Editorial englisch - ZZI 02/2014

Dear Colleagues,

Dear Colleagues,

Treatment and decision-taking in questions of implant-based restorations are becoming more and more complex and present clinicians and practitioners with an increasingly broad range of options.

How can we justify our treatment as the right one in the interest of our patients? Many questions in day-to-day practice demand a clear “yes” or “no” decision. Ideally, this will be aided by the results of high-quality research, but what does quality actually mean in dental and medical research?

Conclusions based on meta-analyses represent the highest level in this scientific hierarchy, followed by randomized clinical studies. Non-experimental descriptive studies (comparative studies, case control studies) and expert opinions provide the lowest level of evidence.

Accordingly, clinical research endeavors should seek to conduct large-scale clinical studies in order to deliver hard facts for treatment decisions. However, in implant dentistry, the knowledge gained from clinical research is often supported by descriptive observational studies (Eckert 2012). This does not mean that this knowledge must be poorer in quality, only that it cannot be regarded unreservedly as a scientifically confirmed aid to decision-taking.

If the majority of decision-taking in implantology is generated by case studies and epidemiological studies, future studies should be adapted to achieve an improvement in quality. How will this improvement succeed in routine practice and which study designs should be preferred?

Retrospective data analyses must be regarded critically as an aid to decisions on treatment strategies. There are usually gaps in the available data material as a definition of the objective and target parameters, along with exact end points of the data analysis are lacking. Good conclusions from epidemiological data can be drawn when all the data obtained from the studied patients are of equal quality and at least some parameters scientifically documented as standard. Besides uniform and optimally clear definitions of success and failure in implant-based restorations (peri-implant health, success of the superstructure, time to repeat treatment), patient-centered data (key words: quality of life, socioeconomic factors) must be included in the data analysis of future studies. Decision-taking for colleagues in clinical practice should reflect these factors as well as medical and technical criteria.

Larger prospective studies, designed with clearly defined aims and parameters over a fairly long period that permit valid conclusions about treatment choices and decisions, would offer improved data. Take the example of implant-based prostheses: if the literature is searched for long-term data on various framework or veneer materials, restorative concepts or technologies, the yield will be very modest; industry promises us guarantees of up to 30 years for their materials but there are practically no valid data on the performance of these materials, either patient-related or implant-related. How does industry arrive at these data?

In future, national, European or international combinations of universities, clinics and centers would be able to investigate a larger study population in a shorter time. Creation of selected and well investigated cohorts (groups of patients) with exactly defined planning, aims and documentation could deliver data pools for high-quality analyses for years. From the point of view of the pending tightening of the MPG by the European Commission, too, industry and research/clinical practice will have to conduct research and development more closely with one another to ensure that patients are offered only those treatments regarded as the best founded scientifically. University research in well planned long-term studies could make an important contribution to better and safe use of technologies promoted by the industry, thus providing greater safety for both patients and the clinicians who treat them.

Sincerely,

Prof. Martin Lorenzoni

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