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Prosthetics in Dentistry

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Readersround table

Los To THE
EDITOR:

ANGELES,

CALIF

It is indeed hard to part with cherished illusions. It is especially true when one has spent his life strengthening, supplementing, and defending them; deriding holders of opposing views. The clinical investigative work of Drs. Brewer, Reibel, and Nassif (J. PROS. DENT. 17: 28-35, 1967) has begun some reappraisal of views in our group, and will someday, I feel, be viewed as a milestone in prosthodontics. We feel a debt of gratitude to Dr. Brewer and his associates. It was most interesting and revealing to note the different conclusions drawn by the authors and the editor, The authors, when confronted by overwhelming evidence of ( 1) lack of superior performance of anatomical teeth, and (2) superior performance of monoplane teeth, concluded that porcelain flat teeth, set on a flat plane, without employing time-consuming articulator techniques, were indicated. The editor, on the other hand, made the observation that this experiment proved that patient acceptance was unreliable in appraising dentures. It is very difficult to understand Dr. Bouchers position at this moment. I, for one, would appreciate his further comments in this regard. ROBERT G. VIG. D.D.S.
COLUMBUS, OHIO

I am pleased to make further comments regarding the article by Drs. Brewer, Reibel, and Nassif, at the request of Dr. Vig. He referred specifically to my comments in the Through the Eyes of the Editor section (J. PROS. DENT. 17: 1-2, 1967). He implied prejudice on my part in making my comments, Nothing could be further from the truth. However, we must recognize some facts. The article reported a blind study with as many of the variables excluded as was possible. The honesty of the reported results is not questioned. The only places where the article could be questioned were in the type of observations that were made, and in the conclusions drawn by the authors. Certainly, the observations were subjective, by patients who were not trained observers. In all research effort, objective observations are more reliable than subjective observations. The subjects involved in this research must not have been very discerning, or they would have noticed the difference between the two sets of teeth when they washed them. This lack seems to cast doubt on the reliability of their subjective observations. When the authors conclude, . . . we have been doing many things that are unnecessary, on the basis of the subjective observations made by their subjects, they are assuming more than I think they should from their evidence. Many denture patients are treated with dentures that do not fit as well as they should, and that have errors in occlusion. Most of these patients get along with these poorly made dentures. This situation occurs most frequently with younger patients, and usually with first dentures. It should be noted that the oldest subject in this study was 49 years old. Would the same results be found in subjects from 50 to 70 years of age, after having worn dentures for 20 to 40 years? Perhaps the study should be extended. I have no difficulty in parting with cherished illusions. I have only a desire to find the best answers, and will be the first to discard unsound techniques when adequate evidence shows them to be unsound. Patient acceptance does not seem to me to be adequate evidence.
CARL 0. BOUCHER, D.D.S. EDITOR

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