placing implants, 60.4% of them for >10 years
and 33.7% >150 implants/year. The majority believes that the prevalence of peri-implant mucositis and periimplantitis in their practices and in the U.S. is up to 25% and that up to 10% of implants must be removed
due to peri-implantitis. Most of the survey participants recognized bacterial biofilm as the main etiological
factor of peri-implant diseases, and recommend oral hygiene instructions, an antimicrobial gel/mouth rinse,
non-surgical debridement and control of occlusion/tensions in the suprastructure for their management. A
significant heterogeneity was recorded in relation to the instruments used for debridement/detoxification, use
of systemic antibiotics, use and type of surgical treatment (debridement/resective/regenerative), and materials
used for regeneration. Of the participants, 78.1% believe that the best maintenance frequency for periimplantitis is every 3 months and 60.2% believe that radiographic evaluation after treatment must be conducted
at 6 months. Additionally, 59.4% of U.S. periodontists consider current management of peri-implant diseases as
moderately effective, while only 5.1% believe that treatment is very effective.
Conclusions: The results of this
survey provide further evidence that
peri-implant diseases are a frequently
encountered problem in clinical
practice and that the absence of a
standard therapeutic protocol results in
significant empirical use of therapeutic
modalities and a moderately effective
treatment outcome. Further research
in the pathogenesis and therapeutic
management of peri-implant diseases is
strongly encouraged.
56
Student and Faculty Research Abstracts 2012 –2013
Wdr43, a Ribosome Biogenesis Factor, Regulates Zebrafish Neural
Crest Development
Chengtian Zhao,1,2 Viktoria Andreeva,1 Yann Gibert,1 Melissa LaBonty,1 Victoria Lattanzi,1
Shubhangi Prabhudesai,1 Yi Zhou,3 Kathleen L. McCann,4 Susan Baserga,4,5 Leonard Zon,3
Claire McCarthy,*1 and Pamela C. Yelick1
1Department
of Oral and Maxillofacial Pathology, Division of Craniofacial and Molecular Genetics,
Tufts University, Boston; 2Institute of Evolution and Marine Biodiversity, Ocean University of China,
Qingdao, China; 3Children’s Hospital Boston and Harvard Medical School, Boston; 4Department of
Genetics, Yale School of Medicine; 5Departments of Molecular Biophysics and Biochemistry and
Therapeutic Radiology, Yale School of Medicine
During vertebrate craniofacial development, neural crest cells (NCCs)
contribute to most of the craniofacial pharyngeal skeleton. Defects in NCC
specification, migration and differentiation resulting in malformations in the
craniofacial complex are associated with several human craniofacial disorders
including Treacher-Collins Syndrome, caused by mutations in Tcof1. It has been
hypothesized that upregulated p53 signaling induced by ribosome biogenesis
defects are the main cause of the observed cell death of NCC progenitors in
mouse Tcof1 mutants. However, the underlying mechanisms linking ribosome
biogenesis and NCC development remain poorly understood. Here we report a
new zebrafish mutant, fantome (fan), characterized by early NC developmental
defects and mutation of zebrafish Wdr43, the ortholog to yeast Utp5.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Objectives: 1) To characterize the role of wild type and fan mutant Wdr43
on Tcof1 subcellular localization. 2) To determine the effects of fan mutant Wdr43 on p53 signaling.
Methods: a) Wild type and fan mutant Wdr43-GFP expression constructs were created using Gateway cloning approaches. 293-T cells were transfected with each, and with B23-RFP constructs to mark nucleoli. IHC
analysis using anti-GFP, anti-Wdr43, and anti-B23 antibodies was then conducted. b) Y2H analysis was performed to determine the binding of wild type and fan mutant Wdr43 to other nucleolar proteins. c) The p53 signaling marker expression was quantified in fan mutants and wild type siblings via qRT-PCR and immunohistochemistry (IHC) using the mouse monoclonal antibody ZFp53-5.1. d) Wild type and fan zebrafish were treated
with Roscovitine (a known p53 upregulator) or a DMSO control and visualized using immunofluorescent IHC.
Results: a) Wild type Wdr43-GFP localizes to nucleoli, while fan mutantWdr43-GFP protein mis-localizes
to the entire nucleus. Full length and C-terminal Wdr43/Utp5 bind to Utp5 and Utp15. In contrast, fan mutant
Wdr43/Utp5 does not bind to either Utp4 or Utp15. b) The p53RNAs are upregulated fan mutants relative to
their wild type siblings. c) The fan mutants exhibit ribosome biogenesis defects.
Conclusions: The C-terminus of Wdr43, which is absent in fan mutant Wdr43, is both necessary and sufficient to mediate nucleolar localization and protein interaction in metazoans. Wdr43 plays a key role in ribosome biogenesis, and in nucleolar fusion. NCC defects observed in fan mutants are associated with upregulated
p53 signaling. Proper nucleolar localization of Tcof1 is dependent on that of Wdr43. Together, our findings
provide new insight into roles for Wdr43 in ribosome biogenesis and craniofacial development, and also into
ribosomopathy-induced craniofacial phenotypes including Treacher-Collins Syndrome.
This research was supported by NIH/NIDCR R01 DE018043 (PCY) and NIH GM52581 (SJB).
Tufts University School of Dental Medicine
57
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Oral Health and Body Mass Index of Intellectually/Developmentally
Disabled Adults
Natalie McClain,* Angel Park, Kathryn Dolan, and John Morgan
Objectives: National data support that intellectually/developmentally disabled (IDD) patients have
disproportionately poor oral health. Limited data are available exploring body mass index (BMI), oral health,
and type of residence in IDD adults. The objective of this study was to investigate BMI and untreated caries, and
BMI and type of residence in the IDD adult population.
Method: Demographic and clinical data (including height and weight) were collected from axiUm electronic
health records of IDD adults aged 20 and older who received a dental exam between April 1, 2009, and March
31, 2010. Accepted formula BMI=(weight/height²)x703 was calculated to explore associations using chi-square
tests of BMI (1=underweight, 2=normal weight, 3=overweight, 4=obese, 5=morbidly obese), untreated caries,
and type of residence (community setting, lives with family, state facility, independently, nursing home, other).
Results: Data for 2714 individuals were available to calculate BMI. The prevalence of untreated caries by BMI
category varied significantly (chi-square p<0.001): underweight (27.3%); normal weight (27.3%); overweight
(34.4%); obese (40.3%); morbidly obese (47.3%). Crude association of BMI categories and type of residence
(chi-square p<0.001) resulted in a “normal weight” prevalence of: (24.5%) living independently; (29.6%) living
with family; (32.8%) other; (35.9%) community setting; (43.4%) state facility; (54.5%) nursing home. Obesity
was most prevalent in people living independently (32.1%).
Conclusion: The prevalence of untreated caries increased with increasing BMI categories in the study
population. Of the five BMI categories, morbidly obese patients had the greatest prevalence of untreated caries.
Those living independently had the highest prevalence of obesity. Further investigation of BMI and type of
residence may assist in identifying risk
factors for dental caries in IDD adults.
This study was supported in part
by grant 1RC1DE020396 from the
National Institute of Dental and
Craniofacial Research, National
Institutes of Health, Bethesda,
Maryland. Also presented at the 2013
IADR/AADR/CADR General Session
in Seattle, Washington. Abstract #249.
58
Student and Faculty Research Abstracts 2012 –2013
Dentin Shear Bond Strength of RMGI Cements
Kyler McEwen,*1 Matthew Finkelman,1 Chase Larsen,1 Masly Harsono,1 Angel Park,1
R. Tuttle,2 and Gerard Kugel1
1Tufts
University School of Dental Medicine, Boston; 2Ultradent Products, Inc., South Jordan, Utah
Objectives: To compare shear bond strength (SBS) of five resin-modified glass ionomer (RMGI) cements to
zirconia and when used in conjunction with a self-etching bonding agent.
Methods: One hundred twenty non-carious extracted human molars were sectioned longitudinally to
produce 240 specimens; each embedded in acrylic resin and polished with 600-grit grinder to expose dentin. A
3.24 mm diameter sand-blasted zirconia button was cemented onto the dentin surface. Five groups were created
using a different RMGI cement for each group, and the samples were incubated in water for 24 hours at 40°C.
The process was repeated, and five additional groups were incubated for 72 hours. In five additional groups, a
layer of Peak Universal Bond (PUB), used as a self-etch, was applied and cured for 10 seconds (Valo Cordless,
Ultradent) before cementing a zirconia button with a different RMGI cement for each group and incubating
in water for 24 hours. SBS testing was performed on an Ultra Tester machine (Ultradent, 91043/KB3) at a
crosshead speed of 1 mm/min. Mode of failure was observed at the dentin-cement interface using a stereo
microscope. Normal distribution among the samples was determined using the Kolmogorov-Smirnov test. A
one-way ANOVA was used to test the SBS among the different cements. Pairwise differences were determined
using post-hoc Tukey tests. An independent samples t-test was used to compare SBS of bonded and non-bonded
samples. Statistical significance was determined at p<0.005.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Group
(n=24/group)
Group
1
2
3
Mean Shear Bond Strength (MPa±SD)
*1 Day
3 Days
Material
1
UltraCem (Ultradent)
7.55±3.70a
13.79±6.38A
2
GC FujiCEM Automix (GC Corp.)
4.87±2.49b,c
3.24±1.96B
3
GC Fuji Plus Capsule (GC Corp.)
6.69±4.00a,c
5.45±5.37B
4
Rely X Luting Plus (3M)
3.39±2.88b
1.80±1.51B,C
5
Meron Plus AC (VOCO)
4.89±2.21b,c
5.03±4.81B
Material
UltraCem (Ultradent)
GC FujiCEM Automix (GC
Corp.)
GC Fuji Plus Capsule (GC
Corp.)
Mean Shear Bond Strength (MPa±SD)
*Non-bonded (n=24/group)
Bonded (n=12/group)
Sig.
7.55±3.70
23.57±9.00
p<0.001
4.87±2.49
8.39±6.73
p=0.104
6.69±4.00
19.87±7.70
p<0.001
4
Rely X Luting Plus (3M)
3.39±2.88
9.92±4.59
p<0.001
5
Meron Plus AC (VOCO)
4.89±2.21
14.26±6.78
p<0.001
*Note that 1-day values and non-bonded values are the same data set.
Tufts University School of Dental Medicine
59
Bates-Andrews Day Abstracts
60
Predoctoral Student Presentations
Conclusion: In the 1-day trial, groups 1 and 2 yielded higher SBS than groups 3, 4, and 5. In the 3-day trial,
group 1 yielded statistically higher SBS values compared to all other groups. When PUB was applied prior to
cementation, SBS values were statistically higher in all groups except group 2.
Research sponsored by Ultradent. Also presented at the 2013 IADR/AADR/CADR General Session in Seattle,
Washington. Abstract #3043.
Student and Faculty Research Abstracts 2012 –2013
Contact Angle and Shear Bond Strength Tests of Silane Primers
Amanda M. Merikas*1 and L. Chen2
1Tufts
University, School of Dental Medicine, Boston; 2Research and Development, BISCO, Inc,
Schaumburg, Illinois
Objectives: To investigate commercial silane primer efficacy through contact angle measurements, shear
bond strength (SBS) test methods.
Methods: Five silane-containing primers were used—Porcelain Primer (Bisco), RelyX Ceramic Primer (3M
ESPE), Monobond Plus (Ivoclar Vivadent), Kerr Silane (Kerr), Scotchbond Universal (3M ESPE). Primers were
applied to wet polished (320-grit SiC paper), etched (Bisco Porcelain Etchant, 4% HF, 25 sec) lithium disilicate
(IPS e.Max), undisturbed (5 min), cleaned by ethanol bath ultrasonication (2 min), and dried. Contact angles
were measured with contact angle meter (NRL-CA Goniometer, New Jersey). SBS tests were completed on
polished, polished/etched ceramics with dual-cure resin cement (Duolink, Bisco, light-cure, 40 sec/500 mW/
cm2) with ultradent jig method (bonding area=4.5 mm2), stored in de-ionized water (24 hr/37¼ C), tested until
failure using Instron 4466 (speed=1 mm/min).
Results:
Contact Angles and Shear Bond Strength on Primed Lithium Disilicate
Primer
No Primer-Control
3M-ESPE-ScotchBond Universal
Kerr
Ivoclar Vivadent
3M-ESPE-RelyX
Bisco
Contact Angle,
degrees (SD), n=12
11.8 (2.1)d
11.3 (2.3)d
14.5 (3.4)d
41.9 (7.3)c
68.8 (7.9)b
84.0 (7.5)a
SBS-polished,
MPa (SD), n=12
2.8 (3.0)e
6.6 (1.2)d
7.6 (4.3)cde
12.3 (4.8)c
30.0 (5.1)a
21.0 (7.6)b
SBS-etched,
MPa (SD), n=16
17.5 (4.2)c
24.6 (5.8)b
22.5 (5.1)b
18.9 (8.5)b
36.3 (10.7)a
38.5 (7.7)a
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Within columns, results with varying superscipts are statistically
different (p<0.01).
Conclusions: Silane primers without additives
(BISCO Porcelain Primer, RelyX Ceramic
Primer) demonstrated the highest contact angle
measurements. Silanes with additives (extra resin in
Kerr Silane, Scotchbond Universal, or acidic monomer
in Monobond Plus) demonstrated contact angles
and SBS significantly lower than silane primers
without additives, or results not statistically different
from control samples. Contact angle and SBS results
indicated that use of additives such as resins and/
or phosphate monomers to silane appears to inhibit
silane interaction.
Also presented at the 2013 IADR/AADR/CADR General
Session in Seattle, Washington. Abstract #1071.
Tufts University School of Dental Medicine
61
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Optimal Silk Coating Parameters for Dental Implants
Courtney Michelson,1 R. Elia,2 Austin Perera,1 Masly Harsono,1 Gary Leisk,3 Hans P. Weber,1
David Kaplan,2 Matthew Finkelman,1 and Gerard Kugel1
1Tufts
University, School of Dental Medicine, Boston; 2Tufts University, Department of Biomedical
Engineering, Medford, Massachusetts; 3Tufts University, Mechanical Engineering Department,
Medford, Massachusetts
Objective: To assess reproducibility and adherence of a novel silk protein-based dental implant coating thickness
via electrogel (e-gel) formation methods to devise standardized procedures for eventual use on dental implants.
Methods: Silk fibroin protein was extracted, purified, and solubilized as a biocompatible protein solution for
coatings. Two procedures were used to coat stainless-steel shims: direct electrogelation (e-gel) formation on the
devices or dip coating to form thin coatings. For direct gelation, e-gels were uniformly deposited onto shims
for various times. For dip coating, e-gels were melted in a temperature-controlled oven maintaining the melted
state of the e-gel while dip coating. Z-wick universal testing machine was programmed to controllably dip the
shims into the silk solution. For both coating procedures, two protein concentrations, 5% and 10% (w/v), were
evaluated. Gels were dried overnight prior to thickness measurement and analysis. In a concurrent study, Straumann SLActive implants were randomly divided into groups designed to mimic implant placement conditions:
(1) placement into acrylic blocks; (2) dry BoneSim; and (3) wet BoneSim. Acrylic blocks and BoneSim were
cut into two pieces and the center drilled to 3.5 mm using appropriate dental implant drill bits. Based on previous findings, e-gels were placed directly on the implants for 5 seconds, creating a uniform coating layer. Coated
implants were drilled into clamped blocks, which, when separated, allowed undisturbed implant removal. Delamination of the coating was determined by comparing original coverage area to the remaining silk layer after
implant insertion. Statistical analysis was calculated using one-way ANOVA with significance at p<0.05.
Results: (Mean±SD)
Direct E-Gel (n=5)
Silk Concentration
5sec
15sec
30sec
45sec
60sec
5%
89±18.5μm 271±44.5μm 393±27.5μm 465±32.4μm 533±17.1μm
10%
171±55.3μm 210±12.7μm 358±62.7μm 523±49.3μm
646±65μm
120sec
1118±136μm
1654±148μm
Melted Dip Coating (n=3)
Silk Concentration
5%
10%
1 dip
37±20.8μm
35±5.0μm
5 dips
90±26.4μm
163±83.2μm
10 dips
180±127.2μm
450±181.9μm
Delamination of Coating (n=5)
1
2
3
Acrylic Block
Dry BoneSim
Wet BoneSim
% Silk Coating Remaining After Insertion (Mean±SD)
87.47±9.58
94.78±3.64
89.36±3.12
Conclusions: Five seconds of direct electro-gelation in 10% silk concentration produced coatings with suitable
silk thickness for eventual implantation. These parameters were then used to demonstrate the excellent adhesion of
the silk coatings to the implant surface and minimal delamination after insertion into simulated sockets.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #2045.
62
Student and Faculty Research Abstracts 2012 –2013
Comparing Composite Wear Rates in Simulated Oral Media
Michael Neglia,* Nicolas Freda, Gerard Kugel, Ronald Perry, and Angel Park
Objectives: To investigate the early three-bodied erosion wear that composites often have in a simulated
contact free area (CFA).
Methods: Ten marketed composites were tested: Aura Dentin and Aura Enamel (AUD, AUE SDI), Durafill
VS (DVS, Heraeus Kulzer), Esthet-X HD (EXHD, Dentsply), Filtek Supreme XTE (FSXTE, 3M ESPE), Kalore
(GCK, GC Dental), Grandio (GRO, Voco), Herculite Ultra (HUE, Kerr), TPH³ (TPH3, DENTSPLY), Vivadent
Tetric EvoCeram (VTEC, Ivoclar). The experiment was performed using the ACTA wear machine. The ten
composites were mounted on a brass specimen wheel
and sanded to proper accommodations. A wear tract
against which tracings were to be measured was then
established on each brass wheel via an antagonist
wheel. Each brass specimen wheel was then exposed to
a different medium with a spring force of 15N applied
to the brass wheels. Mediums consisted of a neutral
control solution, basic enzyme solution, and an acidic
solution. Mixed in each medium was a solution
consisting of slurry of rice and millet seed shells to
simulate a bolus of food. Each specimen was exposed
to 200,000 cycles and then measured with Mitytoyo
SJ-400 Profilometer. A repeated measures model was
created with composite and solution predicting the
measurement value along with Tukey HSD tests for
multiple comparisons (SAS, version 9.2).
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
Wear Values at 200,000 cycles [Mean(SD)]
Materials (n=10)
AUD
AUE
DVS
EXHD
FSXTE
GCK
GRO
HUE
TPH3
Control
57.5 (2.01)
93.4 (5.07)
74.2 (1.17)
54.7 (1.10)
28.7 (0.54)
75.3 (4.89)
41.6 (1.05)
55.6 (2.42)
63.9 (2.13)
Enzyme
59.5 (2.77)
94.4 (5.23)
73.0 (2.16)
54.8 (2.35)
31.7 (0.83)
76.5 (3.93
44.2 (0.71)
52.4 (2.10)
62.0 (1.10)
Acid
56.7 (2.89)
98.3 (3.19)
89.2 (2.20)
50.4 (1.88)
29.5 (0.87)
82.8 (2.78)
37.8 (1.95)
59.1 (3.35)
72.7 (2.72)
Conclusion: Statistical analysis showed that the overall model and each composite compared to the full
model were significant (p<0.0001). Of all composites tested, 3M ESPE Filtek Supreme showed to have the
lowest wear in all three mediums. The environment in the oral cavity may have an influence on how composite
restorations wear over time.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #1931.
Tufts University School of Dental Medicine
63
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Growth Factor Secretion and In Vitro Repair Potential of Diabetic Foot
Ulcer Fibroblasts
Joann O’Brien,1 Yulia Shamis,2 Elana Knight,2 Vanessa Yazes,2 Avi Smith,1 Julia Caine,1
Behzad Gerami-Naini,1 and Jonathan A. Garlick1,2
1Department
of Oral and Maxillofacial Pathology, Tufts University School of Dental Medicine,
Boston;
in Cell, Molecular, and Developmental Biology, Sackler School of Graduate
Biomedical Sciences, Tufts University School of Medicine, Boston
2Program
Objectives: The long-term goal of this study is to develop stem cell therapies that are capable of treating
diabetic foot ulcerations. The main aim of the current study was to determine which patient-derived diabetic
foot ulcer fibroblasts might be repair-deficient based on their growth factor profiles. Following the study, repairdeficient fibroblasts will be reprogrammed to induced pluripotent stem cells (iPSCs) that may improve diabetic
ulcer healing due to their enhanced biological signaling ability.
Methods: Skin biopsies were obtained from diabetic ulcers, non-lesional diabetics, and site-matched controls
from Beth Israel Deaconess Medical Center with IRB approval. These types of tissues were sampled: diabetic
foot ulcers (DFU), non-diabetic foot ulcers (DFF), and site-matched normal skin (NFF). Fibroblasts were
expanded and banked. Serum-free media was added to confluent cultures and cells were allowed to incubate for
24 hours until cell culture supernatants were collected. Cell lines were analyzed via ELISA in both biological and
technical triplicates. A DuoSet ELISA Development kit (R&D Systems, Minneapolis, Minnesota) was used to
test for growth factors that are secreted by fibroblasts including: HGF, PDGF-BB, IGF1, VEGF, IL-6, IL-8, G-CSF,
FGF2, KGF, and TNF-a. Optical density was detected at A450 in the ELISA plate reader machine, and the average
concentration readings were normalized to cell numbers prior to analysis.
Results: Three inflammatory growth factors, HGF
(hepatocyte growth factor), IL-6 (interleukin-6), and IL-8
(interleukin-8), showed significant differences between DFU,
DFF, and control NFF. These growth factors were decreased in
diabetic cell lines (DFU and DFF) when compared to the nondiabetic controls (NFF). DFU cell lines 7 and 8 were identified
as repair-deficient fibroblast cell lines based on their decreased
inflammatory growth factor secretion. DFF cell lines 4, 9, and
10 showed lower levels of cytokines than DFU, but higher than
NFF. NFF cell line 12 had elevated amounts of growth factors
on a consistent basis. Data from RT-PCR, flow cytometry, and
migration assays were used in combination to help determine
which cell lines would be best to reprogram into iPSCs.
Conclusion: Growth factors are well known to contribute to patterns of cell activation in healing wounds.
We found that HGF, IL-6, and IL-8 secretion were decreased in diabetic ulcers and diabetic non-ulcers when
compared to the non-diabetic controls. This decrease in growth factor production may contribute to the
abnormal wound healing seen in diabetics since growth factors influence the cross talk that occurs between cells
in wound healing. We expect that these studies will lay the groundwork for the translation of in vitro and animal
studies into future clinical treatments. The next step is to reprogram these repair deficient cell lines from a nonhealing to a healing phenotype.
Supported by NIH Grant #RO1 DK98055-06A1 and the TUSDM Dean’s Scholars Program.
64
Student and Faculty Research Abstracts 2012 –2013
Adherence of Silk Coatings to Titanium Treatments
Austin Perera,*1 Courtney Michelson,1 Roberto Elia,2 Masly Harsono,1 Gary Leisk,3 Racquel
Legeros,4 David Kaplan,2 and Gerard Kugel 1
1Tufts
University, School of Dental Medicine, Boston; 2Tufts University, Department of Biomedical
Engineering, Medford, Massachusetts; 3Tufts University, Mechanical Engineering Department,
Medford, Massachusetts; 4New York University, College of Dentistry, Department of Biomaterials
and Biomimetics
Objectives: To evaluate techniques to maximize adhesion and integrity
of a silk-based dental implant coating in an aqueous environment.
Methods: Fifty commercially pure 7 mm diameter titanium studs were
split into treatment groups, each consisting of 5 samples. Silk fibroin was
extracted and purified to generate biocompatible protein solutions of either
5% or 10% (w/v). The solutions were pipetted onto one stud face, and a
platinum wire was lowered into the droplet surface. A current was passed
through the solution resulting in gel deposition on the stud. A second
stud was adhered atop the gel and dried for 24 hours. The adhered studs
were pulled apart in an Instron machine to test tensile strength. To study
protection against dissolution of the coating in saline, one treatment group
was water annealed for 24 hours. Half of the group was tested in air and
half submerged in saline for 5 minutes prior to testing. Additionally, adhesion strength was tested on varying
titanium surface roughness and a fluorohydroxyapatite (FHA) coating. Statistical analysis was conducted
through independent t-tests and one-way ANOVA tests. Significance differences were predetermined at p<0.5.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Results:
10% droplet deposition silk coating unless specified; superscripts indicate statistically significant differences.
Silk concentration
Coating method
Water annealing
5%
10%
Droplet deposition onto stud
Melted gel onto stud
No annealing, no saline
No annealing, 5 minute saline soak
Water annealed, no saline
Water annealed, 5 minute saline soak
Tensile Strength (MPa±SD)
0.40±0.10a
1.18±0.32b
1.18±0.32c
0.93±0.30c
1.18±0.32
0.12±0.08d
0.83±0.29
0.40±0.07e
Tensile strengths based on titanium surface modification (MPa±SD).
Machined (0.1µm Ra)
1.18±0.32f
Grit blasted (0.8µm Ra)
1.57±0.39f
Grit blasted (1.5µm Ra)
1.09±0.15f
FHA coated
1.09±0.21f
Conclusions: These new techniques increased tensile bond strength and protected against dissolution in a
saline environment. The results show promise for the application of silk protein coatings on dental implants,
including hydroxyapatite-coated systems.
Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #2047.
Tufts University School of Dental Medicine
65
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Using 3D Imaging Software to Measure Marginal/Internal Fit of
All-Ceramic Crowns
Jeremy R. Plourde,* Masly Harsono, John Orfanidis, and Gerard Kugel
Objective: To use 3D scanning and imaging software to evaluate the in vitro marginal and internal fit of allceramic crowns produced using the E4D Dentist™ (D4D Technologies) CAD/CAM system.
Methods: The extracted mandibular first molar was prepared to receive an all-ceramic crown. The
preparation had a well-defined, rounded shoulder, ~2 mm occlusal reduction, rounded internal angles, and
less than 20° total occlusal convergence. Small indentations were made on the root of the tooth as a plane of
sectioning. The tooth was scanned 30 times using E4D CAD/CAM system and 30 all-ceramic crowns were
milled. Thirty impressions of the prepared tooth were taken using VPS, and 30 die stone models poured. Dies
and crowns were scanned separately and together using the Activity 880 (smartoptics) optical scanner. Digital
images of dies and crowns were aligned using DentalCAD (exocad GmbH) software. DentalCAD was used
to section the digital samples buccolingually in a consistent plane using the root indentations as guidance.
Measurements of the space between die and crown were taken on 3 locations per buccal and lingual side of the
section: marginal-edge, mid-axial wall, and cusp-tip. One measurement was made on the occlusal table. Mean
measurements at each location were calculated.
Results: Mean fits at various locations of prep are shown in Table 1.
Table 1: Space between die and crown measured at marginal and internal locations (n=30).
Measurement
Location
Buccal
Margin
Mid-Axial
Lingual
Cusp
Occlusal
Table
Cusp
Mid-Axial
Margin
Mean
Thickness 174.77±80.46 66.50±30.16 121.17±64.66 193.07±54.42 124.03±50.62 103.37±33.79 165.97±43.09
(µm±SD)
Conclusions: Marginal and
internal fits determined using the
non-destructive digital scanning
technique were comparable to values
found in previous studies using a
destructive sectioning measurement
technique.
Also presented at the 2013 IADR/
AADR/CADR General Session in
Seattle, Washington. Abstract #534.
66
Student and Faculty Research Abstracts 2012 –2013
E-Cadherin Suppression Alters Dab2-Mediated Endocytosis in Squamous
Cell Carcinoma Cells
Shruti Pore,* Elizabeth Bingham, Tanja Petnicki-Ocwieja, Jonathan Garlick, James Baleja,
and Addy Alt-Holland
Objectives: Advanced stages of squamous cell carcinoma (SCC) are linked to loss of E-cadherin-mediated
cell-cell contacts; however, the mechanisms that direct the transition of premalignant lesions to carcinomas are
still elusive. Disabled-2 (Dab2) protein is a candidate to regulate this transition by controlling the endocytosis
of surface proteins
involved in cell adhesion
and proliferation. We
have shown that Dab2 is
down-regulated in human
bioengineered epithelial
tissues and tumors
harboring E-cadherinsuppressed SCC cells. Here
we investigated the effect
of E-cadherin loss on the
localization and expression
of key proteins in Dab2mediated endocytosis.
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Methods: The
cellular distribution and
expression of endocytic
proteins in fixed human
E-cadherin-competent- and E-cadherin-suppressed SCC cell cultures was determined by immunofluorescence
analysis. Localization of acidified vesicular compartments was visualized by a Lysotracker Red-fluorescent probe
in live tumor cells.
Results: We first examined the expression and localization of critical proteins involved in endocytosis of
surface proteins, prior to integration with lysosomal compartments. Dab2, Rab5, and Rab11 showed a weak
perinuclear staining in E-cadherin-suppressed SCC cells and intense staining throughout the cytoplasm of
E-cadherin-competent cells. We next analyzed the distribution of acidified vesicular compartments in live-cell
cultures. These compartments were found in proximity to the nuclei of E-cadherin-suppressed cells, whereas
they spread from the plasma membrane to the perinuclear area in E-cadherin-competent cells.
Conclusions: This study provides new insights into the consequences of E-cadherin loss in epithelial cells
with malignant potential. It indicates that the tumor-promoting effect of E-cadherin suppression is associated
with altered Dab2-mediated endocytosis and trafficking of acidified compartments that can affect, at least in
part, tumor cell adhesion, motility, and invasion. Thus, Dab2 may be a biomarker for SCC development in the
human skin and in life-threatening epithelial cancers, such as oral cancer.
A “Tufts Collaborates!” grant awarded to Drs. Alt-Holland and Baleja funded this study. Also presented at the 2013
IADR/AADR/CADR General Session in Seattle, Washington. Abstract #452.
Tufts University School of Dental Medicine
67
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Remineralization Efficacy of Different Concentrations of Xylitol Gum
Kasun Rajapaksha,* Matthew Finkelman, Masly Harsono, Gerard Kugel, and Ronald D. Perry
Objective: To observe the efficacy of chewing gum with different Xylitol concentrations on demineralized
enamel using hardness testing.
Methods: Obtained for this study were 45 extracted, caries-free human teeth. The teeth were sectioned into
approximately 4 mm x 4 mm thickness squares and embedded in resin. Samples were polished up to 1 μm
using texmet polishing cloth (Buehler, Illinois). All samples were immersed in 10 mL of a 2.2 mM CaCl2, 2.2
mM KH2PO4, 0.05M acetic acid solution (Ten Cate) for 96 hours at 37°C to create the artificial demineralized
lesion. Samples were randomly assigned to three groups (n=15). Two chewing gums products were tested:
Gum 1-Xylitol (Epic Industry) and Gum 2-Orbit (Wrigley’s). Samples were place into the centrifuge tube with
artificial saliva solution. The chewing gums and artificial saliva were changed daily for 14 days. The enamel
hardness was carried out using Vickers indenter with 100 gf and 10 seconds dwelling time. Statistical analysis
was conducted using one-way ANOVA. Statistical differences were predetermined at p<0.05.
Results:
n=15
(VHN+SD)
Control
44.51±18.87a
Gum 1
121.12±48.082b
Gum 2
65.26±27.64a,b
Conclusion: Both chewing gums
resulted in higher Vickers hardness
values than the control group.
However, there was no significant
hardness difference between the
Orbitol and Xylitol chewing gum
groups.
68
Student and Faculty Research Abstracts 2012 –2013
Effect of Loupes on Ocular Blue Light Hazard: Indirect Viewing
Errol N. Ramos,*1 Judyth G. Lee,1 R.B. Price,2 Ronald D. Perry,1 Daniel Labrie,3 and
B. Sullivan2
1School
of Dental Medicine, Tufts University, Boston; 2Dept. of Clinical Dental Sciences, Dalhousie
University, Halifax, Nova Scotia, Canada, 3Physics and Atmospheric Science, Dalhousie University,
Halifax, Nova Scotia, Canada
Objectives: This study measured the effect magnification loupes have on the blue light hazard when a curing
light is viewed indirectly.
Methods: Loupes with 3.5x magnification (Design for Vision [DFV], Carl Zeiss [CZ], Quality Aspirator
[QA]), and 2.5x magnification (DFV and QA) with were tested over three days. The loupes were placed at the
entrance to an integrating sphere connected to a spectrometer (USB 4000, Ocean Optics). A typodont with
human teeth was placed 40 cm away and in line with this sphere. A Sapphire Plus (Den-Mat) curing light was
positioned at a 45 degree angle from the facial of tooth #9. The spectral radiant power reflected from the teeth
was recorded 5 times both with and without the loupes over the entrance into the sphere. The angular subtense
of the experiment was 0.02 radians. The maximum permissible cumulative exposure times in an eight-hour day
were calculated using guidelines set by the American Conference of Industrial Hygienists (ACGIH). Weighted
blue light irradiance values were compared between the brands of loupes using Fisher’s PLSD, α=0.05.
Results: Weighted blue irradiance values were significantly different for each brand of loupe (p<0.05) and
were up to 8 times greater at the pupil than without loupes. However, since the resulting images were now 2.5 to
3.5x larger on the retina, the effective blue light hazard was reduced compared to without the loupes.
Day 1
Brand
Weighted Irradiance
(mW/cm2)
Max. Daily Exposure
Time (seconds)
No Loupes QA 2.5x
DFV
3.5x
Day 2
DFV
No Loupes
2.5x
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Day 3
QA 3.5x No Loupes CZ 3.5x
0.053
0.130
0.330
0.054
0.170
0.430
0.049
0.250
593
1508
1167
582
1153
895
1540
641
Conclusions: Without loupes, at 40 cm
distance, the maximum cumulative daily
exposure time to light reflected from the tooth
was approximately 10 minutes. This maximum
is unlikely to be reached in the dental office. All
the loupes increased the irradiance received at
the pupil. Although the irradiance received by
the eye was greater, the maximum cumulative
daily exposure time was increased. Further
studies are required on the ocular hazards of
loupes and the effects of other curing lights.
Also presented at the 2013 IADR/AADR/
CADR General Session in Seattle, Washington.
Abstract #675.
Tufts University School of Dental Medicine
69
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
Analyzing the Trends and Associated Management Outcomes of Oral
Lesions and Medication Regimens among the HIV-Positive Patient
Population at Tufts University School of Dental Medicine
Jaskaren Randhawa,* Diana Esshaki, Paul Stark, Angel Park, and Kanchan Ganda
Objective: The objective of the study was to determine the incidence and type of oral lesions at different
levels of immunity, as well as oral lesions in the presence and absence of anti-retroviral (ARV) treatment among
Ryan White HIV-positive patients at the Tufts University School of Dental Medicine (TUSDM) undergraduate
clinic.
Methods: A retrospective analysis of HIV-positive patients that were Ryan White grant participants and
received treatment at TUSDM undergraduate clinic from September 1, 2011, to September 1, 2012, was
conducted. Axium electronic health records were utilized for data collection and all data was exported to SAS
for analysis.
The study population was
analyzed based upon the
following factors: demographics,
lab values, medication
regimens, oral conditions and
co-morbidities; all of which
were identified by reviewing
the comprehensive health
history, record of examination,
and medical consult forms on
Axium.
Demographics included: age,
sex, race, smoking status, and
type of insurance. Lab values,
which were used as indicators of
each patient’s level of immunity,
included: absolute neutrophil
count (ANC), white blood count, viral load levels, and CD4 lymphocyte count. The immunity status and stage
of HIV of each patient was classified into three groups according to their respective CD4 count values: CD4
less than 200 cells/mm3, which indicated severe immunosuppression and the diagnosis of acquired immune
deficiency syndrome (AIDS), CD4 200–500 cells/mm3, which indicated moderate immunosuppression, and
CD4 500–1,000 cells/mm3, which represented a normal CD4 count.
Identified medication regimens consisted of anti-retrovirals (ARVs), anti-virals, anti-fungals, and antibiotics.
The incidence of the following most common HIV-associated oral conditions were assessed: oral candidiasis,
hairy leukoplakia, kaposi’s sarcoma, HPV-associated warts, necrotizing stomatitis, lichen planus, herpes simplex
lesions, and recurrent apthous ulcers. Co-morbidities that may influence a patient’s immune status were
identified.
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Results:The study population consisted of 89 Ryan White Grant recipients ranging from 20 to 64 years
old with a mean age of 45 years old. Approximately 65.17% of patients were white and 83% were male. The
insurance distribution was as follows: 50.56% of the population received MassHealth benefits, 37.08% were selfpay, and 12.36% had private dental insurance.
Due to the lack of consistency and standardization in the reporting of ANC, WBC, and viral load values, CD4
was used as the sole immunity defining criteria. As indicated by the CD4 count, 36.5% of the study population
was immunocompromised, with 4.71% categorized as severely immunosuppressed and 31.76% categorized as
moderately immunosupressed.It was determined that 96.4% of all participants were undergoing ARV treatment
with a mean of 2.26 ARVs. Of those receiving ARV therapy 4.76% had CD4 counts less than 200 cells/mm3,
30.05% had CD4 counts between 200–500 cells/mm3, and 51.85% had CD4 counts between 500–1,000 cells/
mm3.
Oral lesions were observed in 24 of 89 (27%) of HIV positive patients. These oral lesions included: herpes
simplex (7.87%), oral candidiasis (4.49%), kaposi sarcoma (4.49%), hairy leukoplakia (3.37%), HPV associated
warts (2.25%), stomatitis (2.25%), lichen planus (1.12%), and apthous ulcers (1.12%). Among patients that
were receiving ARV treatment, 78.82% did not experience any common HIV-associated oral conditions, while
33% of those not receiving ARV treatment experienced these oral conditions.
Co-morbidities were observed in 75 of 89 (84.3%) of all study subjects. The mean number of co-morbidities
each patient experienced was 4.12 with an interquartile range between 2 and 6. Depression (44%) was the most
frequently observed co-morbidity among the study population. Other co-morbidities included: hypertension
(35%), hepatitis (24%), anxiety (22.7%), AIDS (15%), history of cancer (17.3%), asthma (12%), anemia (12%),
hypercholesterolemia (9.3%), herpes zoster (9.3%), bipolar disorder (8%), gastroesophageal reflux disease
(6.7%), diabetes (5.3%), and genital herpes (5.3%).
Bates-Andrews Day Abstracts
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Conclusion: Due to the small sample size, the study served as a descriptive assessment of Ryan White
patients during the given time period. Although it was not possible to determine if a statistically significant
relationship existed between the presence of oral conditions and CD4 count, as well as ARV treatment, there
were apparent trends, showing that the majority of patients receiving ARV treatment did not present with any
HIV-associated oral lesions.
There were uncontrollable factors that may have influenced the results of the study including: methods of data
entry in Axium, patients’ disclosure of existing medical conditions, and human error while conducting the chart
review.
Future Implications: Further studies that analyze a larger population of Ryan White patients over a
longer period of time are recommended in order to evaluate the relationship between oral conditions, ARV
treatment, and CD4 values and assess changes over time.
In addition, it is recommended that changes to Axium forms be made so that entry for lab dates, medications,
and oral conditions is standardized to ensure that consistent data can be extracted for research purposes.
Furthermore, HIV-positive patients should be re-evaluated every 6 months by the medical consult team with
updated medical history and new lab values as needed.
Tufts University School of Dental Medicine
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Community Engagement in Global Oral Health Outreach Project
Development
Laura Rein,*1 John Morgan,1 Kerry Maguire,2 and N. Sayela3
1Tufts
University School of Dental Medicine, Public Health and Community Service; 2Options for
Children in Zambia, Belmont, Massachusetts; 3Dental Training School, Lusaka, Zambia
Background: Chronic diseases are primary health
concerns in all but few parts of the world. Oral health
diseases, specifically, qualify as chronic public health
burdens due to the high prevalence and debilitating
effects on one’s quality of life. In developing nations,
the limited oral healthcare infrastructure, as well as
societal and environmental risk factors, exacerbate this
disparity. Innovative oral health project development
is challenging due to the lack of available resources
and health infrastructure. To achieve a successful
oral health program, it is essential to incorporate the
four main components of the primary health care
(PHC) philosophy: palliative treatment, exposure to
fluoride, oral health education (OHE), and atraumatic
restorative treatment (ART). Utilizing the PHC philosophy, in conjunction with active community engagement
and participation in project development, has the potential to be an extremely effective tool in constructing,
implementing, and evaluating a sustainable global oral health project demonstration.
Materials and Methods: Since 2006, a collaboration of a local community, the Dental Training School
of the Zambian Ministry of Health, Tufts University, and Options for Children in Zambia (NGO) established
a health project in rural Zambia strategically utilizing existing healthcare infrastructure and incorporating
community feedback and participation in the program development. The program includes the four
components of the PHC principles and incorporates input from the local community and the Zambian and
United States teams.
Results: This unique collaboration relied heavily upon a strong community liaison who facilitated and
enabled the U.S. team to build strong communications and relationships within the Zambian community.
After establishing strong rapport and mutual trust, the communities comfortably approached the U.S. team
and articulated community concerns that would improve overall wellbeing. Based on local community
recommendations, the project incorporated the involvement of local leaders, the recruitment and training of
community volunteers to provide oral health education, a clean water project, involvement of women, and the
integration of maternal/child health. Supervised by the local rural health center medical staff, the community
volunteers receive educational assistance and individual mentoring to qualify for admission to the Dental
Training School. Upon graduation, the community volunteers will return to their villages and practice within
the rural communities to assure project sustainability.
Conclusion: Utilizing the principles of PHC and mobilizing community efforts contributes to the
sustainability of an oral health project. The active involvement of the local community in program development
provided the framework for an oral health project that was valued by the community and appropriately made
use of available local resources.
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Student and Faculty Research Abstracts 2012 –2013
Shear Bond Strength of Self-Adhesive Resin Cement Above/Below CEJ
Sepideh Sabooree,* Austin Perera, Masly Harsono, Matthew Finkelman, and Gerard Kugel
Objectives: To test the shear bonding strength of three different self-adhesive cements incorporating
selective etching technique above and below the CEJ (on enamel and cementum).
Methods: Twenty-eight caries-free human extracted teeth were sectioned at the CEJ and longitudinally to
provide 2 enamel and 2 cementum surfaces. The samples were randomly divided into 12 groups: n=8, 6 groups
above CEJ (enamel), 6 groups below CEJ (cementum). Each sample was embedded in acrylic to facilitate
mounting and flattened and polished with Sic paper up to 320-grit (Ecomet3, Buehler). Three self-adhesive
cements were tested with variations in selective etch technique: SpeedCEM (Ivoclar Vivadent), Multilink (Ivoclar
Vivadent), and RelyX Ultimate (3M, ESPE). Cements were applied according to manufacturers’ suggestion
with the exception of using the total etch technique or pre-treating with etch (37% H2PO4). Lithium disilicate
buttons, approximately 3 mm in diameter, were cemented and cured for 40 seconds with LED light (DEMI,
Kerr). After storage in water for 24 hours, the shear bond strength was carried out using a universal testing
machine (Instron 5566A, Norwood, Massachusetts) with a crosshead speed at 1mm/min. Statistical analysis was
done by one-way ANOVA, with post-hoc analysis conducted via Tukey HSD with Bonferroni correction.
Results:
CEJ (MPa±SD)
Above
SpeedCem
Multilink
RelyX Ultimate
Etched
Un-Etched
Etched
Un-Etched
Etched
Un-Etched
17.56±5.841,2
8.09±3.14A
11.35±5.772
14.19±8.59A
26.98±6.551
18.53±10.32A
Below
Bates-Andrews Day Abstracts
Predoctoral Student Presentations
5.53±3.37b
11.72±6.09X
10.24±3.75b,c
13.68±9.55X
17.11±6.32c
17.64±3.75X
Results with varying superscripts are statistically different (p-value<0.0125).
Conclusions: For
applications above the CEJ,
etching prior to cementation
yielded significantly higher
SBS for SpeedCEM and RelyX
Ultimate groups. Below the CEJ
there is no conclusive benefit to
etching prior to application of
the cement.
Also presented at the 2013
IADR/AADR/CADR General
Session in Seattle, Washington.
Abstract #1059.
Tufts University School of Dental Medicine
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Automated Teeth Segmentation in Bitewing Radiographs Using
Various Algorithms
Tej A. Shah* and Aruna Ramesh
Objective: The objective is to create software that will automatically segment teeth in a bitewing radiograph.
Automatic segmentation is a process in which a two-dimensional image (i.e., a radiograph) is marked by
a computer as to which pixels represent which structure in the image. The human eye can already look at
a normal image and be able to detect where a structure will start and end. However, due to the nature of
radiographs and the anatomic variance between patients, it is very difficult to write an accurate segmentation
program. There have been various attempts at solving this problem; however, there are no known papers on
per-pixel segmentation of teeth. Unlike other attempts, this software is free and open source to allow other
researchers to modify and improve all algorithms used in this software. The software created in this project
can also act as a generic radiograph viewer that is free for all doctors to download and use at no cost. The main
advantages of having a computer segment an image include caries detection, radiograph quality detection, and
research in public health. The segmentation software concentrated on bitewings due to the fact that bitewing
radiographs are the standard of care for interproximal caries detection and a number of assumptions that can
be made by the software.
Methods: The first attempted algorithm used Bézier curves to estimate the curve of Spee. Pixels along the
curve of Spee were used to segment the background (the radiolucency) from the foreground (teeth and bone).
Then, each tooth was analyzed to find the pixels associated with enamel, dentin, and pulp. The second algorithm
is very similar to the first except it moves from the mesial to distal portion of the radiograph using a “Greedy
Algorithm” to detect a line of occlusion.
Results: The software (named “GNU Dental Radiograph Program”) has shown a high accuracy for detecting
the background versus the foreground parts of the radiograph. The software is not yet accurate enough to
segment the enamel from the dentin in the radiograph.
Conclusion: More work needs to be done to
perfect the segmentation of teeth. By having the
software be free and open source, any researcher
can help and improve the algorithms that are
being used.
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Student and Faculty Research Abstracts 2012 –2013
Oral Health and Diet Scores in Preschool Asian Children
Leslie Slowikowski,* Wanda Wright, Cheen Loo, and Matthew Finkelman
Objective: The purpose of this study is to compare cariogenic score, diet score, and number of decayed and
filled teeth of Asian children ages 0–3 years, by gender and age.
Methods: This is a retrospective observational study of children treated at a dental training institution.
Data for all children ages 0–3 referred for an initial exam by Tufts baby clinic in aXium (electronic database
for 2004–2012) were analyzed. Records of 75 patients met the inclusion criteria and were included in this
study. Generalized estimating equations (GEE) were used to assess the association between decayed and filled
teeth with gender and age, utilizing SAS version 9.2 software. The Mann-Whitney U test was used to assess the
association of gender with cariogenic and diet score. The Kruskal-Wallis test was used to assess the association
of age with cariogenic and diet score. P-values <0.05 were considered statistically significant.
Results: There was a significant difference (p<0.001) in caries prevalence between subjects with an initial
dental visit at age 0–2 years (0.3%), compared to subjects who had an initial dental visit at age 3 (18%). There
was no association between gender and caries or gender and diet.
Conclusion: Gender does not play a role in susceptibility to caries, but age at initial exam is a statistically
significant factor. This supports the recommendation of American Association of Pediatric Dentistry for
establishing a dental home by the age of 1 year in order to provide pediatric dental care through anticipatory
guidance, diet counseling, and treatment of dental disease.
Bates-Andrews Day Abstracts
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Also presented at the 2013 IADR/AADR/CADR General Session in Seattle, Washington. Abstract #3203.
Tufts University School of Dental Medicine
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In Vitro Studies of a New Zirconium Alloyed Titanium for Implant Dentistry
Jesse Small,*1 Liming Yu,1 Martin Schuler,2 Michel Dard,3 and Jake Chen1,4
1Division
of Oral Biology, Tufts University School of Dental Medicine, Boston; 2Institut Straumann
AG, Basel, Switzerland; 3Department of Periodontology and Implant Dentistry, College of Dentistry,
New York University, New York City; 4Department of Anatomy and Cell Biology, Tufts University
School of Medicine and Sackler School of Biomedical Sciences, Boston
Objective: Dental implants are becoming more and more frequently utilized to treat tooth loss. However, the
inflammation that occurs around the implant after surgery is still a major issue. This in vitro study examines the
inflammatory response of bone cells in response to a new titanium-zirconium alloy (TiZr) recently developed
(Roxolid®, Institut Straumann, Basel, Switzerland).
Method: Mouse leukaemic monocyte macrophage cells (RAW264.7) were cultured comparatively with the
two different materials (TiZr, Ti) in a 5% CO2 atmosphere at 37°C in RPMI 1640 supplemented with 10% (v/v)
FBS for 24 h, 48 h, and 72 h and exposed to either lipopolysaccharide (LPS) or RANKL. Total RNA extraction
was performed and the resulting expression of inflammatory genes and osteoclastic markers were measured by
real time qPCR.
Result: Expression of inflammatory cytokines IL-1, IL-6 and TNF-alpha highly increased after LPS treatment.
Both TiZr and Ti groups showed less inflammation gene expression than the disc(-) LPS(+) group, while the
TiZr group expressed less IL-6 and more anti-inflammatory cytokine IL-10 when compared with the Ti group.
Furthermore, the osteoclastic differentiation genes CtpsK, NFATC, TRACP and TRAF6 were highly expressed
after RANKL treatment in the all groups; however, both TiZr and Ti groups showed less osteoclastogenic gene
expression than the control group. There was no significant difference in gene expression pattern between the
TiZr and Ti groups.
Conclusion: Although there was no significant difference in osteoclastogenic gene expression between
the TiZr and Ti groups, less inflammatory reaction was observed in the presence of TiZr alloy compared
to commercially pure titanium. Thus, TiZr proved to be a better implant material in this in vitro study.
Further studies on the
inflammatory molecular
mechanisms of TiZr are
currently underway in our
laboratory.
Also presented at the 2013
IADR/AADR/CADR
General Session in Seattle,
Washington. Abstract
#2577.
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Student and Faculty Research Abstracts 2012 –2013
Developmentally Disabled Adults Treated under General Anesthesia:
Periodontitis and Correlates
Erica Stutius,* Angel Park, and John Morgan
Objectives: The prevalence of periodontitis and associated risk factors in developmentally disabled adults
are poorly understood. The purpose of this study was to investigate the severity of periodontal disease in a
group of intellectually/developmentally disabled (IDD) adults receiving dental treatment utilizing general
anesthesia (GA) and report potentially related socio-demographic characteristics.
Method: This cross-sectional study utilized clinical and demographic information recorded at the time
of dental treatment at a state-supported system of dental clinics. Data were collected from axiUm electronic
records for IDD adults ≥20 years old receiving dental treatment utilizing GA from 4/1/2009 to 3/31/2010.
Cooperation level, living environment, prevalence and severity of periodontitis, and number of preventative
visits were compiled into an Excel database and analyzed (SAS Version 9.2).
Results: From the
records, 347 IDD dentate
patients met the inclusion
criteria. Mean (SD) age=
44.3±11.0 (range: 21–72
years); 62% male. Median
cooperation level=3
(0=least cooperative,
6=most cooperative).
Periodontitis was reported
in 83% of patients (33.5%
Type II; 48% Type III;
18.5% Type IV). Of the
population, 89.72%
resided in community
settings. Of the patients,
60.3% met recommended
four annual preventative
visits. Those meeting the recommended number of annual preventive visits varied by cooperation levels as
follows: cooperation level 5 and 6, 63.0%; cooperation levels 3 and 4, 69.4%; cooperation levels 0 to 2, 42.5%
(p<0.05).
Bates-Andrews Day Abstracts
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Conclusion: Periodontitis was found to be a significant factor in the study group. An overwhelming
majority had periodontal disease, most with Type III periodontitis. The population, in general, did not meet
the recommended four preventive visits per year. The lowest compliance to preventive visit recommendations
was noted in those with the lowest cooperation levels. Treatment of periodontal disease includes compliance
to recommended preventive protocols, including quarterly recall visits. Identification of risk factors for
periodontitis including the ability to receive routine preventive care may assist in better treatment outcomes for
this high-risk population.
Supported in part by NIH1RC1DE020396-01. Also presented at the 2013 IADR/AADR/CADR General Session in
Seattle, Washington. Abstract #751.
Tufts University School of Dental Medicine
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Microtensile Bond Strength to Ground Enamel by Sealant Materials
Dane Swenson,* Stephanie John, Masly Harsono, Gerard Kugel, and Ronald Perry
Objective: To determine and compare the microtensile bond strength of four dental sealant materials on
primary molar enamel.
Method: Thirty-six extracted caries-free primary molar teeth were obtained for this study. Each tooth
was created by preparing a flat enamel surface on the buccal or lingual side using a p1200 grit SiC polishing
paper (Ecomet, Buehler). Samples were ultrasonic cleaned with deionized water for 10 minutes to remove all
debris from polishing materials and then randomly divided and bonded into four groups of sealant materials
according to manufacturer instruction. The sealants were placed incrementally at approximately 1.5