Paper Review - Randomised Clinical Trial

Paper Review

Cases

Aug 19
paper review

This paper was the subject of significant discussion on a forum so I thought I would take a look at it.

As always, you should basically ignore the abstract. Abstracts dumb down the paper so much that they often bear no resemblance whatsoever.

The opening statement says;

"Clinical studies are the definitive tests to measure the durability of dental adhesive materials".

Rather officially, it has a citation. On looking at the citation, which thankfully was not just a case of the authors citing their own papers, a common way to improve their own academic standing, I could not really see how it supported that statement.

The cited study is a test comparing a range of in vivo and in vitro.

It is important to understand that the hierarchy of evidence is a philosophical idea and is not always true.

Paper Review

Further, I would suggest that dental materials are largely developed to be used in the restoration of teeth in large numbers of patients in general, specialist and government practices across large numbers of clinicians. Their performance in this arena would be what I consider the gold standard.

Anything else is a proxy.

A large number of factors are included in what the study claims are the important factors in success. It throws in the operator at the endo, which of course is the one that can cause failure faster than anything else.

It suggests that the main reason that dentists choose more simple bonding agents is ease of use. However I would suggest that the large number of dentists that use self etching adhesives, at least posteriorly, do so for post operative sensitivity reasons.

Now we come to the most significant problem. The study was 18 months long. As we all know, just about any composite looks good for 18 months unless the patient smokes like a chimney whilst keeping a coffee plantation in business.

The adhesives used are all from Kerr. I'm not sure if Kerr supported the paper, it is not stated one way or another.

As always, in an attempt to make the results tidier, they have excluded about 70% of the teeth we would treat in private practice.

Apparently you cannot apply this study to cases with;
less than 20 teeth.
Non vital teeth.
Teeth not in occlusion.
Bruxism. etc etc etc.

The list of exclusions probably precludes 60% of the teeth that we treat. Perhaps more. And of note is the large percentage that are class one restorations.

The clinical aspects of the treatment were unremarkable. However the photos shown (which are anecdotes it has to be remembered) show patients with perfectly clean teeth that are probably not that susceptible to staining anyway. In other words, they are seeing how the adhesive performs in the most easy and predictable cases. Not difficult ones.

After a long discussion about how good Kerr are at producing adhesives, and various other things with little bearing on the study, we are reminded that the dentists in this study (it doesn't say so explicitly) knew that the teeth were part of the study, so maintained very rigorous standards in all aspects of care.

So in conclusion, this study should be used in extreme caution in the choosing of which Kerr adhesive you would like to use.

It is too short, and excludes the large majority of patients that we see.

It does however tell us that if you know someone is going to look at your work, you will do something that looks good in 18 months no matter what you use.

So on reading this study, I can conclude that you should all take photos of your cases and post them on RIPE (obviously this statement is partially silly, and partially true - you can also post on other forums).

Paper Review

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About the Author

Dr Lincoln Harris has been completely focused on excellence and quality from the beginning of his career as a dentist. He established the first private dental practice in Bargara – Harris Dental Boutique in 2000. Since graduation he has trained extensively in Aesthetic Implant Techniques and Full Mouth Rehabilitation to attain immense skill and knowledge. With his vast dental knowledge Dr Harris coaches and trains dentists from all over the world on complex aesthetic dentistry, surgical techniques and business management. Dr Harris is the founder of RIPE. Restorative Implant Practice Excellence: Full Protocol group an international forum of over 70,000 members worldwide. The purpose of the group is to share information and excellence in the dental industry. He has also lectured in multiple cities throughout Australia, North America, Asia, Singapore, United Kingdom and Europe.