An Evidence Based Approach to Dentistry and Dental Laboratory Technology

Dental laboratory technology can lead the way for all of dentistry regarding the evidence based approach.  Occlusal theories, material selections and clinical therapeutic modalities are currently being challenged by a higher bar than ever before.  Are they scientific?  Not do they work in your hands? Or what have you found that is repeatable?  The body of empirical evidence and personal observations that medicine and dentistry (and lab technology) have relied on for centuries is being replaced rapidly by a more scientific standard.

The American Dental Association defines the term evidence-based dentistry as follows:

Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.

I wish to draw attention to the word pairs, systematic assessments, of clinically relevant and scientific evidence.

Systematic assessments do not mean random evaluations and observations of events, materials or techniques.  It means we should carefully test, measure and adjust the selection criteria based on repeatable studies.  Calibrating ovens to make sure that they fire porcelain to the manufacturer’s schedules is an example.  Using the temperature test devices and the data to maintain optimal working conditions insures appropriate temperatures are achieved.

Clinically relevant implies that the actions taken be directed at improving the clinical outcome.  If we developed a modification of the stent protocol for implant placement, does it increase the efficacy and clinical success? If done from a 3D Cone I-Cat image, is it less intrusive for the patient?  The application of evidence based measures is most critical for clinical applications.  The direct benefit should be to improve patient care in some fashion.

Scientific Evidence is one of the most important filters to apply to this standard.  My favorite example is when a new and improved, scientifically sound device or procedure is available that replaces a historical one, but is poorly adopted because of resistance to change.  The Diagnodent for detecting caries, generations of bonding adhesives and the 3D Shade Master system for matching porcelain to teeth are but a few. The 3D Master Shade guide is especially interesting because Vident is not trying to replace anything other than their own antiquated, empirical shade guide, the Classic Lumin system.  This example serves all three word pairs well.

Classic shades (A1,2,3,3.5,4 etc) were developed in 1956, 50 years ago.  Several of the tabs do not even exist in nature as part of the color space that represents teeth.  They are distributed randomly throughout tooth color space and it is not a system that is selective as our eye is for value, chroma and then finally hue in decreasing sensitivity.  In 1998, the same company introduces a scientific, evidence based, systematic assessment of the color space that makes it easier to match value, then chroma and then hue.  The color space is represented and the tabs evenly distributed so we can talk about half shades.  The tabs are even placed so that the human eye can not discriminate beyond half shades.  Sixteen years later, this evidence based approach is still not as widely used as it should be.

I am glad all three of my knee surgeries were done utilizing arthroscopy instead of the old open procedures of yesteryear.  Time always, and sometimes science, moves on.  I have a cell phone that looks like the communicators used on Star Trek.  It surfs the Web, plays mp3s and even allows me to phone home.  The people at OnStar always know where I am.  Aldous Huxley was right; it is “A brave new world.”  Let’s lead the way by using the evidence based approach to laboratory technology and set a brave new example for dentistry.  At worst, we will appear professional and scientific with the patient’s best interest in focus.  At best, we will become leaders in dentistry, helping to chart a course that improves our stature and professionalism with our peer clinical providers.  And in both cases, the patient, whom we all serve, wins.