Editorial

Time of changes in dentistry: Expectations and realities

It has become an irrevocable evidence that Dentistry has made lately a giant step forward.  The dreams of the past have become much of today's realities.  We have witnessed in the last two decades major developments that have revolutionized our daily practice.  Regenerative therapies and implants have radically changed our philosophy in patient care.  Genius thoughts and brilliant extrapolations produced major changes in our professional lives.  Vague ideas became clinically applicable concepts through constant endeavoring.  Our tireless quest to better serve the needs of our patients has triggered an immense interest for research.  Much need is to be done in our part of the world to encourage young and endeavoring scientists to engage in clinical and experimental investigation.  By all means, they need to be honored, greeted, rewarded, for them to believe that glory is not a vain word...

The new developments that we were fortunate to observe and apply, elicited mixed feelings: an immense excitement in the early days.  Solutions to major problems were thought to be at reach.  The key words became: regenerate and create.  Arresting the diseases and restoring function were no more the only desirable objectives.  Eradicate the disease and its consequences and rehabilitate the patient to full form and function became the new goals to reach.  However, what thought to be an always achievable objective, was in reality, limited to a well-defined set of clinical situations.  Regeneration of the lost periodontal structures worked well up to a certain extent.  Vertical regeneration remained elusive.  Implants provided excellent function which was for many, the overriding priority.  However, esthetics was far from reach in many situations.  The excitement was largely tempered by the unsatisfaction and disappointment following several clinical outcomes.  Much is needed to be done to treat many clinical problems that plaque our ever demanding patients.  We questioned our ability to apply the concepts until we realized that the concepts themselves needed to evolve.  Science backed by the industry is constantly providing improvements in the concepts as well as the componentry.  The implant systems will be more and more easy to use, reliable and affordable so that as many professionals as possible will be capable of providing the service to as many patients as needed.  But again, how to differentiate an easy from a difficult case? Where is the borderline between an untrained and an experienced clinician? What training is needed to assure that the service is properly done? Science must be backed by industry for developments to occur.  But the name of the game must remain ethics and professionalism.  In the near future, we will probably see new implant design and more sophisticated yet friendly user components, safe and more accepted and applicable regenerative products.  However, the application of the concepts and hardware must be evidence-based.  It is unfortunate that many of the componentry and products are launched before that had stood the test of time and the scientific testing.  How much do we know that can be safely and predictably applied in our daily practice? A lot. How much do we think we know, only to realize that it is still experimental and warrants further research? A lot, too.  It becomes crucial to understand the true indications and limitations of our techniques.  The art of practicing dentistry can only be fully expressed if it is enriched by the scientific knowledge. Research is the answer to our challenges and the promise to a better future.  Randomized, double blind controlled clinical trial is the difficult avenue to engage in, if one wants to reach reliable results.  How many of those trials have we seen published on which we can base our clinical concepts?  Some truths are meant to vanish.  Luckily, until we come close to the real truth.

It is the responsibility of all clinicians to commit themselves to continuing education and follow the advancement of science in their field of interest.  It is, by all means, the responsibility of those engaged in academics and research, to convey the true message by a careful and scrupulous appraisal of their work and of those that are presented in the literature.

Georges Tawil, DDS, DSC Od
Professor,
Department of Periodontoloy
St. Joseph University, Beirut, Lebanon