Evidence-based dentistry and the need for clinically relevant models to predict material performance

The Academy of Dental Materials (ADM) has a unique annual meeting, presenting and discussing relevant research at an interesting destination, attractive also for families and tourism. These two factors bring knowledge and friendship together at an excellent venue for pleasurable learning. It was such in 2011, for the largest meeting of the Academy , at the warm and beautiful Costa do Sauipe, Brazil, celebrating the 70th anniversary of the ADM, and followed in 2012 at the Disney’s Grand Floridian Resort and Spa, USA.

In 2012, participants from around the world discussed evidence-based dentistry and the need for clinically relevant models to predict material performance. Distinguished speakers presented excellent talks that are provided in written form as published papers in this journal issue and summarized as follows.

Several of the nine plenary papers had multiple authors, although each paper was presented by the specifically invited author – together these speakers represented the USA, Europe, Scandinavia and Japan. The fact that the overall theme concerned ‘models’ alerts us to the role of ‘models’ in science – that they do not always embody the whole truth, but are valid and necessary mental approximations to the realities under investigation.

The meeting commenced with a lively ‘translational’ research theme, presented by Dr Valeria Gordan, based around her work with a Dental Practice-Based Research Network (PBRN) in the USA. This removed any false impression that the ADM is solely concerned with ‘ivory tower’ research; the reality is that we all are striving to enhance practical care of patients, though that goal entails work at many different levels, including pure and theoretical science. Dr Gordan’s paper was nicely followed by Dr Shisei Kubo’s work on cervical composite restorations, which bring particular adhesion challenges in these Class 5 cavities. He clearly outlined the criteria for assessment, involving both clinical trials and in vitro studies, and the complex influence of several factors on microleakage.

Prof Dr Reinhard Hickel from Munich presented a characteristically definitive treatment of ‘repair versus replacement’ of different restorative materials – resin-based composites, amalgam, glass-ionomer cements, ceramics and metals. This incorporated perspectives on the level of university education on this subject and, most valuably, criteria for decision-making and also for methodologically sound clinical trials.

On the Friday morning, Dr Jack Ferracane addressed the feasibility of making predictions about clinical performance of resin-composites based on in vitro property measurements. This is a topic on which it is possible to veer between extreme optimism and extreme pessimism! Even when correlations can be found between clinical behavior and particular properties, this does not necessarily imply a causal relationship. Nevertheless, some such relationships were adduced but a necessary cautionary note was sounded in several areas, particularly between laboratory bond strengths and clinical longevity. Overall, clinical success is multi-factorial. This presentation was followed by a very detailed paper by Dr Siegeward Heintze on clinical relevance of bonding, sealability and marginal adaptation studies. He has personally employed many innovative techniques, including mapping of the micromorphology of the bonding interface. He discussed which methods are not clinically validated and it is hoped that any aspirant researcher on dental adhesive bonding will read and digest this thorough work. To conclude the days’ session, Dr Isabelle Denry focused on fabrication of all-ceramic single and multi-unit restorations. This is another ‘hot’ topic on which Dr Denry is an international expert. Custom fabrication creates susceptibility to processing defects – and it is well known that defects are the Achilles heel of ceramic structures. Dr Denry clearly illustrated such material defects and issued a call for innovation in design of laboratory test methods that can effectively simulate clinical conditions. Perhaps the potential for empirical ‘prediction’ of clinical behavior may be greater with all-ceramics than with resin-composites?

The concluding session on Saturday morning had a common biological thread and the three speakers orchestrated a resounding finale to the annual meeting. First off was Dr Jacques Nör from Michigan, aiming to bridge the gap between the biological sciences and ‘traditional’ biomaterials science – where, at least with dental materials, the primary concern has been with biocompatibility or biological safety. His inspiring address followed themes of tissue engineering and interactions with enamel, dentine and bone. However, his written paper, published in this issue, details the latter part of his presentation which was about pulp biology and a scaffold material that can maintain viability of the pulp and support differentiation of dental pulp stem cells. This led nicely into the following paper by Dr Tony Tomsia of the Lawrence Berkeley Laboratory in California. This addressed the role of nanotechnology in bone tissue engineering. Dr Tomsia has a keen eye for beauty in material and biological structures and his presentation was illustrated in a really awesome manner. It was a wise move to invite such an eminent scientist from the wider materials science community and the quality of his communication was outstanding. Nevertheless, like a complex symphonic composition, the final paper by Prof Leo Tjäderhane, also excelled in visual biological beauty as he addressed the role of collagen degradation by matrix MMPs and cysteine cathepsins. His paper, with multiple authors, is lengthy and detailed and will be required reading for all researchers in this significant field.

Typically, the participants had the privilege of continuing the discussion with the speakers after the talks, during the poster sessions and socializing in the superb meeting venue. In addition, more than 150 participants submitted their research studies to the 2012 ADM meeting. The abstracts from all these studies were published, along with their respective DOI, by the Dental Materials Supplement 1, 2012, which was available to the participants at the meeting registration and online immediately after the meeting. The papers of this journal issue were also available to the meeting attendants as speakers’ manuscripts. This was just possible, for these last two meetings (2011 and 2012), because of adequate organization, speakers’ dedication and superb work and effort from the Elsevier team.

The Academy will continue to improve interaction with members through the new website and the novel mechanisms that online communication can offer. As stated last year , the Academy President and the Journal editor, truly believe the Academy membership and Dental Materials have a tremendous impact on the present and future of dental products, services, and systems. Yet, we have to recognize and convey hot topics in the science of dental materials, offering the opportunity for discussion and encouraging innovation without misreading and ignoring the history and the prior authors that set up the standards and principles for such challenging science. This is the leading role of the Academy of Dental Materials and its journal, Dental Materials . It is only possible with the support and dedication of the Board members, Corporate members, meeting organizers and sponsors, but specially the commitment of the ADM presidents, who deserve all our respect for running this Academy for more than 70 years.

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Nov 28, 2017 | Posted by in Dental Materials | Comments Off on Evidence-based dentistry and the need for clinically relevant models to predict material performance
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