Year : 2015 | Volume
: 2 | Issue : 4 | Page : 149--150
Guidelines for application of the outcome of adhesive dentistry laboratory research to our daily clinical practice
Hamdi Hosni Hamdan Hamama
Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
Hamama Hamdi Hosni Hamdan Hamama
Department of Operative Dentistry, Faculty of Dentistry, Mansoura University, Mansoura
|How to cite this article:|
Hamama HH. Guidelines for application of the outcome of adhesive dentistry laboratory research to our daily clinical practice.J Dent Res Rev 2015;2:149-150
|How to cite this URL:|
Hamama HH. Guidelines for application of the outcome of adhesive dentistry laboratory research to our daily clinical practice. J Dent Res Rev [serial online] 2015 [cited 2020 Jun 6 ];2:149-150
Available from: http://www.jdrr.org/text.asp?2015/2/4/149/176676
First, it is my pleasure to receive a kind invitation from the executive editor of the Journal of Dental Research and Review (JDRR) to write the guest editorial letter for the current issue of the journal. I also, highly appreciate the editorial board efforts to gain more diversity and internationalism for JDRR.
I am writing this short article as a clinician, before being an academic person interested in adhesive dentistry research, as well as a staff member in the university. Every day, I read a lot of controversial results coming from laboratory studies in the field of adhesive dentistry; some of the authors discussed their results in light of some theoretical "complicated" mathematical equations; others applied the "dynamic" bone model to dentine, or excessively attributed their positive results to the chemical formula of the adhesive system used. Most of these in vitro experiments were performed in an ideal laboratory conditions concerning very limited number of variables. However, the "true" clinical situation contains more "complicated" factors. Furthermore, several studies neglected the changes occurred in the tooth substrate due to the caries process. Also, in laboratory studies, it is too difficult to investigate the effect of clinician's errors on the durability of bonding to dental substrate.
Nowadays, the current trend in adhesive dentistry research is to discover an "ideal" matrix metalloproteinases (MMPs) inhibitor to increase the bond durability to tooth structure. Unfortunately, many research groups working in this field and promoted this topic as "human-MMP" battlefield, trying to defeat this "enemy." However, many of the authors did not consider the good clinical performance of tooth-colored adhesive restoration after 15, 27, and 30 years, which was reported in the randomized clinical trials (RCTs) by Pallesen and van Dijken , and Van Dijken and Lindberg  Although MMPs play a role in degradation of resin/collagen interface, promoting MMPs as the main contributor of bond degradation does not follow a logic way of thinking. Most of the current published work attributed bond degradation to the presence of MMPs, which is normal habitant in human dentine. Theoretically, if MMP is the principal factor of resin/collagen bond instability, all adhesive restorations must fail. However, the results of majority of RCTs did not support this assumption.
Moreover, the role of phosphoric acid (PA) etchant in activation of MMPs is not clearly stated in the published articles. Some of the authors reported that PA deactivates MMPs; however, later on, the same authors reported that it activates MMPs. This conflicted data from the same research groups lead to a lot of confusion to the readers, particularly clinicians, who are not specialized in this field. Nevertheless, conducting laboratory experiments contributes a lot to current scientific knowledge; RCTs and systematic reviews provide more "clinically" reliable outcome following the current philosophy of evidence-based science.
Accordingly, clinician should follow these guidelines before applying the outcome of the laboratory research to their daily clinical practice. Hence, I advise clinical practitioners to:
Improve their basic knowledge by understanding the histological features of tooth substrate and the chemical formula of the currently available bonding systemsScreen the publication series published by same authors and try to filter any confusing results and carefully read the discussion section before reaching any conclusionCarefully understand the caries process and changes occurred to the dental tissues in association to cariogenic attacksRead recent systematic reviews and meta-analysis articles in adhesive dentistry, which save a lot of clinician time and provide strong scientific evidence to their readersFollow the most updated publications via searching popular databases (PubMed, ScienceDirect, EBSCOhost, etc.,) using the concurrent keywords. In addition to attending research scientific meetingsFocus on the clinical relevance of the manuscripts and the benefits the application of its results on his/her clinical performanceCareful follow-up of the clinical cases, which received any modified treatment influenced by the recent knowledge, added to the clinician from laboratory research studies.
Finally, I wish great success to my dental colleagues and hopefully that the above-mentioned guidelines will be helpful for them.
|1||Pallesen U, van Dijken JW. A randomized controlled 27 years follow up of three resin composites in class II restorations. J Dent 2015;43:1547-58.|
|2||Pallesen U, van Dijken JW. A randomized controlled 30 years follow up of three conventional resin composites in class II restorations. Dent Mater 2015;31:1232-44.|
|3||van Dijken JW, Lindberg A. A 15-year randomized controlled study of a reduced shrinkage stress resin composite. Dent Mater 2015;31:1150-8.|