Faculty Spotlight: Two GSDM Faculty Members Win Best Group Article
In 2021, Dr. Gladys Carrasco PEDO 2020, clinical assistant professor of the general dentistry department, and Dr. Ana Keohane DMD 16, director of predoctoral urgent care and clinical associate professor of the general dentistry department, treated a pediatric patient who had severely damaged anterior teeth. Carrasco and Keohane were worried about how to best protect the patient’s healthy roots while preserving the patient’s smile, which ultimately led them to the unique treatment approach of digitally designed endocrowns.
Carrasco and Keohane published a paper in the Journal Hispanic Dental Association about this experience – and in 2023, that paper won a Hispanic, Excellence, Contribution, Heralding, Oral-Health Scholarship (H.E.C.H.O.S) Award for best group article from the journal. Both Carrasco and Keohane said they hope their research will inspire other pediatric dentists to think creatively in their work and potentially use similar treatments methods.
“We really wanted to publish it because it’s something that other pediatric and general dentists can do as temporary restorations until children become adults,” Keohane said. “It’s better to have something permanent than removable because children are noncompliant… We really didn’t know that dentists liked our article that much, and voted for it to obtain this award, so that was very exciting.”
In their article, “A New Treatment Approach Utilizing CAD/CAM Restorations for Endo-Treated Permanent Anterior and Posterior Teeth in Pediatric Patients,” Keohane and Carrasco documented their work with a 13-year-old female patient who came to the GSDM predoctoral treatment center with severe tooth decay in teeth #8 and #9, upper anterior teeth. The patient had previously been treated with root canals and had restoration, but decay had since returned.
The standard treatment for adults with severe damaged teeth is to remove them and then replace them with implants, fixed or removable restorations, Keohane said. However, extractions for pediatric patients can be ill-advised if the roots are healthy – as this patient’s teeth were – it could potentially cause more problems as the patient matures, according to Carrasco.
“If we extracted these teeth, the bone in that area, because the patient is so young, it wasn’t going to finish developing the way it should,” Carrasco said. “It was going to be challenging for the patient to then, later in life, get implants, for example. And if they do bone grafting in that area, it’s usually unsuccessful or it’s not aesthetic as it is when the roots are remaining there, where the bone develops with the teeth in there.”
Carrasco and Keohane noted the patient’s unhappiness with her current teeth, and how her self-image and self-esteem were suffering.
To save the healthy roots and improve the patient’s mental wellbeing, Carrasco and Keohane decided to give the patient another round of endodontic root canal therapy and digital endocrowns, ceramic crowns that were impressed and designed digitally to obtain a good fit and match for the look of natural teeth. Digital impressions were obtained using the Omnicam Intraoral scanner, and the endocrowns were designed digitally, then milled and cemented with a self-adhesive resin cement, multilink.
These temporary restorations will stay until the patient is legally an adult and seeks further treatment, which could be implants or another option the patient decides on.
“The compliance is not very good with a removable option for a teenager, so we really want to offer to her a fixed restoration and feel confident again,” Keohane said. “She really was not in a good mental state. She was sad and depressed. Because of that, Dr. Carrasco and I decided and planned to create restorations that will be fixed and esthetically accepted.”
Carrasco said this case was especially satisfying due to the involvement of GSDM predoctoral students, who assisted during their pediatric dentistry rotation. While Keohane and Carrasco proposed the treatment, the predoctoral students implemented the endocrowns.
“We were supervising, but it was a great way for them to learn how to treat pediatric patients with these challenging conditions,” Carrasco said.
Two years after the endo-crowns were placed, they are still in place thanks to the fitting and the strong cement used, Keohane said. She and Carrasco are hopeful that the endocrowns will last at least three more years, when the patient will be able to make her own dental decisions. For the time being, the patient is happy with the solution.
“It was very successful,” Keohane said. “We still see her every six months for cleanings, and they’re still looking good. What is more important for me is that we really changed her life. She was happier and self-confident. This was very, very rewarding for us.”
Carrasco hopes having the article recognized on a national platform will motivate other dental academics to start their own research.
“I think it will open the door for other people to also be more encouraged to publish their own cases,” Carrasco said. “Especially when we’re in academia, we have a lot of great providers, a lot of great faculty, and I’m sure a lot of them have done their own cases or they’re working on their own articles. So, I think this will be a good incentive for all of them to also publish their own investigations. ”
For Keohane’s part, she hopes that other general and pediatric dentists will embrace digital dentistry for future treatment plans.
“I know digital dentistry is not everywhere yet, but it’s where we’re going,” Keohane said. “I hope dentists can look into digital dentistry not only for this type of treatment, but for everything else. It makes the patient’s experience better because things are done easier and faster than traditional methods. Dentists will have better experience because of the way impressions and crowns are done.”