NL Journal of Dentistry and Oral Sciences
(ISSN: 3049-1053)

The editors have prepared another issue of the magazine, containing, as usual, interesting articles. It is customary to precede each subsequent issue of the journal with general considerations to which the Members of the Editorial Board are invited. This time, this honour was entrusted to us.

The goal of our considerations is a contextual analysis of the state of modern dentistry. A few years ago, in what is probably the most prestigious medical journal, “The Lancet”, one could read a two-part series of scientific articles, prepared by an international team of eminent scientists led by Prof. Marco Peres from Duke-NUS Medical School in Singapore, concerning the need for radical changes in the future development of world dentistry. In general, they stated that it is necessary to focus almost entirely on prevention, preventing dental diseases, which must result in nearly complete abandonment of the development of all forms of interventional dentistry, starting with endodontics and ending with dental implant prosthetics. Forgetting about random situations, such as accidents damaging teeth with aesthetic aspects affecting the well-being of the patient, including psychophysical, even went so far in their reasoning as to suggest the necessity of abandoning the education of personnel in these areas, from higher education to the conferral of degrees and other scientific dignities related to these clinical and research areas. Among the proposals presented, there were also suggestions to liquidate dental faculties and even specialised universities in some countries that educate in these areas. We tried to argue against these radical views. Still, the editors of The Lancet did not consider it appropriate to publish this polemic, thereby preventing what is most valuable in science: discussion and the mature exchange of arguments.

From where else have we known for years the even more shocking summing up the meaning of dentists’ work as “Drill and fill and bill” uttered by Prof. Mikako Hayashi from Osaka University in Japan during the Conference “Dentistry in the 21st Century: Challenges of a Globalising World”, with the comment that too many governments and dentists persist with this expensive and destructive regime. It is difficult to agree with the suggestion that dentists forget their obligations under the Hippocratic Oath, which is clearly contradicted by the commitment and daily patient care of hundreds of thousands of dentists worldwide. We have dedicated two extensive studies, published in 2 books, to the issue of ethics in dentistry.

At the base of our current considerations are several concepts that allow us to view the problem from several sides, just as we do with any object, where we easily define three dimensions (although, in the abstract, it is easy to imagine an n-dimensional space). Another, usually the fourth dimension, is time.

After all, the basis of all analyses is the truth and the pursuit of its determination. It is, among other things, the fundamental task facing every scientist, the purpose of diagnosis and medical action, and, more generally, all activities characteristic of every decent person. There is no doubt, therefore, that truth is an important practical issue, although it is a significant philosophical problem. Aristotle, a student and collaborator of Plato and Socrates, as late as the fourth century BCE, classically defined truth as “the conformity of judgments with the actual state of affairs to which this judgment relates” in his “Metaphysics”, adding that “to say that it exists about something that does not exist is false”, as well as his other significant sentence “we do not know the truth without knowing the cause”. It is a critical thought, because it is necessary to clearly indicate the causes of many phenomena that result in the observed changes.

The contribution of René Descartes at the turn of the sixteenth and seventeenth centuries is essential, who, starting from the assumption that the basis of knowledge is doubt, formulated the thought “Dubito ergo sum” (Latin: “I doubt, therefore I am”), so it is necessary to think and a detailed intellectual analysis to formulate the undoubted foundations of knowledge, which ultimately led to the most famous generalisation in the wording of “Cogito ergo sum” (Latin: “I think, therefore I am”) and therefore to the formulation of truth as specific knowledge. At the turn of the nineteenth and twentieth centuries, Mark Twain, called “the father of American literature” by another writer, William Faulkner, wrote that “if you tell the truth, you don’t have to remember anything” because the information on a given matter repeated will have the same sound every time. I will quote another controversial sentence of Aristotle, that “the truth lies in the middle, and maybe that is why it gets in the way of everyone”. However, the late Polish Minister of Foreign Affairs, Prof. Władysław Bartoszewski, stated that “the truth lies where it lies”, so not necessarily in the middle and cannot interfere, because it simply exists. It also means that there can be no compromises in reaching the truth or in proclaiming it, because there is only one truth. It is what we want to discuss in relation to dentistry in these brief considerations.

Most likely, all readers are familiar with Salvador Dali’s famous painting from 1931 entitled “The Persistence of Memory”, which depicts “leaking clocks” symbolising the passage of time and the memory inherently associated with it. The essence of the matter concerns the time that passes, the energy required to sustain the joy of life, and the implementation of all processes. Time has occupied philosophers’ attention since Antiquity. In Greece, it was analysed whether time is linear or cyclical, and whether it is infinite or finite. Plato believed that the time created by the Creator, together with the heavens, is the period of motion of the celestial bodies. Aristotle noticed the correlation of time with the motion of celestial bodies, whose orbital movements allow people to determine time. St. Augustine considers time to be a “stretch” of the mind, which simultaneously comprehends the past in memory, the present in attention, and the future in expectation.

Isaac Newton recognised absolute space and absolute time, while Gottfried Wilhelm Leibniz believed the opposite, that time and space are relational. René Descartes, John Locke, and David Hume recognised that the prerequisite for understanding time is its prior recognition by the mind. Immanuel Kant considered time to be a fundamental part of the abstract conceptual framework, along with space and number, defining it as the purest possible scheme of a concept or category. Stephen Hawking thought that space and imaginary time were finite, although they had no boundaries. Imaginary time is neither real nor unreal, but difficult to imagine. It can be agreed that physical time exists outside the human mind and is objective, and psychological time is mind-dependent and subjective. There are also quite different ideas of time, which I will not mention here. The notion of time, historically closely related to space, merging into space-time in Albert Einstein’s special and general theories of relativity, depends on the spatial frame of reference of the observer, and human perception, as well as measurement, differ for observers in relative motion. However, causality remains unchanged, as the past is the set of events that can send light signals to an individual, and the future is the set of events to which an entity can send light signals. Einstein showed that the temporal and spatial dimensions can be altered by motion at high speed. In these theories and in the Standard Model of particle physics, time is not quantised, although it is believed that the Planck time (~ 5.4 × 10−44 seconds) is the smallest possible. Anyway, the timing is fascinating. After all, each of us has a watch and often looks at it, being aware of the passage of time, regardless of the results of the analysis presented here. Tempus fugit (from Latin, time runs).

Returning to the main thread of this analysis, it can be stated that the conclusions of Prof. Marco Peres’ team, and even more so the view cited by Prof. Mikako Hayashi, do not correspond to the truth. In addition, Prof. Marco Peres’ group did not account for the passage of time. If we assume (which, after all, is completely unrealistic) that there is not a single patient in the world with teeth damaged by caries, their approach could turn out to be acceptable, although most likely only until the first tooth damaged by caries appears. There is undeniable material evidence for this. The examined teeth, which came from a man found in a glacier crevice in the Dolomites of Veneto, near Belluno, Italy, and dated to the late upper palaeolithic around 14,000 years ago, were damaged by decay and showed traces of intervention with flint tools. There is evidence that prosthetic interventions were also performed in ancient Egypt, Greece and Rome. We have written about it many times. Therefore, even then, there were no conditions for such radical actions as Prof. Marco Peres’ team calls for. Even then, pain, tooth cavities and numerous resulting inconveniences required intervention. The scale of the problem has greatly intensified over time, yet the authors of the team’s work, Prof. Marco Peres, seem to forget this. Currently, it is estimated that 3-5 billion people worldwide are affected by tooth decay, and about 1 billion are affected by toothlessness. The country of which we are citizens is unfortunately among the six countries most affected by caries in the world. It should be remembered that about 500 systemic diseases have their origins in dental diseases. The treatment of heart attacks, strokes and many other diseases requires considerable financial outlays, among others, for the maintenance of intensive care centres and the pension benefit system, which could be partially avoided if the problems related to dental diseases, such as the primary cause of the deterioration of the general health of these patients, were controlled.

Therefore, it requires developed endodontic and implant-prosthetic therapy. The consequence of such an approach is the development of education, scientific research, and clinical work in this area. It is evident that the development of these branches of dentistry is a civilisational necessity, and the theses advocating abandoning interest in these issues indicate an irrational and unacceptable approach.

It also seems reasonable to analyse the scope of dental treatment through the prism of the treatment of congenital and acquired dental deficits resulting from malformations, abnormal tooth growth, abnormal milk teeth, and other diseases. At the same time, it is also necessary to devote attention to all trauma dentistry, which reproduces damage and kills as a result of traffic accidents, as a result of sports and other traumatic acts, in which even children as young as a few years old quite commonly lose both deciduous and permanent teeth. These circumstances are the basis for very complex complications that lead to premature tooth loss over time and the need to rebuild them with the use of prosthetics and implant prosthetics. Finally, we must not forget that, in developed societies, the average life expectancy has almost doubled in a very short time, and the evolution of the entire stomatognathic apparatus seems not quite to keep up with this remarkable progress. For this reason, modern dentistry must support also the aging process of these patients and Them counteract to maintain well-being of increasingly older patients simultaneously taking care to maintain the correct occlusal plane guaranteeing maintaining the proper relationship bones in the temporomandibular joint and, most importantly, enabling properfood, which is in fact the most essential function of this entire apparatus, while ensuring the aesthetic appearance of the whole face so necessary for well-being regardless of age.

Therefore, since we have demonstrably shown that in the name of objective truth, it is necessary for the dental community to be actively interested in the issues of reconstructive dentistry related to implant prosthetic restorations, which is in the vital health interest of billions of patients around the world, it remains to point out the methodology of treatment and design and production of implants and prosthetic restorations, including crowns and prosthetic bridges. Material design remains an open problem. It turns out that using toxic materials for this purpose is unacceptable and therefore endangers patients’ health. Hence, both implants and prosthetic restorations made of nickel-containing alloys, including corrosion-resistant steels of the Fe-Cr-Ni type 18-8, which is still used in many countries around the world for these purposes, as well as cobalt-containing alloys, including the commonly used Co-Cr-Mo-W-Si alloys of the Vitalium type, are currently unacceptable. For economic reasons and because of their low functional and technological properties, there is less interest in the use of Au and Pd alloys. A real alternative is titanium alloys approved for medical use, including TiAl6V4, as well as other titanium alloys, e.g., those containing Nb. However, the use of these alloys requires, especially for prosthetic restorations, a system of thin layers to prevent the diffusion of titanium into the porcelain facing layers. The use of metal alloys with even lower density is also an opportunity. The processes of manufacturing prosthetic restorations require exact diagnostics using cone beam computed tomography, subsequent individual modelling of the patient’s bone and soft tissues, and the design of the entire implant-prosthetic system using computer-aided CAD methods. For ecological reasons, to minimise the consumption of materials and energy, as well as to ensure the most excellent durability of the restorations used, it is necessary to produce by the additive method, preferably selective laser sintering SLS with full use of the computer-aided manufacturing CAM methodology. Computer-assisted methods also include a detailed design of the method of implant and prosthetic restoration installation, ensuring the position and parallelism, as well as the depth of the holes prepared for implant attachment in the patient’s mouth, along with appropriate templates that eliminate geometric installation errors. It is complemented by an implant-scaffold of the original design, containing either superficial protrusions or superficial porous zones, respectively, enabling the ingrowth of the patient’s natural osteoblasts and ensuring high mechanical properties of the implant prepared in this way with the patient’s bone, properties unattainable by other methods. The use of implant-scaffolds allows for immediate installation after tooth removal, without drilling holes in the bone, by inserting them into the socket in place of the removed tooth using a proprietary device during the same procedure, after individually designing an implant-scaffold with geometric features corresponding to this tooth. Thanks to diagnostics using CBCT tomography, it is possible to electronically remotely send the results of this examination performed by the dentist to even a geographically distant prosthetic restoration production center, where all CAD/CAM activities will be performed, and the finished restorations with a detailed treatment plan (installation) and the necessary templates will be sent to the dentist who conducts the treatment in the place where the patient is staying. The centre is therefore a technology hub.

The presented solution has won numerous medals and several major awards at the International Fair of Innovation and Invention in many countries around the world, including Canada, Brazil, China, and Taiwan.

The presented information indicates one similarity with the ideas of Prof. Marco Peres’ team. Well, changes in the approach to dentistry are indispensable. And this is the only similarity to his views. All the others are opposite. These changes cannot consist of abandoning interventional dentistry; instead, they require its intensive development. The Dentistry Sustainable Development model we have presented for years includes prevention, interventional dentistry, Dentistry 4.0/5.0, which is adequate to the current Industry Integrated Idea 4.0/5.0, as presented by us worldwide many times, and the Dental Safety System. It requires not the liquidation of dental faculties and universities, but the introduction of material and technological issues into the curriculum of studies at these universities, not so that doctors can perform these complex engineering design and technological activities, but so that they can and are able to set requirements for the dental engineers cooperating with them consciously. The basic principle of the Hippocratic oath “Primum non nocere (Latin: First of all, do not harm”) requires extensive knowledge, so as not to be deceived by the cheap tricks of various dishonest suppliers of various novelties, which are accepted by many dentists in the world, just because they get lost in engineering issues that are related to the essence and quality of technical devices, which they have to apply every day to patients whose well-being is most dear to their hearts.

As we address this message to the readers of this issue of the journal, we hope that the thoughts contained in this Editorial and the message resulting from it will influence a critical approach to the quality of their daily work in the service of patients, and that the articles contained in this issue will bring them interesting, helpful information in this mission.