The Role of Randomized Controlled Trials in Clinical Dentistry and Future Directions

In clinical practice, one never knows if the particular treatment chosen was the best for the patient under their particular circumstances. There are always many technical factors and differences in patients to take into consideration as one tries to choose the best treatment. When appropriately designed and implemented, the results of randomized controlled trials (RCTs) help guide the clinician to make better choices. In large trials, researchers can generate precise estimates of the efficacy or effectiveness of treatments for particular groups of patients. Thus, RCTs are superior to observation or clinical judgement when assessing an intervention’s effect because they minimize bias related to the assignment and choice of treatment and control of known and unknown prognostic factors. The idea in designing such studies is to aim for prognostic balance. That means the participants and their circumstances are as similar as possible in the treatments being compared in order to reduce, if not eliminate, the impact of known mediators and moderators that may reduce the validity of the findings. Detailed transparent procedures, careful documentation, and adherence to methodological (e.g., randomization, allocation concealment, blinding, and intention-to-treat analysis) and ethical rigor (e.g., good clinical practices) further ensure that study results are repeatable, valid, and useful. This chapter discusses why clinical trials are important in clinical dentistry and identifies factors that investigators should know that influence the usefulness and acceptance of the work that they undertake.