Interview with Dr Michael Miller, REALITY Publishing Co.
REALITY is a US-based consensus report on dental products and techniques that aims to protect patients by informing dentists. In their headquarters in Houston, TX, the company behind it, REALITY Publishing Co., is constantly testing products and techniques using clinically relevant methods under laboratory conditions. An Editorial Team (ET), comprised of leading clinicians from around the world, also uses the products in their clinics and practices. Dental Tribune editor Claudia Salwiczek spoke with Co-Founder Dr Michael Miller about the rating system and what dentists should consider when choosing a product.
Claudia Salwiczek: Dr Miller, how did you get started with REALITY?
Dr Michael Miller: After graduating from dental school, I did a general practice hospital residency, which aroused my curiosity with research. Even though I decided to go into private practice instead of pursuing an academic career, I never lost that urge to participate in the scientific world in some way. About seven years after starting my practice, I decided I was guessing too much about patient care, and especially how to select and use all the new tooth-coloured materials that were just beginning to explode in the marketplace.
It was my contention that dentistry needed a publication that was a non-commercial product and technique guide. Since none existed, I asked another dentist here in Houston if he would like to help me get this publication off the ground. Our first book came out in October 1986 and I’ve been at it ever since.
Some clinicians criticise the REALITY star system as being a commercial process that only supports the marketing of the manufacturers. How do you react to such statements?
Nothing could be farther from the truth. When a manufacturer submits a product, it has absolutely no control over the evaluation process. This is the reason some manufacturers do not submit products—they are wary about what we are going to find. In addition, since there is no fee involved for manufacturers when they submit products, we have no reason to try to please them. While we don’t believe in trashing products unprofessionally, we have warned our readers numerous times about products that don’t live up to their marketing propaganda. Any clinician that believes we are merely a marketing arm for manufacturers has never asked a manufacturer if it’s true.
How exactly does the product rating process work?
Products are listed on a password-protected section of our site for ET Members’ eyes-only. We then ask the ET members to select products that they are interested in evaluating. At least ten members must volunteer
to evaluate a consumable-type product such as a composite or adhesive for it to qualify for a complete evaluation. For more expensive equipment, the minimum is five. The manufacturers of these products are then invited to submit the product. If they agree, we provide them with the list of evaluators who have volunteered to evaluate the product.
Once the evaluators receive the product, they have 90 days to use it clinically and/or perform tests of their choosing if they are privy to a testing lab. During this 90-day period, we perform our own tests on the product in the REALITY Research Lab (RRL), a specialised testing facility we created over ten years ago. At the end of the 90 days, each evaluator completes a form that I write concerning the product and sends it to me via E-mail. I then compile the results from all the evaluators, check the results from the RRL, and write the final report. The actual numerical score and star rating for each product is largely the average of the evaluators’ scores modified by any exemplary or poor results in the RRL although clinical results are always considered at a higher level than those from the lab.
Which facilities are available in the REALITY research Lab?
We have many pieces of equipment you would find in other research labs around the world, including an Instron for testing bond strength of adhesives and other materials, a digital hardness tester for measuring depth of cure, a thermocycler to age materials rapidly, a temperature/humidity chamber to test products in a mouth-like environment, a spectrophotometer to analyse the translucency/opacity of materials, a custom-made black light box to check the fluorescence of materials, and much more.
However, the real difference between our lab and others is the way we perform tests. Our methods have all been designed to simulate the clinical condition as closely as possible, which is the primary reason our results can be radically different compared to those claimed by manufacturers. For example, our depth of cure tests are done in real, human teeth. These tests show that the claims of composite and curing light manufacturers are greatly exaggerated. If any clinician follows a manufacturer’s advice in this area, there is a great probability that the restoration will be undercured.
Aside from checking the REALITY website, what clues should clinicians look for when choosing the right product?
It’s definitely a minefield out there, with clinicians and patients the ones to suffer when manufacturers overhype their products. But the old adage definitely applies—if it sounds too good to be true, it probably is. Reading the scientific research can also be helpful, but pretty boring and possibly outdated when it finally hits print. Listening to lectures from speakers who are honest about their commercial alliances is valuable, assuming the audience can separate the real information from the propaganda. And online chat groups can venture opinions on clinical factors such as whether a composite has nice handling characteristics, but can also be misleading if research is quoted incorrectly.
From your experience, what are the recent trends in cosmetic dentistry in US? What expectations do you have for the future?
Anything digital should be considered as the main trend. From CAD/CAM to digital impressioning, this is definitely the future. But the same caveats apply here than in traditional products. Don’t be on the bleeding edge or you can find yourself with some very expensive white elephants. Another real trend is non-invasive dentistry including innovative ways to diagnose caries at incipient stages and treat it without invading teeth.
Are you familiar with the market in Asia and if so, how does it compare to the US market?
I have lectured in Japan and Thailand, but I am not an expert in how dentistry differs between the two regions. My gut feeling, however, is that there is more dentistry in the US focused on pure cosmetics compared to Asia.
How would you grade the quality of work done by Asian professionals?
I have seen some absolutely beautiful dentistry come from the offices of Asian clinicians. Definitely on par with the US and Europe.
Do you have any suggestions for our young readers who have an interest in incorporating cosmetic dentistry into their practice?
First, it takes a lot of study. You cannot attend a weekend seminar and learn the nuances of really fine cosmetic dentistry. Read as much as possible, attend numerous and varied seminars, and watch as many masters as possible. Then start with easy cases and progress to more demanding ones.
Thank you very much for this interview!
Editorial note: This interview first appeared in Cosmetic Dentistry 4/2008.