|Year : 2011 | Volume
| Issue : 1 | Page : 2-3
Technology supersedes basic science: Are we really in the path of progress?
Reader, Conservative Dentistry and Endodontics, Program Director - Aesthetic Dentistry and Dental Biomaterials, Head, Undergraduate Clinic 6, Saveetha Dental College and Hospitals, Saveetha University, Chennai, India
|Date of Web Publication||29-Jul-2013|
Reader, Conservative Dentistry and Endodontics, Program Director - Aesthetic Dentistry and Dental Biomaterials, Head, Undergraduate Clinic 6, Saveetha Dental College and Hospitals, Saveetha University, Chennai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Neelakantan P. Technology supersedes basic science: Are we really in the path of progress?. J Int Clin Dent Res Organ 2011;3:2-3
|How to cite this URL:|
Neelakantan P. Technology supersedes basic science: Are we really in the path of progress?. J Int Clin Dent Res Organ [serial online] 2011 [cited 2019 Jun 24];3:2-3. Available from: http://www.jicdro.org/text.asp?2011/3/1/2/115760
Technological progress is like an axe in the hands of a pathological criminal - Albert Einstein
Dentistry is at the crossroads with technological advancements on a day-to-day basis. Is this boom a boon or a bane? No doubt, technology has made our jobs easier. We can now do things with motorized equipment in lesser time with lesser fatigue than in the past. Each specialty of dentistry has its own store of technological improvements for making things better - rotary endodontic instruments, lasers, CAD-CAM, and CT imaging to name a few. But in this journey of constant improvement of technology, have we pushed the basics into oblivion? In other words, are we making true progress in patient care?
Over time, we have become increasingly industry and market driven rather than fundamental biology driven. If one takes the case of endodontics, we have learnt and been taught that microbiota are the cause of root canal infection and the ensuing periradicular pathosis. Our rationale for treatment is the elimination of the "infection." For years, this infection was removed by the use of hand instrumentation and irrigation. It is not that those cases demonstrated any lower success rates. Rotary instrumentation has indeed made our job easier. Numerous microCT studies by Frank Paque at the University of Zurich and Ove Peters at the University of the Pacific Arthur A. Dugoni School of Dentistry have shown that rotary instruments do not contact 100% of the canal walls and, hence, may house necrotic tissue even after root canal preparation. But are we still irrigating the root canals the way it should be? Are we still ensuring an adequate hypochlorite irrigation time? Are we still ensuring adequate apical widths to ensure irrigant penetration and biofilm destruction? At a time when knowledge of endodontic biofilms did not exist, these parameters were given importance. Now, at a time when endodontic research has flooded us with so much information (this is a double-edged weapon!), do we still give the same importance that endodontic disinfection deserves? Endodontic research revolves around evaluation of different root canal instruments as well as the efficacy of several irrigants. One must realize that these mechanized instrumentation procedures are intended to offset our hand fatigue and improvise our canal preparation, not necessarily to shorten preparation times. Any endodontic treatment - many file endo, one file endo, reciprocating endo, rotary endo - will fail, if we forget our basic rationale. The need for speed has resulted in conservation of time for a catastrophe. Technological progress has probably provided us with more efficient means of going backward. On the contrary, the use of the operating microscope has indeed taken endodontic care to new heights. We are now able to see what we used to imagine in the past. We are increasingly locating, cleaning, and filling extra canals. We are also increasingly talking about "regenerative endodontics" or more rightly, revascularization therapies in endodontics. This may probably be what endodontics of the future may all be about! We still do not have enough long-term clinical trials to support or refute this approach. Stem cells, collagen scaffolds, and different means of delivering cells and increasing success of these revascularization procedures are being researched upon, all over the world. In fact, the American Association of Endodontists has allocated $2.5 million to obtain reliable evidence under which pulpal regeneration occurs in patients.
The right use of technology with a solid foundation based on biological principles - that is what ultimate care is all about.
I recently came across an article showcasing the first implant that Per-Ingvar Brånemark placed about 50 years back. That was a time when three-dimensional imaging, advanced surgical techniques, and the n number of implant designs were not present. Were those procedures not successful? This does not necessarily mean that the advances we have now are meaningless. But the fact that they may become meaningless in the absence of a solid foundation of basic principles of science is a lingering fear in the minds of every researcher and teacher. A lack of knowledge of case selection, anatomy, and other basic processes revolving around implantology will not be compensated for by the modern technology and implant designs.
Materials science and engineering is a fast developing field and has major implications in dentistry. We now have before us several dentin adhesives and resin composites for use - each one claiming superiority in its internal research reports. But clinical trials seem to show no major difference between the various adhesives or composite resins. Single-step adhesives, three-step etch and rinse adhesives, single-step resin cements, resin cements that require two or three primers before use - no matter what adhesive we use or what resin we use, the absence of isolation with rubber dam is planning for failure of the case. When a composite resin restoration or an adhesively cemented crown fails, one must realize that the cause for failure was on our part in not meticulously following the guidelines for performing a bonded restoration.
No specialty of dentistry is as biology driven as periodontics. Conventional periodontal therapy, despite arresting the progression of disease and allowing healing, cannot result in tissue exactly like the normal healthy periodontium. A basic knowledge of cellular and molecular biology is imperative to understand periodontal regeneration. Reconstruction of small to moderate-sized periodontal bone defects using engineered cell scaffold constructs is now feasible, but studies on predictable and optimal periodontal tissue regeneration and a functionally promising supporting apparatus are still in the preliminary stage.
Let us remember that no matter what technological advancements arise, basic concepts like root canal anatomy or microbiota within the root canal system, the need for isolation, and need for fundamental knowledge of oral tissues do not change. Let us not become the tool of our tools!
This issue of the journal brings to us seven research articles and one review article. The first paper analyzes the biophysical aspects of the gingival epithelium. The second research paper studies the optimization of the sensitometric properties of two light-sensitive dental films using an automatic processor. The third paper from Raagas Dental College, Chennai is an in vitro evaluation of a newer intracanal medicament - Nisin. This paper would be interesting to read considering the presently proven problems with calcium hydroxide in terms of weakening the tooth structure and its inefficacy against Enterococcus faecalis. Natural remedies are increasingly being considered an important part of dental therapeutics. In line with these ethnopharmacotherapeutic approaches, the fourth and fifth papers evaluate the applications of two different herbs on oral health. The sixth paper of this issue is also a clinical study wherein the effect of a 0.2% chlorhexidine gluconate mouthrinse on gingival inflammation of pregnant and non-pregnant women has been studied, without them undergoing periodontal prophylactic procedures. The seventh research paper, which is from D. Y. Patil Dental College, Pune has assessed, in vitro, the smear layer production of greater taper rotary instruments. This is an issue of importance in endodontics and a topical subject.
I am sure that this issue of JICDRO, like its other issues, will offer a wealth of knowledge to specialists and general dentists alike, and help us understand the many complex ways in which dental therapeutics work.
| Authors|| |