Abstract
To the Editor:
In his recent editorial (Mjör, 2008), Ivar Mjör extolled the virtues of practice-based research, but seemed to suggest that practice-based settings may not be conducive to the conduct of randomized clinical trials (RCTs). His point depends on the perception of a RCT as done to demonstrate efficacy in a very controlled environment by one or two highly trained and calibrated expert clinicians who are able to devote extraordinary time and attention to it. However, there is no reason why RCTs cannot be used in a practice-based setting to demonstrate effectiveness (the outcome in practice). One would focus on the intervention as used in practice, with simple clinical outcomes. Variations of participating dentists in background and skill would be present, but are part of the background noise. If the outcome is not significantly greater than the background noise, then it won’t have any impact on practice.
An example is an upcoming RCT in NW PRECEDENT in which we will compare mineral trioxide aggregate (MTA) and calcium hydroxide as pulp-capping materials in member practices. Each dentist will be randomized to use only one of the two for all pulp caps needed over a specified period. Outcomes after two years will be whether the treated tooth required endodontic treatment or extraction, or if it remains vital. This addresses the kind of “identified” and ”recurring” clinical problem Dr. Mjör suggests should be pursued in dental practice-based research networks, but does so with a RCT design that should produce the highest-quality evidence of effectiveness.
Footnotes
Co-Directors, Northwest PRECEDENT Dental Practice Based Research Network