In an interview facilitated by Dr. Damon Adams, Dentistry Today’s editor-in-chief, Drs. John M. Powers, John W. Farah, and Sabiha S. Bunek candidly expresses their thoughts on current topics affecting the profession.
Congratulations on your 30th year! What were the inspiration and reasons for creating THE DENTAL ADVISOR?
Dr. Farah: The inspiration began with a trip to the Chicago Midwinter Meeting in 1977. I had always been a fan of Consumer Reports magazine. The large number of vendors, dental products, and equipment left me with a lasting impression, but more importantly, with questions on the quality and reliability of products. I enlisted the support of Dr. John M. Powers, a colleague of mine, to develop a tool to help dental professionals navigate the extensive selection of products on the market. Dr. Powers and I have research backgrounds, and we wanted to create a publication that disseminated evidence-based information on dental materials in an understandable and clinically relevant manner. With the assistance of a lot of creative dental minds, including Drs. Kamal Asgar, Bill Gregory, Pete Yaman, and others, we started THE DENTAL ADVISOR, publishing our first issue in 1984. Many of those individuals are still with us today, which says a lot for the integrity of the organization as a whole.
What changes have you seen in dentistry in the past 30 years?
Dr. Farah: I always tell colleagues that there is not one single product that I used 30 years ago that I still use today. Composites have come a long way and have totally replaced amalgams in my practice. I now use adhesive resin cements for permanent cementation, replacing the traditional water-based cements. Bonding agents have totally transformed dentistry and ushered in the era of cosmetic dentistry. Lithium disilicate and zirconia ceramics have practically replaced gold and ceramic-metal restorations. Implants are routinely placed, becoming the treatment of choice for dentists and patients. Digital dentistry has had a huge impact on the way I practice dentistry, from record keeping to taking radiographs, milling restorations, and scanning teeth instead of taking impressions. In summary, digital dentistry has affected every aspect of how I practice dentistry every day.
Dr. Powers: Improvements in dental materials and equipment during the past 30 years have been remarkable. Traditional materials and techniques, some of which have been used successfully for decades, are being replaced by new chemistry and technology (Table). Even traditional dental laboratory techniques are being replaced by digital technology.
What changes do you see for THE DENTAL ADVISOR in the next 30 years?
Dr. Powers: Every day, our team discusses new products and clinical trends, as well as the research needed for verifying claims. We are constantly changing and innovating. In the past 5 years, we have added an entirely new area of research, headed up by Dr. John Molinari, an expert in infection control. Dr. Sabiha Bunek was recently appointed editor-in-chief of the publication, and she contributes regularly to our main topic and associated research. Dr. Bunek is also lecturing and working with many companies on new areas important to clinical dentistry. Her energy and passion for dentistry will continue to move THE DENTAL ADVISOR forward into the next 30 years. We will also place increased emphasis on reporting of results from our long-term clinical database, because we have been tracking restorations for 30 years.
What do you consider to be the most exciting area in dentistry right now?
Dr. Bunek: We have been fortunate to have hands-on experience with most of the digital impression and CAD/ CAM systems on the market, and it has been intriguing to watch the evolution of this technology and its integration into our profession. Initially, in 2008, there was a lot of excitement when we started seeing competing manufacturers in the market. While there were some early adopters, the technology did not take off as planned. One of the limiting factors, in addition to cost, was ease of use issues. It has taken a few years, but we are now finally seeing another generation of intraoral scanners. Manufacturers are moving toward smaller and more portable scanners with easy-to-use software, and in some cases, at a lower price point. Scanning teeth is becoming increasingly easier. With so many existing and new manufacturers competing in the market, we will continue to see systems improving in all aspects of digital impressioning and CAD/CAM.
|Figures 1 and 2. Research is custom designed for clinical relevancy.|
|Figure 3. Dr. John Molinari, director of infection control.|
|Figure 4. Composite depth of cure testing.|
What areas of dentistry does THE DENTAL ADVISOR report on?
Dr. Farah: We are a materials- and equipment-based publication, so that is the core of what we do. Our research includes clinical placement data, laboratory data, and long-term clinical performance data. We strive to connect all of the information together that we believe is helpful and important for dentists. A product may handle well, but not perform well in the laboratory or over the course of time. In the early 1990s, we recognized the importance of tracking the clinical performance of dental products throughout time. Now we approach product evaluation on 3 levels: (1) laboratory testing of relevant in vitro properties, (2) feedback from the initial use of products by clinicians, and (3) tracking of clinical performance throughout time. We know from experience that a product that does well in laboratory tests is not necessarily a user-friendly product. So, clinical feedback from dentists on ease of use is important. But even a product that is easy to place may not perform well over the long term. At THE DENTAL ADVISOR, we track the performance of products throughout time. For example, we have 20-year data on one composite and 10- to 15-year data on several other composites. We have fracture data on a number of all-ceramic restorations for more than 25 years. We have shown that the fracture rate of all-ceramic restorations is the same as or less than that of ceramic-metal restorations.
Dr. Bunek: Every issue of THE DENTAL ADVISOR reports on a main category in dentistry, such as bonding agents, cements, or all-ceramics. We review key performance indicators and clinical tips for the use of the products. In an effort to assist in the decision-making process of buying a product, many times we include a table that highlights and compares features of the products we have evaluated. When we find a particular product to be exceptional, we recommend it to our readers. The issue also reviews the outcome of products (typically 8 to 10) that have gone through our clinical evaluation process and have received a plus rating. We feel fortunate to have a diverse group of more than 250 clinicians from all over the United States who participate in the clinical evaluation process.
We know that THE DENTAL ADVISOR reports on dental research. Where is that research done?
Dr. Powers: Our research is performed in the biomaterials and microbiological laboratories at THE DENTAL ADVISOR Biomaterials Research Center. Our team meets weekly to discuss projects in our laboratories. The editorial board often challenges us to design projects that are clinically relevant. As research projects are completed, we report them in THE DENTAL ADVISOR Research Reports and Translating the Science, both available on our Web site (dentaladvisor.com). We regularly present our findings at the International Association for Dental Research and other professional meetings. One area that has been requested for scientific validation is depth of cure and other properties of bulk-fill composites. We have tested several bulk-fill composites and found excellent results. Another area we have extensively studied is bonding to zirconia-based ceramics, which is an ongoing debate in dentistry. We achieved significantly higher bonds when the surface was treated with a ceramic primer based on an acidic monomer.
What is the overall mission of THE DENTAL ADVISOR?
Dr. Bunek: The mission of THE DENTAL ADVISOR is “improving patient care through research and education.” Our readers are important to us. We want to report information that is objective and evidence-based. Our editorial board is experienced in the industry, and most members practice clinical dentistry. The goal is to be a trusted resource and advisor to the entire profession. If our publication can assist a dental professional in treating a patient, we have provided a valuable service.
What area of dentistry do you think is the most confusing for dental professionals at the moment?
Dr. Farah: When I lecture, I think most questions are about basic procedures: bonding, cementation, and material choices. I am continually surprised by the amount of conflicting information out there. The research we do, and have been doing for 30 years, is real world. We are, at the end of the day, dental professionals in practice. We use the products and are aware of how confusing they can be. As such, we try to point out the importance of good products, emphasizing material differences, and we give tips for proper use and handling of products.
Dr. Bunek: I agree. I think the questions are about bread-and-butter dentistry. There are so many new products, and lots of mixing and matching by dentists. People want to know if product x will work with product y, and what the clinical result will be. Although we regularly report on differences in products, there seems to be a need to focus on basics: What should I use, where should I use it, and what is the long-term success? As new products are introduced, I think the dental professional relies on independent, third-party evidence to determine the efficacy of a product. Clinicians need a reason to switch products.
Where does the funding for your research projects come from for THE DENTAL ADVISOR?
Dr. Powers: Our income is from manufacturers and subscriptions. We work and communicate with manufacturers all over the world to assist them in improving their products for the benefit of clinicians and patients. We work with products in all stages: product development (R&D), premarket, during launch, and after market. We do not, however, allow funding to affect our results. Working with companies does not affect our integrity and never sways our findings. Ratings and results are shared with the manufacturers so that they may improve their products where necessary for the good of the profession of dentistry. We have the highest level of respect from manufacturers for remaining unbiased and providing excellent third-party information that is trustworthy and scientifically based.
We have heard that THE DENTAL ADVISOR works behind the scenes with manufacturers on many projects. Can you tell our readers about that?
Dr. Bunek: In my opinion, one of best services we provide is working with manufacturers in the product development phase. Since we have the ability to test materials in our laboratory as well as provide clinical feedback on products that have FDA approval, manufacturers rely on us to assist them. Evaluating so many different products allows us to have a unique insight on the necessary criteria for a successful product. Ultimately, our objective at THE DENTAL ADVISOR is to partner with manufacturers to provide better products and equipment. When we get an opportunity to work with companies at this level, it is a win-win.
If THE DENTAL ADVISOR were to give advice on creating a great product, what would the criteria be?
Dr. Bunek: This is a question we are asked all the time. A product first and foremost has to give a clinician reasons to change the techniques and products he or she is currently using. We know from experience that a great product not only has to be easy to use and handle well in a dentist’s hands, it also needs to be formulated to perform the way it is supposed to.
Dr. Powers: This is why the research we do is important. The numbers we attain in the laboratory often mirror what is seen clinically. The wonderful thing about our organization is that as we see things questioned clinically, we can verify in our laboratories independently. That way, if there is a technique issue, we can often tie changes in technique with different results.
Dr. Farah: Our long-term data play an important role in determining success. A product may perform well initially but show signs of failure over time in areas like marginal staining, lack of retention, or chipping and fracture. It is important to know which products last longest and are the best. We are the only organization that has consistently tracked products throughout time.
What does the future hold for dentistry?
Dr. Farah: After seeing the changes during the last 30 years, the next 30 years hold lots of promise for even more innovation. Materials are constantly improving. For example, resin composites have a 50 times lower wear rate than they did 30 years ago. It is not unreasonable to have a composite last 15 or more years. Look what happened to dentin bonding. It went from almost no bond strength to a bond that is stronger than that of enamel. I love a story that Dr. Bill Gregory told me years ago about his dad, a dentist who practiced in the 1930s, ‘40s, and ‘50s. Bill told me his dad retired from dentistry basically using the same products he was using when he graduated from dental school. The exact opposite is happening now. Dentistry is undergoing constant change.
Dr. Bunek: The evolution of digital dentistry will take us to new areas never considered. As digital scanning grows and integrates with more of our software, we will have the ability to not only treat patients with this technology, but also use the information to diagnose and provide better, more accurate comprehensive treatment.
Dr. Powers: More and more focus will be placed on evidence-based dentistry, as opposed to clinical practice based on anecdotal opinions.
Disclosure: Dr. Powers is senior vice president of Dental Consultants, Inc (publisher of THE DENTAL ADVISOR) and is senior editor of THE DENTAL ADVISOR.
Disclosure: Dr. Farah is president of Dental Consultants, Inc (publisher of THE DENTAL ADVISOR) and is senior editor of THE DENTAL ADVISOR.
Disclosure: Dr. Bunek is vice president of Dental Consultants, Inc (publisher of THE DENTAL ADVISOR) and is editor-in-chief of THE DENTAL ADVISOR.