Delivering Breakthrough Services
Stephen J. Chu, DMD, MSD, CDT
The dental research environment is a dynamic landscape that is continuously changing at a rapid pace. Being in clinical practice for more than 30 years and teaching at the New York University College of Dentistry for more than 20 years, I have realized that an understanding of clinical research and its applications in the clinical theater has become increasingly pertinent to the practice of dentistry. The three main areas that have been most impacted by clinical research within the past several decades are dental implantology, adhesive dentistry, and the science of restorative materials.
Imagine dental implant treatment without any science to support long-term survival and success? The percentage of failures would be enormous and horrendous. The understanding and use of endosseous implants with regard to surgical placement, wound healing, and osseointegration is all based upon scientific research to support consistent clinical outcomes. Studies assessing the timing of integration before impression making and the factors that affect long-term survival all add to the understanding, acceptance, and success of the use of dental implants in everyday clinical practice.
Furthermore, the research supporting immediate loading of implants or immediate tooth replacement therapy, whether it involves a single unit, sextant, full arch, or full mouth, has truly been a game changer in modern day dentistry. The concept of combining surgical and restorative procedures to minimize the number of interventions and reduce the overall treatment time without compromising implant survival rates (delayed and immediate are essentially equivalent) has eminent benefits for the patient and clinician.
Lastly, because osseointegration and survival have become more predictable entities, the latest area of emphasis in implant dentistry is esthetics. Contemporary knowledge supports the immediate provisional restoration of implants placed into "fresh" postextraction sockets with either a custom healing abutment or a full temporary tooth to support and maintain the existing periodontal architecture as well as grafting the "gap" to minimize ridge collapse in the esthetic zone.
Regarding adhesive dentistry, the ability to bond to porcelain, specifically silica-based ceramics, was a significant milestone in esthetic restorative dentistry in the early 1980s. In the early 1990s, the advent of "wet" dentin bonding and the science to support its validity was another groundbreaking achievement. Statistically speaking, the cervical third of the tooth has the least volume of enamel (ie, 0.3 mm to 0.5 mm in thickness). As a result, dentin is frequently exposed during tooth preparation, so understanding the technique of dentin bonding can be critical to the long-term survival of veneer restorations. The treatment of carious and non-carious cervical Class 5 lesions is another common practice that can involve bonding to exposed dentinal surfaces. Even though survival studies indicate that veneer restorations demonstrate the best results when bonded to enamel, the realities of restorative dentistry necessitate that all clinicians be able to bond to dentin.
Historically, restorative materials have evolved from cast gold to gold-acrylics to metal-ceramics, and then ultimately, to all-ceramics. This family of materials includes leucite-reinforced glass, lithium disilicate, zirconia-reinforced lithium silicate, and zirconia ceramics. In vitro strength studies on these materials have given practitioners confidence in their clinical use, applications, and long-term behavior. The use of higher translucency monolithic all-ceramic materials has supplanted the practice of using layered ceramics on high-strength substructures or copings because they can withstand the high masticatory forces experienced in the oral cavity over time. This restorative material concept also crossed over into implant restorations where the "chipping" of veneering ceramics had been a common theme. The use of translucent monolithic zirconia eliminated the chipping dilemma, redefining modern day implant dentistry.
These are landmark, breakthrough services that doctors can deliver to their patient communities-services that we wouldn't have without the support of scientific evidence from clinical research.
About the Author
Stephen J. Chu, DMD, MSD, CDT is an adjunct clinical professor in the Ashman Department of Periodontology & Implant Dentistry and the Department of Prosthodontics at the New York University College of Dentistry.