It is a well-known fact that before a new drug becomes available on the market, it goes through years of clinical trials, performed in multiple centers, on different populations, in order to describe to the highest level of detail not only the beneficial effects, but also every single side effect or complications that may arise from its use. This extremely complex mechanism is rigorously controlled by different governmental agencies, like the FDA in the USA and EMEA in the EU. However, when it comes to treatment techniques that do not involve the use of new chemical substances, these are not as strictly regulated. This responsibility falls on the shoulders of scientific journals, which publish the results from different clinicians. If we were to refer specifically to the field of dentistry, and to be more precise to dental implants, there are virtually no regulations to enforce one technique over the other, even though they may be in perfect opposition to one another.
It is a well-known fact that before a new drug becomes available on the market, it goes through years of clinical trials, performed in multiple centers, on different populations, in order to describe to the highest level of detail not only the beneficial effects, but also every single side effect or complications that may arise from its use. This extremely complex mechanism is rigorously controlled by different governmental agencies, like the FDA in the USA and EMEA in the EU. However, when it comes to treatment techniques that do not involve the use of new chemical substances, these are not as strictly regulated. This responsibility falls on the shoulders of scientific journals, which publish the results from different clinicians. If we were to refer specifically to the field of dentistry, and to be more precise to dental implants, there are virtually no regulations to enforce one technique over the other, even though they may be in perfect opposition to one another. Oral implantology is by definition a very technique-sensitive specialty, which may mean that the same surgical protocol may yield different results when performed by different clinicians. As a result, multicenter clinical trials may not give a true estimate of the effectiveness of a certain surgical technique. Also, it is virtually impossible to design a truly controlled and blinded study, because every single clinical case is unique in its own way, and local conditions may have a high impact on the outcome of the procedure. This brings us to the subject of the day: when can we apply a novel surgical technique in our daily clinical practice? When it is published the first time as a proof of concept? When the first 10 case reports show promising results? Every practitioner has the responsibility to stay up-to-date with the scientific literature in his or her field of work. But who decides when a large enough number of cases with a long enough followup period have been published in order to safely apply that surgical technique in our practices? Maybe young, enthusiastic doctors are eager to apply new techniques as soon as they are published. More experienced professionals may be more skeptical, demanding more data to be published, while others may simply refuse new surgical protocols, because the ones they already use offer them satisfying results. Is there any way to enforce one of these behaviors on all practitioners? I believe not. And I believe there shouldn’t be. The only referees in this matter are the scientific publications. The hard work must be done by the editors and the peer-reviewers, in order to ensure that every clinician receives the correct information in order to make an informed choice. As more literature becomes available on a certain subject, systematic literature reviews and metaanalyses can be the only answer to when a new technique can be routinely introduced in daily practice.