Rethinking research

In a traditionalist sense, one might consider research to be a solitary, microscopic endeavor. A scientist sits in a lab, examining slides or observing chemical reactions. It may seem lonely, unconnected from the larger world and everyday health care.

And yet, this view is reductionistic. At the School of Dentistry, we promote research that impacts care. Every method of scientific discovery, from basic science to public health, seeks to improve lives and shape the way we deliver patient care.

Preclinical and clinical research spans across divisions and specialties, using real-world scenarios to gain insight into behavior, health and more. Researchers in the biomaterials, biomechanics and technology cluster collaborate with industry partners to develop and test dental materials and devices in simulated clinical environments. Meanwhile, members of the clinical and translational research cluster test new methods and products to enhance the prevention, diagnosis and treatment of oral diseases for the patients they serve. Meet the researchers who are embracing these methods of scientific discovery.

Building better biomaterials

The Minnesota Dental Research Center for Biomaterials and Biomechanics (MDRCBB) is a multi-disciplinary resource dedicated to furthering research and development in biomaterials, biomechanics and related sciences. With more than 30 years of collaborations and discovery at the School of Dentistry, the MDRCBB has embraced laboratory and clinical study and testing of dental materials.

Whether through the MDRCBB or researchers’ own labs, the actual and simulated clinical testing of biomaterials has real and lasting impacts on patients’ lives.

“The use of dental materials to restore damaged and replace missing teeth is probably the most common form of dental treatment,” said Alex Fok, PhD, MSc, director of the MDRCBB and professor and director of the Division discovery that advances care and treatment of Biomaterials. “The durability of these materials under the biomechanical challenges in the oral cavity determines the longevity of dental restorations. Laboratory testing under simulated conditions can provide early indications of the clinical performance of new dental products, but clinical studies represent the gold standard for assessing the durability of dental materials in a real-world scenario.”

Partnerships that ignite change

With the ultimate aim of impacting patients and dentists, the testing of dental biomaterials and devices is the core of a decades-long partnership with industry partners, including Solventum, formerly 3M Healthcare.

The School of Dentistry collaborates with industry partners for preclinical research—primarily using technologies like ART, an artificial chewing machine, through the MDRCBB— and clinical research—including trials with patients in restorative dentistry, orthodontics and dental hygiene.

Pre-clinical research allows manufacturers to prescreen new products to the market in a cost-effective manner. “Before any dental material can be used in the mouth, it must first undergo rigorous laboratory testing to ensure that the materials meet specific performance specifications,” explained clinical operations manager at Solventum. “Manufacturers need to know that the materials we are using perform well with regards to strength and durability. Collaborations with Dr. Fok’s team and their ability to conduct specialized independent testing provide evidence and results that can inform any gaps, as well as confirm and validate our own previous findings.”

Clinical testing further allows manufacturers and industry partners to feel confident in the adoption of their products by dental professionals. “It is not enough for a product to be strong and durable,” Lenton explained. “Dental professionals want products that are easy to work with, that provide good results and that are safe.”

For Lenton and her team, the partnership with the School of Dentistry and the ability to provide evidence-based answers is paramount.

“We live in an age where health care professionals are ethically responsible for basing their treatment decisions on evidence-based research, and patients trust their health and wellbeing to providers,” she said. “Well-designed research serves in the development of dental materials, as well as in substantiating their efficacy. Having the School of Dentistry here in our backyard provides for a relationship that is beneficial to industry, academia and, ultimately, to the patients on whom our products are used.”

Making materials more successful

Hooi Pin Chew, BDS, FDSRCS, PhD, associate professor of operative dentistry, examines caries around restoration sites, “one of the main modes of failure for posterior composites.” She is conducting a clinical trial using Optical Coherence Tomography (OCT) to “detect and characterize marginal defects of composite restorations,” hoping to determine whether interfacial gaps and marginal cracks are responsible for caries.

Additionally, “Incongruencies are often observed between the findings of in vitro and in vivo studies on the efficacy of remineralizing materials in reducing the rate of demineralization, or preventing it,” she explained. “One reason for this is that there are no clinical evaluation techniques that are non-invasive and sensitive enough to small changes like those in a laboratory setting,” she explained. Chew hopes that her work with OCT to measure demineralization will help translate laboratory predictions Patricia Lenton, into real-world data.

Collaboration for better outcomes

Jorge Perdigão, DMD, MS, PhD, professor of operative dentistry, has dedicated himself to clinical research on dental adhesives, composite resins, ceramics, pit and fissure sealants, glass-ionomers and dental bleaching since the beginning of his career. Today, Perdigão’s lab is studying two commercial dental adhesives manufactured by 3M, to determine their effectiveness for restoring molars and premolars.

Perdigão’s clinical research has led to 25 publications, numerous presentations and the successful creation of commercial dental products used worldwide. “Our clinical research has impacted day-to-day clinical work,” he explained. “Our teams were the first to report that enamel etching improved the 5-year retention of restorations performed with the new universal adhesives, which challenged some of the recommendations for use from respective manufacturers.”

Clinical research is important to Perdigão because he and his team are what stands between the launch of new materials—not clinically tested before they are approved by the FDA—and their use in private practice. “Being the first clinical researchers to test the new materials is quite a motivation,” he explained. “We are able to have a real impact on the work of our colleagues in private practice, who benefit from our studies that provide clinical outcomes they can relate to their work. Most importantly, we can apply these outcomes in our own clinical teaching.”

Enhancing patient care

In addition to research on dental materials, researchers across the School of Dentistry embrace clinical studies involving real-life patients to improve every aspect of patient care—from streamlining processes to improving quality of life. These studies span across specialties, including comprehensive care, dental hygiene, operative dentistry, orthodontics and more, and seek to change the ways in which care is delivered and disease is treated.

Improving children’s dental experiences

Robert Jones, DDS, PhD, professor of pediatric dentistry and primary investigator in the Biofilms, Apatite and Microbiomes Lab, spends his time developing strategies to reduce biofilm coverage and the effects of sucrose exposure. As a research mentor, he oversees residents who explore the improvement of oral health in children—from caries prevention and pulpal biology to the holistic patient experience in the clinic. His lab’s discoveries have led to the use of weighted blankets and a new combination of sedation medications to improve children’s experiences during invasive procedures, and a collaboration with Mike John, PhD, DMD, MPH, associate professor of oral medicine, diagnosis and radiology, on how patient interventions can impact oral health quality of life.

Digital technology for better orthodontic treatment

Thorsten Gruenheid, DDS, Dr. med. dent., PhD, MHA, associate professor of orthodontics and Assistant Dean for Advanced Education, embraces clinical research to improve orthodontic treatment. His studies include the use of digital technology to enhance care—through methods like intraoral scanning, digital models, cone-beam computed tomography and treatment simulation—and studies of new orthodontic materials and appliances, both in the lab and in real-world settings. Clinical studies are important because “ultimately, I want to improve patient care,” he explained. “Findings from clinical research often lead to better diagnostic methods and treatment protocols.”

Whether it is the development of a digital workflow for nasoalveolar molding devices—an orthopedic treatment that improves outcomes leading up to the first lip repair surgery for children with cleft lip and palate—that avoids the additional time and cost of repeated impressions and allows for more incremental changes, or the use of computer-aided design and manufacturing, Gruenheid’s mission is clear.

“I hope that my research can help make patient care better, safer, cheaper and less burdensome for everyone involved,” he explained. “From an academic standpoint, clinical research advances dental science and helps expand our understanding of oral health, diseases and treatment mechanisms. From a patient care standpoint, it leads to more effective treatments, improving outcomes and experiences. As a clinician, this is very close to my heart.”

Practice-informed research

Gary Hildebrandt, DDS, MS, clinical professor and director of the Division of Operative Dentistry, has always tried to “live in both worlds, the worlds of academics and clinical practice, in order to communicate intelligently with individuals in both areas and crossfertilize endeavors in each sphere.”

Hildebrandt’s area of study is dental caries, particularly the role diet plays in rampant caries. As a result of clinical observations, he has studied the impact of caffeinated soft drinks and taste perception on the disease, among other factors. He allows what he discovers in clinical practice to guide his research questions.

“My clinical practice has allowed me to develop teaching materials that are practical and organized, and provided me with a level of credibility in the eyes of other faculty and students,” he explained. “My research allowed me to investigate the patterns and connections I saw in practice and helped me to develop hypotheses while treating patients with real world dental conditions.”

Mission-driven exploration

Whether they test the durability and safety of materials in a synthetic setting, or experiment with new modes of treatment in the dental chair, researchers at the School of Dentistry share a common goal: making the experience of individuals who seek out care and treatment better. Inspired by the mission of the School of Dentistry and driven by their own passion for discovery, these researchers are making a difference in academia, in industry and in clinical care.

This story initially appeared in the 2024 edition of Dentistry Magazine.