By Lee Ann Brady, DMD The landscape of dental materials is vast, and it is an ever-increasing challenge as a practitioner to know what materials to use in my office. The goals are clear: I want to maximize my clinical success (effectiveness), minimize technique challenges, and minimize my clinical supplies budget (efficiency). OK, so realistically I know I am looking for perfection, and these goals will need to be prioritized. My good friend Gary DeWood always says that dentistry has to be at least 51% health care and no greater than 49% business. I couldn’t agree more, so when I evaluate materials, I look first at effectiveness and then at efficiency.ALSO BY DR. LEE ANN BRADY |One patient, so many appliance designs! What should I use?Evaluating clinical effectiveness begins with knowing what to look for. Dental materials are subjected to a large array of tests and rated for many different criteria. As a clinician, what matters to me are the properties that translate into clinical success. Shrinkage stress is a great example of that for composite. With this in mind, I want to understand the impact that concepts like bond strength, flexural strength, and wear resistance have on clinical performance. I also want to look at data from clinical trials and in vivo performance as well as just the science behind the materials design.Next, I investigate the technique recommendations for any new material I am considering. There is a relationship in my hands between the technique sensitivity and the effectiveness. If a material’s performance is dependent on a very specific, sensitive set of steps, it may be challenging for me to replicate the performance in real life clinical situations. In this scenario, I may choose to use something that has similar effectiveness, but less challenging placement parameters. Efficiency is also related to economics. I heard a lecturer the other day say, “You aren’t going to become independently wealthy by saving 10 seconds when applying your dentin adhesive.” I try and keep in perspective in my practice that “time is money,” so being purposeful and efficient are important, without forgetting “don’t be penny wise and pound foolish.” All this to say, saving 10 seconds while increasing the number of restorations I replace is counterproductive.Lastly, we do simply have the cost of the material to consider. If I had two identical products in every way in front of me, except one was less expensive, it wouldn’t make sense to spend more. Of course, in reality, it is never this clear-cut. If the material I currently use is failing clinically, changing to a new material is a simple process.Is the new material more effective clinically? The decision process becomes more complex if what I am using is already working.Is the new material more effective clinically and equal in efficiency?Is the new material equal in clinical effectiveness and more efficient?Is the new material equal in clinical effectiveness and efficiency and less expensive? The answers to these questions come from a variety of sources. Do your research and use multiple sources before you decide. Spend a certain amount of your continuing education hours staying up-to-date on materials science. Utilize any of the independent product evaluation companies in our industry to sort through the research and clinical trials; they also share the experiences of their clinical evaluators. Your distributor representative or a manufacturer representative can provide you with literature and research, as well as “marketing materials” on different products. Materials work differently in different practitioner’s hands, so what you hear about a dental material over a chicken dinner during a dental meeting may not be applicable. The future of dental materials will only get more complex. Being a savvy consumer begins with knowledge. Determine for yourself how you will differentiate between new materials and the criteria that are most important to you as a clinician.
Dr. Lee Ann Brady earned her DMD degree from the University of Florida College of Dentistry. Her practice experience has been rich and varied. For 17 years, she worked in a variety of practice models from small, fee-for-service offices to large, insurance-dependent practices as an associate and a practice owner. She was invited to join The Pankey Institute in January 2005 as its first female resident faculty member and was promoted to clinical director within a year. She was asked by Dr. Frank Spear to join him in the formation of Spear Education and the expansion of his curriculum in September 2008 as executive vice president of clinical education. This year, Dr. Brady launched her website, www.leeannbrady.com, to offer clinical and practice content daily. In addition to being a dedicated educator, she maintains a private practice in Glendale, Ariz.
