In any field of endeavour, not only in medicine and surgery but also in other activities such as economics, tourism, manufacturing, and art, research plays a pivotal role in progress and adaptation to a changing environment. Explosive advances in molecular biology have revolutionised basic approaches in biomedical research, while exciting advances in the laboratory have given clinical researchers unparalleled opportunities for research.
Clinical research may be divided into basic clinical research (such as experimental or animal studies) and patient-oriented research. Other forms of clinical research include clinical trials, epidemiological surveys, and clinical observations. However, the clinical research process itself, contrary to popular belief, does not begin with discoveries made at the laboratory bench that then go directly to the bedside; rather, it consists of a cycle. Clinical observations, whether made through retrospective analyses or prospective controlled studies, or even those arrived at by pure chance through single case reports, serve to identify a research question whose answer is important for clinical practice. This research question is taken as the basis for designing a study (e.g., a laboratory experiment, an animal study, or a clinical trial involving humans) that is specifically geared to provide the answer. Once the answer is convincingly demonstrated, another set of clinical trials is conducted before the new finding (e.g., a new form of therapy) is integrated into routine clinical use. However, clinical research remains difficult because of ethical constraints, and controlled studies may be difficult to conduct for various reasons. Importantly, the protection of human participants (and animals) is integral to research, and this Journal, like others, adheres strictly to universally accepted guidelines in requiring that humans or animal studies be approved by an institutional review board or research ethics committee before acceptance for publication.
Research in oral and maxillofacial surgery follows the same approaches used in surgical research in general, and from time to time, certain topics seem to permeate through many journals almost simultaneously, indicating a current interest. One of this issue's research articles shows that the combination of platelet-rich plasma (PRP) with cyclooxygenase-2 inhibitor is capable of stimulating bone marrow cell proliferation.1 This study is an example of experimental research that has been inspired by the clinically observed usefulness of autologous platelet-derived enhancement of bone grafting.2-4 Recent issues of other journals show examples of experiments aimed at elucidating additional features5-8 and additional applications9-11 of PRP. In this way, the cycle of observation and experimental study continues until the results are integrated into clinical practice. There is, however, a major gap between reported clinical use or usefulness of a specific treatment method and its true indications. Sometimes in surgery, a treatment method is promoted and applied too widely before its final place in practice is found. One example is total temporomandibular joint replacement by alloplastic prostheses.
Therefore, it is important to recognise that any part of the research process is an important contribution to progress, and that all research output should be encouraged, as long as there is an opportunity for true perspective to be acquired and brought to bear on the clinical situation. As clinicians, our duty is to minimise our patients' exposure to risk beyond what is considered justifiable in relation to the expected benefit from treatment.
Nabil Samman
Editor-in-Chief
Asian Journal of Oral and Maxillofacial Surgery
References
1. Chikazu D, Ohba S, Ogasawara T, Saijo H, Mori Y, Tomizuka K, Kawaguchi H, Yonehara Y, Susami T, Takato T. Combination of platelet-rich plasma and cyclooxygenase-2 inhibitor potently stimulates bone marrow stromal cell proliferation in vitro. Asian J Oral Maxillofac Surg 2005;17:81-87.
2. Tayapongsak P, O'Brien DA, Monteiro CB, Arceo-Diaz LY. Autologous fibrin adhesive in mandibular reconstruction with particulate cancellous bone and marrow. J Oral Maxillofac Surg 1994;52:161-165.
3. Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications inoral and maxillofacial surgery. J Oral Maxillofac Surg1997;55:1294-1299.
4. Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:638-646.
5. Kanno T, Takabashi T, Tsujisawa T, Ariyoshi W, Nisbibara T. Platelet-rich plasma enhances human osteoblast-like cell proliferation and differentiation. J Oral Maxillofac Surg 2005;63:362-369.
6. Tsay RC, Vo J, Burke A, Eisig SB, Lu HH, Landesberg R. Differential growth factor retention by platelet-rich plasma composites. J Oral Maxillofac Surg 2005;63:521-528.
7. Landesberg R, Burke A, Pinsky D, Katz R, Vo J, Eisig SB, Lu HH. Activation of platelet-rich plasma using thrombin receptor agonist peptide. J Oral Maxillofac Surg 2005;63:529-535.
8. Choi BH, Zhu SJ, Kim BY, Huh JY, Lee SH, Jung JH. Effect of platelet-rich plasma (PRP) concentration on the viability and proliferation of alveolar bone cells: an in vitro study. Int J Oral Maxillofac Surg 2005;34:420-424.
9. Merkx MA, Fennis JP, Verhagen CM, Stoelinga PJ. Reconstruction of the mandible using preshaped 2.3 mm titanium plates, autogenous particulate cortico-cancellous bone grafts and platelet rich plasma: a report on eight patients. Int J Oral Maxillofac Surg 2004;33:733-739.
10. Swennen GR, Schutyser F, Mueller MC, Kramer FJ, Eulzer C, Schliephake H. Effect of platelet-rich-plasma on cranial distraction osteogenesis in sheep: preliminary clinical and radiographic results. Int J Oral Maxillofac Surg 2005;34:294-304.
11. Butterfield KJ, Bennett J, Gronowicz G, Adams D. Effect of platelet-rich plasma with autogenous bone graft for maxillary sinus augmentation in a rabbit model. J Oral Maxillofac Surg 2005;63:370-376.
Asian J Oral Maxillofac Surg. 2005;17:73-74.
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