IS IT STILL POSSIBLE TO RUN CLINICAL RESEARCH IN DENTISTRY?

My personal impression, not evidence-based though, is that is becoming more and more complicated, expensive and bureaucratic to run clinical research all over the world. In dentistry this problem is even more severe since we have to follow medical regulations but we have a ridiculous fraction of the funds that medicine receives and, at least in Italy, dentists are not present in the ethical committees, so basically, in the great majority of the cases nobody really understand what the research problem is about, its potential implications and relevance.
I still believe that we need innovation and that innovation must be proved to be more effective than current therapeutic practices, otherwise we simply do not need innovation. We could call it restyling, but I am not really interested in fashion when I am in need of a dental or a medical treatment.
To perform clinical research a group of experts with specific competence (but not dentists!) has to check that it is ethically conducted and this is understandable. However I wonder why to do this 6 months up to more than one year is needed, in particular when we are dealing with “delicate” matters like comparing abutment A already in the market since years and used by hundreds of dentists in thousands of patients with abutment B, also in the market since years and used by hundreds of dentists in thousands of patients? Or what about placing an implant at crestal level or 1 mm deeper or placing an abutment once and never remove it? All simple dental topics treated with the same strict criteria as you are testing a new heart valve.
The matter can be even more paradoxal if somebody wishes try to run a multicentre trial (the type of trials that actually are needed). Each local committee has the right to deform the protocol according their inclinations making this type of projects unrealistic. I personally believe that clinical research should be stimulated and not obstructed but I feel we are going in the wrong direction. As somebody says “the road to hell is paved by good intentions”. I also think that industry should be stimulated and not stripped off to run clinical research by the same committees to pay for their own existence. The advantages of having clinical research ongoing and not trapped by bureaucratic laces can be understood by the most.
I wish not to start a long list of funny anecdotes happened to me when facing ethical committees since entire issue of this journal would not be sufficient to describe them all, also because similar or even more hilarious stories can be told by the most of colleagues attempting to run clinical research and the problems invests almost any country, however we have a problem and we need a solution.
On the desk of an influent Italian professor I read a wise sentence sounding like this: “who comes with a problem without a solution, is also a cause of the problem”. I am bringing up a problem so now I have to propose a solution.
We need the creation of national ethical committees specifically dedicated to dentistry, accessible to all dentists independently whether they are working in hospitals, universi￾ties or private practices and that the access to the committees has to be free of charge. The process should be simple and fast so that even postgraduate students running their little clinical projects (something that now is literally impossible but years ago was the rule) can have an answer before the completion of their training.
Until this will not happen, clinical research in dentistry will be agonizing, real innovations will be delayed if not stopped and the entire field will be stagnating, which is the current situation.
Please have some thoughts about this and feel free to come with additional suggestions

Happy reading
Marco