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Immediate Implants in the Aesthetic Zone:
by Nikos Mattheos - Tuesday, 27 February 2018, 08:45 PM

To do or not to do? ... that is the question...!

Immediate implants in the aesthetic zone remain a hotly debated topic with  many enthusiasts among clinicians, as well as many sceptics.

This controversy appears to extend even to research, with the few available prospective studies often presenting seemingly conflicting outcomes.

In that sense it is not surprising that one of the most common questions I receive from colleagues during courses and events is exactly about this issue:

-“ Do you place Immediates in the aesthetics zone?”
- “Do they work? Is it a treatment option to pursue or to avoid?”For the first question my response would be rather short.  For the second however I will need more of your time and attention!

... click here  to

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A MOOC for Implant Dentistry?
by Nikos Mattheos - Sunday, 9 October 2016, 02:51 AM

Is a MOOC a way to go in Implant Dentistry?

What to expect from the first Implant Dentistry Massive Open Online Course          


It’s been almost a week since enrolment opened for our MOOC, the first Massive Open Online Course in Implant Dentistry! As excitement grows, so does the daily list of mails and messages from all parts of the world crowding my inbox. Supportive comments from friends and strangers, suggestions, ideas, curiosity and questions, a whole lot of questions..! 

… one question that strikes me as particularly interesting: “Will I learn to place implants in your course…?”

 Indeed,  an interesting question! …now let's see if I can come up with an equally interesting answer!

- What is a MOOC?

A MOOC is one of the most exciting educational developments of this century, the child of the marriage of Open Access with e-learning, all broadcasted live by the social media. The idea is relatively simple: make quality education accessible to everyone, anytime for free. In essence this idea has always been there, it’s only that now we have the technology to materialise it, at least to a significant extent. I believe the seed was planted when several top Universities decided to open up and share their curricula with the rest of the world, in several bold “Open Courseware” initiatives.


To read the rest of this article here...

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To floss or not to floss?
by Nikos Mattheos - Friday, 19 August 2016, 11:46 PM

To floss of not to floss..? 
About flossing away the evidence and more...

...In the last few weeks, I've had a few patients asking me what's the purpose of dental floss and if it's all in vain..!

...some few went even further to give me that suspicious "hmmm -really?" look when I recommended interdental brushes...

...and even the most disciplined of my patients have come across the thought that so many kilometres of this tiny white ribbon have been wasted in vain...

So, is it true?Has the world come upside down?  Is flossing useless? 

Well, to strat with, don't rush to flush the floss down the toliet..!   Let's give it a calmer thought! 

 I think what we are caught up with in the case of flossing is not about a medical myth being busted, but rather yet another example of the so called "evidence based Hysteria".

Evidence Based Medicine is a concept developed to free the world of healthcare from individual opinions of all sorts of "experts" , "gurus" and allow decisions to be based on unbiased, objective,  scientific reserach data. Soon however, this noble cause was misinterpreted by some as  the demand  for the highest level of research in order to accept that a procedure is justified. The highest level of evidence is a Randomised Controlled Trial (RCT) , something that requires significant time and costs to be materialised and which in some cases is simply impossible for technical or ethical reasons. Full stop, emphasis on the "impossible".

 In the last few years however, many  "hysteric" calls have surfaced about several medical procedures, implying that unless there is a prospective or  randomised clinilical trial to support it, a procedure  is based on "weak" evidence or is unfounded. 

It is well establisehd that plaque is the cause of periodontal disease and similarly that flossing (or  better "interdental cleaning" of which flossing is one way ) can disturb biofilm and prevent disease. Clinical and in vitro studies provide a good understanding for this. However, we do not have the highest level of evidence to prove it, like a randomised trial. This  is simply not feasible. Such a trial would take many years and would need to involve many people, as periodontal disease is a very slow process. The cost of such as study would be huge!

 If you were a funding agency and you sit on one million dolloars only, where would you chose to spend?
In a study on pediatric cancer or a study about flossing?

Seriously! Furthermore, there is an ethical loophole, as such a  study would require a group of patients to be asked to not clean between their teeth for comparison purposes, something no ethical committee will allow!

The recent "mythbusting" news was not saying that flossing does not work. It simply said that the quality of studies we have to show that flossing works is not of the highest level.

Sure. So what? Is flossing yet another conspiracy of the industry? 

On  this rationale, I can actually say today that the evidence we have that HIV is a sexually transmitted virus is actually even weaker!  And this would be true, because there is no clinical experimental study actually proving that HIV is sexually transmitted and if we want to prove this at the highest level of evidence, we will need to sacrifice a couple of hundred volunteers! So before we go on and blame condoms to a conspiracy theory of the industry, think again!

The truth is that flossing is essential for many patients,
even if we cant bother to prove it at the highest level of evidence.

It is also true that we scientists have great responsibility when embarking on "mythbusting" Cochrane reviews, in order to prevent misinterpretations that actually will cause more public harm than benefit. Maybe it's time to reconsider the purpose of spending time and man/hours on systematic reviews which merely just state the obvious. 

At the end of the day, if the evidence for flossing is weak, is because none of us, Periodontists, bothered to produce it! So if you think a randomised clinical trial about flossing is what we need right now, please, go ahead and do it and show us all the truth. 

The rest, in my humble opinion is just too much trouble for nothing. 



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  • 27 Feb, 20:45
    Nikos Mattheos
    Immediate Implants in the Aesthetic Zone: more...
  • 9 Oct, 02:51
    Nikos Mattheos
    A MOOC for Implant Dentistry? more...
  • 19 Aug, 23:46
    Nikos Mattheos
    To floss or not to floss? more...
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