The value of consensus conferences: Peer review by 50 key opinion leaders! (original) (raw)

2018, STOMATOLOGY EDU JOURNAL

Fifty years ago, for the most part, all the dentist had to know about direct restorative materials was how to use dental amalgam and silicate cement. The preparation design for amalgams was well understood, and mechanical retention was a fundamental requirement. Reliable adhesion to both dentin and enamel was utopian, metal free ceramics were not durable, and light-cured resins had yet to be developed. Today, we have a multitude of materials and techniques that enable the dentist to produce direct and indirect restorations that are practically undetectable for both the dentist and the patient. However, there are tremendous consequences from having so many restorative materials and techniques available, and it has become more and more difficult for both practitioners and university professors to find their way through what is now considered a restorative jungle. On the one side, the internet offers in milliseconds a vast amount of information, which often sounds interesting and authoritative but, unfortunately, it is not always correct. Most dental schools claim to teach evidence-based dentistry and focus on providing treatment recommendations that are free from bias and based on prospective randomized double-blinded clinical trials. This approach should ascertain the truth, but has some severe disadvantages. Firstly, it requires a long time for valid results to be produced; secondly, patients cannot be standardized; thirdly, there is often an element of bias in that the exclusion criteria for the very studies that we rely on often eliminate some significant parts of populations that are candidates for the treatment being evaluated. Finally, ethical considerations often limit the questions that can be asked from a prospective randomized, double-blinded clinical trial. This is further compounded by the fact that it has been estimated that more than 95% of recent prosthodontic and implant review articles failed to use search strategies that were systematic, thus undermining the conclusions upon which treatment decisions are based [1]. One solution to the problems described above is a consensus conference. The principle is the following: experts, key opinion leaders, who represent the profession and industry come prepared to discuss a well-defined topic. Based on all their combined scientific, clinical and epidemiologic knowledge, together with presentations, a structured discussion occurs, in which proven, accepted information is sorted out from less valid information. In essence, this is now peer review by some 50 key opinion leaders instead of peer review by 2 or 3 selected reviewers for a 'peer reviewed' journal publication. At the end of such a conference, a draft consensus paper is formulated, which is subsequently reviewed, edited and approved by those key opinion leaders. The Northern Light conferences at Dalhousie University in Halifax (Canada) have produced such recommendations for the light curing of direct restorations (2014) [2-4], dental light-curing units (2015) [5], bulk-fill restorations (2016)