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Risk Indicators for Gingival Recession with Dr. Lorenzo Tavelli
274 Plays2 months ago
In this episode, Dr. Effie Ioannidou and Dr. Lorenzo Tavelli discuss recent research on risk indicators for gum recession, along with the challenges of residency and the process of involving residents in clinical research. Listen in for a compelling discussion.
Read the full article here. https://aap.onlinelibrary.wiley.com/doi/10.1002/JPER.23-0357
This podcast is produced by the American Academy of Periodontology. To learn more visit perio.org.
The views expressed in this episode are those of the participants and not necessarily those of the AAP.
Music Credit: Groove Nation by OctoSound
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Transcript
Introduction to New Periodontology Resources
00:00:00
Speaker
Whether you're in training, in practice, or in research, the Journal of Periodontology and Clinical Advances in Periodontics have something new for you. Hello everyone,
Meet the Editor and Podcast Host, Dr. Effio Anidou
00:00:12
Speaker
Dr. Effio Anidou and I'm the Editor-in-Chief of the Journal of Periodontology and Clinical Advances in Periodontics.
00:00:20
Speaker
Tune with our team to Probing Period, the podcast that aims to discuss advances and innovation in periodontology and implantology.
Understanding Gingival Recession
00:00:35
Speaker
Hello, everybody. Good to see you again Probing Perio. Today we are here to discuss gingival recession, or as we say in lay terms, the receding gums, right?
00:00:48
Speaker
A condition that happens when the tissues around the tooth pull back and then more tooth is exposed in the mouth and sometimes even the root is exposed. I try to use lay language so even our lay audience can follow up ah with ah with our conversation.
Exploring Clinical Work with Dr. Lorenzo Tavell
00:01:04
Speaker
So hello everybody, I'm Dr. Efio Anidou, I'm the Editor-in-Chief of the Journal of Periodontology and the Clinical Advances in Periodontics. I'm here with you at Probing Perio, the podcast that explores and dives into the clinical and translational work in periodontology and implantology and how grateful we are today to have someone really special joining Probing Perio.
00:01:29
Speaker
But before I forget, if you have enjoyed Probing Perio, please help us by rating the podcast on Apple Podcasts, Spotify, or every anywhere you listen to.
00:01:41
Speaker
And please leave us a review. It will help us continue bridging and bringing ah great episodes and guests. So today we have the great pleasure to have with us an amazing researcher, friend and academician, Dr. lore ah Lorenzo Tavell coming straight from Harvard.
00:02:06
Speaker
Hi, Lorenzo. Welcome to Probing Perio. Hello, hello, Dreschi. Thank you so much for inviting me. and We are going to discuss about this paper that came up on Zay Perio probably, was it almost a year ago, like in May of 24, right? The issue of May 24, and already has a lot of traction. I noticed that it has a lot of traction on social media, a lot of...
00:02:32
Speaker
um ah online views and I thought it was an important ah paper that the community wanted to learn more about the issue and perhaps more about you and the paper so that's why we thought it would be important to have you on this podcast to talk a little bit more about your work Thank you so much they got you for the invitation I'm super happy to have the opportunity to discuss something I love with you in Provinperia Thank you so much Of course, of course, it's a pleasure. But before we dive into the paper, i mean, I know you relatively well, quite well, but um I would like our audience to know you
Dr. Tavell's Journey and Inspirations
00:03:11
Speaker
more. So speak a little bit about yourself, what brought you to periodontology, what brought you to the US.
00:03:18
Speaker
Tell us a little bit about your background and your work. Oh yes, absolutely. So um and I'm originally from Italy, very close to Milan. And I had the pleasure to encounter amazing mentors there when I was doing my dental school in Milan.
00:03:37
Speaker
One of those was Professor Giulio Gasperini. And since I met but Professor Gasperini, I was or basically right away love with periodontology.
00:03:49
Speaker
following his suggestion, but also from a personal point of view, I felt that I wanted to be able to know more about periodontology. I wanted to be able to treat my patients based on the a different level of education, scientific literature, background.
00:04:07
Speaker
So for me, was crystal clear that I had to pursue a specialization in periodontology. And since back then, ita didn't have this option. I decided to explore the opportunity in the United States.
00:04:20
Speaker
And um basically in this manner, I applied to University of Michigan and I did my residency there where I met other two great mentors of mine, Dr. William Genobler, Dr. Homelang Wong, together with other outstanding faculties, clinicians and co-workers.
00:04:37
Speaker
After I did my residency in Michigan, I stayed one additional year as a junior your faculty before moving approximately four years ago ah to Boston, where I'm currently at the Harvard School of Dental Medicine.
00:04:51
Speaker
So this is more or less my background. i just want to add that I've always loved periodontology, but in particular, everything that comes with ah health, of course, but also soft tissue, gum disease, but also gingivariaccession and soft tissue grafting.
00:05:10
Speaker
ah That's that's ah great. Lorenzo, yeah for ah for even the the junior people, the junior faculty or the dental students that listen to this podcast, how was your transition when you moved from there from Italy to Michigan, right?
00:05:29
Speaker
It's a so big leap. So how was this? How did it go? Remember, go back to your first weeks in residency and then share with us what were the the difficulties or, you know, the ah pleasures that you encounter.
00:05:45
Speaker
Yes, ah thank you for this question, which is a very good vague good question that allowed me to say that at the beginning, everything was difficult, like every and we change, every move.
00:05:57
Speaker
um Of course, I moved out from ah my family, my friends, from my comfort zone. And at the beginning, I remember the first weeks, even my comprehension of English was...
00:06:07
Speaker
was okay, but I was not sure if I was understanding 100% when my faculty or my patients were talking to me. But I love in life going through challenges, being placed in a different environment to challenge yourself and ultimately to improve.
00:06:25
Speaker
ah Before then improving as a clinician as a dentist, I'm happy when I can improve as a person. And this is what I encountered at the beginning. Then one suggestion i can give to ah students or to other colleagues that they have to face similar movement or transition is that it is normal to encounter periods like this where you have to adapt.
00:06:48
Speaker
but never lose track, never lose focus on what are your really, yeah about your really, ah the goals that for you are very important. I know that was there for a reason. I know it was there for ah improving as a person, but as a clinician and improving in a way that I wanted to become a periodontist.
00:07:08
Speaker
So even when times were difficult, I had amazing faculties and amazing co-workers that basically were able to support each other. And ultimately, this is what has helped me the most in all of my time as a resident.
00:07:22
Speaker
ah This is very it's ah it's a very encouraging and really a very good advice for people that really transition Either, you know, from dental school to residency or from residency to ah a job or within jobs, right? Because we always make changes in our lives. so ah and And I would add on what you said that people, as they start their careers and they follow these adventures, they really need to realize that life is unpredictable.
Embracing Opportunities in Career Transitions
00:07:51
Speaker
It is so unpredictable because if you go back to your, ah you know, the Lorenzo of 18 years old, would you ever, would you ever guess that you will be spending time of your life in Ann Arbor, Michigan?
00:08:07
Speaker
Right? Absolutely. Absolutely not. But i think this is also the beautiful thing, one of the beautiful things of life that I think you have to be open and ready to embrace new opportunities when they come.
00:08:19
Speaker
Then, of course, it doesn't mean you to say yes to everything, but you have to be open to taking new challenges sometimes. Yes, absolutely true. But you have to end with this saying yes to to life, right? Not to everything, but saying yes to life and embracing the opportunities.
00:08:35
Speaker
Let's talk a little bit about this opportunity. The idea that you had to dive into the Gensival recession, the receding gams. How did you come up with this idea? I know you are, a I know you and I know that you are very much interested in soft tissues. So how did you come up with this idea to examine this hypothesis? And then you will tell us specifically about the hypothesis.
Innovative Research on Gingival Recession
00:08:58
Speaker
But how did this come up to you?
00:09:01
Speaker
um Yes. So it happens that still starting from ah my time when I was the University of Michigan, I had the pleasure to work with a faculty there, Dr. Albert Chan, and also radiologist from the University of Michigan Medical School, Dr. Oliver Pipkans.
00:09:19
Speaker
And these two faculties and mentors of me, they started to bring ah this imaging device, ultrasonography, in the clinic. And they started to apply around teeth, dental implants.
00:09:32
Speaker
And I was involved in a series of literally several clinical studies. So really understood the value of this technology that can allow us to see in a non-invasive way the structures of teeth, dental implants, the blood flow, the dimension of the soft tissue, the phenotype, and much more.
00:09:52
Speaker
Therefore, when um when I moved to Boston ah we with some grants, I was able to apply and to obtain ah the ultrasound imaging device also at the Harvard School of Dental Medicine.
00:10:05
Speaker
And then it happened that ah two residents of all mine came when ah they were probably around the beginning or second year, saying that they were a little bit stuck with the initial thesis project that they had.
00:10:20
Speaker
It was a project that I don't remember well, but due due to the previous period of COVID, they had some ah difficulties. And basically, they asked me if they could work with me ah since they followed a bit of my work and they would like to be guided in some project of clinical research.
00:10:37
Speaker
So based on this and knowing a little bit that I love doing clinical research and I'm doing a lot of clinical research, but it's difficult difficult to start something interventional and finishing in two years.
00:10:50
Speaker
So my idea with the residents for their master thesis was to ah focus on a cross-sectional study to investigate in particular the periodontal phenotype and its correlation with gingiva recession.
00:11:05
Speaker
Because I remember as a resident myself, I studied many articles, epi um amazing epidemiological study with so many patients, very well done.
00:11:15
Speaker
However, they focused on other parameters. It was difficult to know, for example, ah what is the position of the bone, how much baccal bone dehesiveness you have, the thickness of the bone, and in particular, the thickness of the soft tissue, dimension of the papilla, and so on.
00:11:32
Speaker
So we know that it's impossible to conduct a perfect study. But for what we know nowadays, and in line with the 2017 World Workshop that focused on changing and shifting from phenotype to, but sorry, from biotype to phenotype, we know that it's important to to assess parameters like ah the dimension of the bone, baccal bone dehiscence,
00:11:57
Speaker
um gingival thickness, keratinized tissue. So basically we wanted to investigate the influence of these parameters on gingival resection. And our idea was to start to do so with this cross-sectional study where patients later on, and they have been following also longitudinal over time. But this cross-sectional study was actually the initial step to investigate the role of the phenotype on gingival resection.
00:12:27
Speaker
No, this is very interesting. And, you know, as I was ah reading your paper to remember, because there are so many papers that we read through the years, you know, at the editorial aspect of J. Perio, right?
00:12:40
Speaker
So I wanted to refresh my memory and think about your paper more. And I really like the way that you built up your introduction and you... ah ah explain the, first of all, you explain the prevalence of those um ah conditions of the gingival recession and especially how gingival recession affect the aesthetic area, the anterior of the mouth, right? So, and I like the fact that you presented your, ah the the data from the epidemiological studies, as you said, large population studies that unfortunately have the limitations and they do have the limitations because they, you know, examine so many thousands of patients
00:13:17
Speaker
you know The CDC had this capacity to do so, but at the early ages, the early times, they did par partial mouth probing, right? And then even when they extended to full mouth, they didn't have the technology that you are proposing to use to characterize soft tissue. And I really i really enjoyed the fact that you kind of built in the introduction to show exactly why these types of studies like yours are needed now.
00:13:45
Speaker
So this was ah this was really very well done and very well written. I like this. ah But so, Lorenzo, as we move forward now, ah you know our our audience understands how you came up with the idea.
00:13:59
Speaker
But as you did this and you applied the technologies, the CBCT, the scanning, um Was there any unexpected unexpected finding?
00:14:14
Speaker
And first of all, tell us about the major findings. And then was anything that surprised you and you were like, huh, this I didn't expect.
00:14:24
Speaker
Okay, thank you very much for for this question also for your kind comments on the paper and the introduction. and So when we analyze ah with the multivariate analysis, presence of recession, literally just dichotomy, yes or not, we found that basically all the components of the periodontal phenotype were somehow affecting the presence of recessions. So from the keratinous tissue, this can be measured clinically.
00:14:52
Speaker
The dehescence of the baccal bone, this we measure both with the CBCT and also with ultrasonography, further demonstrating that ultrasonography in a non-invasive way can give you the same outcome of the CBCT for this.
00:15:05
Speaker
And here have to open up. again These were all patients that they needed already to take a CBCT for other reasons. They can be maybe for an implant in the posterior.
00:15:16
Speaker
So we didn't take a CBCT for the study. And then also the basically the thickness of the soft tissue and with the scanning, we assess how much a tooth was baccalineal position.
00:15:30
Speaker
And also factor was history of periodontal disease. These in term of recession, the recession was present, yes or not. But also when we assess the magnitude of the recession, how much, for example, is the severity, we still found that the amount of creatinine tissue, history of periodontal disease and the baccal bone dehiscence were the main factor affecting this.
00:15:56
Speaker
um You asked me about unexpected findings. So I was expecting demographic demographic characteristic of the patient, including gender, age ah to affect the either the severity of the recession or the presence of the recession.
00:16:16
Speaker
But we didn't find any correlation or if we didn't find any correlation with the technique of tooth brushing that we try to analyze when we ask patients to show how they were brushing their teeth. And the reason for this can be really just open to speculation.
00:16:31
Speaker
ah Some possibility can be that overall mean age of our population was ah ah close to 51 years old. So maybe other studies showing different demographics, they were moving from patient maybe up to 80 years, 90 years or so, which when you do large studies, that can be absolutely feasible.
00:16:50
Speaker
And also, of course, we were able to have more data from the phenotype, but there are no doubts that our sample size was a little bit limited compared to this classical study as we had 37 patients contributing to almost 270 teeth in the anterior maxilla.
00:17:09
Speaker
And plus is a different different patient population because we included all the patients that they had, they were taking convene CT for other reasons. So maybe it can be a patient that wants to have one implant in the posterior.
00:17:24
Speaker
And we can assume that maybe very young patients do not need often dental implants or maybe patients with more advanced age, maybe they have already several missing teeth we didn't include in the study.
00:17:38
Speaker
So for sure, there could be a different discrepancy compared to other studies for the inclusion criteria. But also, I like to think that it's very important that our study highlighted the importance of the periodontal phenotype, including the soft tissue component and the bone on gingiva reception.
00:17:59
Speaker
And also another very interesting finding that I want to highlight is that other than considering when you have gingival recession, when you don't have when it's RT1 versus RT2, et cetera, et cetera, we also assess dental hypersensitivity in patient reporting aesthetics.
00:18:17
Speaker
So basically, and it's very interesting to to see that the only correlation with dental hypersensitivity was actually not, for example, the depth of the recession, but as a clinician, I thought maybe that would be possible. The more the recession is deeper, the more hypersensitivity you have.
00:18:36
Speaker
But no, actually the only correlation we found is that keratinized tissue width and having attached gingiva width, they were protective factors against dental hypersensitivity, regardless of the presence of recession or not.
00:18:53
Speaker
And also when it comes to patient reported aesthetics, basically, yes, in this case, yes, the only factor are associated with patient reported aesthetic was ah the depth of the mid-facial recession.
00:19:07
Speaker
Yeah, it's ah you know i have to I have to say that you're right. There are so many factors that the one has to think about. and And as you said, that it's surprising that we didn't see any correlation with with the demographics. But at the end of the day,
00:19:26
Speaker
This was the sample that you had. this was ah and but at the end I really like the fact that you did the detailed characterization of the ah yeah you know phenomenon of of recession in the anterior area because you looked at from so many many many different aspects, the aspect of you know the clinical aspect,
00:19:44
Speaker
the aspect of the soft tissue and the bone. So you had the technology to be very detailed as to how these defects were presenting this themselves clinically, but also in ah in the ways that we cannot see with the um a naked eye, right?
00:20:02
Speaker
ah Many times we talk to our patients and we say, oh, we wish we could see under the gums. And now we do see under the gums.
00:20:10
Speaker
Exactly, we have different tools. we We have different tools that give us the ah details. And of course, as you said, as we as I assume that i if you want to expand on this study, what would your next ah steps would be given the yeah the limitations that you just ah discussed?
Future Research Directions and Resident Involvement
00:20:31
Speaker
Yes, absolutely. um I love starting to study a topic as a cross-sectional study because it's where you start to establish initial correlation and everything that we find associated with the condition of interest, in this case, gingiva recession, we can call a risk indicator.
00:20:49
Speaker
But then to actually see how much all of these factors are powerful, how much are they really associated with a condition of interest, ideally you would like to ah study this patient population over time, making this a longitudinal study, which is our plan.
00:21:06
Speaker
Of course, the risk in starting with a relatively small sample size is if you start to lose several of these patients, then you don't have statistical power to reach a meaningful and solid conclusion. But so far, we we're able to follow these patients. So we just have to wait for a little longer time.
00:21:27
Speaker
and and then analyzing the data at think it can be three years, four years or five years. But yes, I always like to study the topic as a cross section and then moving longitudinally.
00:21:40
Speaker
Do you have plans to ah ah follow through with this particular population that you included in this study? Is there any plan to go for more you know forward in, as you said, two, three, four years down the road?
00:21:54
Speaker
Yes, absolutely. We already you have done, as a piece of another resident, the one-year follow-up of this patient because this study was done, I think, was finished in 2023.
00:22:08
Speaker
So we've done the already the one-year follow-up, but I think we have to do probably another one or two rounds of follow-up to have longer data because, as all of my co-workers and statistician friends keep reminding me,
00:22:22
Speaker
the more data point we have longitudinally, the more it's more likely that your models can be accurate and can predict actually what can also happen at later time points. Yeah, so that's good. So then we have a deal now when you are ready with your data analysis and you finalize your manuscript, you bring this again to J. Perriot.
00:22:40
Speaker
This video will seal the deal. Absolutely, absolutely. And this also reminds me that when I was in Michigan, I did a similar study. That's why I decided to do this thesis with the resident here in Boston, because in Michigan, I did a similar cross-sectional study on implant aesthetic complication in the anterior.
00:23:00
Speaker
And this was actually published in 2021 in Journal of Periodontology. And we are finalizing to call back the patient in Michigan for the five-year follow-up of the study. that's great.
00:23:11
Speaker
Yes, I do. I do know this study ah because as I was reading your this paper, ah you referenced the ah clinical protocol that you used in ah from previous studies. So I'm like, oh, what's the previous study? So I went back and I realized that, yes, indeed, you did a very similar um characterization of defects around implants. And this was published, as you said, a few years ago. Yeah, no, I have to complement this work that you do because I think it's really, really important for us to look into the detail of these defects and understand the gingival recession better than we used to
00:23:49
Speaker
um you know, simplify it in the past, right? At least when I was trained 25 years ago, it was like super simplistic. Like everybody was just talking about the brushing technique or, um you know, periodontal therapy, history of surgery, whatever. It was really, really simplistic. It was just the beginning of the biotype concept that now turn to the phenotype more appropriately.
00:24:19
Speaker
But you're absolutely right. And for periodontists that have been around ah for a long time, as but longer than me, I think those conversations are really important because they can even, we can talk about this, they can even shift their understanding and the way they approach Zinzibal recession, right?
00:24:38
Speaker
Yes, absolutely. That are all valid points that we can start to translate also in clinical practice because a lot of time I see patients with recession and maybe before doing orthodontic treatment or maybe because a patient is concerned, I receive a certain patient as an evaluation and one of the parts or that is involved in my evaluation of gingiva recession to understand the possibility of this recession to progress.
00:25:08
Speaker
I would like to see the soft tissue phenotype, how much creatinous tissue I have, how much thickness, where is the bone? And then based on all of these parameters, I can tell the patient, you know, I don't think that here your your gum have a very high risk of progressing.
00:25:24
Speaker
We can just keep a look and see each other once a year or twice a year and let's see how it goes. Versus sometimes maybe they send me a patient before to don't do treatment. And I already see that if maybe there is no gingivari session, maybe just one millimeter, but the bone is so apical and the soft tissue is so thin that you already know that when you change something there, it's very likely that you will have a drop within the soft tissue.
00:25:48
Speaker
So this is what I think we can also take to the results of this study, understanding how the stability of the gingival margin is really affected by all of these components together.
00:26:00
Speaker
And this can also affect our daily practice. Not all recession needs to be treated, and we have to evaluate based on the periodontal phenotype. Yes.
00:26:11
Speaker
Can I ask you something silly and and maybe and but excuse my ignorance on this, but I just wanted to understand when I was reading the study, I know that you were measuring the the thickness of the soft tissue, the gingival tissue in three different distances from the gingival margin at the one millimeter and a half, I think three and five.
00:26:33
Speaker
Why did you pick a millimeter and a half and not one millimeter or two? Yes, thank you very much for this question. I was like, that's interesting. Yes, it's actually not silly. It's a very interesting question. And it starts from the old literature that how gingival thickness was measured in the previous studies when they started I will say this concept arrived later on, but probably around year 2000, 2005. All of these studies, they measure for gingiva recession, the thickness by anesthetizing the patient and using a needle of anesthesia, stabilizing with a silicone tip.
00:27:09
Speaker
Yes. And all of them, or let's say 90, 95% of them, they basically pick this measurement 1.5 millimeter below the soft tissue. Okay.
00:27:20
Speaker
And therefore we want to do measurements that can also be a little bit correlated with previous literature. It will not be wrong to do one, two, three, four, five. It will not be wrong, but we want also to have results that can be compared with existing literature. too that Okay, that makes sense. ah ah paper we have a paper in Journal of Periodontology with my friend Cheyenne Barucci Forstotter, published in 2020. It's a systematic review of metanases of gingival phenotype, where we assess all of the papers talking about this topic, and basically we conclude that...
00:27:56
Speaker
and the majority of the paper assessing gingival thickness use these methods and the report usually just 1.5 mm below the soft tissue margin, sometimes even 3 below the soft tissue margin.
00:28:09
Speaker
So we want it to be consistent with the literature. That's good. Yeah, because I mean, I'm i'm happy that I asked you this question because I was like, that's interesting. You know, I bet that that ah if I want to guess,
00:28:23
Speaker
Was this 1.5 started in ah Europe, maybe in Italy? I would have actually to to go back and check in that paper that I mentioned in review, which is the oldest paper that assessed this 1.5.
00:28:36
Speaker
Yes, yeah but probably, I would assume... Yeah. Yes. um No, that's great. That's great. I love it. So as, you know, I was looking at the list of the authors and I, again, my imagination, I thought that maybe one or two yeah are residents that, that and and I know that you mentioned already that you ah collaborate and you motivate residents to work with you in the clinical research projects.
00:29:07
Speaker
So tell us a little bit about how does this work? How does this collaboration work? And how, what do you think about the participation of residents in research projects within the residency program?
00:29:21
Speaker
Yeah, absolutely. Thank you very much for this presentation. question that allow me to expand a little bit on that and what I believe. ah Personally, I love doing clinical research, but one of the reasons I love doing clinical research is because when I was arrested at University of Michigan, my faculty and my mentor, they trust me to conduct and to actually lead some research project.
00:29:46
Speaker
And based on that, I found my passion and i since then I'm in love with clinical research. So whenever it's possible, i like to do the same with the residents that would like to work with me.
00:29:58
Speaker
Then it depends ah because at the end you always have to be very fair in terms of authorship. But if some residents for some project that maybe are not overly complex because you also have to consider that maybe some of these residents is their first experience in doing clinical research.
00:30:15
Speaker
But when it's feasible and they lead, the they maybe together we establish a protocol, they lead all the patient recruitment, they are with me with patients, they collect the data, and when they put so much effort, I'm just very happy to involve them more and more, even with the writing of the manuscript. Even you can see here that the two first authors, the first and the second authors, are both ah ah previous residents, Dr. Mascardo and Dr. Tomac, and we also put a note that they equally contributed to the the article. So I think it's actually something that
00:30:53
Speaker
is not absolutely a gift. They worked very hard on that. They enjoyed this experience a lot. And for me, i have to say that compared to when I published a paper Stott or Lastot or so, when I see that my residents put so much effort and they receive this award, this personal satisfaction and see their master thesis, accepting journal per odontology, for me means much more than when I do a paper alone.
00:31:20
Speaker
So I think it's one of the amazing opportunities to work with residents. And this is the ethic of a ah good educator, right? the the they To see your mentees shine, I think is... that biggest pleasure in life and satisfaction, right?
00:31:40
Speaker
um So do you think a lot of residents would, the and and and I have to put a parenthesis here and recognize the fact that you have been a program director for quite some time. So do you so do you you have the ah expertise to speak about this? And also you have, you know, the limitations and the the the the these the struggles of the the what the residents go through and how many things have to be satisfied before ah they ah move into doing actually successful clinical research. But do you think it's something that the every program does?
00:32:21
Speaker
should the pursue. And, you know, most of the clinical, most of our residences are clinical residents, right? ah Residences. So a lot of residents come into this yeah game and they think that, you know,
00:32:37
Speaker
at the end of their program, they will graduate, they will go to practice, therefore, who needs this? ah So what what do you think about this? What's the answer? How can we inspire?
00:32:50
Speaker
What's the argument to this to bring residents into clinical research? Oh, absolutely. So that's a very good question. And it happens often that for for many reasons, many residents, they say, OK, I'm here, I want to do this three years, I want to learn, but then I want to go to pra practice. So I think it's very useful as a strategy to engage these residents.
00:33:16
Speaker
for doing their thesis in clinical research. So it's something in that they don't see too far away from their practice. I'm not asking them to work in the lab, which I still love translational research and basic research, but you have to try to find a thesis that also fit the ah fits the the particular resident.
00:33:35
Speaker
So if a resident is focused on finishing the program and going to practice, I feel doing a cross-sectional study on a clinical question of relevance. Here is gingival recession.
00:33:46
Speaker
In the past, I did implant aesthetic complications. can be peri-implantitis, it can be a particular type, it can be a periodontal disease. There are so many topics that clinicians have to face and to deal with every single day in practice.
00:34:00
Speaker
So doing the clinical research in this topic helps you to better understand which are the factors that from a clinical point of view, you have to control on your patients, which are the factors that maybe we can find and discover novel correlation, can be systemically, can be clinically, can be related to the phenotype, can be related to the patient.
00:34:19
Speaker
So I like to involve them in this way, even when they seem to be focused only on the clinic. As long as you engage them in a topic that very relevant clinically and with the goal of finding and new correlation, new answer, I think in this way, ah by choosing this type of topic with the resident, by making the resident ah really in charge of many aspects of the research, I think this could be a very good way to promote more clinical research.
00:34:53
Speaker
Also, I feel that doing cross-sectional study is relatively feasible and with the timing of residency, because if you start saying, I want a randomized clinical trial, I feel that probably residency, we don't have enough time.
00:35:13
Speaker
But when you start this with a resident, a future resident can actually do the long-term follow-up and make this study longitudinal. This is my suggestion to make something feasible, but also good from a scientific point of view and something that at the end, even these residents go in prior practice, they will look back and say, I really enjoy be doing this clinical project that, uh, uh,
00:35:36
Speaker
for me it was something that I'm proud that I did. You see a nice project that you did with your mentors and other residents that is published in Journal of Periodontology. And I know that some of these residents, they maybe printed a copy of the journal and put it there in the office. So you have to make them feel responsible and proud of what they do.
00:35:56
Speaker
I think everything that you you just brought up are very important points. But I would say one more thing. i would say that, you know, ah having the residents engaged in a in ah ah creative activity like this, I think, number one, they they remain curious.
00:36:17
Speaker
and they they they learn how to, they shape this kind of scientific way of thinking, right? They say become ah they they start questioning everything. They become skepticists. They they want to see evidence for everything. They think the right way, if you will. And then when they discover how much work is behind every ah any of these papers that are published at the Journal of Periodontology or any other journal,
00:36:46
Speaker
Then when later on in their life as practitioners, when this journal comes to the office and they open it, they know that all these people work really, really, really hard to put these manuscripts together. So it's, as you said, it's the respect and the the the pride.
00:37:05
Speaker
for what they achieved. So yeah, it's well done. i'm i'm really I'm really excited and I really want always to point out any involvement of graduate students and residents in those publications at that journal.
00:37:18
Speaker
um And I think it's important for the residents to be acknowledged and it's important for the residents to see their names. As you said, they print out at the first page and they many times they carry with them to their offices and they frame it.
00:37:31
Speaker
Residents are proud of this. Absolutely, i agree with everything you said and that's I think is the direction we should try to to go in the future to make them more involved with clinical research.
00:37:43
Speaker
In my office now, and you know here at the the University of California in San Francisco, I still have ah the framed the first page of the classic law and sickness paper, right?
00:37:57
Speaker
ah with Harold Law signed it on my name because Harold used to be the Dean of the University Connecticut, the School of Dental Medicine. And when I started residency, he was still a professor emeritus there and we were chatting and having very nice conversation and interview. And so I, you know, I, he, so he signed my, the, the ah paper for me and he misspelled my name.
00:38:26
Speaker
Darn it.
00:38:29
Speaker
but But nevertheless, I think that going back to what you said, I think that it's important for the residents and I think it's a lot of pride and and and and ah good memories to be involved in projects like this.
00:38:42
Speaker
So, and with this happy note, anything that you would like to add more regarding the paper, ah you regarding, you know, the report,
00:38:54
Speaker
you know, the philosophy of residency programs, any advice for practitioners or residents. I think you're in a position to speak on both. um any Anything that you would like to add?
Ultrasonography: The Future of Dental Research
00:39:07
Speaker
and There will be so much to add but I would like to focus on the value that I've been finding in the last eight years in clinical research, the value of ultrasound and ultrasonography.
00:39:18
Speaker
That is ah an amazing tool, non-invasive, that has been used in the medical field for 30 years or more. And I'm sure it's just a matter of time before you will arrive in a more easier way for every clinician also in dentistry.
00:39:34
Speaker
Right now is basically mostly for clinical research, but the potential ultrasound has to show us all the structure around teeth and dental implants, but also for oral pathology, also the TMJ, if we think, ah including also the possibility of detecting health versus disease.
00:39:53
Speaker
blood flow vascularization, tissue elasticity. I think we will see um a lot of coming in from this topic in the close future. Now, I cannot predict if it will be two years, five years or 50, 100 years, but sooner or later, ultrasonography will be there forever. That's a ah good closing, actually. I really like this. and i really yeah I like that when people think forward, right? What about the utilizing those tools that exist in many different other directions? So,
00:40:23
Speaker
Lorenzo, thank you so much for making the time. Thank you for making the time on a Monday morning to record with us. And um and it was ah it's a pleasure. It has always been a pleasure to talk to you.
00:40:36
Speaker
um And i'm I'm really happy that we have this paper at the ah Journal of Periodontology. And definitely looking forward to your next, the follow-up paper.
00:40:48
Speaker
and With this, Effie, thank you so much for inviting me. It has been an amazing pleasure every time that I talk to you, but in particular, I'm talking about ah this article. Thank you so much for your consideration regarding our paper and clinical research.
00:41:03
Speaker
Of course. And for our audience, if you like this episode, please share the episode with any friend that you have. Subscribe to the podcast to get the latest episodes wherever you're listening. You can also rate us, write a review and follow us on social media. Thank you, everybody. Thank you. Thank you, Lorenzo.
00:41:21
Speaker
Thank you so much.