Goal: The goal of this proposal is to establish a NIDCR supported dental Practice Based Research Network (PBRN).
Background: Without sound evidence, dental practitioners frequently must use anecdotal information to make clinical decisions for patient care. PBRNs can help fill this evidence gap by providing an infrastructure for answering important clinical questions faced by dentists on a daily basis. Indeed, the 2002 ADA Future of Dentistry Report specifically recommends that national clinical research networks be established that link treatment approaches and outcomes in private practice settings. By connecting practitioners with experienced clinical investigators, PBRNs can enhance the clinical research agenda of the NIDCR and produce findings that are immediately relevant to practitioners and their patients. PBRNs are able to support a variety of clinical studies with clear and easily defined outcome measures, and they typically draw on the experience and insight of practicing clinicians to help identify and frame research questions. Because research is conducted in the real-world environment of dental practice, results may be readily accepted by practitioners and translated into daily practice. Moreover, because PBRNs use the existing personnel and infrastructure of established dental practices, certain types of clinical studies can be conducted in a cost-effective manner.
Methods and Implementation: The PBRN will consist of: 1) a Study Chair who will share overall administrative, scientific, and fiscal responsibility with the NIDCR, 2) a Coordinating Center that will manage the PBRN, 3) a network of PBRN certified community based practicing dentists who will implement the research protocols, 4) an Executive Committee who will advise the Study Chair and the NIDCR on scientific and administrative matters, and 5) a Protocol Review Committee, which will serve as peer reviewers for all studies. Suggestions for clinical studies will be made from the Study Chair, participating PBRN dentists and NIDCR program staff. All studies will be reviewed by an IRB and all clinical trials will have an appropriate data and safety monitoring plan.
The initial focus of the network will be general dentistry. The following are examples of clinical studies that could be conducted in a general dentistry focused PBRN.
- Utility and short-term effectiveness of various temporary restorations
- Utility of various forms of periodontal instrumentation
- Effectiveness of various methods for restoring fractured teeth
- Short-term pulpal consequences of restorative and pulp capping procedures
- Short-term effects of immediate implant loading and retainer design
- Comparative studies of implant vs. fixed or removable replacement of lost teeth
- Short-term failure rates of various restorative materials for specific types of restorations
- Anonymous chart reviews to provide data on disease and treatment trends, i.e., trends of amalgam and composite use for posterior class I and II restorations
- Estimates of the prevalence of rare conditions such as xerostomia associated with various systemic conditions