CERECDoctors.com-Q2-2017 - page 22

20 | CERECDOCTORS.COM | QUARTER 2 | 2017
C A S E S T U D Y | | | B Y D E N N I S J . FA S B I N D E R , D . D . S . ; S A M E E R P U R I , D . D . S . ;
M A R K F L E M I N G , D . D . S . ; A N D G I S E L E N E I VA , D . D . S . , M . S . , M . S .
a critical need of any progressive dental practice is having predictable and dependable solutions for its
patients’ dental problems. Even though there is a general tendency to rely on anecdotal information, it is a cornerstone of a
successful dental practice to be able to confidently apply solutions based on evidence of their efficacy. Both patients and clinicians
desire the peace of mind that comes from having self-assurance in the treatments that are proposed and accepted.
Practice-based Research Network
for CEREC Dentistry
Thoughtful clinicianswill collect evidenceof treatment outcomes
from a variety of sources. A very common and trusted source is the
controlled clinical research that has evaluated a technique, mate-
rial or therapy under standardized conditions over a considerable
length of time. Of course, the larger and more diverse the patient
population that is treated in the study, the more confidence clini-
cians place in the published clinical outcomes of that study.
This type of clinical research is generally based in an environ-
ment that allows that technique ormaterial to be applied in away to
maximize the potential clinical outcome. One guiding principle of
designing clinical research projects is to avoid causing poor clinical
outcomes through mishandling the material or technique, or mis-
applying them. Clinical treatment in these sorts of very controlled
clinical conditions do not have the usual constraints found in a
productive, private dental practice; therefore it is not uncommon
to take several hours to complete a clinical research procedure that
could often be completed in less than 60minutes in a private dental
office. Long-term clinical research carried out under controlled
clinical conditions may provide evidence of the optimal potential
outcome for a material or technique.
Clinical experience is also another influencing factor in the deci-
sion-making process for experienced clinicians. Their personal
successes and failures with specific materials or techniques, as well
as those shared by their colleagues, obviously influence their degree
of confidence in procedures and their likelihood of recommending
them to their patients.
It is not uncommon for clinicians to remember the less-than-
desired outcomes as they are significant factors to their dental prac-
tice since they may place the practice at some level of risk relative to
their patient satisfaction and retention. Clinical experiencemay also
lead to clinician “bias” or “tendencies” that influence their treatment
recommendations. A significant challenge for clinicians is to eval-
uate their clinical experience in light of published clinical studies.
One example of this dilemma for clinicians involves percep-
tions about the clinical performance of ceramic onlays compared
to all-ceramic crowns. A survey of doctors from the cerecdoctors.
com website indicated that 80 percent of the 191 clinicians that
responded to the survey reported that at least 75 percent of the
single-tooth CEREC restorations they delivered were crowns. And,
less than 10 percent of the respondents indicated at least 75 percent
of their single-tooth restorations were inlays or onlays.1
There are many of reasons for this significant tendency to provide
CERECcrownsinsteadofCERECinlaysoronlays.Oneofthereasons
is that the main failure mode for all-ceramic restorations is fracture
of the ceramic, and the perception that crowns are more resistant to
fracture than onlays. However, one long-term clinical study on 1,335
all-ceramic restorations reported no clinical difference in fracture
rates between inlays, onlays and crowns, and that parafunction and
nonvital teethwere more of a predictor of restoration failure.2
There are also a number of clinical studies documenting the clin-
ical performance of CAD/CAM ceramic onlays; one clinical study
reported 96 percent success over five years with two different types
of CAD/CAM ceramic materials for onlays3 (Figs. 1-4). A system-
atic review of the clinical performance of CAD/CAM single-tooth
restorations reported that a more conservative onlay restoration
yields similar long-term results compared to full-coverage crowns.4
Therefore, being aware of the evidence in the fieldmay help doctors
to make better informed treatment decisions for their patients.
An obvious question in this balance of clinical experience and
published clinical studies is: to what degree do private practice
treatment outcomes match controlled clinical research outcomes?
Another question: do the features common to private practice influ-
ence the clinical outcomes from controlled clinical research? To
determine answers to these types of questions, clinical outcomes
would need to be collected from a large number and diverse variety
of clinical practices. The collection of dental practices collaborating
to collect data from clinical treatment is called a Practice-based
Research Network (PBRN).
The concept of PBRNs is not particularly new; they were initially
developed in the 1970s in medicine in an attempt to collect clinical