Percentage of Case Longevity is the Measure of Excellence.

Precision Quality for Longevity is the ONWARD credo.  Living by this credo has resulted in a high percentage of cases that have lasted in the mouth for decades.  Considering that dentistry must be made to withstand forces under water and bathed in bacteria 24 hours a day, this achievement is no small feat.  I always felt that if I didn’t get at least 10 years out of a case I considered it a failure.  The philosophy and techniques of ONWARD have a proven track record that cannot be ignored.  As Dr. Branemark proclaims, “Clinical requirements based on clinical documentation established during half a century must be respected”.  I strongly believe that the ONWARD “credo” is the gold standard by which any new procedure MUST be measured.

America was born out of a tradition of quality precision for longevity.  The Harwood Building, which housed the office that my dad and I occupied (separately and together) for 67 years, was built in 1921.  It is 5 stories of solid brick and quality construction and there is no doubt that that building will be around for centuries to come.  How unlike the modern prefab particle-board buildings popping up everywhere! A century from now these buildings will most likely disappear from the landscape. The artisans who built the Harwood Building incorporated their artwork into the structure and the building looks like a cross between a Swiss chalet and a castle—complete with turrets and a bell tower.

Inside the office, quality wallpaper and furniture lasted in great condition for more than 50 years. The treatment rooms were equipped with solid metal Ritter chairs and units that lasted despite heavy usage for more than 40 years! My Dad and I both used the same high quality Kavo handpieces for more than 20 years. The laboratory equipment in our in-office lab was also of solid construction.  Handler lathes in the laboratory spanned the careers of both my father and I—over 70 years—and there was no sign that they would EVER break down!  Obviously, the equipment we used was made to the highest standard of quality with the most durable materials (metal).

During the course of my career, I have seen society’s credo slip from precision quality for longevity to a credo of planned obsolescence through shoddy construction with inferior materials.  The new chairs and units that  I work with today are made of tin and plastic; and they are extremely expensive.  One would be lucky to get ten years out of this equipment! Unlike the Ritter chairs, which had a separate, adjustable headrest designed to maximally support the head and neck, the new units have a headrest that is a simple extension of the chair.  The headrest does not adequately support the patient’s head and neck and it is extremely difficult to adjust—especially for patients with neck and back issues.  Is this progress?

I remember receiving a catalogue of dental instruments and equipment from 1901 (which I donated to the New York State Dental Association).  That catalogue listed dental chairs that were built of solid metal and were truly designed as works of art.  The manufacturers of that era obviously took great pride in what they created for their markets.  Interestingly, that catalogue listed all the burs, Gates-Glidden Drills and Peeso Reamers numbered just the same as they are today.  Who knew that root canal procedures were being done in that era when local anesthesia had just been discovered and was not commonplace?

But sadly, the mindset that now plagues the dental profession emphasizes profits and shortcuts, rather than precision quality for longevity.  A new generation of dentists has been raised to believe that patients should replace their dentistry every few years just like a car, a kitchen appliance or dental equipment.  They believe that hi-tech Dentistry is faster and better without any evidence whatsoever.  A mindset of precision quality for longevity is considered passé and “old fashioned.”  The patients are mesmerized by the fancy technology and they think they are exceptionally lucky because they are getting “Star Trek Dentistry.”

Nothing could be further from the truth!  What they are actually getting is restorative coverings that violate the basic principles that allowed my father and I to have spectacular success.   Often the hi-tech restorations are made from materials that are inferior. Most “hi-tech” protocols could never duplicate what my dad’s teacher did!  And worst of all—most “hi-tech” dentistry is likely to require replacement within a few years for reasons that are outlined in the ONWARD program.  “No matter,” many practitioners think, “the planned obsolescence will bring more business and greater income.”

These practitioners consider me to be a dinosaur and a luddite because I do not share their viewpoint.  I wear those badges proudly because I have the evidence that what I’m doing is right.   But I am not a dinosaur—I watch for all the new innovations and weigh them carefully against the principles that I believe in.  And I am certainly not a luddite!  I can do anything with a computer, and I’ve taken computers apart.  I am quite adept in using Access, Excel, Powerpoint, Word, Quickbooks, Photoshop, Video software, Advertising Software, Learning Management Software,  Membership Platform software, and Dental Practice Management Software—to name a few.  I’ve even done some programming…

It is the outcome of technology that is most important, not the “coolness” of the technology.  Dentists are only responsible for the ultimate outcome of the course of treatment, and not the means by which they arrived at that outcome. The new “hi-tech” dentistry for full coverage restorations does NOT have a proven track record.  Seminars and magazine articles show beautiful, finished cases on the day of insertion but they rarely show finished X-Rays and almost NEVER show follow-up X-Rays 5, 15, 20, 30 or 40 years later.  The cases are almost always done on young individuals with perfect gingiva where almost anything will work for a time. What about patients with periodontal bone loss who have diabetes, cancer, or heart disease?  Seventy years of ONWARD cases demonstrate the principles required to compensate for periodontal bone loss.  A successful outcome can clearly be seen in the follow-up X-Rays:  Minimal changes in the bone over decades. My father and I have documented thousands of cases and some are veritable miracles!  This is the REAL evidence-based dentistry.

Unfortunately, I have had the unpleasant experience of “Evidence-Based Dentistry” experts point the finger at me and demand that I show statistical proof.  Well, there are no such studies.  I have more than enough data that I could do a statistical analysis on the cases seen by my father and I during the last 70 years.  But I am a clinician, not an academician.  If I devote all my time to statistical analysis of the thousands of cases done during this period I will have little time for anything else.  I want to focus on helping others to achieve the success that my father and I have enjoyed in full coverage restorative Dentistry.

The sheer volume and quality of cases shown in the ONWARD courses should serve as proof that the cases are not “anecdotes.”  The same pattern repeats time and time again—and anyone who is looking can see this CLEARLY.  No one can convince me that after 45 years of following ONWARD precepts that I am wrong in my assessments and observations.  There is NO doubt in my mind whatsoever that dentists who follow the tenets of the ONWARD program will enjoy the same percentages of success that my father and I enjoyed.

Relying on literature studies that are “Evidence-Based” to make decisions is actually false security.   Christina Sarich, of Waking Times, says in her essay “Six Reasons why most Scientific Research is Fake, False or Fraudulent,” that “science is broken, and most scientific research is fraudulent.” [http://www.wakingtimes.com/2016/04/21/6-reasons-why-most-scientific-research-is-fake/]  “Odds are its wrong,” says Tom Siegfried in his Science News magazine article with this title. “The way  studies in the literature are conducted is “science’s dirtiest secret.” Statistical tests are supposed to guide scientists in judging whether an experimental result reflects a real effect or some random fluke.  Instead,  standard methods mix inconsistent philosophies and offer no meaningful basis for drawing conclusions. Says Tom, “Even when performed correctly, statistical tests are widely misunderstood and frequently misinterpreted.”  [Science News, March 27th, 2010; Vol.177 #7]

Here are a few reasons why dental research often falls short:

1. Replication Crisis: More and more studies simply cannot be replicated, so false theories are never thrown out.  They are left floating as acceptable ‘fact’ when they are nothing more than studies paid for and promoted by the companies who have a vested interest in proving a financially remunerating hypothesis.

2. Statistical manipulation of Data: Many studies do not include enough clinical subjects and the longevity of the study is inadequate to draw valid conclusions.  Data can also be excluded, included, and re-arranged to support the presupposition of any scientist.”  Statistical analysis can always be employed to come up supporting the desired conclusions.

3. The Scientific Community doesn’t listen to those whose ideas go against the current scientific dogma (like the ONWARD program).

4. Fame and Money kill objectivity. “Industry-funded studies completely ignore conflict of interest and skew any possible hope for truthful, unbiased scientific study.”

5. Social pandering: “We’ve made scientists Gods while ignoring that they are people with greed, lust for power, and other very human traits”, explains Christina Sarich. [http://www.wakingtimes.com/2016/04/21/6-reasons-why-most-scientific-research-is-fake/]

 I’m a reviewer for the Journal of Implantology and I can tell you that most of the submissions I am asked to review are flawed.  There’s always an ulterior motive as to why the study was done in the first place.  Many of the studies are coming from Europe because students there must be published in order to get their doctorates.  These studies never have enough subjects or enough time to properly evaluate the data and draw conclusions.  The only good articles seem to be retrospective articles that survey the literature in an attempt to draw conclusions.

Would mathematical data wean dentists away from a planned obsolescence mindset to a mindset of precision quality for longevity?  I doubt it.  Only the open-minded can be receptive to the idea of precision quality for longevity.  Arguing with the closed minded is like dividing by zero.  The famous motivational speaker Zig Ziglar once said that “If you are not willing to learn, no one can help you…If you are determined to learn, no one can stop you.”

Become the best practitioner in full coverage restorative dentistry that you can be!  Don’t settle!  Join the ONWARD program and learn how to do crown and bridgework with excellence and confidence, how to save “hopeless” teeth, and how to provide new options for patient treatment that you never thought of.  Visit the website and join here:  https://theonwardprogram.com/membership/

Dr. Feinberg is also available to give presentations.  His CV and speaker packet is posted on the website.  (https://theonwardprogram.com/about-dr-feinberg/)  Dr. Feinberg can be reached at info@theONWARDprogram.com.