• The effect of electrical stimulation on success of bone grafts: an in vivo study

      Talwar, Garima Kaur; Masri, Radi, 1975-; Driscoll, Carl F. (2012)
      Purpose: Bone grafting is often unpredictable and is associated with reduced success rate, extended healing times and morbidity. Methods that expedite healing and increase predictability will contribute to the overall success of reconstructive efforts. In this project, the effect of electrical stimulation on bone graft healing in rat calvaria was examined. Materials and Methods: Fifteen adult male Sprague-Dawley rats were used. A 7 mm diameter bone defect at the midline of the calvarium was grafted using freeze-dried mineralized bone. Bipolar platinum stimulating electrodes were overlaid on top of the periosteum on the center of the graft. Animals were divided randomly into two groups. The experimental group (n=8) received electrical stimulation (3 times/day for 10 days) and the control group (n=7) received no stimulation. At 6 weeks, the grafted areas together with the surrounding bone were harvested from the cranium. Tissue sections (5-7 μm) were prepared and stained using hematoxylin and eosin. Mounted slides were analyzed and for each animal, the grafted area was marked and the percent of new bone, remaining graft material and connective tissue was calculated. Data was analyzed using ANOVA. A p≤.05 was considered significant. Results: There were statistically significant differences between the experimental and control group. The electrical stimulation group had significantly more (p=0.034) bone (3.81+3.6 %) compared to the control group (0.47+0.52%). The amount of remaining graft material was also significantly higher (p=0.024)in the control group (26.11+6.54%) compared to the stimulation group (16.64+5.28%). No significant difference (p=0.15) was found between the 2 groups in the amount of connective tissue (stimulation: 79+5.47%; control: 73.2+6.82%). Conclusion: In this animal model of bone graft healing, electrical stimulation resulted in significantly more bone formation and less remaining graft material. These findings suggest that electrical stimulation expedites bone graft healing.
    • The Effects of Local Antibiotic Administration on Endodontic Treatment Outcomes

      Bennett, Ian G.; Fouad, Ashraf F. (2011)
      Teeth with periapical radiolucency have a lower prognosis than those without radiolucency and may take up to 4 years for complete healing after primary endodontic treatment. Local delivery of a non-toxic substance with antimicrobial and anti-inflammatory properties may improve the healing of apical periodontitis. The study was a randomized clinical trial to evaluate the effects of local administration of doxycycline or saline at the periapex of teeth with periapical lesions. The primary aim was to compare the change from baseline to 4 months in periapical radiolucency area between doxycyline and saline groups. The secondary aims were to compare the percentage of healed cases (no detectable periapical radiolucency) at 4 months between doxycycline and saline groups and to compare the post-obturation pain experience between doxycycline and saline groups. 20 single-rooted teeth with pulpal necrosis and periapical radiolucency ≥ 3mm were treated endodontically in two visits. Prior to obturation, doxycycline or saline was delivered through the apical foramen into the periapical tissues. Cone-beam computed tomography (CBCT) imaging of the tooth and periapical tissues was performed post-op and at 4 month recall. All patients reported their post-obturation pain experience using a Visual Analogue Scale (VAS). There was no significant difference when comparing the change from baseline to 4 months in periapical radiolucency area between doxycycline and saline groups (p = 0.36, One-Way ANOVA). There was no difference when comparing the percentage of healed cases (no detectable periapical radiolucency) at 4 months between groups. All patients had mild (<30/100 VAS) to no pain that uniformly resolved within 7 days. There was no significant difference when comparing VAS scores between groups (p > 0.05, One-Way ANOVA controlling for level of pre-op pain using a linear regression model). The local administration of doxycycline at the periapex of teeth with periapical lesions did not significantly improve healing of periapical radiolucencies at 4-months. It did, however, show potential as a clinically important adjunct that warrants future research. Doxycycline did not appear to have any deleterious effects upon healing of periapical lesions and it was not associated with significant increases in post-operative pain.
    • Evaluation of Factors Related to Long-term Healing in Endodontic Treatment

      Orgel, Adam William; Fouad, Ashraf F. (2012)
      Introduction: This study sought to determine the effects of residual root canal bacteria and treatment factors on endodontic treatment outcomes up to 6 years post-operatively using traditional radiography (PA radiographs) and limited cone beam computed tomography (CBCT). Methods: Root canal samples were obtained from 50 patients with pulp necrosis and a periapical lesion, following two-visit treatment using contemporary chemomechanical preparation techniques. PCR, with broad range 16S rDNA bacterial primers, was performed followed by cloning and sequencing on pre-obturation specimens. Periapical and CBCT radiographs were taken at 10 months to 6 years post-treatment. Images were scored by two blinded, calibrated endodontists using the conventional periapical index (PAI) and a CBCT index. Statistical analysis was performed using bivariate and multivariate regression analysis for treatment factors. Kaplan-Meier survival analysis and Pearson's regression analysis was used for year-over-year changes. Results: 41 patients were included in the final data analysis. Recall decreased from 98% at 10-17 months to 51% at 33+ months. The percentage of patients healed at 10-17 months, 18-32 months and 33+ months and overall was 65%, 63%, and 66% respectively. Factors influencing outcomes were presence of bacteria at time of obturation (56% when present, 81% absent), primary versus persistent disease (71% vs. 39%), tooth type (85% anterior,23% molar), obturation to the radiographic apex (100% to the apex, 56% not to the apex), and larger master apical file sizes (73%MAF>45 vs. 36% MAF<45).. Short-term outcomes had a strong positive relationship with final outcome (Pearson's, r2=0.56, p=<0.01). Conclusions: Bacterial DNA presence at the time of obturation adversely affects short-term and intermediate-term endodontic treatment outcomes, but this effect is not found in the long-term. Various patient factors such as tooth type and treatment factors such as master apical file size influence outcomes. Short-term treatment outcomes are good predictors of long-term outcomes.
    • A Phenomenological Study on Lived Experiences of Psycho-Socio-Spiritual Healing in Cardiac Rehabilitation Patients

      Nadarajah, Sheeba Raaj; Wiegand, Debra J. Lynn-McHale (2012)
      Abstract Background: Coronary artery disease is the single leading cause of death in the United States. Secondary prevention programs such as cardiac rehabilitation focus on physical aspects of healing and psycho-socio-spiritual aspects of healing are often given minimal attention or neglected. Considering the chronic nature of cardiac disease, a holistic approach to secondary prevention programs might help to improve health outcomes. Purpose: The purpose of this investigation was to describe the lived experiences of psycho-socio-spiritual healing in cardiac rehabilitation patients. Methods: A descriptive, qualitative, phenomenological approach guided the investigation. A purposive sample of 10 patients was recruited from a cardiac rehabilitation center. In-depth interviews were conducted with each participant. An interview guide was used that included open ended and specific questions related to psycho-socio-spiritual aspects of healing. Interviews were recorded and audio files were transcribed. Colaizzi (1978) method was used to guide data analysis and formulate the structure of the psycho-socio-spiritual healing phenomenon. An audit trail was developed, detailed memos regarding steps in the data anlaysis were written, and peer debriefing was performed. Member checks were conducted to determine credibility. All of the data were reviewed by a second researcher to confirm dependability and confirmability. Results: Participants described the entire experience as life-transforming. Experiencing an acute cardiac event was shocking. Participants were suddenly faced with their own mortality. When faced with this life and death situation, participants chose life and healing. Participants reordered priorities and made necessary lifestyle changes. Living with heart disease had its own challenges that included: maintaining lifestyle changes, living with one's genetic vulnerability, and fear of recurrence of another cardiac event. Heart disease led to positive changes such as weight loss, motivation to others without heart disease and most importantly, transformation and growth. Barriers to healing included lack of support and psychological distress. Healing was facilitated by having a positive attitude and being committed, participating in cardiac rehabilitation, using mind-body interventions, and having social support. Conclusions: This study explored the psycho-socio-spiritual healing phenomena in CR participants. A holistic approach to care that integrates psycho-social-spiritual healing with physical healing may help to support patients and facilitate recovery.