Minutes of meeting  June 22, 2000
Submitted by George F. Green, D.D.S.
 

Critical Evaluation of Literature - Dr. Max Crigger

How careful should we be when integrating dental literature into our practice?
Undergraduate dental student : Nothing is questioned - "do as you are told"
Graduate dental student: exposed in depth in a specific area - encouraged to question
Dental practice is constantly changing, we must be critical with new information

What are expectations in tonight's meeting?
It is difficult to change ideas or feelings (for example, one's political affiliation)
To change one's toothpaste: possible - only need to show equivalency, not superiority
To change antibiotic Rx: Need medico-legal reasoning, need more convincing data
This afternoon on Oprah Winfrey: a Dr. Royce is telling the world that periodontal disease will take 3.5 years off one's life!

1. Jeffcoat Study "Chlorhexidine chip (PerioChip)"  J Periodontal  2000; 71:256-262
Conclusion: data indicate CHX adjunct with scaling and root planing significantly reduces alveolar bone loss
Purpose: To determine whether or not bone loss occurred despite positive effects of CHX on clinical parameters
Materials and methods: study is designed to answer Introductory question.
Discussion: OK for author to "stick his neck out" in Discussion, but Results and Conclusion are sacred.
Problem with method: a site could get three times as much medicine as another site - based upon subjective input - this scrambles results.
Measurements of 0.5mm very difficult to obtain accurately  with perio probe in periodontal disease study (easier to do in a recession study).
No intra-subject comparisons - becomes a parallel study.
Radiographic analysis: human operating computer mouse - can introduce error, bias, most likely is not "blind"
At six months, scaling and root planing alone does better than SRP plus CHX . . . doesn't make sense
Essence of abstract: no control group. Digital x-ray - bone "gain" not at the studied site.

2. Caton Study "Doxycycline" J Periodontal 2000; 71:521-532
Authors: "Big people" - company spent a lot of money for this study
Problems: 1. some patients had local anesthesia for SRP, some did not - should all be the same, should not be optional
2. Clinician had option of doing initial therapy or not doing initial therapy = huge option, ends up comparing apples to oranges
3. Bleeding on probing: important criteria in shallow sites, but no evidence that BOP is valid criteria in deep pockets.
4. Probing depth improvement - is it due to recession or increase in attachment level? In this study, improvement = 0.7-1.0 mm. Improvement due to attachment level increase = less
than 0.1mm.
Do we want to put patients on doxycycline for 9 months for an attachment gain of less than 0.5mm?

3. De Vicente Study Int J Perio & Rest Dent 2000;20:41-49
Most widely distributed dental journal im the world.
24 treatment sites(pig tibia): control, HA, DFDB(demineralized freeze-dried bone),e-PTFE membrane
Method: block section of treatment site, then "slice" block specimen and take radiograph for computer analysis. Will study only 1.0mm adjacent to implant
With different time frames, end up with only one specimen for each group - how can we get a standard deviation with only one sample??!!
Very difficult to obtain consistent, uniform slices of block specimen.
Conclusion: membrane gave significantly greater bone density in bone defect repair = "crazy"!  Does not mean we should throw membranes away, but use of membrane should not
be based upon this study.

4. Soikkonen Study J Clin Periodontol 2000; 27:87-92
This was on Oprah Winfrey today!
Are we going to tell people they will lose 3.5 years from their life if they have periodontal disease?!!
Measured attachment level from radiograph = can't be done. Can only measure bone loss from radiograph
Results: group 1 = older people die more than younger people
               furcation group = you will live longer if you have a furcation involvement!
All conclusions discuss attachment level, when in reality only bone loss was measured.
This paper is ridiculous.

Meeting adjourned at 9:45 PM.