Learning from Failure
Bernard Touati, DDS, MS
In the professional literature, clinical dentistry perpetually demonstrates the success of restorative therapy or patient rehabilitation. In these journals and reference books, implants are fully integrated, composite restorations have enhanced marginal integrity, and aesthetic treatment is harmonious with the adjacent natural tissues and dentition. These presentations can be impressive, and the authors responsible for these successes should be commended for their ability to accomplish daunting restorative goals and patient objectives. Nevertheless, clinicians are aware that restorative efforts often result in a degree of failure. Since a 0% risk (or 100% success) does not exist in medicine, why are such cases generally unrepresented in the scientific literature?
In a clinical environment, failure occurs due to a variety of factors. Restorative materials fracture upon loading or fatigue, tissues may be damaged by iatrogenic influences, and inaccurate placement procedures may violate fundamental biological principles. Failure may also be attributed to the selection of a treatment option that is not fully appropriate as the clinician attempts to reduce procedural complications or minimize tissue reduction (ie, mutilation). Although the clinician may properly address each of these concerns and render a successful treatment, its presentation can be compromised by improper lighting or photographic techniques that fail to document the efficacy of the approach. While treatment is not often a complete failure, less-than-optimal results do occur routinely as dental professionals are forced to contend with various limitations (eg, time, technical proficiency, material properties, patient compliance, and finances) that complicate the delivery of quality healthcare.
The documentation of this clinical experience in the literature can provide valuable information for colleagues who can evaluate the materials and methodology responsible for the result. In a profession characterized by experimentation and innovation, such analysis allows clinicians to avoid similar complications, to learn from these results, and to expand the existing restorative armamentarium. The Japanese philosopher Rikyu states "Fight your shame, forget your pride, and learn everything you can from others. This is the foundation of a well-accomplished life." Although the dental literature is a forum that promotes the collective education of clinicians throughout the world, it could be improved as a resource if less-than-optimal presentations were submitted by contributors along with the solutions to overcome the difficulties encountered.
In the medical and dental professions, every treatment has the potential to fail. In Eastern thought, failure does not have the negative connotation that it does in the West, and it is acknowledged as an admissible result that can be utilized to frame future endeavors. In order to expand the technical proficiency of clinicians and the efficacy of the restorative materials themselves, it is critical for such results to receive increased emphasis in dental journals, conferences, and universities. Once clinicians have accepted the role of failure in the collective educational experience, the provision of improved healthcare will finally become a reality.
*Editor-in-cheif, Practical Procedures & Aesthetic Dentistry; private practice, Paris, France