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GUEST EDITORIAL |
Division of Operative Dentistry/Department of Restorative Dentistry, University of Washington, Box 357456, Seattle, WA 98195-7456, USA; wgert{at}u.washington.edu
KEY WORDS: restorative dentistry • research • weaknesses
The emergence of dentistry as an academic discipline at the end of the 19th century was closely associated with ‘restorative dental sciences’ such as Operative Dentistry and Prosthodontics. The foundation of a predictable and successful treatment of caries and the replacement of missing teeth based on scientific evidence were established in this early phase. Black (1892, 1895), Miller (1890, 1898), Richardson (1897), and many others described the fundamentals of a scientifically oriented dentistry (Davis, 1923; Evans, 1905). But dentistry, including the restorative sciences, has also had a significant impact on medicine. Important examples are the development of local anesthesia, the application of radiography, and the generation of bone cements in orthopedic surgery based on dental acrylics (Bremner, 1946; Osborne, 1948).
The first half of the 20th century was marked by basic in vitro and in vivo studies which, for example, confirmed Miller’s theory on caries (Stephan curve, Vipeholm study, etc.) (Stephan, 1940; Gustafsen et al., 1954). Simultaneously, the demand for innovative tooth-colored filling materials—like acrylics, porcelain, and the increasing number of new substances generated by modern organic chemistry—caused a turn of restorative dentistry to the investigation of the physical, biological, and clinical properties of these materials. New techniques and instruments for tooth preparation were introduced at that time. Specifically, the use of dental acrylics generated a boom of studies in the late ’40s and early ’50s (Osborne, 1948), which even increased after the invention of composite resin by Bowen in the years 1955 through 1963 (Bowen, 1958, 1963). It must be emphasized at this point that scientists in restorative dentistry set the basis for a scientific evaluation of these materials and techniques and thus contributed significantly to their improvement.
An honest look, or, better, my personal view, at subsequent developments in the area of restorative materials, however, reveals that there was only a moderate change of their composition since the ’70s. But the focus of science in restorative dentistry did not change significantly at the same time. Although the need for the evaluation of restorative materials by academic institutions is very limited today, many scientists in our discipline are primarily focused on testing new products or techniques, which, in most cases, are not or only slightly different from previous products or methods. Meanwhile, the industry has built up very well-equipped R & D departments (in terms of personnel and instruments). The industry, therefore, has, in many cases, a much greater expertise in determining the physical and mechanical properties of a product, in comparison with scientists at universities with their chronic lack of personnel and research money. The focus on this area of research—which is not very promising and fruitful from my perspective, like the development of more sophisticated testing methods and their application to the physical evaluation of commercial products—has led to a certain disdain for our scientific work in the dental community. To be frank, this scant regard for our research is mainly ‘home-made’.
But there is another side of the coin: The faculty working in restorative disciplines, such as Operative Dentistry and Prosthodontics, are burdened by an enormous teaching load. Although the undergraduate share of our educational activities is close to 60% or even higher, the number of restorative faculty is small in comparison with other dental disciplines with significantly less teaching commitment. This discrepancy may be due to a traditionally strong clinical focus of ‘restorative dentistry’ and only a moderate interest in innovative research beyond ‘materials or technical science’. One example: When I became ‘faculty’ after graduating at the end of the ’70s, it was a negative assessment of a young ‘restorative academic person’ to call him or her ‘highly scientific’. This may have changed. But today’s consequence of this errant former view is that the number of restorative faculty is chronically much too low, since our discipline did not ‘claim’ faculty with a primarily scientific orientation in time to prevent their pursuing other options. In contrast, the mistake made by many ‘restorative authorities’ in the ’60s and ’70s who did not hold basic research in high esteem (contrary to periodontists and oral biologists) still has severe consequences today and is at least partly responsible for administrations’ tendency to cut the number of restorative faculty even more.
The inevitable effect of an increasing shortage of personnel in a discipline with a very high teaching load is less and less scientific activity, particularly in areas that need consistency for many years, like biologically oriented research. We are obviously in a vicious circle which can be overcome only by a joint effort made by restorative departments and dental schools.
It is our responsibility to identify important scientific areas and problems on which to work, rather than continuing to test old or supposedly new products and to complain about shortages. This will lead to the end of a cul-de-sac. We have some urgent re-thinking to do.
First, we need to interest and attract young gifted dentists with a scientific orientation in restorative disciplines. The vast majority of the talented junior faculty turns presently to Periodontics or Oral Biology. It is also unrealistic to expect equal teaching and research activity from both clinicians and scientists. It would make much more sense if clinicians would focus on clinical teaching, thus giving restorative scientists much more time for challenging research. This can only work, however, if both tracks would make promotion possible. In addition, we need to attract more ‘non-dental’ scientists and engineers who can introduce innovative methods and original ideas into ‘restorative’ research.
Second, we must prove that there are scientifically demanding problems in restorative dentistry which can be solved only by valid and innovative scientific research. Good examples are the interactions of restorative materials with the oral microbiota, systemic long-term effects of oral biomaterials, and the development of materials which are similar to dentin and enamel, and thus allow for a genuine ‘restitutio ad integrum’. There is also a great need for well-designed clinical long-term studies to assess the value of our materials and techniques and to provide the data for evidence-based restorative dentistry. This would be a fruitful and satisfying area of research for dentists in academia who are more interested in clinical research than in basic science.
It is the responsibility of the dental schools to assign faculty positions with little or no teaching commitment to the restorative departments. These positions need to be filled with scientists who can concentrate on innovative research, as is standard in all other dental and medical disciplines.
Is science and restorative dentistry a contradiction? The answer is a clear no. But a significant joint effort must be made by restorative departments and dental schools to strengthen and promote innovative research in one of the most exciting disciplines in dentistry.
Received May 28, 2003; Last revision July 10, 2003; Accepted September 3, 2003
REFERENCES
Black GV (1892). Extension for prevention. IL State Dent Soc Trans.
Black GV (1895). Physical character of filling materials. Dental Cosmos, May.
Bowen RL (1958). Synthesis of a silica-resin direct filling material. J Dent Res 37:90–94.
Bowen RL (1963). Properties of a silica-reinforced polymer for dental restorations. J Am Dent Assoc 66:57–63.
Bremner MD (1946). The story of dentistry. New York: Dental Items of Interest Publications Co.
Davis WC (1923). Essentials of operative dentistry. St. Louis: Mosby.
Evans G (1905). A practical treatise on artificial crown, bridge-, and porcelain-work. Philadelphia: S.S. White Dental Mfg. Co.
Gustafsen BE, Quensel CE, Lanke LS, Lundqvist C, Grahnén H, Bonow BE, et al. (1954). The Vipeholm dental caries study. The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand 11:232–264.
Miller WD (1890). The microorganisms of the human mouth. Philadelphia: S.S. White Co.
Miller WD (1898). Textbook of conservative dentistry. 2nd ed. [Lehrbuch der Conservirenden Zahnheilkunde, 2nd ed]. Leipzig, Germany: Thieme.
Osborne J (1948). Acrylic resins in dentistry. 3rd ed. Oxford: Blackwell.
Richardsen J (1897). Practical treatise on mechanical dentistry. 7th ed. (revised Warren GW). Philadelphia: Blakiston.
Stephan RM (1940). Changes in the hydrogen ion concentration on tooth surfaces and in carious lesions. J Am Dent Assoc 27:718–723.
This article has been cited by other articles:
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  I. A. Mjor A Recurring Problem: Research in Restorative Dentistry ...But There is a Light at the End of the Tunnel J. Dent. Res., February 1, 2004; 83(2): 92 - 92. [Full Text]
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