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Open Access Publications from the University of California

Scholarly Works (12 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2023)

Objective: This systematic review aims to explore the impact of diseases of pulpal origin (DoPO) and subsequent non-surgical root canal treatment (NSRCT) on life impact and health-related quality of life (HRQoL). The focus is on understanding the multidimensional aspects of health-related quality of life (HRQoL) and satisfaction encompassing physical, psychological, and social dimensions of overall well-being.Specific Aims: (1) To measure the impact of DoPO on OHRQoL, satisfaction, and life quality. (2) To identify the key domains by which DoPO has life-impact. (3) To measure the impact of NSRCT on OHRQoL, satisfaction, and life quality over time. Methods: Inclusion criteria encompassed various study designs (comparative or non-comparative, cross-sectional, prospective or retrospective), focusing on quantitative or qualitative data related to quality of life or satisfaction related to DoPO and NSRC) between January 1, 1990, and June 6, 2022. Publications were required to be in English, indexed in refereed literature, and include data on 10 or more individuals with DoPO, needing NSRCT, or receiving NSRCT. Studies needed clear measures, sample size descriptions, treatments provided, follow-up durations. Authors were contacted for clarification or additional data if needed. An electronic search was conducted in PubMed . Complemented by manual searches through citation mining, guidance from a reference librarian, and expert advice. Full-text articles meeting inclusion criteria were analyzed for study quality using the Wong Scale–Revised. Data abstraction facilitated quantitative and qualitative synthesis, meta-analysis where possible, and L’Abbe plotting, with normalization of data to percentages. Results: 243 titles were found through electronic searches, leading to 28 papers covering 60 populations. Most studies were recent (12 in the last 5 years, 20 in the last 10 years), from 18 countries, with acceptable to high quality ratings. Studies varied in methodologies, sample sizes (25 to 1323 individuals); comparisons made; techniques, providers, and age groups studied. OHIP scales were prevalent, but other measures such as other scales and qualitative approaches. Satisfaction was assessed in 10 studies across 18 populations using the Dugas Semantic Differential Scale (DSDS) or specific questions. Disease of pulpal origin was generally of low-to-moderate life impact when measured by OHIP-14 and -7 instruments, but other instruments tended to indicate a higher life impact. Disease of pulpal origin overwhelmingly impacted the domains of physical pain, psychological discomfort, and psychological disability, whereas the domains of functional limitation, physical disability, and social disability were considerably less impacted. Non-surgical root canal treatment provided substantial improvement in life quality when measured by change in oral health-related instruments, such as the OHIP, when measured using the Dugas Semantic Differential Scale, by simple satisfaction questions, and by qualitative methods. Most of the positive impact of NSRCT was discerned in days or weeks following treatment, and the impact was sustained through all time periods measured, up to 2 years. DoPO had a substantial negative impact on OHQoL. Whereas, NSRCT consistently showed a positive impact on HRQoL, notably reducing pain, psychological discomfort, and disability, with improvements often seen shortly after treatment and sustained throughout the study durations. Discussion: It is recommended that future studies use standard instruments, present all the domain and sub-domain data, and use multiple approaches, including the qualitative exploration of patient experience. This investigation underscores the need for standardized measurement tools in assessing the impact of non-surgical root canal treatments. It emphasizes the substantial improvements observed in patients' quality of life post-treatment, thereby advocating for comprehensive assessments in future research endeavors to better understand and enhance oral health outcomes. Conclusions: DoPO had a substantial negative impact on OHQoL, where the domains of physical pain, psychological discomfort, and psychological disability were dominant. NSRCT consistently showed a positive impact on HRQoL, notably reducing pain, psychological discomfort, and disability, where improvements were evident shortly after treatment and sustained throughout the study durations.

  • 1 supplemental ZIP
Cover page: Life Impact of Diseases of Pulpal Origin and its Non-Surgical Root Canal Treatment
  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2012)

Patient-based research provides insight into real-world endodontics. Cross-sectional studies describe the health status of populations. Root canal-associated pain is a source of fear for patients, a concern of dentists, and is remembered and shared.

Inclusion/exclusion criteria and defined searches selected articles in MEDLINE, EMBASE, Cochrane, and PsycINFO databases. Prevalence of periapical radiolucency and root canal treatment were calculated. L'Abbe plots evaluated the influence of root canal treatment on pain prevalence and severity.

5% of teeth had periapical radiolucencies, 9% endodontically treated, 37% of treated teeth had periapical radiolucencies, and 2% of untreated teeth had periapical radiolucencies. Pre-treatment, 24 hour, and 1 week pain prevalences were 81(28)%, 40(24)%, and 11(14)%. Pre-treatment, 24 hour, and 1 week pain severities, were 54(24)%, 24(12)%, and 5(5)%. L'Abbe plots revealed a decrease in pain prevalence and severity.

Prevalence of periapical radiolucency and root canal treatment was very high. Pain prevalence and severities decreased after treatment.

    Cover page: Patient-Based Endodontic Outcomes, Systematic Reviews of Pathology and Pain Prevalences
    • Thesis
    • Peer Reviewed
    UCLA Electronic Theses and Dissertations (2020)

    Statement of problem. Clinicians are regularly confronted with difficult choices. Should a tooth that has not healed through non-surgical root canal treatment be treated through traditional non-surgical retreatment, modern retreatment, or modern apical microsurgery? Acquiring complete, unbiased current information to help clinicians and their patients make these choices requires a systematic review of the literature on treatment outcomes, meta analyses and statistical comparisons.

    Purpose. The purpose of this paper was to answer the following questions: What are the success rates of modern endodontic retreatment in teeth that had previously received NSRCT, where periradicular pathosis had not healed? Does modern endodontic retreatment result in increased healing rates over time? Does modern endodontic retreatment result in improved outcomes to those previously established for traditional retreatment? Does modern endodontic retreatment result in improved outcomes to those previously established for modern apical surgery?

    Materials and methods. Searches were performed in Pubmed, Cochrane Library, and EMBASE databases on modern endodontic retreatment. Previously established datasets describing traditional endodontic retreatment and modern apical microsurgery were identified. Datasets were analyzed using funnel plots to examine bias, Forest plots to calculate weighted mean success rates and their associated confidence limits, and regression analysis to identify the simple linear equations relating percentage success rate to years of follow-up time.

    Results. The quality of the papers reporting on modern endodontic retreatment was high and bias was low. The success rate for modern endodontic retreatment was largely unchanged through a period from 1 to 5 years of follow-up, a steady state was approximated. The success rate of modern endodontic retreatment was approximately 86% through 1 to 5 years after treatment. The success rate of modern endodontic retreatment was significantly higher than of traditional retreatment, 81%. The success rate of modern endodontic retreatment was equivalent to that of modern apical microsurgery, 85%.

    Conclusions. Modern non-surgical endodontic retreatment should generally be the first-line treatment option after failure of initial non-surgical root canal treatment. Prospective, long-term modern retreatment studies of comprehensively described patient populations using a broad range of outcome measures are needed.

      Cover page: Modern endodontic retreatment: A systematic review, meta-analyses, and comparisons to alternative treatment options
      • Thesis
      • Peer Reviewed
      UCLA Electronic Theses and Dissertations (2016)

      Tooth colored all ceramic restorations have been the treatment preference of many patients for esthetics and biocompatibility. This study aimed to test the fracture resistance of posterior ceramic onlays milled with computer-aided design and computer aided manufacturing (CAD/CAM) machines.

      The effects of material type, preparation design, and tooth substrate were evaluated using a full-block design. Ninety teeth were tested. Three different CAD/CAM ceramic onlay material types were included: a lithium disilicate glass-ceramic (IPS-e max CAD), a nano-filled resin-composite (Lava Ultimate), and a feldspathic porcelain (CEREC Blocs C).

      Three different preparation designs were included: an anatomical occlusal onlay preparation, a concave occlusal onlay preparation, and a flat occlusal onlay preparation. Two different tooth substrates were used: all in enamel, or in dentin with enamel peripheries. All teeth were restored and artificially aged. A load-to-failure test was used to measure the resistance to catastrophic fracture.

      Three-way ANOVA determined that of all the simple main effects, and all of their possible interactions, the only significant effect on failure load was that of material type (p < 0.0001). The glass-ceramic and resin-composite materials were stronger than the feldspathic porcelain. Multiple range analysis determined that restorations fabricated from feldspathic porcelain were significantly weaker than those made of glass-ceramic or resin-composite materials.

      The restorations in all 90 specimens fractured catastrophically; but only 26 of the 90 teeth fractured. Material type influenced the incidence of tooth fracture (Chi-square = 12, p < 0.05). Preparation design influenced the incidence of tooth fracture (Chi-square = 7, p < 0.05). Tooth substrate type did not influence the incidence of tooth fracture (Chi-square = 2, p > 0.05). A glass-ceramic restoration, and a concave preparation design were associated with increased incidences of tooth fracture.

      Resistance to catastrophic failure is desirable, as is a failure mode that avoids vertical tooth fracture, but these results showed that these goals might be mutually exclusive.

        Cover page: The Influence of Material Type, Preparation Design, and Tooth Substrate on Fracture Resistance of Molar Onlays
        • Article
        • Peer Reviewed
        UC San Francisco Previously Published Works (2017)
          Cover page: Academy of Prosthodontics centennial: The emergence and development of prosthodontics as a specialty
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2013)

          Introduction

          Root canal treatment (RCT) success criteria inform us of the path to bony healing and of prognostic factors, but tell little about how the patient perceives, feels, or values RCT. Patients choose, undergo, and pay for RCT, they live with the result, and inform their community. The purpose of this narrative review was to appraise patient-centered outcomes of initial non-surgical RCT and nonsurgical retreatment, in adults.

          Materials and methods

          Patient-centered RCT outcome themes were identified in the extant literature: quality of life, satisfaction, anxiety, fear, pain, tooth survival and cost. Narrative review was applied because the disparate themes and data were unsuited to systematic review or meta-analysis.

          Results

          Application of the Oral Health Impact Profile (OHIP) demonstrated that disease of pulpal origin affects quality of life with moderate severity, primarily through physical pain and psychological discomfort, and that RCT results in broad improvement of quality of life. Satisfaction with RCT is extremely high, but cost is the primary reason for dissatisfaction. Anxiety and fear affect RCT patients, profoundly influencing their behaviors, including treatment avoidance, and their pain experience. Fear of pain is "fair" to "very much" prior to RCT. Pain is widely feared, disliked, and remembered; however, disease of pulpal origin generally produces moderate, but not severe pain. RCT causes a dramatic decrease in pain prevalence and severity over the week following treatment. Survival rates of teeth after RCT are very high; complication rates are low. Cost is a barrier to RCT, but initial costs, lifetime costs, cost effectiveness, cost utility, and cost benefit all compare extremely well to the alternatives involving replacement using implants or fixed prostheses.

          Conclusion

          Dentists must strive to reduce anxiety, fear, experienced and remembered pain, and to accurately inform and educate their patients with respect to technical, practical and psychosocial aspects of RCT.
            Cover page: Patient-centered endodontic outcomes: a narrative review.
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2015)
            Enamel is a bioceramic tissue composed of thousands of hydroxyapatite crystallites aligned in parallel within boundaries fabricated by a single ameloblast cell. Enamel is the hardest tissue in the vertebrate body; however, it starts development as a self-organizing assembly of matrix proteins that control crystallite habit. Here, we examine ameloblastin, a protein that is initially distributed uniformly across the cell boundary but redistributes to the lateral margins of the extracellular matrix following secretion thus producing cell-defined boundaries within the matrix and the mineral phase. The yeast two-hybrid assay identified that proteasome subunit α type 3 (Psma3) interacts with ameloblastin. Confocal microscopy confirmed Psma3 co-distribution with ameloblastin at the ameloblast secretory end piece. Co-immunoprecipitation assay of mouse ameloblast cell lysates with either ameloblastin or Psma3 antibody identified each reciprocal protein partner. Protein engineering demonstrated that only the ameloblastin C terminus interacts with Psma3. We show that 20S proteasome digestion of ameloblastin in vitro generates an N-terminal cleavage fragment consistent with the in vivo pattern of ameloblastin distribution. These findings suggest a novel pathway participating in control of protein distribution within the extracellular space that serves to regulate the protein-mineral interactions essential to biomineralization.
              Cover page: Protein Interaction between Ameloblastin and Proteasome Subunit α Type 3 Can Facilitate Redistribution of Ameloblastin Domains within Forming Enamel*
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2012)
              We have previously identified amelotin (AMTN) as a novel protein expressed predominantly during the late stages of dental enamel formation, but its role during amelogenesis remains to be determined. In this study we generated transgenic mice that produce AMTN under the amelogenin (Amel) gene promoter to study the effect of AMTN overexpression on enamel formation in vivo. The specific overexpression of AMTN in secretory stage ameloblasts was confirmed by Western blot and immunohistochemistry. The gross histological appearance of ameloblasts or supporting cellular structures as well as the expression of the enamel proteins amelogenin (AMEL) and ameloblastin (AMBN) was not altered by AMTN overexpression, suggesting that protein production, processing and secretion occurred normally in transgenic mice. The expression of Odontogenic, Ameloblast-Associated (ODAM) was slightly increased in secretory stage ameloblasts of transgenic animals. The enamel in AMTN-overexpressing mice was much thinner and displayed a highly irregular surface structure compared to wild type littermates. Teeth of transgenic animals underwent rapid attrition due to the brittleness of the enamel layer. The microstructure of enamel, normally a highly ordered arrangement of hydroxyapatite crystals, was completely disorganized. Tomes' process, the hallmark of secretory stage ameloblasts, did not form in transgenic mice. Collectively our data demonstrate that the overexpression of amelotin has a profound effect on enamel structure by disrupting the formation of Tomes' process and the orderly growth of enamel prisms.
                Cover page: Targeted Overexpression of Amelotin Disrupts the Microstructure of Dental Enamel
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2013)
                Concurrent chemoradiotherapy (CCRT) has become the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). The comparative merits of two widely used regimens: carboplatin/paclitaxel (PC) and cisplatin/etoposide (PE), each with concurrent radiotherapy, remain largely undefined. Records for consecutive patients with stage III NSCLC treated with PC or PE and ≥60 Gy chest radiotherapy between 2000 and 2011 were reviewed for outcomes and toxicity. Survival was estimated using the Kaplan-Meier method and Cox modeling with the Wald test. Comparison across groups was done using the student's t and chi-squared tests. Seventy-five (PC: 44, PE: 31) patients were analyzed. PC patients were older (median 71 vs. 63 years; P = 0.0006). Other characteristics were comparable between groups. With PE, there was significantly increased grade ≥3 neutropenia (39% vs. 14%, P = 0.024) and thrombocytopenia (10% vs. 0%, P = 0.039). Radiation pneumonitis was more common with PC (66% vs. 38%, P = 0.033). Five treatment-related deaths occurred (PC: 3 vs. PE: 2, P = 1.000). With a median follow-up of 51.6 months, there were no significant differences in relapse-free survival (median PC 12.0 vs. PE 11.5 months, P = 0.700) or overall survival (median PC 20.7 vs. PE 13.7 months; P = 0.989). In multivariate analyses, no factors predicted for improved survival for either regimen. PC was more likely to be used in elderly patients. Despite this, PC resulted in significantly less hematological toxicity but achieved similar survival outcomes as PE. PC is an acceptable CCRT regimen, especially in older patients with multiple comorbidities.
                  Cover page: Comparison of toxicity and outcomes of concurrent radiotherapy with carboplatin/paclitaxel or cisplatin/etoposide in stage III non–small cell lung cancer
                  • Article
                  • Peer Reviewed
                  UCLA Previously Published Works (2015)
                  The bicarbonate transport activities of Slc26a1, Slc26a6 and Slc26a7 are essential to physiological processes in multiple organs. Although mutations of Slc26a1, Slc26a6 and Slc26a7 have not been linked to any human diseases, disruption of Slc26a1, Slc26a6 or Slc26a7 expression in animals causes severe dysregulation of acid-base balance and disorder of anion homeostasis. Amelogenesis, especially the enamel formation during maturation stage, requires complex pH regulation mechanisms based on ion transport. The disruption of stage-specific ion transporters frequently results in enamel pathosis in animals. Here we present evidence that Slc26a1, Slc26a6 and Slc26a7 are highly expressed in rodent incisor ameloblasts during maturation-stage tooth development. In maturation-stage ameloblasts, Slc26a1, Slc26a6 and Slc26a7 show a similar cellular distribution as the cystic fibrosis transmembrane conductance regulator (Cftr) to the apical region of cytoplasmic membrane, and the distribution of Slc26a7 is also seen in the cytoplasmic/subapical region, presumably on the lysosomal membrane. We have also examined Slc26a1 and Slc26a7 null mice, and although no overt abnormal enamel phenotypes were observed in Slc26a1-/- or Slc26a7-/- animals, absence of Slc26a1 or Slc26a7 results in up-regulation of Cftr, Ca2, Slc4a4, Slc4a9 and Slc26a9, all of which are involved in pH homeostasis, indicating that this might be a compensatory mechanism used by ameloblasts cells in the absence of Slc26 genes. Together, our data show that Slc26a1, Slc26a6 and Slc26a7 are novel participants in the extracellular transport of bicarbonate during enamel maturation, and that their functional roles may be achieved by forming interaction units with Cftr.
                    Cover page: SLC26A Gene Family Participate in pH Regulation during Enamel Maturation
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