A concern for bias
- 1. E D I T O R I A L A Concern for Bias P ersonal preference is an inherent component in the fabric of human life. From early childhood through adult years, each individual develops a pat- belittled this obvious progress by repeated, out-of- context comparisons of the new surface types to machined surfaces in reports of relatively short-term tern of likes and dislikes which is unique to that per- case series. son. This trait is revealed in attitudes, interests, and While the early work with endosseous implants is choices involving, for example, foods, clothing styles, meaningful as a baseline experience to which future automobiles, and personal friends. As one’s person- progress in implant design and material can be com- ality and intellect develop, there is an inclination of pared, it is also important to be mindful of the clini- temperament or outlook to focus on certain objects cal condition the early machined implants were or points of view with a certain prepossession that designed to rectify, namely the edentulous man- does not allow the individual to respond impartially dible. For this situation, a 2-staged surgical proce- when the former are challenged. The result is a dure was proposed and has been successfully biased mindset. applied for nearly a quarter of a century. Appended to the closing text of Michael Crichton’s Bias can often be seen in product research and recent novel State of Fear is an author’s message in development, regardless of support source. The rush which Crichton outlines certain conclusions he has to meet commercial competition and patient drawn from his rather extensive review of the litera- demand to lessen treatment time without incon- ture on the environment. He wrote venience has further de-emphasized the need for scientific research into what is being manufactured I believe people are well intentioned. But I have and placed in human mouths. Certainly immediate great respect for the corrosive influence of 1-stage surgical and restorative procedures for situa- bias, systemic distortion of thought, the power tions where indicated are appropriate, and tech- of rationalization, the guises of self-interest, nique refinements will come with time if successful and the inevitability of unintended conse- outcomes can be achieved over the long term. This quences. does not mean that “one size fits all” or that 1-stage procedures are preferred for all patients in whom Akin to these observations is the recent trend of immediate implant placement is indicated, regard- (perhaps unintended but nevertheless misguided) less of system type. indirect, biased bashing of the early pioneers of Bias has no place in scientific design and execu- osseointegration and their conservative concept of a tion, the reporting of results, or appropriate—and in prolonged period of healing following implant context—analysis of the scientific literature. The plea placement. here is for an early return to fundamentally sound Osseointegrated implants are not placed; en- research design, appropriate statistical testing, hon- dosseous implants are placed and become osseo- est reporting of results, and the statement of conclu- integrated under optimal conditions. With the sions based only on the pertinent data emanating advent of treated and roughened implant surfaces from the investigation. The field of implant dentistry and the subsequent development of early healing and the patients we treat will be better served by a and stability following implant placement, appar- return to the unfettered basics. ently the importance of all prior laboratory and sci- entific investigation has diminished. Even though the introduction of osseointegration was recognized as a quantum leap from the prior era of human experimentation with questionable implant materi- William R. Laney, DMD, MS als and designs, proponents of various systems have Editorial Chairman The International Journal of Oral & Maxillofacial Implants 175 COPYRIGHT © 2005 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.