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Mungia R, Funkhouser E, Lobbezoo F, Verhoeff MC, Gilbert GH. Practice-based research in dentistry: Exploring methodologies, benefits, and challenges. J Oral Rehabil 2024. [PMID: 39152542 DOI: 10.1111/joor.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/25/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Practice-Based Research Network (PBRN) studies typically assess the effectiveness of clinical interventions in settings that match real-world conditions. Dental PBRNs have the capacity to amass, identify, and analyze vast amounts of data from patient populations that include diverse racial, ethnic, socio-economic, and geographic backgrounds. These dental studies encompass a broad spectrum of healthcare aspects, including prevention, diagnosis, symptom and disease treatment, quality enhancement, and care coordination. METHODS An extensive range of research methodologies can be employed within dental PBRNs to investigate these topics, including randomized controlled trials. Dental PBRNs have evolved from primarily focusing on case observations to leveraging advanced network infrastructure and collaborating across multiple regional and national sites. In addition to producing numerous high-impact peer-reviewed publications, study results have led to improved clinical care. However, PBRNs encounter challenges, such as the sustainability of research capacity (relying heavily on ongoing support from funding agencies), diverse research cultures, and an imperative to design studies that are both feasible and relevant to everyday clinical practice. Recognizing the pivotal role of real-world evidence, it is important to have sustained investment in dental PBRN infrastructure and feasible opportunities for practitioners to participate in network activities nationwide. CONCLUSION Practice-Based Research Network studies capitalize on an important research context within which to investigate a range of clinical topics that can employ multiple research methodologies. However, sustaining productive networks requires strategic effort, ongoing financial support, and customized organizational skills.
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Affiliation(s)
- Rahma Mungia
- Department of Periodontics, School of Dentistry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Merel Charlotte Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, National Network Director, National Dental PBRN, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cunha-Cruz J, Gilbert GH, Allareddy V, Cochran DL, Fellows J, Kopycka-Kedzierawski DT, McBurnie M, Meyerowitz C, Mungia R, Rindal DB, Gordan VV. Characteristics of dentists in the National Dental Practice-Based Research Network. J Dent 2023; 137:104653. [PMID: 37572986 PMCID: PMC10528504 DOI: 10.1016/j.jdent.2023.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures. METHODS Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics. RESULTS Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%). CONCLUSIONS Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients. CLINICAL SIGNIFICANCE Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States
| | - Veerasathpurush Allareddy
- University of Illinois Chicago College of Dentistry, 801 S. Paulina Street, Chicago, Illinois 60612, United States
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Jeffrey Fellows
- Center for Health Research, Kaiser Permanente, 3800N. Interstate Avenue, Portland, OR 97227-1098, United States
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, PO Box 683, Rochester, NY 14620, United States
| | - MaryAnn McBurnie
- Kaiser Permanente Center for Health Research, 3800N. Interstate Avenue, Portland, OR 97114, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester. 601 Elmwood Avenue, Box 686, Rochester, NY 14642, United States.
| | - Rahma Mungia
- Department of Periodontics, The University of Texas Health San Antonio, 8403 Floyd Curl Drive; MC 8258; Suite 300.29, San Antonio, TX 78229, United States
| | - D Brad Rindal
- HealthPartners Institute, HealthPartners Dental Group, 8170 33rd Avenue South | P.O. Box 1524, MS 21112R, Minneapolis MN 55440-1524, United States
| | - Valeria V Gordan
- University of Florida College of Dentistry, Restorative Dental Sciences Department, PO Box 100415, Gainesville FL 32610-0415, United States
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Mocquot C, Vergnes JN, Julien L, Volgenant C, de Soet H, Seux D, Muller-Bolla M, Kopperud SE, Staxrud F, Grosgogeat B, Doméjean S. How French dentists manage defective restorations: Evidence from ReCOL the French dental practice-based research network--A survey study. J Dent 2022; 125:104244. [PMID: 35914571 DOI: 10.1016/j.jdent.2022.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe the knowledge, opinions and practices about the defective restoration (DR) management of French general dental practitioners (GDPs). METHODS A cross-sectional, online survey-based study was carried out amongst 378 GDPs - members of the dental practice-based research network in France (ReCOL). Bivariate comparisons were made using Fisher's exact test to assess the association of the respondent characteristics (age, gender…) with the decision to repair DRs, and responses to clinical cases. RESULTS The response rate was 82.9%. 50.4% of the respondents declared they at least sometimes consider DRs repair in their clinical practice instead of DRs total replacement. For the 89.8% who at least rarely repaired DRs, the main characteristic determining the therapeutic strategy was the defect size (71%, mainly inclined to repair small defects), followed by the defect type (marginal defect or crack for more than 60% of the respondents) and the material of initial restoration (composite for 63.5%). When shown clinical photographs illustrating DRs, most of respondents proposed a replacement with inlay/onlay or crown. CONCLUSIONS This study indicates that a significant proportion of French GDPs do not make sufficient use of DR repair on a routine basis. A lack of knowledge of the concept seems to explain at least part of this situation. Collective and individual efforts from the profession are still needed to promote DR repair and therefore more often apply MinimalIntervention Dentistry. CLINICAL SIGNIFICANCE This survey shows that MID is not yet sufficiently used in routine practice in France regarding DR management. Further efforts (continuing education toward MID, public funding revaluation for MID strategies…) are needed to help GDPs to implement MID into everyday practice.
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Affiliation(s)
- Caroline Mocquot
- Université Lyon 1, Université de Lyon1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne F-69622, France; Université Paris Cité, Faculté dentaire, Hôpital Rothschild, Assistance Publique-Hôpitaux de Paris, France
| | - Jean-Noël Vergnes
- CHU Toulouse, Service d'Odontologie, Toulouse, France; Université Paul Sabatier, UFR d'Odontologie, Toulouse, France; Division of Oral Health and Society, McGill University, Montreal, Quebec, Canada
| | | | - Catherine Volgenant
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Hans de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Dominique Seux
- Université Lyon 1, Université de Lyon1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne F-69622, France
| | - Michèle Muller-Bolla
- UFR d'Odontologie, Service d'Odontologie pédiatrique, Université Côte d'Azur, CHUN, F-06357 Nice, UR4462-URB2i Université de Paris, Montrouge F-92120, France
| | | | - Frode Staxrud
- Nordic Institute of Dental Materials (NIOM), Oslo, Norway
| | - Brigitte Grosgogeat
- Université Lyon 1, Université de Lyon1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne F-69622, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté d'Odontologie, Lyon, France; Hospices civils de Lyon, Service d'Odontologie, Lyon, France
| | - Sophie Doméjean
- CHU Estaing, Service d'Odontologie, Clermont-Ferrand, France; Université Clermont Auvergne, UFR d'Odontologie, Clermont-Ferrand, France; Centre de Recherche en Odontologie Clinique EA 4847, Clermont-Ferrand, France.
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Structure, function, and productivity from the National Dental Practice-Based Research Network. J Clin Transl Sci 2022; 6:e87. [PMID: 35989860 PMCID: PMC9379935 DOI: 10.1017/cts.2022.421] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction:
Following inception in 2005 as a multiregional practice-based research network (PBRN), the “National Dental PBRN” expanded nationwide in 2012, and in 2019 implemented additional organizational changes. The objectives are to: (1) describe the new structure and function of the network; and (2) quantify its scientific productivity since 2005.
Methods:
A national Administrative and Resource Center is based in Alabama; regional and specialty nodes are based in Alabama, Florida, Illinois, Minnesota, Oregon, New York, and Texas. A Network Coordinating Center is based in Oregon. Studies are funded via investigator-initiated grants. Scientific productivity is assessed using specific metrics, including the Relative Citation Ratio.
Results:
To date, 58 studies have been completed or are in data collection or development. These studies have investigated a broad range of topics using a wide variety of study designs. Of the studies that have completed enrollment, 70,665 patients were enrolled, as were 19,827 practitioners (some participated in multiple studies), plus electronic records for 790,493 patients in two data-only studies. To date, these studies have led to 193 peer-reviewed scientific publications in 62 different journals. The mean (1.40) Relative Citation Ratio of Network publications connotes a greater-than-average influence in their fields.
Conclusions:
These metrics demonstrate that the PBRN research context can successfully engage practitioners and patients from diverse settings nationally with a high and sustained level of scientific productivity. This infrastructure has enabled clinical scientists in oral health and nonoral health topics and provided additional recruitment venues outside of the typical academic health center research context.
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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Takata T, Gordan VV, Gilbert GH. Web-based intervention to improve the evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2021; 115:103854. [PMID: 34688779 DOI: 10.1016/j.jdent.2021.103854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine whether: the evidence-practice gap (EPG) in minimal intervention dentistry (MID) can be improved by a tailored web-based intervention, and specific clinical situations might impede implementing MID. METHODS We conducted a before-after intervention study and a qualitative study. Two web-based questionnaire surveys were conducted among 197 Japanese dentists. In the first questionnaire, a baseline EPG was measured using six questionnaire items. Subsequently, feedback material about the EPG was electronically prepared, including results of the first questionnaire, international comparisons with a previous study from the US, and a summary of recent evidence on MID. In the second questionnaire, the EPG was re-measured after participants read the material. The primary outcome was mean overall concordance between published evidence and the dentist's clinical practice for all six questions. During the second questionnaire, we performed qualitative content analysis using free-text responses to a question about difficult situations encountered when conducting MID. RESULTS Regarding before and after comparisons of concordance between the first and second questionnaires, mean overall concordance improved significantly, from 66% to 89% (p<0.001). Qualitative content analysis identified five difficult situations: "cases where decision making for treatment and prognosis is difficult", "inadequate practice resources", "limitations on patient visit and treatment period", "discrepancy between MID and the patient's values", and "limitations on health insurance and social understanding". CONCLUSIONS These results suggest that it is possible to reduce the EPG in MID using a web-based educational intervention among Japanese dentists. Qualitative content analysis revealed five difficult situations that might hinder implementation of MID. CLINICAL SIGNIFICANCE Although this intervention demonstrated educational effects, perfect concordance was not achieved by all participants. This is possibly associated with the five situations that participants reported facing when conducting MID. Creating an environment to improve these situations may facilitate a reduction in the EPG.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan; University of Florida College of Dentistry, P.O. Box 100415, Gainesville, FL 32610-0415, USA.
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Futoshi Sumida
- Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Tomoka Takata
- School of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Valeria V Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Decup F, Dantony E, Chevalier C, David A, Garyga V, Tohmé M, Gueyffier F, Nony P, Maucort-Boulch D, Grosgogeat B. Needs for re-intervention on restored teeth in adults: a practice-based study. Clin Oral Investig 2021; 26:789-801. [PMID: 34302555 DOI: 10.1007/s00784-021-04058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Evaluate the need for re-intervention on dental coronal restorations in adults seen in a network of general dental practitioners (ReCOL). MATERIALS AND METHODS: This observational, cross-sectional, multicenter study involved 40 practitioners and 400 patients. Coronal restoration failures (needing re-intervention for unsatisfactory outcomes) were assessed with a simplified rating scale of seven criteria from the FDI World Dental Federation. The oral health status, the risk factors, and Oral Health Impact Profile-14 were also examined. Previous restoration characteristics (extent, technique, material) were analyzed according to the need for re-intervention (yes/no), the age group, and the risk profile. Qualitative variables were compared between "re-intervention" and "no re-intervention" group using Fisher exact test. RESULTS The need for re-intervention was estimated at 74% (95% CI: 70; 79); it increased with age (49 to 90%), unfavorable risk profile (82 vs. 62%), and extent of the filling (32, 39, 44, and 44% on 1, 2, 3 surfaces, and crowns, respectively). More posterior than anterior teeth were restored (median per patient: 6 vs. 1) or needed re-intervention (median per patient: 1 vs. 0). CONCLUSIONS The needs for re-intervention in adults are still high within a context of ever-changing materials and techniques, simplified and rationalized decision-makings, and demands for patient involvement. CLINICAL RELEVANCE Meeting these needs requires the following: (i) consensus definitions and assessment methods for "failure" and (ii) reliable feedbacks on materials, procedures, and satisfaction. Building large and detailed databases fed by networks of motivated practitioners will help analyzing complex success/failure data by artificial intelligence and guiding treatment and research.
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Affiliation(s)
- Franck Decup
- Service de Médecine Bucco-Dentaire, Hôpital Charles Foix, Assistance Publique - Hôpitaux de Paris, Ivry sur Seine, France
- Université de Paris, UR 2496, Pathologies, Imagerie Et Biothérapie Orofaciales, Montrouge, France
| | - Emmanuelle Dantony
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
| | - Charlène Chevalier
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Laboratoire Des Multimatériaux Et Des Interfaces, UMR CNRS 5615, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - Alexandra David
- Université de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France
- Laboratoire Des Multimatériaux Et Des Interfaces, UMR CNRS 5615, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - Valentin Garyga
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - Marie Tohmé
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France
| | - François Gueyffier
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université Lyon 1, Lyon, France
- Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France
| | - Patrice Nony
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Université Lyon 1, Lyon, France
- Hôpital Cardiologique, Hospices Civils de Lyon, Bron, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie Et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
| | - Brigitte Grosgogeat
- Université de Lyon, Lyon, France.
- Université Lyon 1, Lyon, France.
- Service d'odontologie, Hospices Civils de Lyon, Lyon, France.
- Laboratoire Des Multimatériaux Et Des Interfaces, UMR CNRS 5615, Lyon, France.
- Faculté d'odontologie, 11 rue Guillaume Paradin, 69008, Lyon, France.
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