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supervision conceivably could cause great harm to the public, which would constitute a breech of professional ethics. The codes of conduct and ethics for both medicine and dentistry call on health profes­ sionals to use their skills, knowledge and abilities to benefit patients (beneficence). The codes also require profes­ sionals to “do no harm ” (non­ maleficence). Ethicists typically declare th a t when there is a conflict between beneficence and non-maleficence, the latter takes precedence. ADHA take note. In your reach for self-regulation, you have not demonstrated bene­ ficence: lower cost, improved access. You have instead under­ mined dentistry’s greatest contribution to patient care: the ability of the general practi­ tioners to provide continuous care to their patients. By wedging your ambition between patients and dentists, you jeopardize a unique relationship. You also risk creating detrimental, even lifethreatening situations. In a self-regulated, unsupervised dental hygiene practice, you alone would decide if your patient should be referred to a dentist. That decision neces­ sarily involves diagnosis, a process reserved only for those who have been trained and licensed as dentists. Are you capable of making a diagnosis? You say YES. “I ’m saying that, yes, that [patient referral] in fact involves diagnosis, and that dental hygiene, as a licensed profes­ sion, is responsible and accountable.” —Virginia Woodward, ADHA president April 6 ADA News

Dental educators would say NO. Contrary to statem ents often made by hygienists seeking self-regulation, dental hygiene students do not receive the same clinical training as dental students. They do not take the same basic science curriculum. They are not trained to handle emergency procedures or diagnose oral cancer. They are not trained to prescribe drugs and so on. To attem pt diagnosis without appropriate training must be classified as maleficence. Is organized hygiene so deter­ mined to sever its long relationship with organized dentistry th a t it would compro­ mise the health and well-being of the American people? Let the clear thinkers prevail. ■

LETTERS ADA welcomes letters from member dentists on topics of current interest in dentistry. JADA reserves the right to edit all communications and re­ quires th a t all letters be typed, double-spaced and signed. The views expressed are those of the letter w riter and do not neces­ sarily reflect the opinion or official policy of the Association. Brevity is appreciated. D E N T A L C A D /C A M

It was very distressing for me to read, “Dental CAD/CAM Systems: W hat is the State of the Art?” by Dr. Dianne Rekow (December). As the creator of the dental CAD/CAM in general JADA, Vol. 123, June 1992


and especially of the CAD/CAM of Sopha Bioconcept, I must tell you th a t much of the information in the article is simply not true. I am writing now to correct some of the misinfor­ mation. I never said th at the accuracy of the Sopha CAD/CAM was 200 microns. In fact, after two years of intensive studies a t USC it has been determined th a t the accuracy ranges from 0 to 35 microns at the margin. The machine does not need a trained technician to operate it. Actually only a few hours training is all th a t is needed, and it can easily be mastered by an auxiliary. If the operator elects, the entire restoration can be automatically designed by the machine in ju st three minutes by pushing a single button. This design includes an occlusal surface which not only incorporates proper mor­ phology, but is in perfect occlu­ sion with the opposing dentition. It is also widely known th a t the Sopha CAD/CAM can be used with several materials, including titanium . Many of the unique features of the machine and its response to individual needs were not mentioned. For example, the operator has a choice of occlusal philosophies built into the software. Even the clearance left for cement is operator adjustable. Every design function can either be used in automatic mode, or can be easily overridden by the operator. Perhaps, the most glaring oversight was the fact th a t Dr. Rekow did not inform her 12

JADA, Vol. 123, June 1992

readers th a t she was the main creator of the DentiCAD system. I have always had the highest regard for JADA and know that articles are carefully monitored. I also know th a t the guidelines for authors clearly state th a t any “financial, economic, or professional interests th a t may influence positions presented in the paper be truthfully disclosed.” I was very disappointed th a t an article which did not comply with your rules and which contained so many obvious errors was published. The JADA has always been my favorite scientific and dental journal. I hope th at you will exert stronger control in the future and continue to hold the respect th a t your fine publica­ tion has earned over the years. Francois Duret Los A ngeles A uthor’s response: Dr. Duret surely m ust be com­ mended for his work in dental CAD/CAM and as the creator of the Sopha Bioconcept system. I am perplexed th a t there may have been any m isunderstanding or misrepresentation of his or any other dental CAD/CAM system. A few points need to be clarified. Concerning fit at the margins, the information th at I used was extracted from Dr. D uret’s presentation at the International Conference on Computers in Clinical Dentistry held in Houston in September 1991. Unless I misunderstood his presentation, he stated th at the data acquisition system of his system has an accuracy of

20 to 30 microns in x and y, and 40 to 50 microns in z. It is rare th a t average values for margin fit will be below the accuracy of the data used for their design. The crown fit at the margin was given as 70 to 500 microns. The mean m arginal fit for crowns produced in 1991 was given as 200 microns with a standard deviation of 40 to 80 microns. It would be most helpful if Dr. Duret were to publish more information concerning this issue. Statem ents relating to long design times and the need for a highly trained user, made in the article, were apparently in error. However, in all of the presentations th a t I have seen concerning this system, I have never seen it operating in an automated mode. Instead, the demonstrations have shown the user interpreting and marking the margins—then designing the restoration interactively, requiring the long design times reported in the article. I am excited th a t the automated version is also available, reducing design times to three to five minutes as well as making the technology easier to use. The intent of the article was to be an educational overview of a number of systems th at are rapidly emerging. So much is happening and the technology used in some of the systems is so complex, I thought such an overview would be of value for clinicians. This would provide them with basic information about the emerging systems and, hopefully, provide some groundwork. They could then ask more questions and make


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