The International Journal of Oral & Maxillofacial Implants 175

Personal preference is an inherent component inthe fabric of human life. From early childhood

through adult years, each individual develops a pat-tern of likes and dislikes which is unique to that per-son. This trait is revealed in attitudes, interests, andchoices involving, for example, foods, clothing styles,automobiles, and personal friends. As one’s person-ality and intellect develop, there is an inclination oftemperament or outlook to focus on certain objectsor points of view with a certain prepossession thatdoes not allow the individual to respond impartiallywhen the former are challenged. The result is abiased mindset.

Appended to the closing text of Michael Crichton’srecent novel State of Fear is an author’s message inwhich Crichton outlines certain conclusions he hasdrawn from his rather extensive review of the litera-ture on the environment. He wrote

I believe people are well intentioned. But I havegreat respect for the corrosive influence ofbias, systemic distortion of thought, the powerof rationalization, the guises of self-interest,and the inevitability of unintended conse-quences.

Akin to these observations is the recent trend of(perhaps unintended but nevertheless misguided)indirect, biased bashing of the early pioneers ofosseointegration and their conservative concept of aprolonged period of healing following implantplacement.

Osseointegrated implants are not placed; en-dosseous implants are placed and become osseo-integrated under optimal conditions. With theadvent of treated and roughened implant surfacesand the subsequent development of early healingand stability following implant placement, appar-ently the importance of all prior laboratory and sci-entific investigation has diminished. Even thoughthe introduction of osseointegration was recognizedas a quantum leap from the prior era of humanexperimentation with questionable implant materi-als and designs, proponents of various systems have

belittled this obvious progress by repeated, out-of-context comparisons of the new surface types tomachined surfaces in reports of relatively short-termcase series.

While the early work with endosseous implants ismeaningful as a baseline experience to which futureprogress in implant design and material can be com-pared, it is also important to be mindful of the clini-cal condition the early machined implants weredesigned to rectify, namely the edentulous man-dible. For this situation, a 2-staged surgical proce-dure was proposed and has been successfullyapplied for nearly a quarter of a century.

Bias can often be seen in product research anddevelopment, regardless of support source. The rushto meet commercial competition and patientdemand to lessen treatment time without incon-venience has further de-emphasized the need forscientific research into what is being manufacturedand placed in human mouths. Certainly immediate1-stage surgical and restorative procedures for situa-tions where indicated are appropriate, and tech-nique refinements will come with time if successfuloutcomes can be achieved over the long term. Thisdoes not mean that “one size fits all” or that 1-stageprocedures are preferred for all patients in whomimmediate implant placement is indicated, regard-less of system type.

Bias has no place in scientific design and execu-tion, the reporting of results, or appropriate—and incontext—analysis of the scientific literature. The pleahere is for an early return to fundamentally soundresearch design, appropriate statistical testing, hon-est reporting of results, and the statement of conclu-sions based only on the pertinent data emanatingfrom the investigation. The field of implant dentistryand the patients we treat will be better served by areturn to the unfettered basics.

William R. Laney, DMD, MSEditorial Chairman

A Concern for Bias

E D I T O R I A L

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